Analysis of Therapeutic Effect of Infliximab on Inflammatory Bowel Disease Patients Associated With Extra-intestinal Manifestations / 胃肠病学

Background: The incidence of inflammatory bowel disease (IBD) is increasing yearly, some of the IBD patients have extraintestinal manifestations (EIM), and EIM has impact on the treatment of IBD. Aims: To summarize the clinical characteristics of IBD patients associated with EIM, and evaluate the therapeutic effect of infliximab (IFX). Methods: The clinical data of IBD patients associated with EIM from January 2010 to December 2020 at the First Affiliated Hospital of Dalian Medical University were retrospectively analyzed, and the therapeutic effect of IFX was investigated. Results: In 811 patients with IBD, 50 (6.17%) patients had EIM. The commonly seen EIM was arthritis (78.00%) and erythema nodosum (26.00%); 52.00% had one EIM; 68.42% of UC patients with EIM involved E3, and 50.00% of CD patients with EIM involved L3. A total of 21 patients received IFX treatment, 2 weeks after medication, HB and ALB significantly increased, while ESR, CRP and PLT significantly decreased. Twenty⁃two weeks after medication, 83.33% of UC patients turned mild, and 70.00% of CD patients entered the remission phase. After the use of IFX, the first disappearance time of arthritis was significantly decreased when compared with those without using IFX (2.50 days vs. 10.50 days, P<0.05). The median time for the first disappearance of arthritis in patients with elevated CRP was significantly decreased than in patients with normal CRP (3.00 days vs. 9.00 days, P<0.05). Conclusions: Arthritis and erythema nodosum are common EMI in patients with IBD, and the treatment with IFX can significantly shorten the time of the first disappearance of some EIM.

A case of very early onset inflammatory bowel disease / 中国综合临床

The clinical data of a child with very early onset inflammatory bowel disease (VEO-IBD) treated in the digestive department of Guangzhou Women's and children's Medical Center in October 2018 were analyzed retrospectively. The patient was hospitalized because of "shortness of breath and abdominal distension" after birth. The gastrointestinal manifestations were diarrhea, mucus bloody stool, feeding intolerance and weight loss; the extraintestinal manifestations were liver function damage and joint damage. Endoscopic examination considered VEO-IBD. The patients were treated with infliximab and enteral nutrition. When the clinical symptoms were relieved and the gastrointestinal mucosa healed, the enteral nutrition regimen was adjusted. At present, she returned to daily diet, and the weight and height reached the level of normal children. VEO-IBD patients can be combined with a variety of extraintestinal manifestations, clinicians need to identify the coexistence of these diseases, effective follow-up.

Analysis of clinical features of 43 cases of inflammatory bowel disease complicated with intra- and extra-intestinal tumors / 中华消化杂志

Objective:To analyze the clinical characteristics of patients with inflammatory bowel disease (IBD) complicated with intra- and extra-intestinal tumors, and so as to provide reference for clinical practice.Methods:From October 2008 to March 2022, the clinical data of 2 360 IBD patients diagnosed at the First Affiliated Hospital of Air Force Military Medical University were collected, and the IBD patients complicated with intra- and extra-intestinal tumors were screened out. IBD with colorectal cancer, small intestine cancer and intestinal lymphoma were enrolled into intra-intestinal tumor group, IBD complicated with other tumors except intra-intestinal tumors were enrolled into extra-intestinal tumor group. The clinical characteristics of the 2 groups were retrospectively compared, and the risk factors affecting survival of IBD complicated intra- and extra-intestinal tumor were analyzed. Kaplan-Meier method was used to draw the survival curve, Cox regression model was performed to analyze the prognostic risk factors, and independent sample t test, Fisher′s exact test and log-rank test were used for statistical analysis. Results:A total of 43 IBD patients with intra- and extra-intestinal tumor were screened out, and the overall tumor incidence rate was 1.82% (43/2 360). The rate of IBD complicated with intra-intestinal tumor accounted for 1.27% (30/2 360). Among them, the rate of ulcerative colitis (UC) complicated with intra-intestinal tumor was 1.48% (25/1 685), and the rate of Crohn′s disease (CD) complicated with intra-intestinal tumor was 0.74% (5/675). The rate of IBD with extra-intestinal tumor accounted for 0.55% (13/2 360). Among them, the rate of UC complicated with extra-intestinal tumor was 0.71% (12/1 685), and the rate of CD complicated with extra-intestinal tumor was 0.15% (1/675). There were no significant differences in the rate of intra- and extra-intestinal tumors between UC and CD patients (both P>0.05). In the intra-intestinal tumor group, the age when diagnosed with IBD and the age when tumor diagnosed were (37.0±13.8) years old and (47.7±13.5) years old, which were both lower than those of the extra-intestinal tumor group ((51.8±6.2) years old and (60.7±7.8) years old), and the differences were statistically significant ( t=-3.69 and -3.24, P=0.001 and 0.002). The lesion location when tumor diagnosed of UC patients with intra-intestinal tumor mainly was extensive colonic type(64.0%, 16/25), followed by left part colonic type and rectal type in turn (28.0%, 7/25 and 8.0%, 2/25). In UC patients with extra-intestinal tumor, mainly was rectal type (8/12), followed by left part colonic type (3/12) and extensive colonic type (1/12) in turn. There was statistically significant difference bwtween the UC patients with intra- and extra-intestinal tumor in the extent of lesions when tumor diaghosed (Fisher′s exact test, P<0.001). The activity of IBD of intra-intestinal tumor group when tumor diagnosed mainly was severe activity phase (46.7%, 14/30), followed by moderate activity phase, mild activity phase and remission phase in turn (33.3%, 10/30; 20.0%, 6/30 and 0). The activity of IBD of extra-intestinal tumor group when tumor diagnosed mainly was remission phase (7/13), followed by moderate activity phase, mild activity phase and severe activity phase in turn (3/13, 2/13 and 1/13). There were statistically significant differences between the 2 groups in the composition of IBD activity when tumor diagnosed (Fisher′s exact test, P<0.001). The survival analysis indicated the median survival time of IBD complicated with intra-intestinal tumor group was 145.9 months, and that of the extra-intestinal tumor group was 29.9 months. The results of multivariate Cox analysis showed that the occurrence of extra-intestinal tumor was an independent risk factor of patient survival rate( HR=5.119, 95% confidence interval 1.485 to 17.643, P=0.010). Conclusions:IBD patients had a high risk of developing intra- and extra-intestinal tumors. The intra-intestinal tumor group mainly is extensive colonic type and severe active period, while the extra-intestinal tumor group mainly is rectal type and remission period. Compared with that of the extra-intestinal tumor group, the age at time of IBD onset and tumor diagnosed of intestinal tumor are younger, and the survival time is longer.

Vasculitis leucocitoclásticas como manifestación extraintestinal dermatológica rara de la enfermedad inflamatoria intestinal asociada con Clostridium: reporte de un caso / Leukocytoclastic vasculitis as a rare extraintestinal dermatologic manifestation of inflammatory bowel disease associated with Clostridium difficile: Case report

Resumen Las vasculitis leucocitoclásticas se definen como el daño e inflamación de las paredes vasculares, son aquellas vasculitis de pequeños vasos que anatomopatológicamente presentan leucocitoclasia y puede observarse como una manifestación extraintestinal de la enfermedad inflamatoria intestinal. En la colitis ulcerativa se presentan en menor frecuencia, por inmunocomplejos generados en la mucosa intestinal debido a la exposición del tejido linfoide submucoso a antígenos fecales; podrían precipitarse en las paredes de los pequeños vasos. Se pueden asociar con Clostridium difficile, que es un bacilo grampositivo esporulado, anaerobio estricto, que se encuentra normalmente en el medio ambiente y produce colitis, que se manifiesta como un cuadro diarreico presentado después de la ingesta de antibióticos y altera la flora bacteriana común de este órgano. El caso se trata de un paciente 36 años de edad con cuadro de diarreas líquidas con moco y escaso sangrado; se realizó un estudio endoscópico y anatomopatológico en el que se observó colitis ulcerativa con coproparasitario positivo para antígeno de C. difficile, y en su hospitalización presentó lesiones dérmicas petequiales y necróticas en el cuarto dedo de la mano izquierda, que en la biopsia dio como resultado vasculitis de pequeños vasos. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, histología, tratamiento y diagnósticos de la manifestación extraintestinal dermatológica rara, como la vasculitis leucocitoclástica en pacientes con colitis ulcerativas asociadas con Clostridium.

Abstract Leukocytoclastic vasculitis is defined as the damage and inflammation of the vascular walls. The term refers to vasculitis of the small vessels that anatomopathologically present leukocytoclasia and it can be seen as an extra-intestinal manifestation of inflammatory bowel disease. In ulcerative colitis, it occurs less frequently due to immune complexes produced in the intestinal mucosa by exposure of the submucosal lymphoid tissue to fecal antigens, which could precipitate in the walls of the small vessels. This condition can be associated with Clostridium difficile, which is a gram-positive, sporulated, strict anaerobic bacillus, normally found in the environment. It causes colitis that manifests as a diarrheal disease following the ingestion of antibiotics that alter the common bacterial flora of this organ. This is the case report of a 36-year-old patient with liquid diarrhea with mucus and scarce bleeding. Endoscopic and anatomopathological studies were performed, finding ulcerative colitis with positive coproparasite for Clostridium difficile antigen. The patient was hospitalized, and during his stay, he presented with petechiae and necrotic skin lesions on the fourth finger of the left hand. Skin biopsy showed small vessel vasculitis. This article is a practical review of the pathophysiology, histology, treatment, and diagnosis of a rare dermatologic extraintestinal manifestation, namely, leukocytoclastic vasculitis, in patients with C. difficile-associated ulcerative colitis.

Pediatric metastatic Crohn's disease / Doença de Crohn metastática pediátrica

Crohn's disease (CD) is a chronic, relapsing, idiopathic condition, characterized by granulomatous, transmural inflammation of the gastrointestinal tract, which can affect its entire length, from mouth to anus. Metastatic Crohn's disease (MCD) is a rare form of skin involvement and is defined by skin lesions without contiguity with the gastrointestinal tract. A 9-year-old patient presented with gastrointestinal complaints and gross skin lesions in the vulva and perianal region. The diagnosis of Crohn's disease was made when the patient was 11 years old, after being evaluated by the colorectal surgeon. Treatment was started with a "top-down" approach, with a sustained response for four years. Afterwards, there was a relapse of the skin disease in previously normal areas, without overt symptoms. Treatment consisted of steroids and local infiltration of infliximab, without improvement. A year later, there was a rapid progression of the skin lesions, and the drug changed to adalimumab, also without response and worsening of the skin lesions. The patient was admitted to the hospital and intravenous steroids were initiated, along with surgical debridement of the lesions. After some improvement, ustekinumab was initiated with satisfactory response. Pediatric MCD has an important impact on the patient's quality of life, with influences on growth and social development. (AU)

A doença de Crohn é uma condição idiopática crônica, recidivante, caracterizada por inflamação granulomatosa transmural do trato gastrointestinal, que pode afetar toda a sua extensão, da boca ao ânus. A doença de Crohn metastática (DCM) é uma forma rara que envolve a pele, e é definida por lesões cutâneas sem contiguidade com o trato gastrointestinal. Uma paciente de 9 anos de idade apresentou queixas gastrointestinais e lesões cutâneas grosseiras na vulva e na região perianal. O diagnóstico de doença de Crohn foi feito quando a paciente tinha 11 anos, após avaliação do coloproctologista. O tratamento foi então iniciado com uma abordagem "top-down", com uma resposta mantida por quatro anos. Posteriormente, houve recidiva da doença de pele em áreas anteriormente normais, sem sintomas evidentes. O tratamento consistiu em corticoide e infiltração local de infliximabe, sem melhora. Um ano depois, houve rápida progressão das lesões cutâneas, sendo a medicação alterada para adalimumabe, também sem resposta e com piora das lesões cutâneas. A paciente foi internada e iniciado tratamento com corticoide intravenoso, juntamente com o desbridamento cirúrgico das lesões. Após alguma melhora, o ustecinumabe foi iniciado com resposta satisfatória. A DCM pediátrica tem um impacto importante na qualidade de vida do paciente, com influências no crescimento e no desenvolvimento social. (AU)

Disseminated microsporidiosis: An underdiagnosed and emerging opportunistic disease

@#Disseminated microsporidiosis is a life-threatening disease resulting from the haematogenous spread of microsporidia species. The diagnosis is challenging owing to its subtle nonspecific clinical presentation, which usually reflects the underlying organ involved. Therefore, a high index of suspicion is required for early diagnosis. Besides, tools for confirmatory laboratory diagnosis are limited. Currently, there is no direct diagnostic method that can detect the infection without involving invasive procedures. Clinical confirmation of disseminated microsporidiosis is usually based on light and transmission electron microscopy of infected tissue specimens. These are then followed by species detection using polymerase chain reaction (PCR). Disseminated microsporidiosis shows the potential to be cleared up by albendazole or fumagillin if they are detected and treated early. Based on a series of case reports, this review aims to present a current update on disseminated microsporidiosis with emphasis on the clinical manifestations based on the organ system infected, diagnostic approach and treatment of this devastating condition. Keywords:

Análise do sistema toxina-antitoxina HipA/B na indução da persistência bacteriana de cepas de Escherichia coli extraintestinal / The importance of HipA/B Toxin-Antitoxin system in extraintestinal Escherichia Coli persistence

Os sistemas toxina-antitoxinas (TA) compreendem um conjunto de genes que são amplamente difundidos em procariotos. No cromossomo, os sistemas podem estar envolvidos na indução de morte celular em resposta a condições estressantes, indução de persistência, formação de biofilme, colonização de novos nichos, manutenção da mobilidade bacteriana e virulência de bactérias patogênicas. Em E. coli K12, 36 sistemas TA foram descritos, dos quais o do tipo II é o mais abundante e estudado. Dentre as oito toxinas pesquisadas nesse trabalho, o gene da toxina HipA está presente em 76 das 100 cepas de ExPEC estudadas. Apesar da abundância de hipA em ExPEC e em diversos genomas bacterianos, a participação dos sistemas hipA/B na indução da persistência ainda não é clara. Portanto, o sistema hipA/B de duas cepas ExPEC isoladas de infecção sanguínea foi deletado, e estas foram avaliadas quando a indução da persistência bacteriana na presença de antibióticos, formação de biofilme, resistência ao soro e sobrevivência em macrófagos. O sistema TA hipA/B não influenciou no fenótipo de resistência ao soro humano e na sobrevivência intracelular em macrófagos, no entanto, participou da indução da persistência por ciprofloxacino em um isolado (EC182); e da formação de biofilme em superfície de vidro do isolado (EC273)

Toxin-antitoxin (TA) systems comprise a set of genes that are widespread in prokaryotes. On the chromosome, the systems may be involved in the induction of cell death in response to stressful conditions, persistence induction, biofilm formation, colonization of new niches, maintenance of bacterial mobility and virulence. In E. coli K12, 36 TA systems have been described, of which type II is the most abundant. Among the eight toxins searched in this work, hipA is present in 76 bacteria of the 100 ExPEC strains studied. Despite the abundance of hipA in ExPEC and in several bacterial genomes, the participation of hipA/B modules in the persistence is still unclear. Therefore, hipA/B system of two ExPEC strains isolated from blood infection was deleted and consequently evaluated in bacterial persistence induced by antibiotics, serum resistance and macrophage survival. Despite the fact that, the TA hipA/B system did not influence the phenotype of resistance to human serum and intracellular survival in macrophages. Herein, we described that hipA/B was important for persistence induction in one isolate (EC182); and may participate in the biofilm formation on the glass surface in the other studied strain (EC273)

Escherichia coli extraintestinal, resistencia antimicrobiana y producción de betalactamasas en aislados cubanos / Extraintestinal Escherichia coli, antimicrobial resistance and betalactamase production in Cuban isolates

Introducción: Escherichia coli extraintestinal constituye uno de los principales patógenos causantes de infecciones asociadas a la asistencia sanitaria con un alto impacto en la salud por su morbilidad y mortalidad. Objetivo: Describir el comportamiento clínico de E. coli extraintestinal en hospitales cubanos, así como determinar la resistencia antimicrobiana y la producción de betalactamasas. Métodos: Se realizó un estudio descriptivo de corte transversal, durante el período de mayo 2017 a junio 2018, en el Laboratorio Nacional de Referencia de Microbiología del Instituto de Medicina Tropical Pedro Kourí que incluyó 119 aislados de Escherichia coli causantes de infecciones extraintestinales en 30 hospitales de diferentes áreas geográficas del país. Se llevó a cabo la identificación mediante el sistema API 20E y la determinación de la susceptibilidad in vitro a 16 antimicrobianos por el sistema automatizado VITEK-2 y el método de difusión por disco, excepto para la colistina que se empleó el método de elución de disco. Se realizó, además, la detección fenotípica de betalactamasa de espectro extendido, de tipo AmpC y metalobetalactamasa. Resultados: E. coli extraintestinal causó con mayor frecuencia infección de herida quirúrgica (23,5 por ciento), infección del torrente sanguíneo (20,7 por ciento), infecciones respiratorias (17,6 por ciento), infecciones de piel (16,8 por ciento) e infección del tracto urinario (12,6 por ciento). Predominó la resistencia a betalactámicos que osciló entre 61,3 por ciento y 89,1 por ciento, mientras que 79,8 por ciento y 80,5 por ciento de los aislados fueron resistentes a trimetoprim/sulfametoxazol y tetraciclina, respectivamente. La amikacina, la fosfomicina, la colistina y los carbapenémicos mostraron mayor actividad in vitro. El 43,7 por ciento produjo betalactamasas de espectro extendido, 7,6 por ciento AmpC plasmídica y 0,8 por ciento metalobetalactamasa. Conclusiones: La escasa sensibilidad en los aislados de E. coli extraintestinal a los antimicrobianos de primera línea, así como la detección de un aislado productor de metalobetalactamasa evidencia la necesidad de mantener un monitoreo continuo de este patógeno para el cual las alternativas de tratamiento son cada vez más restringidas(AU)

Introduction: Extraintestinal Escherichia coli is one of the main pathogens causing infections associated to health care, with a high impact on health, due to its morbidity and mortality. Objective: Describe the clinical behavior of extraintestinal E. coli in Cuban hospitals, and determine antimicrobial resistance and betalactamase production. Methods: A descriptive cross-sectional study was conducted at the Microbiology National Reference Laboratory of Pedro Kourí Tropical Medicine Institute from May 2017 to June 2018. The study included 119 Escherichia coli isolates causing extraintestinal infections in 30 hospitals from various geographic areas in the country. Identification was based on the API 20E system, and determination of in vitro susceptibility to 16 antimicrobials on the automated system VITEK-2 and the disk diffusion method, except for colistin, for which the disk elution method was used. Phenotypical detection was also performed of AmpC extended-spectrum betalactamase and metallobetalactamase. Results: The most common disorders caused by extraintestinal E. coli were surgical wound infection (23.5 percent), bloodstream infection (20.7 percent), respiratory infections (17.6 percent), skin infections (16.8 percent) and urinary tract infection (12.6 percent). A predominance was found of resistance to betalactams, which ranged between 61.3 percent y 89.1 percent, whereas 79.8 percent and 80.5 percent of the isolates were resistant to trimethoprim / sulfamethoxazole and tetracycline, respectively. Amikacin, fosfomycin, colistin and carbapenemics displayed greater in vitro activity. 43.7 percent produced extended spectrum betalactamases, 7.6 percent plasmid AmpC and 0.8 percent metallobetalactamase. Conclusions: The low sensitivity of extraintestinal E. coli isolates to first-line antimicrobials and the detection of a metallobetalactamase producing isolate are evidence of the need to maintain continuous surveillance of this pathogen, for which the treatment options are ever more restricted.

Bilateral pyelonephritis due to Escherichia coli infection in a captive jaguar (Panthera onca) / Pielonefrite bilateral por Escherichia coli em uma onça-pintada (Panthera onca)

Extraintestinal pathogenic Escherichia coli (ExPEC) is a highly diverse pathotype of E. coli which colonizes the intestine, and it is considered an important etiological agent associated with bacteremia and other systemic infections, among them urinary tract infection. Retrospective studies evaluating morbidity and mortality of nondomestic felids have demonstrated that urinary tract diseases are among the main causes of death for geriatric animals. Also, mesenchymal neoplasms of the uterus are common in wild felids, and they possess variable morphologic characteristics related to invasiveness and malignancy. This report describes a case of bilateral pyelonephritis due to extraintestinal uropathogenic E. coli infection in a captive jaguar (Panthera onca). The diagnosis was confirmed through pathological, bacterial and immunohistochemical findings. According to molecular analysis, this E. coli strain was classified in the phylogroup F, possessing the following virulence-associated genes: usp, cnf-1, hlyA, papC and sfa. Additionally, this E. coli was highly resistant to beta-lactams and first-generation cephalosporin. This jaguar also presented a uterine leiomyoma with distinct distribution, and severe degenerative articular disease, both of them described as frequently seen lesions in geriatric animals from the Panthera genus.(AU)

Escherichia coli extraintestinal patogênica (ExPEC) é um patotipo altamente diverso de E. coli que coloniza o intestino e é considerada um agente etiológico importante, associado com bacteremia e outras infecções sistêmicas, dentre elas infecções do trato urinário. Estudos retrospectivos avaliando morbidade e mortalidade de felídeos não domésticos demostram que doenças do trato urinário estão entre as principais causas de morte de animais geriátricos. Ainda, neoplasias mesenquimais uterinas são comuns em felídeos de cativeiro e possuem características morfológicas variáveis relacionadas a invasividade e malignidade. Neste relato é descrito um caso de pielonefrite bilateral por E. coli extraintestinal uropatogênica em uma onça-pintada de cativeiro (Panthera onca). O diagnóstico foi confirmado através dos achados patológicos, bacteriológicos e imuno-histoquímicos. A partir da análise molecular, esta cepa de E. coli foi classificada no filogrupo F, possuindo os seguintes genes associados a virulência: usp, cnf-1, hlyA, papC and sfa. Adicionalmente, a bactéria isolada foi altamente resistente a ß-lactâmicos e cefalosporinas de primeira geração. Foi observado ainda um leiomioma uterino com distribuição distinta e doença articular degenerativa severa, ambas descritas na literatura como comumente observadas em animais geriátricos do gênero Panthera.(AU)

Emerging Threat of Salmonella typhimurium in Extraintestinal Infections: Cases from a Tertiary Care Hospital in North India

Purpose:Infections due to invasive non-typhoid salmonella can be dangerous and fatal. The mode of infection and the severity varies from the typhoidal fevers. It is important to find the association between clinical features and the infecting serovar to understand the pathophysiology and course of treatment Methods:In the present study, extra-intestinal specimens (blood, cerebrospinal fluid and pus) from three patients suffering from septicaemia, meningitis and osteomyelitis were received. Micro-biological and biochemical test for species identification and antibiotic susceptibility was done as per standard protocol.Further, PCR based amplification and sequencing of a portion of the flagellin gene (FliC) was done to confirm the serovar.Results: Salmonellaentericawas identified from all the threeby microbiological and biochemical examination.The sequence of the Flic gene confirmed the serovar to be S.typhimurium. All the patients were treated successfully for the infectionby appropriate antibiotic therapy. Conclusion:The study highlights that serovarTyphimurium is common in invasive non-typhoidal salmonellosis and its pathophysiology and virulence factors expression should be understood in various organ types for better treatment options and outcomes

Intestinal Mucus Barrier: From Basic Research to Clinical Practice / 胃肠病学

Intestinal mucus barrier is a gel network composed of mucin, water and antimicrobial peptides. It is the first line defense of host against intestinal pathogens, and is also important for the survival and proliferation of symbiotic bacteria. Mucins are mainly synthesized and secreted by goblet cells of intestine, forming different structures in different intestinal segments. Nowadays more and more studies have shown that the mucus barrier is not only closely related to intestinal infection, inflammatory bowel disease, intestinal tumor and other intestinal diseases, but also involved in the occurrence and development of some extraintestinal diseases, such as acute pancreatitis, non-alcoholic fatty liver disease, which may become a new target for the treatment of various related diseases in the future.

Pancreatic Manifestations in Inflammatory Bowel Disease: A Review Article / 胃肠病学

Some of the patients with inflammatory bowel disease (IBD) can develop symptoms originated from extragastrointestinal organs and systems, and are called extraintestinal manifestations (EIMs). EIMs may be associated with IBD-related injuries or being drug-induced. These manifestations may occur before, after or simultaneously with the diagnosis of IBD. EIMs may detrimentally impact patient's functional status and quality of life. This article reviewed the pancreatic manifestations in patients with IBD and its underlying pathophysiology. EIMs may complicate the course of IBD. The clinicians must pay real attention to EIMs for facilitating the early diagnosis and treatment.

Role of TNF-α in Development and Progression of Inflammatory Bowel Disease / 胃肠病学

Inflammatory bowel disease (IBD) is a chronic and recurrent inflammation of gastrointestinal tract caused by disorder of immune system. It includes Crohn's disease (CD) and ulcerative colitis (UC). Many factors such as environment and dysbiosis of gut microbiota can lead to IBD. TNF-α is generally considered as playing an important role in the development and progression of IBD. This article reviewed the role of TNF-α in the pathogenesis of IBD.

Discovered on gastrointestinal stromal tumor 1, a keystone in the diagnosis of extraintestinal gastrointestinal stromal tumors

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT) but have a low incidence. Arising from the interstitial cells of Cajal, GISTs occur at different sites in the GIT with stomach being the most common. They can rarely be seen at sites outside the GIT such as omentum, retroperitoneum and are called as extraintestinal GISTs (EGIST). They have a spindle or epithelioid cell morphology and show positivity by immunohistochemistry (IHC) for CD117. Our aim was to study the clinicopathological and immunohistochemical profile of our cases of EGISTs. Materials and Methods: A cross-sectional study of EGISTs received from 2010 to 2015 was done. IHC with CD117 and discovered on GIST1 (DOG1) was performed and tumors were scored based on the percentage of cells that stained positive. Thirteen abdominal non-GIST spindle cell tumors were included in the study as controls. Results: Seven cases of EGIST were included (four-omental, three-retroperitoneal). All cases stained positive for CD117 and DOG1. One case of epithelioid EGIST scored 4 + with DOG1 and 2 + with CD117. Another case with mixed morphology scored 2 + with DOG1 and 4 + with CD117. All controls were negative for both markers. Conclusion: EGISTs are one of the rare differentials for spindle cell lesions outside the GIT. Although both markers stain positive, DOG1 showed higher score with epithelioid GISTs

Cutaneous Extraintestinal Manifestations of Ulcerative Colitis / 胃肠病学

The incidence of ulcerative colitis (UC) is increasing in recent years, and its pathogenesis is not completely clear. The extraintestinal manifestations (EIM) of UC are diverse and can involve multiple organ systems such as bone and joint, skin, liver and gallbladder, eye, etc. The incidence of one EIM increases the risk of development of other EIM. Cutaneous manifestations are important EIM of UC, and are usually classified into reactive, immunity-associated, malnutrition and treatment-induced manifestations. This article reviewed the clinical symptoms, diagnosis and treatment of cutaneous extraintestinal manifestations of UC.

Risk Factors of Extraintestinal Manifestations in Ulcerative Colitis / 胃肠病学

Background: Ulcerative colitis (UC) is often accompanied by a variety of extraintestinal manifestations (EIM). EIM is important for the diagnosis and treatment of UC. Aims: To investigate the risk factors of EIM in patients with UC. Methods: The clinical data of patients with UC from Jan. 2013 to Dec. 2018 at the People's Hospital of Xinjiang Autonomous Region were retrospectively analyzed. Univariate and multivariate analysis were performed to investigate the risk factors of EIM in UC. Results: A total of 260 UC patients were enrolled, of them 120 (46.2%) had EIM. The main EIM were musculoskeletal manifestation, skin disease, eye disease, hepatobiliary disease. Univariate analysis showed that Uyghur (χ2=4.069, P=0.044), older (χ2=4.250, P=0.039), BMI≥24 kg/m2 (χ2=13.913, P=0.000), history of intestinal surgery (χ2=6.089, P=0.014) and disease activity (χ2=27.556, P=0.000) were associated with EIM in UC patients. Multivariate analysis showed that Uyghur (OR=1.802, P=0.042), BMI≥24 kg/m2 (OR=3.163, P=0.000), history of intestinal surgery (OR=4.089, P=0.042) and disease activity (OR=6.347, P=0.000) were risk factors of EIM in UC patients. Conclusions: Uyghur, BMI≥24 kg/m2, history of intestinal surgery and disease activity are important risk factors of EIM in UC patients.

Pulmonary Extraintestinal Manifestation of Crohn's Disease Treated Successfully with Adalimumab / 대한소화기학회지

Pulmonary extraintestinal manifestation is rare in Crohn's disease and has been reported in only a few cases. Despite the presence of pulmonary abnormalities in a significant proportion of patients with inflammatory bowel disease, there are only few case reports, due to complicated diagnosis and low recognition by clinicians. Currently, treatment guidelines for pulmonary Crohn's disease have not been established. There are some case reports of pulmonary Crohn's disease that achieved remission after infliximab treatment. Clinical and radiological remission of pulmonary extraintestinal involvement in Crohn's disease after adalimumab therapy has not been reported yet. Here, we report one case of lung involvement of Crohn's disease, which shows radiological and clinical remission after adalimumab treatment.

Extraintestinal manifestations and characteristics of ulcerative colitis in Xinjiang Uygur Autonomous Region / 中华消化杂志

Objective To analyze the extraintestinal manifestations and clinical characteristics of patients with ulcerative colitis (UC) and to improve the knowledge,diagnosis and treatment of UC with extraintestinal manifestations.Methods From January 2013 to December 2017,at the Department of Gastroenterology,People's Hospital of Xinjiang Uygur Autonomous Region,260 hospitalized patients diagnosed as UC were collected.The demographic characteristics,clinical phenotypes and extraintestinal manifestations were analyzed.Chi square test was used for statistical analysis.Results Among 260 UC patients,41.9％ (109/260) had extraintestinal manifestations,including fatty liver (17.3％,45/260),gallbladder stone (11.9％,31/260),type Ⅰ peripheral arthritis (8.1％,21/260),type Ⅱ peripheral arthritis (3.1％,8/260),oral ulcer (4.6 ％,12/260),erythema nodosum (3.8％,10/260),irireitis (1.9％,5/260),ankylosing spondylitis (1.5％,4/260),sacroiliitis (1.5％,4/260),pyoderma gangrenosum (0.4％,1/260) and primary sclerosing cholangitis (0.4％,1/260).Gender,ethnicity,age,history of intestinal surgery and body mass index (BMI) could affect the occurrence of extraintestinal manifestations in patients with UC (x2 =7.901,4.318,9.291,8.162 and 10.397,all P＜0.05).The incidence of joint lesions in Uygur UC patients was higher than that in Han UC patients (16.6 ％,24/145 vs.7.0％,8/115),and the difference was statistically significant (x2 =5.471,P=0.019).The incidence of extraintestinal manifestations in UC patients in the active phase was higher than that of UC patients in the inactive phase (52.9％,92/174 vs.19.8％,17/86),and the difference was statistically significant (x2 =25.908,P＜0.01).Conclusions UC is complicated with a variety of extraintestinal manifestations.The most commonly involved organs are liver and gallbladder,joint and oral cavity.The extraintestinal manifestations are more common in female,Uygur,patients with high BMI,youth,patients with a history of intestinal surgery and UC patients at the active phase.

Extraintestinal isosporoid coccidian causing atoxoplasmosis in captive green-winged saltators: clinical and hematological features / Coccidiose extraintestinal causando atoxoplasmose em trinca-ferros de cativeiro: aspectos clínicos e hematológicos

Populations of green-winged saltators, Saltator similis, are decreasing especially because of illegal trade and infectious diseases. We describe natural cases of an extraintestinal isosporoid coccidian in caged S. similis, and suggest the need of preventive measures in handling these birds. Nonspecific clinical signs were seen in all of them, however, intracytoplasmic Atoxoplasma sp. was found in peripheral blood, reinforcing the idea of systemic isosporosis. Leukocytosis with high number of heterophils and monocytes suggested that atoxoplasmosis in green-winged saltators can progress as an acute disease. The birds showed clinical improvement after treatment. Handling recommendations were proposed to upgrade hygienic conditions of the facilities. We concluded that nonspecific symptoms and an acute inflammatory process can be associated with atoxoplasmosis in young S. similis. We emphasize the importance of blood smear to detect merozoites.(AU)

As populações de trinca-ferro, Saltator similis, estão declinando especialmente em função do comércio illegal e das doenças infecciosas. Descrevem-se casos naturais de coccidiose extraintestinal em S. similis de cativeiro, sugerindo a necessidade de medidas preventivas no manejo desses animais. Sinais clínicos inespecíficos foram observados em todos os animais, contudo, formas intracitoplasmáticas de Atoxoplasma sp. foram vistas no sangue periférico, reforçando a ideia de isosporose sistêmica. Leucocitose com aumento de heterófilos e monócitos sugeriram que a atoxoplasmose em trinca-ferro pode progredir como uma doença aguda. As aves apresentaram melhora clínica após tratamento. Recomendações de manejo foram propostas a fim de melhorar as condições higiênicas das instalações das aves. Concluiu-se que sinais inespecíficos e processo inflamatório agudo podem ser associados com a atoxoplasmose em S. similis jovens. Enfatizamos a importância da avaliação do esfregaço sanguíneo para detector os merozoítos.(AU)

Distribution characteristics and virulence gene analysis of intestinal and extraintestinal Aeromonas / 临床检验杂志

Objective To investigate the species distribution and the difference of virulence gene spectra of Aeromonas isolated from intestinal tract and extraintestinal body fluid,and the correlation of their pathogenicity with infection sites.Methods A total of 156 Aeromonas strains isolated from the fecal specimens of patients with acute diarrhea and extraintestinal specimens were collected during May 2013 and September 2015.Eighteen virulence genes in these strains,including hlyA,aerA,act,alt,ast,aexT,ascV,aopP,ascF-G,gcat,tapA,fla,Ser,exu,ahyB,eprCAl,lip and laf,were detected by polymerase chain reaction(PCR).Last,the differences of virulence gene spectra between intestinal and extraintestinal Aeromonas were analyzed.Results Among 156 Aeromonas strains,79 were from fecal specimens,and 77 from extraintestinal specimens.Aeromonas caviae(A.caviae,51.9％) was the most common species in the intestinal strains,while Aeromonas hydrophila(A.hydrophila,48.1％) and A.caviae(39.0％) were the main pathogens in extraintestinal infections.The most prevalent virulence genes in intestinal and extraintestinal Aeromonas were gcat,act,fla,ahyB,exu and lip (＞ 45.57 ％),while aexT,aopP,ascF-G and ascV were less frequently detected (＜ 20.78％).The detection rates of gcat,ahyB,laf,ast,exu,lip,hlyA and aerA genes in intestinal Aeromonas were significantly lower than those in extraintestinal isolates (P ＜ 0.05).The detection rates of gcat,ahyB,exu,lip,eprCAl and hlyA genes in extraintestinal A.hydrophila were significantly higher than those in intestinal A.hydrophila (P ＜ 0.05).The detection rates of lip and hlyA genes in extraintestinal A.caviae were significantly higher than those in intestinal A.caviae (P ＜ 0.05),while that of aopP gene was just the reverse.There was no significant difference in the detection rates of virulence genes between intestinal and extraintestinal Aeromonas veronii.Conclusion There are significant differences in the species distribution and virulence genes of Aeromonas isolated from intestinal and extraintestinal specimens,indicating that clinicians should treat them differentially.