Worms and the treatment of inflammatory bowel disease: are molecules the answer?

The lack of exposure to helminth infections, as a result of improved living standards and medical conditions, may have contributed to the increased incidence of IBD in the developed world. Epidemiological, experimental, and clinical data sustain the idea that helminths could provide protection against IBD. Studies investigating the underlying mechanisms by which helminths might induce such protection have revealed the importance of regulatory pathways, for example, regulatory T-cells. Further investigation on how helminths influence both innate and adaptive immune reactions will shed more light on the complex pathways used by helminths to regulate the hosts immune system. Although therapy with living helminths appears to be effective in several immunological diseases, the disadvantages of a treatment based on living parasites are explicit. Therefore, the identification and characterization of helminth-derived immunomodulatory molecules that contribute to the protective effect could lead to new therapeutic approaches in IBD and other immune diseases

Double-Balloon Enteroscopy to Remove a Strangulated Enteroclysis Catheter from the Small Bowel

We present the case of a 77-year-old male who was referred for magnetic resonance (MR) enteroclysis because of small bowel subobstruction. To optimise small bowel distention during MR, a nasojejunal balloon catheter was placed to perfuse iso-osmotic water solution into the small bowel. However, after deflation of the balloon, the catheter could not be removed by gentle traction. Subsequently, computed tomography (CT) of the abdomen revealed that the catheter was strangulated deep in the jejunum and traction resulted in painful backward intussusception of the small bowel. In order to avoid surgical intervention, we decided to perform urgent proximal double-balloon enteroscopy to remove the enteroclysis catheter. Under fluoroscopic guidance, the enteroscope was introduced into the jejunum until the tip of the enteroscope reached the tip of the catheter. By straightening the enteroscope, the catheter could then be retracted from the jejunum, using the enteroscope as a guide wire along the catheter. Urgent surgical intervention was avoided and the patient completely recovered the same day