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Surveillance for colitis-associated colon neoplasia

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World Journal of Gastroenterology 2010年第37期16卷 4646-4651页

作者： hugh James freeman Department of Medicine University of British Columbia

The risk of developing colon cancer is increased in colitis patients, particularly if the disease is extensive and its duration long-standing. Endoscopic guidelines have been developed with the goal of detecting early neoplastic changes prior to development of advanced malignancy. Unfortunately, the natural history of this superimposed neoplastic process in colitis appears to be very heterogeneous and poorly understood. Moreover, there are numerous confounding variables in colitis patients that limit accurate assessment of the surveillance effectiveness of colonoscopy and multi-site biopsy protocols. Although the clinical challenge posed to even the most experienced clinicians remains significant, evolving methods of endoscopic imaging may facilitate better evaluation of this highly select group of patients.

关键词： Ulcerative colitis Crohn’s disease Colon cancer Surveillance colonoscopy Colon biopsies

Multifocal stenosing ulceration of the small intestine

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World Journal of Gastroenterology 2009年第39期15卷 4883-4885页

作者： hugh James freeman Department of Medicine University of British ColumbiaUBC Hospital

Several reports have described an apparently uncommon clinicopathological disorder that is characterized by multifocal stenosing small-intestinal *** to Crohn's disease,the ulcers are not transmural and typically remain shallow,and involve only the mucosa and *** disorder seems to be localized in the jejunum and proximal ileum only,and not the distal ileum or *** nonspecif ic inflammatory changes are present without giant cells or other typical features of granulomatous *** patients present clinically with recurrent obstructive events that usually respond to steroids,surgical resection,or *** the development of newer imaging modalities to visualize the small-intestinal mucosa,such as double-balloon enteroscopy,improved understanding of the long-term natural history of this apparently distinctive disorder should emerge.

关键词：溃疡小肠狭窄临床病理典型特征非特异性手术切除肠黏膜

Malignancy in adult celiac disease

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World Journal of Gastroenterology 2009年第13期15卷 1581-1583页

作者： hugh James freeman Department of Medicine (Gastroen-terology) University of British Columbia Hospital

Prior studies have suggested that the incidence of some neoplastic disorders,particularly malignant lymphoma and small intestinal adenocarcinoma,are increased in celiac *** studies from the United Kingdom have also suggested a link between celiac disease and esophageal carcinoma,although this has not been confi rmed in North *** risk of other gastrointestinal cancers seems to be *** cancer does not appear to be detected more frequently,although direct endoscopic visualization of the upper gastrointestinal tract is now very common in patients with celiac *** cancer also appears to be limited in celiac disease,even in patients first diagnosed with celiac disease late in *** has led to the hypothesis that untreated celiac disease may be protective,possibly owing to impaired absorption of fat or fat-soluble agents,including hydrocarbons and putative co-carcinogens implicated in the pathogenesis of colon cancer,which may be poorly absorbed and rapidly excreted.

关键词：腹腔疾病腺癌淋巴瘤细胞肠病

Risk factors in familial forms of celiac disease

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World Journal of Gastroenterology 2010年第15期16卷 1828-1831页

作者： hugh James freeman Department of Medicine University of British Columbia Hospital

Celiac disease has been reported in up to 2% of some European populations. A similar risk has been identified in the America and Australia where immigration of Eu-ropeans has occurred. Moreover, an increasing number of celiac disease patients are being identified in many Asian countries, including China and India. Finally, celiac disease has also been detected in Asian immigrants and their descendants to other countries, such as Canada. Within these so-called "general" celiac populations, however, there are specific high risk groups that have an even higher prevalence of celiac disease. Indeed, the single most important risk factor for celiac disease is having a first-degree relative with already-defined celiac disease, particularly a sibling. A rate up to 20% or more has been noted. Risk is even greater if a specific family has 2 siblings affected, particularly if a male carries the human leukocyte antigen-DQ2. Both structural changes in the small bowel architecture occur along with func-tional changes in permeability, even in asymptomatic first-degree relatives. Even if celiac disease is not evident, the risk of other autoimmune disorders seems significantly increased in first-degree relatives as well as intestinal lymphoma. Identification of celiac disease is important since recent long-term studies have shown that the mortality of celiac disease is increased, if it is unrecognized and untreated.

关键词： Celiac disease Screening Risk factors Fa-milial disease Human leukocyte antigen-DQ2 Genome-wide association studies Genomewide linkage studies

Reproductive changes associated with celiac disease

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World Journal of Gastroenterology 2010年第46期16卷 5810-5814页

作者： hugh James freeman Department of Medicine (Gastroenterology) University of British Columbia Hospital

Celiac disease is a mucosal disorder of the small intestine that may be triggered by dietary exposure to gluten in genetically-susceptible *** disorder is often associated with diarrhea,malabsorption and weight loss along with other extra-intestinal *** changes have been described,including impaired fertility and adverse pregnancy outcomes possibly related to immune-mediated mechanisms or nutrient *** possible pathogenetic factors that may alter placental function include maternal celiac disease autoantibodies binding to placental transglutaminase,and genetic mutations that may facilitate microthrombus *** noting activation during pregnancy or the puerperium may be important,and suggest that celiac disease may also be hypothetically precipitated by maternal exposure to one or more fetal antigens.

关键词： Celiac disease Infertility Pregnancy Post-partum celiac disease Fetal outcome

Mesenteric lymph node cavitation syndrome

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World Journal of Gastroenterology 2010年第24期16卷 2991-2993页

作者： hugh James freeman Department of Medicine (Gastroenter-ology) University of British Columbia Hospital

The mesenteric lymph node cavitation syndrome consists of central necrosis of mesenteric lymph nodes and may occur with either celiac disease or a sprue-like intestinal disease that fails to respond to a gluten-free diet. Splenic hypofunction may also be present. The cause is not known but its development during the clinical course of celiac disease is usually indicative of a poor prognosis for the intestinal disorder, a potential for signif icant compli-cations including sepsis and malignancy, particularly T-cell lymphoma, and signif icant mortality. Modern abdominal imaging modalities may permit earlier detection in celiac disease so that earlier diagnosis and improved under-standing of its pathogenesis may result.

关键词： Mesenteric lymph node Celiac disease Yersinia infection Tuberculosis Kikuchi disease Hyposplenism Lymphoma

Tropheryma whipplei infection

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World Journal of Gastroenterology 2009年第17期15卷 2078-2080页

作者： hugh James freeman Department of Medicine (Gastroen-terology) University of British Columbia Vancouver V6T 1W5 Canada

Whipple's disease was initially described in 1907. Over the next century, the clinical and pathological features of this disorder have been better appreciated. Most often, weight loss, diarrhea, abdominal and joint pain occur. Occasionally, other sites of involvement have been documented, including isolated neurological disease, changes in the eyes and culture-negative endocarditis. In the past decade, the responsible organism Tropheryma whipplei has been cultivated, its genome sequenced and its antibiotic susceptibility defined. Although rare, it is a systemic infection that may mimic a wide spectrum of clinical disorders and may have a fatal outcome. If recognized, prolonged antibiotic therapy may be a very successful form of treatment.

关键词： Tropheryma 系统性感染 Whipple氏病神经系统疾病抗生素治疗临床疾病病理特征体重减轻

Colitis associated with biological agents

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World Journal of Gastroenterology 2012年第16期18卷 1871-1874页

作者： hugh James freeman Division of Gastroenterology Department of MedicineUniversity of British Columbia HospitalVancouverBCV6T 1W5Canada

In the past,there has been considerable focus on a host of drugs and chemicals that may produce colonic ***,a variety of new biological monoclonal antibody agents,usually administered by infusion,have appeared in the clinical realm over the last decade or so to treat different chronic inflammatory or malignant *** some of these agents,adverse effects have been documented,including apparently new forms of immune-mediated inflammatory bowel *** some,only limited symptoms have been recorded,but in others,severe colitis with serious complications,such as bowel perforation has been *** others,adverse effects may have a direct vascular or ischemic basis,while other intestinal effects may be related to a superimposed *** new onset cases of ulcerative colitis or Crohn's disease may also be attributed to the same agents used to treat these diseases,or be responsible for disease *** and well documented side effects have been observed with ipilimumab,a humanized monoclonal antibody developed to reduce and overcome cytotoxic T-lymphocyte antigen 4,a key negative feedback regulator of the T-cell anti-tumor *** agent has frequently been used in the treatment of different malignancies,notably,malignant *** effects with this agent occur in up to 40% and these are believed to be largely *** of these is a form of enterocolitis that may be severe,and occa-sionally,*** agents include rituximab(an antiCD20 monoclonal antibody),bevacizumab(a monoclonal antibody against the vascular endothelial growth factor) and anti-tumor necrosis factor agents,including infliximab,adalimumab and etanercept.

关键词：溃疡性结肠炎生物制剂细胞毒性T淋巴细胞血管内皮生长因子单克隆抗体抗体药物恶性黑色素瘤肿瘤坏死因子

Long-term natural history of Crohn’s disease

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World Journal of Gastroenterology 2009年第11期15卷 1315-1318页

作者： hugh James freeman Department of Medicine (Gastroen-terology) University of British Columbia Vancouver V6T 1W5 Canada

Crohn’s disease is a chronic inflammatory granulomatous process that usually involves different sites in the intestinal tract. Genetic and environmental factors are thought to play a role in its etiology and pathogenesis. The disorder has a heterogeneous clinical expression and data from tertiary care settings have documented its female predominance, occasional familial nature, and high rate of stricture formation and penetrating disease. It may appear from early childhood to late adulthood, although over 80% are currently diagnosed before age 40 years, usually with terminal ileal and colonic involvement. Several studies have now shown differences in phenotypic clinical expression depending on the initial age at diagnosis, with pediatric-onset disease being more severe and more extensive with more involvement of the upper gastrointestinal tract compared to adult-onset disease. In addition, long- term studies from these tertiary care settings have documented that the disorder may evolve with time into a more complex disease with stricture formation and penetrating disease complications (i.e. fistula and abscess). Although prolonged remission with no evidence of inflammatory disease may occur, discrete periods of symptomatic and active granulomatous inflammatory disease may re-appear over many decades. Long-term studies on the natural history have also suggested that discrete events (or agents) may precipitate this granulomatous inflammatory process.

关键词：克罗恩病慢性炎性肉芽肿成人疾病炎症性疾病发病机制临床表现初步诊断环境因素