ABSTRACT
Background:Ulcerative colitis(UC)is often accompanied by a variety of extraintestinal manifestations. Recently, the role of extraintestinal manifestations in diagnosis and treatment of UC has aroused widespread concern in clinical practice. Aims:To study the extraintestinal manifestations of patients with UC in order to elevate diagnosis level of UC. Methods:A total of 208 inpatients from June 2008 to September 2011 at Beijing Military General Hospital were enrolled. The extraintestinal manifestations of UC were retrospectively analyzed. Results:The ratio of male to female was 1. 14: 1, mean age was(41. 17 ± 13. 57)years,mean disease duration was(62. 6 ± 79. 4)months. Thirty-three patients had proctitis,52 had left-sided colitis,and 123 had extensive colitis. Forty-nine patients were mild UC,80 were moderate UC, and 79 were severe UC. The incidence of extraintestinal manifestations was 28. 8%(60 / 208);13 patients(6. 3% )had more than one extraintestinal manifestation. The main extraintestinal manifestations were oral ulcer(13. 0% ),arthropathy (11. 1% ),hepatobiliary disease( 3. 8% ) and skin lesion( 1. 4% ). The trend of incidence of extraintestinal manifestations increased from patients with proctitis,left-sided colitis to extensive colitis(21. 2% ,28. 8% ,30. 9% , respectively),however,the difference was not statistically significant(P > 0. 05). No significant difference in incidence of extraintestinal manifestations in patients with mild UC,moderate UC and severe UC was found(22. 4% ,33. 8% ,27. 8% , respectively)(P > 0. 05). Conclusions:Patients with UC are often accompanied by extraintestinal manifestations,and the recognition of extraintestinal manifestations is helpful for improving diagnosis and treatment level of UC.
ABSTRACT
Objective To analyze the miss rates of colorectal adenomas during colonoscopy as well as risk factors influencing the adenoma miss rates and to take corresponding measures. Methods A total of 432 patients who underwent index and follow-up colonoscopy in 18 months were randomized and investigated. The results of two colonoscopies were compared and the missed adenomas were defined as the adenomas de-tected only during the second colonoscopy. Miss rates were calculated according to patient-based methods. Chi-square test was used to analyze the relative factors influencing the adenoma miss rate of per-patient. Then the meaningful factors were chosen into the logistic regression model for multiple factors analysis. Results Of 432 patients,116(26. 9%)had missed adenomas on first colonoscopy. Single factor analysis found that the size of adenoma( χ2 = 89. 686,P = 0. 000),the shape of adenoma( χ2 = 68. 488,P = 0. 000),the location of adenoma(χ2 = 77. 055,P = 0. 000)and adenoma tissue types(χ2 = 417. 000,P = 0. 000)were the risk factors for miss rates of colorectal adenomas. Number of polyps(χ2 = 8. 450,P= 0. 038),the organi-zation type of polyp(χ2 = 10. 718,P= 0. 013)and proficiency of colonoscopists(χ2 = 56. 069,P= 0. 000), the quality of bowel preparation(χ2 = 39. 195,P = 0. 000),insertion time(χ2 = 13. 133,P = 0. 001)were also the risk factors for miss rates of colorectal adenomas. Logistic regression analysis showed that the bigger the adenoma size,the less missed adenomas(OR= 0. 341,95%CI:0. 173-0. 671). Also,the longer insertion time took,the lower the adenoma miss rate(OR = 0. 987,95% CI:0. 981-0. 994). Per-patient miss rates were lower for high-risk adenomas compared with low-risk adenomas(OR = 0. 324,95%CI:0. 154-0. 680). Adenomas happening in multiple parts of bowel easily leads to missing(OR= 3. 791,95%CI:1. 505-9. 546). Conclusion The missed diagnosis of adenomas is not only significantly associated with features of missed adenomas,but also with skills of colonoscopists,insertion time,and bowel preparation. The key is high-quality index colonoscopy to avoid adenomas missing.
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Objective To evaluate the effect of various methods of fecal exfoliated cell testing for screening of colorectal cancer.Methods The stool samples from 814 patients who underwent colonoscopy were collected for fecal exfoliated cell testing using diarrhea feces,twice naturally evacuated feces,magnetic separation or naturally evacuated combined with diarrhea feces.The fecal exfoliated cells were isolated and examined cytologically.The DNA quantitative analysis and gene detection were carried out.Fecal occult blood test was simultaneously performed in twice naturally evacuated feces and naturally evacuated combined with diarrhea feces.Results The sensitivity and specificity of exfoliated cells testing for colorectal Cancer was 66.27%(112 of 169 cases of colorectal cancer)and 99.56%(225 of 226 normal subjects),respectively.There was no correlation of positive rate with differentiations of colorectal cells or Duke's stages(P＞0.05).The nuclear DNA quantitative analysis showed that the sensitivity for detecting cancer was 76.09%for twice naturally evacuated feces and 68.29%for naturally evacuated combined with diarrhea feces,which was superior than diarrhea feces(26.31%)and magnetic separation (43.24%).The positive rate of genes detected in carcinoma tissues concordant with fecal exfoliated cells testing were 83.33%(25/30)for p53,9/10 for APC and 9/10 for K-ras.The sensitivity of cytology was higher than gene detection.The sensitivity of cancer detection was higher in combining exfoliated cells test with fecal occult blood test(93.10%)than exfoliated cells test(73.56%)or fecal occult blood test (80.46%)alone(P＜0.05).Conclusions Fecal exfoliated cells test is an effective method for screening of colorectal cancer.It is the best option for detecting cancer by twice tests of fecal exfoliated cells with liquid-based thin-layer cytological test,and combined with fecal occult blood test.