Correlation between Helicobacter pylori-associated gastric diseases and colorectal neoplasia

AIM: To explore the correlation between Helicobacter pylori(H. pylori)-associated gastric diseases and colorectal neoplasia.METHODS: Patients included in this study underwent a colonoscopy and esophago-gastro-duodenoscopy(EGD) along with histopathological measurement between March 2012 and March 2015 at Qi-Lu Hospital of Shandong University, who also had results of H. pylori detection. A total of 233 cases were selected. Demographic data, H. pylori infection status(including results of rapid urease tests and gastric mucosa pathological examinations) and histopathological examination results of gastric and colorectal mucosa were gathered and analyzed. The statistical analysis focused on the prevalence of colorectal neoplasms among patients with various histopathological categories of the stomach. ORs and their 95%CI were calculated to describe the strengths of the associations.RESULTS: The incidence rates of colorectal adenoma without high-grade intraepithelial neoplasia(HGIEN)(OR = 2.400, 95%CI: 0.969-5.941), adenoma with HGIEN(5.333, 1.025-27.758) and adenocarcinoma(1.455, 0.382-5.543) were all higher for patients with H. pylori-associated gastritis than for those in the control group. The incidence rate of colorectal adenoma with HGIEN(3.218, 0.767-13.509) was higher in patients with intestinal metaplasia than in the control group, while the incidence rates of adenoma without HGIEN(0.874, 0.414-1.845) and adenocarcinoma(0.376, 0.096-1.470) were lower in the intestinal metaplasia group than in the control group. The incidence rate of colorectal adenoma without HGIEN(3.111, 1.248-7.753) was significantly higher in the gastric intraepithelial neoplasia group than in the control group, while the rates of adenoma with HGIEN(1.481, 0.138-15.941) and adenocarcinoma(2.020, 0.561-7.272) were higher in the gastric intraepithelial neoplasia group. Incidence rates of colorectal adenoma without HGIEN(1.067, 0.264-4.314), adenoma with HGIEN(2.667, 0.231-30.800) and adenocarcinoma(2.182, 0.450-10.585) were all higher in the gastric adenocarcinoma group than in the control group.CONCLUSION: H. pylori infection as well as H. pylori-associated gastric diseases are risk factors for colorectal neoplasia.

Narrow-band imaging endoscopy with and without magnification in diagnosis of colorectal neoplasia

AIM:To evaluate the diagnostic efficacies of narrowband imaging(NBI) endoscopy with and without high magnification in distinguishing neoplasia from nonneoplasia colorectal lesions.METHODS:A total of 118 patients with 123 colorectal lesions examined by NBI endoscopy in the Zhejiang Provincial People's Hospital from September 2008 to April 2010 were enrolled in this study.These lesions were classified by pit pattern and capillary pattern,and then assessed by histopathology.RESULTS:Ten lesions not meeting the diagnostic criteria were excuded,the overall diagnostic accuracy of NBI endoscopy in distinguishing neoplasia from non-neoplasia colorectal lesions was 91.2%(103/113),and that of NBI endoscopy with and without high magnification was 93.0%(40/43) and 90.0%(63/70),respectively.Both were significantly higher than that of conventional colonoscopy reported in the literature(P < 0.05),but there was no significant difference between the two groups(P > 0.05).CONCLUSION:Besides NBI magnifying endoscopy,NBI endoscopy without magnification may also be used to distinguish neoplasia from non-neoplasia colorectal lesions.

Patients with inflammatory bowel disease and post-inflammatory polyps have an increased risk of colorectal neoplasia:A metaanalysis

BACKGROUND Longstanding intestinal inflammation increases the risk of colorectal neoplasia in patients with inflammatory bowel disease(IBD).Accurately predicting the risk of colorectal neoplasia in the early stage is still challenging.Therefore,identifying visible warning markers of colorectal neoplasia in IBD patients is the focus of the current research.Post-inflammatory polyps(PIPs)are visible markers of severe inflammation under endoscopy.To date,there is controversy regarding the necessity of strengthened surveillance strategies for IBD patients with PIPs.AIM To determine whether IBD patients with PIPs carryan increased risk of colorectal neoplasia.METHODS Researchers searched the following databases up to July 31,2021:MEDLINE(PubMed),MEDLINE(Ovid),EMBASE,Cochrane Library,China National Knowledge Infrastructure,Wan-Fang Data,China Science and Technology Journal Database and Chinese BioMedical Literature Database.Cohort and casecontrol studies that compared the risk of colorectal neoplasia between IBD patients with or without PIPs and published in English or Chinese were included.Methodological quality was assessed using the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool.The outcomes of interest were the rates of various grades of colorectal neoplasia.The pooled risk ratio(RR)and 95%confidence interval(95%CI)were calculated using the random-effects model.Begg’s test and Egger’s test were used to calculate the publication bias.Sensitivity and subgroup analyses were performed to verify the robustness of the results.The Grading of Recommendations,Assessment,Development and Evaluation approach was used to assess the overall quality of evidence supporting the outcomes of interest.RESULTS Nine studies involving 5424 IBD patients(1944 with PIPs vs 3480 without PIPs)were included.The overall bias in each included study ranged from moderate to serious.Compared with nonconcurrent PIPs,patients with PIPs had a higher risk of colorectal neoplasia(RR=1.74,95%CI:1.35-2.24,P<0.001,I2=81.4%;aHR=1.31,95%CI:1.01-1.70,P=0.04,I2=26.2%;aOR=2.62,95%CI:1.77-3.88,P<0.001,I2=0%),advanced colorectal neoplasia(RR=2.07,95%CI:1.49-2.87,P<0.001,I2=77.4%;aHR=1.63,95%CI:1.05-2.53,P=0.03,I2=10.1%)and colorectal cancer(RR=1.93,95%CI:1.32-2.82,P=0.001,I2=83.0%).Publication bias was not observed in Begg’s test or Egger’s test.Sensitivity and subgroup analyses showed that the results are robust.The overall quality of evidence was assessed as moderate to low.CONCLUSION IBD patients with PIPs may have an increased incidence of colorectal neoplasia.

Increased risk of colorectal neoplasia in inflammatory bowel disease patients with post-inflammatory polyps:A systematic review and meta-analysis

BACKGROUND Inflammatory bowel disease(IBD)patients with post-inflammatory polyps(PIPs)may carry an increased risk of colorectal neoplasia(CRN)including dysplasia and cancer.Current guidelines recommend active colonoscopy follow-up for these patients.However,the evidence for guidelines is still poor.In addition,some recent high-quality reports present a different view,which challenges the current guidelines.We hypothesize that IBD patients with PIPs are at increased risk of CRN.AIM To evaluate the risk of CRN in IBD patients with and without PIPs.METHODS A systematic search of PubMed,Embase,Cochrane Library,and Web of Science was performed to identify studies that compared the risk of CRN in IBD patients with and without PIPs.In addition,we screened the reference lists and citation indices of the included studies.Quality assessment was performed using the Newcastle–Ottawa Scale.Pooled odds ratio(OR)was calculated using the random-effects model to explore the final pooled effect size of the included studies and determine whether PIPs increase the risk of CRN.Sensitivity analysis,subgroup analysis,and assessment of publication bias were performed to examine the sources of heterogeneity.RESULTS Twelve studies with 5819 IBD patients,including 1281(22.01%)with PIPs,were considered eligible for this meta-analysis.We found that IBD patients with PIPs were at an increased risk of CRN as compared to those without PIPs[OR 2.01;95%confidence interval(CI):1.43–2.83].The results were similar when colorectal cancer was used as the study endpoint(OR 2.57;95%CI:1.69–3.91).Furthermore,the risk of CRN was still increased(OR 1.80;95%CI:1.12–2.91)when restricted to ulcerative colitis patients.Heterogeneity was high among the included studies(I^(2)=75%).Subgroup analysis revealed that the high heterogeneity was due to the study design.Sensitivity analysis showed that the main statistical outcomes did not essentially change after excluding any one of the included studies.No significant publication bias was found in the funnel plots.CONCLUSION IBD patients with PIPs have an increased risk of CRN as compared with those without PIPs,which support the current guidelines.However,a high-quality randomized controlled trial is warranted.

Gene mutations in stool from gastric and colorectal neoplasia patients by next-generation sequencing

AIM To study cancer hotspot mutations by next-generation sequencing(NGS) in stool DNA from patients with different gastrointestinal tract(GIT) neoplasms. METHODS Stool samples were collected from 87 Finnish patients diagnosed with various gastric and colorectal neoplasms, including benign tumors, and from 14 healthy controls. DNA was isolated from stools by usingthe PSP~? Spin Stool DNA Plus Kit. For each sample, 20 ng of DNA was used to construct sequencing libraries using the Ion AmpliS eq Cancer Hotspot Panel v2 or Ion AmpliS eq Colon and Lung Cancer panel v2. Sequencing was performed on Ion PGM. Torrent Suite Software v.5.2.2 was used for variant calling and data analysis.RESULTS NGS was successful in assaying 72 GIT samples and 13 healthy controls, with success rates of the assay being78% for stomach neoplasia and 87% for colorectal tumors. In stool specimens from patients with gastric neoplasia, five hotspot mutations were found in APC,CDKN2 A and EGFR genes, in addition to seven novel mutations. From colorectal patients, 20 mutations were detected in AKT1, APC, ERBB2, FBXW7, KIT, KRAS,NRAS, SMARCB1, SMO, STK11 and TP53. Healthy controls did not exhibit any hotspot mutations, except for two novel ones. APC and TP53 were the most frequently mutated genes in colorectal neoplasms, with five mutations, followed by KRAS with two mutations.APC was the most commonly mutated gene in stools of patients with premalignant/benign GIT lesions.CONCLUSION Our results show that in addition to colorectal neoplasms,mutations can also be assayed from stool specimens of patients with gastric neoplasms.

Comparison of virtual colonoscopy and colonoscopy in diagnosis of colorectal neoplasia

The diagnostic value of virtual colonoscopy versus colonoscopy was compared in detection of colorectal neoplasia. Virtual colonoscopy was performed on 29 patients with suspected colorectal diseases, Results were compared with colonoscopy for each case. Virtual colonoscopy was successfully performed on each patient. All patients tolerated virtual colonoscopy well, had no complications. All colorectal malignance were identified both by virtual colonoscopy and colonoscopy. Twenty-five polyps were detected with colonoscopy, whereas only 16 polyps were defined by virtual colonoscopy. Detection rates of polyps greater than 1.0 cm,between 0.5-0.9 cm and less than 0.5 cm in size were 90%,62.5% and 28.6% respectively. Virtual colonoscopy is fast, minimally invasive and well tolerated. This technique is a valuable clinical method in diagnosis of colorectal malignance and polyps larger than 0.5 cm in size.

Care Technologies in Nursing for People with Colorectal Neoplasia: Integrative Review

Objective: Identifying in the literature the care technologies used by nurses for people with colorectal neoplasia on Nietzsche’s conceptual perspective. Method: It consists in an integrative review of the literature held in the database: Latin-American Literature and Caribbean in medical health sciences Literature Analysis and Retrieval System Online, Database in Nursing, US National Library of Medicine, Cumulative Index to Nursing & Allied Health Literature, Scopus Info Site and Web of Science in December 2015. Results: 28 articles were selected to compose the final sample of this review, which were analyzed and categorized in management technology (86.20%), assistance technology (20.68%) and educational technology (10.34%). Studies published in the last five years have predominated (62.06%), in international territory (82.75%) and with evidence level IV (44.82%). Conclusion: Today the growth on the production about this theme has been highlighted, but there is an important discrepancy between the researches with high and low level of scientific evidence, showing the need of more studies about technologies that strengthen the experience of nursing.

Overexpression of p53 predicts colorectal neoplasia risk in patients with inflammatory bowel disease and mucosa changes indefinite for dysplasia

Background and aims:We previously demonstrated a significant colorectal neoplasia risk in inflammatory bowel disease(IBD)patients with mucosal changes indefinite for dysplasia(IND)and the potential diagnostic utility of p53 and cytokeratin 7 immunohistochemistry in IBD-associated neoplasia.The primary aim of this exploratory study was to determine the predictive value of the two markers for neoplasia risk in the IBD-IND population.Methods:We identified 44 eligible cases with IBD and IND in colon biopsy from our pathology database.We semi-quantified the expression of p53 and cytokeratin 7 in the colon biopsies by immunohistochemistry and correlated their expression,demographic information,and clinical features with colorectal neoplasia outcome.Results:The mean age of the cohort was 46.6615.1 years,with 25(56.8%)being male.The median follow-up was 101 months(range:6–247)after IND diagnosis.Among these 44 patients,11(25%)progressed to neoplasia(low-grade dysplasia¼6;high-grade dysplasia¼2;cancer 3)at a median follow-up of 66 months(range:19–145).Univariate analysis demonstrated that age and p53 overexpression were associated with progression to neoplasia.Conclusions:Twenty-five percent of patients with IBD and IND developed colorectal dysplasia or cancer.Overexpression of p53 and age are associated with neoplastic progression.

Risk factors for colorectal neoplasia in patients with underlying inflammatory bowel disease:a multicenter study

Background:This study sought to evaluate the risk factors for the development of colitis-associated neoplasia(CAN)in Chinese patients with inflammatory bowel disease(IBD).Methods:IBD patients who developed CAN between 1999 and 2016 were identified from eight medical centers.In addition to initial pathology evaluation,a CAN diagnosis was confirmed by two expert pathologists.Patients with CAN(n=29)were compared with non-CAN controls(n=87).Matching was performed for gender and IBD type with a ratio of three controls to one subject.Results:Of the 29 patients with CAN,8(27.6%)had colorectal cancer(CRC),20(69.0%)had a final diagnosis of low-grade dysplasia and 1(3.4%)had high-grade dysplasia.Multivariate analysis revealed that an older age at the time of IBD diagnosis and a longer IBD duration were independent risk factors for the development of CAN,with odds ratios of 1.09[95%confidence interval(CI):1.04–1.14,P<0.001]and 1.14(95%CI:1.03–1.27,P=0.013),respectively.Comparison between IBD patients with CRC and those with dysplasia indicated that the former were older at the time of IBD diagnosis(P=0.012)and had longer IBD durations(P=0.019).Conclusions:Older age at the time of IBD diagnosis and longer IBD duration were found to be associated with the development of CAN in IBD patients.

Software for automated classification of probe-based confocal laser endomicroscopy videos of colorectal polyps

AIM:To support probe-based confocal laser endomi-croscopy (pCLE) diagnosis by designing software for the automated classification of colonic polyps. METHODS:Intravenous fluorescein pCLE imaging of colorectal lesions was performed on patients under-going screening and surveillance colonoscopies, followed by polypectomies. All resected specimens were reviewed by a reference gastrointestinal pathologist blinded to pCLE information. Histopathology was used as the criterion standard for the differentiation between neoplastic and non-neoplastic lesions. The pCLE video sequences, recorded for each polyp, were analyzed off-line by 2 expert endoscopists who were blinded to the endoscopic characteristics and histopathology. These pCLE videos, along with their histopathology diagnosis, were used to train the automated classification software which is a content-based image retrieval technique followed by k-nearest neighbor classification. The performance of the off-line diagnosis of pCLE videos established by the 2 expert endoscopists was compared with that of automated pCLE software classification. All evaluations were performed using leave-one-patient- out cross-validation to avoid bias. RESULTS:Colorectal lesions (135) were imaged in 71 patients. Based on histopathology, 93 of these 135 lesions were neoplastic and 42 were non-neoplastic. The study found no statistical significance for the difference between the performance of automated pCLE software classification (accuracy 89.6%, sensitivity 92.5%, specificity 83.3%, using leave-one-patient-out cross-validation) and the performance of the off-line diagnosis of pCLE videos established by the 2 expert endoscopists (accuracy 89.6%, sensitivity 91.4%, specificity 85.7%). There was very low power (< 6%) to detect the observed differences. The 95% confidence intervals for equivalence testing were:-0.073 to 0.073 for accuracy, -0.068 to 0.089 for sensitivity and -0.18 to 0.13 for specificity. The classification software proposed in this study is not a "black box" but an informative tool based on the query by example model that produces, as intermediate results, visually similar annotated videos that are directly interpretable by the endoscopist. CONCLUSION:The proposed software for automated classification of pCLE videos of colonic polyps achieves high performance, comparable to that of off-line diagnosis of pCLE videos established by expert endoscopists.

Vitamin D receptor gene Tru9I polymorphism and risk for incidental sporadic colorectal adenomas

AIM： Recent laboratory and epidemiological studies suggest that vitamin D is a potential agent for colorectal cancer prevention. Its function is partially mediated by the vitamin D receptor （VDR）. The aim of this study was to investigate whether a novel G （allele ‘U’g〉A （allele ‘u’ polymorphism （Tru9I） in the VDR intron 8 region is associated with risk for colorectal adenoma in a colonoscopy-based case-control study. METHODS： Genotyping for a total of 391 subjects was carried out through PCR and restriction fragment length polymorphism. RESULTS： The frequencies of ‘U’ and ‘u’ alleles were 89.3% and 10.7%, respectively. The ‘Uu’ and ‘uu’ genotypes were associated with decreased risk for adenoma （OR, 0.71; 95%CI, 0.40-1.25）. The inverse association was more pronounced for multiple adenomas and adenomas that were larger had moderate or greater dysplasia, or were sessile： the odds ratios （ORs） were, 0.51 （95%CI, 0.21-1.24）, 0.37 （95%CI, 0.11-1.28）, 0.68 （95%CI, 0.33- 1.41）, and 0.36 （95%CI, 0.13-0.97） respectively. In joint/ combined analyses, inverse associations were more obvious among those who had at least one ‘u’ allele and also were younger （OR, 0.60; 95%CI, 0.26-1.37）, women （OR, 0.38; 95%CI, 0.17-0.88）, did not smoke （OR, 0.39; 95%CI, 0.13-1.23）, or took NSAID （OR, 0.38; 95%CI, 0.12-1.25）, but no evidence existed for interactions with calcium or vitamin D intake.CONCLUSION： Our findings suggest that the VDR TrugI polymorphism may be associated with lower risk for colorectal adenoma, particularly in interaction with various risk factors, but not with calcium or vitamin D.

Novel genetic variations of the p53R2 gene in patients with colorectal adenoma and controls

AIM: p53-Inducible ribonucleotide reductase small subunit 2 (p53R2) encodes a 351-amino-acid peptide, which catalyzes conversion of ribonucleoside diphosphates to the corresponding deoxyribonucleotides required for DNA replication and repair. A recent study reported that a point mutation (G/T) in the p53 binding sequence in a colon cancer cell line completely impaired p53R2 protein activity.METHODS: We screened the p53R2 gene coding regions and a regulatory region which contains a p53 binding sequence in 100 patients with colorectal adenoma and 100 control subjects using PCR, cold SSCP, and direct DNA sequencing.RESULTS: Although we did not identify genetic variation in all nine exons, four regulatory-region variants were found,of which three were single nucleotide polymorphisms (SNPs) (nt 1 789 C/G, nt 1 928 A/G, 1 933 T/C), and one was 20 bp insertion which replaced a ATTTT between nt 1 831 and 1 835. Additionally, we determined the frequency of these p53R2 variants in a recently concluded case-control study of incident sporadic colorectal adenomas (163 cases and 210 controls).CONCLUSION: Although more detailed functional characterizations of these polymorphisms remain to be undertaken, these polymorphic sites may be useful for identifying alleles associated with mis-splicing, additional transcript factors and, more generally, in cancer-susceptibility association studies.

Emerging use of artificial intelligence in inflammatory bowel disease

Inflammatory bowel disease(IBD)is a complex,immune-mediated gastrointestinal disorder with ill-defined etiology,multifaceted diagnostic criteria,and unpredictable treatment response.Innovations in IBD diagnostics,including developments in genomic sequencing and molecular analytics,have generated tremendous interest in leveraging these large data platforms into clinically meaningful tools.Artificial intelligence,through machine learning facilitates the interpretation of large arrays of data,and may provide insight to improving IBD outcomes.While potential applications of machine learning models are vast,further research is needed to generate standardized models that can be adapted to target IBD populations.

Does training and experience influence the accuracy of computed tomography colonography interpretation?

AIM: To evaluate the effect of experience on the accuracy rate of computed tomography colonography (CTC) interpretation and patient preferences/satisfaction for CTC and colonoscopy.

IGF2 differentially methylated region hypomethylation in relation to pathological and molecular features of serrated lesions

AIM: To investigate insulin-like growth factor 2 (IGF2) differentially methylated region (DMR)0 hypomethylation in relation to clinicopathological and molecular features in colorectal serrated lesions.