Search

Background: Serum globulin is an inflammation marker. To date, no evidence regarding the association between serum globulin and disease activity in patients with ulcerative colitis has been reported. Aims: We evaluated the association between serum globulin and endoscopic activity in patients with ulcerative colitis. Methods: Serum globulin was divided into tertiles based on the distribution of study subjects (low globulin, ≤ 2.7 g/dl (reference); moderate globulin, 2.7–3.1 g/dl; and high globulin, > 3.1 g/dl). A single endoscopic specialist evaluated the endoscopic findings, and mucosal healing was based on Mayo endoscopic subscore. Results: A total of 277 patients with ulcerative colitis were included in the study. Serum globulin was independently positively associated with diminished or absent vascular markings [moderate: adjusted odds ratio (OR) 3.70 (95% confidence interval, CI: 1.82–7.88) and high: adjusted OR 2.40 (95%CI: 1.20–4.94), p for trend = 0.005]. A similar positive association between globulin and erosion was found [high: adjusted OR 2.00 (95%CI: 1.05–3.86)]. Serum globulin was independently inversely associated with mucosal healing [moderate: adjusted OR 0.37 (95%CI: 0.18–0.73) and high: adjusted OR 0.31 (95%CI: 0.14–0.64), p for trend = 0.001] and adjusted partial mucosal healing [moderate: OR 0.51 (95%CI: 0.26–0.98), p for trend = 0.048]. The inverse association between globulin and mucosal healing was significant in the low but not the high C-reactive protein group. Conclusions: In patients with ulcerative colitis, serum globulin was significantly positively associated with endoscopic activity, and was significantly inversely associated with mucosal healing, especially in the low C-reactive protein group. [ABSTRACT FROM AUTHOR]

Purpose: Bilirubin is known to have antioxidant effects. Several pieces of evidence regarding association between serum bilirubin and UC exist. Three studies found that serum bilirubin was inversely associated with severity of ulcerative colitis (UC), but no evidence regarding an association between serum bilirubin and mucosal healing (MH) has yet been shown. Thus, we evaluated this issue among Japanese patients with UC. Methods: The study subjects consisted of 304 Japanese patients with UC. Serum total bilirubin and indirect bilirubin were divided into quartiles on the basis of the distribution of all study subjects (low, moderate, high, and very high). Several endoscope specialists were responsible for evaluating MH, which was defined as a Mayo endoscopic subscore of 0. The information on clinical remission was collected using medical records. Results: The mean age was 49.9 years, the percentage of male patients was 59.2%, and the percentage of MH was 29.3%. High serum total bilirubin was independently positively associated with MH (OR 2.26 [95%CI 1.13–4.61]. However, after adjustment for confounding factors, the association between total bilirubin and MH disappeared. Very high serum indirect bilirubin was independently positively associated with MH (OR 2.31 [95%CI 1.10–5.00], p for trend = 0.026). No association between bilirubin and clinical remission was found. Conclusions: Among Japanese patients with UC, serum indirect bilirubin, but not total bilirubin, was significantly positively associated with MH but not clinical remission. [ABSTRACT FROM AUTHOR]

A 77-year-old man with hypertension, diabetes mellitus, ischemic heart disease and a smoking habit presented at our hospital with sudden abdominal pain. Computed tomography indicated edematous swelling and pneumatosis of the intestinal wall in a localized area of the ascending colon with inflamed adipose tissue. Acute mesenteric ischemia was diagnosed. Abdominal angiography showed stenosis of the mesenteric arteries. Virtual histology-intravascular ultrasound imaging indicated a fibrous change in the superior mesenteric artery with a necrotic core. Endovascular treatment with stent placement after percutaneous transluminal angioplasty was effective. Surgery would usually be considered as the first choice for treating patients with acute mesenteric ischemia; however, when this condition is complicated with metabolic diseases, stenotic changes in the mesenteric arteries that would normally be found in patients with chronic mesenteric ischemia need to be considered to ensure optimal treatment. [ABSTRACT FROM AUTHOR]

Background: A few reports suggest that the emergence of double balloon endoscopy (DBE) has likely changed the clinical picture of small bowel tumors (SBTs).Aim: To further clarify the characteristics of SBTs detected by DBE.Methods: A retrospective chart review was conducted in 227 patients who had undergone DBE.Results: The SBT group contained more symptomatic patients than the non-SBT group (90% vs. 49%, P<0.0005) with a significantly higher rate of gastrointestinal symptoms at presentation (72% vs. 33%, P<0.005). Twenty patients (8.8%) were eventually diagnosed with SBT, and their indications for DBE were obscure gastrointestinal bleeding (n=5), abdominal pain (n=5), abdominal fullness (n=5), vomiting (n=2), and diarrhea (n=1). Tumors were located in the jejunum in 14 patients (70%) and in the ileum in 6 (30%). A final histological diagnosis was assigned to all 20 patients: primary adenocarcinoma (n=8, 40%), malignant lymphoma (n=5, 25%), metastatic cancer (n=4, 20%), gastrointestinal stromal tumor (n=1, 5%), carcinoid tumor (n=1, 5%) and inflammatory fibroid polyp (n=1, 5%). Stenosis or ulceration were the most frequently observed endoscopic findings (n=13, 65%). All primary adenocarcinomas and three of four (75%) metastatic cancers showed stenosis or ulceration. Three of five (60%) malignant lymphomas showed multiple lymphomatous polyps. All patients but one underwent surgical resection or chemotherapy or both.Conclusion: DBE is a safe and useful procedure that enables a precise diagnosis of SBTs. [ABSTRACT FROM AUTHOR]

An asymptomatic 66-year-old woman was admitted to our hospital for detailed evaluation of a 63-mm mass in the tail of the pancreas detected on abdominal computed tomography (CT). Abdominal ultrasound (US) revealed a hypoechoic solid mass, but on contrast-enhanced ultrasound (CE-US) with perflubutane, a stellate structure within the tumor, characteristic of a serous cystadenoma, was observed. A distal pancreatectomy was performed, and histologic examination confirmed a serous cystadenoma of the pancreas. This case highlights the usefulness of CE-US with perflubutane for diagnosis of pancreatic serous cystadenomas. [ABSTRACT FROM AUTHOR]

Double-balloon endoscopy (DBE) and capsule endoscopy have opened up a new field of investigation regarding the small intestine. Although DBE has been widely used for diagnosis and treatment of different lesions in the small intestine, there is a paucity of information regarding endoscopic features of the small intestine in patients with liver cirrhosis (LC). Endoscopic images of the small intestine were taken in 21 patients with LC by DBE (EN-450P5/20 or EN-450T5/W). Biopsy specimens were taken from various parts of the small intestine and examined microscopically. Different endoscopic features of the small intestine were compared in relation to the clinical parameters of these patients. Erythema and telangiectasia were observed in five patients (24%) and one patient (5%), respectively. In eight patients (38%), the small intestinal mucosa was edematous, and the intestinal villi of these patients were swollen and rounded, resembling herring roe. The patients with a herring roe appearance in the small intestine had advanced LC (Child’s classification B and C), and all of them also had portal hypertensive gastropathy and portal hypertensive colopathy. In comparison with patients without a herring roe appearance in the small intestine, patients with a herring roe appearance had a significantly increased spleen volume ( P < 0.05) and decreased platelet counts ( P < 0.05). Although preliminary, this study indicated that DBE may be useful for detecting different types of endoscopic lesions in patients with LC. A herring roe appearance seems to be one of the characteristic features of portal hypertensive enteropathy. However, further study will be required to develop insights about its pathogenesis. [ABSTRACT FROM AUTHOR]

Regulatory dendritic cells (Reg-DCs), which induce regulatory T cells and interleukin (IL)-10 in vitro, are capable of inducing immunogenic tolerance in vivo. In this study, we assessed whether Reg-DCs modulate the course of autoimmune processes in a murine model of autoimmune gastritis (AIG). AIG mice were produced by neonatal thymectomy of 3-day old BALB/c mice followed by administration of polyinosinic:polycytidylic acid (poly I:C). Reg-DCs were produced by culturing bone marrow DCs with IL-10, lipopolysaccharide, and parietal cell (PC) antigen for 2 days. In the course of development of AIG, BALB/c mice were administered either Reg-DCs, mature DCs, or phosphate-buffered saline, intraperitoneally, four times. The levels of gastritis and autoantibody to PC antigen were assessed serially in these mice. The stages of gastritis and the titers of autoantibody to PC antigen were significantly lower in Reg-DC-treated mice than in mature DC-treated mice ( P < 0.05). Spleen cells from Reg-DC-treated mice produced increased levels of IL-10 and decreased levels of IL-12p70 and interferon-γ ( P < 0.05). Also, frequencies of IL-10-producing CD4+CD25+ T cells in the spleen and Foxp3+CD4+CD25+ T cells in the peripheral blood were significantly higher in Reg-DC-treated mice than in mature DC-treated mice ( P < 0.05). Taken together, these results suggest that increased induction of CD4+CD25+ regulatory T cells by Reg-DCs might contribute to downregulation of inflammatory processes and autoantibody production during AIG development in mice. [ABSTRACT FROM AUTHOR]

Background. Variceal bleeding is a common, lifethreatening complication of primary biliary cirrhosis (PBC). Recently, several reports have suggested that the existence of esophageal varices in patients with PBC is a significant factor in the assessment of disease prognosis. However, there have been no reports on the recurrence of esophageal varices following treatment in patients with PBC. In this study, we investigated the recurrence of esophageal varices in PBC patients and attempted to identify predictive factors for the recurrence of esophageal varices. Methods. Between April 1993 and August 2003, 138 patients with esophageal varices who had been treated by endoscopic variceal ligation (EVL; 96 men and 42 women; age, 33-83 years; mean, 62.6 ± 10.1 years), were enrolled in the present study. The diagnosis of esophageal varices was made by upper gastrointestinal endoscopy, and the varices were graded according to the criteria of the Japanese Research Society for Portal Hypertension. The relationship between the recurrence of esophageal varices and factors such as biochemical and hematological parameters, as well as the etiology of the liver disease, was analyzed using the Kaplan-Meier method and the multivariate Weibull regression model. Results. PBC patients had an earlier recurrence of esophageal varices compared to non-PBC patients, and two factors, prothrombin time and etiology (PBC/non-PBC), were indicative of significantly earlier recurrence of esophageal varices. Conclusions. We should be extra careful in the follow-up of patients with PBC after therapy for esophageal varices. [ABSTRACT FROM AUTHOR]