[Inflammatory fibroid polyp in the jejunum - a case report].

Inflammatory fibroid polyps (IFP) are rare type of benign tumours found in the gastrointestinal tract. IFP´s are in most cases small in size and without symptoms but can cause intussuception and haemorrhage. We present a case of a 25 year old female who presented with abdominal pain and symptoms and signs of anemia, hemoglobin was 36 g/L upon arrival. Further workup revealed a large tumor in the small intestine. The patient underwent a partial resection of the proximal jejunum. Pathology of the specimen showed inflammatory fibroid polyp.

Incidence of inflammatory bowel disease in Iceland 1995 - 2009. A nationwide population-based study.

OBJECTIVE: We analyzed the incidence of inflammatory bowel disease (IBD) in Iceland for the period 1995-2009. MATERIAL AND METHODS: New cases of ulcerative colitis (UC) and Crohn's disease (CD) were retrieved by thorough review of all small and large intestinal pathology reports with any type of inflammation from all the pathology departments in Iceland for the period 1995-2009. All suspicious new cases of IBD were then scrutinized retrospectively by examination of their clinical records. RESULTS: A total of 1175 cases of IBD were diagnosed, 884 UC, 279 CD and 12 IBD unclassified. The crude annual incidence of UC was 20.5/100,000, increasing from 18.1 the first 5-year period to 22.1 the last 5-year period. The crude annual incidence of CD was 6.5/100,000, 6.7 the first 5-year period and 6.6 the last 5-year period. CONCLUSIONS: This study shows statistically significant increase in the incidence of UC during the study period. The incidence of CD has however remained stable.

Colonic adenomas found via colonoscopy: yield and risk factors for high-grade dysplasia.

BACKGROUND AND AIMS: The adenoma-carcinoma sequence is the model for colorectal carcinoma (CRC) developing through high-grade dysplasia (HGD) to CRC. The aim was to assess prevalence and location of adenomas found during colonoscopy and risk factors for HGD. MATERIAL AND METHODS: A population-based study using all colonoscopies and polyp specimens registered between 2000 and 2004 in Iceland. Multiple logistic regression analysis was used to assess independent risk factors for HGD. RESULTS: A total of 3,315 adenomas were removed from 2,385 patients. Only 14.0% were >1 cm in size. HGD was found in 135 (4.1%) of the adenomas and tubulovillous/villous histology in 15.0%. The prevalence of adenomas in the 50- to 69-year age group was 15.5%, and 21.5% in the >or=70-year group. 60.9% of them were located distal to the splenic flexure. Independent risk factors for HGD were in the order of importance: size; multiplicity; tubulovillous/villous histology; location in rectum, and age. The prevalence of HGD in the group with an adenoma size of 0.6-1.0 cm was 4.1% and in the 40- to 69-year age group it was 3.7%. CONCLUSION: The study suggests a potential 15% yield per colonoscopy of adenomas in 50- to 69-year-olds. There is an appreciable risk of HGD in diminutive polyps and in middle age.

Liver cirrhosis in Iceland and Sweden: incidence, aetiology and outcomes.

OBJECTIVE: The objectives of this study were to investigate the incidence, aetiology and mortality of liver cirrhosis in Iceland and in Gothenburg in Sweden. Further objectives were prognosis in relation to different aetiologies and to evaluate the relationship between alcohol consumption in these countries and the incidence of alcoholic cirrhosis in recent decades. The incidence and mortality of liver cirrhosis in Iceland has been reported to be the lowest in the Western world. There are very few data on aetiology, incidence and prognosis among cirrhotics in Sweden. MATERIAL AND METHODS: All patients diagnosed with liver cirrhosis in Gothenburg (600,000 inhabitants) and Iceland (300,000 inhabitants) during the period 1994-2003 were included. RESULTS: A total of 918 patients in Gothenburg and 98 in Iceland were identified. The annual incidence in Gothenburg was 15.3+/-2.4/100,000 compared to 3.3+/-1.2/100,000 in Iceland (p<0.0001). In Gothenburg, 69% were male and in Iceland 52% (p<0.001). In Gothenburg, 50% of the patients had alcoholic cirrhosis compared to 29% in Iceland (p<0.0001). In Gothenburg, the patients had a higher Child-Pugh score (9.0) (SD 2.5) compared to Iceland (7.3) (SD 2.7) (p<0.0001). There was no difference in survival between patients with alcoholic liver disease and those with other aetiologies. CONCLUSIONS: The incidence of liver cirrhosis is low in Iceland, i.e. 24% of the incidence in Gothenburg, due to the lower incidence of alcoholic and hepatitis C cirrhosis in Iceland. No increasing trends in the incidence of cirrhosis in these two countries were observed during the study period.

The prevalence of celiac disease in blood donors in Iceland.

BACKGROUND: Prospective epidemiological studies based on serological methods have shown that celiac disease is more common than previously thought. The aim of this study was to evaluate the prevalence of celiac disease among apparently healthy blood donors in Iceland. METHODS: Plasma samples were obtained from 813 apparently healthy blood donors at the FSA Hospital Blood Bank in Akureyri, Iceland, between December 2004 and January 2007 and screened for human tissue transglutaminase IgA antibodies. Positive samples were retested and, if the test was again positive, the subject was referred to a gastroenterologist for clinical examination and a duodenoscopy with mucosal biopsies. RESULTS: Six subjects tested positive for tissue transglutaminase. The prevalence of biopsy-confirmed celiac disease, according to modified Marsh classification, among apparently healthy blood donors in Iceland was found to be 1:136 (0.74%, 95% confidence interval 1/667-1/75, 0.15-1.33%). CONCLUSION: Prevalence of celiac disease in Iceland is similar to what has been reported in many other countries.

[Caroli's disease, case report and review of the literature]. / Sjúkdómur Carolis--sjúkratilfelli og yfirlit fraedigreina.

In 1958 Caroli described a rare disease with multifocal, segmental and saccular dilation of the large intrahepatic bile ducts which causes stagnation of bile and formation of bile sludge and stones. This results in recurrent abdominal pain, cholangitis and hepatic abscesses. The diagnosis is confirmed with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) and the purpose of treatment is to restore normal bile flow. Partial resection of the liver has given good results in patient with localized disease. The prognosis is poor despite drainage of bile and 46% of patients die from sepsis, hepatic abscesses, hepatic failure or portal hypertension. There is more than a hundred fold risk of cholangiocarcinoma. We report a case where a male who had a history of recurrent bouts of abdominal pain and pancreatitis was diagnosed with Caroli's disease. He later developed cholangiocarcinoma. Caroli's disease has not, to our knowledge, been reported in Iceland before.

[Corpus gastritis -- Helicobacter pylori -- gastrin]. / Magabolsbólga -- Helicobacter Pylori -- Gastrin.

OBJECTIVE: Corpus gastritis is a common diagnosis. Studies have shown that about 25% of patients that undergo gastroscopy receive this diagnosis. This study was undertaken to investigate etiological associations in patients with corpus gastritis in our northern Icelandic population. MATERIAL AND METHODS: Patients who had had a histological diagnosis of chronic corpus gastritis between the years of 1994 to 1998 were retrieved from the computer files of the department of pathology. In all 172 patients fulfilled the Sydney pathological criteria. Pathology review was performed by the same pathologist. Blood samples were also taken for variable serology and a urea breath test for Helicobacter pylori (H. pylori) was performed. RESULTS: Mean age 71 year old (24-99 year). Males were 57%. H. pylori infection was diagnosed in 39%. There appears to be a relationship between active gastritis and H. pylori positivity, especially if there was only chronic gastritis without atrophy or metaplasia. Atrophy was significantly greater if anti-parietal antibody was present. No connections were found between anti-parietal antibody and anti-microsomal antibody. There was significantly higher mean gastrin levels in patients with atrophy or metaplasia compared with only chronic gastritis (p<0.05), present also in patients with chronic gastritis vs active gastritis (p<0.01). There was no difference in mean gastrin levels between H. pylori positive and H. pylori negative patients. Significantly higher mean gastrin levels were seen in patients with anti-parietal antibody (p<0.001). No difference was found in mean gastrin levels between patients with or with out antimicrosomal antibody. CONCLUSIONS: There is a high probability that corpus gastritis and related complications are related to H. pylori infection in a large proportion of our population. Serum gastrin may well be a predictor of the histological grading of the chronic gastritis. We did not see a relationship with antimicrosomal activity.

[NSAIDs-induced colopathy with diaphragm-like strictures. Case report.].

A sixty-eight-year old male with osteoarthritis was admitted for elective hip replacement. Routine preoperative tests found the patient to be anemic and the operation was postponed. Colonoscopy revealed diaphragm-like strictures and ulcerations in the right colon. A right hemicolectomy was performed. It is believed that the lesions were due to the use of non-steroidal anti-inflammatory drugs (NSAIDs), as the patient had been taking diclofenac for the preceding eighteen months due to hip pain. At the time of this diagnosis, apparoximately thirty cases of colopathy with diaphragm-like strictures due to NSAID use had been reported worldwide. It is likely that with increasing use of slow-release and enterocoated preparations of NSAIDs, the number of similar cases will increase.

Subclinical intestinal inflammation: an inherited abnormality in Crohn's disease relatives?

BACKGROUND & AIMS: One approach to unraveling the genetics of complex inherited disease, such as Crohn's disease, is to search for subclinical disease markers among unaffected family members. We assessed the possible presence, prevalence, and inheritance pattern of subclinical intestinal inflammation in apparently healthy relatives of patients with Crohn's disease. METHODS: A total of 49 patients with Crohn's disease, 16 spouses, and 151 (58%) of 260 available first-degree relatives underwent a test for intestinal inflammation (fecal calprotectin concentration). The mode of inheritance was assessed from 36 index patients (by variance component analysis) when more than 50% of relatives were studied. RESULTS: Fecal calprotectin concentrations in patients with Crohn's disease (47 mg/L; confidence interval [CI], 27-95 mg/L) and relatives (11 mg/L; CI, 9-14 mg/L) differed significantly (P < 0.0001) from controls (4 mg/L; CI, 3-5 mg/L), whereas that of the spouses did not (4 mg/L; CI, 3-6 mg/L; P > 0.5). Fecal calprotectin concentration was increased in 49% of all relatives studied. The increased fecal calprotectin concentration among the relatives of the 36 index patients had an inheritance pattern that was most consistent with an additive inheritance pattern. CONCLUSIONS: There is a high prevalence of subclinical intestinal inflammation in first-degree relatives of patients with Crohn's disease that conforms best to an additive inheritance pattern. The genetic basis for this abnormality may represent a risk factor for Crohn's disease.

Collagenous and lymphocytic colitis in Iceland.

The aim of this study was to determine the nationwide incidence of collagenous and lymphocytic colitis in Iceland and the location of histopathological changes in the large bowel. All pathology reports of patients diagnosed with or suspected of having collagenous colitis or lymphocytic colitis in the period 1995-1999 were identified. All pathology samples were reevaluated using strict diagnostic criteria. After reevaluation 125 patients fulfilled our diagnostic criteria, 71 as collagenous colitis and 54 as lymphocytic colitis. The mean annual incidence for collagenous colitis was 5.2/100,000 inhabitants, and the mean age at diagnosis was 66.1 years. The mean annual incidence for lymphocytic colitis was 4.0/100,000 inhabitants, the mean age at diagnosis was 68.7 years. Both diseases more commonly involved the colon than the rectum. The incidence of collagenous colitis and lymphocytic colitis is high in Iceland. The mean annual incidence of collagenous colitis is much higher in Iceland than hitherto reported elsewhere.