Macroscopic findings in collagenous colitis: a multi-center, retrospective, observational cohort study.

BACKGROUND: Collagenous colitis (CC) is by definition a histological diagnosis. However, colonoscopy often reveals characteristic endoscopic findings. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in 4 participating centers. METHODS: This was a retrospective study; the databases of 2 university hospitals in Edinburgh (Scotland) and Malmö (Sweden), and 2 district general hospitals in Tomelloso (Spain) and Gateshead (England) were interrogated for patients diagnosed with CC between May 2008 and August 2013. Endoscopy reports and images were retrieved and reviewed; data on lesions, sedation, bowel preparation and endoscopist experience were abstracted. Categorical data are reported as mean±SD. Fischer's exact, chi-square and t (unpaired) tests were used to compare datasets. A two-tailed P-value of <0.05 was considered statistically significant. RESULTS: 607 patients (149 male, mean age 66.9±12.25 years) were diagnosed with CC. A total of 108/607 (17.8%) patients had one or more suggestive endoscopy findings: i.e., mucosal erythema/edema, 91/607 (15%); linear colonic mucosal defects, 12/607 (2%); or mucosal scarring, 5/607 (0.82%). For colonic mucosa erythema, there was no difference in the odds of finding erythema with the use of different bowel preparation methods (P=0.997). For colonic mucosal defects there was some evidence (P=0.005) that patients colonoscoped by experienced endoscopists had 87% less odds of developing such defects. Moreover, there was evidence that analgesia reduced the odds of developing mucosal defects by 84%. CONCLUSION: A significant minority of patients with CC have endoscopic findings in colonoscopy. The description of such findings appears to be related to the endoscopist's experience.

Distinct colonoscopy findings of microscopic colitis: not so microscopic after all?

Microscopic colitis (MC) is considered an "umbrella term", comprising two subtypes, i.e., collagenous colitis (CC) and lymphocytic colitis (LC). They are classically associated with normal or unremarkable colonoscopy. In the last few years, reports have been published revealing findings that are thought to be characteristic or pathognomonic of MC, especially CC. A systematic electronic and manual search of PubMed and EMBASE (to December 2010), for publications on distinct endoscopic findings in MC, resulted in 42 relevant reports for inclusion in this review. Eighty eight patients with collagenous colitis were presented. Only one publication describing a distinct endoscopic pattern in LC was found. Typical findings in CC are alteration of the vascular mucosal pattern, mucosal nodularity, a sequence of change from mucosal defects to mucosal cicatricial lesions, and perhaps (although of doubtful relevance) mucosal pseudomembranes. A causal connection of mucosal defects with the use of lansoprazole seems to exist. Adoption of the proposed lesion description herein is recommended in order to improve homogeneity of future reports.

Urdu translation of the ICD-10 chapter V (F), research diagnostic criteria (RDC): process and principles of translation.

Although there is some literature on translation and cultural adaptation of measurement scales, none is available on the translation of diagnostic guidelines, such as the International Classification of Diseases Tenth Edition (ICD-10). Our group translated ICD-10, Research Diagnostics Criteria (RDC) into Urdu, which is the official language of Pakistan but is also spoken in some states in India. Significant diasporas of Urdu speakers also exist in Western Countries. We describe the translation process and the principles that guided our work. The translation process consisted of preparation, forward-translation, external translation, synthesis, focus group discussions with laypersons to clarify terminology, and review by mental health professionals and laypersons. Translation also included a wider consultation process in which the final version was sent to Pakistani mental health professionals in Pakistan and abroad.

Soluble transferrin receptors and iron deficiency, a step beyond ferritin. A systematic review.

UNLABELLED: Iron deficiency is a common disorder; it can also be the first indicator of significant gastrointestinal pathology. Total iron stores are evaluated by ferritin measurement, but this is often difficult, as coexistent disease can obscure ferritin results. Bone marrow (BM) examination was previously felt to be superior to all known serological markers of iron status, but it has a number of disadvantages. The validity of measurement of soluble transferrin receptors (sTfR) as a surrogate marker of BM iron stores has been the subject of various studies so far. AIM: To critically review the use of sTfR as a marker for the evaluation of iron stores. METHODS: A systematic computerised literature search, in order to identify studies that compared sTfR measurement against BM iron stain. RESULTS: Twenty prospective studies were identified, of which nine fulfilled the inclusion criteria (sTfR measurement in anaemic adults alongside BM iron staining). For a total of 979 patients, a different sTfR reference range was used, but levels of 2.5 mg/L (29.5 nmol/L) were consistently used as the threshold for iron-deficiency anaemia resulting in good specificity and sensitivity. CONCLUSION: The use of sTfR improves the clinical diagnosis of iron deficiency anaemia, especially in the presence of coexisting chronic disease or gastrointestinal malignancies. The safety and cost-effectiveness of a ferritin/sTfR-based approach to exclude gastrointestinal cancer in the presence of iron deficiency has to be proven with a prospective, well standardised, multicentre trial or a meta-analysis.

A ferritin level >50 microg/L is frequently consistent with iron deficiency.

BACKGROUND: The British Society of Gastroenterology (BSG) suggests that a serum ferritin level or=2 and 17 had Index

Spontaneous bacterial peritonitis.

Since its initial description in 1964, research has transformed spontaneous bacterial peritonitis (SBP) from a feared disease (with reported mortality of 90%) to a treatable complication of decompensated cirrhosis, albeit with steady prevalence and a high recurrence rate. Bacterial translocation, the key mechanism in the pathogenesis of SBP, is only possible because of the concurrent failure of defensive mechanisms in cirrhosis. Variants of SBP should be treated. Leucocyte esterase reagent strips have managed to shorten the 'tap-to-shot' time, while future studies should look into their combined use with ascitic fluid pH. Third generation cephalosporins are the antibiotic of choice because they have a number of advantages. Renal dysfunction has been shown to be an independent predictor of mortality in patients with SBP. Albumin is felt to reduce the risk of renal impairment by improving effective intravascular volume, and by helping to bind pro-inflammatory molecules. Following a single episode of SBP, patients should have long-term antibiotic prophylaxis and be considered for liver transplantation.

Leucocyte esterase reagent strips for the diagnosis of spontaneous bacterial peritonitis: a systematic review.

The reported incidence of spontaneous bacterial peritonitis (SBP) is 7-30% per annum in cirrhotic patients. Timely diagnosis and treatment is crucial to reduce mortality owing to this infection. Recently, leucocyte esterase reagent strips have been tested in the diagnosis of infection in the ascitic fluid. The objective was to evaluate the diagnostic value of leucocyte esterase reagent strips in SBP in cirrhotic patients with ascites, by systematically reviewing the evidence from prospective clinical studies. We performed a comprehensive literature search in Medline up to July 2007 for adult human prospective clinical studies. Two reviewers independently checked all identified studies for fulfillment of predefined inclusion criteria, extracted data and assessed methodological quality of included studies. We had decided a priori to pool the studies via meta-analysis, only if statistical heterogeneity was found to be nonsignificant (P>0.10). Seventeen studies were included. Statistical heterogeneity among studies was found to be highly significant (P<0.001) in all analyses, precluding pooling of data for meta-analysis. Compared with the manual polymorphonuclear count ('gold standard'), leucocyte esterase reagent strips were found to have sensitivity ranging from 45 to 100%, specificity ranging from 81 to 100%, positive predictive value ranging from 42 to 100% and negative predictive value ranging from 87 to 100%. Despite the wide variation in sensitivity and positive predictive value between studies, the consistently high negative predictive value of leucocyte esterase reagent strips in SBP diagnosis should gain it a place in the ascitic tap diagnostic algorithm.