Diagnosis and management of small intestinal diseases

Topics related to the diagnosis of small intestinal diseases that are covered in this review include improved endoscopic, radiographic, and nuclear medicine methods for detecting the site of obscure gastrointestinal bleeding; the combined use of magnification endoscopy with chromoendoscopy to evaluate suspected malabsorption; the application of duplex Doppler analysis to the evaluation of small intestinal motility; and the use of magnetic resonance imaging techniques for evaluating the functional status of mesenteric blood vessels. The pathogenesis of and risk factors for small intestinal cancer are also reviewed. Treatment topics include the use of nitrous oxide-releasing nonsteroidal anti-inflammatory (NSAID) derivatives to reduce the small intestinal morbidity of these drugs; the management of asymptomatic and symptomatic small intestinal diverticula; the evaluation of glutamine, growth hormone, and vitamin A as potential therapeutic agents to augment small bowel adaptation in the short bowel syndrome; and experimental strategies for limiting radiation damage to the small intestine.