Metabolic syndrome and colorectal neoplasms:An ominous association

AIM:To evaluate the association of metabolic syndrome(MS) and colorectal cancer and adenomas in a Western country,where the incidence of MS is over 27%.METHODS:This was a prospective study between March 2013 and March 2014.MS was diagnosed according to the National Cholesterol Education ProgramATP III.Demographic characteristics,anthropometric measurements,metabolic risk factors,and colonoscopic pathologic findings were assessed in patients with MS(group 1) who underwent routine colonoscopy at our department.This data was compared with consecutive patients without metabolic syndrome(group 2),with no differences regarding sex and age.Patients with incomplete colonoscopy,family history,or past history of colorectal neoplasm were excluded.Informed consent was obtained and the ethics committee approved this study.Statistical analysis was performed using Student's t-test and χ2 test,with a P value ≤ 0.05 being considered statistically significant.RESULTS:Of 258 patients,129 had MS;51% males;mean-age 67.1 years(50-87).Among the MS group,94% had high blood pressure,91% had increased waist circumference,60% had diabetes,55% had low high-density lipoprotein cholesterol level,50% had increased triglyceride level,and 54% were obese [body mass index(BMI) 30 kg/m2].51% presented 4 criteria of MS.MS was associated with increased prevalence of adenomas(43% vs 25%,P = 0.004) and colorectal cancer(13% vs 5%,P = 0.027),compared with patients without MS.MS was also positively associated with multiple(≥ 3) adenomas(35% vs 9%,P = 0.024) and sessile adenomas(69% vs 53%,P = 0.05).No difference existed between location(P = 0.086),grade of dysplasia(P = 0.196),or size(P= 0.841) of adenomas.In addition,no difference was found between BMI(P = 0.078),smoking(P = 0.146),alcohol consumption(P = 0.231),and the presence of adenomas.CONCLUSION:MS is positively associated with adenomas and colorectal cancer.However,there is not enough information in western European countries to justify screening in patients with MS.To our knowledge,no previous study has evaluated this association in Portuguese patients.

Esophageal stenosis with sloughing esophagitis:A curious manifestation of graft-vs-host disease

We report a case of a 56-year-old woman with a history of allogenic bone marrow transplantation for two years,complaining with dysphagia and weight loss. Upper endoscopy revealed esophageal stenosis and extensive mucosa sloughing. Biopsies confirmed the diagnosis of graft-vs-host disease(GVHD). Balloon dilation,corticosteroids and cyclosporin resulted in marked clinical improvement. Gastrointestinal tract is involved in the majority of patients with chronic GVHD. Esophageal manifestations are rare and include vesiculobullous disease,ulceration,esophageal webs,casts or strictures. Sloughing esophagitis along with severe stenosis requiring endoscopic dilation has never been reported in this context.

Systemic mastocytosis: A rare cause of non-cirrhotic portal hypertension

Mastocytosis is a clonal neoplastic disorder of the mast cells(MC) that can be limited to the skin(cutaneous mastocytosis) or involve one or more extracutaneous organs(systemic mastocytosis). The clinical manifestations of mastocytosis are heterogeneous ranging from indolent disease with a long-term survival to a highly aggressive neoplasm with survival of about 6 mo. Although liver involvement in aggressive systemic mastocytosis(ASM) is relatively common, the development of portal hypertension with or without cirrhosis is rare. We report a case of ASM without skin involvement in a 72-year-old caucasian male who presented with non-cirrhotic portal hypertension based on clinical, analytical, imagiological and endoscopic findings. Given the hematological picture, the correct diagnosis was established based on ancillary tests for MC using bone marrow aspirates and biopsy. Extensive involvement of the liver and gastrointestinal tract was histologically documented. The disease progressed rapidly and severe pancytopenia and recurrent upper gastrointestinal bleeding became the dominant problem. This case illustrates the challenge in establishing a diagnosis of ASM especially when the clinical picture is atypical and without skin involvement. Gastroenterologists should consider infiltrative disease, particularly systemic mastocytosis, as a differential diagnosis in a clinical case of portal hypertension of unknown etiology.