Colonic Crohn’s disease-decision is more important than incision:A surgical dilemma

The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal area.It is estimated that patients with CD have one in four chance of undergoing surgery during their life.As surgery in ulcerative colitis ultimately cures the disease,in CD,regardless of the extent of bowel removed,the risk of disease recurrence is as high as 40%.In elective surgery,management of isolated Crohn’s colitis continues to evolve.Depending on the type of surgery performed,colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence.The elective surgical treatment of colonic CD is strictly dependent on the localization of disease,and the choice of the procedure is dependent of the extent of colonic involvement and previous resection.The most common surgical options in colonic CD are total proctocolectomy(TPC)with permanent ileostomy,segmental bowel resection,subtotal colectomy.TPC completely removes all colonic and rectal disease and avoids the use of a potentially diseased anus.We will review current options for the elective surgical treatment of colonic CD,based on the current literature and our own personal experience.

Colonic diverticulitis with comorbid diseases may require elective colectomy

AIM:To investigate the comorbid disease could be the predictors for the elective colectomy in colonic diverticulitis.METHODS:A retrospective chart review of 246 patients with colonic diverticulitis admitted between 2000and 2008 was conducted,and 19 patients received emergent operation were identified and analyzed.Data were collected with regard to age,sex,albumin level on admission,left or right inflammation site,the history of recurrent diverticulitis,preoperative comorbidity,smoking habits,medication,treatment policy,morbidity,and mortality.Preoperative comorbid diseases included cardiovascular disease,diabetes,pulmonary disease,peptic ulcer disease,gouty arthritis,and uremia.Medications in use included non-steroidal anti-inflammatory drugs,acetylsalicylic acid(Aspirin),and corticosteroids.Univariate and multivariate logistic regression analyses were performed to identify the relevant risk factors correlating to colectomy.RESULTS:The mean age of the 246 patients was 69.5years(range,24-94 years).Most diverticulitis could be managed with conservative treatment(n=227,92.3%),and urgent colectomy was performed in 19patients(7.7%).There were three deaths in the surgical group and four deaths in the nonsurgical group.The overall mortality rate in the study was 1.7%among patients with conservative treatment and 15.7%among patients undergoing urgent colectomy.Multiple logistic regression analysis indicated that comorbidities were risk factors for urgent colectomy for diverticulitis.CONCLUSION:To avoid high mortality and morbidity related to urgent colectomy,we suggest that patients with colonic diverticulitis and comorbid diseases may require elective colectomy.

Health related quality of life after surgery for colonic diverticular disease

Diverticular disease(DD) of the colon is very common in developed countries and is ranked the fifth most important gastrointestinal disease worldwide.The management of acute diverticulitis without perforation and peritonitis is still debated.Health related quality of life(HRQL),subjectively perceived by patients,is becoming a major issue in the evaluation of any therapeutic intervention,mainly in patients with chronic disease.To date only a few published studies can be found on Medline examining HRQL in patients with DD.The aim of this study was to review the impact of surgery for DD on HRQL.All Medline articles regarding HRQL after surgery for colonic DD,particularly those comparing different surgical approaches,were reviewed.DD has a negative impact on HRQL with lower scores in bowel function and systemic symptoms.Both surgery-related complications and disease activity have a significant impact on patients' HRQL.While no signif icant differences in HRQL between different operations for DD in non-randomized studies were revealed,the only prospective double-blind randomized study that compared laparoscopic and open colectomy found that patients undergoing laparoscopic colectomy had signif icantly reduced major postoperative complication rates and subsequently had better HRQL scores.Formal assessment of HRQL could be a good instrument in the selection of appropriate patients for elective surgery as well as in the assessment of surgical outcome.

Effect of tight junction protein of intestinal epithelium and permeability of colonic mucosa in pathogenesis of injured colonic barrier during chronic recovery stage of rats with inflammatory bowel disease

Objective: To discuss the changes in the tight junction protein of intestinal epithelium and permeability of colonic mucosa and its possible mechanism by building the rat mode of inflammatory bowel disease at the chronic recovery stage. Methods: A total of 36 SD rats were divided into the model group and control one according to the random number table, with 18 rats in each group. Rats in the model group were given the 3% dextran sulfate sodium solution by the way of drinking for 7 d to build the rat model of inflammatory bowel disease, while rats in the control group were given free drinking of water. Six rats were executed at day 7, 14 and 21 respectively. The colonic tissues were collected from rats to observe the pathological changes of colonic mucosa. The activity of myeloperoxidase was detected and the white blood count was performed for rats in each group. The Ussing chamber technique was employed to detect the transepithelial electrical resistance(TER) and short-circuit current(SC) of colonic mucosa of rats in different time intervals; the quantum dots labeling technique was employed to detect the expression level of claudin-1 and claudin-2 in the colonic tissues. Results: After the successful modeling, the weight of rats in the model group was significantly reduced, while the disease activity index score was increased. The weight was at the lowest level at day 14 and then it began to increase afterwards. The disease activity index score was at the highest level at day 12 and then it began to decrease gradually. The activity of myeloperoxidase and WBC for rats in the model group all reached the peak value at day 14 and then decreased gradually. There was no significant difference in the changes of TER and SC in different time intervals for rats in the control group(P>0.05). TER of model group was at the lowest level at day 14 and then increased gradually; SC was at the highest level at day 14 and then decreased gradually. TER of model group at day 7, 14 and 21 was significantly lower than that of control group, while SC of model group was significantly higher than that of control group(P<0.05). There was no significant difference in the change of mean fluorescence intensity of claudin-1 and claudin-2 in different time intervals for rats in the control group(P>0.05). The claudin-1 and claudin-2 for rats in the model group reached the highest level at day 14 and then decreased gradually. The claudin-1 and claudin-2 of model group at day 7, 14 and 21 was significantly higher than that of control group(P<0.05). Conclusions: After the acute stage, the inflammatory bowel disease is then in the chronic recovery stage; the increased permeability of colonic mucosa and increased expression of tight junction protein of intestinal epithelium are closely related to the pathogenesis and development of disease. The tight junction protein plays a key role in the pathogenesis of injured colonic barrier of inflammatory bowel disease.

Herbal cake-partitioned moxibustion inhibits colonic autophagy in Crohn’s disease via signaling involving distinct classes of phosphatidylinositol 3-kinases

BACKGROUND Autophagy is an evolutionarily conserved biological process in eukaryotic cells that involves lysosomal-mediated degradation and recycling of related cellular components.Recent studies have shown that autophagy plays an important role in the pathogenesis of Crohn’s disease(CD).Herbal cake-partitioned moxibustion(HM)has been historically practiced to treat CD.However,the mechanism by which HM regulates colonic autophagy in CD remains unclear.AIM To observe whether HM can alleviate CD by regulating colonic autophagy and to elucidate the underlying mechanism.METHODS Rats were randomly divided into a normal control(NC)group,a CD group,an HM group,an insulin+CD(I+CD)group,an insulin+HM(I+HM)group,a rapamycin+CD(RA+CD)group,and a rapamycin+HM(RA+HM)group.2,4,6-trinitrobenzenesulfonic acid was administered to establish a CD model.The morphology of the colonic mucosa was observed by hematoxylin-eosin staining,and the formation of autophagosomes was observed by electron microscopy.The expression of autophagy marker microtubule-associated protein 1 light chain 3 beta(LC3B)was observed by immunofluorescence staining.Insulin and rapamycin were used to inhibit and activate colonic autophagy,respectively.The mRNA expression levels of phosphatidylinositol 3-kinase class I(PI3KC1),Akt1,LC3B,sequestosome 1(p62),and mammalian target of rapamycin(mTOR)were evaluated by RT-qPCR.The protein expression levels of interleukin 18(IL-18),tumor necrosis factor-α(TNF-α),nuclear factorκB/p65(NF-κB p65),LC3B,p62,coiled-coil myosin-like BCL2-interacting protein(Beclin-1),p-mTOR,PI3KC1,class III phosphatidylinositol 3-kinase(PI3KC3/Vps34),and p-Akt were evaluated by Western blot analysis.RESULTS Compared with the NC group,the CD group showed severe damage to colon tissues and higher expression levels of IL-18 and NF-κB p65 in colon tissues(P<0.01 for both).Compared with the CD group,the HM group showed significantly lower levels of these proteins(PIL-18<0.01 and Pp65<0.05).There were no significant differences in the expression of TNF-αprotein in colon tissue among the rat groups.Typical autophagic vesicles were found in both the CD and HM groups.The expression of the autophagy proteins LC3B and Beclin-1 was upregulated(P<0.01 for both)in the colon tissues of rats in the CD group compared with the NC group,while the protein expression of p62 and p-mTOR was downregulated(P<0.01 for both).However,these expression trends were significantly reversed in the HM group compared with the CD group(PLC3B<0.01,PBeclin-1<0.05,Pp62<0.05,and Pm-TOR<0.05).Compared with those in the RA+CD group,the mRNA expression levels of PI3KC1,Akt1,mTOR,and p62 in the RA+HM group were significantly higher(PPI3KC1<0.01 and PAkt1,mTOR,and p62<0.05),while those of LC3B were significantly lower(P<0.05).Compared with the RA+CD group,the RA+HM group exhibited significantly higher PI3KC1,p-Akt1,and pmTOR protein levels(PPI3KC1<0.01,Pp-Akt1<0.05,and Pp-mTOR<0.01),a higher p62 protein level(P=0.057),and significantly lower LC3B and Vps34 protein levels(P<0.01 for both)in colon tissue.CONCLUSION HM can activate PI3KC1/Akt1/mTOR signaling while inhibiting the PI3KC3(Vps34)-Beclin-1 protein complex in the colon tissues of CD rats,thereby inhibiting overactivated autophagy and thus exerting a therapeutic effect.

Moxibustion down-regulates colonic epithelial cell apoptosis and repairs tight junctions in rats with Crohn's disease

AIM: To investigate the effects of moxibustion on down-regulation of the colonic epithelial cell apoptosis and repair of the tight junctions in rats with Crohn's disease (CD). METHODS: Sixty male Sprague-Dawley rats were randomly divided into a normal control (NC) group, a model control (MC) group, an herbs-partitioned moxibustion (HPM) group, a mild-warm moxibustion (MWM) group and a salicylazosulphapyridine (SASP) group, with 12 rats in each group. The CD model rats were treated with trinitrobenzene sulphonic acid to induce intestinal inflammation. The rats in the HPM and MWM groups were treated at the Tianshu (ST25) and Qihai (CV6) acupoints once daily for 14 d, and the SASP group was fed SASP twice daily for 14 d. No additional treatment was given to the MC and NC groups. Themicrostructure of the colonic epithelium was observed under a transmission electron microscope, the transepithelial resistance was measured using a shortcircuit current, colonic epithelial cell apoptosis was determined by terminal deoxynucleotidyl transferasemediated dUTP-biotin nick end labelling assay, and the expression of occludin, claudin-1 and zonula occludens-l (ZO-1) in the colonic epithelial junction was determined by Western blotting and immunofluorescence staining. RESULTS: Compared with the MC group, the microstructure of the colonic epithelial barrier was signifi-cantly improved in rats treated with HPM, MWM or SASP, meanwhile, the current flow was reduced signifi-cantly, with values of 168.20 ± 6.14 vs 99.70 ± 3.13, 99.10 ± 4.28 and 120.30 ± 3.65 mA, respectively (P = 0.001). However, the HPM and MWM groups had higher current flow rates than the SASP group (99.70 ± 3.13, 99.10 ± 4.28 vs 120.30 ± 3.65 mA, P = 0.001). The number of the apoptotic colonic epithelial cells in HPM, MWM and SASP groups was largely reduced (61.5 ± 16.91 vs 15.5 ± 8.89, 14.8 ± 6.27 and 24.7 ± 9.68, respectively (P = 0.001); and the expression of occlu- din, claudin-1 and ZO-1 in the MWM and HPM groups was signifi cantly enhanced (0.48 ± 0.10, 0.64 ± 0.09 vs 0.18 ± 0.05 for occludin, 0.12 ± 0.02, 0.17 ± 0.03 vs 0.05 ± 0.01 for claudin-1, and 0.08 ± 0.01, 0.11 ± 0.01 vs 0.02 ± 0.01 for ZO-1). And in SASP group, the expression of occludin and ZO-1 was also signifi cantly increased (0.27 ± 0.04 vs 0.18 ± 0.05 for occludin and 0.05 ± 0.01 vs 0.02 ± 0.01 for ZO-1), but there was no significant difference for claudin-1. The HPM and MWM groups had higher expression of occludin, claudin-1 and ZO-1 than the SASP group. CONCLUSION: HPM and MWM treatment can down-regulate apoptosis of colonic epithelial cells, repair tight junctions and enhance colonic epithelial barrier function in rats with CD.

Qualitative and quantitative analyses of the bifidobacterial microbiota in the colonic mucosa of patients with colorectal cancer, diverticulitis and inflammatory bowel disease

AIM: To characterize the bifidobacterial microbiota of the colonic mucosa in patients with colon cancer, inflammatory bowel disease or diverticulitis. METHODS: A sample of the distal colonic mucosa was taken during surgery from a total of 34 patients, twenty-one with diagnosed colorectal cancer, nine with diverticulitis and four with inflammatory bowel disease, requiring surgery for their condition. Bacterial DNA was extracted from the resected mucosal samples and bifidobacterial mucosa-associated microbiota was qualitatively and quantitatively determined by means of qualitative and quantitative PCR. RESULTS: Bifidobacteria were found in 100% of the samples from patients with diverticulitis or IBD and a 76% of those suffering colon cancer. The species B. longum and B. bifidum were the most widely found, followed by B. animalis, B. catenulatum and B. adolescentis. B. breve, B. dentium and B. angulatum were not detected in any sample. A significantly higher occurrence of B. longum was observed in patients with diverticulitis than in those with colon cancer or IBD (100%, 62% and 75%, respectively, P < 0.05). Similar results were obtained for B. animalis (56%, 0% and 25%, P < 0.05), while B. adolescentis was only found in the mucosa from patients with colon cancer (5 out of 21, 24%). At the quantitative level, patients with colon cancer or IBD showed lower counts of total Bifidobacterium (4.94 and 5.91 vs 6.96 log Cells/sample, respectively, P < 0.05) and of the species B. longum (4.05 and 4.79 vs 6.76, P < 0.05) than those with diverticulitis. CONCLUSION: Aberrancies in mucosa associated microbiota are present in different intestinal diseases. This may indicate a role of the microbiota in the pathogenesis of these diseases.

Relationship between methylation and colonic inflammation in inflammatory bowel disease

AIM:To investigate the relationship between the methylation status in the SLIT2 and TGFB2 promoters and colonic inflammation in inflammatory bowel disease patients.METHODS:We evaluated the methylation status of 2genes(SLIT2 and TGFB2)in 226 biopsies taken from62 colonoscopies of 38 patients(29 ulcerative colitis and 9 Crohn’s colitis)using methylation-specific melting curve analysis.The relationships between methylation status and clinical,biological,endoscopic and histological activities were evaluated.Twenty-three of the 38patients had a second colonoscopy and were included in a longitudinal analysis.Numerical results were given as the means±SD of the sample and range,except when specified.Student t analysis,U Mann Whitney and ANOVA factor were used to compare the means.Qualitative results were based on theχ2 test.RESULTS:SLIT2 methylation was more frequent in samples with endoscopic activity than with endoscopic remission(55%vs 18%,P<0.001).SLIT2 methylation was also higher in samples with acute inflammation(56.5%)than in samples with chronic(24%)or absent inflammation(15%)(P<0.001).For TGFB2methylation,the correlation was only significant with endoscopic activity.Methylation was higher in the distal colon for both genes(P<0.001 for SLIT2 and P=0.022for TGFB2).In the multivariate analysis,only inflammation status(and not disease duration or extension)was independently associated with SLIT2 methylation[OR=6.6(95%CI:1.65-27.36),P=0.009].In the longitudinal analysis,the maintenance of endoscopic remission was protective for methylation.CONCLUSION:Endoscopic and histological inflammation are predictive for SLIT2 methylation.

Intestinal Behcet's disease with esophageal ulcers and colonic longitudinal ulcers

因为食道、回肠结肠的打外面的溃疡的周期性的口头的 aphthous，红斑象 nodosum 一样爆发，生殖器的溃疡，和内视镜的调查结果的历史，肠的 Behcet 在一个 38 岁的女人的疾病与结肠的纵的溃疡被诊断。食道的损害和结肠的纵的溃疡很少在肠的 Behcet 的疾病被看见。没有任何不利效果，食管和 ileocolon 的溃疡与氢化尼松和 mesalazine 与处理的 3 wk 愈合了。Mesalazine 可以减少氢化尼松的全部的剂量要求了治疗疾病。

Association between colonic polyps and diverticular disease

AIM: To evaluate the association between colonic polyps and diverticular disease in Japan. METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex. RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7). CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.

Intestinal alkaline phosphatase in the colonic mucosa of children with inflammatory bowel disease

AIM:To investigate intestinal alkaline phosphatase(iAP) in the intestinal mucosa of children with inflammatory bowel disease(IBD).METHODS:Colonic biopsy samples were taken from 15 newly diagnosed IBD patients and from 10 healthy controls.In IBD patients,specimens were obtainedboth from inflamed and non-inflamed areas.The iAP mRNA and protein expression was determined by reverse transcription-polymerase chain reaction and Western blotting analysis,respectively.Tissue localization of iAP and Toll-like receptor(TLR) 4 was investigated by immunofluorescent staining.RESULTS:The iAP protein level in the inflamed mucosa of children with Crohn's disease(CD) and ulcerative colitis(UC) was significantly decreased when compared with controls(both P < 0.05).Similarly,we found a significantly decreased level of iAP protein in the inflamed mucosa in CD compared with non-inflamed mucosa in CD(P < 0.05).In addition,the iAP protein level in inflamed colonic mucosa in patients with UC was decreased compared with non-inflamed mucosa in patients with CD(P < 0.05).iAP protein levels in the non-inflamed mucosa of patients with CD were similar to controls.iAP mRNA expression in inflamed colonic mucosa of children with CD and UC was not significantly different from that in non-inflamed colonic mucosa with CD.Expression of iAP mRNA in patients with noninflamed mucosa and in controls were similar.Co-localization of iAP with TLR4 showed intense staining with a dotted-like pattern.iAP was present in the inflamed and non-inflamed mucosa of patients with CD,UC,and in control biopsy specimens,irrespective of whether it was present in the terminal ileum or in the colon.However,the fluorescent signal of TLR4 was more pronounced in the colon compared with the terminal ileum in all groups studied.CONCLUSION:Lower than normal iAP protein levels in inflamed mucosa of IBD patients may indicate a role for iAP in inflammatory lesions in IBD.Based on our results,administration of exogenous iAP enzyme to patients with the active form of IBD may be a therapeutic option.

Colonic sarcoidosis:Unusual onset of a systemic disease

Sarcoidosis is a multisystem chronic inflammatory condition of unknown etiology that has the potential to involve every tissue in the body.Sarcoidosis in the gastrointestinal system,and particularly the colon,is very rare.Here,we report the case of a 57-yearold man with no previous diagnosis of sarcoidosis who presented with new onset of abdominal pain and constipation.A colonoscopy revealed that the abdominal pain was caused by an obstructing lesion in the cecum-ascending colon and lacked a clear histologic diagnosis.Radiologic investigation revealed concentric wall thickening of the cecum-ascending colon with multiple satellite lymphadenopathies,highly suggestive of a malignancy.The patient underwent a laparotomy and a right hemicolectomy was performed.A diagnosis of colonic sarcoidosis was made after the resected specimen was examined.Additionally,a chest computed tomography scan revealed lung involvement with atypical radiologic features in the absence of respiratory symptoms.Only histologic examination of the surgical specimen can yield a diagnosis of gastrointestinal sarcoidosis due to the non-specificity of endoscopic and radiologic findings.

Surgical management of colonic perforation due to ulcerative colitis during pregnancy: Report of a case

This report describes a young female in her secondtrimester of pregnancy with known ulcerative colitis onmaintenance medical therapy. She was admitted forabdominal pain, and workup revealed a colonic stric-ture and ulceration with contained perforation. Aftermultidisciplinary discussion she was managed withcolectomy and end ileostomy. She delivered a healthynewborn 18 wk after surgery. Only a few prior reportsdescribed surgical management of inflammatory boweldisease during pregnancy, with recent results indicatinglow risk of adverse outcomes.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors:A decade-apart study of two nationwide cohorts

BACKGROUND Over the years,strides in colon cancer detection and treatment have boosted survival rates;yet,post-colon cancer survival entails cardiovascular disease(CVD)risks.Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited.AIM To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago.METHODS We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample,studying two colon cancer survivor groups for CVD risk factors,mortality rates,and major adverse events like pulmonary embolism,arrhythmia,cardiac arrest,and stroke,adjusting for confounders via multivariable regression analysis.RESULTS Of total colon cancer survivors hospitalized in 2007(n=177542)and 2017(n=178325),the 2017 cohort often consisted of younger(76 vs 77 years),male,African-American,and Hispanic patients admitted non-electively vs the 2007 cohort.Furthermore,the 2017 cohort had higher rates of smoking,alcohol abuse,drug abuse,coagulopathy,liver disease,weight loss,and renal failure.Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities,including hypertension,hyperlipidemia,diabetes,obesity,peripheral vascular disease,congestive heart failure,and at least one traditional CVD(P<0.001)vs the 2007 cohort.On adjusted multivariable analysis,the 2017 cohort had a significantly higher risk of pulmonary embolism(PE)(OR:1.47,95%CI:1.37-1.48),arrhythmia(OR:1.41,95%CI:1.38-1.43),atrial fibrillation/flutter(OR:1.61,95%CI:1.58-1.64),cardiac arrest including ventricular tachyarrhythmia(OR:1.63,95%CI:1.46-1.82),and stroke(OR:1.28,95%CI:1.22-1.34)with comparable all-cause mortality and fewer routine discharges(48.4%vs 55.0%)(P<0.001)vs the 2007 cohort.CONCLUSION Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events(stroke 28%,PE 47%,arrhythmia 41%,and cardiac arrest 63%).It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

Immunoglobulin G4-related disease in the sigmoid colon in patient with severe colonic fibrosis and obstruction:A case report

BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is an immune-mediated condition characterized by abundant IgG4 positive plasma cells and fibrosis in the affected tissues.It affects most parts of the body;however,there are not many reports on IgG4-RD involving the colon.CASE SUMMARY A 50-year-old man complaining of intermittent fever for more than two years was referred to our hospital.Based on various investigations before surgery,we diagnosed him with chronic perforation of the sigmoid colon caused by inflammatory change or tumor.IgG blood tests before the operation suggested IgG4-RD,and postoperative pathology confirmed this prediction.CONCLUSION We present a patient with IgG4-RD with colon involvement,which is an uncommon site.This report will expand the understanding of IgG4-RD in unknown tissues.

Bitter Melon Powder Protects against Obesity-associated Fatty Liver Disease by Improving Colonic Microenvironment in Rats with High-fat Diet-induced Obesity

This study explored how bitter melon powder （BMP） alters the colonic microenvironment during the development of obesity-associated fatty liver in rats. We observed that BMP effectively inhibited the body weight gain and lipid accumulation in the liver, ameliorated glucose intolerance, and increased the colon weight after an 8-week treatment compared to that in the high-fat diet （HFD） group. BMP significantly decreased fecal water toxicity towards HT-29 cells, as revealed by the cell counting kit （CCK）-8 assay results, and the mRNA expression of Toll-like receptor 4 （TLR4） in colon mucosa. Additionally, gut permeability in the BMP group was restored to normal levels. Finally, BMP alleviated the inflammatory state of the rat colon mucosa and liver tissues as well as the systemic inflammation.

Protective links between vitamin D,inflammatory boweldisease and colon cancer

Vitamin D deficiency has been associated with a wide range of diseases and multiple forms of cancer including breast, colon, and prostate cancers. Relatively recent work has demonstrated vitamin D to be critical in immune function and therefore important in inflammatory diseases such as inflammatory bowel disease(IBD). Because vitamin D deficiency or insufficiency is increasingly prevalent around the world, with an estimated 30%-50% of children and adults at risk for vitamin D deficiency worldwide, it could have a significant impact on IBD. Epidemiologic studies suggest that low serum vitamin D levels are a risk factor for IBD and colon cancer, and vitamin D supplementation is associated with decreased colitis disease activity and/or alleviated symptoms. Patients diagnosed with IBD have a higher incidence of colorectal cancer than the general population, which supports the notion that inflammation plays a key role in cancer development and underscores the importance of understanding how vitamin D influences inflammation and its cancer-promoting effects. In addition to human epidemiological data, studies utilizing mouse models of colitis have shown that vitamin D is beneficial in preventing or ameliorating inflammation and clinical disease. The precise role of vitamin D on colitis is unknown; however, vitamin D regulates immune cell trafficking and differentiation, gut barrier function and antimicrobial peptide synthesis, all of which may be protective from IBD and colon cancer. Here we focus on effects of vitamin D on inflammation and inflammation-associated colon cancer and discuss the potential use of vitamin D for protection and treatment of IBD and colon cancer.

Effect of entacapone on colon motility and ion transport in a rat model of Parkinson's disease

AIM: To study the effects of entacapone, a catecholO-methyltransferase inhibitor, on colon motility and electrolyte transport in Parkinson's disease(PD) rats.METHODS: Distribution and expression of catecholO-methyltransferase(COMT) were measured by immunohistochemistry and Western blotting methods. The colonic smooth muscle motility was examined in vitroby means of a muscle motility recording device. The mucosal electrolyte transport of PD rats was examined by using a short-circuit current(I SC) technique and scanning ion-selective electrode technique(SIET). Intracellular detection of c AMP and c GMP was accomplished by radioimmunoassay testing. RESULTS: COMT was expressed in the colons of both normal and PD rats, mainly on the apical membranes of villi and crypts in the colon. Compared to normal controls, PD rats expressed less COMT. The COMT inhibitor entacapone inhibited contraction of the PD rat longitudinal muscle in a dose-dependent manner. The β2 adrenoceptor antagonist ICI-118,551 blocked this inhibitory effect by approximately 67%(P < 0.01). Entacapone increased mucosal ISC in the colon of rats with PD. This induction was significantly inhibited by apical application of Cl- channel blocker diphenylamine-2, 2'-dicarboxylic acid, basolateral application of Na+-K+-2Cl-co-transporter antagonist bumetanide, elimination of Cl- from the extracellular fluid, as well as pretreatment using adenylate cyclase inhibitor MDL12330 A. As an inhibitor of prostaglandin synthetase, indomethacin can inhibit entacaponeinduced ISC by 45%(P < 0.01). When SIET was applied to measure Cl- flux changes, this provided similar results. Entacapone significantly increased intracellular c AMP content in the colonic mucosa, which was greatly inhibited by indomethacin.CONCLUSION: COMT expression exists in rat colons. The β2 adrenoceptor is involved in the entacaponeinduced inhibition of colon motility. Entacapone induces c AMP-dependent Cl- secretion in the PD rat.

The development of colon innervation in trisomy mice and Hirschsprungs disease

AIM To study the colon innervation of trisomy16 mouse, an animal model for Downssyndrome, and the expression of protein geneproduct 9.5 ( PGP 9.5) in the stenosed segmentof colon in Hirschsprungs disease (HD).METHODS Trisomy 16 mouse breeding;cytogenetic analysis of trisomy 16 mice; andPGP 9.5 immunohistochemistry of colons oftrisomy 16 mice and HD were carried out.RESULTS Compared with their normalIittermates, the nervous system of colon intrisomy 16 mice was abnormally developed.There existed developmental delay of muscularplexuses of colon, no submucosal plexus wasfound in the colon, and there was 5mmaganglionic bowel aparting from the anus intrisomy 16 mice. The mesentery nerve fiberswere as well developed as shown in their normallittermates. Abundant proliferation of PGP 9.5positive nerve fibers was revealed in thestenosed segment of HD colon.CONCLUSION Trisomy 16 mice could serve asaganglionic bowel in the distal part of colon.Abundant proliferation of PGP 9.5 positive fibersresulted from extrinsic nerve compensation,since no ganglionic cells were observed in thestenosed segment of the colon in HD. HD has agenetic tendency.

Pattern and distribution of colonic diverticulosis:Analysis of 2877 barium enemas in Thailand

AIM:To determine the pattern and distribution of colonic diverticulosis in Thai adults.METHODS:A review of the computerized radiology database for double contrast barium enema(DCBE)in Thai adults was performed at the Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded.The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined.The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were reported.Factors influencing the presence of colonic diverticulosis were evaluated.RESULTS:A total of 2877 suitable DCBE examinations were retrospectively reviewed.The mean age of patients was 59.8±14.7 years.Of these patients,1778(61.8%)were female and 700(24.3%)were asymptomatic.Colonic diverticulosis was identified in 820patients(28.5%).Right-sided diverticulosis(641 cases;22.3%)was more frequently reported than left-sided diverticulosis(383 cases;13.3%).Pancolonic diverticulosis was found in 98 cases(3.4%).The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were 1.5%(42 cases),0.4%(12 cases),and 0.03%(1 case),respectively.There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients(28.3%vs 28.6%,P=0.85).DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals(29.5%vs 25.3%,P=0.03).Change in bowel habit was strongly associated with the presence of diverticulosis(a relative risk of 1.39;P=0.005).The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals(P>0.05).CONCLUSION:Colonic diverticulosis was identified in28.5%of DCBE examinations in Thai adults.There was no association between the presence of diverticulosis and gender or age.