Olmesartan,an angiotensin Ⅱ receptor blocker,is a commonly used antihypertensive drug.Several case reports and cohort studies in recent years have described a severe gastrointestinal adverse event with chronic diarrhea,intestinal malabsorption,and weight loss after the administration of olmesartan.In such cases,the patients recovered after discontinuing olmesartan.This adverse effect is called olmesartan-associated enteropathy(OAE).This article reviews the potential pathogenesis and clinical characteristics of OAE,which broadens the disease spectrum for the differential diagnosis of chronic diarrhea and intestinal malabsorption.
Angiotensin Receptor Antagonists ; Humans ; Imidazoles ; Intestinal Diseases/diagnosis* ; Tetrazoles/adverse effects*

Almost 50% of patients with inflammatory bowel disease (IBD) exhibit at least one extra-intestinal manifestation in their lifetime. Extra-intestinal manifestations of IBD are often associated with the intestinal disease activity, reducing the quality of life of the patient but rarely leading to fatal complications. Musculoskeletal involvement is the most frequent extra-intestinal manifestation of patients with IBD but this rarely occurs before IBD is diagnosed. They are manifested in various forms, such as arthropathy, fibromyalgia, and osteoporosis. Therefore, a multidisciplinary team approach including gastroenterologists and rheumatologists are necessary for optimal treatment. This review focuses on the diagnosis and treatment of musculoskeletal manifestations of IBD from the perspectives of rheumatologists who can assist gastroenterologists.
Diagnosis ; Fibromyalgia ; Humans ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Joint Diseases ; Musculoskeletal Diseases ; Osteoporosis ; Quality of Life

OBJECTIVE: To observe the correlation between referred pain distribution and acupoint sensitization in patients with intestinal diseases. METHODS: In clinical research, 443 patients from 8 hospitals were recruited, including the outpatients and inpatients of Crohn's disease (=143), ulcerative colitis (=108), chronic appendicitis (=87) and other intestinal diseases (=105). The site with tenderness on the body surface and the morphological changes of local skin were observed and recorded in the patients. Using a sensory tenderness instrument, the pain threshold at the sensitization point was measured in 60 patients with ulcerative colitis. In animal experiment, SD rats were used and divided into a enteritis group (=8), in which the enteritis model were established, and a control group (=3), in which no any intervention was given. After the injection of Evans blue (EB) at caudal vein, the blue exudation points on the body surface were observed and the distribution rule was analyzed statistically. RESULTS: The referred pain on the body surface in the patients with intestinal diseases was mainly located in the lower abdomen (93.9%, 416/443), the lumbar region (70.9%, 314/443) and the lower legs (33.0%, 146/443). The diameter of tenderness region was 1.5 to 2.5 cm. Compared with the region without sensitization, the pain threshold of the sensitization point in the patients with ulcerative colitis was reduced significantly (<0.001). The referred pain on the body surface in the patients with appendicitis was located in the right lower abdomen (97.7%, 85/87), the waist and back (54.0%, 47/87) and the right lower limbs on the medial side (71.3%, 62/87). The tenderness region was 1 to 2 cm in diameter and was irregular in form. After modeling of enteritis in the rats, the EB exudation points were visible from T to L. CONCLUSION Intestinal diseases induce referred pain on the body surface where is the same as or adjacent to the location of the spinal segment corresponding to the affected intestinal section. These sensitization regions are related to the locations of acupoints.
Acupuncture Points ; Animals ; Colitis, Ulcerative ; Humans ; Intestinal Diseases ; Pain Threshold ; Pain, Referred ; diagnosis ; therapy ; Rats ; Rats, Sprague-Dawley ; Sensation

Almost 50% of patients with inflammatory bowel disease (IBD) exhibit at least one extra-intestinal manifestation in their lifetime. Extra-intestinal manifestations of IBD are often associated with the intestinal disease activity, reducing the quality of life of the patient but rarely leading to fatal complications. Musculoskeletal involvement is the most frequent extra-intestinal manifestation of patients with IBD but this rarely occurs before IBD is diagnosed. They are manifested in various forms, such as arthropathy, fibromyalgia, and osteoporosis. Therefore, a multidisciplinary team approach including gastroenterologists and rheumatologists are necessary for optimal treatment. This review focuses on the diagnosis and treatment of musculoskeletal manifestations of IBD from the perspectives of rheumatologists who can assist gastroenterologists.
Diagnosis ; Fibromyalgia ; Humans ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Joint Diseases ; Musculoskeletal Diseases ; Osteoporosis ; Quality of Life

BackgroundThe diagnosis and treatment of small-bowel diseases is clinically difficult. The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases.

MethodsThe history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed, which included 562 patients with obscure digestive tract bleeding, 457 patients with obscure diarrhea, 930 patients with obscure abdominal pain, 795 patients with obscure weight loss, and 62 patients with obscure intestinal obstruction. Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images. If a lesion was not detected through one direction, examination through the other direction was performed as necessary. Eighty-four patients with small-bowel polyps, 26 with intestinal obstruction caused by enterolith, and 18 with bleeding from Dieulafoy's lesions in the small intestine were treated endoscopically.

ResultsA total of 2806 patients underwent double-balloon enteroscopy, and no serious complications occurred. An endoscopic approach through both the mouth and anus was used in 212 patients. Lesions were detected in 1696 patients, with a detection rate of 60.4%; the rates for obscure digestive tract bleeding, diarrhea, abdominal pain, weight loss, and intestinal obstruction were 85.9% (483/562), 73.5% (336/457), 48.2% (448/930), 49.1% (390/795), and 62.9% (39/62), respectively. For patients with small-bowel polyps who underwent endoscopic therapy, no complications such as digestive tract bleeding and perforation occurred. Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy. Among the 18 patients with bleeding from small-bowel Dieulafoy's lesions, 14 patients were controlled with endoscopic hemostasis.

ConclusionDouble-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Double-Balloon Enteroscopy ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; surgery ; Humans ; Intestinal Diseases ; diagnosis ; surgery ; Intestinal Obstruction ; Intestine, Small ; diagnostic imaging ; Leiomyosarcoma ; diagnosis ; surgery ; Lymphoma ; diagnosis ; surgery ; Male ; Middle Aged ; Polyps ; diagnosis ; surgery ; Young Adult

The peritoneum is one of the common extrapulmonary sites of tuberculosis infection. Patients with underlying end-stage renal or liver disease are frequently complicated by tuberculous peritonitis; however, the diagnosis of the tuberculous peritonitis is difficult due to its insidious nature, well as its variability in presentation and limitation of available diagnostic tests. Once diagnosed, the preferred treatment is usually antituberculous therapy in uncomplicated cases. However, surgical treatment may also be required for complicated cases, such as small bowel obstruction or perforation. An 85-year-old woman was referred our hospital for abdominal pain with ileus. Despite medical therapy, prolonged ileus and progression to sepsis were shown, she underwent surgery to confirm the diagnosis and relief of mechanical ileus. Intraoperative peritoneal biopsy and macroscopic findings confirmed tuberculous peritonitis. Therefore, physicians should consider the possibility of tuberculous peritonitis in patients with unexplained small bowel obstruction.
Abdominal Pain ; Aged, 80 and over ; Biopsy ; Diagnosis ; Diagnostic Tests, Routine ; Female ; Humans ; Ileus ; Intestinal Obstruction ; Laparoscopy ; Liver Diseases ; Peritoneum ; Peritonitis, Tuberculous* ; Sepsis ; Tuberculosis

Pediatric onset Crohn's disease (CD) tends to have complicated behavior (stricture or penetration) than elderly onset CD at diagnosis. Considering the longer duration of the disease in pediatric patients, the accumulative chance of surgical treatment is higher than in adult onset CD patients. Possible operative indications include perianal CD, intestinal stricture or obstruction, abdominal abscess or fistula, intestinal hemorrhage, neoplastic changes and medically untreatable inflammation. Growth retardation is an operative indication only for pediatric patients. Surgery can affect a patient's clinical course, especially for pediatric CD patient who are growing physically and mentally, so the decision should be made by careful consideration of several factors. The complex and diverse clinical conditions hinder development of a systemized treatment algorithm. Therefore, timing of surgery in pediatric CD patients should be determined with individualized approach by an experienced and well organized multidisciplinary inflammatory bowel disease team. Best long-term outcomes will require proactive post-operative monitoring and therapeutic modifications according to the conditions.
Abdominal Abscess ; Adult ; Aged ; Child ; Colorectal Surgery ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Hemorrhage ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Intestinal Fistula

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications

OBJECTIVES: Confirmation of Kudoa septempunctata (K. septempunctata) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with K. septempunctata would result in increased diagnosis of food poisoning by K. septempunctata, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of K. septempunctata food poisoning in 2015, Korea.METHODS: Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of Kudoa food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted.RESULTS: Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman's rho and Kendall's tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively.CONCLUSIONS: An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of K. septempunctata caused acute food poisoning.
Bias (Epidemiology) ; Centers for Disease Control and Prevention (U.S.) ; Diagnosis ; Fisheries ; Flounder ; Food Parasitology ; Foodborne Diseases ; Incidence ; Intestinal Diseases, Parasitic ; Jeju-do ; Korea ; Myxozoa ; Olea ; Seasons ; Ships ; Virulence

OBJECTIVES: Confirmation of Kudoa septempunctata (K. septempunctata) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with K. septempunctata would result in increased diagnosis of food poisoning by K. septempunctata, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of K. septempunctata food poisoning in 2015, Korea. METHODS: Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of Kudoa food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted. RESULTS: Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman's rho and Kendall's tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively. CONCLUSIONS: An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of K. septempunctata caused acute food poisoning.
Bias (Epidemiology) ; Centers for Disease Control and Prevention (U.S.) ; Diagnosis ; Fisheries ; Flounder* ; Food Parasitology ; Foodborne Diseases* ; Incidence ; Intestinal Diseases, Parasitic ; Jeju-do* ; Korea* ; Myxozoa ; Olea* ; Seasons ; Ships* ; Virulence