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Do I Have IBS?
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
While many doctors and hospitals still use these tried and true procedures, a newer way to visualize the intestines is with MRE (magnetic resonance enterography). MRE is more sensitive to real-time changes than CT scans are, so it’s able to tell the difference between a narrowing that’s due to normal peristalsis (muscle contractions that move food along) and a narrowing that’s due to a stricture, or the formation of scar tissue.
Crohn’s Disease
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Lohith Umapathi, Divya Manikandan, Govind Nandakumar
Computed tomographic enterography or magnetic resonance enterography may also be used for surveillance of patients following surgery. However, in this indication they run the risk of being unable to differentiate active disease from scarring. Although neither of the scans specifically detects fibrosis, MRIs with a special sequence called magnetization transfer may help measure fibrosis semi-quantitatively. It is important to know if the stricture is inflammatory or fibrotic, as fibrotic strictures are best managed surgically.
Personalized Nutrition in Children with Crohn Disease
Published in Nilanjana Maulik, Personalized Nutrition as Medical Therapy for High-Risk Diseases, 2020
The diagnosis of CD is based primarily upon endoscopic, histologic and radiological findings (Lemberg and Day 2015). Standard serum-based tests indicating an inflammatory response (e.g. elevated C-reactive protein or platelet count) along with increased fecal calprotectin levels (a more specific indicator of gut inflammation) in an individual with relevant symptoms should prompt further investigations to establish the diagnosis and to define the phenotype of disease fully. The Porto criteria guiding the diagnosis of IBD in children specify a requirement to perform upper gastrointestinal endoscopy and ileocolonoscopy (with mucosal biopsies) and (in most cases) an assessment of the small bowel (IBD Working Group 2005). Magnetic resonance enterography would be preferred in most centers as it provides high-quality cross-sectional imaging of the small bowel without radiation exposure.
New magnetic resonance imaging sequences for fibrosis assessment in Crohn’s disease: a pilot study
Published in Scandinavian Journal of Gastroenterology, 2022
Bénédicte Caron, Valérie Laurent, Freddy Odille, Silvio Danese, Gabriela Hossu, Laurent Peyrin-Biroulet
Patients with Crohn’s disease (CD) commonly develop strictures, containing various degrees of inflammation and fibrosis [1]. Characterization of intestinal strictures is crucial for the management of CD [1]. Differentiation of inflammation from fibrosis by currently available cross-sectional imaging techniques remains challenging [1]. No consensus on the most reliable method for evaluating intestinal fibrosis in CD exists [2]. Magnetic resonance enterography (MRE) has excellent capability to assess the degree of inflammation, but fibrosis detection is problematic [1,3–7]. Additional sequences might enhance accuracy of fibrosis detection. Intravoxel incoherent motion imaging (IVIM) can provide contrast-free measurers of tissue perfusion which is related to inflammation [8]. T1 mapping is a sequence allowing quantification of the T1 relaxation time, which is significantly longer in patients with liver fibrosis [9]. We evaluated these new magnetic resonance imaging (MRI) sequences (IVIM and T1 mapping) for assessing fibrosis in CD.
IgA nephropathy in a child: Crohn’s disease-associated or adalimumab induced?
Published in Current Medical Research and Opinion, 2022
Francesco Graziano, Martina Busè, Nicola Cassata, Vincenzo Luca Lentini, Michele Citrano
In the suspicion of an early onset IBD, esophagogastroduodenoscopy (EGDS) and colonscopy with biopsies were performed, with negative result. Despite a slight temporary improvement of his general conditions, after six months, there was an important resurgence of symptoms, so the boy was readmitted to our Unit for a new evaluation. We performed Magnetic Resonance Enterography (MRE) which highlighted parietal thickening of some intestinal loops with moderate contrast enhancement. Recording with videocapsule showed jejunitis and proximal ileitis with longitudinal and deep serpiginous ulcers, showing severe activity. So the boy was underwent again to EGDS with biopsies which showed ulcerative duodenitis and jejunitis and focal granulomatous gastritis, compatible with Crohn disease. Second colonscopy was negative. The patient was initially treated with oral prednisone, followed after two months by Adalimumab: first induction dose 120 mg, second induction dose 80 mg, subsequent doses 40 mg subcutaneous every two weeks, with gradual improvement of clinical conditions until clinical remission is achieved, with a good statural and weight growth over the following months. On routine follow-up laboratory analysis ESR, CRP and Faecal calprotectin were negative, blood urea nitrogen (BUN) and serum creatinine were always normal.
Monitoring established Crohn’s disease with pan-intestinal video capsule endoscopy in Europe: clinician consultation using the nominal group technique
Published in Current Medical Research and Opinion, 2021
Cristina Carretero, Franck Carbonnel, Marc Ferrante, Torben Knudsen, Nancy Van Lent, Alan J. Lobo, Lucian Negreanu, Ana Vojvodic, Salvatore Oliva
Video capsule endoscopy has the potential to address many limitations of other diagnostic modalities. Clinicians perceived the ability to perform PCE in a single procedure as the most important comparative benefit. The second most important comparative benefit of PCE was considered its ability to visualize the small bowel and colonic mucosa directly and with higher sensitivity. Compared to PCE, magnetic resonance enterography (MRE) presents with comparable diagnostic accuracy for small bowel disease and enables visualization of transmural and extramural abnormalities41. However, MRE presents with a lower accuracy for mucosal inflammation42, where its ability to monitor response to therapy has yet to be determined43. Finally, the available magnetic resonance index of activity (MaRIA) has only been validated on the terminal ileum and colonic segments44.