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Rheumatologic Manifestations of Gastrointestinal Diseases

Enteropathic Arthritis 1. How often does an inflammatory peripheral or spinal arthritis occur in patients with idiopathic inflammatory bowel disease (IBD)? Arthritis is the most common extraintestinal manifestation (EIM) of either type of IBD (Crohn’s disease [CD] and ulcerative colitis [UC]) affecting up to 20% of patients ( Table 63-1 ). Table 63-1 Frequency of Peripheral or Spinal Arthritis in Inflammatory Bowel Disease Ulcerative Colitis Crohn’s…

Endoscopic Cancer Screening and Surveillance

1. What is endoscopic cancer screening and surveillance? Endoscopic screening for premalignant or malignant conditions is the one-time application of a test to search for lesions in asymptomatic persons in the hope that an early diagnosis will have an effect on disease outcomes. Endoscopic surveillance is testing patients with known premalignant or malignant conditions repeatedly over time to search for additional lesions in patients at increased…

Small Bowel and Colon Pathology

Small Intestine 1. What are the morphologic features of celiac disease? The normal duodenal mucosa has numerous fingerlike projections, or villi, as shown in Figure 59-1 A, whereas in celiac disease the normal villous architecture is lost (blunted villi and crypt hyperplasia) and intraepithelial lymphocytes (IELs) are increased, as shown in Figure 59-1 B . Increased IELs are seen more toward the tips of the villi.…

Nutrition, Malnutrition, and Probiotics

1. What is meant by nutritional status? Nutritional status reflects how well nutrient intake contributes to body composition and function in the face of the existing metabolic needs. The four major body compartments are water, protein, mineral, and fat. The first three compose the lean body mass (LBM); functional capacity resides in a portion of the LBM called the body-cell mass. Registered dietitians or registered dietitian…

Ischemic Bowel Disease

1. What is ischemic bowel disease? Ischemic bowel disease is caused by tissue hypoxia and ischemic injury of the small or large intestine as a result of a persistent decrease in mesenteric blood flow, decreased oxygen content of red blood cells, or mesenteric venous stasis. Ischemic bowel disease can manifest in numerous ways, such as acute or chronic midabdominal pain (meal-induced), vomiting, sitophobia (fear of eating),…

Chronic Diarrhea

1. Define chronic diarrhea. Diarrhea is defined as an increase in the frequency and fluidity of stools. For most patients, diarrhea means the passage of loose stools. Although loose stools are often accompanied by an increase in the frequency of bowel movements, most patients do not classify frequent passage of formed stools as diarrhea. Because stool consistency is difficult to quantitate, many investigators use frequency of…

Evaluation of Acute Infectious Diarrhea

Epidemiology 1. What is acute diarrhea? The most important defining aspect of diarrhea is a change in frequency or consistency of bowel movements from baseline. For research purposes, acute diarrhea is defined as production of abnormally loose stools, with more than three episodes daily for less than 14 days . Generally a daily output increase from the normal of 100 to 200 mg per day is…

Occult and Obscure Gastrointestinal Bleeding

1. What is occult gastrointestinal (GI) bleeding and how does it differ from overt GI bleeding? Occult GI bleeding is microscopic blood loss from the GI tract that is not overtly or grossly apparent. It is typically detected by a guaiac test or fecal immunologic test (FIT, see [CR] ). Overtly apparent GI bleeding includes the following (see Chapter 50 , Chapter 51 ): Hematemesis: bright…

Colitis: Pseudomembranous, Microscopic, and Radiation

Pseudomembranous Colitis 1. What is Clostridium difficile? First isolated in 1935 and named for its difficult isolation from the feces of infants, Bacillus difficile is an anaerobic, gram-positive, spore-forming, toxin-producing bacteria spread by the fecal-oral route. By the 1970s, this bacillus was renamed Clostridium difficile and its toxins were implicated as a major cause of diarrhea and as the cause of pseudomembranous colitis (PMC). C. difficile…