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Failed stapled rectal resection in a constipated patient with rectal aganglionosis

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World Journal of Gastroenterology 2014年第15期20卷 4462-4466页

作者： Lorenzo C Pescatori vincenzo villanacci Mario Pescatori Coloproctology Unit Clinica Parioli00100 RomeItaly Patology Unit Spedali Civili25100 BresciaItaly

A rare case of a severely constipated patient with rectal aganglionosis is herein *** patient,who had no megacolon/megarectum,underwent a STARR,i.e.,stapled transanal rectal resection,for obstructed defecation,but her symptoms were not *** started suffering from severe chronic proctalgia possibly due to peri-retained staples *** transit times were normal and no megarectum/megacolon was found at barium enema.A diverting sigmoidostomy was then carried out,which was complicated by an early parastomal hernia,which affected stoma *** also had a severe diverting proctitis,causing rectal bleeding,and still complained of both proctalgia and tenesmus.A deep rectal biopsy under anesthesia showed no ganglia in the rectum,whereas ganglia were present and normal in the sigmoid at the stoma *** she refused a Duhamel procedure,an intersphincteric rectal resection and a refashioning of the stoma was *** case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure.

关键词： Constipation Rectal agangliosis Obstructed defecation Stapled rectal resection Parastomal hernia

Cellular and molecular basis of chronic constipation: Taking the functional/idiopathic label out

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World Journal of Gastroenterology 2013年第26期19卷 4099-4105页

作者： Gabrio Bassotti vincenzo villanacci Dragos Cretoiu Sanda Maria Cretoiu Gabriel Becheanu Gastroenterology and Hepatology Section Department of Clinical and Experimental Medicine University of Perugia Second Pathology Section Spedali Civili Division of Cellular and Molecular Medicine Department of Morphological Sciences "Carol Davila" University of Medicine and Pharmacy Department of Molecular Medicine "Victor Babes" National Institute of Pathology Department of Ultrastructural Pathology "Victor Babes" National Institute of Pathology Department of Gastroenterology and Hepatology Fundeni Clinical Institute

In recent years, the improvement of technology and the increase in knowledge have shifted several strongly held paradigms. This is particularly true in gastroenterology, and specifically in the field of the so-called "functional" or "idiopathic" disease, where conditions thought for decades to be based mainly on alterations of visceral perception or aberrant psychosomatic mechanisms have, in fact, be reconducted to an organic basis (or, at the very least, have shown one or more demonstrable abnormalities). This is particularly true, for instance, for irritable bowel syndrome, the prototype entity of "functional" gastrointestinal disorders, where low-grade inflammation of both mucosa and myenteric plexus has been repeatedly demonstrated. Thus, researchers have also investigated other functional/idiopathic gastrointestinal disorders, and found that some organic ground is present, such as abnormal neurotransmission and myenteric plexitis in esophageal achalasia and mucosal immune activation and mild eosinophilia in functional dyspepsia. Here we show evidence, based on our own and other authors' work, that chronic constipation has several abnormalities reconductable to alterations in the enteric nervous system, abnormalities mainly characterized by a constant decrease of enteric glial cells and interstitial cells of Cajal (and, sometimes, of enteric neurons). Thus, we feel that (at least some forms of) chronic constipation should no more be considered as a functional/idiopathic gastrointestinal disorder, but instead as a true enteric neuropathic abnormality.

关键词： Constipation Enteric glia Enteric nervous system Enteric neurons Interstitial cells of Cajap Neurogastroenterology

Gastrointestinal motility disorders in inflammatory bowel diseases

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World Journal of Gastroenterology 2014年第1期20卷 37-44页

作者： Gabrio Bassotti Elisabetta Antonelli vincenzo villanacci Marianna Salemme Manuela Coppola Vito Annese Gastroenterology and Hepatology Section Department of Clinical and Experimental MedicineUniversity of Perugia06156 PerugiaItaly Second Pathology Section Spedali Civili of Brescia25100 BresciaItaly Gastroenterology Unit Careggi University Hospital50134 FlorenceItaly

The relationship between motility and inflammatory gastrointestinal disorders is at the same time complex and intriguing since these conditions might share some genetic, environmental, immunological and microbial predisposing factors. In addition, significant symptom overlapping may occur, muddling the waters within the clinical context. Although on one hand this represents a challenge for the clinician for a potential under- or over-treatment and diagnostic delay, on the other hand it possibly represents an opportunity for the researcher to better disclose the intimate relationship between chronic (often low-grade) inflammation, motor disorders and deranged sensory function. The best example is probably represented by Crohn’s disease and ulcerative colitis. In fact, a number of gastrointestinal motor disorders have been described in association with these diseases, disorders which span from the esophagus to the anorectum, and which will be extensively covered in this review. It is conceivable that at least part of this derangement is strictly related to inflammatory cytokine trafficking and neuromuscular changes; however, given the high prevalence of functional gastrointestinal disorders in the general population, this overlap might also be serendipitous. However, it is worth noting that literature data on this topic are relatively scarce, sometimes quite outdated, and mostly focused on the interplay between irritable bowel syndrome and inflammatory bowel disease. Nevertheless, both researchers and clinicians must be aware that symptoms related to gastrointestinal motility disorders may be highly prevalent in both active and inactive inflammatory bowel disease, correlate with greater psychological comorbidity and poorer quality of life, and may negatively influence the therapeutic approaches.

关键词： Crohn’ s disease, Gastrointestinal motility disorders, Gut, Inflammatory bowel diseases, Perception, Ulcerative colitis

Histological healing in inflammatory bowel disease:A still unfulfilled promise

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World Journal of Gastroenterology 2013年第7期19卷 968-978页

作者： vincenzo villanacci Elisabetta Antonelli Karel Geboes Giovanni Casella Gabrio Bassotti Department of Pathology Spedali Civili of Brescia25100 BresciaItaly Gastroenterology and Hepatology Section Department of Clinical and Experimental MedicineUniversity of Perugia06156 PerugiaItaly Department of Pathology University Hospital KU Leuven and UZ Gent3000 LeuvenBelgium Division of Internal Medicine Desio General Hospital20033 DesioItaly

Treatment of inflammatory bowel disease(IBD) is traditionally based on several drugs,including salicylates,corticosteroids,and antibiotics;in addition,the therapeutic armamentarium has considerably evolved with the advent of newer,effective therapeutic measures(such as the biological agents) that are able to improve in a considerable manner both the clinical and endoscopic ***,mucosal healing,at least considered from an endoscopic point of view,is today regarded as the ultimate endpoint for treatment of these ***,it is also increasingly clear that endoscopic healing is not necessarily paralleled by histological healing;There are few doubts that the latter should be considered as a true,objective healing and the ultimate goal to reach when treating patients with ***,and surprisingly,only a few,incomplete,and somewhat conflicting data exist on this topic,especially because there is still the need to standardize both histological assessment and the severity grading of these disorders;Issues that have not been yet been resolved for clinical practice and therapeutic ***,with the help of an increased awareness on the clinical researchers' side,and the availability of dedicated pathologists on the other side,this matter will be effectively faced and resolved in the near future.

关键词： Crohn’s disease Healing Histology Inflammatory bowel diseases Ulcerative colitis

Inflammatory bowel disease in the dog:Differences and similarities with humans

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World Journal of Gastroenterology 2010年第9期16卷 1050-1056页

作者： Matteo Cerquetella Andrea Spaterna Fulvio Laus Beniamino Tesei Giacomo Rossi Elisabetta Antonelli vincenzo villanacci Gabrio Bassotti School of Medical Veterinary Sciences University of CamerinoVia Circonvallazione Gastroenterology and Hepatology Section Department of Clinical and Experimental MedicineSanta Maria della Misericordia Hospital 2nd Department of Pathology Spedali Civili of BresciaPiazza Spedali Civili

Inflammatory bowel diseases (IBD) represent important chronic conditions affecting the gastrointestinal tract in ***,similar disorders are found in several animal species and the IBD affecting dogs are particularly *** are encompassed by an umbrella of probably several different entities with common symptoms,some of which seem to share striking similarities with human *** review will focus on the actual knowledge of IBD in dogs,and attempt to identify differences and similarities with human IBD conditions.

关键词： Colitis Dog Inflammatory bowel diseases

ntestinal-mucosa anti-transglutaminase antibody assays to test for genetic gluten intolerance

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Cellular & Molecular Immunology 2014年第6期11卷 617-620页

作者： Sara Quaglia Luigina De Leo Fabiana Ziberna Serena Vatta vincenzo villanacci Marilena Granzotto vincenzo Petix Stefano Martelossi Grazia Di Leo Lucio Torelli Tarcisio Not Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo' Trieste Italy Department of Pathology Spedali Civili University of Brescia Brescia Italy University of Trieste Trieste Italy These two authors contributed equally to the study

Celiac disease （CD） is an autoimmune enteropathy character- ized by gluten-triggered intestinal mucosa lesions in genetically susceptible individuals carrying the HLA DQ2 or DQ8. CD diagnosis is based on the concentration of IgA serum anti- transglutaminase （anti-tTG） antibodies together with mucosal damage at intestinal biopsy.

关键词： Intestinal-mucosa antibody assays genetic gluten intolerance

Slow transit constipation: A functional disorder becomes an enteric neuropathy

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World Journal of Gastroenterology 2006年第29期12卷 4609-4613页

作者： Gabrio Bassotti vincenzo villanacci Gastroenterology and Hepatology Section Department of Clinical and Experimental Medicine University of PerugiaItaly 2~(nd) Pathology Section Spedali Civili BresciaItaly

Slow transit constipation has been traditionally considered and classified as a functional disorder. However, clinical and manometric evidence has been accumulating that suggests how most of the motility alterations in STC might be considered of neuropathic *** addition, further investigations showed that subtle alterations of the enteric nervous system, not evident to conventional histological examination, may be present in these patients. In the present article we will discuss these evidences, and will try to put them in relation with the abnormal motor function of the large bowel documented in this pathological condition.

关键词： Constipation Enteric neuropathy Functionaldisorders Slow transit

Neurological disorders and inflammatory bowel diseases

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World Journal of Gastroenterology 2014年第27期20卷 8764-8782页

作者： Giovanni Casella Gian Eugenio Tontini Gabrio Bassotti Luca Pastorelli vincenzo villanacci Luisa Spina Vittorio Baldini Maurizio Vecchi Medical Department Desio Hospital Gastroenterology and Gastrointestinal Endoscopy Unit IRCCS Policlinico San Donato 20097 San Donato Milanese Italy Gastroenterology Section Department of Medicine University of Perugia Medical School Department of Biomedical Sciences for the Health University of Milan Institute of Pathology Spedali Civili 25123 Brescia Italy

Extraintestinal manifestations occur in about one-third of patients living with inflammatory bowel disease(IBD) and may precede the onset of gastrointestinal symptoms by many years. Neurologic disorders associated with IBD are not frequent, being reported in 3% of patients, but they often represent an important cause of morbidity and a relevant diagnostic issue. In addition, the increasing use of immunosuppressant and biological therapies for IBD may also play a pivotal role in the development of neurological disorders of different type and pathogenesis. Hence, we provide a complete and profound review of the main features of neurological complications associated with IBD, with particular reference to those related to drugs and with a specific focus on their clinical presentation and possible pathophysiological mechanisms.

关键词： Inflammatory bowel diseases Crohn's disease Ulcerative colitis Extraintestinal manifestations Neurological disorders Multiple sclerosis Progressive multifocal encephalopathy Demyelinating neuropathies Cerebrovascular diseases Side effects

Inflammatory bowel disease:A proposal to facilitate the achievement of an unequivocal diagnosis

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World Journal of Gastroenterology 2013年第3期19卷 426-428页

作者： Gabriella Canavese Gabrio Bassotti Marco Astegiano Isabella Castellano Paola Cassoni Anna Sapino vincenzo villanacci Ⅲ Service of Pathology Department of Laboratory DiagnosisAzienda Ospedaliera Cittàdella Salute e della Scienza di TorinoDepartment of Medical SciencesUniversity of Torino10100 TorinoItaly Gastroenterology and Hepatology Section Department of Clinical and Experimental MedicineUniversity of Perugia06100 PerugiaItaly Gastroenterology and Hepatology Section Azienda Ospedaliera Città della Salute e della Scienza di Torino 10100 TorinoItaly Department of Pathology Spedali Civili of Brescia25100 BresciaItaly

Following the international guidelines criteria an adequate"diagnostic conclusion"of inflammatory bowel disease(IBD)can be achieved only if clinical,endoscopic and laboratory findings,together with sample technical adequacy and unequivocal histomorphological signs of the disease are ***,a conclusive diagnosis requires a complex combination of clinical, endoscopic and histological data.A considerable number of endoscopic biopsies obtained from IBD patients do not meet the above-mentioned *** aim of the present proposal is to introduce a binary system of evaluation in the"diagnostic conclusion"of the histopathological report that will help to simplify the clinical decisions and consequent patient *** patients with no history of disease,the pathologist should classify the biopsies in"Diagnostic",when the criteria established by the international guidelines are satisfied and"not diagnostic"when one or more of the above-mentioned criteria are not met. The term"not diagnostic"should replace"highly suggestive"and"probable".This new terminology could avoid ambiguous expressions that encourage the clinician to classify the patient as affected by IBD without fulfilling all of the requirements for an accurate diagnostic approach.

关键词： Inflammatory bowel disease Diagnosis Biopsy