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Koysombat K, Capanna MV, Stafford N, Orchard T. Combination therapy for systemic sclerosis-associated pneumatosis intestinalis. BMJ Case Rep 2018; 2018:bcr-2018-225068. [PMID: 30002210 DOI: 10.1136/bcr-2018-225068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We present a case of a patient with pneumatosis intestinalis and pneumoperitoneum secondary to gastrointestinal systemic sclerosis, who presented following recurrent accident and emergency attendances with abdominal pain. Pneumatosis intestinalis is a rare complication of systemic sclerosis; management approaches focus largely on exclusion of life-threatening surgical pathologies and subsequent symptom control. To date, there are still no established gold-standard treatment strategy and no large-scale trial data to support a specific management strategy. We describe a case of successful medical management with a combination of antimicrobial, elemental diet and high-flow inhalation oxygen therapy, with supporting evidence of CT image confirming resolution. This case therefore contributes to the literature, being the first to report both symptomatic and radiological improvement following combination therapy without the need for surgical intervention.
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Affiliation(s)
- Kanyada Koysombat
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Nina Stafford
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Orchard
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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Abstract
We present a case of a patient with pneumatosis intestinalis and pneumoperitoneum secondary to gastrointestinal systemic sclerosis, who presented following recurrent accident and emergency attendances with abdominal pain. Pneumatosis intestinalis is a rare complication of systemic sclerosis; management approaches focus largely on exclusion of life-threatening surgical pathologies and subsequent symptom control. To date, there are still no established gold-standard treatment strategy and no large-scale trial data to support a specific management strategy. We describe a case of successful medical management with a combination of antimicrobial, elemental diet and high-flow inhalation oxygen therapy, with supporting evidence of CT image confirming resolution. This case therefore contributes to the literature, being the first to report both symptomatic and radiological improvement following combination therapy without the need for surgical intervention.
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Affiliation(s)
- Kanyada Koysombat
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Nina Stafford
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Orchard
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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NELSON TA, HOLMES S, ALEKSEYENKO AV, SHENOY M, DESANTIS T, WU CH, ANDERSEN GL, WINSTON J, SONNENBURG J, PASRICHA PJ, SPORMANN A. PhyloChip microarray analysis reveals altered gastrointestinal microbial communities in a rat model of colonic hypersensitivity. Neurogastroenterol Motil 2011; 23:169-77, e41-2. [PMID: 21129126 PMCID: PMC3353725 DOI: 10.1111/j.1365-2982.2010.01637.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a chronic, episodic gastrointestinal disorder that is prevalent in a significant fraction of western human populations; and changes in the microbiota of the large bowel have been implicated in the pathology of the disease. METHODS Using a novel comprehensive, high-density DNA microarray (PhyloChip) we performed a phylogenetic analysis of the microbial community of the large bowel in a rat model in which intracolonic acetic acid in neonates was used to induce long lasting colonic hypersensitivity and decreased stool water content and frequency, representing the equivalent of human constipation-predominant IBS. KEY RESULTS Our results revealed a significantly increased compositional difference in the microbial communities in rats with neonatal irritation as compared with controls. Even more striking was the dramatic change in the ratio of Firmicutes relative to Bacteroidetes, where neonatally irritated rats were enriched more with Bacteroidetes and also contained a different composition of species within this phylum. Our study also revealed differences at the level of bacterial families and species. CONCLUSIONS & INFERENCES The PhyloChip is a useful and convenient method to study enteric microflora. Further, this rat model system may be a useful experimental platform to study the causes and consequences of changes in microbial community composition associated with IBS.
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Affiliation(s)
- T. A. NELSON
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA,Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA,Department of Microbiology & Immunology, Stanford University, Stanford, CA, USA,Stanford University Bio-X Program, Stanford, CA, USA
| | - S. HOLMES
- Department of Statistics, Stanford University, Stanford, CA, USA
| | - A. V. ALEKSEYENKO
- Department of Statistics, Stanford University, Stanford, CA, USA,Center for Health Informatics and Bioinformatics, NYU School of Medicine, New York, NY, USA
| | - M. SHENOY
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - T. DESANTIS
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - C. H. WU
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - G. L. ANDERSEN
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - J. WINSTON
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
| | - J. SONNENBURG
- Department of Microbiology & Immunology, Stanford University, Stanford, CA, USA
| | - P. J. PASRICHA
- Department of Microbiology & Immunology, Stanford University, Stanford, CA, USA,Stanford University Bio-X Program, Stanford, CA, USA,Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - A. SPORMANN
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA,Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA,Department of Microbiology & Immunology, Stanford University, Stanford, CA, USA,Stanford University Bio-X Program, Stanford, CA, USA
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