Unusual Findings in the Small Bowel

AbstractSmall bowel endoscopy has now become a routine investigation. The most common methods to visualize the small bowel are balloon-assisted enteroscopy and capsule endoscopy. Currently, the most common indications for small bowel endoscopy are obscure gastrointestinal bleeding and suspected or established Crohn's disease. Common findings of small bowel endoscopy include arteriovascular malformations, erosions, ulcers, and edema in the mucosa. However, there are myriad uncommon small bowel conditions which can now be visualized endoscopically. These include vasculitis, neuroendocrine tumors, familial polyposis syndromes such as Peutz–Jeghers syndrome; ulcerative celiac disease; enteropathy-associated T-cell lymphoma; and infections such as Whipple's disease, tuberculosis, and blastomycosis. The aim of this video is to demonstrate the endoscopic characteristics of various unusual but very important small bowel diseases. This article is part of an expert video encyclopedia

Persistent viral shedding of SARS‐CoV‐2 in faeces – a rapid review

Aim In addition to respiratory symptoms, COVID‐19 can present with gastrointestinal complaints suggesting possible faeco‐oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS‐CoV‐2 in patients with COVID‐19. Methods A systematic literature review identified studies describing COVID‐19 patients tested for faecal virus. Search terms for MEDLINE included ‘clinical’, ‘faeces’, ‘gastrointestinal secretions’, ‘stool’, ‘COVID‐19’, ‘SARS‐CoV‐2’ and ‘2019‐nCoV’. Additional searches were done in the American Journal of Gastroenterology , Gastroenterology , Gut , Lancet Gastroenterology and Hepatology , the World Health Organization Database, the Centre for Evidence‐Based Medicine, New England Journal of Medicine , social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco‐oral transmission of the virus. Results Twenty‐six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID‐19 is transmitted via faecally shed virus. Conclusion There is a high rate of positive polymerase chain reaction tests with persistence of SARS‐CoV‐2 in faecal samples of patients with COVID‐19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco‐oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract

Bullous and Exfoliative Esophagitis

AbstractBullous pemphygoid is an uncommon cause of atypical esophagitis. Nevertheless, awareness of this condition is important to make a diagnosis and institute appropriate therapy. There are many autoimmune skin disorders that also affect the esophagus, as both skin and esophagus are covered with squamous epithelium. Some of these blister- and bullae-forming diseases are bullous pemphygoid, pemphygus vulgaris, cicatricial pemphygoid, epidermolysis bullosa acqusita, and lichen planus pemphygoides. Herein is presented a patient with bullous pemphygoid, focusing on the endoscopic and histological characteristics of the disease. This article is part of an expert video encyclopedia

Probekapitel: Gastrointestinale Endoskopie

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