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Do we really understand what the immunological disturbances in inflammatory bowel disease mean?

World Journal of Gastroenterology 2009年第5期15卷 521-525页

作者： epameinondas v tsianos Konstantinos Katsanos 1st Department of Internal Medicine and Hepato-Gastroenterology Unit Medical School University of Ioannina Ioannina 45110 Greece

The gastrointestinal tract uses a system of tolerance and controlled inflammation to limit the response to dietary or bacteria-derived antigens in the gut. When this complex system breaks down, either by a chemi- cal or pathogenic insult in a genetically predisposed individual the resulting immune response may lead to inflammatory bowel disease. Although the aetio- pathogenesis of inflammatory bowel disease remains unsolved current evidence indicates that defective T-cell apoptosis and impairment of intestinal epithelial barrier function play important roles. In inflammatory bowel disease, it has been reported that activation of macrophages seems to be as important as increased production of the macrophage-derived cytokines such as TNF-α, IL-1 and IL-6. The triggering factor for this cascade is still to be elucidated as to whether it rep- resents an auto-antigen or a hetero-antigen. It has been also demonstrated that a serologic anti-microbial response exists. This response includes antibodies against saccharomyces cerevisiae （ASCA）, E. coli outer membrane porin C （Omp-C）, flagelin （cBirl） and pseu- domonas aeroginosa （I2）. Host response to microbial pathogens includes self-defense mechanisms including defensins, pattern recognition receptors and Toll-like receptors. Neuroimmunomodulation in inflammatory bowel disease （IBD） is another interesting approach with implications on the influence of brain-gut axis on intestinal inflammation and its perpetuation. It isprobable that inflammatory bowel disease represents a heterogenic group of diseases that share similar mechanisms of tissue damage but have different ini- tiating events and immunoregulatory abnormalities. A better understanding of all these events will hope- fully provide new insights into the mechanisms of epithelial responses to microorganisms and ideas for therapies.

关键词： Inflammatory bowel disease Immunologicaldisturbances Serological markers Pathogenesis

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Role of endoscopic retrograde cholangiopancreatography in pancreatic diseases

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World Journal of Gastroenterology 2010年第38期16卷 4755-4761页

作者： Dimitrios K Christodoulou epameinondas v tsianos 1st Division of Internal Medicine and Hepato-Gastroenterology Unit Medical School of Ioannina-GreeceUniversity Campus

Over the last 15 years,endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to one that is primarily used to provide therapy. This development occurred f irst for biliary disorders and subsequently to a lesser extent for pancreatic diseases. Computed tomography, magnetic resonance imaging,magnetic resonance cholangiopancreatography and endoscopic ultrasonography suggest a diagnosis in the majority of patients with pancreatic diseases today and can help physicians and patients avoid unnecessary ERCP. However, a selected number of patients with pancreatic diseases may benef it from pancreatic endotherapy and avoid complex surgery and chronic use of medications. Pancreatic sphincterotomy, pancreatic stenting and pancreatic cyst drainage are some of the most effective and challenging endoscopic pancreatic interventions and should be performed with caution by expert therapeutic *** has been a paucity of randomized studies investigating endoscopic techniques in comparison with surgery and medical therapy for the treatment of most benign and malignant pancreatic disorders due to the limited number of patients and the expertise required to attempt these procedures.

关键词： Endoscopic retrograde cholangiopancreatography Pancreas Pancreatic disease Pancreatic endotherapy Therapeutic endoscopy

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Terlipressin improves pulmonary pressures in cirrhotic patients with pulmonary hypertension and variceal bleeding or hepatorenal syndrome

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Hepatobiliary & Pancreatic Diseases International 2012年第4期11卷 434-437页

作者： George N Kalambokis Konstantinos Pappas epameinondas v tsianos 1st Division of Internal Medicine and Hepato Gastroenterology UnitUniversity Hospital of IoanninaIoannina 45500Greece Department of Cardiology University Hospital of IoanninaIoannina 45500Greece

Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We investigated the pulmonary and systemic hemodynamic effects of the first terlipressin dose(2 mg) in 7 cirrhotic patients with PH presenting with variceal bleeding(n=4) or hepatorenal syndrome(n=3).Terlipressin decreased pulmonary vascular resistance(158.8±8.9 vs 186.5±13.9 dynes sec cm-5 ;P=0.003) together with an increase in systemic vascular resistance(2143± 126 vs 1643±126 dynes sec cm-5 ;Pvasoconstrictor treatment of choice when patients present with variceal bleeding or HRS.

关键词： terlipressin pulmonary hypertension cirrhosis variceal bleeding hepatorenal syndrome

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Haemodynamic and renal effects of tadalafil in patients with cirrhosis

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World Journal of Gastroenterology 2010年第39期16卷 5009-5010页

作者： Georgios N Kalambokis Paraskevi Kosta Konstantinos Pappas epameinondas v tsianos 1st Division of Internal Medicine and Hepato-Gastroenterology Unit University HospitalMedical School of Ioannina Department of Radiology University Hospital Department of Cardiology University Hospital

A recent report introduced the phosphodiesterase-5 inhibition by vardenafil as a novel treatment of portal hypertension in patients with *** the herein presented"letter to the editor",the administration of tadalafil did not influence portal haemodynamics but impaired systemic haemodynamics in patients with *** observations concur with the results of a report in a previous issue of World Journal of Gastroenterology(October 2008).Moreover,tadalafil adversely affected renal function in patients with decompensated liver disease.

关键词： Tadalafil Portal hypertension Cirrhosis Ascites Phosphodiesterase-5 inhibition

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Rifaximin for the prevention of spontaneous bacterial peritonitis

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World Journal of Gastroenterology 2012年第14期18卷 1700-1702页

作者： Georgios N Kalambokis Athanasia Mouzaki Maria Rodi epameinondas v tsianos The First Division of Internal Medicine and Hepato-Gastroenterology Unit Medical School of Ioannina45110 IoanninaGreece Division of Hematology Department of Internal MedicineMedical School26504 PatrasGreece

According to a review article by Biecker et al published in a previous issue of World Journal of Gastroenterology in March 2011,intestinal decontamination with norfloxacin remains the mainstay of primary prophylaxis of spontaneous bacterial peritonitis(SBP) at the expense of development of quinolone-resistant bacteria after long-term *** our research,the administration of a 4-wk regimen with rifaximin 1200 mg/d reduced significantly the ascitic neutrophil count in cirrhotic patients with sterile ascites in line with a significant decrease in plasma endotoxin *** observations concur with recent findings,showing a significantly reduced 5-year probability of SBP in cirrhotic patients taking rifaximin.

关键词： Rifaximin Cirrhosis Ascites Spontaneous bacterial peritonitis

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Pseudopolyps in inflammatory bowel diseases: Have we learned enough?

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World Journal of Gastroenterology 2017年第9期23卷 1541-1551页

作者： Dimitrios S Politis Konstantinos H Katsanos epameinondas v tsianos Dimitrios K Christodoulou Department of Gastroenterology University Hospital of IoanninaFaculty of MedicineSchool of Health SciencesUniversity of Ioannina45110 IoanninaGreece

Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasiaassociated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.

关键词： Pseudopolyps Inflammatory polyps Post-inflammatory polyps Giant pseudopolyps Ulcerative colitis Inflammatory bowel disease Crohn’s disease Classification Dysplasia-associated mass or lesion

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Role of genetics in the diagnosis and prognosis of Crohn's disease

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World Journal of Gastroenterology 2011年第48期17卷 5246-5259页

作者： epameinondas v tsianos Konstantinos H Katantions vasileios E tsianos 1st Division of Internal Medicine and Hepato-Gas-troenterology Unit Department of Medicine Medical SchoolUniversity of Ioannina Leoforos Stavrou Niarxou PO Box 118645110 Ioannina Greece

Considering the epidemiological, genetic and immunological data, we can conclude that the inflammatory bowel diseases are heterogeneous disorders of multifactorial etiology in which hereditability and environment interact to produce the disease. It is probable that patients have a genetic predisposition for the development of the disease coupled with disturbances in immunoregulation. Several genes have so far been related to the diagnosis of Crohn's disease. These genes are related to innate pattern recognition receptors, to epithelial barrier homeostasis and maintenance of epithelial barrier integrity, to autophagy and to lymphocyte differentiation. So far, the strongest and most replicated associations with Crohn's disease have been demonstrated with NOD2 , IL23R and ATG16L1 genes. Many genes have so far been implicated in the prognosis of Crohn's disease and many attempts have been made for classification of genetic profiles in Crohn's ***15 seems to be not only a susceptibility gene, but also a disease-modifier gene for Crohn's disease. Enriching our understanding of Crohn's disease genetics is of value, but when combining genetic data with functional data the outcome could be of major importance to clinicians.

关键词： Crohn's disease Genetics Polymorphism Diagnosis Prognosis Genome-wide scan Genetic consortium

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Role of genetics in the diagnosis and prognosis of Crohn's disease

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World Journal of Gastroenterology 2012年第2期18卷 105-118页

作者： epameinondas v tsianos Konstantinos H Katsanos vasileios E tsianos 1st Division of Internal Medicine and Hepato-Gastroenterology Unit Department of MedicineMedical SchoolUniversity of IoanninaLeoforos Stavrou NiarxouPO Box 118645110 IoanninaGreece

Considering epidemiological,genetic and immunological data,we can conclude that the inflammatory bowel diseases are heterogeneous disorders of multifactorial etiology in which hereditability and environment interact to produce the *** is probable that patients have a genetic predisposition for the development of the disease coupled with disturbances in *** genes have been so far related to the diagnosis of Crohn's *** genes are related to innate pattern recognition receptors,to epithelial barrier homeostasis and maintenance of epithelial barrier integrity,to autophagy and to lymphocyte *** far,the most strong and replicated associations with Crohn's disease have been done with NOD2,IL23R and ATG16L1 *** genes have so far been implicated in prognosis of Crohn's disease and many attempts have been made to classify genetic profiles in Crohn's ***15 seems not only a susceptibility gene,but also a disease-modifier gene for Crohn's *** our understanding on Crohn's disease genetics is important but when combining genetic data with functional data the outcome could be of major importance to clinicians.

关键词： Crohn's Genetics Polymorphism Diagnosis Prognosis Genome wide scan Genetic consortium

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Steatosis and steatohepatitis in postmortem material from Northwestern Greece

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World Journal of Gastroenterology 2010年第31期16卷 3944-3949页

作者： Christos D Zois Gerasimos H Baltayiannis Anna Bekiari Anna Goussia Peter Karayiannis Michalis Doukas Demetrios Demopoulos Antigoni Mitsellou Theodoros vougiouklakis vasiliki Mitsi epameinondas v tsianos 1st Department of Internal Medicine and Hepato-Gastroenterology Unit Medical SchoolUniversity of Ioannina Laboratory of Pathology Medical SchoolUniversity Hospital of Ioannina Department of Medicine Hepatology Sec-tionDivision of MedicineImperial College LondonVariety Wing Floor DSt.Mary's Campus Norfolk Place London W2 1PGLondonUnited Kingdom Department of Forensic Medicine and Toxicology Medical SchoolUniversity of Ioannina

AIM: To determine the prevalence of steatosis and steatohepatitis in a series of autopsies in Northwestern Greece. METHODS: Liver biopsy material from a total of 600 autopsies performed over a period of 2 years (2006-2008) to def ine the cause of death was subjected to histological examination. Patient demographic data were also collected. Tissue sections were stained with different dyes for the evaluation of liver architecture, degree of fibrosis and other pathological conditions when necessary. RESULTS: Satisfactory tissue samples for histological evaluation were available in 498 cases (341 male, 157 female) with a mean age of 64.51 ± 17.78 years. In total, 144 (28.9%) had normal liver histology, 156 (31.3%) had evidence of steatosis, and 198 (39.8%) had typical histological findings of steatohepatitis. The most common causes of death were ischemic heart disease with or without myocardial infarction (43.4%), and traffic accidents (13.4%). CONCLUSION: A high prevalence of steatosis and steatohepatitis was detected in postmortem biopsies from Northwestern Greece. Since both diseases can have serious clinical consequences, they should be considered as an important threat to the health of the general population in Greece.

关键词： Fatty liver Non-alcoholic liver disease Steatosis Steatohepatitis Autopsy

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Association of liver cirrhosis related IgA nephropathy with portal hypertension

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World Journal of Gastroenterology 2007年第43期13卷 5783-5786页

作者： Georgios Kalambokis Leonidas Christou Dimitrios Stefanou Evdokia Arkoumani epameinondas v tsianos Division of Internal Medicine and Hepato-gastroenterology Unit University Hospital Ioannina Greece Department of Pathology University Hospital Ioannina Greece

A high incidence of IgA nephropathy has been reported in patients with liver cirrhosis, though, clinically evident nephrotic syndrome is very uncommon. Impaired hepatic clearance of circulating IgA immune complexes and subsequent deposition in renal glomeruli has been considered principally in the pathogenesis of liver cirrhosis associated IgA nephropathy. Here we report on a patient with cryptogenic liver cirrhosis and splenic vein thrombosis, who presented with nephrotic syndrome. Renal biopsy showed findings consistent with IgA nephropathy. Lower endoscopy showed features of portal hypertensive colopathy. Following initiation of propranolol and anticoagulant treatment to reduce portal pressure, a gradual decrease of proteinuria and hematuria to normal range was noted. The potential pathogenetic role of portal hypertension in the development of IgA nephropathy in cirrhotic patients is discussed.

关键词： IgA nephropathy Nephrotic syndrome Portalhypertension Liver cirrhosis

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