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1.
Cancers (Basel) ; 15(12)2023 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-37370706

RESUMEN

Colorectal carcinoma (CRC) represents a lethal disease with heterogeneous outcomes. Only patients with mismatch repair (MMR) deficient CRC showing microsatellite instability and hyper-mutated tumors can obtain clinical benefits from current immune checkpoint blockades; on the other hand, immune- or target-based therapeutic strategies are very limited for subjects with mismatch repair proficient CRC (CRCpMMR). Here, we report a comprehensive typing of immune infiltrating cells in CRCpMMR. We also tested the expression and interferon-γ-modulation of PD-L1/CD274. Relevant findings were subsequently validated by immunohistochemistry on fixed materials. CRCpMMR contain a significantly increased fraction of CD163+ macrophages (TAMs) expressing TREM2 and CD66+ neutrophils (TANs) together with decrease in CD4-CD8-CD3+ double negative T lymphocytes (DNTs); no differences were revealed by the analysis of conventional and plasmacytoid dendritic cell populations. A fraction of tumor-infiltrating T-cells displays an exhausted phenotype, co-expressing PD-1 and TIM-3. Remarkably, expression of PD-L1 on fresh tumor cells and TAMs was undetectable even after in vitro stimulation with interferon-γ. These findings confirm the immune suppressive microenvironment of CRCpMMR characterized by dense infiltration of TAMs, occurrence of TANs, lack of DNTs, T-cell exhaustion, and interferon-γ unresponsiveness by host and tumor cells. Appropriate bypass strategies should consider these combinations of immune escape mechanisms in CRCpMMR.

2.
Gastric Cancer ; 24(4): 897-912, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33755862

RESUMEN

BACKGROUND: Trastuzumab is the only approved targeted therapy in patients with HER2-amplified metastatic gastric cancer (GC). Regrettably, in clinical practice, only a fraction of them achieves long-term benefit from trastuzumab-based upfront strategy. To advance precision oncology, we investigated the therapeutic efficacy of different HER2-targeted strategies, in HER2 "hyper"-amplified (≥ 8 copies) tumors. METHODS: We undertook a prospective evaluation of HER2 targeting with monoclonal antibodies, tyrosine kinase inhibitors and antibody-drug conjugates, in a selected subgroup of HER2 "hyper"-amplified gastric patient-derived xenografts (PDXs), through the design of ad hoc preclinical trials. RESULTS: Despite the high level of HER2 amplification, trastuzumab elicited a partial response only in 2 out of 8 PDX models. The dual-HER2 blockade with trastuzumab plus either pertuzumab or lapatinib led to complete and durable responses in 5 (62.5%) out of 8 models, including one tumor bearing a concomitant HER2 mutation. In a resistant PDX harboring KRAS amplification, the novel antibody-drug conjugate trastuzumab deruxtecan (but not trastuzumab emtansine) overcame KRAS-mediated resistance. We also identified a HGF-mediated non-cell-autonomous mechanism of secondary resistance to anti-HER2 drugs, responsive to MET co-targeting. CONCLUSION: These preclinical randomized trials clearly indicate that in HER2-driven gastric tumors, a boosted HER2 therapeutic blockade is required for optimal efficacy, leading to complete and durable responses in most of the cases. Our results suggest that a selected subpopulation of HER2-"hyper"-amplified GC patients could strongly benefit from this strategy. Despite the negative results of clinical trials, the dual blockade should be reconsidered for patients with clearly HER2-addicted cancers.


Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Medicina de Precisión/métodos , Receptor ErbB-2/metabolismo , Neoplasias Gástricas/tratamiento farmacológico , Inhibidores Enzimáticos/uso terapéutico , Humanos , Inmunoconjugados/uso terapéutico , Estudios Prospectivos , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Neoplasias Gástricas/genética , Ensayos Antitumor por Modelo de Xenoinjerto
3.
Dig Liver Dis ; 53(8): 950-957, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33712395

RESUMEN

Pathologists are often called upon to diagnose colitides that differ from the two main forms of inflammatory bowel disease (IBD). These non-IBD colitides include infectious colitis, microscopic colitis, ischemic colitis, eosinophilic colitis, autoimmune enterocolitis, segmental colitis associated with diverticulosis, drug-induced colitis, radiation colitis and diversion colitis. The diagnosis of these different disease entities relies on the histopathological examination of endoscopic biopsies of the gastrointestinal tract. This paper reviews the main histomorphological characteristics of the various Non-IBD colitides.


Asunto(s)
Colitis/diagnóstico , Endoscopía Gastrointestinal/métodos , Patología/métodos , Biopsia , Diagnóstico Diferencial , Tracto Gastrointestinal/patología , Humanos
4.
Updates Surg ; 72(3): 761-772, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32607845

RESUMEN

BACKGROUND: Indocyanine green (ICG) has been recently introduced in clinical practice as a fluorescent tracer. Lymphadenectomy is particularly challenging in gastric cancer surgery, owing to the complex anatomical drainage. AIM: The primary outcomes of this study were the feasibility and usefulness of ICG-guided lymphadenectomy in gastric cancer surgery, considering both the success rate and improved understanding of the surgical anatomy of nodal basins. The secondary outcome was the diagnostic ability of ICG to predict the presence of nodal metastases. PATIENTS AND METHODS: We conducted a single-center prospective trial comprising 13 patients with gastric cancer. ICG was injected the afternoon prior to surgery or intraoperatively via the submucosal or subserosal route. Standard lymphadenectomy was performed in all patients, according to patient age and tumor stage, as usual, but after standard lymphadenectomy the residual ICG + nodes were harvested and analyzed. Each nodal station and each dissected node was recorded and classified as ICG + or ICG- (both in vivo and back table evaluation was utilized for classification). After pathological analysis, each nodal station and each dissected node was recorded as metastatic or nonmetastatic (E&E staining). RESULTS: The feasibility rate was 84.6% (11/13). The mean number of dissected lymph nodes per patient was 37.9. Focusing on the 11 patients in whom ICG-guided nodal navigation was successfully performed, 81 lymph node stations were removed, for a total of 417 lymph nodes. Sixty-six stations (81.48%), comprising a total of 336 lymph nodes, exhibited fluorescence. No IC- node was metastatic; all 54 metastatic nodes were ICG + . A total of 282 ICG + nodes were nonmetastatic. In two cases, some nodes outside D2 areas were harvested, being ICG + (1 case of metastatic node). CONCLUSIONS: Fluorescence lymphography-guided lymphadenectomy is a promising new technique that combines a high feasibility rate with considerable ease of use. Regarding its diagnostic value, the key finding from this prospective series is that no metastatic nodes were found outside fluorescent lymph node stations. Further studies are needed to investigate whether this technique can help surgeons performing standard lymphadenectomy and selecting cases for D2 + lymphadenectomy.


Asunto(s)
Fluorescencia , Verde de Indocianina , Escisión del Ganglio Linfático/métodos , Neoplasias Gástricas/cirugía , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias Gástricas/patología
5.
Dig Liver Dis ; 52(3): 262-267, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31884010

RESUMEN

Diagnosis of the inflammatory bowel diseases ulcerative colitis (UC) and Crohn's disease (CD) relies mainly on the histopathological examination of endoscopic biopsies of the gastrointestinal tract. To facilitate the accurate diagnosis of these two conditions, this paper addresses key issues on the: (A) gastrointestinal biopsy procedure, (B) histomorphological characteristics of UC and CD, and (C) diagnosis of dysplasia. The 13 statements presented here represent the consensus of two groups of Italian pathologists (IG-IBD and GIPAD).


Asunto(s)
Neoplasias Colorrectales/patología , Tracto Gastrointestinal/patología , Enfermedades Inflamatorias del Intestino/patología , Biopsia , Colitis Microscópica/patología , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/patología , Neoplasias Colorrectales/complicaciones , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/patología , Diagnóstico Diferencial , Endoscopía Gastrointestinal , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Italia
6.
Ann Diagn Pathol ; 41: 8-13, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31112900

RESUMEN

Serrated polyps evaluation represents a challenge for pathologists for lacking of univocal criteria that leads to different inter -individual interpretation. The aim of our review is to offer an alternative simpler histologic and endoscopic approach to these lesions for a more correct relationship between endoscopists and pathologists.


Asunto(s)
Pólipos del Colon/clasificación , Pólipos del Colon/patología , Lesiones Precancerosas/clasificación , Lesiones Precancerosas/patología , Humanos
7.
Clin Gastroenterol Hepatol ; 15(9): 1382-1389.e1, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28286192

RESUMEN

BACKGROUND & AIMS: Mucosal healing, determined by endoscopic evaluation, is one of the most important prognostic markers for patients with inflammatory bowel diseases. Findings from histologic evaluation, however, could complement findings from endoscopy in assessing mucosal responses to treatment. We analyzed long-term results of children treated with thalidomide to determine the association between clinical response and histology and endoscopy findings. METHODS: We collected data from 2 multicenter trials of 70 children with refractory Crohn's disease (CD) or ulcerative colitis (UC) (2-18 years old; ileocolonic or colonic disease) given thalidomide or placebo (NCT00720538). Clinical remission and clinical response at 8 weeks were defined as a pediatric CD activity index scores 10 points or lower and a decrease of at least 50% from baseline, respectively, for patients with CD; and as a pediatric UC activity index score below 10 and a decrease of at least 20 points from baseline, respectively, for patients with UC. Patients with a clinical response to 8 weeks' treatment with thalidomide underwent endoscopic examination with biopsy collection at study weeks 12 and 52. Severity of inflammation in patients with UC was assessed by Mayo score and in patients with CD by 4-grade system. Biopsies were assessed for signs of active inflammation, erosion or ulceration, and crypt abscesses and assigned a histologic score. RESULTS: Clinical remission was observed in 42 patients (60.0%) and clinical response in 45 patients (64.2%) at Week 8. At Week 52, a total of 38 patients (54.3%) were still in clinical remission or still had a clinical response; 29 patients (41.4%) had mucosal healing, defined as complete healing of erosions or ulcerations, and 20 patients (27.7%) had histologic healing, defined as complete absence of markers of inflammation. Of patients with clinical remission or clinical response, 75.3% also had mucosal healing and 52.6% also had histologic healing. The probability of achieving mucosal healing decreased significantly with increasing values of erythrocyte sedimentation rate (adjusted odds ratio, 0.96; 95% CI, 0.93-0.98; P = .006). CONCLUSIONS: In a long-term analysis of data from 2 clinical trials of pediatric patients with CD or UC, 52 weeks' treatment with thalidomide led to clinical remission in 54.3% of patients with ileocolonic or colonic disease; of these patients, 75.3% had mucosal healing and 52.6% also had histologic healing. Further studies are needed to determine how thalidomide therapy affects long-term progression of inflammatory bowel diseases. (ClinicalTrials.gov number NCT00720538).


Asunto(s)
Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/patología , Talidomida/uso terapéutico , Adolescente , Niño , Preescolar , Ensayos Clínicos como Asunto , Endoscopía , Femenino , Estudios de Seguimiento , Histocitoquímica , Humanos , Mucosa Intestinal/patología , Masculino , Estudios Multicéntricos como Asunto , Placebos/administración & dosificación , Estudios Prospectivos , Resultado del Tratamiento
8.
Inflamm Bowel Dis ; 21(8): 1739-49, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26185909

RESUMEN

BACKGROUND: In a randomized controlled trial, thalidomide has shown to be effective in refractory Crohn's disease in children. This pilot study aimed at evaluating thalidomide in refractory pediatric ulcerative colitis (UC). METHODS: Double-blind, placebo-controlled randomized clinical trial on thalidomide 1.5 to 2.5 mg/kg/day in children with active UC despite multiple immunosuppressive treatments. In an open-label extension, nonresponders to placebo received thalidomide for an additional 8 weeks; all responders were followed up for a minimum of 52 weeks. RESULTS: Twenty-six children with refractory UC were randomized to thalidomide or placebo. Clinical remission at week 8 was achieved by significantly more children treated with thalidomide {10/12 (83.3%) versus 2/11 (18.8%); risk ratio, 4.5 (95% confidence interval [CI], 1.2-16.4); P = 0.005; number needed to treat, 1.5}. Of the nonresponders to placebo who were switched to thalidomide, 8 of 11 (72.7%) subsequently reached remission at week 8 (risk ratio, 4.0 [95% CI, 1.1-14.7]; number needed to treat, 2.45; P = 0.01). Clinical remission in the thalidomide group was 135.0 weeks (95% CI, 32-238), compared with 8.0 weeks (95% CI, 2.4-13.6) in the placebo group (P < 0.0001). Cumulative incidence of severe adverse events was 3.1 per 1000 patient-weeks. Peripheral neuropathy and amenorrhea were the most frequent adverse events. CONCLUSIONS: In this pilot randomized controlled trial on cases of UC refractory to immunosuppressive therapy, thalidomide compared with placebo resulted in improved clinical remission at 8 weeks of treatment and in longer term maintenance of remission. These findings require replication in larger clinical studies evaluating both thalidomide efficacy and safety.


Asunto(s)
Colitis Ulcerosa/tratamiento farmacológico , Resistencia a Medicamentos/efectos de los fármacos , Inmunosupresores/uso terapéutico , Terapia Recuperativa , Talidomida/uso terapéutico , Adolescente , Niño , Preescolar , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Proyectos Piloto , Pronóstico , Inducción de Remisión
9.
World J Gastroenterol ; 21(19): 6060-4, 2015 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-26019473

RESUMEN

This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.


Asunto(s)
Colitis Ulcerosa/complicaciones , Megacolon Tóxico/etiología , Complicaciones Infecciosas del Embarazo/etiología , Sepsis/etiología , Adulto , Biopsia , Cesárea , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/terapia , Colonoscopía , Descompresión Quirúrgica/métodos , Femenino , Edad Gestacional , Humanos , Inmunosupresores/uso terapéutico , Megacolon Tóxico/diagnóstico , Megacolon Tóxico/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Tercer Trimestre del Embarazo , Nacimiento Prematuro , Sepsis/diagnóstico , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
10.
Clin Nucl Med ; 39(10): e442-4, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24561683

RESUMEN

A 75-years-old patient with a history of prostate cancer, previously treated with radical prostatectomy, underwent C-choline PET/CT for restaging due to a rise in the prostate-specific antigen level. The study revealed a focal uptake of C-choline in the esophagus. A subsequent endoscopic examination showed the presence of an esophageal lesion, and after surgery, the histologic diagnosis was mildly differentiated squamous cell carcinoma. In our case, the incidental esophageal uptake revealed by C-choline PET/CT allowed the early diagnosis of an unsuspected esophageal carcinoma.


Asunto(s)
Carcinoma/diagnóstico por imagen , Colina , Neoplasias Esofágicas/diagnóstico por imagen , Hallazgos Incidentales , Neoplasias de la Próstata/diagnóstico por imagen , Radiofármacos , Anciano , Radioisótopos de Carbono , Humanos , Masculino , Imagen Multimodal , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X
11.
JAMA ; 310(20): 2164-73, 2013 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-24281461

RESUMEN

IMPORTANCE: Pediatric-onset Crohn disease is more aggressive than adult-onset disease, has high rates of resistance to existing drugs, and can lead to permanent impairments. Few trials have evaluated new drugs for refractory Crohn disease in children. OBJECTIVE: To determine whether thalidomide is effective in inducing remission in refractory pediatric Crohn disease. DESIGN, SETTING, AND PATIENTS: Multicenter, double-blind, placebo-controlled, randomized clinical trial of 56 children with active Crohn disease despite immunosuppressive treatment, conducted August 2008-September 2012 in 6 pediatric tertiary care centers in Italy. INTERVENTIONS: Thalidomide, 1.5 to 2.5 mg/kg per day, or placebo once daily for 8 weeks. In an open-label extension, nonresponders to placebo received thalidomide for an additional 8 weeks. All responders continued to receive thalidomide for an additional minimum 52 weeks. MAIN OUTCOMES AND MEASURES: Primary outcomes were clinical remission at week 8, measured by Pediatric Crohn Disease Activity Index (PCDAI) score and reduction in PCDAI by ≥25% or ≥75% at weeks 4 and 8. Primary outcomes during the open-label follow-up were clinical remission and 75% response. RESULTS: Twenty-eight children were randomized to thalidomide and 26 to placebo. Clinical remission was achieved by significantly more children treated with thalidomide (13/28 [46.4%] vs 3/26 [11.5%]; risk ratio [RR], 4.0 [95% CI, 1.2-12.5]; P = .01; number needed to treat [NNT], 2.86). Responses were not different at 4 weeks, but greater improvement was observed at 8 weeks in the thalidomide group (75% response, 13/28 [46.4%] vs 3/26 [11.5%]; RR, 4.0 [95% CI, 1.2-12.5]; NNT = 2.86; P = .01; and 25% response, 18/28 [64.2%] vs 8/26 [30.8%]; RR, 2.1 [95% CI, 1.1-3.9]; NNT = 2.99; P = .01). Of the nonresponders to placebo who began receiving thalidomide, 11 of 21 (52.4%) subsequently reached remission at week 8 (RR, 4.5 [95% CI, 1.4-14.1]; NNT = 2.45; P = .01). Overall, 31 of 49 children treated with thalidomide (63.3%) achieved clinical remission, and 32 of 49 (65.3%) achieved 75% response. Mean duration of clinical remission in the thalidomide group was 181.1 weeks (95% CI, 144.53-217.76) vs 6.3 weeks (95% CI, 3.51-9.15) in the placebo group (P < .001). Cumulative incidence of severe adverse events was 2.1 per 1000 patient-weeks, with peripheral neuropathy the most frequent severe adverse event. CONCLUSIONS AND RELEVANCE: In children and adolescents with refractory Crohn disease, thalidomide compared with placebo resulted in improved clinical remission at 8 weeks of treatment and longer-term maintenance of remission in an open-label follow-up. These findings require replication to definitively determine clinical utility of this treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00720538.


Asunto(s)
Enfermedad de Crohn/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Talidomida/uso terapéutico , Adolescente , Edad de Inicio , Niño , Enfermedad de Crohn/patología , Método Doble Ciego , Femenino , Humanos , Inmunosupresores/efectos adversos , Masculino , Inducción de Remisión , Índice de Severidad de la Enfermedad , Talidomida/efectos adversos , Resultado del Tratamiento
12.
Rev Esp Enferm Dig ; 105(6): 326-33, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24090014

RESUMEN

BACKGROUND AND AIMS: the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. METHOD: information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. RESULTS: the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively. CONCLUSIONS: despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease.


Asunto(s)
Enfermedad Celíaca/patología , Endoscopía Gastrointestinal , Adolescente , Adulto , Anciano , Biopsia , Niño , Preescolar , Duodeno/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
13.
Rev. esp. enferm. dig ; 105(6): 326-333, jul. 2013. tab, ilus
Artículo en Inglés | IBECS | ID: ibc-115796

RESUMEN

Background and aims: the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. Method: information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. Results: the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively. Conclusions: despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease(AU)


Asunto(s)
Humanos , Masculino , Femenino , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/cirugía , Biopsia/instrumentación , Biopsia/métodos , Anemia/complicaciones , Anemia/diagnóstico , Síndromes de Malabsorción/complicaciones , Síndromes de Malabsorción/diagnóstico , Endoscopía/instrumentación , Enfermedad Celíaca/fisiopatología , Enfermedad Celíaca , Estudios Retrospectivos , Diarrea/complicaciones , Diarrea/diagnóstico , Endoscopía/métodos , Endoscopía , Dispepsia/complicaciones , Dispepsia/diagnóstico
15.
Arch Iran Med ; 16(2): 78-82, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23360628

RESUMEN

BACKGROUND: Celiac disease (CD) may have a variety of different presentations. This study has aimed to explore the prevalence of gastrointestinal (GI) and non-GI symptoms in patients with CD according to data collected in Italy and Romania (Europe) and Iran (Middle East). METHODS: This is a retrospective cross-sectional study conducted in Iran, Romania and Italy with data collection during the period from May 2009 - May 2011. For each center we included only patients with CD that was confirmed by endoscopy, small bowel biopsies and positive serology. GI symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, weight loss and flatulence, as well as additional signs and symptoms of iron deficiency anemia (IDA), osteoporosis, hypertransaminasemia, and other related abnormalities were collected. RESULTS: Overall, 323 women and 127 men, whose mean age at diagnosis was 34.2 ± 16.47 years were included in this study. Of these, 157 subjects (34.9%) reported at least one GI symptom. The majority of cases had the following primary presenting GI symptoms: diarrhea (13.6%), dyspepsia and constipation (4.0%). Other disease symptoms were reported by 168 (37.3%) patients. The most presenting non-GI symptoms in the majority of cases were anemia (20.7%) and osteopenia (6%). There were statistically significant differences between the majority of symptoms when we compared the reported clinical symptoms from different countries. CONCLUSION: This study indicated that upper abdominal disorders such as abdominal pain and dyspepsia were the most common primary complaints among European patients, whereas Iranian patients had complaints of diarrhea and bloating as the classic presentations of CD. For non-GI symptoms, anemia was the most frequent complaint for both Iranian and Italian patients; however it was significantly higher in Iranians.


Asunto(s)
Enfermedad Celíaca/patología , Dolor Abdominal/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico , Niño , Preescolar , Estreñimiento/etiología , Diarrea/etiología , Dispepsia/etiología , Femenino , Flatulencia/etiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Náusea/etiología , Vómitos/etiología , Pérdida de Peso , Adulto Joven
16.
Int J Colorectal Dis ; 28(2): 267-72, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22864621

RESUMEN

BACKGROUND: Gut mast cells represent an important cell population involved in intestinal homeostasis and inflammatory processes. However, their possible role has not to date been investigated in colonic diverticular disease. AIMS: This study aims to evaluate colonic mast cells in patients undergoing surgery for diverticular disease. METHODS: Surgical resection samples from 27 patients undergoing surgery for diverticular disease (12 emergency procedures for severe disease and 15 elective procedures) were evaluated. The number of mast cells was assessed in the various layers by means of a specific antibody (tryptase) and compared with those evaluated in ten controls. In patients with mast cells degranulation, double immunohistochemistry, also assessing nerve fibres, was carried out. In addition, the presence of myenteric plexitis was sought. RESULTS: Compared with controls, the number of mast cells in diverticular patients was significantly increased, both as an overall figure and in the various layers of the large bowel. In patients in whom mast cells degranulation was present, these were always closed to nerve fibres. No differences were found between the two subgroups of patients with respect to the number and distribution of mast cells; however, all patients undergoing emergency surgery (but none of those undergoing elective procedures) had myenteric plexitis, represented by lymphocytic infiltration in 67 % and eosinophilic infiltration in 33 % of cases. CONCLUSIONS: Patients with diverticular disease display an increase of mast cells in the large bowel. The presence of myenteric plexitis in those with complicated, severe disease, suggest that this could represent a histopathologic marker of more aggressive disease.


Asunto(s)
Colon/patología , Diverticulitis/patología , Mastocitos/patología , Plexo Mientérico/patología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Degranulación de la Célula , Femenino , Humanos , Masculino , Mastocitos/fisiología , Persona de Mediana Edad , Fibras Nerviosas/patología
17.
Dig Dis Sci ; 57(1): 65-71, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21814802

RESUMEN

BACKGROUND: Mast cells are involved in visceral hypersensitivity and motor activity of the gastrointestinal tract. However, there is almost no information concerning mast cells in constipated patients. AIMS: The purpose of this study was to investigate mast cells distribution in all colonic layers in controls and severely constipated patients with obstructed defecation. METHODS: Full-thickness specimens from colons of patients undergoing surgery for obstructed defecation due to refractoriness to other therapeutic interventions (n = 11), compared to controls, were obtained and the number of mast cells (evaluated by specific monoclonal antibodies) were counted in the whole viscus and in the various colonic segments (cecum, ascending, transverse, descending, and sigmoid). RESULTS: Compared to controls, constipated patients had significantly higher numbers of mast cells, both as an overall number and in single colonic segments. This increase was especially evident in the mucosa and submucosa. Mast cells were homogeneously represented in the various segment of the large bowel, in both controls and patients. Degranulated mast cells were found to be close to enteric glial cells and glial filaments. CONCLUSIONS: Colonic mast cells are increased in obstructed defecation patients. This might represent a vicariating mechanism to the impaired colonic propulsive activity of these patients.


Asunto(s)
Colon/patología , Estreñimiento/patología , Sistema Nervioso Entérico/patología , Mastocitos/patología , Neuroglía/patología , Adulto , Anciano , Biopsia , Estudios de Casos y Controles , Recuento de Células , Estreñimiento/fisiopatología , Defecación/fisiología , Femenino , Motilidad Gastrointestinal/fisiología , Humanos , Mucosa Intestinal/patología , Masculino , Persona de Mediana Edad
18.
Rev Esp Enferm Dig ; 103(7): 366-72, 2011 Jul.
Artículo en Inglés, Español | MEDLINE | ID: mdl-21770683

RESUMEN

Apart from inflammatory bowel diseases (IBD), there are several other form of colitis that may resemble macroscopically IBD, entering the differential diagnosis. These forms are represented by infectious colitis, ischemic colitis, pseudomembranous colitis, colitis related to diverticular disease, colitis related to mucosal prolapse, drug colitis, allergic colitis, and microscopic colitis. However, to distinguish between these forms is not always easy, and it frequently requires a strict interrelationship between the pathologist and the gastroenterologist. Here we discuss the more frequent forms of non- inflammatory bowel diseases colitides, trying to give useful hints for helping the clinician to better understand the extent to which the pathologist is called to give a definitive response in the differential diagnosis of these entities.


Asunto(s)
Colitis/diagnóstico , Colitis/patología , Colitis Colagenosa/diagnóstico , Colitis Colagenosa/patología , Colitis Isquémica/diagnóstico , Colitis Isquémica/patología , Diagnóstico Diferencial , Diverticulitis del Colon/diagnóstico , Diverticulitis del Colon/patología , Enterocolitis Seudomembranosa/diagnóstico , Enterocolitis Seudomembranosa/patología , Humanos , Hipersensibilidad/complicaciones , Infecciones/complicaciones , Mucosa Intestinal/patología
19.
Rev. esp. enferm. dig ; 103(7): 366-372, jul. 2011. tab, ilus
Artículo en Español | IBECS | ID: ibc-90593

RESUMEN

Apart from inflammatory bowel diseases (IBD), there are several other form of colitis that may resemble macroscopically IBD, entering the differential diagnosis. These forms are represented by infectious colitis, ischemic colitis, pseudomembranous colitis, colitis related to diverticular disease, colitis related to mucosal prolapse, drug colitis, allergic colitis, and microscopic colitis. However, to distinguish be - tween these forms is not always easy, and it frequently requires a strict interrelationship between the pathologist and the gastroenterologist. Here we discuss the more frequent forms of non- inflammatory bowel diseases colitides, trying to give useful hints for helping the clinician to better understand the extent to which the pathologist is called to give a definitive response in the differential diagnosis of these entities(AU)


Asunto(s)
Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/cirugía , Enterocolitis Seudomembranosa/complicaciones , Enterocolitis Seudomembranosa/diagnóstico , Enfermedades Inflamatorias del Intestino/fisiopatología , Enfermedades Inflamatorias del Intestino
20.
Pathology ; 43(5): 465-71, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21670722

RESUMEN

BACKGROUND: Foxp3(+) regulatory T lymphocytes (T-regs) represent an important regulatory cell subset in inflammatory, preneoplastic and neoplastic conditions of the gastrointestinal tract. METHODS: Inflammatory, preneoplastic and neoplastic conditions of the gastrointestinal tract (189 cases) were studied with the evaluation of Foxp3 regulatory T cells based on immunohistochemistry. RESULTS: Few Foxp3(+) cells were found in controls and inflammatory conditions (oesophagitis, gastritis, coeliac disease, inflammatory bowel disease); in preneoplastic and neoplastic conditions the number of Foxp3(+) cells was significatively increased. CONCLUSIONS: In normal conditions the number of mucosal lymphocytes is very low throughout the gastro-intestinal tract; in active coeliac disease patients or on a gluten-free diet, only a slight increase in Foxp3(+) cells may be found. Gastrointestinal cancers are associated with higher Foxp3(+) cell proportion, compared with microscopically normal tissue and with precancerous conditions. However, it is uncertain whether the increase in these regulatory cells is a cause or a consequence of tumour progression.


Asunto(s)
Factores de Transcripción Forkhead/metabolismo , Lesiones Precancerosas/patología , Gastropatías/patología , Adulto , Anciano , Enfermedad Celíaca/metabolismo , Enfermedad Celíaca/patología , Recuento de Células , Progresión de la Enfermedad , Esofagitis/metabolismo , Esofagitis/patología , Femenino , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Gastritis/metabolismo , Gastritis/patología , Humanos , Enfermedades Inflamatorias del Intestino/metabolismo , Enfermedades Inflamatorias del Intestino/patología , Linfocitos/patología , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/metabolismo , Gastropatías/metabolismo , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patología , Adulto Joven
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