Search

Background Since HLA-G is an immune checkpoint molecule and since Crohn’s disease (CD) and ulcerative colitis (UC) exhibit immune-mediated mechanism deregulation, we aimed to evaluate HLA-G intestinal expression and soluble (sHLA-G) levels in CD/UC patients, stratified according to CD phenotype/localisation and UC extension. Methods HLA-G tissue expression was assessed by immunohistochemistry in biopsies collected from 151 patients (90 CD, 61 UC) and 24 healthy controls, and in surgical resections (28 CD, 12 UC). Plasma sHLA-G levels (97 CD, 81 UC and 120 controls) were evaluated using ELISA Results HLA-G expression was observed in intestinal epithelial cells of controls and CD/UC specimens, exhibiting closely similar profiles, and in lamina propria infiltrating cells, exhibiting differential patterns. In biopsies, CD/UC lamina propria plasma cells/lymphocytes presented: i) increased HLA-G expression compared with controls (p < 0.0001), ii) irrespective of the extent, UC cell staining was greater compared with CD cells (p = 0.0011), and iii) the inflammatory CD phenotype presented increased number of infiltrating cells compared with stenosing and fistulizing phenotypes (p = 0.0407). In surgical resections, CD/UC patients exhibited increased infiltrating cell HLA-G expression in lesion areas compared with margins. sHLA-G levels were increased in UC/CD patients (p < 0.0001) when compared with controls, but no difference was observed between patients. Conclusion Increased infiltrating cell HLA-G expression associated with increased sHLA-G levels in CD/UC patients may reflect host on-going strategies to suppress chronic inflammation. References

Background Ulcerative proctitis (UP) accounts for a significant proportion of cases of ulcerative colitis (UC) and implies limited involvement of the rectum. Some patients presenting initially with UP may progress to more extensive colitis (inflammation found distally to the rectum-sigmoid junction). Although several predictive factors for this progression have been described, none has been established as definitive. We aimed at determining risk factors predictive of proximal disease extension in UP. Methods Retrospective analysis of data from 97 patients (67% female) with UP (Montreal Classification: E1) with at least 12 months of follow-up at the IBD tertiary centre from January 2001 up to December 2018. Proximal extension was evaluated endoscopically during follow-up and was defined as E1 progressing to E2/E3. Factors examined comprised age, gender, race, presence of extra-intestinal manifestations, Mayo endoscopic score, disease relapse, use of corticosteroids, immunosuppressive and biological agents and colectomy. We used univariate analysis (Chi-square test) to assess the association of individual factors to proximal disease extension. Results A total of 29 (29.9%) patients experienced proximal disease extension during a mean follow-up of 137.36 ± 86.63 months. The following factors were significantly associated with proximal disease extension: higher initial Mayo score (p = 0.035) and higher initial disease severity (p = 0.0024). Use of corticosteroids initially (86.2% vs. 41.2%, p Conclusion UP is a dynamic disease that may progress over time. UP patients with increased clinical and endoscopic severity at the diagnosis are likely to evolve with proximal extension and should be more carefully followed up. Reference

Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.