Clinical Value of CXCL5 for Determining of Colorectal Cancer

Background: Several studies indicate that chemokines play important roles in colorectal mucosal immunity. The chemokine CXCL5 which is expressed by epithelial cells within colorectal mucosa is a promoter of cell proliferation, migration and invasion, is a novel serum prognostic marker in patients with colorectal cancer. The purpose of this study was to investigate whether serum and tissue CXCL5 levels is altered in colorectal carcinomas (CRC) compared to colonic adenoma and normal mucosa.It also aimed to compare colon adenoma and colorectal cancer for blood CXCL5 and CEA levels, their sensitivity, and specificity. Methods: CXCL5 expression was assessed with immunohistochemistry staining in biopsy samples taken during colonoscopy in 22 colonic adenomas, 23 colorectal carcinomas and 23 normal colonic tissue samples. Also all patients' serum CXCL5 and CEA levels were measured. This stduy was prospective observational study. Results: The number of cases who were stained positive with immunohistochemistry was found to be higher in the group with CRC. When compared with the other groups, both levels of serum CXCL5 and CEA were significantly high in the group CRC. Sensitivity and specificity of serum CXCL5 were found to be low as a result of the ROC analysis. Conclusion: Although the level of CXCL5 is high in CRC, its level in serum is not significant enough to support the early diagnosis of the disease.

Conventional DMARD therapy (methotrexate-sulphasalazine) may decrease the requirement of biologics in routine practice of ankylosing spondylitis patients: a real-life experience.

AIM: The effect of disease-modifying antirheumatic drugs (DMARDs) in ankylosing spondylitis (AS) is still controversial. We aimed to evaluate the efficacy of sulphasalazine (SSZ) mono- or combination therapy with methotrexate (MTX) in AS patients naive to anti-tumor necrosis factor alpha (TNFα) agents. METHODS: Patients with AS (n = 87, male : female, 46 : 41) treated with SSZ (n = 61) or SSZ + MTX (n = 26) combination and a documented 6-month follow-up were evaluated retrospectively. Disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive protein and erythrocyte sedimentation rate. Requirement for anti-TNFα therapy was assessed after 6 months. RESULTS: Mean (SD) age was 43.0 (11.0) versus 40.2 (11.1) and disease duration was 11.0 (8.6) versus 8.2 (5.2) years, in the SSZ and SSZ + MTX groups, respectively. Initially, 59% (34/61) of the patients in SSZ monotherapy and 68% (17/26) in the combination arm had BASDAI > 4. At the end of the study, BASDAI scores decreased similarly in both groups (mono: 1.4 [-7-6] versus combination: 0.7 [-3-6] P = 0.2). BASDAI was > 4 in 32.8% (20/61) of patients in the SSZ monotherapy and in 44% (11/26) in the combination arm. Only 4 (6.6%) patients in the SSZ group and 2 (7.7%) in the ombination arm were switched to anti-TNFα therapies. DISCUSSION: A significant subset of our AS patients responded to SSZ mono or SSZ + MTX combination therapies at 6 months follow-up. Using BASDAI, the requirement for biological therapies decreased by 21-24%. In AS patients, including those with axial involvement only, DMARD therapy may be a reasonable first alternative to anti-TNFα therapy and may delay the switch to biologic agents.

The frequency of microscopic and focal active colitis in patients with irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. The frequency of microscopic colitis and focal active colitis in the colonic mucosa has been investigated in IBS patients. METHODS: Between June 2007 and September 2010, 378 patients (between 16 and 84 years) were recruited prospectively. Of these 378 patients, 226 patients were diagnosed with IBS using the Rome III criteria. 152 control patients were also enrolled who were undergoing colonoscopy for colorectal cancer screening or investigation of anemia. Histopathological abnormalities identified during colonoscopy were compared between the IBS and control groups. RESULTS: The average age of the IBS group was 46.13 ± 14.16 years and and the average age of the control group was 57.01 ± 13.07 years. The prevalence of microscopic colitis (MC) in the diarrhea predominant and the mixed subgroup of IBS patients was 4.32% (7/162) whereas in all IBS patients, the prevalence was 3.09% (7/226). MC was not found in the 152 control cases, (p = 0.045). Lymphocytic colitis was seen in 7 IBS patients, with 1 case in the mixed group and 6 cases in the diarrhea group and there was a significant difference in the frequency of lymphocytic colitis between the IBS subgroups (p < 0.01). Focal active colitis was found in 6.6% (15/226) of the IBS patients and in none of the controls (p < 0.01), and there was no differences between IBS subtypes. CONCLUSION: Microscopic colitis was more often found in the diarrhea predominant/mixed subgroups of IBS patients and in patients who were older women. In patients who are older woman with non-constipated IBS, it may be reasonable to perform a biopsy to screen for microscopic colitis. Focal active colitis was significantly increased in patients with IBS compared to controls.