Histological healing favors lower risk of colon carcinoma in extensive ulcerative colitis

AIM:To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer(CC)or high grade dysplasia(HGD).METHODS:This is a single center(Lenox Hill Hospital)retrospective cohort and descriptive study of extensive ulcerative colitis(UC)for 20 years or more with a minimum of 3 surveillance colonoscopies and biopsies performed after the first 10 years of UC diagnosis.Data analyzed included:duration of UC,date of diagnosis of(CC)or(HGD),number of surveillance colonoscopies,and biopsies showing histological inflammation and its severity in each of 6 segments when endoscopic appearance is normal.Two subgroups of patients were compared:group 1 patients who developed CC/HGD and group 2 patients who did not develop CC/HGD.RESULTS:Of 115 patients with longstanding UC reviewed,68 patients met the inclusion criteria.Twenty patients were in group 1 and 48 in group 2.We identified the number of times for each patient when the endoscopic appearance was normal but biopsies nevertheless showed inflammation.Overall,histological disease activity in the absence of gross/endoscopic disease was found in 31.2%(95%CI:28%-35%)of colonoscopies performed on the entire cohort of 68 patients.Histological disease activity when the colonoscopy showed an absence of gross disease activity was more common in group 1 than group 2 patients,88%(95%CI:72%-97%)vs 59%(95%CI:53%-64%).Only 3/20(15%)of patients in group 1 ever had a colonoscopy completely without demonstrated disease activity(i.e.,no endoscopic or histological activity)as compared to 37/48(77%)of patients in group 2,and only 3.3%(95%CI:0.09%-8.3%)of colonoscopies in group 1 had no histological inflammation compared to23%(95%CI:20%-27%)in group 2.CONCLUSION:Progression to HGD or CC in extensive ulcerative colitis of long standing was more frequently encountered among those patients who demonstrate persistent histological inflammation in the absence of gross mucosal disease.Our findings support including the elimination of histological inflammation in the definition of mucosal healing,and support this endpoint as an appropriate goal of therapy because of its risk of increasing dysplasia and colon cancer.

彩色多普勒超声诊断颈动脉粥样硬化与脑梗死的相关性研究

目的利用彩色多普勒超声诊断颈动脉异常,分析颈动脉内-中膜厚度(IMT)、粥样硬化斑块及溃疡斑块与脑梗死的相关性。方法选择临床及影像学资料完整的脑梗死患者89例为脑梗死组,并选择同期健康体检者50例为对照组,采用彩色多普勒超声对颈动脉IMT进行测量并对颈动脉粥样硬化斑块的性质进行观测,将结果进行统计学分析。结果脑梗死组较对照组IMT厚,差异有统计学意义(P<0.001);脑梗死组较对照组颈动脉粥样硬化斑块和溃疡斑块检出率高,差异有统计学意义(P<0.001),且随着年龄增长颈动脉斑块检出例数及溃疡斑块检出例数明显增加,差异有统计学意义(P<0.05)。结论颈动脉IMT增厚及颈动脉粥样硬化斑块中溃疡斑块的形成与脑梗死的发生密切相关。

Role of the gut microbiota in inflammatory bowel disease pathogenesis: What have we learnt in the past 10 years?

Our understanding of the microbial involvement in inflammatory bowel disease(IBD) pathogenesis has increased exponentially over the past decade. The development of newer molecular tools for the global assessment of the gut microbiome and the identification of nucleotide-binding oligomerization domain-containing protein 2 in 2001 and other susceptibility genes for Crohn's disease in particular has led to better understanding of the aetiopathogenesis of IBD. The microbial studies have elaborated the normal composition of the gut microbiome and its perturbations in the setting of IBD. This altered microbiome or "dysbiosis" is a key player in the protracted course of inflammation in IBD. Numerous genome-wide association studies have identified further genes involved in gastrointestinal innate immunity(including polymorphisms in genes involved in autophagy: ATG16L1 and IGRM), which have helped elucidate the relationship of the local innate immunity with the adjacent luminal bacteria. These developments have also spurred the search for specific pathogens which may have a role in the metamorphosis of the gut microbiome from a symbiotic entity to a putative pathogenic one. Here we review advances in our understanding of microbial involvement in IBD pathogenesis over the past 10 years and offer insight into how this will shape our therapeutic management of the disease in the coming years.

Inflammatory bowel disease and thromboembolism

Patients with inflammatory bowel disease(IBD) have an increased risk of vascular complications. Thromboembolic complications,both venous and arterial,are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to Thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown,but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature,as well as in the systemic circulation. Clinicians' awareness of the risks,and their ability to promptly diagnose and manage TEs are of vital importance. In this review we discuss how thromboembolic disease is related to IBD,specifically focusing on:(1) the epidemiology and clinical features of thromboembolic complications in IBD;(2) the pathophysiology of thrombosis in IBD;and(3) strategies for the prevention and management of thromboembolic complications in IBD patients.

Inflammatory bowel disease in an underdeveloped region of Northeastern Brazil

AIM: To evaluate the demographic characteristics and clinical phenotypes of inflammatory bowel disease(IBD) in a geographic area in Northeastern Brazil.METHODS: This retrospective study was conducted at the Hospital of the Federal University of Piauí in Northeastern Brazil. Demographic characteristics and clinical phenotypes of IBD were analyzed in relation to the time of diagnostic confirmation, which was defined as the date of disease onset. Data were collected between January 2011 and December 2012 and included all census patients 18 years of age or older during that period for whom there was diagnostic confirmation of Crohn's disease(CD), ulcerative colitis(UC), or unclassified colitis according to the Montreal criteria. We also analyzed the period of time between the onset of clinical manifestations and the diagnosis of IBD(delay in the diagnosis). Statistical analyses included means and standard deviations for numeric variables and the Pearson χ2 adherence test for nominal variables. The annual index occurrence and overall prevalence of IBD at our institution were also calculated, with P values < 0.05 indicating statistical significance. This study was approved by the Institutional Ethics and Research Committee.RESULTS: A total of 252 patients with IBD were included, including 152(60.3%) UC patients and 100(39.7%) CD patients. The clinical and demographic characteristics of all patients with IBD showed a female to male ratio of 1.3:1.0 and a mean age of35.2(SD = 14.5) years. In addition, the majority of patients were miscegenated(171, 67.9%), had received higher education(157, 62.4%), lived in urban areas(217, 86.1%), and were under the age of 40 years(97, 62.5%). For patients with CD, according to the Montreal classification, the predominant features present from the onset of disease were an age between 17 and 40 years(A2); colonic disease location(L2); and nonstricturing, nonfistulizing disease behavior(B1). However, approximately one-quarter of all CD patients demonstrated perineal involvement. We also observed considerable delay in the diagnosis of IBD throughout the entire study period(mean = 35.5 mo). In addition, the annual index occurrence rose from 0.08 to 1.53 cases/105 inhabitants/year during the study period, and the prevalence rate was 12.8 cases/105 inhabitants in 2012. Over the last two decades, there was a noted increase in the frequency of IBD in the study area.CONCLUSION: In this study, there was a predominance of patients with UC, young people under 40 years of age, individuals with racial miscegenation, and low annual incomes.

Neurological disorders and inflammatory bowel diseases

Extraintestinal manifestations occur in about one-third of patients living with inflammatory bowel disease(IBD) and may precede the onset of gastrointestinal symptoms by many years. Neurologic disorders associated with IBD are not frequent, being reported in 3% of patients, but they often represent an important cause of morbidity and a relevant diagnostic issue. In addition, the increasing use of immunosuppressant and biological therapies for IBD may also play a pivotal role in the development of neurological disorders of different type and pathogenesis. Hence, we provide a complete and profound review of the main features of neurological complications associated with IBD, with particular reference to those related to drugs and with a specific focus on their clinical presentation and possible pathophysiological mechanisms.

中医辨证论治非溃疡性消化不良的探讨——附62例临床分析

根据62例非溃疡性消化不良患者的临床表现,辨证分为肝郁气滞型、肝郁胃热型、肝郁湿阻型、肝郁脾虚型、肝郁阴虚型共5型,以清润通降法为原则进行治疗,结果痊愈12例(19.4％),显效32例(51.6％),有效15例(24.2％),无效3例(4.8％)。总有效率为95.2％。

Pulmonary manifestations of inflammatory bowel disease

Extraintestinal manifestations of inflammatory bowel disease(IBD) are a systemic illness that may affect up to half of all patients. Among the extraintestinal manifestations of IBD, those involving the lungs are relatively rare and often overlooked. However, there is a wide array of such manifestations, spanning from airway disease to lung parenchymal disease, thromboembolic disease, pleural disease, enteric-pulmonary fistulas, pulmonary function test abnormalities, and adverse drug reactions. The spectrum of IBD manifestations in the chest is broad, and the manifestations may mimic other diseases. Although infrequent, physicians dealing with IBD must be aware of these conditions, which are sometimes life-threatening, to avoid further health impairment of the patients and to alleviate their symptoms by prompt recognition and treatment. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment. The treatment of IBD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management. Corticosteroids, both systemic and aerosolized, are the mainstay therapeutic approach, while antibiotics must also be administered inthe case of infectious and suppurative processes, whose sequelae sometimes require surgical intervention.

Epidemiological studies of migration and environmental risk factors in the inflammatory bowel diseases

Inflammatory bowel diseases(IBD)are idiopathic chronic diseases of the gastrointestinal tract well known to be associated with both genetic and environmental risk factors.Permissive genotypes may manifest into clinical phenotypes under certain environmental influences and these may be best studied from migratory studies.Exploring differences between first and second generation migrants may further highlight the contribution of environmental factors towards the development of IBD.There are few opportunities that have been offered so far.We aim to review the available migration studies on IBD,evaluate the known environmental factors associated with IBD,and explore modern migration patterns to identify new opportunities and candidate migrant groups in IBD migration research.

Temporal trends in inflammatory bowel disease publications over a 19-years period

AIM: To determine whether temporal changes occurred in the pediatric vs adult inflammatory bowel disease(IBD), both in terms of number and type of yearly published articles.METHODS:We aimed to evaluate all Pub Med-registered articles related to the field of IBD from January1,1993 and until December 31,2011.We searched for articles using the key words"inflammatory bowel disease"or"Crohn’s disease"or"ulcerative colitis"or"undetermined colitis",using the age filters of"child"or"adult".We repeated the search according to the total number per year of articles per type of article,for each year of the specified period.We studied randomized controlled trials,clinical trials,case reports,meta-analyses,letters to the editor,reviews,systematic reviews,practice guidelines,and editorials.RESULTS:We identified 44645 articles over the 19year-period.There were 8687 pediatric-tagged articles vs 19750 adult-tagged articles.Thus 16208 articles were unaccounted and not assigned a"pediatric"or"adult"tag by Pub Med.There was an approximately3-fold significant increase in all articles recorded both in pediatric and adult articles.This significant increase was true for nearly every category of article but the number of clinical trials,meta-analysis,and randomized controlled trials increased proportionally more than the number of"lower quality"articles such as editorials or letters to the editor.Very few guidelines were published every year.CONCLUSION:There is a yearly linear increase in publications related to IBD.Relatively,there are more and more clinical trials and higher quality articles.

“肠疡宁”灌肠治疗溃疡性结肠炎51例临床观察

本文报道用中药“肠疡宁”保留灌肠治疗经纤维结肠镜确诊为溃疡性结肠炎患者51例,与锡类散对照组30例对比.结果表明,治疗组总有效率为96.1%,无效率3.9%;对照组总有效率36.7%,无效率63.8%,经统计学处理P<0.001,二者有显著差异.

加味生脉散结合西药治疗慢性心力衰竭的临床观察

生脉散中加入生龙骨、生牡电蛎基本方,中西医结合治疗慢性心力衰竭18例,并与西药对照组20例进行临床观察。治疗组临床心功能改善总有效率88.9％,核素心功能检测和运动负荷试验结果示SV、EF、ER和RCO均有明显提高,和西药对照组比较差异显著(P<0.05)。

复发性口腔溃疡与口唇微循环

本文将281例飞行人员分为两组:正常164例,易患复发性口腔溃疡117例。分别对其口唇微循环21项指标进行观测。其结果:除管径及管拌长有显著或非常显著差异外（P<0.05、0.01）,在微血管形态、血流速度以及血管排列、缺血区、渗出、出血诸指标方面也有显著或非常显著性差异（P<0.05、0.005）。提示口唇微循环障碍可能是导致复发性口腔溃疡的原因之一。

复发性口腔溃疡与口唇微循环

将２８１例飞行人员分为二组：正常１６４例，易患复发性口腔溃疡１１７例。分别对其口唇微循环２０项指标进行观测。其结果：除管径及管袢长有显著或非常显著差异外（Ｐ＜０．０５、０．０１），在微血管形态、血流速度以及血管排列、缺血区、渗出、出血诸指标方面也有显著或非常显著性差异（Ｐ＜０．０５、０．００５）。提示口唇微循环障碍可能是导致复发性口腔溃疡的原因之一。

蜈蚣咽喉部溃疡病的研究

广西蜈蚣常发生以咽喉局部成弥漫性炎症、溃疡及大量干酪样物沉着于咽喉部为特征的咽喉部溃疡。表现为口腔不能启闭、分泌物增多、不能采食吞咽,精神萎颓,逐渐消瘦衰竭致死,发病原因未见报道。对34条自然发病死亡的蜈蚣经病理剖检、细菌学检查,并与标准菌株(10104-7)作了一系列的对比试验,认定为铜绿色假单胞菌(Pseudomos aeruginosa)为蜈蚣咽喉部溃疡病病原菌。对该病原菌进行了药物预防及治疗试验,结果表明,15种药物敏感试验中,氯霉素、复方新诺明、丁胺卡那霉素等3种药物最为敏感,并将其中两种药物作治疗对比试验,结果氯霉素治愈率最为理想,田间扩大治疗试验的结果与实验室治疗结果差异不大。另外选用高锰酸钾溶液作为蜈蚣的体表及房舍用具的消毒剂,对预防蜈蚣咽喉部溃疡病有较好的效果。