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The Turkish Journal of Gastroenterology... Aug 2022Endoscopy remains the gold standard for evaluating mucosal healing in ulcerative colitis. However, given its invasiveness and high cost, it is not always possible to...
BACKGROUND
Endoscopy remains the gold standard for evaluating mucosal healing in ulcerative colitis. However, given its invasiveness and high cost, it is not always possible to perform it as often. This study aimed to evaluate value of numerous patient-reported symptoms in the prediction of endoscopic mucosal healing.
METHODS
We prospectively conducted a cohort involving 143 patients with ulcerative colitis (men: 63.6%, median age: 40.0 years) in a tertiary teaching hospital between May 2017 and May 2020. Clinical remission was defined as resolution of rectal bleeding and normalization of stool frequency, set as basic patient-reported outcomes. The presence of additional 4 patient-reported outcomes (urgency, tenesmus, mucoid stool, and night defecation) were evaluated. Endoscopic activity was graded using the Ulcerative Colitis Endoscopic Index of Severity and endoscopic mucosal healing was defined as Ulcerative Colitis Endoscopic Index of Severity 0-1.
RESULTS
A total of 44 (30.77%) ulcerative colitis patients were categorized as achieving endoscopic mucosal healing. Across different patient-reported outcomes status in predicting endoscopic mucosal healing, clinical remission status inferred from basic patient-reported outcomes was superior to additional 4 patient-reported outcomes collectively (sensitivity/specificity: Ulcerative Colitis Endoscopic Index of Severity = 0/1, basic patient-reported outcomes 59.09%/75.76%, additional 4 patient-reported outcomes 70.45%/72.73%). Combination of basic and additional patient-reported outcomes revealed increased specificity of 83.84%. Multivariate analysis adjusted for age, sex, disease extent, and disease duration also revealed consistent results that patient-reported outcomes were independently associated to endoscopic mucosal healing (P < .001).
CONCLUSION
Recognizing the presence of additional patient-reported outcomes may be useful in clinical practice as it is a simple and easy method that not only reflects patient's quality of life but can also relatively better predict endoscopic mucosal healing status than basic patient-reported outcomes.
Topics: Adult; Colitis, Ulcerative; Colonoscopy; Humans; Intestinal Mucosa; Male; Patient Reported Outcome Measures; Quality of Life; Severity of Illness Index
PubMed: 35946876
DOI: 10.5152/tjg.2022.21375 -
Medicina 2022We present the case of a female patient with a history of high-grade urothelial carcinoma of the bladder with secondary lymph node and bone involvement, who presented...
We present the case of a female patient with a history of high-grade urothelial carcinoma of the bladder with secondary lymph node and bone involvement, who presented with hematochezia, tenesmus and rectal pain one year after her oncological surgery. The abdomen and pelvis magnetic resonance image showed a 5 cm solid rectal lesion that stenosed the lumen and crossed the peritoneum, 6 cm away from the anal margin. The histology of this lesion reported an urothelial metastasis at the level of the lower rectum according to the patient's history. This case identifies an atypical evolution of urothelial carcinomas (UC), highlighting an unusual route of distant metastasis. UC can, on rare occasions, metastasize to the rectum, usually in advanced or recurrent cases of the disease. As the literature available on this topic is scarce, it is crucial to highlight the importance of maintaining high suspicion in patients with a history of urothelial carcinoma and urinary/rectal symptoms (rectal pain and urgency, suprapubic pain, urinary and fecal incontinence).
Topics: Carcinoma, Transitional Cell; Female; Humans; Pain; Urinary Bladder Neoplasms
PubMed: 35904918
DOI: No ID Found -
Annals of Medicine and Surgery (2012) Jul 2022The argon plasma coagulation is a technique used for noncontact thermal coagulation of tissue. Hyperplastic polyps are the most common non-neoplastic polyps in the colon.
INTRODUCTION AND IMPORTANCE
The argon plasma coagulation is a technique used for noncontact thermal coagulation of tissue. Hyperplastic polyps are the most common non-neoplastic polyps in the colon.
CASE PRESENTATION
We presented a 3-year-old girl with a chief complaint of bloody stool and rectal tenesmus that began 5 days ago. She was previously being treated because of a history of chronic constipation. She underwent a one stage surgery for Hirschsprung's disease, after a full-thickness rectal wall biopsy was obtained and it consistent with Hirschsprung's disease. Three months after the surgery, the girl presented to our clinic with rectal blood loss and rectal tenesmus. Endoscopic examination of her colon demonstrated sessile and pedunculated polyps. The pedunculated polyps were removed endoscopically. Biopsies were taken from the sessile polyps. Histopathologic examination of the polypectomy specimen and the biopsies of the sessile polyps showed hyperplastic polyps. The endoscopy was repeated for the purpose of argon plasma coagulation ablation of the sessile polyps. Argon plasma coagulation caused an adequate ablation and the entire polyps were burned.
CLINICAL DISCUSSION
Argon plasma coagulation is an effective and safe technique in the endoscopic management of gastrointestinal conditions.
CONCLUSION
Further clinical trials including a comparison of argon plasma coagulation to other treatment modalities, as well as long-term follow-up after argon plasma coagulation treatment are required.
PubMed: 35860107
DOI: 10.1016/j.amsu.2022.104098 -
Annals of Parasitology 2022Cystoisospora belli is an obligate intracellular coccidian parasite known to cause chronic persistent diarrhoea in immunocompromised individuals such as human...
Cystoisospora belli is an obligate intracellular coccidian parasite known to cause chronic persistent diarrhoea in immunocompromised individuals such as human immunodeficiency virus (HIV) infection, long term corticosteroid therapy, cancer chemotherapy and solid organ transplant recipients. Trichuris trichiura is a soil transmitted helminth, which predominantly causes asymptomatic or mild infections but heavy worm load can sometimes lead to chronic diarrhoea, tenesmus or rectal prolapse. We report a case of co-infection with Cystoisospora belli and Trichuris trichiura in an adult patient causing intractable diarrhea, which led to the unraveling of a severely compromised immune status in the patient enabling an appropriate therapeutic approach and further management.
Topics: Adult; Animals; Coinfection; Diarrhea; HIV Infections; Humans; Immunocompromised Host; Trichuris
PubMed: 35842846
DOI: 10.17420/ap6802.446 -
The Journal of Small Animal Practice Oct 2022To report the clinical presentation, complications, and long-term outcomes of cats treated for perineal hernia with modified internal obturator muscle transposition.
OBJECTIVES
To report the clinical presentation, complications, and long-term outcomes of cats treated for perineal hernia with modified internal obturator muscle transposition.
METHODS
The medical records of cats surgically treated for perineal hernia between 2013 and 2019 were reviewed and an owner questionnaire was conducted to determine long-term outcome.
RESULTS
Thirty-six cats were included in the study: 34 had bilateral and two unilateral hernias. Of these 36, 24 (67%) were male neutered with a median age of 10 (range: 1 to 18) years. The complication rate was low, however, one cat experienced a major postoperative complication: rectal prolapse requiring revision surgery 48 hours postsurgery. Short-term outcomes were available for 32 of 36 (89%) cats. Of the 32, 23 were examined 6 weeks postoperatively, and a telephonic consultation was performed for an additional nine of 32. Of the 23 cats examined directly, none had recurrence. Overall 12 of 32 experienced short-term postoperative tenesmus which resolved in nine of 12 (75%). Long-term outcomes were available for 31 of 36 cats (86%), with a median of 18.5 (6 to 89) months follow-up. A good outcome was achieved in 23 of 31 (74%) whereas three of 31 (10%) had fair outcomes and five of 31 (16%) had a poor outcome. Of the five cats with a poor outcome, two required subtotal colectomy to manage clinical signs related to megacolon, two were euthanised following a return of clinical signs, and one developed unilateral recurrence.
CLINICAL SIGNIFICANCE
Perineal hernia should be considered in cats presenting with tenesmus or recurrent obstipation. Surgical treatment of perineal hernias in cats can result in good owner-assessed long-term outcome.
Topics: Animals; Cat Diseases; Cats; Colectomy; Female; Hernia, Abdominal; Herniorrhaphy; Male; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 35840129
DOI: 10.1111/jsap.13534 -
Journal of Investigative Medicine High... 2022Rectal infection with the L1, L2, and L3 serovars of can cause lymphogranuloma venereum (LGV) proctocolitis, particularly among men who have sex with men (MSM)....
Rectal infection with the L1, L2, and L3 serovars of can cause lymphogranuloma venereum (LGV) proctocolitis, particularly among men who have sex with men (MSM). Symptoms of this sexually transmitted infection include anal pain, rectal bleeding and discharge, tenesmus, constipation, and fever. Clinicians should consider LGV when there is a history of receptive anal intercourse and symptoms of proctocolitis. A positive nucleic acid amplification test (NAAT) on a rectal sample is diagnostic. This report describes a man with HIV and chronic proctocolitis in whom the diagnosis of LGV was delayed because the clinical picture mimicked inflammatory bowel disease.
Topics: Chronic Disease; Homosexuality, Male; Humans; Inflammatory Bowel Diseases; Lymphogranuloma Venereum; Male; Proctocolitis; Sexual and Gender Minorities
PubMed: 35762449
DOI: 10.1177/23247096221107233 -
Endoscopy International Open Jun 2022Chronic radiation proctitis (CRP) occurs in 5 % to 20 % of patients undergoing pelvic radiation therapy and frequently manifests with rectal bleeding. Endoscopic...
Chronic radiation proctitis (CRP) occurs in 5 % to 20 % of patients undergoing pelvic radiation therapy and frequently manifests with rectal bleeding. Endoscopic management of more severe and refractory cases can be challenging. Rectal band ligation (RBL) has been shown to be a feasible alternative to current available techniques, especially in extensive CRP. Our aim is to evaluate clinical and technical success of RBL. We enrolled all consecutive patients treated with RBL for severe or recurrent hemorrhagic CRP. Success was defined as endoscopic evidence of complete rectal healing and/or cessation of bleeding not requiring further treatment or blood transfusion. We enrolled 10 patients (7 males, mean age 75.6 years). Median length of the CRP from the anal verge was 4.5 cm and mean surface area involved was 89 %. Eight patients (80 %) were naïve to endoscopic treatment, while two had undergone argon plasma coagulation (APC). Median follow-up was 136.5 days. Success was achieved in 100 % of patients after a mean number of 1.8 RBL sessions. A mean number of 4.7 bands were released in the first session while a mean of 3.1 and 2 bands were placed in the second and third sessions, respectively. As for adverse events, only one patient reported mild tenesmus and pelvic pain after the procedure. RBL is a safe and effective therapeutic modality for the treatment of hemorrhagic CRP. It could be considered a valid first-line option in case of extensive rectal involvement as well as a viable rescue treatment after failed APC.
PubMed: 35692922
DOI: 10.1055/a-1821-0776 -
Reviews on Recent Clinical Trials 2022Ulcerative colitis may impair anorectal function, causing disabling symptoms such as incontinence and/or increase in the stool frequency, urgency and tenesmus. Data on...
BACKGROUND
Ulcerative colitis may impair anorectal function, causing disabling symptoms such as incontinence and/or increase in the stool frequency, urgency and tenesmus. Data on anorectal function in these patients evaluated by conventional anorectal manometry are conflicting.
OBJECTIVES
The aim of this prospective study was to assess by means of high resolution anorectal manometry the anorectal function in patients with mild-to-moderate ulcerative colitis at presentation and after remission. Anorectal function of ulcerative colitis patients was compared to that observed in healthy volunteers.
METHODS
20 patients with mild to moderate left-sided ulcerative colitis or proctitis and 20 healthy volunteers were prospectively enrolled. All ulcerative colitis patients underwent high resolution anorectal manometry before treatment and after clinical remission.
RESULTS
Ulcerative colitis patients showed similar values for anal sphincter function as healthy volunteers, whereas rectal threshold volume for the first sensation, desire to defecate, urgency to defecate and maximum discomfort were significantly lower than in healthy volunteers (p<0.05). Rectal compliance was significantly lower in ulcerative colitis than in healthy volunteers (p<0.05). After remission, rectal threshold volumes, as well as rectal compliance, significantly increased. An inverse linear correlation was found between regression of urgency and stool frequency and rectal compliance (r=0.811; p<0.05).
CONCLUSION
Ulcerative colitis patients show altered rectal function, with increased rectal sensitivity and lower compliance, compared to controls. This altered function is restored after successful treatment of the underlying inflammatory process. Finally high resolution anorectal manometry provides useful information on anorectal functionality and, in our opinion, should be preferred over conventional manometry.
Topics: Humans; Anal Canal; Colitis, Ulcerative; Manometry; Pilot Projects; Prospective Studies; Rectum; Remission Induction; Case-Control Studies
PubMed: 35570544
DOI: 10.2174/1574887117666220513110705 -
BMJ Open May 2022Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disease of the large intestine. Ustekinumab is a monoclonal antibody against the p40 subunit of... (Observational Study)
Observational Study
Symptom Improvement of ulceRative colitis after an Induction dose of UStekinumab in Japanese clinical practice (SIRIUS), measured using patient-reported outcomes: a prospective observational study.
INTRODUCTION
Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disease of the large intestine. Ustekinumab is a monoclonal antibody against the p40 subunit of interleukin-12 and interleukin-23 and has proven efficacy in inducing and maintaining remission in adult patients with moderate-to-severe UC. In the Symptom Improvement of ulceRative colitis after an Induction dose of Ustekinumab study, we will document the initial treatment response (daily patient-reported outcomes for 8 weeks from first infusion) and treatment patterns of patients wih UC receiving an induction dose of ustekinumab in the real-world setting in Japan. We will also investigate the relationship between the treatment response at week 8 and early indicators of response and determine patient factors that may define the appropriate dosing interval for maintenance therapy.
METHODS AND ANALYSIS
For this single-arm, prospective observational study at 24 centres in Japan with a follow-up period of 16/20 weeks, we aim to recruit 140 patients with moderate-to-severe UC between July 2021 and July 2022. All surveys will be conducted in Japanese and patient-reported outcomes relating to rectal bleeding, stool frequency, abdominal pain, nocturnal diarrhoea, tenesmus and perception of UC symptoms will be recorded using a smartphone application, where the patients can enter their initial response to ustekinumab induction therapy on a daily basis. Dosing intervals and the reasons for selecting this interval, and concomitant medications taken during treatment with ustekinumab will be collected by a physician questionnaire at the end of the study. On completion of primary end point (8-week patient-reported outcomes) data collection, results will be reported sequentially.
ETHICS AND DISSEMINATION
The study has been approved by the ethics committee of each facility involved and the Institutional Review Board of the non-profit organisation MINS.
TRIAL REGISTRATION NUMBER
UMIN000043753, NCT04963725.
Topics: Adult; Colitis, Ulcerative; Humans; Japan; Patient Reported Outcome Measures; Remission Induction; Treatment Outcome; Ustekinumab
PubMed: 35508346
DOI: 10.1136/bmjopen-2021-060081