Brown Bowel Syndrome: A Rare Complication in Diseases Associated with Long-Standing Malabsorption

Albrecht, Heinz; Hagel, Alexander; Rossi, Thomas de; Rau, Tilman T.; Kirchner, Thomas; Neurath, Markus F.; Raithel, Martin

doi:10.1159/000357228

Cited by 14 publications

(14 citation statements)

References 36 publications

(32 reference statements)

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“…It is also possible that increased utilization of α‐tocopherol because of oxidative stress could contribute to altered vitamin E metabolism in dogs with EPI. Long‐term malabsorptive diseases such as EPI are associated with brown bowel syndrome (BBS), a condition associated with vitamin E deficiency . In BBS, vitamin E deficiency is thought to induce oxidative damage to mitochondria in enteric smooth muscle, resulting in atony and lipofuscinosis which may exacerbate the malabsorptive disease process …”

Section: Discussionmentioning

confidence: 99%

Serum concentrations of lipid‐soluble vitamins in dogs with exocrine pancreatic insufficiency treated with pancreatic enzymes

Barko

Williams

2018

Veterinary Internal Medicne

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BackgroundIn humans, exocrine pancreatic insufficiency (EPI) is associated with deficiencies in lipid‐soluble vitamins. Little is reported regarding lipid‐soluble vitamin status in dogs with EPI.Hypothesis/ObjectivesCompare serum concentrations of retinol, 25‐hydrocholecalciferol (25OHD), and α‐tocopherol among dogs with EPI, those with subclinical EPI (sEPI), and healthy dogs. Detect associations between serum concentrations of lipid‐soluble vitamins and residual clinical signs in treated dogs with EPI and sEPI.AnimalsTwenty dogs with EPI and five dogs with sEPI receiving pancreatic enzyme replacement therapy. Ten healthy dogs sampled before and after 10 days of pancreatic enzyme supplementation.MethodsCase‐control study. Serum retinol and α‐tocopherol concentrations were measured by high‐performance liquid chromatography. Serum 25OHD concentrations were measured by radioimmunoassay.ResultsSerum retinol concentration was significantly lower in dogs with EPI (median, 490 ng/mL; range, 322‐990 ng/mL) and serum α‐tocopherol concentration was significantly lower in dogs with EPI (median, 11.51 μg/L; range, 4.8‐27.1 μg/L) and sEPI (median, 12.66 μg/L; range, 10.21‐21.03 μg/L) compared with healthy dogs (median, 1203 ng/mL; range, 637‐1768 ng/mL and median, 43.54 μg/L; range, 34.26‐53.97 μg/L, respectively). Dogs with weight loss had significantly lower 25OHD (mean, 243.50 nmol/L; standard deviation [SD], 3.54 nmol/L) than dogs with stable weight (314.0 nmol/L; SD, 138.38 nmol/L).Conclusions and Clinical ImportanceAltered homeostasis of lipid‐soluble vitamins is present in dogs with EPI and sEPI, despite enzyme replacement therapy. Additional studies are needed to determine the clinical relevance of these findings and the therapeutic potential of lipid‐soluble vitamin supplementation in dogs with EPI and sEPI.

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Section: Discussionmentioning

confidence: 99%

Serum concentrations of lipid‐soluble vitamins in dogs with exocrine pancreatic insufficiency treated with pancreatic enzymes

Barko

Williams

2018

Veterinary Internal Medicne

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“…When there is a deficiency, lipofuscin is deposited into the membrane leading to atony and atrophy of the smooth muscle layer, thus resulting in nonfunctional bowel. It has been described in severe malnutrition states such as celiac sprue, inflammatory bowel disease and chronic pancreatitis, but only has been reported once as a result of JIB [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

A unique case report of jejunoileal bypass reversal with review of the literature

Justice

Keilani

Tribble

2018

International Journal of Surgery Case Reports

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Highlights Jejunoileal bypass is a surgery of the past however still affects patients being see by surgeons today.The pathophysiology is complicated and it should be known these patients suffer from chronic kidney disease, liver failure, chronic diarrhea and many vitamin deficiencies.Bypass reverseal can help preserve kidney function but may not reverse damages already done.From our experience, Bypassed bowel incorporation back into enteric tract can produced a immune response causing functional obstruction only relieved by removal of this bowel.

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“…The proposed mechanism explains multiple findings, including general muscular dystrophia, weight loss, signs of vitamin deficiency, abdominal pain, bowel atonia, dysmotility, intussusception, and pseudo-obstruction. 2 , 3 However, there is some disagreement as to whether the bowel dysmotility is a cause of or a result of the lipofuscin-like pigment deposition.…”

Section: Discussionmentioning

confidence: 99%

“…Decreased fat-soluble vitamin (vitamins A, D, E, and K) levels are specifically associated with BBS along with dry skin, fatigue, coagulation problems, infection, and cognitive deficits. 2 …”

Section: Introductionmentioning

confidence: 99%

Severe chronic bowel obstruction associated with brown bowel syndrome

Wongworawat

Propst

Raza

et al. 2020

SAGE Open Medical Case Reports

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A 61-year-old alcoholic male with history of cholecystectomy presented with a 20-year history of recurrent bowel obstruction and a 30 lb weight loss. After numerous attempts at conservative management, exploratory laparotomy was performed, which showed no mechanical cause. Despite no clear etiology, the obstruction persisted and intensified. A follow-up computed tomography scan revealed a small bowel obstruction with concurrent megacolon. A total abdominal colectomy was performed, with ileostomy. Grossly, there was intestinal dilation up to 15 cm with prominent brown discoloration of bowel wall. No strictures or other fixed obstruction were identified. Microscopic examination revealed prominent lipofuscin-like pigment deposition, involving the muscularis propria, muscularis mucosae, and vascular smooth muscle. Histochemical staining was positive for periodic acid–Schiff and negative for iron and calcium, consistent with lipofuscin. The gross and histologic findings fit with brown bowel syndrome. Brown bowel syndrome is a very rare condition characterized by lipofuscin deposits predominantly within the smooth muscle of the muscularis mucosae and/or muscularis propria that imparts a brown color to the bowel. It is generally thought to be a smooth muscle mitochondrial myopathy due to chronic vitamin E deficiency secondary to fat malabsorption syndromes, resulting in free radicals causing peroxidation of unsaturated membrane lipids with accumulation of lipofuscin. Brown bowel syndrome may be seen in patients with alcohol abuse, maldigestion, chronic bowel inflammation, and intestinal lymphangiectasia. Our patient’s severe chronic intestinal pseudo-obstruction, low levels of certain fat-soluble vitamins (A, D, and E), significant weight loss and history of cholecystectomy with alcohol abuse correlates with brown bowel syndrome clinically.

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Brown Bowel Syndrome: A Rare Complication in Diseases Associated with Long-Standing Malabsorption

Cited by 14 publications

References 36 publications

Serum concentrations of lipid‐soluble vitamins in dogs with exocrine pancreatic insufficiency treated with pancreatic enzymes

Serum concentrations of lipid‐soluble vitamins in dogs with exocrine pancreatic insufficiency treated with pancreatic enzymes

A unique case report of jejunoileal bypass reversal with review of the literature

Severe chronic bowel obstruction associated with brown bowel syndrome

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