Microscopic analysis of patients with chronic diarrhea without macroscopic disease / Análise microscópica de pacientes com diarreia crônica sem doença macroscópica

BACKGROUND: Colonoscopy is part of the current diagnostic armamentarium. However, in some patients with chronic diarrhea, a colonoscopy may show normal mucosa; in these cases, serial biopsies can provide important information for the diagnosis and treatment of patients. AIM: To analyze patients with chronic diarrhea having a macroscopically normal colonoscopy, by evaluating histological changes. METHODS: 30 patients with chronic diarrhea and normal colonoscopy were prospectively evaluated and submitted to serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: The sample of 30 patients showed a ratio of 18 men (60%) and 12 women (40%). On histological types, it was found that 13 patients (43.3%) had lymphoid hyperplasia, eosinophilic inflammation in 4 (13.3%), nonspecific inflammation in 4 (13.3%), regenerative changes in 3 (10%), lymphocytic colitis in 2 (6.6%) and changes consistent with Crohn's disease in 1 (3.3%). CONCLUSIONS: One can observe that even chronic diarrhea patients, without other associated factors, benefited from colonoscopy with biopsy, because it held the etiologic diagnosis in some cases as also excluded by histopathology. It was noticed that the frequency of patients with altered biopsy and less dragged diarrheal episodes (84.2%) was large, should consider their achievement.

INTRODUÇÃO: A colonoscopia faz parte do arsenal de diagnóstico atual. Porém, em alguns pacientes com diarreia crônica, a colonoscopia pode evidenciar mucosa normal; nesses casos biópsias seriadas podem trazer informações importantes para o diagnóstico e tratamento dos pacientes. OBJETIVO: Analisar pacientes com diarreia crônica submetidos à colonoscopia macroscopicamente normal, avaliando assim histologicamente as alterações. MÉTODOS: Análise prospectiva da histologia 30 pacientes com diarreia crônica e colonoscopias normais, submetidos a biópsias seriadas de íleo terminal, cólon ascendente e reto. RESULTADOS: A amostra de 30 pacientes mostrou uma proporção de 18 homens (60%) e 12 mulheres (40%). Sobre os tipos de alterações histológicas, foi verificado que 13 pacientes (43,3%) apresentaram hiperplasia linfóide, inflamação eosinofílica em 4 (13,3%), inflamação inespecífica em 4 (13,3%), alterações regenerativas em 3 (10%), colite linfocítica em 2 (6,6%) e alterações compatíveis com Doença de Crohn em 1 (3,3%). CONCLUSÕES: Observou-se que mesmo pacientes com diarreia crônica, sem outros fatores associados, beneficiaram-se da colonoscopia com biópsia, pois a mesma realizou o diagnóstico etiológico em alguns casos como também o excluiu através da histopatologia. Verificou-se que a frequência de pacientes com biópsia alterada e quadros diarreicos menos arrastados (84,2%) foi grande, devendo-se considerar a realização do exame.

Site-specific Colorectal Cancer; How Is It Different? / 대한소화기학회지

One of the most critical characteristics of colorectal cancer (CRC) is the difference between proximal (right-sided colon cancer, RCC) and distal (left-sided colon cancer, LCC) disease. The recent CRC studies showed the unique characteristics of RCC; RCCs were more prevalent in women than men and old patients, and the age difference between RCC and LCC was more apparent in women. Moreover, relatively poor protection against RCC by colonoscopy is a clearly hot issue for alarm. Thus, the left and right colon have been considered as dichotomous or even different organs in the view of molecular, histopathological, epidemiologic and clinical bases for over three decades. However, the evolutionary data suggesting linearity from the rectum to ascending colon beyond the simple right-left dichotomization in the views of cancer molecular features and site-specific clinicopathological differences, support the need for a paradigm shift to the colorectal continuum model rather than the traditional two-colon concept. This new multi-segmental or colorectal continuum hypothesis would provide both the better understanding of the complex etiology of colorectal carcinogenesis and the tailored preventive and therapeutic strategies for CRC including individualized CRC screening programs.

Clinical Outcomes in Ischemic Colitis: According to the Colonoscopic Extent and Feature / 대한소화기학회지

BACKGROUND/AIMS: Ischemic colitis (IC) usually occurs in the elderly population and has a various clinical presentations from mild to severe forms. The aim of this study was to investigate the clinical outcomes according to the involved sites and colonoscopic findings in IC. METHODS: We retrospectively analyzed the medical records of 77 patients who had diagnosed with IC between January 2000 and July 2010. The clinical outcomes were compared according to numbers of the involved segments, location and endoscopic findings. RESULTS: Mean age of the patients was 70+/-11 years and male to female ratio was 1:1.26. Hematochezia (67.5%) and abdominal pain (63.6%) were the most common associated symptoms. The colonoscopic examination was performed at mean 4.6+/-3.7 days after the symptom onset. The most common involved segment was the sigmoid colon (72.7%). Duration of fasting, antibiotics therapy, hospital stay and mortality were significantly increased in the patients group with more involved segments (p<0.001, p=0.004, p<0.001, p<0.001, respectively). Duration of antibiotics therapy and hospital stay were significantly longer in the right colon involvement group (p=0.038, p=0.002, respectively). The time taken until the alleviation of symptoms and the white blood cells count were significantly longer and higher in the ulcer or gangrenous group (p=0.001, p=0.022, respectively). CONCLUSIONS: Evaluating the involved sites, the degree and severity of mucosal damage by colonoscopy may be important in predicting the clinical course and prognosis of the patients with IC. Early detection, careful monitoring and prompt treatment are crucial especially in the patients with ulcer or necrosis in colonscopic findings.

Intestinal ascending colon morphometrics in rats submitted to severe protein malnutrition / Morfometría de la pared intestinal del colon ascendente de ratas sometidas a desnutrición proteica severa

This paper aims to verify the effects of severe protein malnutrition over the intestinal ascending colon morphometrics in adult rats. 12 rats (90 days old) were divided into 2 groups: control (n = 5) and malnutritioned (n = 7). In the following 90 days, the rats of the control group received a 24 percent protein chow as the malnourished group received 4 percent protein chow. The animals were submitted to euthanasia according to the anesthetic protocol. Colon segments were collected and submitted to routine histological processing. The cuts were stained with HE and histochemical techniques for mucines. The morphometric analyses showed the sustenance of the whole wall and muscle tunic thickness, as well as the reduction of the thickness of the mucosa tunic, the amount of goblet cells, the depth of the crypt and the height of the enterocytes as well as their nucleus on malnutritioned animals. The data suggest that protein malnutrition causes alterations on adult rat ascending colon intestinal morphometrics, especially in tissues which present a high level of cell turnover such as the mucosa tunic and consequently their structures such as the enterocytes, goblet cells, and crypts

El objetivo de este trabajo fue verificar los efectos de la desnutrición proteica severa sobre la morfometría de la pared intestinal del colon ascendente de ratas adultas. Fueron utilizadas 12 ratas (90 días de edad), divididas en dos grupos: control (n=5) y desnutrido (n=7). En los 90 días siguientes, las ratas del grupo control recibieron ración con 24 por ciento de contenido proteico y los del grupo desnutrido con 4 por ciento. Los animales fueron eutanasiados de acuerdo al protocolo anestésico. Segmentos del colon fueron retirados y sometidos a procesamiento histológico de rutina. Los cortes fueron teñidos con HE y técnicas histoquímicas para mucinas. El análisis morfométrico mostró la mantención de la pared total y del grosor de la túnica muscular, y reducción en el espesor de la túnica mucosa, en el número de células caliciformes, en la profundidad de las criptas y en la altura de los enterocitos y de sus núcleos, en los animales desnutridos. Los datos obtenidos sugieren que la desnutrición proteica provoca alteraciones en la morfometría intestinal del colon ascendente de ratas adultas, principalmente en tejidos de alto índice de renovación celular como la mucosa y, consecuentemente, de sus estructuras como los enterocitos, células caliciformes y criptas

A Case of Benign Schwannoma in the Ascending Colon / 대한소화기학회지

Schwannomas are rare tumors derived from the cells of Schwann which form the neural sheath. Some patients with gastrointestinal schwannoma have been previously reported in the literature. However, schwannomas of the colon are extremely rare. We herein describe a case of schwannoma of the colon. A 49-year-old woman was admitted with complaint of abdominal pain and investigations revealed the presence of a 4 cm sized mass in the ascending colon. Following right hemicolectomy, histopathology and immunohistochemistry confirmed the colonic lesion to be a benign schwannoma. There was no evidence of specific complication or recurrence until now.