Chronic ulcerative (nongranulomatous) jejunitis

Jeffries, Graham H.; Steinberg, Herman; Sleisenger, Marvin H.

doi:10.1016/0002-9343(68)90236-2

Cited by 81 publications

(22 citation statements)

References 19 publications

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“…We are convinced that CMUSE is distinct from chronic ulcerative jejunitis (14,25), collagen sprue (17) and from autoimmune or eosinophilic enteritis (9,40). Similarly, non-specific small intestinal ulcers (5,6,9,26) should not be considered to be CMUSE if multiple stenoses of the small bowel are absent.…”

Section: Discussionmentioning

confidence: 89%

Severe Cryptogenic Multifocal Ulcerous Stenosing Enteritis. A Report of Three Cases and Review of the Literature

Kohoutová

Bureš

Tyčová

et al. 2010

Acta Med. (Hradec Kralove, Czech Repub.)

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IntroductionCryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare condition characterised by chronic or relapsing moderate ileous episodes resulting from multiple small intestinal strictures, multiple shallow ulcers of the small bowel and beneficial therapeutical effect of glucocorticosteroids (1, 2). Japanese gastroenterologists call this syndrome chronic non-specific multiple ulcers of the small intestine (CNSU) (3). The aetiology of CMUSE has not been clarified yet and pathogenesis is still poorly understood. Some authors even doubt the real existence of this entity.Patients with CMUSE are often referred for surgery because of symptomatic small intestinal strictures and several resections of the small bowel had to be performed.We report three cases of CMUSE diagnosed within the past 10 years at a single tertiary centre, where more than eight thousand GI endoscopies are performed per year. Review of available relevant literature is provided. Case reports Case 1A 35-year-old woman was admitted to our department because of chronic diarrhoea, colicky abdominal pain, weight loss (16 kg during previous five years) and repeated moderate ileous episodes. She was cachectic (body-mass index 12.8 kg/m 2 ). Laboratory tests showed iron-deficiency anaemia (haemoglobin 96 g/L), thrombocytosis (459.10 9 g/L) and proteino-energy malnutrition (serum prealbumin 0.17 g/L). Abdominal ultrasound revealed strenuous small intestinal peristalsis and a large volume of fluid in the intestinal loops. Enteroclysis provided no further information. Gastroscopy and colonoscopy were normal. Push-enteroscopy found multiple shallow ulcers of the distal duodenum and proximal jejunum ( Fig. 1) and increased stagnant fluid content in the proximal part of the small bowel. A non-specific inflammatory process was detected at histology and electron microscopy of small intestinal biopsy specimens. Coeliac disease, lymphoma, Crohn's disease and vasculitis were excluded. No infective agent was found. Total parenteral nutrition and glucocorticosteroids improved her general condition including nutritional status (serum albumin 35.8 g/L, prealbumin 0.29 g/L, body-mass index 13.4 kg/m 2 ). The patient was discharged on enteral nutrition, glucocorticosteroids (prednisone was gradually replaced by budesonide) and 5-aminosalicylates. She was followed-up at regular controls. Nine months later the patient had to be admitted because of a worsened general condition (frequent watery stools, fatigue, oedemas of lower extremities, fluidothorax and ascites). Laboratory tests revealed hypo-25 CASE REPORT Summary: Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare condition characterised by chronic or relapsing moderate ileous episodes resulting from multiple small intestinal strictures, multiple shallow ulcers of the small bowel and favourable therapeutical effect of glucocorticosteroids. The aim of this paper was to evaluate three cases of CMUSE diagnosed within 10 years at a tertiary gastroenterology centre. Three females (35, 50, ...

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Section: Discussionmentioning

confidence: 89%

Severe Cryptogenic Multifocal Ulcerous Stenosing Enteritis. A Report of Three Cases and Review of the Literature

Kohoutová

Bureš

Tyčová

et al. 2010

Acta Med. (Hradec Kralove, Czech Repub.)

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“…1 Giant cell granulomas and transmural ulceration were absent, making Crohn's disease unlikely (at a histology meeting none of three pathologists thought the slides consistent with Crohn's), whilst the absence of villous atrophy and malabsorption excluded chronic ulcerative nongranulomatous jejunitis. 2 Review of the small-bowel barium study confirmed unusual discrete strictures in the jejunum and proximal ileum which were not typical of Crohn's. Damage induced by non-steroidal anti-inflammatory drugs was offered as an alternative radiological explanation, but apart from an occasional aspirin our patient had not taken such agents for many years.…”

Section: Case Historymentioning

confidence: 94%

“…The features resembled those in occasional cases of SLE, as did the response to treatment. Al Arfaj and Naddaf 1 saw one patient with cerebellar ataxia in a series of 150 with SLE and this patient responded to high-dose steroids and azathioprine; Singh et al 2 detected cerebellar signs in 3 of 350 SLE patients, and these patients too improved on steroid therapy. The mechanism in some patients may be immunological.…”

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confidence: 99%

Cryptogenic multifocal ulcerous stenosing enteritis

Spencer

Kitsanta

Riley

2004

JRSM

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“…However, CMUSE, which has been mainly reported from European countries [8,[20][21][22], is another differential diagnosis. According to reports by Perlemuter et al [8,22], the clinicopathologic features of CMUSE are quite similar to those of CNSU.…”

Section: Differential Diagnosismentioning

confidence: 99%