Collagenous colitis and lymphocytic colitis: clinical and endoscopic findings.

OBJECTIVE: collagenous colitis (CC) and lymphocytic colitis (LC) are two entities of unknown cause, characterized by chronic watery diarrhea, grossly normal-appearing colonic mucosa and abnormal histopathological findings in colonic biopsies. The clinical features of the disease are based mainly on case reports or small uncontrolled series. Although normal colonoscopic findings are, as a rule, part of the diagnosis of CC, several cases of macroscopic colitis associated with CC have been reported, and the spectrum of endoscopic mucosal changes has not been described in large series. METHODS: we present a retrospective study of all patients who underwent total colonoscopy and mucosal biopsy in our Endoscopy Unit between 1991 and 1997. Clinical and endoscopic findings in patients diagnosed as having CC or LC were recorded. RESULTS: of 676 patients studied, 398 suffered from chronic diarrhea. Collagenous colitis was diagnosed in 22 patients and LC in 10. Eleven per cent of the patients with CC and 20% of those with LC did not have diarrhea. Macroscopic colitis was observed in 6 out of 22 patients with CC (27%) and in 4 out of 10 with LC (40%). Macroscopic lesions included edema, erythema, abnormal vascular pattern, superficial erosions or ulcerations and hemorrhagic lacerations. In this series 7.03% of the patients with chronic diarrhea were diagnosed as having CC or LC. CONCLUSIONS: collagenous colitis and LC are two entities that should be considered in the differential diagnosis of chronic diarrhea. Total colonoscopy with multiple biopsies that include the right colon are mandatory. The presence of macroscopic lesions on endoscopy does not rule out a diagnosis of either entity. We identified patients who fulfilled the histopathological criteria for CC or LC but who did not have diarrhea.

Colitis colágena y colitis linfocítica: aspectos clínicos y endoscopicos / Collagenous colitis and lymphocytic colitis: clinical and endoscopic findings

INTRODUCCIÓN: la Colitis Colágena (CC) y la Colitis Linfocítica (CL) son dos entidades de etiología desconocida caracterizadas por diarrea crónica acuosa, mucosa de colon macroscópicamente normal y alteraciones histopatológicas de las biopsias de la mucosa de colon. Las características clínicas de esta enfermedad están fundamentalmente basadas en casos publicados o pequeñas series no controladas. Aunque una mucosa de colon macroscópicamente normal, clásicamente, forma parte del diagnóstico de CC, han sido publicados varios casos de colitis macroscópica asociada con CC, pero el espectro de los cambios endoscópicos de la mucosa no han sido descritos en series importantes. MÉTODOS: presentamos un estudio retrospectivo de todos los pacientes estudiados en nuestra Unidad de Endoscopia mediante colonoscopia completa y biopsias de mucosa entre 1991 y 1997. En los pacientes diagnosticados de CC y CL se revisaron los datos clínicos y endoscópicos. RESULTADOS: de 676 pacientes estudiados, 398 presentaban diarrea crónica. Se diagnosticó CC en 22 casos y CL en diez. Un 11 por ciento de las CC (2/22) y un 20 por ciento de las CL (2/10) no presentaban diarrea. Se observó colitis macroscópica en seis de los 22 casos con CC (27 por ciento) y en cuatro de los diez casos con CL (40 por ciento). Las lesiones macroscópicas incluyen edema, eritema, pérdida del patrón vascular subcutáneo, erosiones o ulceraciones superficiales y sufusión hemorrágica. En nuestra serie, las CC y las CL representan el 7,03 por ciento de los pacientes con diarrea crónica. CONCLUSIÓN: la CC y la CL son entidades a tener en cuenta en el diagnóstico diferencial de la diarrea crónica, que requieren la realización de colonoscopia completa y toma de biopsias múltiples incluyendo colon derecho. La existencia de lesiones macroscópicas durante la endoscopia no excluye su diagnóstico. Existen casos de CC y CL que cumplen criterios histológicos pero no presentan diarrea (AU)

Superoxide dismutase in patients with chronic hepatitis C virus infection.

It has been reported that hepatitis C virus (HCV) may cause oxidative stress in infected cells. Patients with chronic hepatitis C exhibit an increased production of tumor necrosis factor-alpha (TNF alpha), a cytokine that can produce oxidative stress by stimulating the generation of reactive oxygen species (ROS). Cell defense against ROS includes overexpression of Mn-superoxide dismutase (SOD), an inducible mitochondrial enzyme. To investigate cell defense against oxidative stress in HCV infection, we analyzed Mn-SOD mRNA in liver and in peripheral blood mononuclear cells (PBMC) from patients with chronic hepatitis C. Mn-SOD expression in PBMC was significantly increased in patients with HCV infection. Patients with sustained virological and biochemical response after therapy showed significantly lower Mn-SOD than patients with positive viremia. By contrast, Mn-SOD expression was not enhanced in the liver of patients with chronic hepatitis C. The values of Mn-SOD mRNA did not correlate with TNF alpha mRNA expression, viral load, or liver disease activity. Our results indicate that in HCV infection an induction of Mn-SOD was present in PBMC but absent in the liver, suggesting that this organ could be less protected against oxidative damage. Oxidative stress could participate in the pathogenesis of HCV infection.

[Dementia caused by bacterial overgrowth in a patient with Billroth II gastrectomy]. / Demencia por sobrecrecimiento bacteriano en paciente portador de gastrectomía Billroth II.

We report the case of a patient in the Psychiatric Department who complained of progressive impairment of cerebral functions consistent with dementia, diarrhea and fecal incontinence in the last few months. His medical history included a Billroth II gastrectomy for gastric ulcer. Biochemical tests detected cobalamin deficiency, without megaloblastic anemia, and an abnormal Schilling test that was not due to intrinsic factor deficiency. Once other causes of cobalamin deficiency were ruled out, we considered it as a deficiency disease due to blind loop syndrome. Treatment with parenteral vitamin B complex and long term oral antibiotic therapy allowed the complete and permanent resolution of neurologic and digestive symptoms. We consider this case to be interesting because it shows the existence of curable dementias and the usefulness of taking into account bacterial overgrowth, usually underestimated, as an entity that can produce a variety of disorders.

Endoscopic diagnosis of gastric peptic ulcer penetrating into the liver.

A 61-year-old man was admitted with upper gastrointestinal bleeding. Endoscopy showed a large gastric peptic ulcer with a pseudotumoral mass protruding from the ulcer bed. Histological examination of biopsies taken from the mass revealed distorted hepatic tissue and inflammatory changes. Hepatic penetration was diagnosed as the cause of bleeding. Surgery findings confirmed the endoscopic diagnosis.

[Haptoglobin in the biological diagnosis of gastric cancer (author's transl)]. / La haptoglobina en el diagnóstico biológico del cáncer gástrico.

Serum haptoglobin has been determined in a series of 69 patients with metastatic and non-metastatic gastric cancer. In both circumstances a marked increase of haptoglobin levels in comparison to the results in the control group was observed. A significant decrease was noticed in the presence of liver metastasis. Total alpha 2-globulin levels were also high in this patients, but a significant decrease was not observed in cases with liver metastasis. There was no parallelism between the values of haptoglobin and total alpha 2-globulins. The usefulness of these results in the diagnosis and prognosis of gastric cancer is stressed. Radial immunodiffusion using immunoserum anti-haptoglobin 1-1 is the technique of choice.