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Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis:Relationship with colonic metaplasia

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World Journal of Gastroenterology 2008年第34期14卷 5290-5300页

作者： Livia Biancone Emma Calabrese Giampiero Palmieri Carmelina Petruzziello Sara Onali Giuseppe Sigismondo Sica Marta Cossignani Giovanna Condino kiron moy das Francesco Pallone Cattedra di Gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di Anatomia ed Istologia Patologica Università di "Tor Vergata" Cattedra di Gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di Chirurgia Generale Università di "Tor Vergata" Cattedra di Gastroenterologia Dipartimento di Medicina Interna Università di "Tor Vergata" GI Unit Department of Gastroenterology & Hepatology University of Medicine & Dentistry of New Brunswick

AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

关键词：溃疡性结肠炎肠阻塞回盲肠吻合术结肠组织转化

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Pathogenesis and clinical spectrum of primary sclerosing cholangitis

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World Journal of Gastroenterology 2017年第14期23卷 2459-2469页

作者： Neelam G Gidwaney Swati Pawa kiron M das Division of Gastroenterology and Hepatology Rutgers-Robert Wood Johnson Medical School

Primary sclerosing cholangitis(PSC) is a disease of the biliary tract, which has been documented in the literature since 1867. This disease has a strong predilection for affecting men and can be seen in individuals as young as 2 years of age. PSC has a strong associated with inflammatory bowel disease, more commonly with ulcerative colitis, and is also part of the clinical spectrum of Ig G4-related diseases. Smallduct PSC, a variant of PSC, also has an association with inflammatory bowel disease. The exact pathogenesis of PSC is not well understood at present, however, is likely a combination of a genetic predisposition with alteration of the molecular structure of the gut. Abnormal serum liver chemistry and presence of certain autoimmune markers are usually the first indicators leading to a diagnosis of PCS, however, these may often be normal in early stages of this disease. The diagnosis is made by cholangiography, which is now considered the gold standard. PSC is a known pre-malignant condition. Such patients have an increased risk of developing cholangiocarcinoma, gallbladder neoplasia, and colon cancer. Many new treatment modalities have emerged in the recent past, including anti-tumor necrosis factor-α and anti-integrins; however, liver transplantation is the only known cure for PSC. Despite past and present research, PSC remains an enigmatic biliary disease with few viable treatment options.

关键词：主要 sclerosing 胆管炎 Cholestasis 煽动性的肠疾病自体免疫胆囊瘤形成 Cholangiocarcinoma IgG4 相关疾病结肠癌肝移植

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Current medical therapy of inflammatory bowel disease

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World Journal of Gastroenterology 2000年第4期6卷 483-489页

作者： kiron M. das Sherif A. Farag Department of Medicine Division of Gastroenterology and Hepatologyand Crohn's and Colitis Center of New JerseyUMDNJ Robert Wood Johnson Medical SchoolNew BrunswickNJ 08903USA

INTRODUCTIONThe 1990’s have brought a significant promise and the hopefor a better and brighter future in the new millennium forpatients with inflammatory bowel disease(IBD).A betterunderstanding of the pathophysiolo... 详细信息

关键词： ulcerative colitis Crohn’s disease therapy sulfasalazine 5-aminosalicylic acid glucocorticoids immunosuppresive agents immunomodulatory agents antibiotics nutrition

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Helicobacter pylori associated chronic gastritis,clinical syndromes,precancerous lesions,and pathogenesis of gastric cancer development

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World Journal of Gastroenterology 2014年第18期20卷 5461-5473页

作者： Jiro Watari Nancy Chen Peter S Amenta Hirokazu Fukui Tadayuki Oshima Toshihiko Tomita Hiroto Miwa Kheng-Jim Lim kiron M das Division of Gastroenterology Department of Internal MedicineHyogo College of MedicineNishinomiya 663-8501Japan Division of Gastroenterology and Hepatology Departments of Medicine and PathologyRobert Wood Johnson Medical SchoolRutgersCancer Institute of New JerseyNew BrunswickNJ 08903United States

Helicobacter pylori(H.pylori)infection is well known to be associated with the development of precancerous lesions such as chronic atrophic gastritis(AG),or gastric intestinal metaplasia(GIM),and cancer.Various molecular alterations are identified not only in gastric cancer(GC)but also in precancerous lesions.H.pylori treatment seems to improve AG and GIM,but still remains controversial.In contrast,many studies,including meta-analysis,show that H.pylori eradication reduces GC.Molecular markers detected by genetic and epigenetic alterations related to carcinogenesis reverse following H.pylori eradication.This indicates that these changes may be an important factor in the identification of high risk patients for cancer development.Patients who underwent endoscopic treatment of GC are at high risk for development of metachronous GC.A randomized controlled trial from Japan concluded that prophylactic eradication of H.pylori after endoscopic resection should be used to prevent the development of metachronous GC,but recent retrospective studies did not show the tendency.Patients with precancerous lesions(molecular alterations)that do not reverse after H.pylori treatment,represent the"point of no return"and may be at high risk for the development of GC.Therefore,earlier H.pylori eradication should be considered for preventing GC development prior to the appearance of precancerous lesions.

关键词： Helicobacter pylori Gastric atrophy Intestinal met

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