Nonspecific Colitis Research Articles

Active Ingredients and Potential Mechanisms of the Gan Jiang-Huang Qin-Huang Lian-Ren Shen Decoction against Ulcerative Colitis: A Network Pharmacology and Molecular Docking-Based Study.

Background Ulcerative colitis (UC), a chronic and nonspecific inflammatory bowel disease, seriously affects the quality of patients' life. Han Re Bing Yong Fa (treating diseases with both cool- and warm-natured herbs) is a classical therapeutic principle of traditional Chinese medicine (TCM), which is often used to treat chronic diseases, including UC. The Gan Jiang-Huang Qin-Huang Lian-Ren Shen decoction (GJHQHLRSD), a representative of Han Re Bing Yong Fa, is effective in alleviating inflammatory symptoms in UC. However, the pharmacological mechanism underlying its anti-inflammatory effect remains unclear. Methods A network pharmacology strategy, including the construction and analysis of the drug–disease network, was used to explore the complex mechanism of GJHQHLRSD treatment of UC. In addition, molecular docking technology was used to preliminarily examine the binding ability of the potential active components and core therapeutic targets of GJHQHLRSD. Results The network pharmacology results revealed 140 targets of GJHQHLRSD which are involved in UC. The PPI network analysis identified seven target genes: BCL2L1, NR3C1, ALOX5, S1PR5, NR1I2, CYP2D6, and LPAR6. The molecular docking results revealed that the following displayed strongest combined effects: EGFR with kaempferol, ERK1 with worenine, STAT3 with Palmidin A, BCL2L1 with diop and VEGFA with ginsenoside Rg3. The KEGG and gene ontology enrichment analyses results indicated that GJHQHLRSD functions by regulating the EGFR signaling pathway in UC treatment. Other effective biological processes involved in UC treatment included cancer-related as well as inflammation and viral infection signaling pathways, such as the “MicroRNAs in cancer,” “TNF signaling pathway,” and “JAK-STAT signaling pathway.” Conclusions This study reflects the multicomponent, multitarget, and multipathway characteristics of the action mechanism of GJHQHLRSD in treating UC. Furthermore, it helps better understand the TCM therapeutic principle of Han Re Bing Yong Fa and explore novel candidate drug targets for UC treatment.

Застосування препаратів 5-аміносаліцилової кислоти в лікуванні запальних захворювань кишечника

Стаття присвячена порівняльній характеристиці різних похідних 5-аміносаліцилової кислоти. Дослідження останніх десятиліть змінили уявлення про можливості застосування аміносаліцилатів у терапії різних запальних захворювань кишечника. У зв’язку з невідомою етіологією хвороби Крона та неспецифічного виразкового коліту етіотропної терапії цих захворювань немає. Сутність лікування зводиться до гальмування активності запалення при загостреннях і проведенні курсів протирецидивної терапії. Численні дослідження, проведені протягом останніх 20 років, показали, що основу базисної терапії хронічних неспецифічних запальних захворювань кишечника становлять препарати 5-аміносаліцилової кислоти, або саліцилати. При виборі лікарської форми слід ураховувати відмінності між препаратами месалазину залежно від типу оболонки. Показано, що з точки зору фармакокінетики найбільш ефективними лікарськими формами месалазину для лікування неспецифічного виразкового коліту та хвороби Крона з ураженням товстої кишки є таблетки з кишковорозчинним покриттям, що забезпечує рН-залежне поступове вивільнення 5-аміносаліцилової кислоти на протязі усієї товстої кишки. Наявні на сьогодні на фармацевтичному ринку препарати 5-аміносаліцилової кислоти здатні контролювати перебіг виразкового коліту та хвороби Крона з ураженням товстої кишки в переважної більшості пацієнтів. Застосування препаратів 5-аміносаліцилової кислоти не обмежується терапією неспецифічного виразкового коліту та хвороби Крона. Препарат широко застосовується при інших захворюваннях кишечника, таких як дивертикулярна хвороба товстої кишки, банальні коліти, променеві ураження ободової кишки, а також для лікування такої поширеної хвороби, як синдром подразненого кишечника. Результати дослідження, що було проведено у відділенні захворювань кишечника ДУ «Інститут гастроентерології НАМН України» упродовж 2 років, показали позитивний ефект 20-денного лікування Месаколом неускладненої дивертикулярної хвороби. Месакол у дозі 1600 мг на добу призвів до повного купірування абдомінальної симптоматики у 68,7 % хворих.

Місце фосфатидилхоліну в лікуванні запального ураження кишечника

У патогенезі більшості захворювань кишечника важливе, а часто вирішальне значення має запалення. Широко і всебічно його патогенетична роль вивчена при ЗЗК. В останні роки розпочато дослідження його вкладу в по­шкодження кишечника при функціональній патології — синдромі подразненої кишки (СПК). Парадоксальною здається участь запалення в розвитку ерозивно-виразкових уражень нижніх відділів шлунково-кишкового тракту на тлі прийому нестероїдних протизапальних препаратів (НПЗП-ентероколопатії). Добре відома роль фосфоліпідів у побудові клітинних мембран. Одним з основних мембранних фосфоліпідів більшості живих організмів (за винятком бактерій) є фосфатидилхолін (ФХ). У мембранах кишкового епітелію вміст ФХ збільшується з 10 до 50 % у напрямку від апікальної поверхні до базальної, причому максимальна кількість ФХ розташовується із зовнішнього боку клітинних мембран. Фосфатидилхолін показав свою високу ефективність і безпеку в лікуванні такого запального захворювання кишечника, як неспецифічний виразковий коліт. У людей, що приймають нестероїдні протизапальні засоби, доведена протективна роль ФХ у попередженні пошкодження верхніх і нижніх відділів шлунково-кишкового тракту. З огляду на загальні патогенетичні механізми цих захворювань і СПК нам представляється перспективним використання ФХ у хворих із СПК, особливо його постінфекційним варіантом.

Гендерные и возрастные особенности морфологического состояния слизистой оболочки толстой кишки больных хроническими воспалительными заболеваниями кишечника

Актуальность. Важность проблемы хронических заболеваний кишечника на сегодняшний день не подлежит сомнению. Это подтверждается этиологией неизвестного генеза, отсутствием специфического лечения, развитием ­угрожающих жизни осложнений, необходимостью проведения длительной, часто пожизненной, дорогой терапии и неблагоприятным прогнозом. Большую часть больных составляют лица молодого трудоспособного возраста, средний возраст которых — 20–35 лет. Но в 30–50 % случаев заболевание может проявиться в любом возрасте. Цель: оценить особенности морфологического состояния слизистой оболочки толстой кишки больных при хронических воспалительных заболеваниях кишечника в зависимости от возраста и пола. Материалы и методы. Для исследования были использованы биоптаты слизистой оболочки толстой кишки больных, находившихся на лечении в отделении заболеваний кишечника ГУ «Институт гастроэнтерологии НАМН Украины» и распределенных по полу и возрасту. Результаты. При анализе морфофункционального состояния слизистой оболочки больных были выявлены признаки хронического неспецифического воспаления умеренной и четко выраженной степени выраженности при неспецифическом язвенном колите. При болезни Крона как у мужчин, так и у женщин отмечались признаки хронического неспецифического воспаления первой степени. Аллергический компонент воспаления, представленный эозинофилами, был отмечен во всех случаях. Также отмечались нарушение архитектоники крипт, истощение муцинового слоя и нарушение целостности эпителия. Выводы. Пациенты молодого возраста имели более четко выраженную морфологическую картину хронического воспаления слизистой оболочки толстой кишки при неспецифическом язвенном колите. Мужчины, больные неспецифическим язвенным колитом, имеют большее истощение слоя муцина и нарушение архитектоники крипт в молодом и среднем возрасте, а при болезни Крона такие признаки чаще встречаются у женщин.

1

1

Paediatric Colonoscopy: Experience from Pediatric Gastroenterology and Nutrition Department, BSMMU

Background: Colonoscopy of the lower gastrointestinal tract has both diagnostic and therapeutic value.
 Objective: This cross-sectional study aimed to investigate the indications, findings and complications of children who underwent the colonoscopy.
 Materials & Methods: We studied the children between 1 and 18 years of age who presented with various indications and underwent both diagnostic and therapeutic colonoscopy in the Department of PGN, BSMMU, Dhaka from January 2015 to February 2018.
 Results: Among the total 332 patients reviewed,61.7% (205) were male and 38.3% (127)with a male to female ratio of 1.61:1. The most common (69.8%) indication was lower gastrointestinal bleeding (LGIB) followed by diarrhea (15.9%) and altered bowel (14%) as well. No serious complications occurred during the procedures. A total of 211 patients (63.5%) received a diagnosis, including 137 (41.3%) patients with colorectal polyps, erythema 40(12%) and diffuse nonspecific colitis 34(10.2%).Ninety four percent polyps are located in recto-sigmoid region. Juvenile polyp was the most common pathological findings.
 Conclusion: LGIB is the commonest indication for pediatric colonoscopy. Pediatric colonoscopy is effective diagnostic as well as therapeutic option for lower GI pathology.
 BANGLADESH J CHILD HEALTH 2021; VOL 45 (1) : 25-28

THE ROLE OF ENDOTHELIAL DYSFUNCTION IN INFLAMMATORY BOWEL DISEASES

The purpose of the study – to assess the disorders’ degree of endothelium dysfunction inpatients with nonspecific ulcerative colitis (NUC) and Crohn's disease (CD), dependingon the severity of inflammation.Material and methods. 34 patients with NUC and 18 people with CD with continuousrecurrent courses, 15 patients with NUC and 15 patients with CD in remission wereobserved. The control group included 30 healthy volunteers.Results. It has been established that patients with active NUC had a significantly higherlevel of markers characterizing changes of proliferative (VEGF-165) and adhesive(VCAM-1) endothelial functions vs. control (in 4.62 and 2.01 times) and patients whohad an inactive disease (at 3.95 and 4.62) (p<0.05). In the active course of NUC, VEGF-165 level increased by 3.27 and 5.03 times, the level of VCAM by 1.83 and 2.09 times vs.inactive and control group (p<0.05).In patients with severe and moderate degrees of NUC, we have set an increase in theconcentration of VEGF-165 compared with mild degree, p<0.05. It has been proven thatin severe degree of CD, the concentration of VEGF-165 increased 21.5% vs. moderateactivity and 63.1% vs. mild activity, p<0.05.It has been established that adhesive phenotype of endothelial dysfunction with severeactivity of NUC was associated with an elevated content of adhesion molecule, dependingof activity, p<0.05. The adhesive phenotype of endothelial dysfunction is proved forpatients with severe activity of CD compared with moderate and mild activity, p<0.05.We have revealed a reliable direct regression relationship between the concentration ofthe vascular endothelial growth factor and the activity of UC according to the TrueloveWitts scale (R=0.29, p<0.05), between the CDAI index level in CD and the content ofVCAM-1 (R=0.29, p<0.05).Conclusions. Inflammatory bowel diseases - NUC and CD are accompanied withendothelium dysfunction, proliferative and adhesive phenotypes, associated with theactivity of process.

Multi-System Inflammatory Syndrome Presenting as Non-Specific Colitis: A Medical Diagnosis with a Surgical Presentation.

A 20-year-old woman with previous COVID-19 diagnosis presented with abdominal pain and colitis on CT scan. She was admitted in septic shock, with etiology of colitis unclear. After resuscitation, antibiotics, and steroids, she clinically deteriorated. Worsening Clostridioides difficile infection was most likely and she was taken to the operating room. Intraoperatively, only a segment of transverse colon appeared abnormal on gross and endoscopic evaluation. Total colectomy was deferred in favor of segmental resection. Given her unusual disease pattern and recent COVID-19 infection, diagnosis of MIS-C was considered. Steroids were continued and treatment broadened to include heparin and IVIG. The patient returned to the operating room for planned reexploration, endoscopy, and end colostomy. On hospital day three, the patient had an acute mental status change. Computed tomography demonstrated acute cerebral edema with brainstem herniation. The family chose comfort-care measures. Final pathology from the transverse colon demonstrated COVID-19-associated vasculitis.

A qualitative and quantitative analysis of open citations to retracted articles: the Wakefield 1998 et al.'s case

In this article, we show the results of a quantitative and qualitative analysis of open citations on a popular and highly cited retracted paper: “Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children” by Wakefield et al., published in 1998. The main purpose of our study is to understand the behavior of the publications citing one retracted article and the characteristics of the citations the retracted article accumulated over time. Our analysis is based on a methodology which illustrates how we gathered the data, extracted the topics of the citing articles and visualized the results. The data and services used are all open and free to foster the reproducibility of the analysis. The outcomes concerned the analysis of the entities citing Wakefield et al.’s article and their related in-text citations. We observed a constant increasing number of citations in the last 20 years, accompanied with a constant increment in the percentage of those acknowledging its retraction. Citing articles have started either discussing or dealing with the retraction of Wakefield et al.’s article even before its full retraction happened in 2010. Articles in the social sciences domain citing the Wakefield et al.’s one were among those that have mostly discussed its retraction. In addition, when observing the in-text citations, we noticed that a large number of the citations received by Wakefield et al.’s article has focused on general discussions without recalling strictly medical details, especially after the full retraction. Medical studies did not hesitate in acknowledging the retraction of the Wakefield et al.’s article and often provided strong negative statements on it.

SURGICAL TREATMENT OF ULCERATIVE COLITIS. HISTORY

The article describes the main achievements in the study of ulcerative colitis (UC) - a disease known since ancient times. «Bloody» non-epidemic diarrhea was described by Hippocrates. The first detailed description was made by K. Rokitansky in 1842. In 1875, S. Wilks and W. Mason first studied the pathomorphology of the colon in UC. The term «non-specific ulcerative colitis» was proposed by the Russian surgeon A. S. Kazachenko in 1913 at the 13th Congress of Russian surgeons. The historical excursion presents the main stages and achievements of surgical treatment of UC.

Prevalence of Microscopic Colitis in Diarrhea-predominant Irittable Bowel Syndrome Patients: Cohort Study From Upper Egypt.

There is controversy about colonoscopy and taking biopsy from the normal colonic mucosa in patients with a clinical diagnosis of diarrhea-predominant irritable bowel syndrome (D-IBS). This study aims to estimate the prevalence of microscopic colitis (MC) in D-IBS patients and to select patients without the well-known alarming features who will benefit from colonoscopy and biopsies from the normal colonic mucosa. We performed a cohort cross-sectional study over 6 months duration in a total of 129 patients with Rome III criteria of D-IBS after excluding cases with features of organic diseases. Cases were subjected to colonoscopy and biopsies from the colonic mucosa that seemed normal. Histopathologic examination of biopsies taken from cases with normal colonic mucosa revealed 86 (71.66%) cases with nonspecific colitis, 26 (21.66%) cases with MC and 8 (6.66%) cases with ulcerative colitis. Concomitant immunologic diseases (P=0.00005) and triggering drugs intake (P=0.006) were significantly more common in the MC group. The mean duration of diarrhea in MC patients was significantly longer than that of nonspecific colitis and ulcerative colitis patients (P=0.0006). Prevalence of MC in D-IBS patients from Upper Egypt is relatively high (21.66%). Concomitant immunologic diseases, possible triggering drugs intake, and long duration of diarrhea are significant risk factors for undiagnosed MC in D-IBS patients.

Potential protein-phenotype correlation in three lipopolysaccharide-responsive beige-like anchor protein-deficient patients.

BACKGROUNDPatients with lipopolysaccharide (LPS)-responsive beige-like anchor protein (LRBA) deficiency have a variety of clinical symptoms, but there is no apparent genotype–phenotype correlation, and patients carrying the same mutations may have different phenotypes. Therefore, it is not easy for doctors to make a decision regarding hematopoietic stem cell transplantation (HSCT) for LRBA-deficient patients. We hypothesized that there may be a protein–phenotype correlation to indicate HSCT for LRBA-deficient patients.AIMTo report on three Chinese LRBA-deficient patients and determine the correlation between residual protein expression and disease phenotypes. METHODSClinical data of three Chinese LRBA-deficient patients were collected, and protein levels were detected by Western blot analysis. In addition, LRBA mutation information of another 83 previously reported patients was summarized.RESULTSAll the major clinical findings indicated enteropathy, but patients 1 and 3 presented with more severe symptoms than patient 2. Endoscopy and histology indicated nonspecific colitis for patients 1 and 3 but Crohn's disease-like colitis for patient 2. Compound heterozygous mutations in LRBA were found in patient 1, and homozygous mutations in LRBA were found in patient 2 and patient 3. Only patient 2 responded well to traditional immunosuppressive treatment. Residual expression of the LRBA protein in patients 1 and 3 was very low, but in patient 2, a more than 0.5-fold in expression of the LRBA protein was found compared to that in the control. After HSCT, patient 1 had increased LRBA protein expression. We summarized the genetic information of 86 patients, and the mutations in patients 1 and 3 were novel mutations.CONCLUSIONWe described three Chinese LRBA-deficient patients, two of whom carried novel mutations. These patients had no genotype-phenotype correlations, but their residual LRBA protein expression might be associated with disease outcome and could be an indicator for HSCT.

Etiology of Colitis-Complex Diarrhea in Growing Pigs: A Review

Simple SummaryDiarrhea in growing pigs is a challenge for the pig industry since it is associated with reduced animal welfare, retarded growth, increased feed conversion ratio, and is often treated with antibiotics. One of the major causes of diarrhea in the growing period is large intestinal inflammation, often referred to as colitis. The exact causes of colitis-complex diarrhea are still to be understood, but dietary factors and/or pathogens have been recognized as the major factors in developing colitis-complex diarrhea. In this review, a thorough picture of pathogens, dietary factors, and a number of possible biomarkers related to colitis-complex diarrhea is presented.Colitis-complex diarrhea (CCD) in pigs can be defined as a type of diarrhea, which is associated with colonic inflammation and disrupted colonic gut barrier functionality in growing pigs (4–16 weeks post-weaning). It is a challenge for the pig industry as it is associated with the high use of antibiotics, reduced animal welfare, and depressed growth rate. The exact etiology of CCD is still unclear; however, pathogens including Brachyspira (B.) hyodysenteriae, B. pilosicoli, and swine whipworms such as Trichuris (T.) suis have been involved in specific colitis (SC). In the absence of specific pathogens, dietary factors, such as high levels of protein, pelleted feedstuffs, and lack of sufficient antioxidants, can result in non-specific colitis (NSC). On the other hand, supplement of polyunsaturated fatty acids (PUFA) and polyphenols, sufficient supply of essential amino acids (e.g., threonine, cysteine, and proline), short-chain fatty acids (SCFA; especially butyrate), and resistant starch have shown to confer preventing/ameliorating effects on CCD. Different putative biomarkers associated with CCD have been presented. It is anticipated that a comprehensive picture of the possible causes of CCD and potential dietary interventions could cast light on the direction of future studies aimed at developing preventive and curative strategies against CCD in growing pigs.

Effects of Different Treatment of Fecal Microbiota Transplantation Techniques on Treatment of Ulcerative Colitis in Rats.

Background: Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease with abdominal pain, mucus, pus and blood in the stool as the main clinical manifestations. The pathogenesis of UC is still not completely clear, and multiple factors, such as genetic susceptibility, immune response, intestinal microecological changes and environmental factors, together lead to the onset of UC. In recent years, the role of intestinal microbiota disturbances on the pathogenesis of UC has received widespread attention. Therefore, fecal microbiota transplantation (FMT), which changes the intestinal microecological environment of UC patients by transplantation of normal fecal bacteria, has attracted increasing attention from researchers. However, there are no guidelines to recommend fresh FMT or frozen FMT in the treatment of UC, and there are few studies on this. Therefore, the purpose of this study was to explore the effects of fresh and frozen FMT methods on the treatment of experimental UC models in rats.Results: Compared with the model control group, all FMT groups achieved better efficacy, mainly manifested as weight gain by the rats, improvements in fecal characteristics and blood stools, reduced inflammatory factors and normal bacterial microbiota. The efficacy of the frozen FMT group was better than that of the fresh FMT group in terms of behavior and colon length.Conclusion: FMT method supplements the gut microbiota with beneficial bacteria, such as short-chain fatty acid-producing bacteria. These bacteria can regulate intestinal function, protect the mucosal barrier and reduce harmful bacteria, thus mitigating the damage to the intestinal barrier and the associated inflammatory response, resulting in UC remission. FMT is a feasible method for treating UC, with frozen FMT having a superior therapeutic effect than that of fresh FMT.

MiRNA-Based Potential Biomarkers and New Molecular Insights in Ulcerative Colitis.

Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease, which usually manifests as abdominal pain, diarrhea and hematochezia. The disease often recurs and is difficult to cure. At present, the pathogenesis is not clear, but it is believed that the disease is caused by a complex interaction among immunity, heredity, environment and intestinal microflora disorders. MicroRNA (miRNA) is endogenous single-stranded non-coding RNA of 17–25 nucleotides (nts). They target the 3'Untranslated Region of a target gene and inhibit or degrade the target gene according to the extent of complementary bases. As important gene expression regulators, miRNAs are involved in regulating the expression of most human genes, and play an important role in the pathogenesis of many autoimmune diseases including UC. Studies in recent years have illustrated that abnormal expression of miRNA occurs very early in disease pathogenesis. Moreover, this abnormal expression is highly related to disease activity of UC and colitis-associated cancer, and involves virtually all key UC-related mechanisms, such as immunity and intestinal microbiota dysregulation. Recently, it was discovered that miRNA is highly stable outside the cell in the form of microvesicles, exosomes or apoptotic vesicles, which raises the possibility that miRNA may serve as a novel diagnostic marker for UC. In this review, we summarize the biosynthetic pathway and the function of miRNA, and summarize the usefulness of miRNA for diagnosis, monitoring and prognosis of UC. Then, we described four types of miRNAs involved in regulating the mechanisms of UC occurrence and development: 1) miRNAs are involved in regulating immune cells; 2) affect the intestinal epithelial cells barrier; 3) regulate the homeostasis between gut microbiota and the host; and 4) participate in the formation of tumor in UC. Altogether, we aim to emphasize the close relationship between miRNA and UC as well as to propose that the field has value for developing potential biomarkers as well as therapeutic targets for UC.

CLINICOPATHOLOGIC PECULIARITIES OF NONSPECIFIC ULCERATIVE COLITIS AND CROHN'S DISEASE

Currently, inflammatory bowel diseases (IBD), in nonspecific ulcerative colitis (NUC) and Crohn's disease (CD), are an extremely urgent problem. The incidence of both ulcerative colitis and Crohn's disease worldwide is increasing every year, and mainly among the working-age population, which makes inflammatory bowel disease (IBD) a socially significant disease. The clinical picture of IBD is diverse, which often makes it difficult to timely diagnose and prescribe adequate therapy and inevitably negatively affects the prognosis of diseases. Here are some of the characteristics of the NUC and CD. The histogram results of numerous studies indicate the following: in Crohn's disease (CD), the thickness of the intestinal wall is often significantly increased. In the mucous membrane, slit-like ulcerative defects are detected, in the bottom of which there are signs of inflammation in the form of infiltration of the bottom of the ulcers by leukocytes, lymphocytes, histiocytes. As for colitis, based on these clinical cases, it can be concluded that children and adolescents are characterized by a total lesion of the colon and the appearance of segmental forms. In adult patients, distal colitis, the so-called proctosigmoiditis, prevails. On examination, the mucous membrane was edematous, vividly hyperemic, edematous, with superficial erosions.

CLINICOPATHOLOGIC PECULIARITIES OF NONSPECIFIC ULCERATIVE COLITIS AND CROHN'S DISEASE

Currently, inflammatory bowel diseases (IBD), in nonspecific ulcerative colitis (NUC) and Crohn's disease (CD), are an extremely urgent problem. The incidence of both ulcerative colitis and Crohn's disease worldwide is increasing every year, and mainly among the working-age population, which makes inflammatory bowel disease (IBD) a socially significant disease. The clinical picture of IBD is diverse, which often makes it difficult to timely diagnose and prescribe adequate therapy and inevitably negatively affects the prognosis of diseases. Here are some of the characteristics of the NUC and CD. The histogram results of numerous studies indicate the following: in Crohn's disease (CD), the thickness of the intestinal wall is often significantly increased. In the mucous membrane, slit-like ulcerative defects are detected, in the bottom of which there are signs of inflammation in the form of infiltration of the bottom of the ulcers by leukocytes, lymphocytes, histiocytes. As for colitis, based on these clinical cases, it can be concluded that children and adolescents are characterized by a total lesion of the colon and the appearance of segmental forms. In adult patients, distal colitis, the so-called proctosigmoiditis, prevails. On examination, the mucous membrane was edematous, vividly hyperemic, edematous, with superficial erosions.

Lower Gastrointestinal Endoscopy

Background: Histopathological examination of endoscopic biopsy specimens support diagnosis, monitoring the course of the diseases and recognize complications. The aim of this study was to determine the type and frequency of histopathological change in colonic biopsies and its correlations with age and sex. Materials and Methods: Two hundred and fifty-eight colonic biopsies were collected from January 2016 to December 2017. The tissue was subjected to histopathological examination, the data collected and statistically analyzed. Results: Neoplastic colonic lesions form 52% and nonneoplastic form 48%. Cases of adenocarcinoma form 39.1%, nonspecific colitis form 29.1%, adenoma form 12.8%, ulcerative colitis was seen in 7.4% of cases, hyperplastic polyps form 6.2%, and Crohn's disease from 5.4%. Most of adenocarcinomas were moderately differentiated, the grade was higher in females (P = 0.032). Most of nonspecific colitis cases showed mild inflammation. Most of the adenomas were tubular type. More than 90% of neoplastic lesions were in patients above 40 years and 45.5% of inflammatory bowel disease (IBD) cases were present in the age group of between 20 and 39 years (P = 0.001). Most of the cases of adenomas were seen in the age group between 40 and 80 years and (P = 0.018) Conclusion: Adenocarcinoma is the most frequent abnormality, mainly above 40 years of age. IBDs were seen below 40 years of age. In general, in all lesions, males were more affected than females except in cases of IBD and moderately differentiated adenocarcinoma.

Clinical Profile and Colonoscopic Findings in Patients Presented with Lower Gastrointestinal Bleeding in UCMS

INTRODUCTION
 The lower gastrointestinal bleeding (LGIB) is an alarming symptom and common disease with annual admission of 0.15% with mortality rate of 5-10%. LGIB is caused by neoplastic and non-neoplastic lesions. For accurate diagnosis of various colorectal lesions, colonoscopy is gold standard, convenient and cost effective procedure. It is the investigation of choice in LGIB and helps in early diagnosis of colorectal carcinoma. This study was aimed to scrutinize the clinical and colonoscopic findings in patients with LGIB in UCMS.
 
 MATERIAL AND METHODS
 This was a hospital based prospective observational study conducted after taking permission from institutional review committee in January 2017 at UCMS-TH from 15th January 2017 to 15th January 2018. All patients presenting with LGIB who fulfilled inclusion and exclusion criteria and gave written consent were included.
 
 RESULTS
 Total 88 patients were included in the study. The mean age of our patients was 48 ±17 years with age range from 17-81 years. Majority were in the age group 50-60 years (25%) (n=22). Colonoscopy detected abnormality in 73.8% cases. The common non-neoplastic were haemorrhoids and non-specific colitis (14.5% each) followed by 12.5% of neoplastic cases. The higher frequency of colorectal lesions was observed in males comprising 72.7% (n=64) patients. The most commonly diagnosed etiologies of LGIB were haemorrhoid and nonspecific colitis respectively.
 
 CONCLUSION
 Colonoscopy detected abnormality in 75% of cases. The common causes of LGIB were haemorrhoids and non-specific colitis followed by neoplastic lesion. A careful history, physical and colonoscopic examination with or without biopsy makes significant impact for early diagnosis and treatment.

НЕСПЕЦИФИЧЕСКИЙ ЯЗВЕННЫЙ КОЛИТ И COVID-19, СЛУЧАЙ ИЗ ПРАКТИКИ

Background. COVID-19 infection keeps changing our understanding of its clinical course when associated with various somatic diseases. Objective. To present a clinical case of a patient with non-specific ulcerative colitis (NUC) and COVID-19 infection. Material and methods: medical documentation, general clinical, laboratory and instrumental data as well as histological examination of bioptates stained with hematoxylin and eosin that were obtained during colonoscopy. Results. The article presents a case history of a patient with manifestations of severe total NUC developed in association with the subclinical form of COVID-19 infection, the former being the cause of death in concomitant pathology. Conclusions. This clinical case describes a variant of an unfavorable outcome of NUC, one of the reasons for the manifestation of which was the atypical form of COVID-19 infection, which became a trigger for an autoimmune inflammatory process in the intestine. The accumulation of new knowledge about the features of the pathogenesis and manifestations of both pathologies will make it possible to improve the effectiveness of treatment and predict the course and outcomes of combined pathology.