Ileal Resection Research Articles

P174 Defining Crohn’s Disease Strictures Using Intestinal Ultrasound Compared to Histopathology

Abstract Background Fibrostenotic Crohn’s Disease (CD) is a challenging phenotype often requiring surgical resection. MRE (magnetic resonance enterography) is commonly used to diagnose CD strictures, but is limited by access, cost, and long acquisition time. The CONSTRICT consensus criteria for defining CD strictures is based only on MRE or CT (computed tomography) and includes: increased bowel wall thickness (BWT), narrowed luminal apposition, and pre-stenotic dilation > 3cm. This definition has not been studied using intestinal US (IUS). IUS is a cost-effective, easily repeatable, and well-tolerated tool with similar sensitivity and specificity to MRE in diagnosing and monitoring CD. In patients with a confirmed CD stricture on ileal resection (gold standard for diagnosis), we aim to assess the applicability of CONSTRICT criteria in diagnosing strictures with IUS. Methods In this pilot study, thirty CD patients who underwent small bowel resection from 2015–2019 with IUS (fasting, no oral contrast) within 6 months prior to surgery (excluding fistulizing disease) were randomly identified for chart review Stricture was confirmed on resected ileum as microscopic presence of fibrosis, muscle hypertrophy, inflammation, and macroscopic localized luminal narrowing with decreased circumference on pathology. Student’s t-tests, sensitivities and specificities were calculated for IUS in detecting strictures. Results 20 out of 30 patients had fibrostenosis on pathology and IUS. Only 40% (8/20) met CONSTRICT criteria for stricture diagnosis on IUS, despite having a stricture on pathology. All patients had elevated BWT and luminal narrowing, but 60% (12/20) of patients did not have prestenotic dilation > 3cm. Mean dilation was 2.9 cm (SD 1.38) and was significantly different from the mean stricture diameter of 1.3cm (SD 0.59 cm, p=0.0001, 95% CI: 0.9–2.2). Mean BWT was 8.7 mm (SD: 2.5, range 5–15), and mean luminal apposition was 2.3 mm (SD 1.2, range 0.2–5.8mm). IUS has a sensitivity of 95.2% (CI: 76.2 - 99.9%) and specificity of 66.7% (29.9 - 92.5%) in detecting strictures, when compared to the gold standard. Conclusion Diagnosis of fibrostenotic CD with CONSTRICT criteria using CT/MR may not be applicable to IUS. Only 40% of patients met criteria despite histologic-confirmed strictures. Unlike MR/CTE, IUS is not routinely performed with oral contrast, and as a result prestenotic dilation may be underestimated. Thus, perhaps additional criteria of stricture diameter < 50% of prestenotic dilation size is more appropriate for IUS. This pilot study provides the initial data to further delineate the definition of strictures on IUS for future validation and will inform both clinical practice and trial design.

P537 Anemia in Crohn’s Disease: Response to treatment and risk of recurrence

Abstract Background Anemia is common in Crohn’s Disease (CD). Iron deficiency and inflammation are the most common etiologies. The aim of our study is to assess the response of patients with CD to anemia treatment , as well as the predisposing factors for recurrence after treatment. Methods This is a retrospective study including patients with CD complicated by anemia, treated in the gastroenterology department between January 2015 and December 2019. Iron deficiency anemia is defined by a ferritin level <50 ng /ml, it is inflammatory if the CRP level is high with a ferritin level which exceeds 100 ng/ml and mixed if this later ranges between 50 and 100 ng/ml. Results Fifty-four patients were included with a M / F sex ratio of 1.3. The mean age was 40.5 years old with a mean age at diagnosis of CD of 29 years old. Patients had ileal or ileocolic involvement in 82.2% of cases and pure colonic involvement in 16.7%. The main symptoms of anemia were asthenia (64.8%) and mucocutaneous pallor (42.6%). Severe anemia was noted in 64.8% of patients. The factors statistically associated with severe anemia were: the number of relapses before the diagnosis of anemia (p= 0.012), an active disease (p = 00.024) assessed by the CDAI score, the presence of a deficiency syndrome, in particular hypocholesterolemia (p= 0.007) and hypocalcemia (p= 0.006). The anemia was inflammatory in 44.4% of patients, iron deficiency in 31.7%, mixed in 20.4% and vitamin B12 deficiency in 16.7% of them. Treatment of anemia depending on the etiology was effective in 72% of patients. The response was partial in 24% of cases. Only 4% of patients did not respond to treatment. The predictive factors of a poor response to anemia treatment were: the disease duration (p= 0.05), an active disease at the time of diagnosis of anemia (p= 0.025) and an extended ileal resection (p= 0.005). Patients with inflammatory anemia responded better to treatment (p= 0.006). A longer duration of iron suplementation (p = 0.02), as well as the route of administration (IV) (p= 0.014) were correlated with a better response to therapy in case of iron deficiency anemia. Recurrence of anemia was observed in 84.3% of patients with a mean time after anemia correction of 11.5 months. Serum ferritin levels <20 ng/ml during follow-up was the main risk factor for recurrence of anemia (p= 0.01). Conclusion Even after treatment, recurrence of anemia is common especially in patients followed for CD with ileal involvement. A clinical-biological remission, a sufficient duration of iron treatment and the control of the response to treatment by the dosage of the ferritin level even after the correction of the anemia is necessary in order to avoid this recurrence and thus ensure a better quality of life .

P252 Medication adherence in inflammatory bowel diseases in the era of biotherapies

Abstract Background Failure or poor adherence to therapy is a general problem ofpublic health, particularly common in chronic inflammatory bowel disease (IBD). In these pathologies, good compliance is, however, one of the keys to obtaining remission and in preventing relapses and complications. The objective of this study was to assess treatment compliance in our patients followed for IBD. Methods We conducted a single-center cross-sectional study, including all patients with IBD, who presented to our consultation during the three months preceding the study. We used the Morisky questionnaire to assess treatment adherence. This was considered low if the score is less than 6, medium if the score is between 6 and 8, and good if the score is equal to 8. Results We collected 100 patients, average age of 42.18 ± 15.71 years and a sex ratio (M / F) = 1.5. Sixty eight patients (68%) had CD and thirty two patients (32%) had UC. The mean duration of IBD progression was 9.02 ± 6.57 years. Anoperineal lesions were present in 38.2% of cases. Fourteen patients (20.6%) followed for CD and ten patients (31.3%) with UC had severe disease activity. The history of surgical resection was noted in 18.75% of patients followed for UC and 47.05% of those followed for CD. Extensive ileal resection was noted in 6.5% of patients with CD. At the time of the study, 20% of patients were on systemic corticosteroid therapy, 22% on Azathioprine, 4% on Salazopyrine, 8% on 5-ASA and 46% on Anti-TNFα in combination therapy. The mean Morisky score was 6.78 ± 1.31. Adherence to treatment was poor in 42% of cases, average in 34% of cases, and good in 24% of cases. Good treatment adherence was observed in 34.78% of patients taking Anti-TNFα vs. 14.81% in other patients with no statistically significant difference (p = 0.077). Morisky score was correlated with age (p = 0.032, r = 0.38). In addition, no significant association was found, with the duration of evolution (p = 0.75), the existence of other chronic diseases (p = 0.3), the number of outbreaks of IBD (p = 0.52), and disease activity (p = 0.38 for CD, p = 0.22 for UC). Conclusion The overall rate of treatment non adherence in IBD patients was significant in our series. It concerns nearly one in two patients. Prescribing Anti-TNFα does not appear to improve compliance. The integration of therapeutic education into our therapeutic strategy should be an asset major in improving treatment adherence.

Nintedanib, a multitarget tyrosine kinase inhibitor, suppresses postoperative peritoneal adhesion formation in a rat model

BackgroundNintedanib is an antifibrotic agent approved by the United States Food and Drug Administration for the treatment of lung fibrosis. This study aimed to evaluate the efficacy of nintedanib for the prevention of postoperative peritoneal adhesion formation in a rat model. MethodsEighteen female Sprague-Dawley rats underwent peritoneal ischemic button creation to induce peritoneal adhesion formation and were randomly allocated to receive 1 mL saline, 50 mg/kg nintedanib, or 100 mg/kg nintedanib by gavage once daily for 7 days. Peritoneal adhesion evaluation and histological and immunochemical examinations were performed on postoperative day 7. Twelve additional Sprague-Dawley rats underwent ileal resection and anastomosis and were randomized to receive saline or 100 mg/kg nintedanib by gavage once daily for 7 days. Anastomotic bursting pressure was assessed on postoperative day 7. ResultsAll rats survived until death 7 days after surgery without complications. Peritoneal adhesion incidence, quality, and tenacity were lower in both nintedanib groups than in the saline group (P < .01), but no differences were found between the 2 nintedanib groups (P > .05). Histological and immunochemical results demonstrated less inflammation, fibrosis, collagen, and cell proliferation and fewer myofibroblasts in the ischemic buttons treated with 50 mg/kg or 100 mg/kg nintedanib than in those treated with saline (P < .01), but no difference was found between the 2 nintedanib groups (P > .05). Anastomotic bursting pressures were not significantly different between the saline and nintedanib groups (P > .05). ConclusionNintedanib is effective for the prevention of postoperative peritoneal adhesion formation in a rat model.

Increased Fecal Bile Acid Excretion in a Significant Subset of Patients with Other Inflammatory Diarrheal Diseases.

Increased fecal bile acid excretion (IBAX) occurs in a third of patients with functional diarrhea. To assess the prevalence of IBAX in benign inflammatory intestinal and colonic diseases presenting with chronic diarrhea. All patients with known inflammatory diseases or resections who underwent 48h fecal fat and BA testing for chronic diarrhea at a single center were included. Quiescent disease was based on clinical evaluation and serum, endoscopic and imaging studies. IBAX was defined by: > 2337µmol total BA/48h; or primary fecal BAs > 10%; or > 4% primary BA plus > 1000µmol total BA /48h. Demographics, fecal weight, fecal fat, stool frequency and consistency were collected. Nonparametric statistical analyses were used for group comparisons. Sixty patients had celiac disease (51 quiescent, 9 active), 66 microscopic colitis (MC: 34 collagenous, 32 lymphocytic), 18 ulcerative colitis (UC), and 47 Crohn's disease (CD). Overall, fecal fat, 48h stool weight, frequency and consistency were not different among subgroups except for inflammatory bowel disease (IBD) based on disease location. Almost 50% patients with celiac disease and MC had IBAX, with a greater proportion with increased primary fecal BA. Among UC patients, rates of IBAX were higher with pancolonic disease. A high proportion of patients with ileal resection or CD affecting ileum or colon had IBAX. IBAX was present even with quiescent inflammation in UC or CD. A significant subset of patients with MC, quiescent celiac disease and IBD had increased fecal BA excretion, a potential additional therapeutic target for persistent diarrhea.

Acute intussusception in adults; study of two observations at the Friendship Hospital Sino-Guinean in Kipe

Aim The study aim to make our contribution to the study of intussusception in adults, rare pathology in adults, acute intussusception also called (AII) refers to penetration of an intestinal segment into the underlying segment, by turning into a glove finger (invagination roll). The aim of this work is to report two cases of acute intussusception in adults in the surgical department of the Sino-Guinean friendship hospital in kipe. Republic of Guinea. Material and Method This is a prospective two-year study, running from October 1, 2018 to September 30, 2020 Inclusive. All patients admitted for operated for acute intestinal invagination, whose age is between 25 and 50 years were included in our study. The operative specimen was analyzed anatomo pathologically after fixation with 10 percent formalin. Clinical presentation It concerned a man and a woman, in both cases the localization was ileal. Treatment was surgical and consisted of ileal resection followed by end-to-end ileoileale anastomosis in two planes. The operative consequences were simple. Conclusion Acute intussusception in adults is rare, the symptoms are noisy.

Ileal Crohn's Disease Exhibits Similar Transmural Fibrosis Irrespective of Phenotype.

INTRODUCTION:In Crohn's disease (CD), the assessment of transmural inflammation and fibrosis is of utmost importance. This study aimed to quantify these parameters in CD ileal specimens and correlate them with disease progression.METHODS:This is a retrospective unicentric study based on the analysis of archived specimens (n = 103) of primary ileal resection. Data were retrieved from a prospective national inflammatory bowel disease registry. Two pathologists, blinded for CD phenotype and clinical indications for surgery, examined 3 sections per patient and graded inflammation and fibrosis, based on a histopathological score.RESULTS:Penetrating (B3, n = 74) CD exhibited significantly higher inflammation in diseased areas, compared with stricturing (B2, n = 29) disease (score 3: 96% vs 76%, P = 0.005 in inflamed areas; 78% vs 55%, P = 0.019 in most affected areas). This was also observed for the comparison of B2 CD with B3 CD with (B3s, n = 54) and without associated stricture (B3o, n = 20): B3s vs B2: 81% vs 55%, P = 0.033 in most affected areas; B3o vs B2: 100% vs 76%, P = 0.006 in inflamed areas; 70% vs 55%, P = 0.039 in most affected areas. We could not show differences in fibrosis scores between the subphenotypes. Postoperative new penetrating events occurred only in B3s (n = 6, 11%, P = 0.043) patients. The changing of biologic therapy after surgery correlated with severe inflammation at the proximal ileal margin (55% changed vs 25% not changed, P = 0.035).DISCUSSION:In our cohort, fibrosis scores and fibromuscular changes were comparable, irrespective of CD phenotype. Inflammation severity was the major differentiator between penetrating and stricturing disease.

Pyogenic granuloma in small intestine associated with Cowden's disease in a patient with gastrointestinal bleeding:a case report

A 57-year-old female with a history of Cowden's disease was referred to our hospital because of black stool, loss of consciousness, and severe anemia. Upper and lower gastrointestinal endoscopy findings could not confirm the source of hemorrhage. Capsule endoscopy (CE) of the small intestine showed an active exudative hemorrhagic site near the ileum, although a definitive diagnosis was difficult. In a double balloon enteroscopy examination, it was difficult to observe the entire small intestine due to adhesions and the responsible lesion could not be confirmed, even when ink spots were applied to the deepest observation points through the mouth and anus. Hemostasis spontaneously occurred, and then anemia occurred again approximately 1 month later and a second CE examination was performed including passage of an ink stick through the oral side, which revealed an exudative elevated polyp with erosion and a white moss appearance in the ileum. Partial ileal resection was performed and pyogenic granuloma of the small intestine was the diagnosis. We report here a case of pyogenic granuloma of the small intestine associated with Cowden's disease.

A combination of surgery, theranostics, and liquid biopsy - a personalised oncologic approach to treatment of patients with advanced metastatic neuroendocrine neoplasms.

Rationale: Neuroendocrine neoplasia (NEN) of small bowel (SBNEN) frequently present with metastatic disease. Theranostics (molecular imaging followed by targeting therapy) allow for personalised medicine. Liquid biopsies enable precise identification of residual disease and real-time monitoring of therapeutic response. Our aim was to determine the clinical utility of a combination of surgery, theranostics, and a multigene blood measurement in metastasised SBNEN.Methods: Inclusion criteria were SBNEN, G1/G2 NEN, initial tumour diagnosis, stage IV NEN, positivity on 68Ga somatostatin analogue PET/CT, eligible for surgery, and 177Lu peptide receptor radionuclide therapy (PRRT). Blood samples for NETest were collected longitudinally. Progression-free survival (PFS) and overall survival (OS) were calculated. NETest results were assessed prior to surgery and during clinical follow-up.Results: A surgical cohort of 39 SBNEN patients met eligibility criteria. Thirty-two patients underwent ileal resection and 7 right hemicolectomy. The mean number of 177Lu PRRT cycles was 4. Mortality was nil. Surgical morbidity was 10.3%. Transient grade 1/2 toxicity occurred in 41% (PRRT). NETest scores (n=9 patients) decreased in 100% following treatment and correlated with diminished tumour volume and disease stabilization following surgery and PRRT. Median follow-up: 78 months. Median PFS and OS: 42.7 and 110 months, respectively. Progression-free survival at 1-, 3-, and 5-years was 79.4%, 57.1% and 40.5%, respectively. Overall survival at 1-, 3-, and 5-years was 97.4%, 97.4%, and 94.1%, respectively.Conclusions: Surgery combined with 177Lu PRRT is safe and provides favourable PFS and OS in selected patients with advanced SBNEN. Liquid biopsy (NETest) has the potential to accurately delineate disease status.

Morphological spectrum of gallstone and bacteriology of bile in patient of cholelithiasis visiting tertiary care centre in North India

Background: Calculus biliary tract disease continues to be a major health concern. It is normal to see predisposing factors such as cirrhosis, ileal resection in the West; while infection predominates in South East Asia as a cause. We prospectively examined gall stones in this study to investigate the causes and role of bacteria in the disease of gall stone disease.Methods: This is a cross sectional study conducted in department of surgery, Sri Guru Ram Das University of Health Sciences, Sri Amritsar, India, from November 2018-August 2020. Total 50 cases were selected and operated by lap/open cholecystectomy were included in this study. During cholecystectomy bile was aspirated and was sent to laboratory for culture. Gallstone retrieved from the specimen was classified based on morphological appearance. Results: Gallstone disease found to be common in female 92% and in the age group of 4-50 years. Bile of gallstones patients is often infected. In this study though morphologically cholesterol stones were commonest but mixed stones were associated with highest infection rates. Most common bile infecting bacterium in all kinds of stones was found to be E. coli 60.8% followed by klebsiella 17.3% and proteus 17.3%. All the organisms cultured were sensitive to cephalosporins, quinolones, aminoglycosides and penicillin group of antibiotics.Conclusions: Bile culture was positive in 46% of the cases. Morphologically cholesterol stones were commonest 52% but mixed stones were associated with highest infection rates (80%). Most common bile infecting bacterium in all kinds of stones was found to be E. coli.

Neglected prognostic importance of ileal resection in patients with peritoneal metastasis

Rationale: The ileum has unique functions: enzymatic digestion of nutrients, absorption of vitamin B12, fats and bile salts, and immunologic functions. We aimed to determine the prognostic role of ileal resection on postoperative complications and final oncological results of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) treatment in patients with peritoneal metastasis (PM).

Ovarian metastases of ileal neuroendocrine tumor

A 55-year-old, menopausal woman with history of breast carcinoma was referred for recurrent abdominal pain without diarrhea. Physical examination, routine biological investigation, and serum CA15-3 were normal. Abdominal contrast-enhanced computed tomography (CT) found a 15-mm ileal hyper-vascularized lesion with mild intestinal dilation and a mesenteric mass of about 20 mm. Both ovaries were moderately enlarged without radiological overt signs of malignancy. CT findings were consistent with ileal neuroendocrine tumor (ileal-NET) with mesenteric invasion. Serum value of chromogranin A was normal. 18F-Fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography (PET)/CT was added to the preoperative work-up 1 Addeo P. Poncet G. Goichot B. et al. The added diagnostic value of 18F-fluorodihydroxyphenylalanine PET/CT in the preoperative work-up of small bowel neuroendocrine tumors. J Gastrointest Surg. 2017; 22: 722-730 Crossref PubMed Scopus (7) Google Scholar and distinctly identified the primary ileal-NET with the mesenteric involvement. Moreover, intense and pathological 18F-FDOPA uptake was shown in both ovaries and 1 peritoneal nodule of a few millimeters in the Douglas space (Fig 1, A), suggesting ovarian metastases with peritoneal carcinomatosis. Surgical exploration found the primary tumor and the mesenteric lesion that were removed by a 20-cm ileal resection and mesenteric lymphadenectomy. Intervention was completed by bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies (Fig 1, B). Postoperative course was uneventful, and pathology confirmed a 20-mm, well-differentiated grade-2 ileal-NET (Ki-67: 4%) with mesenteric invasion, ovarian bilateral spread, and pelvic peritoneal metastases as small as a few millimeters in size (pT4N2M1, UICC 2016).

Prospective analysis of tumor spread to the small bowel mesentery in cases of right-sided colon cancer

Guidelines advocate minimal ileal resection when right hemicolectomy is performed for right-sided colon cancer. The practice, thought to prevent malabsorption syndrome, does not appear to foster local recurrence. Little evidence based on rigorous study exists, however. To understand the pattern of lymphatic spread of right-sided colon cancer toward the small bowel and thus determine the appropriate margin size, we prospectively investigated anatomical distribution of lymph nodes (LNs) in the small bowel mesentery and of metastasis to these nodes in patients with right-sided colon cancer treated by such surgery. In each case, the mesenteric specimen, which had been dissected along the ileocolic vessels and included intermediate LNs, was divided into 2 areas: that 0-3cm from the vessel pedicle (area 1) and that 3-5cm from the pedicle (area 2). The peri-intestinal mesentery was cut into 9 segments. Ninety-one patients were included in the study. Overall, 3366 LNs were dissected. Four hundred fifty-three of these LNs were located in area 1 (90 cases), and 15 (3.3%) were metastatic. Only 63 LNs were located in area 2 (34 cases; average of 0.69 per patient); none was metastatic. Overall, 269 LNs were found in the small bowel mesentery (in 56 of the 91 patients). Only 4 were positive (3 cases), and all were within 5cm of the ileocecal valve. Our data indicate that a surgical margin 3cm from the ileocecal pedicle and a short (5cm) ileal margin are oncologically reasonable for effective right hemicolectomy.

S0797 Paneth Cell Phenotype at Ileal Resection Margin Obtained at the Time of Ileocolectomy for Ulcerative Colitis Predicts Time to Pouchitis Development

S0797 Paneth Cell Phenotype at Ileal Resection Margin Obtained at the Time of Ileocolectomy for Ulcerative Colitis Predicts Time to Pouchitis Development

Translocation of Viable Gut Microbiota to Mesenteric Adipose Drives Formation of Creeping Fat in Humans

A mysterious feature of Crohn’s disease (CD) is the extra-intestinal manifestation of “creeping fat” (CrF), defined as expansion of mesenteric adipose tissue around the inflamed and fibrotic intestine. In the current study, we explore whether microbial translocation in CD serves as a central cue for CrF development. We discovered a subset of mucosal-associated gut bacteria that consistently translocated and remained viable in CrF in CD ileal surgical resections, and identified Clostridium innocuum as a signature of this consortium with strain variation between mucosal and adipose isolates, suggesting preference for lipid-rich environments. Single-cell RNA sequencing characterized CrF as both pro-fibrotic and pro-adipogenic with a rich milieu of activated immune cells responding to microbial stimuli, which we confirm in gnotobiotic mice colonized with C. innocuum. Ex vivo validation of expression patterns suggests C. innocuum stimulates tissue remodeling via M2 macrophages, leading to an adipose tissue barrier that serves to prevent systemic dissemination of bacteria.

Anatomical Variation in Mesenteric Macrophage Phenotypes in Crohn's Disease.

INTRODUCTION:Clinical trials are currently investigating whether an extended mesenteric resection for ileocecal resections could reduce postoperative recurrence in Crohn's disease. Resection of the mesorectum, which contains proinflammatory macrophages, during proct(ocol)ectomy, is associated with reduced recurrent inflammation and improved wound healing. We aimed to characterize the macrophages in the ileocecal mesentery, which were compared with those in the mesorectum, to provide a biological rationale for the ongoing trials.METHODS:In 13 patients with Crohn's disease and 4 control patients undergoing a proctectomy, tissue specimens were sampled at 3 locations from the mesorectum: distal (rectum), middle, and proximal (sigmoid). In 38 patients with Crohn's disease and 7 control patients undergoing ileocecal resections, tissue specimens also obtained from 3 locations: adjacent to the inflamed terminal ileum, adjacent to the noninflamed ileal resection margin, and centrally along the ileocolic artery. Immune cells from these tissue specimens were analyzed by flow cytometry for expression of CD206 to determine their inflammatory status.RESULTS:In the mesorectum, a gradient from proinflammatory to regulatory macrophages from distal to proximal was observed, corresponding to the adjacent inflammation of the intestine. By contrast, the ileocecal mesentery did not contain high amounts of proinflammatory macrophages adjacent to the inflamed tissue, and a gradient toward a more proinflammatory phenotype was seen in the central mesenteric area.DISCUSSION:Although the mesentery is a continuous structure, the mesorectum and the ileocecal mesentery show different immunological characteristics. Therefore, currently, there is no basis to perform an extended ileocecal resection in patients with Crohn's disease.

Intestinal volvulus on Meckel's diverticulum: about an observation

Meckel's diverticulum most often remains asymptomatic and is diagnosed only fortuitously or when complications arise. We report a case of intestinal volvulus on Meckel's diverticulum in a 19-year-old patient. The surgical procedure was an ileal resection with anastomosis. The postoperative follow-up was simple.

The Role of Bile Acids in Chronic Diarrhea.

Bile acids (BAs) are the central signals in enterohepatic communication, and they also integrate microbiota-derived signals into enterohepatic signaling. The tissue distribution and signaling pathways activated by BAs through natural receptors, farsenoid X receptor and G protein-coupled BA receptor 1 (GPBAR1, also known as Takeda G-coupled receptor 5), have led to a greater understanding of the mechanisms and potential therapeutic agents. BA diarrhea is most commonly encountered in ileal resection or disease, in idiopathic disorders (with presentation similar to functional diarrhea or irritable bowel syndrome with diarrhea), and in association with malabsorption such as chronic pancreatitis or celiac disease. Diagnosis of BA diarrhea is based on Se-homocholic acid taurine retention, 48-hour fecal BA excretion, or serum 7αC4; the latter being a marker of hepatic BA synthesis. BA diarrhea tends to be associated with higher body mass index, increased stool weight and stool fat, and acceleration of colonic transit. Biochemical markers of increased BA synthesis or excretion are available through reference laboratories. Current treatment of BA diarrhea is based on BA sequestrants, and, in the future, it is anticipated that farsenoid X receptor agonists may also be effective. The optimal conditions for an empiric trial with BA sequestrants as a diagnostic test are still unclear. However, such therapeutic trials are widely used in clinical practice. Some national guidelines recommend definitive diagnosis of BA diarrhea over empirical trial.

P0132DIAGNOSIS OF HYPEROXALURIA FROM RENAL BIOPSY

Abstract Background and Aims Crystal-induced kidney disease refers to kidney injury caused by intratubular crystal deposition. The most common forms of crystalline nephropathy encountered in renal pathology are nephrocalcinosis and oxalate nephropathy. The purpose of our study is to determine the epidemiological and clinical characteristics of hyperoxaluria diagnosed from renal biopsy. Method We retrospectively reviewed all kidney biopsy specimens evaluated at renal pathology laboratory, from 1976 to 2019. The biopsy specimens were received from multiple medical department and medical centers. We studied 8900 biopsy specimens and we were focused on patients whose diagnosis of hyperoxaluria was made from renal biopsy Results We identified 25 cases (15 children and 10 adults) with a sex ratio H / F of 0.9. Mean age at diagnosis was 17.2 years old [4 months-73 years old]. Most patients were offspring of consanguineous mating (14 of 25) with intermarriage of first-degree cousins being the most common pattern. A family history of chronic kidney disease was found in 13 patients: indeterminated nephropathy (n = 6) and renal stone (n = 5) and primary hyperoxaluria (n=2). Among our patients, five had a history of urolithiasis. One patient had a history of chronic diarrhea related to Crohn's disease and one patient had a history of cephalic pancreatectomy and ileal resection. Initial symptoms and signs were dominated by renal failure (n = 25) with mean creatinine of 789.5 μmol / l [306-1832μmol / l], associated with proteinuria in 10 patients and hematuria in 11 patients. Arterial hypertension was present in 4 patients. Oligo anuria was reported in 4 patients without dilation of the urinary excretory pathways. In our patients, the diagnosis of crystalin nephropathy was revealed by renal biopsy. In one case, the diagnosis was made after renal transplant. In 4 cases the diagnosis was made by postmortem kidney biopsy. In all cases, the kidney biopsy specimen showed extensive intratubular crystal deposition and tubulointerstitial mononuclear cell infiltration with features of tubular injury and interstitial fibrosis. Examination of histologic slides showed colorless refractile crystals of polygonal appearance. Multicolored birefringence under polarized light identified these crystals as calcium oxalate. After different investigations (genetic and biological analysis), the diagnosis of hyperoxaluria was confirmed. Hyperoxaluria was primary in 23 patients and secondary in 2 patients. Conclusion Hyperoxaluria is a rare condition, often serious, involving renal prognosis and sometimes life-threatening, especially in early-onset forms. Early diagnosis and treatment should be done as soon as possible to slow the progression to end-stage renal failure. In patients with renal insufficiency, the diagnosis of hyperoxaluria is difficult. Renal biopsy can help when clinical and radiological data are not sufficient.

EVALUATION OF URETEROCYSTOPLASTY AS AN ALTERNATIVE FOR AUGMENTATION ILIOCYSTOPLASTY IN THE PRESENCE OF DILATED URETERS

Background: Ureterocystoplasty has been considered as an alternative for iliocystoplasty when there is dilated ureters inassociation with renal impairment/extensive ileal resection, several studies reported variable results after ureterocystoplasty Aim of the work: To compare the outcomes of augmentation ureterocystoplasty in patients with dilated ureters to conventional augmentation iliocystoplasty in patients who can undergo both procedures. Patients and Methods: In a prospective randomized clinical study, 10 patients will undergo ureterocystoplasty; another 10 patients will undergo iliocystoplasty. The inclusion criteria include patients with unilateral or bilateral ureteric dilatation after failure of conservative measures. The Exclusion criteria were insufficient ureteric dilatation, elevated S.creat. or previous extensive ileal resection Results: Our results showed significant improvement in capacity and compliance in all groups, the degree of urodynamic improvement was however inferior when the distal segment of 2 ureters were used for augmentation versus the use of ileum or an entire ureter of a nonfunctioning kidney, the degree of hydronephrosis improved or resolved in all patients, continence improved in all patients despite the requirement for CIC in most patients, the frequency of urinary tract infections was similar in both groups. Conclusions: Our study concludes that augmentation with sufficient amount of ureteric tissue provides adequate augmentation with similar urodynamic outcome to augmentation with the use ofileum, however if the ureteric tissue used was insufficient such as when using the distal segment of 1 or 2 ureters especially when the ureters are not sufficiently dilated the improvement in urodynamic outcome was inferior to the use of ileum.