A mineral-rich red algae extract inhibits polyp formation and inflammation in the gastrointestinal tract of mice on a high-fat diet.

The purpose of this study was to determine whether a mineral-rich extract derived from the red marine algae Lithothamnion calcareum could be used as a dietary supplement for chemoprevention against colon polyp formation. A total of 60 C57bl/6 mice were divided into 3 groups based on diet. One group received a low-fat, rodent chow diet (AIN76A). The second group received a high-fat "Western-style" diet (HFWD). The third group was fed the same HFWD with the mineral-rich extract included as a dietary supplement. Mice were maintained on the respective diets for 15 months. Autopsies were performed at the time of death or at the completion of the study. To summarize, the cumulative mortality rate was higher in mice on the HFWD during the 15-month period (55%) than in mice from the low-fat diet or the extract-supplemented high-fat diet groups (20% and 30%, respectively; P < .05 with respect to both). Autopsies revealed colon polyps in 20% of the animals on the HFWD and none in animals of the other 2 groups (P < .05). In addition to the grossly visible polyps, areas of hyperplasia in the colonic mucosa and inflammatory foci throughout the gastrointestinal tract were observed histologically in animals on the high-fat diet. Both were significantly reduced in animals on the low-fat diet and animals on the extract-supplemented HFWD.These data suggest that the mineral-rich algae extract may provide a novel approach to chemoprevention in the colon.

Dietary-induced ERbeta upregulation counteracts intestinal neoplasia development in intact male ApcMin/+ mice.

Most sporadic colorectal cancers (CRCs) develop through the adenoma-carcinoma sequence pathway and are initiated by adenomatous polyposis coli (APC) gene mutations. Estrogen receptor beta (ERbeta) is recognized to progressively reduce its expression in adenomatous and carcinomatous tissues in humans. Moreover, ERbeta deficiency enhances small intestinal tumorigenesis in rodents. In the Apc(Min/+) mouse model, we evaluated intestinal polyp development and ERbeta expression plus other biological parameters influencing tumor growth (epithelial cell proliferation, apoptosis and migration) following the addition of a combination of the ERbeta-selective agonist silymarin (SIL) and/or lignin (LIG) to a high-fat/low-fiber diet. Forty-five Apc(Min/+) mice were divided in four groups: animals fed on the tumorigenic high-fat/low-fiber diet, the tumorigenic diet supplemented with SIL (0.02%) or purified LIG (6.24%) or SIL (0.005%) + LIG (6.24%). In these animals, we assessed polyp number and volume and their degree of dysplasia together with ERbeta messenger RNA (mRNA) and protein levels and epithelial cell proliferation, migration and apoptosis. The latter group of parameters was evaluated in normal and adenomatous mucosa and the results compared with those found in wild-type (WT) mice fed on the control diet. The addition of SIL or LIG to the diet and even more the specific combination of the two significantly counteracted intestinal tumorigenesis and increased ERbeta mRNA and protein levels. Cell proliferation and apoptosis were rebalanced and cell migration accelerated, restoring values similar to those observed in WT animals. Our results further support a protective effect of ERbeta in CRC suggesting the use of the combination of SIL-LIG as a potential approach against CRC development.

[Small intestinal polyposis in Peutz-Jeghers syndrome: combined treatment with surgery and intra-operative endoscopy]. / La poliposi del tenue nella sindrome di Peutz-Jeghers: trattamento combinato chirurgia-endoscopia intraoperatoria.

Polyps occur throughout the gastrointestinal tract in Peutz-Jeghers syndrome, but the most serious problems are encountered in the management of small bowel polyposis. We report here on a case of Peutz-Jeghers syndrome admitted to hospital for intestinal obstruction and anaemia. The patient was submitted to colonoscopy, oesophagogastro-duodenoscopy and small bowel enema. At laparotomy, multiple intussusceptions were found and we conducted a combined surgical-endoscopic approach. Most of the polyps were identified and removed endoscopically (snare polypectomy). Five enterotomies were performed to remove 18 very large polyps (> 3 cm). Finally, a limited portion of the jejunal tract (20 cm) was resected owing to the presence of multiple, large, obstructive polyps. None of the polyps showed cancerous transformation. The shortcomings of the traditional surgical approach include repeated small bowel resections and often early reoperation to manage complications caused by polyps missed at the time of previous surgery. If surgical intervention is required, intraoperative endoscopy is always indicated. Conservative surgical management, the role of intraoperative endoscopy, planned medical follow-up and the need for a national registration system are stressed.

Radiologic and endoscopic diagnosis of Crohn's disease.

This article reviews the radiologic and endoscopic diagnosis of Crohn's disease. Radiographic and endoscopic findings of Crohn's disease are discussed; a practical approach to the selection of radiologic modalities is presented; and the role of endoscopy in diagnosis and treatment is explained.

[Gastrointestinal polyposis in Bourneville's tuberous sclerosis: an involvement often overlooked]. / La polypose digestive de la sclérose tubéreuse de Bourneville: une atteinte souvent méconnue.

Ten patients (5 male, 5 female, mean age: 29.4 years) with tuberous sclerosis were investigated for gastrointestinal polyps. Three had adenomatous colonic polyps, one had a single duodenal hamartomatous polyp and the fifth a hyperplastic gastric polyp. This high prevalence (50%) should put the gastro-intestinal investigation as a useful test in the diagnosis of tuberous sclerosis, particularly in the incomplete varieties of disease. Conversely, tuberous sclerosis should be considered in the differential diagnosis of digestive polyposis.

Mucosal proliferation characteristics in ureterosigmoidostomy: effect of calcium supplement.

Ureterosigmoidostomy, frequently performed in children for urinary diversion, is a known premalignant condition. Dietary calcium supplements have been shown to normalize mucosal proliferative patterns in other human premalignant colonic conditions, which might decrease the risk of cancer. However, calcium supplementation has not been investigated in ureterosigmoidostomy. We used a rat model to study the effects of increased dietary calcium on the progression to carcinoma in ureterosigmoidostomy. Twenty-five Wister rats underwent ureterosigmoidostomy by anastomosis of bladder trigone and ureters to sigmoid, and were divided into two groups: group 1, regular diet (14); and group 2, calcium supplemented (2%) diet (11). All animals received the diet for 9 months. At death the anastomosis was weighed and examined histologically. In addition, ornithine decarboxylase (ODC), an enzyme involved in polyamine synthesis that becomes elevated in neoplastic and proliferative disorders, was determined at the anastomosis and 8 cm proximal (normal colon). All animals developed proliferative metaplastic polyposis at the anastomosis. Tumor weights were 2.6 +/- 1.1 g for group 1 and 4.8 +/- 1.2 g for group 2 (P less than .05). The ODC levels were: group 1, normal colon 78.2 +/- 15.6 and tumor 321.3 +/- 58.8 (P less than .002); and group 2, normal colon 425.8 +/- 65.4 and tumor 568.0 +/- 40.9 (P = NS). The difference between group 1 normal colon and group 2 normal colon was significant (P less than .001), as was group 1 tumor and group 2 tumor (P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)

Colorectal polyps and diet: a case-control study in Marseilles.

This study investigates the differences in usual past diet between 252 subjects with newly diagnosed adenomatous or villous polyps of the colon and rectum and a group of 238 hospital controls. Cases and controls were interviewed in hospital by 3 nutritionists using a dietary history questionnaire focused on the diet during the preceding year. Nutrient intake was estimated by means of ad hoc food tables adapted from French and British tables. Out of 16 food groups considered in the analyses, the cases reported lower consumption of oil and potatoes and higher consumption of sugar added to food and drink. Among nutrients, we found that cases had a lower consumption of carbohydrates (not taking into account added sugar), potassium, magnesium and vitamin B6. We found a slightly lower intake of fibre and a slightly higher intake of saturated fat among cases, though neither was statistically significant. Intake values for fibre and for carbohydrates were highly intercorrelated and, due to measurement errors, the effect of one may be masked by the other and vice versa. The hypothesis that some components of carbohydrates (starches, fibre and natural sugars but not added sugar) play a protective role in relation to the biology of tumours of the intestinal tract is considered in further multivariate analyses and in the "Discussion".

Pólipos de colon y recto / Colon and rectum polyps

Se llevó a cabo una investigación prospectiva sobre pólipos de colon y recto; se integraron dos grupos, el primero considerado como de estudio correspondió a 20 enfermos portadores de la enfermedad. El segundo, lo integraron 8 sujetos sanos. El objetivo fue la de reafirmar o eliminar algunos conocimientos actuales sobre su origen, diagnóstico y tratamiento. El hallazgo encontrado con respecto a la dieta rica en carbohidratos puede ser coincidental; pero al igual que en el carcinoma, se puede sospechar que existe una relación entre ingesta de azúcares refinados y la aparición de pólipos colorectales. Los niveles de IgG sérica se encontraron disminuidos en el grupo de estudio con valor medio de 1148.7 + ou - 473.6, ésto proporcionó una p=0.001. En neoplasias malignas de colon también se demostraron disminución de los niveles de IgG, lo que señala, factores inhibitorios humorales en la linfoblastogénesis y en la producción de inmunoglobulinas. Se precisó que la endoscopía es el método de elección para el diagnóstico de pólipos en colon y recto, en nuestro trabajo se observó importante diferencia al ser comparada con el colon por enema, doble contraste. El diagnóstico temprano y el tratamiento oportuno de esas neoplasias proporcionaron magníficos resultados en dos enfermos que les fueron extraídos de ámpula rectal, pólipos con carcinoma in-situ. Se demostró que la polipectomía transendoscópica tiene más ventajas que el tratamiento quirúrgico. El análisis histológico informó predominio de pólipos adenomatosos

Ureterosigmoidostomy: the development of tumors, diagnosis, and pitfalls.

The development of colon carcinoma after ureterosigmoidostomy has not received adequate attention in the radiologic literature. Two patients who had ureterosigmoidostomy and subsequently developed tumors are described. The third case is a patient with a ureterosigmoidostomy and a ureterocele that simulated the appearance of carcinoma in the sigmoid colon. This is the first report of this entity. Ureterosigmoidostomy patients need frequent follow-up studies since their incidence of carcinoma is significant. The use of barium to study the colon in this group of patients is controversial. Barium can potentially reflux into the kidney with fecal material, which can lead to fibrosis and impaired renal function. However, barium reflux up the ureter is usually of no significance except on those rare occasions when intrarenal reflux occurs and inflammatory changes may develop. The diagnosis of tumors in these patients, diagnostic pitfalls, and controversy regarding use of barium enemas in following these patients are discussed.

Inflammatory polyposis in an ileal blind loop.

A case of inflammatory polyposis of the ileum after ileosigmoid anastomosis is reported. Two features are noteworthy. First, the polyps were localized in a blind ileal loop. Second, while rare ileal inflammatory polyps related to enteroenteric anastomosis have been reported, to our knowledge this is the first instance of approximately 50 polyps to be described at such a site. The etiology of these lesions is unknown but may be related to fecal irritation, stasis, bacterial overgrowth, or bacterial toxin. These polyps may ulcerate and bleed, causing iron deficiency anemia, and they must be distinguished from neoplastic polyps. Since side-to-side and end-to-side anastomoses have become more common with use of the surgical stapler, inflammatory polyps may be encountered more frequently.

An unusual pedunculated polyp of the colon: association with schistosomiasis.

A patient with long-standing, nonspecific abdominal symptoms had a barium enema showing a single pedunculated polyp. This was removed by colonoscopic polypectomy and found to be an inflammatory polyp associated with Schistosoma mansoni infection. We review the relationship and significance of schistosomiasis to colonic polyps.

Localized giant pseudopolyposis of the colon in ulcerative colitis.

Recently a patient with ulcerative colitis developed abdominal pain and a left upper quadrant mass. A 67Ga-citrate scintiscan showed increased activity over the mass. A barium enema demonstrated retrograde obstruction at the splenic flexure and intraluminal multilobulated tissue masses. The total abdominal colectomy specimen showed localized giant pseudopolyposis at the splenic flexure. This condition is a rare local complication of both ulcerative and granulomatous colitis. It resembles a villous adenoma on barium enema and, although inflammatory, may simulate a colonic carcinoma. When symptomatic, local resection may be sufficient treatment.

Radiology in the current assessment of ulcerative colitis.

Plain abdominal radiography in acute ulcerative colitis is essential to detect acute colonic complications, such as acute dilatation and free perforation. Sealed perforations may not be detected. Useful information can be gained as to the extent and severity of the mucosal lesions, but can be unreliable so that a contrast examination is required. The double contrast barium enema is more accurate than the single contrast study in revealing the early mucosal lesions of colitis. It is the examination of choice to show the extent and severity of disease, and is of considerable value in the differential diagnosis of colitis. In active colitis, the unprepared double contrast barium enema is recommended. The success of the examination relies on the absence of fecal residue adjacent to an active mucosa. The technique, uses, and limitations of this type of examination are described. In the long-term management of colitis, the role of radiology is to show the presence of extensive disease, which indicates an increased risk of malignancy. Lesions such as strictures or polyps may be found and are more likely to be benign than malignant, but confirmation often requires endoscopic biopsy. In the search for malignancy regular barium enema examination is not recommended, as this can only reveal an overt tumor, whereas premalignancy can be detected histologically from an endoscopic biopsy.