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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

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： Adult Celiac disease Adenocarcinoma Lymphoma T cell enteropathy

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： Ulcer Stenosis Intestinal diseases Small intestine Crohn's disease

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 whipplei Small intestinalmalabsorption Abdominal lymphadenopathy Periodicacid-Schiff staining Whipple's disease

Intraductal papillary mucinous neoplasms and other pancreatic cystic lesions

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World Journal of Gastroenterology 2008年第19期14卷 2977-2979页

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

Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance cholangio pancreatography (MRCP) and computer tomography (CT) scanning. During the past 2 decades, better imaging of these cystic lesions has resulted in definition of different types, including pancreatic intraductal papillary mucinous neoplasms (IPMN). While IPMN represent only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. Moreover, IPMN have a much better outcome and prognosis compared to pancreatic ductal adenocarcinomas. Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer.

关键词： Pancreatic cancer Pancreatic intraductal papillary mucinous neoplasms Mucinous cystic neoplasm of pancreas Serous cystadenoma Pancreatic cysticlesions

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： Natural history Crohn's disease Age-dependent phenotypes Clinical behavior Granulomatous inflammation