Role of Adipose Tissue Hormones in Pathogenesis of Cryptoglandular Anal Fistula.

The cryptoglandular perianal fistula is a common benign anorectal disorder that is managed mainly with surgery and in some cases may be an extremely challenging condition. Perianal fistulas are often characterized by significantly decreased patient quality of life. Lack of fully recognized pathogenesis of this disease makes it difficult to treat it properly. Recently, adipose tissue hormones have been proposed to play a role in the genesis of cryptoglandular anal fistulas. The expression of adipose tissue hormones and epithelial-to-mesenchymal transition (EMT) factors were characterized based on 30 samples from simple fistulas and 30 samples from complex cryptoglandular perianal fistulas harvested during surgery. Tissue levels of leptin, resistin, MMP2, and MMP9 were significantly elevated in patients who underwent operations due to complex cryptoglandular perianal fistulas compared to patients with simple fistulas. Adiponectin and E-cadherin were significantly lowered in samples from complex perianal fistulas in comparison to simple fistulas. A negative correlation between leptin and E-cadherin levels was observed. Resistin and MMP2 levels, as well as adiponectin and E-cadherin levels, were positively correlated. Complex perianal cryptoglandular fistulas have a reduced level of the anti-inflammatory adipokine adiponectin and have an increase in the levels of proinflammatory resistin and leptin. Abnormal secretion of these adipokines may affect the integrity of the EMT in the fistula tract. E-cadherin, MMP2, and MMP9 expression levels were shifted in patients with more advanced and complex perianal fistulas. Our results supporting the idea of using mesenchymal stem cells in the treatment of cryptoglandular perianal fistulas seem reasonable, but further studies are warranted.

Colitis-Associated Colorectal Cancer in Patients with Inflammatory Bowel Diseases in a Tertiary Referral Center: A Propensity Score Matching Analysis.

BACKGROUND: Inflammatory bowel disease (IBD) is a risk factor in developing colitis-associated colorectal cancer (CA-CRC). CA-CRC causes the death of about 15% IBD patients and the risk is 1.5-2.4 fold higher among IBD sufferers than in the general population. The dysplasia CA-CRC develops in a different mechanism in comparison to sporadic colorectal cancer (CRC). This study aimed at evaluating the surgical treatment and its outcomes as well as 5-year survival rates in the CA-CRC and sporadic CRC patients. MATERIALS AND METHODS: This single-center, retrospective, propensity score-matched case-control study was conducted with 2204 patients operated on due to primary CRC, who were hospitalized from 2003 to 2019. The CA-CRC group consisted of 49 patients with CRC in the course of IBD. The sporadic CRC group was selected with the propensity score matching technique and comprised 98 patients with sporadic CRC who did not have clinical or histopathological features characteristic for IBD. RESULTS: CA-CRC is characterized by a more aggressive clinical course. Surgical treatment of CA-CRC involves more palliative operations and is related with a higher risk of perioperative and postoperative complications. Further studies of CA-CRC risk factor stratification and the development of molecular markers hold promise in reducing CRC in IBD patients in the future were warranted.

Preferences of patients with inflammatory bowel disease for receiving specialized health services using technology: the role of Internet and other sources of medical information.

INTRODUCTION: It is notable that patients with inflammatory bowel disease (IBD) have insufficient knowledge about their disease and are willing to be more involved in their treatment. Nowadays medical information is easily available and health-related topics state the third most frequent reason for using the Internet. Therefore, patient's health-related self-awareness and willingness to take part in medical decisions have improved. The possibility of choice of specialized health services may have a positive effect on patient's satisfaction. The aim of the study was to characterize the extent of Internet use for health information among a representative sample of IBD patients and to examine the effects that Internet and other sources of information about specialized health services have on patients' choices of a doctor and hospital department. MATERIALS AND METHODS: In total, 135 IBD patients admitted to the Department of General and Colorectal Surgery at Medical University of Lodz were asked to complete an anonymous questionnaire. Only 123 fully completed questionnaires were included for analysis. The study group involved 68 women and 55 men. RESULTS: A total of 85.4% IBD patients used Internet in order to gather medical information about their disease. Age of those patients was significantly lower than of those patients who did not use Internet. The most reliable source of information about physicians was Internet. Opinions and recommendations gathered from the Internet have a notable influence on patients' preference of hospital department and attending physician. CONCLUSIONS: A majority of patients used Internet as a source of medical information related to IBD. Opinions obtained from the Internet seem to be the most reliable regarding attending physicians treating IBD patients.