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.

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.

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.

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.

Quality of life after laparoscopic and open colorectal surgery: A systematic review

This study was a systematic review of the available evidence on quality of life in patients after laparoscopic or open colorectal surgery. A systematic review was performed of all randomized clinical trials (RCTs) that compared laparoscopic with open colorectal surgery. Study selection, quality assessment and data extraction were carried out independently by two reviewers. Primary endpoint was quality of life after laparoscopic and open colorectal surgery, as assessed by validated questionnaires. The search resulted in nine RCTs that included 2263 patients. Shortand long-term results of these RCTs were described in 13 articles. Postoperative follow-up ranged from 2 d to 6.7 years. Due to clinical heterogeneity, no meta-analysis could be conducted. Four RCTs did not show any difference in quality of life between laparoscopic or open colorectal surgery. The remaining five studies reported a better quality of life in favor of the laparoscopic group on a few quality of life scales at time points ranging from 1 wk to 2 years after surgery. In conclusion, based on presently available high-level evidence, this systematic review showed no clinically relevant differences in postoperative quality of life between laparoscopic and open colorectal surgery.

Quality of life after surgery of the alimentary tract

In recent decades, patient-reported outcomes have become important in clinical medicine. Nowadays, health-related quality of life (HRQOL) is considered a primary outcome in many clinical trials, and it is often the major criterion for judging treatment success. At the beginning of the 21st century, morbidity and mortality rates after surgery of the alimentary tract have dropped dramatically and they can no longer be considered the only outcome measures to determine the success of a surgical procedure. QOL can yield a definitely more patient-orientated measure of outcome that provides us with a more formal measure of the patient’s judgment and desires, which can influence treatment decisions. Nevertheless, despite a very large number of published papers on HRQOL, there is some skepticism on the value of HRQOL and other patientrelated outcomes. Therefore, this topic highlight aims to assess how QOL after surgery of the alimentary tract is covered in the medical literature. Different reviews have analyzed the topic according to different points of view: benign and malignant disease; curative and palliative treatment; open and minimally invasive surgical approach; traditional and newly introduced surgical procedures. This topic highlight does not aim to cover all the possible diseases or different surgical procedures, but it does describe the different approaches in order to give the reader a broad spectrum of analysis of QOL after surgery. This quick overview could stimulate the reader to form his/her own opinion about how to use this primary outcome measure.

Epidemiologic study of the irritable bowel syndrome in Beijing: stratified randomized study by cluster sampling

OBJECTIVE: To explore the prevalence of irritable bowel syndrome (IBS) in Beijing and its risk factors. METHODS: Phase I: a screening for IBS in Beijing area according to symptoms using both Manning (modified including constipation) and Rome criteria. 2486 subjects were studied by cluster sampling of the inhabitant groups according to a stratified design of urban, suburban and rural areas, and sample size of each area studied was in proportion to the population of the area. Selection of the inhabitant groups was made by simple random sampling. Age of subjects enrolled in the study was 18-70 years. All subjects fulfilling the selection criteria were requested to fill in a questionnaire assisted by trained doctors or medical students during the visit to their families. Phase II: an aliquot of patients who fulfilled at least the Manning criteria were further selected according to their scoring series to undergo detail clinical examination in the hospital including laboratory examination, abdominal ultrasonography, colonoscopy or/and barium enema to exclude organic disease of the colon. Prevalence of IBS of the population was then adjusted by the rate of correct diagnosis during Phase II study. Study using Minnesota Multi-Personality Indices (MMPI) was done in some cases. Probable risk factors were explored by comparing their frequencies among IBS group and non-IBS group using chi 2 and logistic analysis of multifactors. RESULTS: The adjusted point prevalence of IBS in Beijing is 7.26% according to Manning criteria, and is 0.82% according to Rome criteria. There is a higher prevalence rate in city (10.50%) than in rural areas (6.14%) by stratified analysis (P