Is ileocecal valve intubation essential for routine colonoscopic examination?

BACKGROUND: In this study, we aimed to assess the diagnostic yield of terminal ileum intubation during routine colonoscopy. MATERIALS AND METHODS: We routinely performed terminal ileum intubation in all patients who underwent colonoscopy at Dokuz Eylul University Hospital between February 2014 and June 2015. Two gastroenterology fellows performed colonoscopies in the Central Endoscopy Unit. Demographic data of patients, indications of colonoscopies, cecum and ileum intubation rate/time, and endoscopic and histopathologic findings of the terminal ileum were all assessed. RESULTS: A total of 1310 consecutive patients (726 female and 584 male, median age: 55.79±14.29 years) underwent colonoscopy during this study period. The colonoscopy was successfully completed in 1144 (87.3%) cases. The terminal ileum was successfully intubated in 1032 (90.2%) cases. The mean time taken to reach the ileum from the cecum was 63.08±64.16 s. Endoscopic abnormalities on the terminal ileum were present in 62 (6%) cases, and biopsies were taken from these patients. However, endoscopic abnormalities were found in 7 and 3.3% of patients who were symptomatic and asymptomatic, respectively. There were statistically significant differences between symptomatic and asymptomatic patients (P=0.02). Clinically significant histopathologic findings were observed in 22 cases, and 12 of the 22 cases were diagnosed as having Crohn's disease. CONCLUSION: Terminal ileum intubation is particularly indicated in symptomatic patients. In cases of chronic diarrhea, iron-deficiency anemia, abdominal pain, and suspected inflammatory bowel disease, terminal ileum intubation should be done.

Evaluation of early atherosclerosis in patients with inflammatory bowel disease.

BACKGROUND: Data regarding early atherosclerosis and inflammatory bowel disease are limited and conflicting results are present. AIMS: The purpose of this study was to evaluate serological and sonographical evidence of subclinical vascular involvement in patients with inflammatory bowel disease. METHODS: Thirty-nine patients with inflammatory bowel disease (20 Crohn's disease, and 19 ulcerative colitis patients) and 31 healthy controls were consecutively enrolled in the study. Flow mediated dilatation of the brachial artery and intima media thickness assessments of the common carotid artery were measured sonographically. Soluble CD40 ligand levels were evaluated. Crohn's disease activity index and modified Truelove-Witt's criteria were also noted. RESULTS: Age, sex distribution, serum lipids, smoking status, and intima media thickness of the common carotid artery were similar between the inflammatory bowel disease patients and controls (p > 0.05). However, both endothelium dependent and independent flow mediated dilatation values were significantly impaired in the inflammatory bowel disease group compared with healthy controls (p < 0.05). Erythrocyte sedimentation rate, C-reactive protein and soluble CD40 ligand values were significantly increased in inflammatory bowel disease patients compared with controls (p < 0.05), and soluble CD40 ligand was negatively correlated with flow mediated dilatation (r = -0.3, p < 0.05). Flow mediated dilatation was significantly predicted from the concentrations of C-reactive protein and soluble CD40 ligand. CONCLUSION: Functional atherosclerosis is present in inflammatory bowel disease before early structural changes occur in vasculature. Higher sCD40L may indicate worse vascular outcome for IBD.

Does glucagon like peptide-2 receptor expression have any effect on the development of human colorectal cancer?

BACKGROUND/AIMS: Glucagon like peptide-2 may play an important role in human colon cancer and polyp development because of its proliferative and antiapopitotic effects especially in colon. In this study, we investigated the role of human glucagon like peptide and it's receptor in development of human colorectal carcinogenesis. MATERIAL AND METHODS: The study includes 30 patients in colon cancer group and 20 patients in colonic polyp group who have been diagnosed by endoscopic and pathologic examination in Dokuz Eylül University, Department of Gastroenterology within 2 year-period. For comparison biopsies were taken from normal appearing colonic mucosa of the same patient. The cancer, polyp and normal colon mucosa samples were stained with glucagon like peptide receptor antibody by immunohistochemical method. RESULTS: Glucagon like peptide 2 receptor positivity of colon cancer patients was 20 % (6/30) in focal cytoplasmic coloration while it was 0 % in colonic adenomas and 100 % in enteroendocrine cells of normal colonic mucosa. Statistically significant differences were found by the comparison of colonic polyp and normal colonic tissue (p=0.000), colonic cancer and normal colonic tissue (p=0.000) and colonic polyp and cancer tissues (p= 0.023). CONCLUSION: Glucagon like peptide-2 receptor expression in colonic adenomas was not detected in human in contrary to the study on mice. Our study suggested that Glucagon like peptide-2 receptor expression is not a factor in adenoma-cancer pathogenesis. More studies are needed on this subject with more facts and different methods.

Diffuse gastrointestinal involvement of mantle cell lymphoma.

The gastrointestinal tract is the predominant site of appearance of extranodal non-Hodgkin lymphomas. The most frequent endoscopic finding of mantle cell lymphoma is multiple lymphomatous polyposis, which is a very rare entity. Multiple lymphomatous polyposis is characterized by multiple polypoid lesions involving long segments of the gastrointestinal tract and it accounts for 2% of primary gastrointestinal tract lymphomas. A 68-year-old patient was admitted to our clinic with intermittent diarrhea, weight loss, hematochezia and fatigue. Multiple lymphomatous polyposis was detected on the endoscopic evaluations. Gastrointestinal mantle cell lymphoma was confirmed with histopathological and immunohistochemical studies on biopsy specimens from colon, small intestine and stomach. The patient was successfully treated by combination chemotherapy.

A case of angiographically verified non-occlusive mesentery ischemia induced by digitalis.

Here we present a case of non-occlusive mesentery ischemia induced by digitalis, which was verified angiographically. Nonocclusive mesentery ischemia, a subgroup of "acute mesentery ischemia", is known as a period of intestinal ischemic hypoperfusion without a demonstrable vascular occlusion in the mesentery bed. It can be caused by factors leading to splanchnic hypoperfusion, which can be of cardiac, renal or hepatic origin. In addition, it can be induced by certain drugs such as digitalis, ergotamines and vasoactive agents. In clinical practice, digitalis toxicity is commonly seen. In contrast, non-occlusive mesentery ischemia secondary to digitalis is quite rare. However, nonocclusive mesentery ischemia should be included in the differential diagnosis for patients who develop sudden and diffuse abdominal pain while on digitalis therapy.

Reticulated platelet levels in patients with ulcerative colitis.

BACKGROUND AND AIMS: In this study, we investigated whether reticulated platelets (RP) would be useful markers in the evaluation of ulcerative colitis (UC) activity and also aimed to gain indirect information about the platelet kinetics. MATERIALS AND METHODS: Complete blood count, C-reactive protein, erythrocyte sedimentation rate, and proportion of RP were measured in 16 active, 21 inactive UC patients, and 20 healthy blood donors. UC activity was assessed by Truelove-Witts criteria. RESULTS: Mean platelet count was increased in patients with active compared to inactive UC (p=0.008) or healthy donors (p=0.000). Mean platelet volume (MPV) was significantly decreased in patients with active compared to inactive (p=0.015) and healthy donors (p=0.001). RP values was significantly decreased in active and inactive UC groups compared to healthy donors (p=0.000, p=0.000, respectively), while there was no significant difference between active and inactive UC patients (p=0.980). Significant negative correlation between platelet count and MPV in patients with active UC (r=-0.542, p=0.030) was observed. CONCLUSIONS: RP values is reduced in active and inactive UC patients compared to healthy donors. To our knowledge, this is the first study about proportion of RP with UC in literature. However, the role of low RP values have not been determined clinically. Further studies are needed to evaluate the role of platelet abnormalities and changes in megakaryopoiesis caused by inflammatory state on low MPV and RP values during the course of UC.

The development of pulmonary adenocarcinoma in a patient with Job's syndrome, a rare immunodeficiency condition.

The hyperimmunoglobulin E (HIE) (Job's) syndrome often has it onset in childhood and is characterized by markedly elevated serum IgE levels, chronic dermatitis and recurrent pyogenic infections. Lymphoid malignancies have most commonly been associated with this syndrome while the first case in the literature of carcinoma associated with HIE syndrome was a squamous cell carcinoma of the vulva, described by Clark et al. in 1998. We observed a male patient with Job's syndrome diagnosed at age three who presented with bone pain and a metastatic epithelial tumor of the bone revealed by biopsy. Diagnostic procedures aimed at detecting the primary site showed multiple mediastinal lymph nodes with lung and liver metastases on computed tomography scans and an extradural spinal metastasis at the upper thoracic level on magnetic resonance imaging. Although the patient refused a bronchoscopic procedure, a diagnosis of pulmonary adenocarcinoma was established on the basis of sputum cytology and the clinical aspects of tumor extent. Intravenous corticosteroids and palliative radiotherapy were given for the spinal metastasis. Palliative chemotherapy could not be started because of the patient's poor performance status as well as nosocomial fungal pneumonia and pseudomonal urogenital infection with bacteremia. Despite the antifungal and broad-spectrum antimicrobial treatments, the patient died of pseudomonal sepsis.