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Revista Espanola de Enfermedades... Jun 2024Cap polyposis is a rare disease characterized by the presence of inflammatory polyps with an adherent fibrin sheath ("cap"), in variable number and size, in the rectum...
Cap polyposis is a rare disease characterized by the presence of inflammatory polyps with an adherent fibrin sheath ("cap"), in variable number and size, in the rectum and sigmoid. It presents with tenesmus, mucous stools and rectorrhagia. There is currently no standardized treatment, having been treated empirically with aminosalicylates, oral or rectal steroids, metronidazole, H. pylori eradication therapy and infliximab with variable results. In refractory cases, endoscopic resection of polyps may be used and surgery may even be necessary. We present the case of a 36-year-old patient diagnosed in our center with cap polyposis, refractory to both pharmacological and endoscopic treatment, and therefore treatment with infliximab was decided out of indication. The case we present is the fourth case of cap polyposis treated with infliximab available in the current literature and highlights the difficulty of achieving a clinical response with pharmacological treatment, including biologic drugs such as infliximab.
PubMed: 38873995
DOI: 10.17235/reed.2024.10297/2024 -
The Korean Journal of Internal Medicine May 2024A poor prognostic factor for Crohn's disease (CD) includes perianal fistulizing disease, including perianal fistula and/or perianal abscess. Currently, a tool to assess...
BACKGROUND/AIMS
A poor prognostic factor for Crohn's disease (CD) includes perianal fistulizing disease, including perianal fistula and/or perianal abscess. Currently, a tool to assess perianal symptoms in patients with CD remains nonexistent. This study aimed to develop a perianal fistulizing disease self-screening questionnaire for patients with CD.
METHODS
This prospective pilot study was conducted at three tertiary referral centers between January 2019 and May 2020. We formulated questions on perianal symptoms, including tenesmus, anal discharge, bleeding, pain, and heat. A 4-point Likert scale was used to rate each question. Patients with CD completed a questionnaire and underwent pelvic magnetic resonance imaging (MRI).
RESULTS
Overall, 93 patients were enrolled, with 51 (54.8%) diagnosed with perianal fistulizing disease, as determined by pelvic MRI. The Spearman correlation findings demonstrated that anal pain (p = 0.450, p < 0.001) and anal discharge (p = 0.556, p < 0.001) were the symptoms that most significantly correlated with perianal disease. For anal pain and discharge, the area under the receiver operating characteristic curve of the scores was significantly higher than that of the combined score for all five symptoms (0.855 vs. 0.794, DeLong's test p = 0.04). For the two symptoms combined, the sensitivity, specificity, and positive predictive and negative predictive values were 88.2, 73.8, 80.4, and 83.8%, respectively, with 81.7% accuracy for detecting perianal fistulizing disease.
CONCLUSION
This study indicates that simple questions regarding anal pain and discharge can help accurately identify the presence of perianal fistulizing disease in patients with CD.
Topics: Humans; Crohn Disease; Male; Female; Adult; Rectal Fistula; Prospective Studies; Pilot Projects; Magnetic Resonance Imaging; Middle Aged; Predictive Value of Tests; Surveys and Questionnaires; Young Adult; Reproducibility of Results
PubMed: 38576234
DOI: 10.3904/kjim.2023.410 -
Clinical Oncology (Royal College of... May 2024Pelvic radiotherapy can induce gastrointestinal injury and symptoms, which can affect quality of life. We assessed interventions for managing these symptoms. (Meta-Analysis)
Meta-Analysis
AIMS
Pelvic radiotherapy can induce gastrointestinal injury and symptoms, which can affect quality of life. We assessed interventions for managing these symptoms.
MATERIALS AND METHODS
A review of randomised controlled trials published between January 1990 and June 2023 from databases including MEDLINE, EMBASE, CENTRAL, CINAHL, clinicaltrials.gov, ISRCTN and grey literature sources was conducted. Meta-analyses were carried out using the DerSimonian and Laird random effects model to produce overall treatment differences with 95% confidence intervals.
RESULTS
Twenty-eight studies (2392 participants) of varying methodological quality were included. 4% formalin was superior to sucralfate for improving gastrointestinal symptom score (standardised mean difference [SMD] -1.07, 95% confidence interval -1.48 to -0.65). Argon plasma coagulation (APC) was inferior to sucralfate (SMD 1.22, 95% confidence interval 0.84 to 1.59). Counselling positively influenced symptom score (SMD -0.53, 95% confidence interval -0.76 to -0.29), whereas hyperbaric oxygen therapy showed conflicting results. Sucralfate combined with APC increased endoscopic markers of moderate-severe bleeding versus APC alone (risk ratio 2.26, 95% confidence interval 1.12 to 4.55). No definite conclusions on pain, incontinence, diarrhoea, tenesmus or quality of life interventions were confirmed.
CONCLUSIONS
Small study sizes, methodological quality and heterogeneity limit support of any individual intervention. APC and 4% formalin seem to be promising interventions, with further larger randomised controlled trials now warranted.
Topics: Humans; Sucralfate; Quality of Life; Gastrointestinal Tract; Rectum; Formaldehyde
PubMed: 38431427
DOI: 10.1016/j.clon.2024.02.011 -
Revista Espanola de Enfermedades... Feb 2024Lymphogranuloma Venereum (LGV) is a notifiable disease linked to high-risk sexual practices such as cruising, chemsex, or orgies. The anorectal manifestation is...
Lymphogranuloma Venereum (LGV) is a notifiable disease linked to high-risk sexual practices such as cruising, chemsex, or orgies. The anorectal manifestation is associated with receptive anal sex and presents with characteristic symptoms such as proctitis, tenesmus, suppuration, and in advanced cases, anorectal fistulas or stenosis. The case of a 57-year-old man engaging in high-risk sexual practices is presented, showing symptoms such as discharge, fistulizations, rectal stenosis, and a weight loss of 15 kg. Following diagnostic studies, a neoplastic and inflammatory origin was ruled out, confirming the LGV diagnosis. Although the patient responded positively to a three-week course of doxycycline, the stenosis persisted, ultimately necessitating a terminal colostomy. The patient was scheduled to undergo a protectomy to control the inflammatory and infectious process, a procedure that took place months later without significant incidents. The primary treatment for LGV continues to be doxycycline. In cases of complications, such as fistulas, abscesses, or stenosis, surgical interventions, drainage, or pneumatic dilations may be necessary.
PubMed: 38345513
DOI: 10.17235/reed.2024.10264/2024 -
Military Medicine Feb 2024Proctitis is an inflammation of the lining of the rectum that can be either acute or chronic in presentation. Symptoms include rectal bleeding, constipation, rectal...
Proctitis is an inflammation of the lining of the rectum that can be either acute or chronic in presentation. Symptoms include rectal bleeding, constipation, rectal discharge, rectal pain, and tenesmus. It is commonly associated with inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn's disease. However, it is important to consider the infectious causes of proctitis such as the sexually transmitted infections (STIs), especially Chlamydia trachomatis and Neisseria gonorrhoeae, as these can mimic the symptoms and pathology of IBD. We present the case of a young male sailor with subacute rectal bleeding who was hospitalized with initial concern for an index presentation of IBD. Endoscopic evaluation revealed proctitis although findings were atypical for inflammation related to IBD. Acquisition of additional history revealed that he had both receptive and insertive anal intercourse with both male and female partners. A full STI screening, including HIV was performed. Results were positive for both rectal C. trachomatis and HIV antigen and antibody serology, which were confirmed as HIV-1 on confirmatory testing. He was treated with doxycycline for his chlamydial proctitis with symptom resolution and was also initiated on antiretroviral therapy for his HIV infection. This case highlights the importance of obtaining a sexual history and considering STIs as a cause of proctitis, as this will ensure proper screenings and prompt subsequent treatment and potentially avoid unnecessary endoscopic and medical evaluation, which could potentially worsen the underlying process.
PubMed: 38345141
DOI: 10.1093/milmed/usae027 -
Frontiers in Medicine 2023Radiation proctitis is a common complication that occurs as a result of radiation therapy used to treat pelvic malignancies. The most common and bothersome symptom...
BACKGROUND
Radiation proctitis is a common complication that occurs as a result of radiation therapy used to treat pelvic malignancies. The most common and bothersome symptom resulting from radiation proctitis is rectal bleeding, which can be persistent or recurrent. This study aimed to review our experience and evaluate the efficacy and safety of transcolonoscopic spraying of formalin solution in patients with hemorrhagic radiation proctitis.
METHODS
A total of 37 patients with hemorrhagic radiation proctitis, aged between 48 and 79 years (mean age 62.56 ± 8.48 years), were divided into three cohorts based on the severity of radiation injury. Under direct endoscopic vision, a 4% formalin solution was applied directly to the rectal hemorrhagic mucosa. The patients were followed for a period of over 6 months after receiving treatment, during which the therapeutic effectiveness and occurrence of complications were observed.
RESULTS
The study resulted in an overall response rate of 89.2% among all patients. The response rates for patients with grades 1-3 were 100, 100, and 66.7%, respectively. Notably, the rate of response among patients with grade 3 radiation injury was significantly lower compared to those with grades 1-2 ( = 0.009). Mild adverse reactions, such as anal pain and tenesmus, were reported in a small number of patients but could be alleviated without any intervention.
CONCLUSION
The endoscopic application of formalin solution for the treatment of hemorrhagic radiation proctitis has shown a significant effect, particularly in patients with grades 1-2 radiation injury. The observed effect is superior to that observed in patients with grade 3 radiation injury.
PubMed: 38249964
DOI: 10.3389/fmed.2023.1241833 -
Cureus Dec 2023The monkeypox (mpox) outbreak that began in May 2022 spread globally with a wide range of presentations. Mpox proctitis has been recognized as one of the severe forms of...
The monkeypox (mpox) outbreak that began in May 2022 spread globally with a wide range of presentations. Mpox proctitis has been recognized as one of the severe forms of the virus during this outbreak. We present the case of a 33-year-old male with well-controlled HIV engaging in receptive anal intercourse presented with profuse rectal bleeding, tenesmus, and anal pain in July 2022. His symptoms persisted despite treatment for his rectal chlamydia with doxycycline. Rectal imaging with computed tomography demonstrated impressive inflammation. Contrast-enhanced images highlighted rectal wall thickening and submucosal edema. Diffuse lymphadenopathy of the anorectal region was also clearly seen. He received symptomatic treatment with tecovirimat resulting in the resolution of his symptoms and complaints. Subsequent rectal imaging displayed improvement and decreased inflammation. A better understanding of various presentations, imaging characteristics, and management is necessary to curb further dissemination.
PubMed: 38249221
DOI: 10.7759/cureus.50918 -
Cureus Dec 2023This case describes a seven-year-old healthy boy who presented with seven days of abdominal pain, small-volume liquid stools, tenesmus, fevers, and dehydration after...
This case describes a seven-year-old healthy boy who presented with seven days of abdominal pain, small-volume liquid stools, tenesmus, fevers, and dehydration after consuming an unknown amount of shelled watermelon seeds. He was ultimately found to have a large rectal seed bezoar that caused irritation, resulting in stercoral colitis with rectal inflammation. He was additionally found to have sigmoid volvulus during one of his disimpactions, which was also likely secondary to his rectal seed bezoar. This case uniquely highlights the importance of maintaining an index of suspicion for rectal seed bezoars, discusses previously unreported pediatric complications of rectal seed bezoars, including stercoral colitis and sigmoid volvulus, and addresses the management of this rare presentation.
PubMed: 38226100
DOI: 10.7759/cureus.50625 -
BMJ Open Gastroenterology Jan 2024Mpox is a viral infection caused by the monkeypox virus, a member of the Poxviridae family and Orthopoxvirus genus. Other well-known viruses of the Orthopoxvirus genus...
INTRODUCTION
Mpox is a viral infection caused by the monkeypox virus, a member of the Poxviridae family and Orthopoxvirus genus. Other well-known viruses of the Orthopoxvirus genus include the variola virus (smallpox), cowpox virus and vaccinia virus. Although there is a plethora of research regarding the dermatological and influenza-like symptoms of mpox, particularly following the 2022 mpox outbreak, more research is needed on the gastrointestinal (GI) effects.
OBJECTIVES
This systematic review is to outline the GI manifestations of the monkeypox virus.
METHODS
The authors conducted this systematic review using guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search was conducted through the PubMed, EMBASE and MEDLINE databases from January 1958 to June 2023. The authors selected English language papers that discussed the GI symptoms in mpox patients. A manual search was also conducted in the reference sections of these publications for other relevant papers.
RESULTS
33 papers involving 830 patients were selected for this review. The GI manifestations in mpox patients are proctitis, vomiting, diarrhoea, rectal pain, nausea, tenesmus, rectal bleeding and abdominal pain. Although various papers explored transmission routes, one paper established a direct connection between anal-receptive sex transmission route and the development of a GI complication (proctitis). Another study reported that the mode of transmission could potentially impact the occurrence of GI symptoms and severity of the disease. The reviewed papers did not discover a relation between the severity of dermatological and influenza-like symptoms and the GI manifestations mentioned.
CONCLUSION
This systematic review confirms that GI manifestations are observed in mpox patients. GI symptoms of mpox are crucial for gastroenterologists and other healthcare professionals to recognise in order to address patient discomfort and further understand the pathophysiology of the virus.
Topics: Humans; Gastrointestinal Hemorrhage; Mpox (monkeypox); Proctitis; Vomiting
PubMed: 38184298
DOI: 10.1136/bmjgast-2023-001266 -
Journal of the European Academy of... Apr 2024The transmission dynamics and presenting symptoms of intestinal spirochaetosis (Brachyspira pilosicoli, Brachyspira aalborgi) are poorly understood but is seen more... (Review)
Review
The transmission dynamics and presenting symptoms of intestinal spirochaetosis (Brachyspira pilosicoli, Brachyspira aalborgi) are poorly understood but is seen more frequently in men who have sex with men (MSM) where sexual transmission may occur. We aimed to systemically review the literature to define the factors and presenting symptoms associated with intestinal spirochaetosis in MSM. We systematically searched three bibliographical databases (MEDLINE, EMBASE and Scopus) for manuscripts written in English up to November 2022. The primary author conducted an initial screen and three authors conducted independent reviews to determine the final eligible manuscripts. We only included manuscripts where there were specific data on factors and presenting symptoms associated with intestinal spirochaetosis in MSM. Fifteen manuscripts published between 1981 and 2022 met the inclusion criteria that included 188 MSM. Sexually transmitted intestinal spirochaetosis in MSM was associated with-living with HIV (including having a low CD4 count <200 mm), having a concomitant sexually transmitted infection, a history of a sexually transmitted infection, co-infection with intestinal parasites; and sexual behaviour including oro-anal sexual contact, oro-genital contact, fisting, condom-less anal sex, receptive anal sex, multiple non-regular sexual partners and increased number of lifetime sexual partners. The presenting symptoms of MSM with intestinal spirochaetosis were diarrhoea, abdominal pain, constitutional symptoms and proctitis, including rectal pain, rectal bleeding rectal discharge, flatulence and tenesmus. We have highlighted some biological and behavioural factors and presenting symptoms associated with intestinal spirochaetosis in MSM which provide insight for clinicians, guidelines and future public health control strategies.
Topics: Male; Humans; Homosexuality, Male; Sexual and Gender Minorities; Sexual Behavior; Sexually Transmitted Diseases; Sexual Partners; HIV Infections
PubMed: 38031524
DOI: 10.1111/jdv.19689