Nonspecific Colitis Research Articles

Przestrzeganie zaleceń w chorobach przewlekłych na przykładzie leczenia mesalazyną w nieswoistych zapalnych chorobach jelit

Przestrzeganie zaleceń w chorobach przewlekłych na przykładzie leczenia mesalazyną w nieswoistych zapalnych chorobach jelit

Imunodeficiência comum variável associada à doença de Crohn-like: relato de caso e revisão da literatura

AIMS: To report the case of a patient diagnosed with common variable immunodeficiency and Crohn-like disease, describing the clinical picture, the diagnostic investigation process, the therapeutic approaches and the clinical outcome of the patient. To carry out a literature review of case reports addressing patients with the common variable immunodeficiency and Crohn-like disease association. Emphasize the importance of early diagnosis and treatment.CASE DESCRIPTION: A male patient was diagnosed with common variable immunodeficiency at nine years of age and with non-specific inflammatory bowel disease at 10 years, after colonoscopy and colonic biopsy indicated moderate lymphoplasmacytic, eosinophilic infiltrate and some neutrophils in lamina propria, with absence of granulomas. At age 14, the diagnosis of Crohn-like disease was confirmed by specialist after correlation between clinical history and complementary exams. Currently with 18 years of age, the patient is under treatment with intravenous human immunoglobulin, infliximab and azathioprine, with stabilization of the clinical picture.CONCLUSIONS: The literature review identified 11 case reports on the association between common variable immunodeficiency and Crohn-like disease, with no Brazilian studies, which highlights the rarity of such association. In this report, the patient received extensive and empirical treatments due to the difficulty in reaching a specific diagnosis, which was only performed at age 14, when more targeted and individualized treatment was started. Although currently stable, the patient presented several complications during the diagnostic investigation, which emphasizes the importance of early diagnosis and more precise treatment, targeted to meet the health needs of these patients.

Tendencja do refleksji–ruminacji a elastyczność w radzeniu sobie w grupie osób z nieswoistymi chorobami zapalnymi jelit

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Basińska M, Przyborowska-Stankiewicz S, Kruczek A, Liebert A. Reflective-ruminative tendencies and coping flexibility in patients with non-specific inflammatory bowel diseases. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii. 2019;28(2):99-115. doi:10.5114/ppn.2019.86254. APA Basińska, M., Przyborowska-Stankiewicz, S., Kruczek, A., & Liebert, A. (2019). Reflective-ruminative tendencies and coping flexibility in patients with non-specific inflammatory bowel diseases. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, 28(2), 99-115. https://doi.org/10.5114/ppn.2019.86254 Chicago Basińska, Małgorzata Anna, Sandra Przyborowska-Stankiewicz, Agnieszka Kruczek, and Ariel Liebert. 2019. "Reflective-ruminative tendencies and coping flexibility in patients with non-specific inflammatory bowel diseases". Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii 28 (2): 99-115. doi:10.5114/ppn.2019.86254. Harvard Basińska, M., Przyborowska-Stankiewicz, S., Kruczek, A., and Liebert, A. (2019). Reflective-ruminative tendencies and coping flexibility in patients with non-specific inflammatory bowel diseases. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, 28(2), pp.99-115. https://doi.org/10.5114/ppn.2019.86254 MLA Basińska, Małgorzata Anna et al. "Reflective-ruminative tendencies and coping flexibility in patients with non-specific inflammatory bowel diseases." Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, vol. 28, no. 2, 2019, pp. 99-115. doi:10.5114/ppn.2019.86254. Vancouver Basińska M, Przyborowska-Stankiewicz S, Kruczek A, Liebert A. Reflective-ruminative tendencies and coping flexibility in patients with non-specific inflammatory bowel diseases. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii. 2019;28(2):99-115. doi:10.5114/ppn.2019.86254.

Rigid Sigmoidoscopic Examination, an Investigation Down but Not Out: A 5-Year Single-Center Experience on 9418 Patients

ABSTRACT Background: Rigid sigmoidoscopy (RS) in the present era of flexible sigmoidoscopies is falling out of favor although it continues to be used in some centers as an outpatient (OP) department procedure. Aims: This study aims to determine the utility of RS for diagnosis of rectosigmoidal pathologies in the OP setting with emphasis on neoplastic lesions. Methods: We retrospectively studied the RS records and histopathology reports (HPRs) of 5 years (July 2013–June 2018) done in the Department of Gastroenterology at Medical College Calicut. Results: During the study period, 9418 RS examinations were done, and a total of 6921 abnormalities were picked up, giving a diagnostic yield of 73.5%. Most common indication was bleeding per rectum (PR) (51%), followed by constipation (29%). The most common lesion found was hemorrhoids 39.8% followed by proctitis 13.7%, neoplasms 9.7%, and others 10.3% while 26.5% studies were normal. HPRs showed 7.7% to be malignant, 5.8% were adenoma, 12.2% were inflammatory bowel disease ulcerative colitis (IBD UC), 2.2% were solitary rectal ulcer syndrome, 1.2% nonspecific colitis, 1.7% nonneoplastic polyps, 2.7% were normal, and 1.4% were inconclusive. Of the 4812 patients with complaints of bleeding PR, 4739 (98.5%) had a diagnosis after RS, of which hemorrhoids (72.7%) was the most common cause followed by proctitis (14.2%), neoplasm (9%), and others (4.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of RS in detecting neoplasia was 98.2%, 96.8%, 66.1%, and 99.9%, respectively, when HPR was gold standard. RS was found to be effective for assessing activity in IBD UC. Conclusion: RS is a simple, cheap, and effective tool for diagnosing various rectosigmoid pathologies. RS can be used as an effective screening test for rectosigmoid pathologies, especially neoplasia and IBD UC.

Role of colonoscopy in the diagnosis of lower gastrointestinal disorders in children

Introduction Adult colonoscopies are widely and routinely performed worldwide and provide a safe and effective diagnostic and therapeutic tool. Moreover, safety and effectiveness of pediatric colonoscopy in lower gastrointestinal diseases have been established. Aim To assess the role of colonoscopy in the diagnosis of lower gastrointestinal tract diseases in a group of Egyptian children. Patients and methods A total of 40 children were admitted to the Endoscopy Unit of Al-Zahraa University Hospital, Al-Azhar University, in both Pediatric and Tropical Medicine Departments in the period from October 2014 to December 2015. They presented with various lower gastrointestinal symptoms, indicated for colonoscopy evaluation. Thorough clinical history taking and clinical examination, complete blood count, bleeding profile, liver enzymes, and kidney function tests were done. Colonoscopy and histopathological examination of colonoscopic specimen were done. Results The most common indications of colonoscopy were bleeding per rectum in 42.5% of cases followed by bleeding per rectum associated with chronic abdominal pain in 25% of cases, bleeding per rectum associated with vomiting, hematemesis, and melena in 15% of cases, bloody chronic diarrhea in 7.5% of cases, chronic constipation associated with bleeding per rectum in 5% of cases, and nonbloody chronic diarrhea in 5% of cases. Regarding endoscopic results, colorectal polyps, inflammation with superficial ulceration, and normal mucosa were the main endoscopic findings, representing 42.5, 37.5, and 20% of cases, respectively. Based on histopathological results, juvenile polyps were the most common diagnoses in 42.5% of cases, whereas 37.5% of cases were chronic nonspecific colitis, 12.5% of cases were eosinophilic colitis, and 7.5% of cases were ulcerative colitis. Conclusion Colonoscopy is a valuable and safe tool for diagnosis of lower gastrointestinal diseases in children.

Effects of Non-Steroid Anti-Inflammatory Drugs on the Lower Gastrointestinal Tract.

BACKGROUND & AIMS: Adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDS) on the upper gastrointestinal (GI) tract and small intestine are well described. Evidence is also accumulating that NSAIDS can induce and/or exacerbate the underlying pathology in the distal GI tract. The aim of this study was to estimate the effect NSAIDs on distal GIT
 METHODS: In 79 consecutive patients with chronic user of NSAIDs and 50 matched controls were included in this study which is done in Aldewanyia city. A detailed clinical history and physical examination were taking. Sigmoidoscopy; with or without colonoscopy were done were done to all patients and volunteer candidates, with histopathological study of rectal and colonic biopsies
 RESULTS: Of the 79 cases of patients, 38 (48%) were had lower clinical manifestation and 31(39%) of patients had histopathological which is mainly non-specific colitis vs. 9 (22%), 4(8%) of controls; P < 0.0001). NSAID use was aspirin (alone or combined) in 34.2% of cases, and 70.25% were using other NSAIDs alone or combined. Other independent risk factors were also assessed like smoking, diabetes, and body weight.
 CONCLUSIONS: NSAID use is strongly associated with an increased risk of upper GIT. This review study point up that NSAIDs can cause significant morbidity in some patients ranging from changing of bowel motion, profuse diarrhea, exacerbating of underlying inflammatory bowel disease, to chronic blood loss with iron deficiency anemia. The pathogenesis is likely multifactorial and is thought to be related to inhibition of prostaglandin synthesis with direct effect of drugs or its metabolites.
 The high prevalence of aspirin and other NSAIDs use suggests that adverse effects on GIT are increasing and should increasing the clinical awareness of these adverse effect throughout the GI tract may reduce morbidity. Concomitant NSAID use, smoking, and alcohol use is a widely association.

Case of surgical treatment of the heavy nonspecific ulcer colitis complicated by massive bleeding

Complex treatment of patients with nonspecific ulcerative colitis is one of the most difficult problems of modern gastroenterology and is characterized by ulcerative-destructive changes of its mucous membrane. The main indications for surgical treatment of patients with nonspecific ulcer colitis are its complications, as well as the inefficiency of multi-component conservative therapy. The case of treatment of a young patient suffering from ulcerative colitis complicated by bleeding is considered. The possibility of performing radical surgical interventions for complications of ulcerative colitis is shown. One of the most dangerous, life-threatening complications of ulcerative colitis is bleeding. Most operations in patients with bleeding are performed urgently in extremely adverse conditions, due not only to the severity of bleeding, posthemorrhagic anemia and significant violations of hemostasis, but also the presence of concomitant complications of nonspecific ulcerative colitis, as well as associated multiple organ dysfunction. Thus, during the hospitalization of the patient, which amounted to 48 days, the patient underwent 11 open surgical interventions. For proper treatment it took more than 25 liters of blood products. Attention is paid to the favorable long-term result of treatment of patients with this pathology. In the treatment of this category of patients should be aware of the possibility of using minimally invasive technologies. The urgency of the problem under consideration is increased due to the steady increase in the incidence of nonspecific ulcerative colitis, which is naturally accompanied by an increase in the frequency of complications and disability of patients, a significant part of whom are the most efficient and socially active patients aged 20-40 years, with the causes and mechanisms of their development are not fully known.

A Clinical Case of Combined Primary Sclerosing Cholangitis, Nonspecific Ulcerative Colitis and Autoimmune Hepatitis

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown etiology, leading to the development of secondary biliary cirrhosis, portal hypertension and liver failure. Many scientists point to the possibility of combining primary sclerosing cholangitis with such autoimmune diseases as ulceral colitis, Crohn’s disease, rheumatoid arthritis, autoimmune thyroiditis, Sjogren’s syndrome, autoimmune pancreatitis and autoimmune hepatitis.The article describes a clinical case of combined autoimmune damage to the gastrointestinal tract deals with primary sclerosing cholangitis and nonspecific ulcerative colitis.

Nonspecific Ulcerative Colitis in Practice of Family Doctor

The article presents the main diagnostic criterias and management of patients with ulcerative colitis in the conditions of primary care. An algorithm has been formulated for the action of the general practitioner-family doctor in the diagnosis and treatment of this category of patients.

Research progress on the relationship between inflammatory bowel disease and intestinal trefoil factor

Inflammatory bowel disease (IBD) is a group of chronic non-specific inflammatory bowel diseases that requires lifelong treatment and long-term follow-up.In recent years, the incidence of IBD in children is increasing year by year, which seriously affects children′s quality of life, growth and mental health.The diagnosis of IBD requires a comprehensive analysis of patients′ history, lab biochemistry, radiology, endoscopy and histopathology examinations and so on.There are no reliable non-invasive tests and biomarkers for follow-up.Trefoil factor family 3 (TFF3), identified essencial in the repairment of intestinal inflammation and promoting mucosal regeneration, playsan important rolein the pathogenesis of IBD.We review the relationship between intestinal trefoil factor and IBD, and further to discuss the possibility whether intestinal trefoil factor can act as a serum marker to assess the activity of IBD. Key words: Inflammatory bowel disease; Trefoil factor family 3; Biochemical marker; Intestinal epithelial barrier

Insult to Injury: A Multifactorial Etiology of Ischemic Colitis

Ischemic Colitis (IC) is a common cause of intestinal tract ischemic injury and is caused by transient hypoperfusion to the gut. Ischemic colitis is associated with female and elderly patients but can occur in younger patients with a precipitating cause. Contributors include vascular abnormalities, coagulation disorders and medications, including oral contraceptives and antibiotics. Typical presentation includes sudden onset cramping lower abdominal pain and bright red blood per rectum with blood clots. Endoscopic evaluation and histology is the gold standard to diagnose colon ischemia, but this may be time consuming and invasive. Our patient is a 24-year old woman with abdominal pain and bloody diarrhea. She was in her normal state of health until experiencing two days of sudden onset left sided abdominal pain, cramping, tenesmus and multiple episodes of bloody diarrhea. She denied fevers or chills, weight loss, foreign travel, abnormal food intake or family history of IBD. She later endorsed intermittent hematochezia for the past two years. Medications included chronic combined estrogen-progesterone oral contraceptive and new medication of doxycycline po bid this year. She had no previous endoscopies. Labs were notable for leukocytosis, negative pregnancy test, positive fecal leukocytes and CT scan w/o contrast indicating a nonspecific colitis in the sigmoid and descending colon. The patient was given empiric antibiotics and supportive care with initial resolution of leukocytosis and symptom improvement. Stool studies were negative and antibiotics were discontinued, but recurrence of bloody diarrhea and blood clots in her stool prompted further workup. Sigmoidoscopy was performed showing ishemic colitis, confirmed on pathology. Patients may undergo unnecessary treatment and testing for other pathologies such as infection, IBD or malignancy. Our patient improved with conservative management but surgery may be required in cases of gangrene colitis or stricture. Associations between ocp, antibiotics and acute ischemic colitis have been described previously. Our patient endorsed intermittent hematochezia prior to starting doxycycline, suggesting chronic colonic ischemia due to ocp prior to developing acute ischemic colitis from doxycycline sensitivity. Our case illustrates the need for a high index of suspicion for IC in young patients and further research is needed to determine potential synergistic mechanisms of medications that may cause ischemic colitis.1595_A Figure 1. Images from the sigmoid colon showing loss of vascularity and as well as erythema and edema consistent with ischemic colitis.1595_B Figure 2. Images from the sigmoid colon showing loss of vascularity and as well as erythema and edema consistent with ischemic colitis.1595_C Figure 3. Demonstration of colonic mucosa with mucosal hemorrhage and detachment of surface epithelial cells from the basement membrane. Necrosis of the superficial crypts with hyalinization of the lamina propria is noted. Findings are consistent with acute ischemic colitis.

Repeat Colonoscopy Revealing CMV Ileitis in an ALL Patient With GVHD

Introduction Graft-versus-host disease (GVHD) and Cytomegalovirus (CMV) infection of the GI tract can occur concomitantly as a complication of allogenic stem cell transplantation (SCT). Repeat endoscopy is sometimes necessary to diagnose GI CMV in the setting of GVHD. Case Patient is a 42 year old female with relapsed acute lymphoblastic leukemia (ALL), s/p chemotherapy and allogenic SCT who presents with intractable diarrhea. Her post SCT course was complicated by recurrent C. difficile diarrhea, CMV viremia and cutaneous GVHD. The Gastroenterology (GI) service was consulted and colonoscopy revealed diffuse colitis with crypt loss and focal apotosis consistent with Grade 2 GVHD. No evidence of infection was seen. She was started on IV steroids and tacrolimus, however, had persistent diarrhea. CT showed non-specific colitis and repeat infectious work-up was unrevealing. GI was re-consulted, and the utility of repeating a colonoscopy in the setting of known GI GVHD was considered. Repeat endoscopy revealed terminal ileum mucosa with extensive ulceration, neutrophilic exudate, apoptosis and regenerative changes suggestive of Grade 4 GVHD (Figure 1 and 2). CMV immunostain was positive, as was CMV PCR (Figure 3). Given findings, she was treated with IV foscarnet with eventual resolution of GI symptoms. Discussion Diagnosis of CMV infection in the setting of GVHD is challenging. After SCT, both are common complications and can occur together. The histologic hallmark of GI GVHD is epithelial cell apotosis. This is however nonspecific as other etiologies such drugs and infections including CMV are known to elicit epithelial apoptosis. During initial colonoscopy in our case, inclusion bodies were not seen, and CMV PCR was negative. Although CMV PCR has a high sensitivity at 89%, it is not perfect, as evidenced by an initially negative result. An important learning point is that repeat endoscopy might be necessary if there is no improvement despite treatment. A similar case is reported by Sun, et. al. Further, GI CMV disease was diagnosed at follow-up endoscopies in 39% of patients with GI GVDH in a study by Cho, et. al. As GI CMV can lead to dire complications such as obstruction and perforation, accurate diagnosis is vital and justifies repeat endoscopy.1914_A Figure 1. Terminal ileum showing ulceration and edema.1914_B Figure 2. Microphotograph of colonic biopsy showing changes of GVHD including apoptosis (arrow), crypt loss (arrowheads) and regenerative changes.1914_C Figure 3. Microphotograph of terminal ileal biopsy showing background of severe GVHD without surviving crypts. Few viral inclusions are seen (arrows) that are positive for CMV with CMV immunostain (dark brown nuclear staining in the inset).

Utility of CT Angiography (CTA) in Diagnosis and Treatment of Acute Lower GI Bleeding (LGIB)

Introduction: To investigate the diagnostic performance of CTA in identifying the cause of acute lower GI bleeding and to determine the clinical features associated with positive test result of CTA. Acute Lower GI bleed warrants quick detection and localization of the bleed. Various studies have shown that CTA can detect active hemorrage at rate of 0.3 ml/min (compared to bleeding scan detection rate of 0.2 ml/min) Methods: Retrospective chart review study of all patients who had CTA performed for suspected acute LGIB in last 5 years in a community hospital in Brooklyn Results: 84 patients with mean age of 69 years were included. 41% were male and 59% were females. 49% were on antiplatelet therapy.29% had history of diverticulosis. Mean Hb value was 8.34 g/dL. Presenting complaints were lower GI bleeding in 86%, upper GI bleeding in 9.5%, abdominal pain with anemia in 4.5%. On abd CTA, 86% had no active bleeding and 14% had active bleeding. 9/12 had LGI and 3/12 had upper GI bleeding. EGD showed antral/duodenal ulcers in patients where CT had localized disease to upper GI tract. 5/9 with localized bleeding to lower GI tract had colonoscopy done. Colonoscopy showed diverticulosis in 3, mass in 1 and colitis in 1. CTA was negative in 44%, non-specific colitis 13%, diverticulosis in 15%. 20% patients had bleeding scan done. 11/17 had positive bleeding scan. In patients with positive bleeding scan,10/11 had initial negative CTA, 6/11 had EGD done which did not show active bleeding. 7 had colonoscopy done which did not show active bleeding. EGD was done in 41/84 patients. No active bleeding was identified in all patient who had EGD done. Conclusion: In patients with acute LGIB, CTA lacks sensitivity and was positive only in14% of the patients. Bleeding scan was more sensitive however, lacked specificity in localizing the bleeding. Patients who had positive CT scan for active bleeding, only one had active bleeding on Colonoscopy. All the patients who had CT evidence of diverticulosis, were found to have diverticulosis on colonoscopy.Diverticular bleeding is most common cause of LGIB. CTA should only be reserved for patients with continued bleeding despite usual standard of care and in patients in whom vascular intervention is needed. Majority of patients can be spared from radiation and IV contrast exposure from CTA. However, further large prospective studies are needed to define the role of CT in acute GI bleeding when other investigations are unable to provide a diagnosis.

Reporting Colonic Biopsies in Patients With Inflammatory Bowel Disease; a Practical Approach.

Crohn's disease (CD) and ulcerative colitis (UC) are common diseases; for convenience, we lump them together as inflammatory bowel disease (IBD). Colonic biopsies are essential for establishing a diagnosis, monitoring treatment, and/or identifying complications. This article attempts to detail the histological criteria of UC and CD and also informs on a lifelong approach of reporting colonic biopsies from patients with IBD. Often the clinical information on the accompanying request form is not available to the pathologist. In these cases, the author has initiated a reproducible system of pattern-based reporting with a differential diagnosis. This type of report offers a working diagnosis for the clinician before the final diagnosis, which is recommended to be undertaken in a setting of combined clinico-pathological conference (CPC). This system carries objective parameters and standardizes reporting to significantly minimize the interobserver variations among reporting pathologists. If a CPC facility is not available, we offer an alternative evidence-based arrangement. We discourage the use the term "nonspecific colitis" as we have shown that it has no clinical value or agreed-upon and recognized histopathological features. As the paper addresses mucosal biopsies, the entity of indeterminate colitis will not be included in this article as this diagnosis is strictly based on colonic resectate. 10.1093/ibd/izy288_video1 izy288.video1 5839278247001.

Etiological Aspects of Nonspecific Ulcerative Colitis

Etiological Aspects of Nonspecific Ulcerative Colitis

Profile of Colonoscopy Findings: A single Centre Experience

Background: About 30% of patients presenting to surgical outpatient department has lower gastrointestinal (LGI) symptoms. Colonoscopy is a low risk and at the same time investigation of choice in these patients which allows visualization of the entire colon and the terminal portion of ileum. This study was done to evaluate the role of colonoscopy.
 Methods: This was an observational, hospital based study from February 2014 to March 2018, carried out at Nepalgunj Medical College and Teaching Hospital.
 Results: 245 patients underwent colonoscopy, among them 62.85% were male and 37.14% were female with the M:F ratio being 1.6:1. The youngest patient undergoing colonoscopy was 21 and the eldest was 78 with the mean age being 53.6±12. The common indications were per rectal bleeding (49.38%), alteration in bowel habit (40.49%), and constipation (13.46%). In 85.71% patients entire large bowel could be visualized. In 21.22% no abnormality was detected. Haemorrhoids (27.34%) were the most common findings and then nonspecific inflammatory bowel diseases (17.55%), colorectal polyps (15.51%) and colorectal cancers (14.28%). Biopsy was done in 39.51% patients and the most common finding was nonspecific inflammatory bowel disease, 36.08% had adenocarcinomas and rest had ulcerative colitis, juvenile and hamartomatous polyps.
 Conclusion: Colonoscopy is a safe and effective investigation in diagnosing as well as managing the patients with LGI symptoms.

A concurrent presentation of nonspecific colitis as well as likely myocarditis

An ST-segment elevation myocardial infarction represents a time-sensitive cardiac pathology with utmost importance placed upon timely coronary angiography with percutaneous coronary intervention. While emphasis is placed on atherosclerotic or thrombotic coronary occlusion, it is important to recognize other etiologies which may present in a similar fashion. This case demonstrates a 71-year-old female patient with prior coronary artery disease and stenting who presented with acute abdominal pain and elevated cardiac biomarkers as well as ST-segment elevation on initial EKG. Coronary angiography revealed only mild to moderate coronary lesions and patent stents while echocardiography was essential unchanged from prior evaluation. Computed tomography of the abdomen would show findings suggestive of infectious colitis and empiric antibiotics led to full resolution of symptoms. While no definitive cause for her cardiac manifestations was discovered, the authors propose coronary vasospasm or myo-pericarditis as likely etiologies in response to an overwhelming inflammatory state. The case underscores the importance of formulating a comprehensive differential diagnosis during the initial workup of a ST-segment elevation myocardial infarction.

Diagnostic Markers for Nonspecific Inflammatory Bowel Diseases.

The nonspecific inflammatory bowel diseases (IBD) represent a heterogeneous group of chronic inflammatory disorders of the gastrointestinal tract, and Leśniowski-Crohn's disease (CD) and ulcerative colitis (UC) are among the two major clinical forms. Despite the great progress in understanding the pathogenesis of these diseases, their etiology remains unclear. Genetic, immune, and environmental factors are thought to play a key role. The correct diagnosis of nonspecific inflammatory bowel diseases as well as the determination of disease activity, risk stratification, and prediction of response to therapy still relies on a multidisciplinary approach based on clinical, laboratory, endoscopic, and histologic examination. However, considerable effort has been devoted to the development of an accurate panel of noninvasive biomarkers that have increased diagnostic sensitivity and specificity. Laboratory biomarkers useful in differentiating IBD with functional disorders and in evaluating disease activity, prognosis, and treatment selection for IBD are presented in this study.

Inflammatory Bowel Diseases Prevalence in Patients Underwent Colonoscopy in Zagazig University Hospitals

Background and study aim: Colonoscopy is recommended by many international gastroenterology and cancer societies as the initial diagnostic modality for colorectal cancer. It is considered the most accurate diagnostic tool in inflammatory bowel disease. These are two identified subtypes of the disease, ulcerative colitis (UC) and Crohn's disease. The previous studies on Egyptian patients said that the incidence of IBD increased significantly in the past ten years. The aim of this study was to calculate the prevalence of IBD among patients referred to endoscopy units to perform colonoscopy and define the most common presenting symptoms of IBD. We also wanted to shed light on the most common presenting complaints that lead to referral to colonoscopy and the common colonic lesions that were diagnosed by colonoscopy.r Patients and Methods: Cross sectional study involved 250 patients who underwent colonoscopy in the period from November 2014 to November 2015, the presenting complaint was recorded as well as the results of colonoscopy. Results: Bleeding per rectum was the commonest indication for colonoscopy (46%) followed by chronic abdominal pain (20%), then chronic diarrhea (17%). The commonest pathological conditions were internal hemorrhoids in 27.6% followed by nonspecific colitis in 20.4%, ulcerative colitis in 10.4%, carcinoma in 10.4%, Crohn's in 0.8% then polyps in 0.4%. UC/CD ratio was 13:1. Conclusion: In a group of Egyptian patients undergoing colonoscopy the most frequent diagnosis were internal piles, non-specific colitis followed by inflammatory bowel disease with a prevalence of 11.2% and predominance of UC over CD.

Acute lower gastrointestinal bleeding in Sudanese patients: a study on 301 patients in a specialized centre

Background and study aimsLower gastrointestinal bleeding originates from a site distal to the ligament of Treitz. It can present as an acute life-threatening or chronicbleeding. It is common among older patients and those with comorbidity. The common causes are diverticular disease, angiodysplasias, neoplasms, colitis, ischaemia and anorectal disorders. The aim of this study is to determine the prevalence and causes of acute lower gastrointestinal bleeding among Sudanese patients. Patients and methodsIn a period of 2 years we studied 301 patients with fresh rectal bleeding out of 5625 patients with gastrointestinal bleeding in Ibn Sina Specialized Hospital, Khartoum, Sudan, This is a cross sectional observational hospital based study. All patients with fresh rectal bleeding within 24 h were included and consented. ResultLower gastrointestinal bleeding constituted 5.37% of total cases of gastrointestinal bleeding. The mean age of patients was 55.43 ± 17.779, male: female ratio was 2:1. The most common cause (if upper gastrointestinal bleeding is excluded) was diverticular disease 39.6% (n = 61) followed by piles 24.1% (n = 35), colonic tumours 12.34% (n = 19), ulcerative colitis 5.19% (n = 8), Crohn’s 5.19% (n = 8), colonic polyps 3,89% (n = 6), angiodysplesia 4.5% (n = 7), colonic ulcer 2.59% (n = 4), ischaemic colitis 1.3%, nonspecific colitis 1.3% (n = 2), and small bowel source in 1.3% (n = 2). The majority of those patients with diverticular disease were male and with first presentation. The commonest cause in those patients younger than 20 years was polyps, and in those between 21 and 40 was piles followed by inflammatory bowel disease, and in those between 41 and 60 years old was piles followed by diverticular disease and tumours, and in those above 60 years was diverticular disease followed by piles and tumours. The correlation between positive colonoscopy finding and diabetes and the use of nonsteroidal anti-inflammatory drugs were statistically significant. The one-month mortality rate was 2.3% ConclusionAcute lower gastrointestinal bleeding is common among elderly patients and the commonest cause is diverticular disease. Colonoscopy plays an important role in the diagnosis. Most patients respond to conservative therapy.