methylcellulose and Intestinal-Diseases

The small intestine is a difficult organ to image. Its considerable length, the changing location of its many overlapping coils, and the often adverse effect of luminal fluids on the coating ability of barium necessitate the use of special techniques employing special barium formulations.

Topics: Barium Sulfate; Enema; Humans; Intestinal Diseases; Intestine, Small; Methylcellulose; Pneumoradiography; Ultrasonography

Since the advent of endoscopy for evaluating the upper and lower gastrointestinal (GI) tracts, it has become clear that only in the small bowel does barium radiography remain unchallenged. Regrettably, barium examination of the small bowel has traditionally been regarded by many radiologists as a study of minor importance. Small bowel follow-through techniques and enteroclysis methods differ in their diagnostic purpose, potential, and methods of performance. This review examines in detail the spectrum of barium examination techniques currently available for evaluating the small bowel. The benefits of enteroclysis in the majority of clinical situations requiring contrast examination of the small bowel are stressed. Radiologists play the crucial role in the diagnostic evaluation of the small bowel and should strive to refine and advance the accuracy of small bowel radiography.

Topics: Administration, Oral; Air; Barium Sulfate; Enema; Humans; Ileostomy; Infusion Pumps; Intestinal Diseases; Intestine, Small; Intubation, Gastrointestinal; Methylcellulose; Radiography

The image quality of oral small bowel imaging is often poor on account of the small bowel enema. A new contrast medium should increase the image quality due to better compliance of patient because of the better taste of substance. The loading of patient with radiation or time should not increase.. We investigated prospectively 40 patients, randomized in two groups of 20 patients each. Two different substances were used as contrast medium: barium-methylcellulose and Barium-Mucofalk, respectively. The quality of the double contrast, profile of the mucosa, duration of radiation, duration of examination, dose-area product, and taste of the substance were judged for significance.. The taste of the new contrast medium was judged to be better: twice as often as "good" and five times less often as "bad", the difference was not significant due to the small number of patients. There is no significant difference in the other criterias.. Mucofalk is an alternative contrast medium for oral small bowel radiology in cases of difficult placement of the tube for enema. The quality of double contrast and visualization of the profile of mucosa are the same while the taste is better.

Topics: Administration, Oral; Barium Sulfate; Contrast Media; Crohn Disease; Humans; Intestinal Diseases; Intestinal Mucosa; Intestine, Small; Methylcellulose; Prospective Studies; Radiation Dosage; Radiography

The purpose of this study was to compare the diagnostic performance of axial and coronal views in multidetector CT enteroclysis (MDCTE). We retrospectively evaluated 48 patients with pathological correlation investigated by MDCTE for small bowel disorders. After nasojejunal administration of 2 l of 5% methylcellulose axial arterial and venous acquisition of MDCTE was followed by coronal reconstructions using equal slice thicknesses of 2.5 mm with 2 mm increments. Spatial resolution of both planes was evaluated by phantom. Three radiologists independently read axial and coronal images concerning 12 pathological features. The interobserver agreement and time of reading was calculated. Sensitivity and specificity resulted from comparison with histopathology (n=39) or follow-up (n=9). Phantom study revealed higher spatial resolution for axial than coronal views, whatever reconstruction interval was used. However, spatial frequency always remained high. Most pathological signs, such as bowel wall thickening (BWT), bowel wall enhancement (BWE) and intraperitoneal fluid (IPF), showed better interobserver agreement on axial than coronal views (BWT: 0.61 vs. 0.44; BWE: 0.56 vs. 0.5; IPF:0.53 vs. 0.43). The Wilcoxon signed-rank test revealed significantly higher sensitivity for axial than coronal views (P=0.0453); the time of reading was significantly shorter for the latter (P=0.0146). The diagnostic value of axial slices is superior to coronal reconstructions despite the reduced data volume and display of the physiological course of bowel loops on the coronal plane.

Topics: Adult; Aged; Contrast Media; Female; Humans; Image Processing, Computer-Assisted; Intestinal Diseases; Male; Methylcellulose; Middle Aged; Phantoms, Imaging; Retrospective Studies; Sensitivity and Specificity; Statistics, Nonparametric; Tomography, X-Ray Computed

Our objective was a prospective comparison of MR enteroclysis (MRE) with multidetector spiral-CT enteroclysis (MSCTE). Fifty patients with various suspected small bowel diseases were investigated by MSCTE and MRE. The MSCTE was performed using slices of 2.5 mm, immediately followed by MRE, obtaining T1- and T2-weighted sequences, including gadolinium-enhanced acquisition with fat saturation. Three radiologists independently evaluated MSCTE and MRE searching for 12 pathological signs. Interobserver agreement was calculated. Sensitivities and specificities resulted from comparison with pathological results ( n=29) and patient's clinical evolution ( n=21). Most pathological signs, such as bowel wall thickening (BWT), bowel wall enhancement (BWE) and lymphadenopathy (ADP), showed better interobserver agreement on MSCTE than on MRE (BWT: 0.65 vs 0.48; BWE: 0.51 vs 0.37; ADP: 0.52 vs 0.15). Sensitivity of MSCTE was higher than that of MRE in detecting BWT (88.9 vs 60%), BWE (78.6 vs 55.5%) and ADP (63.8 vs 14.3%). Wilcoxon signed-rank test revealed significantly better sensitivity of MSCTE than that of MRE for each observer ( p=0.028, p=0.046, p=0.028, respectively). Taking the given study design into account, MSCTE provides better sensitivity in detecting lesions of the small bowel than MRE, with higher interobserver agreement.

Topics: Artifacts; Contrast Media; Enema; Female; Gadolinium DTPA; Gastrointestinal Hemorrhage; Humans; Inflammatory Bowel Diseases; Injections, Intravenous; Intestinal Diseases; Intestine, Small; Magnetic Resonance Imaging; Male; Methylcellulose; Middle Aged; Observer Variation; Postoperative Complications; Prospective Studies; Sensitivity and Specificity; Tomography, Spiral Computed

The diagnostic value of enteroclysis in patients with obscure gastrointestinal bleeding of small bowel origin was evaluated. Further diagnostic approaches in patients in whom enteroclysis did not yield a source for bleeding are discussed.. A total of 62 patients with gastrointestinal bleeding of obscure origin were retrospectively evaluated by enteroclysis. Patients in whom a specific pathology could not be identified on enteroclysis were further followed-up clinically and by laboratory examinations. Recurrent gastrointestinal bleeding had been considered an indication for further diagnostic evaluation.. Accurate cause of the pathology which may explain the source of bleeding was achieved via enteroclysis in 29 of the patients. Of the pathologies, most were inflammatory bowel disease (n=18), followed by neoplasms (n=4), malabsorption (n=3) and miscellaneous disorders (n=4). Thirty-three patients had normal findings on enteroclysis. Six patients were diagnosed as angiodysplasia on angiography and nine patients had either gastritis or duodenitis. A final diagnosis to explain the source of bleeding could not be achieved in 18 cases.. Enteroclysis provides essential information in gastrointestinal bleeding of obscure origin and its role in the diagnosis should not be undermined. Recurrent and consistent GI bleeding should be considered an indication for further diagnostic evaluation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Barium Sulfate; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Intestine, Small; Male; Methylcellulose; Middle Aged; Radiography; Reproducibility of Results; Retrospective Studies; Young Adult

To compare small bowel lesions, especially stenoses, with conventional enteroclysis, static MRI and dynamic MR-enteroclysis.. Forty-two patients with Crohn's disease or other suspected small bowel lesions were examined. MRI was performed in a static and a dynamic way either within one hour after conventional enteroclysis (n = 30) or a few days afterwards (n = 12). In order to monitor bowel filling and to characterize stenoses in a dynamic fashion, 4 series of coronal T2w HASTE breath hold sequences were used, first without additional bowel opacification and then during administration of 1,5 l methyl cellulose via a naso-intestinal tube in the MR unit. Intravenously applied Buscopan was used to reduce bowel movement.. In 4 out of 42 Patients, application of methylcellulose was limited to 1000 ml because of gastrointestinal complaints or visible gastral reflux. All patients could be evaluated. Static MRI performed within one hour after conventional enteroclysis and no additional bowel opacification showed insufficient bowel distension. Distension was still better than in MRI without prior application of contrast medium. On the contrary, dynamic MR - enteroclysis lead to controlled and complete bowel distension which allowed for significantly better evaluation of normal bowel anatomy and pathological alterations of the gut. Because of a better bowel distension and dynamic evaluation, MR-enteroclysis revealed significantly more stenoses (n = 42) than MRI obtained with less distension (n = 27, p < 0.001), and characterization of lesions was comparable to conventional enteroclysis (p < 0.001). Fixed and non-fixed stenoses could be differentiated by dynamic MR-enteroclysis. Furthermore, extraluminal complication of Crohn's disease such as abscesses and fistulae or large bowel manifestation of disease were shown in 13 patients.. Dynamic MR-enteroclysis is feasible in routine diagnostic work-up of the small bowel. It is superior in depicting intra- and extraluminal manifestation of small bowel lesions and enables characterization of stenoses comparable to conventional enteroclysis.

Topics: Adolescent; Adult; Aged; Contrast Media; Crohn Disease; Enema; Female; Humans; Image Enhancement; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Magnetic Resonance Imaging; Male; Methylcellulose; Sensitivity and Specificity

To evaluate the efficacy of barium suspension prepared in methylcellulose (MC) in modified small-bowel follow-through (SBFT).. The authors evaluated 155 patients who underwent modified SBFT with oral administration of MC after ingesting barium suspension. Of these patients, 52 received 40% suspension in MC, 46 received 40% suspension in water, and 57 received 70% suspension in water. Patients were divided into normal (n = 74) and abnormal (n = 81) groups according to the final results. The image quality, transit time to the cecum, and time to and frequency of flocculation were compared for both groups.. In the normal group, the quality of the images in patients receiving 40% suspension in MC or 70% suspension in water was superior to that of images in patients receiving 40% suspension in water. In the abnormal group, the best image quality was achieved for the patients who received 40% suspension in MC. In the normal group, the difference in transit time between the three preparations was not substantial. In the abnormal group, however, the 40% suspension in MC showed the fastest transit time. Use of the 40% suspension in MC helped lower the frequency of flocculation in the normal group.. Use of 40% barium suspension in MC is effective for improving the image quality in modified SBFT.

Topics: Barium Sulfate; Case-Control Studies; Cathartics; Contrast Media; Evaluation Studies as Topic; Female; Humans; Intestinal Diseases; Intestine, Small; Male; Methylcellulose; Middle Aged; Radiography

SC-53450 is a new polybutadiene-based polymer system with an acid labile diisopropyl silyl ether linker to which the active isomer of misoprostol (SC-30249) is attached covalently at position C-11. It was studied in rats and dogs to define its profile of gastrointestinal effects relative to misoprostol-hydroxypropyl methylcellulose (HPMC) and the systemic availability of prostaglandin from the polymer. Results of rat studies indicate that SC-53450 has a spectrum of mucosal protective activity similar to misoprostol-HPMC, being protective against indomethacin-induced gastric, cysteamine/indomethacin-induced duodenal and indomethacin-induced lower small bowel damage. SC-53450, in contrast to misoprostol-HPMC, was not diarrheagenic in the rat when administered intragastrically. The observation that SC-53450 is more than 4 times more potent than misoprostol-HPMC suggests the possibility of sustained gastric availability of the prostaglandin SC-30249. SC-53450 exhibited gastric antisecretory activity in histamine-stimulated gastric fistula dogs and protected against acidified aspirin-induced gastric damage in normal fasted beagles. Rat and dog experiments indicate that little, if any, polymer-derived prostaglandin is available systemically, suggesting SC-53450 will have reduced abuse potential in abortion induction. SC-53450 is a potential candidate to replace the present misoprostol formulation in the marketplace for the prevention of nonsteroidal anti-inflammatory drug-induced gastric damage.

Topics: Animals; Antacids; Aspirin; Biological Availability; Butadienes; Depression, Chemical; Diarrhea; Dogs; Drug Carriers; Ethanol; Female; Gastric Mucosa; Hypromellose Derivatives; Indomethacin; Intestinal Diseases; Male; Methylcellulose; Misoprostol; Polymers; Rats; Rats, Inbred Strains; Stomach Diseases

One hundred twenty-five consecutive enteroclysis studies performed for the indication of gastrointestinal bleeding were reviewed. The overall yield of positive studies was low (10%) but important lesions were found. Patients with unequivocally normal evaluations of the upper gastrointestinal tract and colon had the highest yield of positive enteroclysis studies (20%). Neither the specific type of bleeding, the presence or absence of abdominal symptoms or physical examination findings, nor the results of laboratory tests were associated with a positive or negative enteroclysis study.

Topics: Angiography; Barium Sulfate; Endoscopy; Enema; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Methylcellulose; Radionuclide Imaging

Topics: Aged; Barium Sulfate; Female; Humans; Intestinal Diseases; Intestine, Small; Male; Methods; Methylcellulose; Middle Aged; Radiography

An analysis of the records of 300 patients who had had 370 small-bowel radiologic examinations and a subsequent 102 patients examined by fluoroscopy and enteroclysis suggests that enteroclysis (small-bowel enema) is extremely valuable in the radiologic evaluation of small intestinal disease. Our results suggest that best results are obtained if the radiologist spends adequate time to participate in and observe the studies carefully. We believe that the fluoroscopic observation of low-density barium passing through distended small bowel gives a much clearer picture of its status than routine follow-through examinations. Disagreement exists concerning the choice of Sellink's method, using dilute barium, and Herlinger's technique, using a somewhat denser barium followed by methylcellulose. We prefer the latter. Enteroclysis probably should not be done in the presence of a high small-bowel obstruction because of the danger of reflux and aspiration. If intubation is unsuccessful, an oral study should be postponed until the effects of the topical anesthesia disappear. A controlled prospective study of the accuracy of fluoroscopic enteroclysis versus a good detailed independent follow-through examination is needed.

Topics: Barium Sulfate; Colonoscopy; Enema; Evaluation Studies as Topic; Female; Humans; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Methods; Methylcellulose; Radiography; Retrospective Studies

The experiences from a total of 303 small intestine examinations of different techniques show that especially the double-contrast representation using barium sulfate and air achieves the best diagnostical findings. The double-contrast representation can be achieved by an antegrade small intestine enema (enteroclysis) or within the conventional small intestine passage by retrograde air insufflation. These examination techniques make optimal fine diagnostics especially of the lower ileum possible. The indications for the different methods are explained.

Topics: Air; Barium Sulfate; Cellulose; Contrast Media; Crohn Disease; Diverticulum; Enema; Humans; Intestinal Diseases; Intestine, Small; Methylcellulose; Radiography; Tissue Adhesions; Water

A modification of the small-bowel enema with barium and methylcellulose is described and findings in 300 consecutive examinations compared with the clinical diagnoses. The radiograph was positive in 37% of cases and the clinical examination in 29%. Diseases and abnormalities of the small bowel, including motility disorders, can be diagnosed with high sensitivity and specificity using this technique.

Topics: Adenocarcinoma; Adult; Barium Sulfate; Celiac Disease; Crohn Disease; Evaluation Studies as Topic; Gastrointestinal Motility; Humans; Intestinal Diseases; Intestinal Neoplasms; Intestinal Obstruction; Intestine, Small; Methods; Methylcellulose; Radiography

Topics: Contrast Media; Evaluation Studies as Topic; Humans; Intestinal Diseases; Intestine, Small; Methods; Methylcellulose; Radiography; Suspensions

A modified technique of the small bowel enema is described. Diluted barium followed by an aqueous suspension of 0.5% methylcellulose is injected through a duodenal tube. Pathologic findings can be better recognized by the resulting double-contrast images than by other techniques. A detailed description of this method, and of our own experience, is given.

Topics: Barium Sulfate; Female; Humans; Intestinal Diseases; Intestine, Small; Male; Methylcellulose; Radiography

A small bowel enema technique is described which makes it possible to achieve double-contrast images comparable to those routinely obtained in the stomach or colon. It is a biphasic procedure, requiring the transtubal injection of barium sulfate, followed by 0.5% methylcellulose. Adjustment of relative injection quantities and injection speeds can adapt each examination to a patient's individual diagnostic problem. Indications for the examination are discussed.

Topics: Barium Sulfate; Enema; Humans; Intestinal Diseases; Intestine, Small; Intubation, Gastrointestinal; Methylcellulose; Radiography

Topics: Cathartics; Constipation; Flatulence; Humans; Intestinal Diseases; Methylcellulose