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Introduction. Colon biopsies are among the most frequently examined specimens by pathologists. Many pathology practices, ours included, review upfront levels on all gastrointestinal biopsies. In our experience, when a lesion is present on specimens labeled "colon polyp," it is readily identified on the first level. To test our hypothesis, we re-reviewed 500 cases in which a lesion was identified histologically and determined if the diagnosis could be made on the first level. Furthermore, we examined 50 additional cases of high-grade dysplasia/carcinoma to determine if the higher-grade component was also present on the first level. Materials and Methods. Cases were retrieved for lesions that could account for a colon polyp clinically, and the first level was examined to determine if lesional tissue was present on the first level. Fifty additional cases of higher-grade lesions were included to ensure higher-grade lesions were present on the first level. Results. Overall, 497/500 (99.4%) of the non–high-grade lesions were present on the first level, whereas 3/500 (0.6%) required the additional level for diagnosis. All 50 high-grade lesions were present on the first level examined. Discussion. Many pathology practices routinely order upfront levels on all gastrointestinal biopsies, often generating 2 or 3 slides. Additional slides increase costs, increase the likelihood of laboratory-generated errors, and can waste limited tissue on small biopsies for which ancillary studies may be necessary. Our study showed that a single level is sufficient in the overwhelming majority of cases in which a lesion is identified histologically. [ABSTRACT FROM AUTHOR]

We present a novel method to segment instances of glandular structures from colon histopathology images. We use a structure learning approach which represents local spatial configurations of class labels, capturing structural information normally ignored by sliding-window methods. This allows us to reveal different spatial structures of pixel labels (e.g., locations between adjacent glands, or far from glands), and to identify correctly neighboring glandular structures as separate instances. Exemplars of label structures are obtained via clustering and used to train support vector machine classifiers. The label structures predicted are then combined and post-processed to obtain segmentation maps. We combine hand-crafted, multi-scale image features with features computed by a deep convolutional network trained to map images to segmentation maps. We evaluate the proposed method on the public domain GlaS data set, which allows extensive comparisons with recent, alternative methods. Using the GlaS contest protocol, our method achieves the overall best performance. [ABSTRACT FROM AUTHOR]

Background: Diverticulitis in Asians is a different disease entity from Western counterparts. Few Asian studies have evaluated the management of acute Hinchey Ia diverticulitis with consideration for outpatient management. The purpose of this study was to evaluate the outcomes of Asian patients with Hinchey Ia acute diverticulitis. Methods: A retrospective review of all patients who were treated for Hinchey Ia acute colonic diverticulitis between 2012 and 2014 was performed. All patients were diagnosed on computed tomography (CT). Results: There were 129 patients with Hinchey Ia acute diverticulitis. Fifty-five (42.6%) patients were male, and the median age was 54 years (range, 30-86). Eighty-seven (67.4%) patients had right-sided diverticulitis. Most patients were treated empirically with intravenous ceftriaxone and metronidazole (89.1%). They were then discharged with oral antibiotics. Only 6.1% of patients had a positive blood culture. The median length of stay in the hospital was 4 (range, 3-4) days. Only three (2.3%) patients were readmitted for acute diverticulitis within 30 days. They were managed with antibiotics and discharged well. The repeated CT scans reconfirmed Hinchey Ia diverticulitis. No patients required emergency surgery, and there were no 30-day mortalities. Conclusion: Asian patients with Hinchey Ia diverticulitis recovered well with conservative management and could be amenable to outpatient therapy. Future prospective studies should be performed amongst Asians to evaluate managing this condition in an ambulatory setting. [ABSTRACT FROM AUTHOR]

Objectives: To develop guidelines describing a standardised approach to patient preparation and acquisition protocols for magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) of the small bowel and colon, with an emphasis on imaging inflammatory bowel disease.Methods: An expert consensus committee of 13 members from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Paediatric Radiology (ESPR) undertook a six-stage modified Delphi process, including a detailed literature review, to create a series of consensus statements concerning patient preparation, imaging hardware and image acquisition protocols.Results: One hundred and fifty-seven statements were scored for agreement by the panel of which 129 statements (82 %) achieved immediate consensus with a further 19 (12 %) achieving consensus after appropriate modification. Nine (6 %) statements were rejected as consensus could not be reached.Conclusions: These expert consensus recommendations can be used to help guide cross-sectional radiological practice for imaging the small bowel and colon.Key Points: • Cross-sectional imaging is increasingly used to evaluate the bowel • Image quality is paramount to achieving high diagnostic accuracy • Guidelines concerning patient preparation and image acquisition protocols are provided. [ABSTRACT FROM AUTHOR]

Objectives: Adenoma detection rate (ADR) is the most established indicator of the quality of screening colonoscopy. The effect of gastroenterology (GI) fellows on the quality of screening colonoscopies has been evaluated previously; however, the effect of starting a new GI fellowship program on the quality of screening colonoscopies has not been studied. The aim of our study was to assess the effects of starting a GI fellowship program and the participation of fellows in screening colonoscopies on ADR and other measures of quality.Methods: This was a retrospective, cross-sectional study of all screening colonoscopies performed 20 months before and 20 months after starting the GI fellowship at our medical center (November 2010-February 2014). Colonoscopy procedure notes and pathology records were reviewed for each patient. Data from the two periods were compared using either the Fisher exact test or the two-sample t test.Results: A total of 2127 complete colonoscopies were included in the analysis. The mean age of patients was 58.8 ± 6.6 years. Of the 2127 colonoscopies, GI fellows were involved in 385 (18%), whereas 1742 (82%) were performed solely by GI attendings (attending physicians). Multivariate analysis using relative risk (RR) of regression was done. The after starting the GI fellowship period was significantly associated with an increase in ADR (RR 1.19, 95% confidence interval 1.10-1.30, P < 0.001) and advanced adenoma detection rate (RR 1.17, 95% confidence interval 1.00-1.38, P < 0.001) compared with the before starting the GI fellowship period. In the after starting the GI fellowship period, the polyp detection rate and ADR for colonoscopies performed by the attending physicians with the fellows were significantly higher than colonoscopies performed solely by the same attendings (58.4% vs 44.5%, P = 0.001, 42.0% vs 32.9%, P = 0.017, respectively).Conclusions: Starting a GI fellowship program significantly increased the polyp detection rate, ADR, and advanced ADR. [ABSTRACT FROM AUTHOR]

Acute diverticulitis of the colon is a common indication for computed tomography, and its diagnosis and complications are essential to determining the proper treatment and establishing the prognosis. The adaptation of the surgical classification for computed tomography has allowed the extent of intestinal inflammation to be established, the computed tomography findings correlating with the indication for treatment. In addition, computed tomography has proven able to distinguish among the main differential diagnoses of diverticulitis. This pictorial essay aims to present the computed tomography technique, main radiological signs, major complications, and differential diagnoses, as well as to review the classification of acute diverticulitis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 41-year-old man who decided to undergo Roux-en-Y gastric bypass which is a bariatric surgical treatments for obesity, after he underwent cholecystectomy. Topics discussed include creation of an upper gastric pouch during his treatment; reduction observed in the weight of the patient; and treatment of the patient using omeprazole. Topics discussed include observation of muscle cramps, weakness and myalgia in the patient.

In the recent years, wireless capsule endoscopy (WCE) technology has played a very important role in diagnosing diseases within the gastro intestinal (GI) tract of human beings. The WCE device captures images of the GI tract of patient with a certain frame rate. Physicians examine these images in order to find abnormalities in the GI tract. This examination process is very time consuming and hectic for the physician as a WCE device captures around 60,000 images on the average. At present, there are no standards defined for the WCE image classification. Computer aided methods help reducing the burden on the physicians by automatically detecting the abnormalities in the GI tract such as small colon bleeding. In this paper, a pixel based approach to detect bleeding regions in the WCE videos by using a support vector classifier is proposed. Threshold analysis in HSV color space is performed to compute the features for training an optimal support vector machine. The HSV features of the WCE images are fed to the trained support vector classifier for classification. Also, our method includes image enhancement and edge removal in WCE images, which is done prior to classification, for robust results. The method offers high sensitivity, specificity and accuracy in terms of correctly classifying images that contain bleeding regions as compared to another contemporary method. A detailed experimental analysis is also provided for the purpose of method evaluation. [ABSTRACT FROM AUTHOR]

Mouse models of colitis are used for efficacy testing of novel therapeutic compounds. A commonly used endpoint for colitis studies is the microscopic scoring of lesions on whole colon samples, either manually or by automated image analysis platforms. A comprehensive scoring system must evaluate the complete and continuous mucosal surface of the entire colon, so areas prone to show pathology are visible on a single hematoxylin and eosin (H&E)-stained slide. Slide preparation requires rolling the colon into a Swiss roll configuration in a biopsy cassette, fixing the tissue in formalin, embedding in paraffin, and sectioning sagittally through the center of the sample. Technical challenges often arise during the collection, embedding, and sectioning of samples, and errors lead to artifacts that compromise microscopic evaluation. Artifacts typically present as overlap of colon coils are termed ‘tissue folds’; segments of tissue absent from the slide is termed ‘tissue loss.’ We have identified key processing steps prone to contribute to these two artifacts and developed a method using the HistoPress embedding tool (American Master Tech) that significantly reduces their occurrence. [ABSTRACT FROM PUBLISHER]

Background Oxytocin ( OT) reduces rat duodenal tone and mouse intestinal transit; however, the underlying mechanisms are not totally understood. Consequently, this study was designed to investigate the influence of OT on spontaneous mechanical activity and neurally evoked responses, to characterize the mechanisms of the action, and to determine the distribution of the OT receptor ( OTR) in rat proximal colonic muscle strips. Methods The organ bath technique with electrical field stimulation, western blotting, and immunofluorescence were used. Key Results In rat proximal colon, exogenous OT induced a concentration-dependent reduction of the spontaneous mechanical activity without affecting the resting basal tone, which was abolished by atosiban, an OTR antagonist, by tetrodotoxin ( TTX), a neural blocker or by N ω-propyl- l-arginine hydrochloride, an inhibitor of neuronal nitric oxide synthase ( nNOS). The inhibitory effects of OT were not affected by atropine or the vasoactive intestinal peptide ( VIP) receptor antagonist [Lys1, Pro2,5, Arg3,4, Tyr6]-VIP ( VIPHyb). Proximal colon responses to electrical field stimulation were characterized by nonadrenergic, noncholinergic ( NANC) relaxation, which was followed by an off-contraction. Oxytocin enhanced only NANC relaxation. Oxytocin stimulated spontaneous NO release from the longitudinal muscle myenteric plexus preparation of rat proximal colon. Western blot and immunohistochemistry experiments showing the presence of the OTR in proximal colon, and its co-localization with nNOS established that myenteric nitrergic neurons express OTR. Conclusions & Inferences The activation of OTR located on nitrergic neurons may negatively modulate colonic spontaneous contraction and enhance electrically evoked NANC relaxation through excitation of NO release. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate contrast agents for their ability to improve visualization of the colon wall and lumen during CT and ultrasonography. ANIMALS: 10 healthy adult Beagles. PROCEDURES: Food was withheld from dogs for 36 hours, after which dogs consumed 250 mL of polyethylene glycol solution. Dogs were then anesthetized, a contrast agent (tap water, diluted barium, or air; order randomly assigned) was administered rectally, iodine contrast medium (880 mg of I/kg) was administered IV,and CT and ultrasonography of the colon were performed. After a I-week washout period, this process was repeated with a different contrast agent until all agents had been evaluated. Two investigators reviewed the CT and ultrasonographic images for colon wall thickness, conspicuity, artifacts, wall layering, and degree of lumen dilation at 4 sites. RESULTS: Thickness of the colon wall was greatest in CT and ultrasonographic images with water used as contrast agent, followed by barium and then air. The CT images obtained after water administration had a smooth appearance that outlined the colonic mucosa and had the highest score of the 3 contrast agents for wall conspicuity. Although no substantial artifacts related to any of the contrast agents were identified on CT images, barium- and gas-induced shadowing and reverberation artifacts hindered wall evaluation during ultrasonography. For ultrasonography, the degree of conspicuity was highest with barium in the near-field wall and with water in the far-field wall. In contrast to CT, ultrasonography could be used to distinguish wall layering, and the mucosal and muscular layers were distinct w ith all contrast agents. CONCLUSIONS AND CLINICAL RELEVANCE: Use of water as a contrast agent fo r both CT and ultrasonography of the colon in dogs compensated for each imaging modality's disadvantages and could be beneficial in the diagnosis of colon disease. [ABSTRACT FROM AUTHOR]

Background: The majority of primary care patients referred for bowel endoscopy do not have significant colorectal disease (SCD), and are - in hindsight - unnecessarily exposed to a small but realistic risk of severe endoscopyassociated complications. We developed a diagnostic strategy to better exclude SCD in these patients and evaluated the value of adding a faecal calprotectin point-of-care (POC) and/or a POC faecal immunochemical test for haemoglobin (FIT) to routine clinical information. Methods: We used data from a prospective diagnostic study in SCD-suspected patients from 266 Dutch primary care practices referred for endoscopy to develop a diagnostic model for SCD with routine clinical information, which we extended with faecal calprotectin POC (quantitatively in µg/g faeces) and/or POC FIT results (qualitatively with a 6 µg/g faeces detection limit). We defined SCD as colorectal cancer (CRC), inflammatory bowel disease, diverticulitis, or advanced adenoma (>1 cm). Results: Of 810 patients, 141 (17.4%) had SCD. A diagnostic model with routine clinical data discriminated between patients with and without SCD with an area under the receiver operating characteristic curve (AUC) of 0. 741 (95% CI, 0.694-0.789). This AUC increased to 0.763 (95% CI, 0.718-0.809; P = 0.078) when adding the calprotectin POC test, to 0.831 (95% CI, 0.791-0.872; P < 0.001) when adding the POC FIT, and to 0.837 (95% CI, 0. 798-0.876; P < 0.001) upon combined extension. At a = 5.0% SCD probability threshold for endoscopy referral, 30. 4% of the patients tested negative based on this combined POC-tests extended model (95% CI, 25.7-35.3%), with 96.4% negative predictive value (95% CI, 93.1-98.2%) and 93.7% sensitivity (95% CI, 88.2-96.8%). Excluding the calprotectin POC test from this model still yielded 30.1% test negatives (95% CI, 24.7-35.6%) and 96.0% negative predictive value (95% CI, 92.6-97.9%), with 93.0% sensitivity (95% CI, 87.4-96.4%). Conclusions: FIT - and to a much lesser extent calprotectin - POC testing showed incremental value for SCD diagnosis beyond standard clinical information. A diagnostic strategy with routine clinical data and a POC FIT test may safely rule out SCD and prevent unnecessary endoscopy referral in approximately one third of SCD-suspected primary care patients. [ABSTRACT FROM AUTHOR]

Currently, the most commonly used classification of acute colonic diverticulitis (ACD) is the modified Hinchey classification, which corresponds to a slightly more complex classification by comparison with the original description. This modified classification allows to categorize patients with ACD into four major categories (I, II, III, IV) and two additional subcategories (Ia and Ib), depending on the severity of the disease. Several studies have clearly demonstrated the impact of this classification for determining the best therapeutic approach and predicting perioperative complications for patients who need surgery. This review provides an update on the classification of ACD along with a special emphasis on the corresponding MDCT features of the different categories and subcategories. This modified Hinchey classification should be known by emergency physicians, radiologists, and surgeons in order to improve patient care and management because each category has a specific therapeutic approach. [ABSTRACT FROM AUTHOR]

Background: Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. Methods: This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. Discussion: If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. Trial Registration: NCT02657044 (Clinicaltrials.gov), registered January 8, 2016. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy and safety of endoscopic resection of large colorectal polyps. Design Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ⩾20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed. Results 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients ( pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 ( pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%). Conclusions Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy. [ABSTRACT FROM AUTHOR]

The article discusses updates to the consensus guidelines of medical personnel society European Neuroendocrine Tumor Society (ENETS) for the diagnosis and treatment of colorectal neuroendocrine neoplasms. Topics of the consensus guideline include the epidemiology of rectal tumors, the use of colonscopy screening programs for diagnosis of tumors in colon and terminal ileum and its short-term prognosis. It also outlines the surgical treatment for colorectal tumors such as simple polypectomy.

Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group. Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema; Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide; Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients. Results. Group C had the highest cleaning score, compared with the other groups (2.2±0.4 versus 2.7±0.4 versus 3.7±0.4, p value =0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5–10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively. Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies. [ABSTRACT FROM AUTHOR]

Background: Splenic injury following colonoscopy is a rare yet life-threatening complication. These injuries are often associated with delayed diagnosis and may require invasive intervention. We sought to study the emergent presentation associated with splenic injury post-colonoscopy and to suggest a new treatment algorithm. Methods: Six cases of splenic injury following colonoscopy were collected from three medical centers. Data regarding patient medical history, clinical presentation, laboratory and imaging findings and clinical management were recorded. A systematic PubMed/MEDLINE search was performed. Non-English-language publications and publications dating earlier than 2010 were excluded. An emergency department trauma-based management algorithm was designed according to the identified publications and review of the available trauma literature. Results: The mean age was 65.3 years and the male-to-female ratio was 1:5. Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels. All of the patients underwent initial resuscitation and a computerized abdominal tomography scan. Four of them required emergent splenectomy. No mortality or major morbidity was reported following the hospitalization. Conclusions: Although very rare, splenic injury during colonoscopy is an acute, severe and possible fatal complication. Patients may present with a rapid clinical deterioration and hemodynamic instability. Physicians should be familiar with the practical management of this surgical emergency and the treatment options available. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the prevalence of lymphoid hyperplasia in the lower gastrointestinal tract and its role in patients undergoing colonoscopic examinations, particularly focusing on any allergic predisposition. Methods: A database search performed at the Department of Gastroenterology at Onomichi Municipal Hospital identified seven patients with lymphoid hyperplasia in the large intestine (i.e., cecum, colon, and/or rectum). Data regarding the endoscopic, biological, and pathological examinations performed and the allergic histories for each patient were retrospectively reviewed from the clinical records. Results: Median age of the patients (four males, three females) was 50 years. Lymphoid hyperplasia was seen in the cecum ( n = 5), ascending colon ( n = 2), and transverse colon ( n = 1). Six patients (85.7 %) had one of the allergic airway diseases: allergic rhinoconjunctivitis for pollen ( n = 3), bronchial asthma ( n = 1), infantile asthma ( n = 1), or allergic bronchitis ( n = 1). Drug allergy ( n = 3) and urticaria ( n = 2) were also found. All seven patients had one or more allergic diseases; however, none had a history of food allergy. Blood tests for allergens revealed that six patients (85.7 %) had positive reactions to inherent allergens, whereas only one patient had a positive reaction to food allergens. Conclusions: Our results indicate that lymphoid hyperplasia in the large intestine may be associated with allergic airway diseases rather than with food allergies; thus, its presence may be useful to detect patients with underlying airway hyperreactivity. [ABSTRACT FROM AUTHOR]

Sigmoid volvulus (SV) is a rare form of acute intestinal obstruction in which the sigmoid colon wraps around itself. The disease generally presents as a mechanical bowel obstruction with clinical features that are not pathognomonic. Similarly, X-ray films are not diagnostic in most cases. It is difficult to establish the correct preoperative diagnosis when CT and MRI are not used. The principal strategy in the treatment of SV in uncomplicated patients is emergency endoscopic detorsion followed by elective surgery; emergent surgery is required in patients with bowel gangrene, bowel perforation, peritonitis, or unsuccessful endoscopic treatment. In this review, we have discussed the role of sigmoidoscopy in the diagnosis and treatment of SV. Additionally, we have retrospectively and prospectively evaluated our 49-year, 987-patient clinical experience, the largest single-center SV series ever reported. [ABSTRACT FROM AUTHOR]

Background In the esophagus, high-resolution manometry ( HRM) has become a standard diagnostic tool in the investigation of suspected motility disorders. However, at the opposite end of the digestive tract (i.e., the colon and anorectum), the use of HRM still remains in its infancy, with relatively few published studies in the scientific literature. Further, the clinical utility of those studies that have been performed is largely undetermined. Purpose This review assesses all of the HRM studies published to date from both the colon and anorectum, explores the catheter types used, and attempts to determine the worth of HRM over traditional 'low-resolution' recordings from the same regions. Ultimately, this review addresses whether HRM currently provides information that will benefit patient diagnosis and treatment. [ABSTRACT FROM AUTHOR]

l-Carnitine, a key component of fatty acid oxidation, is nowadays being extensively used as a nutritional supplement with allegedly 'fat burning' and performance-enhancing properties, although to date there are no conclusive data supporting these claims. Furthermore, there is an inverse relationship between exogenous supplementation and bioavailability, i.e., fairly high oral doses are not fully absorbed and thus a significant amount of carnitine remains in the gut. Human and rat enterobacteria can degrade unabsorbed l-carnitine to trimethylamine or trimethylamine- N-oxide, which, under certain conditions, may be transformed to the known carcinogen N-nitrosodimethylamine. Recent findings indicate that trimethylamine- N-oxide might also be involved in the development of atherosclerotic lesions. We therefore investigated whether a 1-year administration of different l-carnitine concentrations (0, 1, 2 and 5 g/l) via drinking water leads to an increased incidence of preneoplastic lesions (so-called aberrant crypt foci) in the colon of Fischer 344 rats as well as to the appearance of atherosclerotic lesions in the aorta of these animals. No significant difference between the test groups regarding the formation of lesions in the colon and aorta of the rats was observed, suggesting that, under the given experimental conditions, l-carnitine up to a concentration of 5 g/l in the drinking water does not have adverse effects on the gastrointestinal and vascular system of Fischer 344 rats. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 70-year-old woman who was admitted due to massive hematochezia, where contrast-enhanced computed tomography (CECT) showed numerous diverticula located in the ascending colon.

The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options. [ABSTRACT FROM AUTHOR]

The article discusses a clinical research which examines the relevance of serotonin receptor splice variant distribution in human colon. The study explores the gene expression of descending and sigmoid colon in the regional differences of receptor desensitization in human colon. The study also explores the clinical approach of secretomotor function for determining gastrointestinal diseases.

Imaging mass spectrometry is becoming a reference technique in the field of lipidomics, due to its ability to map the distribution of hundreds of species in a single run, along a tissue section. The next frontier is now achieving increasing resolution powers to offer cellular (or even sub-cellular) resolution. Thus, the new spectrometers are equipped with sophisticated optical systems to decrease the laser spot to <30 μm. Here, we demonstrate that by using the correct matrix (i.e., a matrix that maximizes ion detection and forms small crystals) and a careful preparation, it is possible to achieve resolutions of ∼5-10 μm, even with spectrometers equipped with non-optimal optics, which produces laser spots of 50 μm or even larger. As a proof of concept, we present images of distributions of lipids, both in positive and negative ion mode, over human colon endoscopic sections, recorded using 2-mercaptobenzothiazole for positive ion mode and 2,5-diaminonaphtalene for negative ion mode and an LTQ-Orbitrap XL, equipped with a matrix-assisted laser desorption ionization (MALDI) source that produces astigmatic laser spots. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

Accurate and automatic colon segmentation from CT images is a crucial step of many clinical applications in CT colonography, including computer-aided detection (CAD) of colon polyps, 3-D virtual flythrough of the colon, and prone/supine registration. However, the existence of adjacent air-filled organs such as the lung, stomach, and small intestine, and the collapse of the colon due to poor insufflation, render accurate segmentation of the colon a difficult problem. Extra-colonic components can be categorized into two types based on their 3-D connection to the colon: detached and attached extracolonic components (DEC and AEC, respectively). In this paper, we propose graph inference methods to remove extracolonic components to achieve a high quality segmentation. We first decompose each 3-D air-filled object into a set of 3-D regions. A classifier trained with region-level features can be used to identify the colon regions from noncolon regions. After removing obvious DEC, we remove the remaining DEC by modeling the global anatomic structure with an a priori topological constraint and solving a graph inference problem using semantic information provided by a multiclass classifier. Finally, we remove AEC by modeling regions within each 3-D object with a hierarchical conditional random field, solved by graph cut. Experimental results demonstrate that our method outperforms a purely discriminative learning method in detecting true colon regions, while decreasing extra-colonic components in challenging clinical data that includes collapsed cases. [ABSTRACT FROM AUTHOR]

Background: Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people compared to developed countries. No prospective study has been done on this subject in Tanzania and Bugando Medical Centre in particular. This study describes in our region, the clinical presentation, management and outcome of sigmoid volvulus. Methods: This was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014. Results: A total of 146 patients (M: F = 5.1: 1) representing 14.2% of all cases of bowel obstruction were studied. The median age at presentation was 48 years. The disease significantly affected the older males compared with females (P = 0.012). The majority of the patients 102, (93.2%) presented acutely and had to undergo emergency surgical intervention, the rest were either sub-acute or chronic. Out of the 146 patients studied, 24 (16.4%) had ileo-sigmoid knotting. The majority of patients, 102(69.9%) were treated with resection and primary anastomosis, of which 63.0% were emergency cases. Colostomy was offered to 30.1% of cases. No patient had sigmoidoscopic derotation. Complications mainly surgical site infections were reported in 20.5% of cases. The overall median length of hospital stay was 14 days. Overall mortality rate was 17.1%. The main predictors of mortality were advanced age (>60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel (P < 0.001). The follow up of patients in this study was generally poor as more than half of patients were lost to follow up. Conclusion: Sigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that in viable bowel, sigmoid resection and primary anastomosis is feasible as it may not adversely affect outcome. Temporary colostomy should be considered if the bowel is gangrenous or perforated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease. [ABSTRACT FROM AUTHOR]

Colonoscopy is the reference medical examination for early diagnosis and treatment of colonic diseases. This minimally invasive technique allows endoscopists to explore the colon cavity and remove neoplasias – abnormal growths of tissue – which may develop into malignant tumors. The size, shape and appearance of a neoplasia are essential cues for diagnostic. However, the size is difficult to estimate because the absolute scale of the observed tissue is not directly conveyed in the 2D colonoscopic images. An erroneous size estimate may lead to inappropriate treatment. There currently exist no solutions to reproducible neoplasia size measurement adapted to colonoscopy. We propose a colonoscopic size measurement system for neoplasias. By using a simple planar geometry, the key technical problem is reduced to resolving scale. Our core contribution is introducing the Infocus-Breakpoint (IB) that allows us to resolve scale from a regular colonoscopic video. We define the IB as the lower limit of the colonoscope’s depth of field. The IB corresponds to a precise colonoscope to tissue distance, called the reference depth , which we calibrate preoperatively. We detect the IB intraoperatively thanks to two novel modules: deformable Blur-Estimating Tracking (BET) and Blur-Model Fitting (BMF). With our system, the endoscopist may interactively measure the length and area of a neoplasia in a 2D colonoscopic image directly. Our system needs no hardware modification to standard monocular colonoscopes, yet reaching a size measurement accuracy of the order of a millimeter, as shown on several phantom and patient datasets. [ABSTRACT FROM AUTHOR]

Objective: To prospectively evaluate the radiation dose and image quality comparing low-dose CT colonography (CTC) reconstructed using different levels of iterative reconstruction techniques with routine-dose CTC reconstructed with filtered back projection. Methods: Following institutional ethics clearance and informed consent procedures, 210 patients underwent screening CTC using automatic tube current modulation for dual positions. Examinations were performed in the supine position with a routine-dose protocol and in the prone position, randomly applying four different low-dose protocols. Supine images were reconstructed with filtered back projection and prone images with iterative reconstruction. Two blinded observers assessed the image quality of endoluminal images. Image noise was quantitatively assessed by region-of-interest measurements. Results: The mean effective dose in the supine series was 1.88 mSv using routine-dose CTC, compared to 0.92, 0.69, 0.57, and 0.46 mSv at four different low doses in the prone series ( p < 0.01). Overall image quality and noise of low-dose CTC with iterative reconstruction were significantly improved compared to routine-dose CTC using filtered back projection. The lowest dose group had image quality comparable to routine-dose images. Conclusions: Low-dose CTC with iterative reconstruction reduces the radiation dose by 48.5 to 75.1 % without image quality degradation compared to routine-dose CTC with filtered back projection. Key Points: • Low-dose CTC reduces radiation dose ≥48.5 % compared to routine-dose CTC. • Iterative reconstruction improves overall CTC image quality compared with FBP. • Iterative reconstruction reduces overall CTC image noise compared with FBP. • Automated exposure control with iterative reconstruction is useful for low-dose CTC. [ABSTRACT FROM AUTHOR]

OBJECTIVES:No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS).METHODS:We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defined as sigmoid colon, descending colon, and rectum. Right-sided colon was defined as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics.RESULTS:Patient characteristics included mean age, 64.2±12.9 years and male:female ratio, 1.62:1. Right-sided DD was identified in 21.6% of subjects. Left-sided and bilateral DD was identified in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confidence interval (CI): 1.4-7.1; P=0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P=0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS.CONCLUSIONS:Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specific changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS (Trial registration # R000012739). [ABSTRACT FROM AUTHOR]

Background: Cyclophosphamide (CP) is an alkylating anticancer drug used for the treatment of various cancer and noncancer disorders. Toxicity of CP is well characterized using different test systems. However, its intestinal genotoxicity and cytotoxicity are the least explored and the mechanism is not fully investigated. Valproic acid (VPA) has been reported as a histone deacetylase (HDAC) inhibitor, which modulates the cytotoxicity of anticancer drugs. The present study aimed to investigate the influence of VPA on CP-induced genotoxicity and cytotoxicity in the colon of mice. Methods: In the 16-day experiment, animals were treated with VPA alone (500 mg/kg/day), CP alone (50 mg/kg, on the 4th, 8th, 12th, and 16th days), and the combination of CP and VPA, while in the 28-day experiment, animals were treated with VPA alone (300 mg/kg/day, 5 days/week), CP alone (100 mg/kg/week), and the combination of low and high dose of VPA (VPA150+CP and VPA300+CP). Animals were sacrificed 24 h after the administration of the last dose. The influence of VPA treatment on CP-induced genotoxicity and cytotoxicity was assessed by the evaluation of oxidative stress, DNA damage, histology, and the expression of 8-hydroxy-guanosine and phosphorylated histone H2AX by immunohistochemistry. Results and conclusions: The present study's results demonstrated that VPA treatment significantly decreased the CP-induced DNA damage, cytotoxicity, and expression of γH2AX in the colon as revealed by the comet assay and histological as well as immunohistochemical evaluation. VPA treatment significantly ameliorated the CP-induced DNA damage and cytotoxicity in the colon of mice. [ABSTRACT FROM AUTHOR]

The author comments the study that investigates the effectiveness of Rome IV diagnostic guidelines in testing the irritable bowel syndrome (IBS) of patients. The topics discussed include the reasons for revising the Rome III criteria, its effects in managing patients with IBS, and the clinical validation for Rome IV criteria.

Raman spectroscopy has shown considerable promise as a medical diagnostic tool. The technique is safe for use in vivo and is capable of rapid, objective assessment of neoplastic and inflammatory tissue enabling early diagnosis and targeted treatment. We review potential applications of Raman spectroscopy in the oesophagus, colon and breast where this new technology has the potential to revolutionise patient care. [ABSTRACT FROM AUTHOR]

The article discusses the symptoms, treatment, and diagnosis of irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) (functional constipation). Emphasis is given to the efficacy of medical interventions such as diet and dietary manipulation, the modification of microbiota, and evaluation of the agonists and antagonists to serotonergic receptors.

In this paper, we propose a fast three-material modeling for electronic cleansing (EC) in computed tomographic colonography. Using a triple arch projection, our three-material modeling provides a very quick estimate of the three-material fractions to remove ridge-shaped artifacts at the T-junctions where air, soft-tissue (ST), and tagged residues (TRs) meet simultaneously. In our approach, colonic components including air, TR, the layer between air and TR, the layer between ST and TR (LST/TR), and the T-junction are first segmented. Subsequently, the material fraction of ST for each voxel in LST/TR and the T-junction is determined. Two-material fractions of the voxels in LST/TR are derived based on a two-material transition model. On the other hand, three-material fractions of the voxels in the T-junction are estimated based on our fast three-material modeling with triple arch projection. Finally, the CT density value of each voxel is updated based on our fold-preserving reconstruction model. Experimental results using ten clinical datasets demonstrate that the proposed three-material modeling successfully removed the T-junction artifacts and clearly reconstructed the whole colon surface while preserving the submerged folds well. Furthermore, compared with the previous three-material transition model, the proposed three-material modeling resulted in about a five-fold increase in speed with the better preservation of submerged folds and the similar level of cleansing quality in T-junction regions. [ABSTRACT FROM PUBLISHER]

Background: The impact of one-stage polypectomy (removal of all neoplasms during diagnostic colonoscopy) versus two-stage polypectomy (removal of all neoplasms during therapeutic colonoscopy following the initial diagnostic colonoscopy) on the development of metachronous neoplasms is poorly understood. Our aim was to compare the effects of one- versus two-stage polypectomy on the development of metachronous neoplasms Methods: We retrospectively reviewed the medical records of 249 patients in a tertiary center who underwent one-stage polypectomy, which was followed by one or more surveillance colonoscopy. The development of metachronous neoplasm in this group was compared with that of an age- and sex-matched two-stage polypectomy group consisting of 498 patients Results: In total, 346 (46.3 %) patients developed any metachronous neoplasm and 29 (3.9 %) patients developed advanced metachronous neoplasm. The 5 years cumulative incidences of any and advanced metachronous neoplasm were 46.2 and 5.0 %, respectively, in the one-stage group, which are not significantly different from the rates of 50.7 and 3.3 % in the two-stage group ( p = 0.94 and 0.30, respectively). The only significant risk factor for developing any metachronous neoplasm was ≥3 neoplasms at the baseline polypectomy [hazard ratio (HR) 1.75; 95 % confidence interval (CI) 1.41-2.17; p < 0.001]. The only significant risk factor for developing advanced metachronous neoplasm was advanced neoplasm at the baseline polypectomy (HR 2.37; 95 % CI 1.16-4.84; p = 0.01). One- and two-stage polypectomy did not affect the development rates of metachronous neoplasm Conclusions: The risks of developing metachronous neoplasm may be similar following one- and two-stage polypectomy. [ABSTRACT FROM AUTHOR]

Objectives: To assess the frequency of oral contrast coating of flat polyps, which may promote detection, and influencing factors within a screening CT colonography (CTC) population. Methods: This was a retrospective, observational study performed at one institution. From 7,426 individuals, 123 patients with 160 flat polyps were extracted. Flat polyps were defined as plaque-like, raised at most 3 mm in height and reviewed for contrast coating. Factors including demographic variables such as age and sex, and polyp variables such as polyp size, location and histology were analysed for effect on coating. Results: Of 160 flat polyps (mean size 9.4 mm ± 3.6), 78.8 % demonstrated coating. Mean coat thickness was 1.5 mm ± 0.6; 23.8 % ( n = 30) demonstrated a thin film of contrast. Large size (≥10 mm) and proximal colonic location (relative to splenic flexure) were predictive variables by univariate logistic regression [OR (odds ratio) 3.4 (CI 1.3-8.9; p = 0.011), 2.0 (CI 1.2-3.5; p = 0.011), respectively]. Adenomas (OR 0.37, CI 0.14-1.02; p = 0.054) and mucosal polyps or venous blebs (OR 0.07, CI 0.02-0.25; p < 0.001) were less likely to coat than serrated/hyperplastic lesions. Age and sex were not predictive for coating ( p = 0.417, p = 0.499, respectively). Conclusions: Surface contrast coating is common for flat polyps at CTC, promoted by large size, proximal location and serrated/hyperplastic histology. Given the difficulty in detection, recognition may aid in flat polyp identification. Key points: • Oral contrast coats the surface of most flat colorectal polyps at CT colonography. • Large size, proximal colonic location and serrated/hyperplastic histology increase polyp coating. • Contrast coating increases diagnostic confidence for flat polyps. • Contrast coating may help in flat polyp detection at CTC. [ABSTRACT FROM AUTHOR]

Objective. Colon capsule endoscopy (CCE) proved to be highly sensitive in detection of colorectal polyps (CP). Major limitation is the time-consuming video reading. The aim of this prospective, double-center study was to assess the theoretical time-saving potential and its possible impact on the reliability of 'QuickView' (QV), in the presentation of CP as compared to normal mode (NM). Methods. During NM reading of 65 CCE videos (mean patient´s age 56 years), all frames showing CPs were collected and compared to the number of frames presented by QV at increasing QV settings (10, 20, ... 80%). Reliability of QV in presenting polyps <6 mm and ≥6 mm (significant polyp), and identifying patients for subsequent therapeutic colonoscopy, capsule egestion rate, cleansing level, and estimated time-saving potential were assessed. Results. At a 30% QV setting, the QV video presented 89% of the significant polyps and 86% of any polyps with ≥1 frame (per-polyp analysis) identified in NM before. At a 10% QV setting, 98% of the 52 patients with significant polyps could be identified (per-patient analysis) by QV video analysis. Capsule excretion rate was 74% and colon cleanliness was adequate in 85%. QV´s presentation rate correlates to the QV setting, the polyp size, and the number of frames per finding. Conclusions. Depending on its setting, the reliability of QV in presenting CP as compared to NM reading is notable. However, if no significant polyp is presented by QV, NM reading must be performed afterwards. The reduction of frames to be analyzed in QV might speed up identification of candidates for therapeutic colonoscopy. [ABSTRACT FROM AUTHOR]

Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

IMPORTANCE Diverticulitis is a common disease. Recent changes in understanding its natural history have substantially modified treatment paradigms. OBJECTIVE To review the etiology and natural history of diverticulitis and recent changes in treatment guidelines. EVIDENCE REVIEW We searched the MEDLINE and Cochrane databases for English-language articles pertaining to diagnosis and management of diverticulitis published between January 1,2000, and March 31,2013. Search terms applied to 4 thematic topics: pathophysiology, natural history, medical management, and indications for surgery. We excluded small case series and articles based on data accrued prior to 2000. We hand searched the bibliographies of included studies, yielding a total of 186 articles for full review. We graded the level of evidence and classified recommendations by size of treatment effect, according to the guidelines from the American Heart Association Task Force on Practice Guidelines. FINDINGS Eighty articles met criteria for analysis. The pathophysiology of diverticulitis is associated with altered gut motility, increased luminal pressure, and a disordered colonic microenvironment. Several studies examined histologic commonalities with inflammatory bowel disease and irritable bowel syndrome but were focused on associative rather than causal pathways. The natural history of uncomplicated diverticulitis is often benign. For example, in a cohort study of 2366 of 3165 patients hospitalized for acute diverticulitis and followed up for 8.9 years, only 13.3% of patients had a recurrence and 3.9%, a second recurrence. In contrast to what was previously thought, the risk of septic peritonitis is reduced and not increased with each recurrence. Patient-reported outcomes studies show 20% to 35% of patients managed nonoperatively progress to chronic abdominal pain compared with 5% to 25% of patients treated operatively. Randomized trials and cohort studies have shown that antibiotics and fiber were not as beneficial as previously thought and that mesalamine might be useful. Surgical therapy for chronic disease is not always warranted. CONCLUSIONS AND RELEVANCE Recent studies demonstrate a lesser role for aggressive antibiotic or surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary. [ABSTRACT FROM AUTHOR]

We tested the hypothesis that 5-aminosalicylic acid (5-ASA) inhibits toxin A-induced generation of colonic leukotriene B4 (LTB4) and toxin A colitis in rats. Isolated colonic segments in anesthetized rats were treated intraluminally with toxin A for 3 hours with or without 30 minutes of pretreatment with either 5-ASA or sulfapyridine and then colonic tissue levels of LTB4 were measured and inflammation was assessed. Separately, sulfasalazine was administered to rats in their drinking water for 5 days, isolated colonic segments were then prepared, toxin A was administered, and inflammation was assessed as before. Pretreatment with 5-ASA inhibited toxin A-induced increased tissue LTB4 concentration in the colon. Sulfasalazine and 5-ASA but not sulfapyridine significantly inhibited toxin A colitis. However, pretreatment with 5-ASA did not protect against direct TRPV1-mediated colitis caused by capsaicin. Toxin A stimulated the release of substance P (SP), and this effect was also inhibited by sulfasalazine and 5-ASA but not by sulfapyridine. Thus, toxin A stimulates colonic LTB4 resulting in activation of TRPV1, release of SP, and colitis. Inhibition of 5-LO by 5-ASA disrupts this pathway and supports the concept that LTB4 activation of TRPV1 plays a role in toxin A colitis. [ABSTRACT FROM AUTHOR]

Background and Aims: In isolated colonic mucosa, decreases in short-circuit current ( I) and transepithelial resistivity ( R) occur when hypoxia is either induced at both sides or only at the serosal side of the epithelium. We assessed in human colon biopsies the sensitivity to serosal-only hypoxia and mucosal-only hypoxia and whether Na, K-ATPase blockade with ouabain interacts with hypoxia. Materials and Methods: Biopsy material from patients undergoing colonoscopy was mounted in an Ussing chamber for small samples (1-mm window). In a series of experiments we assessed viability and the electrical response to the mucolytic, dithiothreitol (1 mmol/l). In a second series, we explored the effect of hypoxia without and with ouabain. In a third series, we evaluated the response to a cycle of hypoxia and reoxygenation induced at the serosal or mucosal side while keeping the oxygenation of the opposite side. Results: 1st series: Dithiothreitol significantly decreased the unstirred layer and I but increased R. 2nd series: Both hypoxia and ouabain decreased I, but ouabain increased R and this effect on R prevailed even during hypoxia. 3rd series: Mucosal hypoxia caused lesser decreases of I and R than serosal hypoxia; in the former, but not in the latter, recovery was complete upon reoxygenation. Conclusions: In mucolytic concentration, dithiothreitol modifies I and R. Oxygen supply from the serosal side is more important to sustain I and R in biopsy samples. The different effect of hypoxia and Na, K-ATPase blockade on R suggests that their depressing effect on I involves different mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess safety, efficacy, and clinical outcomes following transcatheter arterial embolization (TAE) of acute gastrointestinal (GI) bleeding. Materials and Methods: Ninety-five patients (male:female ratio = 53:42, mean age 62 years) that underwent 95 TAEs for GI hemorrhage between 2002 and 2010 were retrospectively studied. Seventy-six of 95 (80 %) patients had upper GI bleeds and 19/95 (20 %) patients had lower GI bleeds. A mean of 7 (range 0-27) packed red blood cell units were transfused pre-procedure, and 90/95 (95 %) procedures were urgent or emergent. Twenty-seven of 95 (28 %) patients were hemodynamically unstable. Measured outcomes included procedure technical success, adverse events, and 30-day rebleeding and mortality rates. Results: Bleeding etiology included peptic ulcer disease (45/95, 47 %), cancer (14/95, 15 %), diverticulosis (13/95, 14 %), and other (23/95, 24 %). Vessels embolized ( n = 109) included gastroduodenal (42/109, 39 %), pancreaticoduodenal (22/109, 20 %), gastric (21/109, 19 %), superior mesenteric (12/109, 11 %), inferior mesenteric (8/109, 7 %), and splenic (4/109, 4 %) artery branches. Technical success with immediate hemostasis was achieved in 93/95 (98 %) cases. Most common embolic agents included coils (66/109, 61 %) and/or gelatin sponge (19/109, 17 %). Targeted versus empiric embolization were performed in 57/95 (60 %) and 38/95 (40 %) cases, respectively. Complications included bowel ischemia (4/95, 4 %) and coil migration in 3/95 (3 %). 30-day rebleeding rate was 23 % (22/95). Overall 30-day mortality rate was 18 % (16/89). Empiric embolization resulted in similar rebleeding (23 vs 24 %) but higher mortality (31 vs 9 %) rates compared to embolization for active extravasation. Conclusions: TAE controlled GI bleeding with high technical success, safety, and efficacy, and should be considered when endoscopic therapy is not feasible or unsuccessful. [ABSTRACT FROM AUTHOR]

Epidemiologic evidence supports that diets rich in polyphenols promote health and may delay the onset of colon cancer. Cocoa and chocolate products have some of the highest polyphenolic concentrations compared to other polyphenolic food sources. This study tested the hypothesis that a diet including dark chocolate can protect against colon cancer by inhibiting aberrant crypt foci (ACF) formation, downregulating gene expression of inflammatory mediators, and favorably altering cell kinetics. We also investigated whether bloomed dark chocolate retains the antioxidant capacity and protects against colon cancer. Forty-eight rats received either a diet containing control (no chocolate), regular dark chocolate, or bloomed dark chocolate and were injected subcutaneously with saline or azoxymethane. Relative to control, both regular and bloomed dark chocolate diets lowered the total number of ACF (P= 0.022). Chocolate diet-fed animals downregulated transcription levels of COX-2 (P= 0.035) and RelA (P= 0.045). Both chocolate diets lowered the proliferation index (P= 0.001). These results suggest that a diet including dark chocolate can reduce cell proliferation and some gene expression involving inflammation, which may explain the lower number of early preneoplastic lesions. These results provide new insight on polyphenol-rich chocolate foods and colon cancer prevention. [ABSTRACT FROM AUTHOR]

Fibroblast growth factor 19 (FGF19) is proposed to be a negative feedback regulator of hepatic bile acid (BA) synthesis. We aimed to clarify the distribution of FGF19 expression in human intestine and to investigate induction in a novel explant system. Ileal and colonic mucosal biopsies were obtained at endoscopy and analyzed for FGF19 transcript expression. Primary explants were incubated with physiological concentrations of various BA for up to 6 h, and expression of FGF19 and other genes was determined. FGF19 transcripts were detected in ileum but were unquantifiable in colon. No loss of FGF19 mRNA occurred as a consequence of the explant system. Ileal FGF19 transcript expression was induced 350-fold by 50 μM chenodeoxycholate (CDCA, n = 24, P < 0.0001) and 161-fold by 50 μM glycochenodeoxycholate (GCDCA, n = 12, P = 0.0005). The responses of other genes to CDCA or GCDCA (50 μM) were smaller: median increases of ileal bile acid binding protein, organic solute transporter-α and -β, and short heterodimer partner were 2.4- to 4.0-fold; apical membrane sodium bile acid transporter and farnesoid X receptor (FXR) showed little change. The EC50 for FGF19 transcript induction by CDCA was 20 μM. FGF19 protein concentrations were significantly higher in the culture fluid from BA-stimulated explants. FGF19 induction with cholate was 81% of that found with CDCA, but deoxycholate (40%) and lithocholate (4%) were significantly less potent. The synthetic FXR agonist obeticholic acid was much more potent than CDCA with a 70-fold FGF19 stimulation at 1 μM. We concluded that FGF19 expression in human ileum is very highly responsive to BA. Changes in FGF19 induction are a potential mechanism involved in disorders of BA homeostasis. [ABSTRACT FROM AUTHOR]

Despite clear patient experience advantages, low specificity rates have thus far prevented swallowable capsule endoscopes from replacing traditional endoscopy for diagnosis of colon disease. One explanation for this is that capsule endoscopes lack the ability to provide insufflation, which traditional endoscopes use to distend the intestine for a clear view of the internal wall. To provide a means of insufflation from a wireless capsule platform, in this paper we use biocompatible effervescent chemical reactions to convert liquids and powders carried onboard a capsule into gas. We experimentally evaluate the quantity of gas needed to enhance capsule visualization and locomotion, and determine how much gas can be generated from a given volume of reactants. These experiments motivate the design of a wireless insufflation capsule, which is evaluated in ex vivo experiments. These experiments illustrate the feasibility of enhancing visualization and locomotion of endoscopic capsules through wireless insufflation. [ABSTRACT FROM PUBLISHER]

Aim Current recommendations regarding the triage of patients with acute diverticulitis for inpatient or outpatient treatment are vague. We hypothesized that a significant number of patients treated as an inpatient could be managed as an outpatient. Method A retrospective cohort study was carried out of 639 patients admitted for a first episode of diverticulitis. The diagnosis of acute diverticulitis was confirmed by computed tomography ( CT). The endpoints included length of stay, need for surgery, percutaneous drainage and mortality. Patients were considered to have had a minimal hospitalization, defined as survival to discharge without needing a procedure, hospitalization of ≤ 3 days and no readmission for diverticulitis within 30 days after discharge. Results Of 639 patients, 368 (57.6%) had a minimal hospitalization. Female gender and CT scan findings of free air/fluid were negatively associated with the likelihood of minimal hospitalization. The presence of an abscess < 3 cm and stranding on CT did not predict the need for a higher level of care. Despite the statistical significance of several patient-level predictors, the model did not identify patients likely to need only minimal hospitalization. Conclusion Most patients admitted with acute diverticulitis are discharged after minimal hospitalization. Free air/liquid in a patient admitted for acute diverticulitis indicates a more severe clinical course. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents a novel computer aided technique for screening of Collagenous Colitis (CC). CC is a type of microscopic colitis mostly characterized by chronic watery diarrhea which is a common feature with a range of other etiologies. Routine paraclinical tests from CC patients such as endoscopic and radiographic studies are usually normal, and diagnosis must be made by biopsy. The gold standard for a confirmative diagnosis of CC is to measure the thickness of the sub-epithelial collagen (SEC) in colon tissue samples. Visual inspection of microscopic samples is often time-consuming, cumbersome and subject to human errors. This fact demonstrates the necessity of developing an automated method which assists pathologists in evaluating histopathological samples more accurately in the busy clinical environment. To the best of our knowledge, this is the first time that a computer-assisted diagnosis algorithm has been applied to CC detection. The proposed method uses a pre-trained Multi-Layer Perceptron neural network to segment SEC band in colon tissue images. We compared a variety of different color and texture descriptors and explore the best set of features for this task. The investigation of the proposed method shows 94.5% specificity and 95.6% sensitivity rate. [Copyright &y& Elsevier]

Although computed tomography (CT) scans play an important role in the diagnosis and management of anastomotic leaks (AL), there is no consensus on what radiographic findings are associated with AL. The purpose of this study is to identify the most common CT scan findings associated with AL and whether the amount of extraluminal air or the density of extraluminal fluid can be correlated with the presence of an AL. A retrospective chart review of 210 patients with anastomotic leaks from 2003 to 2010 at Mount Sinai Medical Center was performed. Eighty-six patients fit our criteria and were included. All CT scans were reread by an independent radiologist not involved with patient care. Our study included 59 per cent men and 41 per cent women with a mean age of 51 years. Diagnoses included inflammatory bowel disease (53%), malignancy (21%), and diverticulitis (12%). One hundred per cent of the patients had one of three findings: extraluminal air (92%), extraluminal fluid (88%), or extravasation of contrast (32%). Eighty-one per cent (70/86) had both fluid and air simultaneously. Extraluminal air was seen in 79 patients. The estimated amounts of extraluminal air were as follows: 0 to 25 mL (49%), 26 to 500 mL (41%), 500 to 1000 mL (5%), and more than 1000 mL (5%). The Hounsfield unit (HU) measurements of the fluid ranged from 3 to 633 HUs. The most common CT findings associated with AL are pneumoperitoneum and extraluminal fluid, including extravasation of contrast, which can be seen in up to 100 per cent of patients. The amount of estimated extraluminal air and density of fluid collection have no prognostic value in predicting AL. [ABSTRACT FROM AUTHOR]