Neoplasias extra-colónicas en pacientes con enfermedad inflamatoria intestinal / Extra-intestinal malignancies in patients with inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) have shown to be at increased risk of developing extraintestinal malignancies. Immunomodulators (immunosuppressant and anti-tumor necrosis factor) diminish the mucosal inflammatory response changing the evolution of the disease, especially when these strategies are introduced earlier. However, therapies that alter the immune system may also promote carcinogenesis. Treatment of IBD in patients with prior malignancy is challenging and the final decision regarding therapeutic strategy should be made on a case-by-case basis. The purpose of this review is to show the characteristics of extra-colonic cancer in patients with IBD, including risks, pathogenesis and management of IBD after cancer diagnosis, the effect of neoplasm treatment on IBD, and the effect of IBD and its treatments on cancer outcomes.

Los pacientes con enfermedad inflamatoria intestinal (EII) presentan un mayor riesgo de desarrollar neoplasias extraintestinales. Los inmunomoduladores (inmunosupresores y terapia biológica anti-TNF) disminuyen la respuesta inflamatoria a nivel de la mucosa, modificando la evolución de la enfermedad, especialmente cuando son introducidos precozmente. Sin embargo, estas terapias pueden alterar el sistema inmune y promover la carcinogénesis. El tratamiento de la EII en pacientes con antecedentes de cáncer es un desafío y la decisión final sobre la estrategia terapéutica debe ser determinada caso a caso. Esta revisión tiene como objetivo mostrar las características de las neoplasias extra-intestinales en pacientes con EII, incluyendo los riesgos, patogénesis y manejo de la EII posterior al diagnóstico del cáncer, el efecto de la neoplasia sobre el tratamiento de la EII y el efecto de la EII y su tratamiento sobre el cáncer.

Caracterización de pacientes con colitis ulcerosa atendidos en centro de nivel terciario / Characterization of patients with ulcerative colitis treated at tertiary center

Introducción: la colitis ulcerosa es una afección de la sociedad moderna y su frecuencia en los países desarrollados ha ido en aumento desde mediados del siglo XX. Objetivo: caracterizar a pacientes con colitis ulcerosa. Métodos: se realizó un estudio descriptivo de corte transversal a 176 pacientes, con una edad media de 41,1 ± 14,5 años y colitis ulcerosa, atendidos en el Instituto de Gastroenterología desde enero 2011 hasta diciembre 2012. Resultados: se halló predominio del sexo femenino y el color de la piel blanca, mayor número de pacientes no fumadores y localización de la colitis hacia zona más distal del colon. Los síntomas más frecuentes fueron las diarreas con flemas y el sangrado rectal; mientras que las estenosis y el cáncer, al nivel de colon, y las alteraciones articulares y hepatobiliares, al nivel extracolónico, resultaron las complicaciones predominantes. El tratamiento medicamentoso más utilizado fue azulfidina, mesalazina y prednisona, por vía oral. Las causas más frecuentes de tratamiento quirúrgico fueron la estenosis y el cáncer colorrectal; las de muerte, el cáncer colorrectal y el colangiocarcinoma. Conclusiones: la colitis ulcerosa requiere especial atención por un equipo multidisciplinario y la familia, a partir del conocimiento de la enfermedad y sus complicaciones(AU)

Introduction: ulcerative colitis is a pathology of the modern society, and its frequency in developed countries has been growing since the middle of twenty century. Objective: characterize patients with ulcerative colitis. Methods: a transversal study was conducted in 176 patients with ulcerative colitis who are treated at Gastroenterology Institute from January 2011 to December 2012. Results: predominance of females and white skin color subjects was found, as well as higher number of nonsmoking subjects, the most frequent location of colitis was toward the distal colon area. The most common symptoms were diarrhea with mucus and rectal bleeding; but stenosis and cancer at colon level, joint disorders and hepatobiliary at extracolonic level were the predominant complications. The most widely used drug treatment was Azulfidine, mesalazine and prednisone orally. The most common causes of surgical treatment were stenosis and colorectal cancer. The most common cause death were colorectal cancer and cholangiocarcinoma. Conclusions: ulcerative colitis require special care by a multidisciplinary team and family, from knowledge of the disease and its complications(AU)

Diagnostic value of low-dose CT colonography on incidental extracolonic lesions * / 重庆医学

Objective To evaluate the value of low-dose computed tomographic colonography (CTC) performed with 64-slice CT in the diagnosis of incidental extracolonic lesions and its clinical significance .Methods The image data in 158 CTC examinations with two positions were retrospectively analyzed .All abdominal extracolonic lesions were recorded .According to the age ,the pa-tients were divided into two groups :elderly and non-elderly groups .The extracolonic lesions were divided into 4 groups(E1- E4) according to the clinical importance .The incidence rates in two groups were calculated respectively .Results The incidence rate of the E2-E4 level extracolonic lesions in the elderly group was higher than that in the non -elderly group ,the difference between them had statistical signficance (P< 0 .05) .Conclusion Low-dose CTC has the high diagnostic value in finding extracolonic le-sions ,and the incidence rate of extracolonic lesions with important clinical significance is increased with the age increase ,especially for the elder patients over the age of 60 years .

Clinical Analysis of 40 Patients with Familial Adenomatous Polyposis (FAP)

PURPOSE: This study was carried to find the clinical characteristics of incidence and the phenotype of familial adenomatous polyposis (FAP). METHODS: This retrospective analysis was performed on 40 patients who were diagnosed as having FAP and who underwent surgery due to FAP from June 1985 to April 2005. The operative method, extra-colonic symptoms, and number of polyps were analyzed. RESULTS: From June 1985 to April 2005, 0.65% (40 patients) of all surgically treated colon-cancer patients were diagnosed as having FAP. Seventeen patients had familial history, and 23 patients were neither aware of any familial history nor had taken any tests. The primary symptoms were hematochezia, diarrhea, mucous discharge, constipation, and abdominal pain, but 5 patients had no specific symptoms. The mean age was 38.0 years. A total colectomy with ileostomy was performed in 19 cases, a total colectomy with ileorectal anastomosis in 2 case, and a total proctocolectomy with ileal J pouch anal anastomosis in 17 cases. One case was only diagnosed as having a FAP without surgical treatment, and one cases had palliative surgery due to carcinomatosis. Thirty-five cases had more than one hundred polyps, and 5 cases had less than one hundred polyps with a higher mean age of 62.2 (50~74) years and having no familial history. Extracolonic manifestations, were congenital hypertrophy of the retinal pigment epithelium, submandibular tumor, thyroid cancer, and intraabdominal desmoid tumor. The polyps could develop in other organs, such as the stomach or the duodenum. Because they can progress to cancer, a gastroduodenoscopy needs to be done. As for result, 17 cases underwent endoscopic gastroduodenoscopy, and among them, 9 cases had multiple adenomas. CONCLUSIONS: FAP has been considered as a rare disease. Because of its association with early development of colorectal cancer, measures for early detection of the disease and for identification of other family members at risk should be performed. Furthermore, early prophylactic treatment should be undertaken to reduce the incidence of cancer in these conditions. For early detection and better outcome, clinical and radiological examination and treatment for extracolonic manifestations and extracolonic tumor (thyroid cancer, desmoid tumor, medulloblastoma, hepatoblastoma) are necessary.

Analysis of 141 Patients with Ulcerative Colitis / 中国医师杂志

In order to study the clinical features and therapeutic status of ulcerative colitis(UC) in south China.Method A retrospective analysis was performed in 141 patients with UC diagnosed in past 12 years.Results The most frequent age at onset of disease was 20～45 years and the second was 57～67.Diarrhea and bloody stools were the most common symptoms which were present in 87.2% and 87.9% of cases.Severe complications and colon carcinoma were few in the cases.There was significant correlation in the extent of colonic involvement,the severity of illness and extracolonic manifestations.Severe complication and total colitis were more frequently seen in the patients with extracolonic manifestations than that in the patients without extracolonic manifestations(P