Microencapsulated sodium butyrate reduces the frequency of abdominal pain in patients with irritable bowel syndrome.

AIM: Abdominal pain, defaecation disorder and change of bowel habit are the commonest symptoms of irritable bowel syndrome (IBS). The effect of microencapsulated sodium butyrate (MSB) was assessed on the severity of symptoms in patients with IBS. METHOD: Sixty-six patients treated with one of the standard pharmacological therapies for at least 3 months were included in the study. They were randomized to receive MSB as a supplemental treatment to standard therapy or to receiving a placebo. Previous pharmacological therapy was continued throughout the study in both arms. Clinical evaluation was performed at baseline, 4 and 12 weeks. Each assessment was documented by a validated visual analogue score questionnaire measuring the severity of selected clinical symptoms, a closed-end questionnaire measuring the frequency of selected clinical symptoms and a single closed-end question measuring the subjective improvement of symptoms. RESULTS: After 4 weeks there was a significant decrease of pain during defaecation in the MSB group which extended to improvement of urgency and bowel habit at 12 weeks. Reduction of abdominal pain, flatulence and disordered defaecation was not statistically significant. CONCLUSIONS: MSB as a supplemental therapy can reduce the frequency of selected clinical symptoms in patients with IBS, without significant influence on reducing symptom severity.

Pouchitis may increase the risk of dysplasia after restorative proctocolectomy in patients with ulcerative colitis.

AIM: Dysplasia of the pouch mucosa after restorative proctocolectomy is rare. The aim of this study was to establish whether there is a correlation between pouchitis and dysplasia. METHOD: A group of 276 patients treated for ulcerative colitis by restorative proctocolectomy between 1984 and 2009 was analysed. The presence or absence of pouchitis and dysplasia within the pouch was evaluated. RESULTS: Inflammation was diagnosed in 66 (23.9%) patients, low-grade dysplasia in five (1.8%), high-grade dysplasia in three (1.1%), and cancer in one patient (0.4%). The prevalence of low-grade dysplasia was significantly higher in patients with inflammation than in those without (P < 0.04). High-grade dysplasia was significantly more frequent in pouchitis than in non-inflamed pouches (P < 0.01). Logistic regression analysis suggested that the occurrence of mucosal inflammation increased the risk of low grade dysplasia. CONCLUSION: Patients with chronic pouchitis are at risk of dysplasia and require surveillance of the pouch.

Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease.

OBJECTIVE: A modification of Doppler guided haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and safety of third and fourth degree haemorrhoidals are given. METHOD: Thirty patients underwent DGHAL combined with recto-anal-repair (RAR). Each had rectal examination, anorectal manometry and Quality of Life assessment before and 3 months after the procedure. RESULTS: Twenty-nine patients were included in the final analysis. There were three (10.34%) patients of intra-operative and one (3.45%) of postoperative bleeding. Three months after RAR (17.24%) patients with minor residual mucosal prolapse were detected, three (10.34%) patients reported residual symptoms. There was no case of recurrent bleeding. Anal manometry at 3 months after RAR was significantly lower than before the procedure (P < 0.05). One (3.45%) patient reported occasional soiling 3 months after RAR. CONCLUSION: Recto-anal-repair is safe in treating third and fourth degree haemorrhoids with no major complications and low rate of residual disease.

Functional expression of HGF and its receptor in human colorectal cancer.

BACKGROUND: Hepatocyte growth factor (HGF) stimulates proliferation, migration and morphogenesis of epithelial cells by specific binding to its receptor c-met. Overexpression of HGF or c-met has been reported for human gastric or pancreatic cancer. In colorectal cancer overexpression of c-met but not HGF has been shown. However, elevated HGF serum levels have been detected in colorectal cancer patients. Therefore, the present study was performed to investigate expression patterns of both c-met and HGF in colorectal cancers and metastasis in comparison to normal mucosa. Furthermore, the mitogenic actions of HGF on colorectal cancer cells were studied in vitro. METHODS: Expression of c-met and HGF were analyzed by RT-PCR and Western blotting and localized in the tissues utilizing immunohistochemistry. Mitogenic effects of HGF were determined in four human colon cancer cell lines by (3)H-thymidine incorporation studies. RESULTS: C-met and HGF mRNA were detectable in 60% of the normal specimen, but in the majority of cancer samples, and in just 33% of the liver metastasis. In cancer samples a coexpression of c-met and HGF was detected in 77% of the specimens. The extent of protein expression of receptor and ligand correlated with the mRNA expression. Moreover, c-met protein expression was increased 2- to 3-fold in colorectal cancers. C-met was detected in cells of epithelial origin, whereas HGF was expressed by mesenchymal cells. In vitro, HGF significantly stimulated cell growth in all four cell lines. CONCLUSION: Overexpression of c-met protein in colorectal cancers is combined with an expression of HGF in the majority of cases suggesting a paracrine manner of growth enhancement, while only a weak expression of c-met or HGF was detected in metastatic tissues.

Endoscopical and histological aspects of inflammatory changes in J-pouch mucosa.

The aim of the study was endoscopic and histological evaluation of mucosal inflammatory changes in the ileal reservoir after restorative proctocolectomy with ileoanal anastomosis (IPAA) because of FAP (27 patients) and ulcerative colitis (34 patients). Endoscopic symptoms of pouchitis (edema, granularity, contact bleeding, loss of vascular pattern, mucus, erosions) were found in 13 patients (4 were operated on because of FAP, 9 because of UC). A statistically significant difference (p < 0.0001) was found between endoscopic inflammatory index in UC (4.0 +/- 0.5) and in FAP (1.00 +/- 0.00). The endoscopic changes were correlated with the Moskowitz histological classification, in 12 acute score and in 6 chronic score were above 4 points. In 18 patients histological diagnosis of pouchitis was made (5 in FAP, 13 in UC). Acute pouchitis occurred in 12 patients and chronic in 6. In one patient histological changes resembled Crohn's disease. Regular endoscopic control with histological examination and verification of inflammatory lesions in the ileal reservoir is necessary.

[Personal experiments in treating rectal rumors with the TEM technique]. / Doswiadczenia wlasne w leczeniu guzów odbytnicy technika TEM.

Transanal Endoscopic Microsurgery (TEM) was introduced to clinical practice by Buess in 1983. After several years of gaining experience technique has been used for the excisions of rectal tumours. TEM enables excisions of the tumours localised in the rectum and distal portion of the sigmoid colon from 5 to 25 cm from the anal verge. Until now 13 patients have been operated using TEM method. The group includes also rectal cancers classified as pT-1 and G-1. Preliminary results are encouraging. The patients left the hospital four days after the procedure and started professional activity two weeks postoperatively. All the patients are followed-up: patients who had adenomas once a year and those with pT-1 low-risk rectal cancer-every three months in their first postoperative year and then in six month intervals. Local excision of the adenomas and early cancers of the rectum with the use of TEM proves to be an effective method of surgical treatment in a selected group of patients.

[Removal of rectal adenoma with the TEM technique]. / Usuniecie gruczolaka odbytnicy technika TEM.

The paper presents the operation of local excision of a rectal polyp using TEM technique. The operation was performed at our Department on the 12th of April 1996 with the instruments for transanal endoscopic microsurgery made by Wolf Company according to professor Buess. The patient was 49 year old woman, in whom rectoscopy revealed at 8 cm above the dantate line a cauliflower like lesion, 3 cm in diameter, bleeding on touch and not fixed to the underlying tissues. Transrectal sonography showed the tumor was confined to the mucosa with the absence of muscularis propria infiltration. During the operation the polyp was removed with the full thickness portion of rectal wall. Wound edges were approximated with Vicryl 3-0. Histopathology confirmed villous papillary adenoma with a mild focal epithelial dysplasia. The excision was complete. The postoperative course was free of any complications and the patient being appointed for a control, was discharged from the hospital four days after the surgery. On the follow ups she presented with no complaints. When preparing the instruments, it is important to fix the apparatus properly allowing enough room for the operator's hands and getting used to the stereoscopic view. A very helpful device is the instrument for monopolar coagulation, bipolar cutting, suction and flushing, lately introduced by professor Buess.

[Local excision of early rectal cancer]. / Miejscowe wyciecie wczesnego raka odbytnicy.

The authors discuss 56 patients operated for rectal cancer primarily estimated as noninvasive. Applied procedures were: local excision through stretched anus /46 cases/, Localio technique /6 cases/, rectotomy during a laparotomy /1 case/ and Transrectal Endoscopic Microsurgery /3 cases/. The patients were divided into 3 groups according to tumor's grading and staging. All patients with cancer infiltration limited to submusosal layer were cured. In the group of infiltrated muscularis layer 36.4% of patients had local recurrences. They were reoperated or irradiated. Two of them died due to cancer spread. The late results in patients with cancer invasion through muscularis layer were poor.

[Loop ileostomy--use and results]. / Ileostomia petlowa--zastosowanie i wyniki.

Loop ileostomy (LI) is created to obtain a complete diversion of feces with defunctioning of the distal colon. LI can be temporary or permanent for palliative reasons. The purpose of this study was to assess the morbidity related to LI created at our Institution between 1985 and 1996 in 135 patients. According to the results of the study and the review of the literature, the authors conclude that LI is a simple and safe method, providing an effective fecal diversion. LI should be the procedure of choice if the risk of bowel suture line complications is expected.

[Surgical procedure in fulminant colitis and toxic megacolon]. / Postepowanie chirurgiczne w colitis fulminant oraz toxic megacolon.

Both fulminant colitis and toxic megacolon are regarded as the sequelae of colitis in which irreversible changes in the whole thickness of colonic wall have occurred. These condition both call for an immediate, emergent surgical intervention. Until recently the procedure of choice in this acute phase of the disease was colectomy with Brooke ileostomy and Hartmann type closure of the distal rectum. Colectomy with ileal pouch anal anastomosis was reserved only for elective surgery. The improvement in surgical technique, but first of all widespread of stapling devices, have shortened the time of operation and simplified the procedure, so that creation of an ileal reservoir is currently more often performed as a one step procedure and without an increased risk. Between 1985 and 1997 in our Department, 120 patients had ileal pouches created for various conditions. There were 72 patients with ulcerative colitis in this series and 10 of them had-one-step procedure involving pouch formation in the acute phase of the disease. Multi-step procedures, including Hartmann's colectomies were performed in 16 patients. One-step operations involving ileal pouch creation in the acute phase of the ulcerative colitis are feasible in selected cases and in experienced centres. Such an approach shortens the time of treatment.

Ultrastructural changes in the small intestinal epithelium after total resection of the colon.

UNLABELLED: The aim of the study was to analyze ultrastructural changes in the mucosa of the small intestine after total resection of the colon in 29 patients (familial polyposis in 21, ulcerative colitis in 8). We studied specimens of the small intestinal mucosa obtained from ano- and rectoscopy. The specimens were routinely processed for transmission electron microscopy. Early after the operation (up to 4-5 months) we observed marked structural disorders of the mucosal epithelium and regenerative cell atypia (dysplasia-like changes). At 6 months after the operation we found rapidly progressing normalization of the epithelial mucosa and its mimicking the epithelium of the colon: increased amount of mucous cells, formation of vacuolized cells, almost complete atrophy of microvilli on the surface of enterocytes, increase of the intercellular space (retention space). Foci with dysplasia features were quite numerous in group I, in contrast to group II where they were sporadic. CONCLUSION: the epithelium of small intestinal mucosa has the ability of convergence towards the epithelium of colon.