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Clinical and Translational... Jan 2022Microscopic colitis, a common cause of diarrhea, is characterized by a largely normal appearance of the mucosa but increased numbers of lymphocytes in the epithelium and...
INTRODUCTION
Microscopic colitis, a common cause of diarrhea, is characterized by a largely normal appearance of the mucosa but increased numbers of lymphocytes in the epithelium and lamina propria on microscopy. We sought to determine whether T-cell percentage was associated with exposures or symptoms.
METHODS
We conducted a case-control study that enrolled patients referred for colonoscopy for diarrhea. Patients were classified as microscopic colitis cases or controls by an experienced pathologist. Participants provided information on symptoms and exposures during a telephone or internet survey. Research biopsies from the ascending colon and descending colon were examined using immunofluorescence stains for CD3, CD8, and FOXP3 to determine percent T cells per total epithelial or lamina propria cells. Digital images were analyzed by regions of interest using Tissue Studio.
RESULTS
There were 97 microscopic colitis cases and 165 diarrhea controls. There was no association between demographic factors and percentage of intraepithelial or lamina propria T cells. In cases, the mean percent T cells were similar in the right colon and left colon. There was no association between mean percent T cells and stool frequency or consistency. There was no association with irritable bowel syndrome, abdominal pain, or medications purported to cause microscopic colitis.
DISCUSSION
The lack of association between the density of T cells and medications raises further doubts about their role in disease etiology. Loose and frequent stools in patients with microscopic colitis are not correlated with T-cell density.
Topics: Case-Control Studies; Colitis, Microscopic; Humans; Lymphocytes; Mucous Membrane
PubMed: 35166714
DOI: 10.14309/ctg.0000000000000467 -
Cureus Sep 2021Diverticular disease is a common condition responsible for significant costs to the healthcare system in the Western world. It ranges from asymptomatic diverticulosis...
Diverticular disease is a common condition responsible for significant costs to the healthcare system in the Western world. It ranges from asymptomatic diverticulosis to complicated diverticulitis. Here, we present a unique case of recurrent, complicated diverticulitis in a 62-year-old Caucasian male. Within a span of one year, he was hospitalized six times with diverticulitis before undergoing elective sigmoid colon resection. Imaging showed diverticulitis of distal descending and proximal sigmoid colon with sealed perforation, recurrent abscesses, and formation of colocutaneous fistulas. During each hospitalization, the patient was advised to follow up with general surgery and/or outpatient gastroenterology but chose not to do so. Eventually, he required an elective sigmoid colectomy with a takedown of the colocutaneous fistulas. In this case report, we discuss the atypical features and criteria for prophylactic colon resection in diverticulitis to highlight the importance of outpatient follow-up with general surgery and gastroenterology.
PubMed: 34667666
DOI: 10.7759/cureus.17983 -
American Journal of Physiology.... Jul 2019The pathophysiology of colonic diverticulosis has not been completely understood. The development of appropriate animal models is essential to study diverticular...
The pathophysiology of colonic diverticulosis has not been completely understood. The development of appropriate animal models is essential to study diverticular disease. To date, no large animal models are available for this disease condition. The objective of this study was to develop a swine model by damaging the colon wall, combined with or without a low-fiber diet to mimic the pathogenesis of diverticulosis. To create a weakness on the colon wall, collagenase was applied in vivo to degrade the collagen in the colon wall. Three groups of Yucatan minipigs were included. ( = 12) underwent collagenase injection (CI) with a low-fiber diet for 6 mo, ( = 8) underwent CI alone with a standard swine diet for 6 mo, and ( = 12) received a low-fiber diet alone for 6 mo. We found that diverticulosis occurred in 91.7% (11 of 12) of pigs in the CI + diet group and 100% (8 of 8) in CI-alone group. Moreover, around 30-75% of colon CI spots for each pig developed diverticular lesions. Diet alone for 6 mo did not induce diverticulosis. The endoscopic and histological examinations revealed the formation of multiple wide-mouthed diverticular lesions along the descending colon. Our results provide convincing evidence of the high efficacy of the reduced colon wall strength caused by CI in the development of a swine model of diverticulosis. Low-fiber diet consumption for 6 mo had no influence on the generation time or incidence rate of diverticulosis. In this model, digestion of the collagen in the colonic wall is sufficient to cause diverticulosis. Effective large animal models of diverticulosis are currently lacking for the study of diverticular disease. This study marks the first time that a swine model of diverticulosis was developed by damaging colon wall structure, combined with or without a low-fiber diet. We found that a defect of colon wall could result in colon diverticular lesions within 6 mo in swine. This animal model mimicking the pathological process of diverticulosis is of great clinical value.
Topics: Animal Feed; Animal Nutritional Physiological Phenomena; Animals; Collagenases; Colon; Dietary Fiber; Disease Models, Animal; Disease Progression; Diverticulitis, Colonic; Female; Sus scrofa; Swine; Time Factors
PubMed: 31091148
DOI: 10.1152/ajpgi.00408.2018 -
Gastroenterology Jul 2020The molecular features of colorectal tumors differ with their anatomic location. Colorectal tumors are usually classified as proximal or distal. We collected data from 3...
BACKGROUND & AIMS
The molecular features of colorectal tumors differ with their anatomic location. Colorectal tumors are usually classified as proximal or distal. We collected data from 3 cohorts to identify demographic, clinical, anthropometric, lifestyle, and dietary risk factors for colorectal cancer (CRC) at 7 anatomic subsites. We examined whether the associations differ among refined subsites and whether there are trends in associations from cecum to rectum.
METHODS
We collected data from the Nurses' Health Study, Nurses' Health Study 2, and Health Professionals Follow-up Study (45,351 men and 178,016 women, followed for a median 23 years) on 24 risk factors in relation to risk of cancer in cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectosigmoid junction, and rectum. Hazard ratios were estimated using Cox proportional hazards regression. We tested for linear and nonlinear trends in associations with CRC among subsites and within proximal colon, distal colon, and rectum.
RESULTS
We documented 3058 cases of CRC (474 in cecum, 633 in ascending colon, 250 in transverse colon, 221 in descending colon, 750 in sigmoid colon, 202 in rectosigmoid junction, and 528 in rectum). The positive associations with cancer risk decreased, from cecum to rectum, for age and family history of CRC. In contrast, the inverse associations with cancer risk increased, from cecum to rectum, for endoscopic screening and intake of whole grains, cereal fiber, and processed red meat. There was a significant nonlinear trend in the association between CRC and female sex, with hazard ratios ranging from 1.73 for ascending colon cancer to 0.54 for sigmoid colon cancer. For proximal colon cancers, the association with alcohol consumption and smoking before age 30 years increased from the cecum to transverse colon. For distal colon cancers, the positive association with waist circumference in men was greater for descending vs sigmoid colon cancer.
CONCLUSIONS
In an analysis of 3058 cases of CRC, we found that risk factor profiles differed for cancers along the colorectum. Proximal vs distal classifications are not sufficient to encompass the regional variations in colorectal tumor features and risk factors.
Topics: Adult; Aged; Alcohol Drinking; Colon; Colonoscopy; Colorectal Neoplasms; Female; Follow-Up Studies; Humans; Incidence; Male; Mass Screening; Middle Aged; Patient Acceptance of Health Care; Proctoscopy; Rectum; Risk Factors; Sex Factors; Smoking; United States; Waist Circumference
PubMed: 32247020
DOI: 10.1053/j.gastro.2020.03.054 -
American Journal of Nuclear Medicine... 2021To develop a methodology for the quantification of gastrointestinal (GI) inflammation as indicated by 2-deoxy-2-(F)fluoro-D-glucose (FDG) uptake on positron-emissions...
PURPOSE
To develop a methodology for the quantification of gastrointestinal (GI) inflammation as indicated by 2-deoxy-2-(F)fluoro-D-glucose (FDG) uptake on positron-emissions tomography/computed tomography (PET/CT) imaging. This is intended to investigate the feasibility of using standard uptake value (SUV) levels to assess levels of GI inflammation in humans.
METHODS
131 participants were injected with a weight-controlled dose of FDG 180 minutes prior to PET/CT scanning. Operator-guided software was used to segment the GI tract and perform (SUV) calculations. Regions of interest (ROIs) were created using CT images and stacked to create three dimensional volumes of interest (VOIs). These VOIs defined 6 sections of the GI tract: esophagus, stomach, descending colon, ascending and transverse colon, bowel below the ilium and small bowel above the ilium.
RESULTS
This study found a significant correlation between age and average FDG uptake (avg-SUV) of the GI tract (P=.0003) with the esophagus showing the highest significance. Correlations were found between avg-SUV of the sigmoid segment and the group average (P<.0001), and between the descending colon VOI and the group (P<.0001). Intra-operator reproducibility over 3 trials showed a coefficient of variation (CV) of .63%. Inter-operator CV over 5 randomly selected patients was 5.6% over the entire GI tract.
CONCLUSION
This study shows that FDG-PET/CT imaging is a promising technique for quantifying bowel inflammation, despite the fact that age related inflammation may not be of clinical utility. The fact that we were able to detect these subtle changes indicates this as an avenue for potential future investigation.
PubMed: 34513280
DOI: No ID Found -
International Journal of Surgery Case... Jul 2021In this case report from Muhimbili National Hospital, Dar es salaam, Tanzania, we present the unexpected findings of anorectal malformation, colonic atresia, and...
INTRODUCTION AND IMPORTANCE
In this case report from Muhimbili National Hospital, Dar es salaam, Tanzania, we present the unexpected findings of anorectal malformation, colonic atresia, and intestinal malrotation in a 2-day old neonate. This combination is exceedingly rare, with only case reports published in the literature. We describe the challenges in diagnosis and offer our insights based on this experience and review of the literature.
CASE PRESENTATION
Our patient was a male born at term, weighing 2600 g, diagnosed clinically with a high anorectal malformation. He was planned for colostomy, and we unexpectedly found a collapsed descending colon. Exploration revealed intestinal malrotation and three segments of type I colonic atresia from the mid transverse colon to the sigmoid colon in addition to the high anorectal malformation.
CLINICAL DISCUSSION
Creating a colostomy in a high anorectal malformation and failure to identify proximal intestinal atresia would result in potentially devastating consequences. Colonic atresia and anorectal malformation will both present as large bowel obstruction. In the extremely rare situation, when occurring in combination, the obvious clinical diagnosis of anorectal malformation will mask the clinical suspicion of the possibility of colonic atresia. Finding a distal bowel air bubble above the pubococcygeal line on an invertogram is useful in identifying proximal atresia preoperatively.
CONCLUSION
The current report emphasizes the importance of maintaining an awareness of possible associated colonic atresia in neonates with anorectal malformation. An invertogram and intraoperative finding of a collapsed descending colon should prompt evaluation for a proximal obstructing lesion.
PubMed: 34218019
DOI: 10.1016/j.ijscr.2021.106159 -
World Journal of Clinical Cases Mar 2022Neuraminidase inhibitor-associated acute hemorrhagic colitis is rare. We report a case of ischemic enterocolitis that was likely caused by laninamivir.
BACKGROUND
Neuraminidase inhibitor-associated acute hemorrhagic colitis is rare. We report a case of ischemic enterocolitis that was likely caused by laninamivir.
CASE SUMMARY
A 54-year-old female patient with influenza type A was administered 40 mg of laninamivir inhalation once. On the same day, the patient experienced bloody stools and lower abdominal pain. A contrast-enhanced abdominal computed tomography showed edema-like changes from the descending colon to the sigmoid colon, which suggested ischemic enterocolitis.
CONCLUSION
We treated a patient with ischemic enterocolitis caused by laninamivir, a rare but similar symptom following the administration of oseltamivir.
PubMed: 35434102
DOI: 10.12998/wjcc.v10.i9.2864 -
Journal of Gastroenterology and... Aug 2023Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We...
AIMS
Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We aimed to investigate whether mucosal eosinophils and other immune cells are increased in colonic diverticula.
METHODS
Hematoxylin and eosin stained sections from colonic surgical resections (n = 82) containing diverticula were examined. Eosinophils, neutrophils, and lymphocytes, in five high power fields in the lamina propria were counted at the base, neck, and ostia of the diverticulum and counts compared to non-diverticula mucosa. The cohort was further subgrouped by elective and emergency surgical indications.
RESULTS
Following an initial review of 10 surgical resections from patients with diverticulosis, a total of 82 patients with colonic resections containing diverticula from the descending colon were evaluated (median age 71.5, 42 M/40F). Eosinophil counts for the entire cohort were increased in the base and neck (median 99 and 42, both P = <0.001) compared with the control location (median 16). Eosinophil counts remained significantly increased in the diverticula base (both P = <0.001) and neck (P = 0.01 and <0.001, respectively) in both elective and emergency cases. Lymphocytes were also significantly increased at the diverticula base compared to controls in both elective and emergency subgroups.
CONCLUSION
Eosinophils are significantly and most strikingly increased within the diverticulum in resected colonic diverticula. While these observations are novel, the role of eosinophil and chronic inflammation is as yet unclear in the pathophysiology of colonic diverticulosis and diverticular disease.
Topics: Humans; Diverticulum, Colon; Eosinophils; Diverticulosis, Colonic; Mucous Membrane; Eosinophilia
PubMed: 37415341
DOI: 10.1111/jgh.16278 -
BMC Surgery May 2022Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs...
BACKGROUND
Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum.
METHODS
This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated.
RESULTS
Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations.
CONCLUSION
Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer.
Topics: Colectomy; Colon, Descending; Colon, Transverse; Colonic Neoplasms; Humans; Laparoscopy; Retrospective Studies
PubMed: 35538458
DOI: 10.1186/s12893-022-01603-1 -
Frontiers in Psychiatry 2020Several studies have implied a role of brain-derived neurotrophic factor (BDNF) in abdominal pain modulation in irritable bowel syndrome (IBS). The aim of this study was...
Several studies have implied a role of brain-derived neurotrophic factor (BDNF) in abdominal pain modulation in irritable bowel syndrome (IBS). The aim of this study was to establish BDNF protein expression in human colonic biopsies and to show variation in IBS compared to controls. BDNF protein and mRNA levels were correlated with IBS symptom severity based on the IBS-symptom severity score (IBS-SSS). Biopsies from the descending colon and IBS-SSS were obtained from 10 controls and 20 IBS patients. Total protein of biopsies was extracted and assessed by ELISA and Western Blot. Total mRNA was extracted and gene expression measured by nCounter analysis. In IBS patients, symptom severity scores ranged from 124 to 486 (mean ± sem: 314.2 ± 21.2, >300 represents severe IBS) while controls ranged from 0 to 72 (mean ± sem: 27.7 ± 9.0, <75 represents healthy subjects, < 0.001). IBS patients reported significantly more food malabsorption, former abdominal surgery and psychiatric comorbidities. BDNF protein was present in all samples and did not differ between IBS and controls or sex. Subgroup analysis showed that female IBS patients expressed significantly more BDNF mRNA compared to male patients ( < 0.05) and male IBS-D patients had higher IBS symptom severity scores and lower BDNF mRNA and protein levels compared to male controls ( < 0.05). Scatter plot showed a significant negative correlation between IBS-SSS and BDNF mRNA levels in the cohort of male IBS-D patients and their male controls ( < 0.05). We detected a high proportion of gastrointestinal surgery in IBS patients and confirmed food intolerances and psychiatric diseases as common comorbidities. Although in a small sample, we demonstrated that BDNF is detectable in human descending colon, with higher BDNF mRNA levels in female IBS patients compared to males and lower mRNA and protein levels in male IBS-D patients compared to male controls. Further research should be directed toward subgroups of IBS since their etiologies might be different.
PubMed: 33519536
DOI: 10.3389/fpsyt.2020.531385