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Purpose To prospectively evaluate interobserver agreement for small bowel ultrasound (SBUS) in newly diagnosed and relapsing Crohn’s disease. Methods A subset of patients recruited to a prospective trial comparing the diagnostic accuracy of MR enterography and SBUS underwent a second SBUS performed by one of a pool of six practitioners, who recorded the presence, activity and location of small bowel and colonic disease. Detailed segmental mural and extra-mural observations were also scored. Interobserver variability was expressed as percentage agreement with a construct reference standard, split by patient cohort, grouping disease as present or absent. Prevalence adjusted bias adjusted kappa (PABAK), and simple percentage agreement between practitioners, irrespective of the reference standard, were calculated. Results Thirty-eight patients (11 new diagnosis, 27 relapse) were recruited from two sites. Overall percentage agreement for small bowel disease presence against the consensus reference was 82% (52–95% (95%CI)), kappa coefficient (κ) 0.64, (substantial agreement) for new diagnosis and 81%, κ 0.63 (substantial agreement) for the relapsing cohort. Agreement for colonic disease presence was 64%, κ 0.27 (fair agreement) in new diagnosis and 78%,κ 0.56 (moderate agreement) in the relapsing cohort. Simple agreement between practitioners was 84% and 87% for small bowel and colonic disease presence respectively. Practitioners agreed on small bowel disease activity in 24/27 (89%) where both identified disease. Kappa agreement for detailed mural observations ranged from κ 0.00 to 1.00. Conclusion There is substantial practitioner agreement for small bowel disease presence in newly diagnosed and relapsing CD patients, supporting wider dissemination of enteric US.

Background It is known that patients with ulcerative colitis (UC) have reduced numbers of short‐chain fatty acid (SCFA) producing bacteria and reduced SCFA concentration in feces. There is also evidence that Hispanic patients have increased incidence of UC and increased likelihood of developing disease at a younger age. To understand why this might be, we compared fiber intake and fecal SCFA concentrations in Hispanic children with UC and non‐Hispanic children with UC. Methods In this cross‐sectional study conducted at the Children's Hospital of Los Angeles, stool was collected from 22 Hispanic and 31 non‐Hispanic children with UC. SCFAs in the stool were quantified using mass spectrometry. Diet information was collected at the time of stool collection using food frequency questionnaires. Results Acetic acid, butyric acid, isovaleric acid, and propionic acid concentrations are significantly lower in Hispanic children with UC compared to age, gender, and disease activity matched non‐Hispanic children with UC (p, Hispanic children with ulcerative colitis have lower short chain fatty acids.

Purpose Surgical site infection (SSI) is the most frequently occurring nosocomial infection. Remarkable surgical progress has recently been made in laparoscopic surgery. Therefore, our objective was to investigate the association between increased rates of laparoscopic colon surgery and SSI. Methods We retrospectively investigated SSI surveillance data from July 2003 to December 2015. Two university hospitals and 25 university-affiliated hospitals participated in prospective SSI surveillance. Univariate and multivariate analyses were performed to detect significant associations. Results We investigated 9655 colon surgeries. The year in which surgery was performed was significantly associated with the SSI rate (p = 0.0381). The rate of laparoscopic surgery gradually increased during the study period, and by 2012 it was routinely used for > 50% of colon surgeries. Laparoscopic surgery became a significant factor associated with reduced SSI rates compared with conventional open surgery once the performance rate of laparoscopic surgery reached > 50%. Conclusions Increasing rates of laparoscopic colon surgery tended to be associated with a reduction in the SSI risk after surgical treatment of colonic disease. The results of this study might encourage surgeons to view laparoscopic surgical techniques as an evidence-based approach for reducing the risk of SSI. Electronic supplementary material The online version of this article (10.1007/s00595-019-1760-1) contains supplementary material, which is available to authorized users.

BackgroundThe primary aim was to scrutinize our hypothesis: “Do more mature preterm (MMP) babies with surgical necrotizing enterocolitis (NEC) predominantly develop the colonic disease and are different in their response and behaviour in comparison to exceedingly preterm (EP) babies?” Secondary outcomes were to define time taken in developing NEC, time from diagnosis to laparotomy, requirement of parenteral nutrition (PN), and ventilatory support.MethodsWe defined MMP babies as ≥30 weeks of gestation and EP babies as ≤29 weeks+6 days of gestation. Inclusion criteria were all babies ResultsOf the total, 41% (97/234) of babies underwent laparotomy between 2010 and 2019. Totally, 81% were EP and 19% were MMP babies. Pure colonic involvement was seen in 9% of EP babies in comparison to 56% in the MMP babies (p=0.0001). Involvement of only the small bowel was seen in two-thirds of EP babies in comparison to only one-third in MMP babies (p=0.01). EP cohort required PN for 82 days (median) in comparison to 17 days (median) in the MMP cohort (p=0.001). Ventilation requirement in the EP group versus the MMP group was 24 vs 9 days (median), respectively (p=0.0006).ConclusionsMMP babies predominantly developed colonic disease, whereas EP babies predominantly developed small bowel disease. EP babies required a longer duration of PN and ventilation support. This study opens a new area of research to differentiate pathogenesis and maturation patterns of the small and large bowels in babies with NEC.

Background The aim of the current study was to assess histological features of appendices from patients with UC and its clinical relevance. Methods Patients with UC in remission and active UC (therapy refractory) that underwent an appendectomy in the frame of clinical trials between 2012–2019 were included. Histological features of UC appendices were compared to those of patients with acute appendicitis and colon carcinoma. The Robarts Histopathology Index score (RHI) was used to assess appendiceal inflammation. In patients with active UC, clinical and histological characteristics were compared between patients with and without endoscopic response after appendectomy. Results In total, 140 appendix specimens were assessed (n=35 UC remission, n=35 active UC, n=35 acute appendicitis, n=35 colon carcinoma). Histological features of appendices from UC patients looked like UC rather than acute appendicitis. The incidence of active appendiceal inflammation was not different between UC patients in remission versus active disease (53.7% versus 46.3%, p=0.45) and limited versus extensive disease (58.5% versus 41.5%, p=0.50). Endoscopic response, assessed in 28 therapy refractory patients, was more frequently seen in patients with higher RHI scores (RHI>9 81.8% versus RHI≤9 9.1%, p=0.004) and limited disease (proctitis/left sided 63.6% versus pancolitis 36.4%, p=0.02). Conclusion The presence of active appendiceal inflammation is common in UC and not related to disease activity in the colon. More than 50% of UC patients in remission show active histological disease in the appendix. Favorable response to appendectomy for refractory UC was seen in cases with ulcerative appendicitis. These findings might support the role of the appendix as a driving force in UC.

Little is known about the incidence of metachronous advanced neoplasia (AN) following resection of submucosal invasive colorectal cancer (SM-CRC). Here, we aimed to assess the occurrence of metachronous AN following SM-CRC resection. We retrospectively reviewed consecutive patients who underwent SM-CRC resection at an academic medical center between 2005 and 2013. Among 343 patients, 250 (72.9%) underwent surgical resection or endoscopic resection followed by surgical resection and 93 (27.1%) underwent only endoscopic resection. During a median follow-up period of 61.5 months, the overall incidence of metachronous AN was 7.6%, and the cumulative incidence at 5 years was 6.1%. The cumulative incidence was significantly higher in the endoscopic resection group than in surgical resection group, in patients with colonic disease than in those with rectal disease, and in patients with synchronous AN than in those without. Multivariate analysis revealed that synchronous AN was the only significant risk factor for metachronous AN (HR 4.35; 95% CI 1.88–10.1). These findings imply that depending on synchronous AN, a surveillance protocol following SM-CRC resection can be changed for better detection of metachronous AN.

INTRODUCTION: Colonoscopy is the standard investigation for assessing colonic disease, with moderate yield. The American Society for Gastrointestinal Endoscopy (ASGE) published guidelines to tailor the appropriate use of colonoscopy. The aims of this study were to determine the frequency at which colonoscopy was performed for an appropriate indication based on ASGE´s 2012 guidelines, and to determine if there was an association of appropriateness of indication with endoscopic findings. METHODS: a retrospective study of colonoscopies performed in a private endoscopy centre in Lagos, Nigeria, between January 2014 and December 2016. Ethical approval was obtained before commencement. Data retrieved were basic demographics, indication of, and findings at colonoscopy. Data were analysed using SPSS 23. A p-value of

Neonatal small left colon syndrome is a rare cause of intestinal obstruction in the newborns. This is a report of 4 cases outlining aspects of diagnosis and treatment.

Curcumin-loaded chitosan-pectin microparticles based on polymeric microencapsulation were prepared by two methods to delay the release of curcumin in the digestive system, employing Mg2+ as a pectin-crosslinking agent for the first time. Pectin-coated curcumin-chitosan microparticles (C-g-PMg) and curcumin-loaded chitosan-pectin composite microparticles (C-PMg-g) were formulated, and their release profiles at pH 1.2 and at pH 6.8 were tested. The former (C-g-PMg) showed slower curcumin release profiles than the latter (C-PMg-g) because the C-g-PMg are composed of two layers, a chitosan-glutaraldehyde layer and a pectin-Mg2+ layer, which together hold the curcumin for a longer duration. Of the pectin-coated microparticles, those crosslinked with Mg2+ showed a slower release rate than those crosslinked with Ca2+, but the former showed a faster release rate at pH 6.8 in the presence of pectinase, acting as a promising drug delivery carrier for treating a colonic disease. The pectin layer and the pectin-crosslinking agent play a vital role in prolonging the release of curcumin until pectin is degraded by pectinase.

Background and Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.

RESUMEN La enfermedad diverticular corresponde a una condición habitual en el territorio occidental, siendo el hallazgo más frecuente en población de zonas urbanizadas. Respecto a su origen, se ha planteado la influencia de factores ambientales y genéticos, incluyendo en su etiología una inadecuada ingesta de fibra dietética, disbiosis de la microbiota intestinal y niveles alterados de vitamina D. A su vez, la enfermedad diverticular sintomática no complicada (EDNC) corresponde a un tipo de diverticulosis crónica cuyas características asemejan al síndrome de intestino irritable, lo que resalta la importancia en la comprensión de esta condición. Recientemente, se ha discutido la forma en que se aborda la enfermedad diverticular y en el siguiente escrito se expondrá evidencia sobre la patogénesis y su actual manejo. ABSTRACT Diverticular disease corresponds to a habitual condition in the western territory, being frequently found among the population of urban areas. Regarding its origin, the influence of environmental and genetic factors, including the etiology of dietary fiber intake, intestinal microbiota dysbiosis and altered levels of vitamin D have been recognized. Symptomatic uncomplicated diverticular disease corresponds to a type of chronic diverticulosis whose characteristics resemble irritable bowel syndrome, highlighting the importance of understanding this condition. Recently, the treatment of the disease has been discussed and the following review presents evidence on pathogenesis and its management.

[EN] Colon targeted drug delivery is highly relevant not only to treat colonic local diseases but also for systemic therapies. Mesoporous silica nanoparticles (MSNs) have been demonstrated as useful systems for controlled drug release given their biocompatibility and the possibility of designing gated systems able to release cargo only upon the presence of certain stimuli. We report herein the preparation of three gated MSNs able to deliver their cargo triggered by different stimuli (redox ambient (S1), enzymatic hydrolysis (S2), and a surfactant or being in contact with cell membrane (S3)) and their performance in solution and in vitro with Caco-2 cells. Safranin O dye was used as a model drug to track cargo fate. Studies of cargo permeability in Caco-2 monolayers demonstrated that intracellular safranin O levels were significantly higher in Caco-2 monolayers when using MSNs compared to those of free dye. Internalization assays indicated that S2 nanoparticles were taken up by cells via endocytosis. S2 nanoparticles were selected for in vivo tests in rats. For in vivo assays, capsules were filled with S2 nanoparticles and coated with Eudragit FS 30 D to target colon. The enteric coated capsule containing the MSNs was able to deliver S2 nanoparticles in colon tissue (first step), and then nanoparticles were able to deliver safranin O inside the colonic cells after the enzymatic stimuli (second step). This resulted in high levels of safranin O in colonic tissue combined with low dye levels in plasma and body tissues. The results suggested that this combination of enzyme-responsive gated MSNs and enteric coated capsules may improve the absorption of drugs in colon to treat local diseases with a reduction of systemic effects., The authors acknowledge the financial support from the Spanish Government (Projects MAT2015-64139-C4-1-R, SAF2016-78756 and AGL2015-70235-C2-2-R) and the Generalitat Valenciana (Project GVA/2014/13).

Background The dynamic changes of serum circRNAs, which act as a sponge of microRNA, has a great potential in predicting colonic disease, especially in malignant diseases. However, whether the mechanism of circRNA in regulating colonic epithelial mucosa is still unknown. Here, we explore the sponging effects of hsa_circ_0053063 targeting miR-361-3p in colon epithelial cells. Methods According to the ceRNA analysis, the potential target miRNAs of hsa_circ_0053063 were collected. Dual-luciferase reporter gene assays were performed to confirm the circRNA sponge of miRNAs. Then the potential target gene of miR-361-3p was predicted. Dual-luciferase reporter gene assays and real-time PCR were performed to detect the regulation between ncRNAs and target gene in colon epithelial cells HCoEpiC and NCM460. Results According to the ceRNA analysis, we found that miR-361-3p might be a target of hsa_circ_0053063 (figure 1a). Dual-luciferase reporter gene assays demonstrated that hsa_circ_0053063 bound miR-361-3p directly (figure 1b). Then we predicted that ATG13 was a target gene of miR-361-3p. Dual-luciferase reporter gene assays demonstrated that miR-361-3p bound ATG13 directly. Real-time PCR revealed that miR-361-3p decreased expression of ATG13, however, hsa_circ_0053063 reversed the inhibition of expression of ATG13 by miR-361-3p. Conclusions Hsa_circ_0053063 released the inhibition of expression of ATG13 by miR-361-3p. hsa_circ_0053063 may act as a sponge of miR-361-3p targeting ATG13 in colon epithelial cell.

Introduction In Kettering General Hospital (KGH) we perform almost 500 CT colonograms (CTCs) annually for patients who; do not want, are unable to tolerate, or have failed a colonoscopy (which is considered the “gold standard” colonic examination). The most common reasons for CTC are iron deficiency anaemia, and change in bowel habit, often with the aim of detecting colorectal cancer (CRC). We have seen an increase over time, in the use of CTC in elderly patients, as a first line investigation. With an ageing population, we explore the significance of performing this examination, in an elderly population who may not be suitable for further investigation/intervention. Methods We reviewed 1479 patients who had undergone a CT Colonogram between October 2015 and October 2018. Of these, we focused on patients aged ≥80 at the time of scanning. CTC reports were analysed and categorised into those with positive, indeterminate findings, and those with no significant findings. All patients ≥80 years old were followed up (via their electronic records) to observe their outcomes. Results 1479 patient underwent a CTC at KGH during the 3-year period. 454 patients were aged ≥80 years old (30.7%) – mean & median age 84, range 8–7. 69 patients had positive colonic findings (15.2% - see figure). Of which, 31 had CRC reported (14 operated straight away, 5 had endoscopy then surgery, 1 had endoscopy only (no tumour seen), 11 were not operated on). 22 had polyps reported (13 had endoscopy at which 12 had polypectomy, 9 did not have endoscopy). 16 had indeterminate findings (10 had endoscopy which nil significant found). Of the 385 patients who had CTCs with nil significant colonic findings, 9 had extra colonic tumours. At follow up (105 patients in 12 months from October 2015, 137 patients in 201–7, 143 patients in 201–8, range 0 – 36 months), none of the patients have been diagnosed with CRC thus far. Conclusion In this study, CT colonography was used in elderly patients aged ≥80 years old as a first or second line colonic examination. The yield of diagnosing colorectal cancer was 6.9% (31/454). CTC that reported negatively for colonic findings seems to protect patients for –6 months. Whilst colonoscopy may be the preferred diagnostic test for colonic disease, it is an invasive test with a small risk of perforation. CTC is safer, and better tolerated. The reports are generally accurate with regards to significant colonic findings, especially when diagnosing CRC. This study does confirm the safety and efficacy of CTC and suggests that it is an appropriate colonic investigation for elderly patients (aged ≥80 years old) first or second line.

The real diffusion of laparoscopy for the treatment of colorectal diseases in Italy is largely unknown. The main purpose of the present study is to investigate among surgeons dedicated to minimally invasive surgery, the volume of laparoscopic colorectal procedures, the type of operation performed in comparison to traditional approach, the indication for surgery (benign and malignant) and to evaluate the different types of technologies used. A structured questionnaire was developed in collaboration with an international market research institute and the survey was published online; invitation to participate to the survey was issued among the members of the Italian Society of Endoscopic Surgery (SICE). 211 surgeons working in 57 surgical departments in Italy fulfilled and answered the online survey. A total of 6357 colorectal procedures were recorded during the year 2015 of which 4104 (64.1%) were performed using a minimally invasive approach. Colon and rectal cancer were the most common indications for laparoscopic approach (83.1%). Left colectomy was the operation most commonly performed (41.8%), while rectal resection accounted for 23.5% of the cases. Overall conversion rate was 5.9% (242/4104). Full HD standard technology was available and routinely used in all the responders' centers. The proportion of colorectal resections that are carried out laparoscopically in dedicated centers has now reached valuable levels with a low conversion rate.