The natural history and pathophysiology of diverticular disease (DD) are still uncertain. An ex-vivo human complicated DD (cDD) model has recently shown a predominant transmural oxidative imbalance. The present study aims to evaluate whether the previously described alterations may precede the symptomatic form of the disease. Colonic surgical samples obtained from patients with asymptomatic diverticulosis (DIV), complicated DD, and controls were systematically and detailed morphologically and molecularly analyzed. Therefore, histologic, histomorphometric, immunohistochemical evaluation, and gene and protein expression analysis were performed to characterize colonic muscle changes and evaluate chronic inflammation, oxidative imbalance, and hypoxia. Functional muscle activity was tested on strips and isolated cells in response to contractile and relaxant agents. Compared with controls, DD showed a marketed increase in muscle layer thickness, smooth muscle cell syncytium disarray, and increased interstitial fibrosis; moreover, the observed features were more evident in the cDD group. These changes mainly affected longitudinal muscle and were associated with altered contraction-relaxation dynamics and fibrogenic switch of smooth muscle cells. Chronic lymphoplasmacytic inflammation was primarily evident in the mucosa and spared the muscle. A transmural increase in carbonylated and nitrated proteins, with loss of antioxidant molecules, characterized both stages of DD, suggesting early oxidative stress probably triggered by recurrent ischemic events, more pronounced in cDD, where HIF-1 was detected in both muscle and mucosa. The different DD clinical scenarios are part of a progressive process, with oxidative imbalance representing a new target in the management of DD.

Introduction Colorectal cancer (CRC) is the world’s third most common malignant neoplasm. In Egypt, a small incidence of CRC and a high proportion of young-onset disease is observed. Colonoscopy is commonly used for neoplastic colorectal screening. The aim of this work was to assess colonoscopy in high-risk groups as a screening and diagnostic method for early detection of CRC. Patients and methods The study included 200 patients, with age varying from 20 to 83 (mean: 53.42±15.50) years. They were presented to GIT Surgery Unit, Alexandria University Hospital, complaining of lower gastrointestinal tract symptoms and/or high risk of CRC over 9 months. Two professional endoscopists have performed 200 colonoscopies over 9 months. Results Total colonoscopy was done in 94% of cases, and the biopsies were tested. Colorectal polyps were observed in 54 (27%) patients. Of these polyps, the most common were adenomatous polyps (81.5%). Colonic masses were typically seen in males in 22 (11%) cases. Adenocarcinomas were the most common of these masses, accounting for 9% of all cases. A total of 14 (7%) patients reported inflammatory conditions. 6.7% of all cases were diagnosed as colitis. Eight cases were diverticulosis, and 10 cases were hemorrhoid. Conclusion There is an increased rate of detection of adenoma by using screening colonoscopy among endoscopists. Colonoscopy is a valuable screening and diagnostic tool for early detection of CRC.

Mo1664 EXAMINATION OF LEFT-SIDED DIVERTICULOSIS AS A RISK FACTORS FOR DISTAL COLONIC POLYPS

Diverticulosis of the colon is the most frequent anatomical alteration diagnosed at colonoscopy. The prevalence of the disease is higher in elderly patients over 65 years old, recent studies show an increment also in youngers over 40 years old. Even its large prevalence in the population, its pathophysiology still remain poorly understood. It’s widely accepted that diverticula are likely to be the result of complex interactions among genetic factors, alteration of colonic motility, lifestyle conditions such as smoking, obesity, alcohol consumption, fiber and meat intake with diet. Recently many authors considered also alterations in colonic microbiota composition, co-morbidity with diabetes and hypertension and the chronic assumption of certain medications like PPI, ARB and aspirin, as important risk factors for the development of diverticulosis. The aim of this narrative review is to summarise current knowledges on this topic. (www.actabiomedica.it)

Background Unintentional weight-loss is a common clinical encounter. Frequently, these patients are referred for colonoscopy to rule out lower gastrointestinal pathology. Aim Determine the diagnostic yield in colonoscopies performed for unintentional weight-loss (WL-O) versus weight-loss and associated GI symptoms (WL-GIs). Method Retrospective analysis of colonoscopies performed in our centre (May 2013-July 2016). Data was obtained from the Endoscopic Reporting System. Baseline characteristics were established. For sub-analysis, we stratified our cohort into four age groups ( 75 years). Results Of 5290 colonoscopies performed, 240 met our inclusion criteria (WL-O n=83, WL-GIs n=157). Baseline demographics were similar in both groups (WL-O Male 54%, mean age 56 years (SD ±16.6) compared with WL-GIs Male 52%, mean age 58 years (SD ±17.2)). Caecal intubation rates were similar in both groups (88% WL-O, 86% WL-GIs). Overall, colonoscopy was normal in 37.9% (64/169). Diverticulosis was detected in 24.9% (42/169), Colitis in 3% (5/169) and adenoma/polyp in 35.4% (85/240). For diagnostic yield between WL-O and WL-GIs, advanced adenoma detection rate was 7.2% (n=6) versus 8.3% (n=13) and CRC detection rate was 2.4% (n=2) versus 2.5% (n=4). CRC plus advanced adenomas was 9.6% (n=8) versus 10.8% (n=17)(p=0.774). Notably, in the WL-O group no high risk pathology was detected in colonoscopies in patients>75 years compared with n=3 in the WL-GIs group. Conclusions For both groups diagnostic yield was low, comparable to the asymptomatic generapopulation. Diagnostic yield is extremely low in colonoscopies for weight-loss only in patients>75 years. Weight-loss may not be a valid indication for colonoscopy, particularly in >75 years.

Traditional syndromes stemming from diverticulosis include diverticulitis, diverticular bleeding, and symptomatic diverticular disease, with the latter

Colonic diverticulosis has been associated with an increased prevalence of colorectal adenomas in some studies. Investigators have now prospectively

Wolff-Parkinson-White syndrome­ and diverticulosis of the heart?

虫垂真性憩室症の1例

Colonic samples from asymptomatic diverticulosis (DS) patients presented enhanced electrical field stimulation (EFS)-contractions, in an earlier study of ours, suggesting increased endogenous responses. The aim of this study was to explore changes in excitatory neuromuscular transmission and to assess the pharmacodynamics of spasmolytic agents in DS. Circular muscle strips fromsigmoid colon of DS patients (n=30; 69.5±14.8years) and controls (n=32; 64.7±16.2years) were studied using organ baths to evaluate the direct effect of excitatory agonists (carbachol, neurokinin A [NKA] and substance P [SP]), and the effect of antagonists (atropine and NK2 antagonist GR94800) and spasmolytic drugs (otilonium bromide [OB] and N-butyl-hyoscine) on the contractions induced by EFS-stimulation of excitatory motorneurons. qRT-PCR was also performed to compare mRNA expression of M2 , M3 , NK2 receptors and L-type calcium channels. Contractions to carbachol (Emax : 663.7±305.6% control vs 2698.0±439.5% DS; p<0.0005) and NKA (Emax : 387.8±35.6% vs 1102.0±190.1%; p<0.0005) were higher in DS group, without differences for SP. Higher potency for DS patients was observed in the concentration-response curves for atropine (pIC50 =8.56±0.15 control vs pIC50 =9.95±0.18 DS group; p<0.005) and slightly higher for GR94800 (pIC50 =7.21±0.18 control vs pIC50 =7.97±0.32 group; p<0.0001). Lower efficacy (Emax ) and potency (pIC50 ) was observed for spasmolytic drugs in DS, whereas no differences were found regarding the relative expression of the receptors evaluated between groups. The greater response to cholinergic and tachykinergic agonists and greater potency for muscarinic and NK2 antagonists observed in DS might play a role in the spasticity found in diverticular disease.

Neuro-transmission impairment could be associated to motility changes observed in patients with diverticular disease. Therefore, the objective was to characterize the inhibitory neuro-muscular transmission and gene expression changes of the enteric inhibitory pathways in patients with diverticulosis (DS). Circular muscle strips from sigmoid colon of patients with DS and controls were studied using the organ bath technique to evaluate spontaneous contractility and enteric motor neurons stimulated by electrical field and qRT-PCR to assess the expression of nNOS, iNOS, P2Y1 R and PGP9.5. Patients with DS presented decreased spontaneous rhythmic contractions (SRC) that were significantly enhanced after incubation with L-NNA (1mM) and TTX (1μM), and unaffected by the P2Y1 antagonist MRS2500 (1μM). Stimulation on enteric motor neurons caused an increased duration of the latency of OFF-contractions in DS group (p<0.001), antagonized by L-NNA and slightly affected by MRS2500 (1μM). No differences in the IC50 between controls and DS patients were observed on inhibition of SRC for the NO-donor sodium nitroprusside (SNP) and the preferential P2Y agonist ADPβS. Moreover, nNOS relative expression was also up-regulated 2.3-fold in the DS group (p<0.05) whereas there was no significant difference in relative expression of iNOS, P2Y1 R and the neuronal marker PGP9.5 between groups. Patients with DS presented an over-expression of nNOS with increased endogenously NO-mediated responses suggesting enhanced NO-release. Up-regulation in the nitrergic pathway in early stages of the disease might play a role in colonic motor disorders associated to diverticular disease.

In patients who have diverticulosis, the risk for acute diverticulitis is often estimated at between 10% and 25%. However, this estimate is based on

Diverticular disease of the Jejunum is a rare entity. Most patients with small bowel diverticula are asymptomatic. Patients who develop symptoms generally report symptoms that reflect associated complications. The most common are nonspecific epigastric pain or flatulent dyspepsia, mainly post prandial. Complication rates as high as 10-12% for duodenal diverticulosis and 46% for jejunal diverticulosis have been reported. Although there is no consensus on the management of asymptomatic jejunal diverticula disease, some complications are potentially life-threatening and require early surgical intervention. J Med Cases. 2013;4(7):439-442 doi: https://doi.org/10.4021/jmc1276w

Pseudo-tumoral rectal diverticulosis infected

Abstract Background: Inflammatory bowel disease (IBD) is a recognized high risk condition to develop colorectal cancer (CRC) and other intestinal cancers. Several risk factors have been described, allowing preventive strategies to focus on these patients: extensive long-standing disease, severity of inflammation, family history of CRC and primary sclerosing cholangitis (PSC). Aims: While using MALDI MS tissue profiling, we found a unique spectral peak at mass-to-charge ratio (m/z) 5045 to be more intense in inflamed colon samples from IBD patients compared to adjacent normal tissue and/ or diverticulosis (DV). We investigated this signal as a possible transforming factor in CRC initiation, in the setting of IBD. Methods: We profiled colonic mucosal and submucosal layers of 99 IBD patients for biomarkers that differentiated ulcerative colitis (UC) from Crohn's colitis (CC). We determined these unique differentiating proteins by histology-directed proteomic profiling using MALDI MS; protein identification utilized LC/MS/MS. We tested DNA damage by exposing an identified protein to a normal colonic epithelial cell-line (NCM 356). DNA damage was tested by comet assay. Results: LC-MS/MS identified m/z 5045 in CC/UC subjects as triply charged free hemoglobin ion chain (Hb). Validation studies used protein extracts and tissues from full thickness samples from UC, CC, and diverticulosis (DV, controls) subjects. Both CC and UC mucosal and submucosal samples were strongly positive for Hb-α. However, DV staining was restricted to erythrocytes found in submucosal capillaries. There was no significant difference in Hb-α level between UC and CC; however UC and CC levels were significantly higher than those in DV samples (p&amp;lt; 0.006 and p&amp;lt; 0.0001, respectively). When normal colonocytes (1x105 cells/ml) were exposed to Hb (300μM for 4 hours), there was clear DNA damage analyzed by comet assay. We noted macrophage erythrophagocytosis of extravasated erythrocytes. Conclusion: Free Hb was found in UC/CC but not DV mucosa/submucosa tissue. Free Hb resulted from extravasated macrophage erythrophagocytosis. Hb significantly induced DNA-damage of normal epithelial colonocytes (NCM356). DNA-damage could potentially increase risks for CRC transformation. Further elucidative studies are underway. Citation Format: Laura A. Franklin, Joan C. Smith, Billy R. Ballard, Erin H. Seeley, Mary K. Washington, Jeremy L. Norris, Kevin L. Schey, Harold L. Moses, Richard M. Caprioli, Samuel E. Adunyah, Amosy E. M'Koma. Potential role of hemoglobin in colorectal cancer initiation in inflammatory bowel disease setting. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B71.

Objective To analyze the risk factors for false negative diagnosis of obscure gastrointes- tinal bleeding （OGIB） by capsule endoscopy. Methods A total of 133 OGIB inpatients, 104 in true posi- tive group and 29 in false negative group, were reviewed. The features of demography, diseases and capsule endoscopy were collected and then analyzed, which included 10 variables like age, sex, time of bleeding, diseases accompanied, type and location of the disease, hemoglobin concentration, transit time of CE, quality of CE pictures and type of purgative agents. All data were analyzed with t test, and all the enumeration data were analyzed with chi square test. Logistic regression was used to analyze the correlation between the factors and results of diagnosis. Results Age （ t = 2. 095, P ： 0. 038 ）, concentration of hemoglobin （ t=2. 143, P = 0. 034）, type （X2 = 20. 222, P 〈 0. 001 ） and location （X2 = 33. 732, P 〈 0. 001 ） of the diseases, image quality of the CE （X2 =9. 219, P =0. 002） and the type of purgative agents （X2 =6. 999, P =0. 024） were found to have statistical differences between the two groups. Chi-square and partition Chi-square test revealed the occurrence of divertieulosis and lesion location, i.e. lower ileum and ileumcecum, were of statistical difference between the two groups （X2 = 22. 233, P 〈0. 001 and x2 = 24. 412, P 〈 0. 001 ）. Univariate logis- tic regression showed diverticulosis （ OR = 0. 102, P 〈 0. 001 ） , lower bowel diseases （ OR = 0. 110, P 〈 O. 001 ）, poor quality of CE pictures （ OR = 0. 258, P = 0. 004 ） and the use of sodium phosphate agent （ OR = 0. 367, P = O. 027 ） were risk factors for false negative diagnosis, while older age facilitated diagnosis （ OR = 1. 024, P =0. 041 ）. However, multivariate logistic regression showed no statistic significance in type of purgative agent （ P = 0. 05 ） or the concentration of hemoglobin （ P = 0. 394）. Furthermore, elder age facilitated positive diagnosis （ OR = 1. 031, P =0. 032）, while divertieulosis （ OR =0. 118, P =0. 001 ）, low- er bowel diseases （ OR = 0. 145, P = 0. 001 ） and poor quality of CE pictures （ OR = 0. 245, P = 0. 016） were correlated with higher probability of false negative diagnosis. Conclusion Age, disease type, disease location and image quality exert great influence on CE diagnosis. Divertieulosis, lower location of the disea- ses and poor CE image quality are risk factors for false negative diagnosis. Key words: Capsule endoscopes; Obscure gastrointestinal bleeding

According to conventional wisdom — but not robust evidence — a high-fiber diet protects against diverticulosis. In a cross-sectional study designed to evaluate this theory, researchers administered detailed food-frequency questionnaires to 2100 adults who underwent colonoscopy (primarily for routine screening). Participants were asked to provide responses that reflected …

大腸憩室疾患に伴う稀な粘膜脱症候群様病変2症例を経験した．大腸憩室疾患で長期経過観察中に憩室多発部位にみられた病変である．内視鏡所見は，境界不明瞭な発赤調の多発した粘膜下腫瘍様形態であった．病理学的には粘膜筋板から粘膜固有層上方へ伸びる平滑筋線維の増生，いわゆる線維筋症を認め，直腸にみられる粘膜脱症候群に類似した所見であった．経過中，腺腫や早期癌の併存がみられ，内視鏡摘除を施行した．本病変の確定診断には生検による病理診断が有用であり，腫瘍性病変と鑑別が困難な場合は内視鏡摘除が必要である．わが国では大腸憩室疾患が増加傾向にあり，今後本病変に遭遇する機会が増加することが予想される．憩室多発例では本病変を念頭に入れ，内視鏡観察をすべきである．

But : recenser les étiologies des rectorragies au CHU Campus de Lomé. Méthodologie : Il s’agit d’une étude rétrospectivr sur 12 ans (1er janvier 1990 - 31 décembre 2001), réalisée à partir des comptes-rendus de coloscopie. Elle a inclus les dossiers des malades des deux sexes, âgés de plus de 15 ans, ayant présenté une rectorragie explorée par une ano-rectoscopie et une coloscopie totale. Résultats : les rectorragies représentent 38,72 % des indications de la coloscopie. Les malades âgés de 24 à 45 ans ont été les plus atteints (52,94 %). Une prédominance masculine a été retrouvée (sex-ratio : 2,4). Parmi les étiologies retrouvées, les hémorroïdes ont été plus fréquentes (23,53 %) suivies par les colites non spécifiques (16,47 %), la recto-colite ulcéro-hémorragique (15,29 %), la diverticulose colique (10,58 %), les colites amibiennes (9,4 %) et le cancer colorectal (5,88%). Les hémorroïdes étaient associées à une colite non spécifique (1 cas), à une recto-colite ulcéro-hémorragique (1 cas), à une colite amibienne (1 cas) et à une diverticulose colique (1 cas). Dans 12 cas (14,12 %), aucune étiologie n’a été retrouvée. Conclusion : Les hémorroïdes représentent l’étiologie la plus fréquente des rectorragies à Lomé; cependant leur découverte à l’ano-rectoscopie ne doit pas dispenser de la réalisation d’une coloscopie complète à la recherche de lésions associées.Mots clés : Rectorragie, étiologie, ano-rectoscopie, coloscopie.Purpose: To count the aetiology of proctorrhagia in Lomé. Methods: It is a retrospective study, over 12 years (1st January 1990-31 December 2001), realised from the reports of the coloscopy. It included the patients of the two sexes, old of more than 15 years, having presented a proctorrhagia explored by ano-rectoscopy and coloscopy. Results: The proctorrhagia represent 38.72 % of the indications of the coloscopy. The patients from 24 to 45 years were reached (52.94 %). A male prevalence was found (sex-ratio: 2.4). Among the aetiology found, the haemorrhoids more frequent (23.53 %) were followed by the non specific colitis (16.47 %), the ulcero-haemorrhage rectocolitis (15.29 %), the colon diverticulosis (10.58 %), the amoebic colitis (9.4%) and colorectal cancer (5.88 %). The haemorrhoids were associated with a non specific colitis (1 case), an ulcero-hemorrhagic rectocolitis (1 case), an amoebic colitis (1 case) and diverticulose colic (1 case). In 12 cases (14.12 %), no aetiology was found. Conclusion: The haemorrhoids represent the most frequent aetiology of the proctorrhagia in Lomé; however their discovery in ano-rectoscopy should not exempt realisation of a complete coloscopy in the search of other causes.Key words: Proctorrhagia, aetiology, ano-rectoscopy, coloscopy.

Diverticulosis—acromegaly link?