Search

Background. The purpose of the study was to identify correlational parallels between morphological manifestations, clinical and hematological indicators and lymphocyte indices in patients with ulcerative colitis (UC). Materials and methods. Ninety patients with UC were examined. Morphologically, the degree of damage to the intestinal mucosa, the presence of crypt abscesses, atrophic changes, and changes in crypt architectonics were determined. The number of cells of the inflammatory infiltrate, linear measurements of the mucosa were assessed by morphometric method. Clinical blood parameters were evaluated in the inpatients of the department of intestinal diseases at the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. The severity of the disease was assessed according to the Mayo score. Statistical processing of the results was carried out using the Statistica 6.1 program. Results. In patients with UC, histological changes in the intestinal mucosa were found. The activity of the disease was evaluated by the presence of an increased number of inflammatory cells in the infiltrate of the mucosa: neutrophils (212.20 ± 20.93), lymphocytes (2922.80 ± 76.63), eosinophils (332.50 ± 17.24), macrophages (369.70 ± 16.21). Multiple crypt abscesses, deformation of the musocal epithelium in the form of erosions and ulcers were also noted. Clinical indicators of peripheral blood also confirmed the exacerbation of the disease (anemic state, increased inflammatory markers). An increased depth of the crypts correlated with such a morphometric indicator as mucosal thickness (r = 0.46; p

Background. It is important to search for biological markers with high specificity and sensitivity as a non-invasive method for accurate diagnosis of inflammatory bowel disease (IBD), in particular, differentiation of ulcerative colitis (UC) and Crohn’s disease (CD), which is important for both prognosis and treatment. The purpose of the study was to determine the titer of anti-Saccharomyces cerevisiae antibodies (ASCA) IgG, IgA, perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) and their clinical significance in patients with ulcerative colitis and Crohn’s disease. Materials and methods. The study included 49 patients with IBD who were treated at the Department of Intestinal Di­seases of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. All patients were divided into two groups: 33 individuals with UC and 16 with CD. In addition, the patients were divided into groups depending on the severity of UC course: mild — 3, moderate — 26, and 4 individuals had severe UC. Among patients with CD, severity was moderate in 13 cases and severe CD was detected in 3 cases. p-ANCA IgG were determined by an indirect immunofluorescence assay. The serum level of ASCA IgA and IgG was evaluated by the enzyme-linked immunosorbent assay. The results were statistically processed using the Statistica 6.1 software package. Results. Most patients with UC appeared to have p-ANCA, and in patients with CD, an increased level of ASCA IgA and IgG was found. Among patients with CD, the level of ASCA IgA and IgG depended on the severity of the disease, which was confirmed by the revealed correlation between their level and the severity of the disease (r = 0.608; p = 0.012). Analysis showed that the p-ANCA IgG test for confirming the diagnosis of UC has a sensitivity of 63 % and a specificity of 86 %, whereas the presence of an elevated level of ASCA IgA or IgG for the diagnosis of CD has a sensitivity of 72 % and a specificity of 82 %. The combination of positive p-ANCA IgG and negative ASCA IgA, IgG in patients with UC showed a sensitivity and specificity of 75.6 and 68.8 %, respectively, with a diagnostic accuracy of 68.8 %. For combination of positive ASCA IgA, IgG and negative p-ANCA IgG in patients with CD, the sensitivity was 81.3 % and the specificity was 80 % with a diagnostic accuracy of 80.8 %. Therefore, the simultaneous determination of ASCA IgA, IgG and p-ANCA IgG increases the positive predictive accuracy in the differential diagnosis of UC and CD among patients with IBD. Conclusions. It was found that the separate assessment of ASCA IgA, IgG and p-ANCA IgG for the differentiation of UC and CD has lower sensitivity and specificity, but when the two tests are combined, the predictive value of a positive result and specificity can be significantly increased.

Background. Inflammatory bowel diseases, including ulcerative colitis and Crohn’s disease, are an urgent problem of modern gastroenterology. Therefore, the discovery of new laboratory approaches makes it possible to assess the degree of the disease. Purpose: to reveal the relationship between morphological manifestations and immunological indicators in patients with ulcerative colitis. Materials and methods. The studies were conducted on biological material (blood and colonic biopsy samples) of 90 patients with ulcerative colitis. The thickness of the mucosa, density of the inflammatory infiltrate and its composition, crypt sizes, their architectonics, the presence of crypt abscesses, atrophic and fibrotic changes were calculated in biopsies by morphological and morphometric methods. Immunological studies included the evaluation of mononuclear cells, the levels of B-lymphocytes, interleukin-10, tumor necrosis factor α, immunoglobulins (Ig) A, M, G. Results. The histological activity of the disease was determined by an increased level of inflammatory infiltrate (14,431.4 ± 483.3 per 1 mm2 of stroma) and the presence of many neutrophilic granulocytes (212.2 ± 20.9 per 1 mm2 of stroma) and lymphocytes (2,922.8 ± 76.6 per 1 mm2 of stroma) in it. Also, some patients had crypt abscesses (36.7 % of the total number of patients) and breaches in the epithelial integrity (54.4 % of the total number of patients). A correlation was found between the level of CD22+ lymphocytes and some morphometric parameters: the width of the crypts (r = 0.27; P

Background. Accurate assessment of the fibrosis stage is crucial for effective treatment. Histological examination, the primary method used for assessing liver fibrosis, has certain limitations due to variation within each stage. Computer morphometry offers an objective and quantitative approach to complement histological analysis, providing additional diagnostic information. The purpose of this study was to analyze the computer morphometry data in patients with chronic liver diseases (CLD) of different etiologies and determine their diagnostic accuracy for liver fibrosis diagnosis. Materials and methods. Seventy-five patients with CLD, namely 24 with non-alcoholic fatty liver disease (NAFLD), 8 with alcoholic liver disease (ALD), 1 with toxic hepatitis, and 42 with chronic hepatitis C (CHC), were included in the study. Percutaneous liver biopsy was performed under ultrasound guidance using a semi-automatic needle Colt Shot 16 G. The severity of fibrosis was assessed using the Metavir scale. For computer morphometry, biopsies were photographed and evaluated using the ImageJ 1.45S program (National Institutes of Health, USA). The computerized fibrosis index (CFI), steatosis index, and the number of apoptotic cells in 5 consecutive high-power fields were calculated. Receiver operating characteristic analysis was performed for CFI diagnostic accuracy assessment. Results. Advanced liver fibrosis (F3-F4) was diagnosed in 62.5 % of ALD cases and 31.0 % of CHC. The highest CFI was found in ALD, it exceeded the level of NAFLD and CHC patients by 3.3 (p

Background. Chronic inflammatory bowel disease (CIBD) is one of the most complex nosological groups in gastroenterology, due to the constant increase in their prevalence, shif­ting the onset to an earlier age, increasing the frequency of severe complicated forms. The most common representative of CIBD is nonspecific ulcerative colitis (UC). At the heart of UC is a diffuse ulcerative-inflammatory lesion of the colon. The leading role in the diagnosis of UC belongs to the comparison of the results of endoscopic and morphological methods of research. The morphological method of colonobiopsy examination in UC is the gold standard of diagnosis and makes it possible to determine the signs of disease activity even in endoscopic remission. In contrast to descriptive histology, pathological anatomy, quantitative morphology complements and clarifies the data of studies conducted by conventional morphological methods from the standpoint of generalized approaches. The purpose of quantitative morphology is the maximum objectification of the study of qualitative and quantitative manifestations of pathological processes, nosological units, their pathogenesis, morphogenesis, as well as the exclusion of measurement errors and, as far as possible, the subjectivity of the researcher. The purpose of the study: to conduct a comparative histological examination of biopsies of the mucous membrane of the colon in patients with UC of different severity of the disease. Materials and methods. Histological examination of intestinal biopsy specimens was performed in 55 patients with ulcerative colitis. Patients were divided according to the severity of the disease. Group I (n = 11) — mild form, group II (n = 39) — moderate form and group III (n = 5) — patients with severe UC. Results. In 63.6 % with a mild severity of UC edema was not observed, the condition of the epithelium was unchanged, the architecture is not disturbed. Crypt abscesses were detected in 54.6 % of cases, atrophic changes — in 90.9 %. Inflammatory infiltrate consisted mainly of neutrophils ((176.0 ± 8.22) per 1 mm2 stroma) and mononuclear cells ((232.4 ± 22.83) per 1 mm2 stroma), which indicates the activation of regenerative functions of the mucous membrane. From morphometric measurements the highest indicator was the height of the crypt epithelium (38.3 ± 1.49) μm. With an moderate degree of UC in 33.3 % of cases there was a violation of the integrity of the epithelium, atrophic changes were diagnosed in 23.1 % of cases, violations of crypt architecture — in 17.9 %, the presence of crypt abscesses — 48.8 %, edema — 64.1 %. Morphometric measurement of intestinal mucosal biopsies with moderate severity of UC showed the highest crypt depth (452.6 ± 8.12) μm, crypt epithelial height (42.3 ± 0.33) μm and the number of goblet cells (26.6 ± 1.43). The height of the crypt epithelium was positively correlated with the number of goblet cells (r = 0.30; p

Background. Despite some progress in addressing gastric cancer, a marked reduction in morbidity in all developed countries, the search for changes that precede carcinogenesis remains relevant and far from complete. The purpose of the study: to assess the content of aggressive and protective factors of gastric juice and oral fluid in comparison with morphological changes in patients with chronic atrophic gastritis. Materials and methods. The study included 56 patients: group I included 12 patients with atrophic changes of the gastric mucosa of varying severity, group II — 24 patients with atrophic changes diagnosed with intestinal metaplasia only in the antrum of the stomach, in group III group — 20 patients with intestinal metaplasia in the body and antrum of the stomach. The control group consisted of 16 healthy individuals. Assessment of the degree of atrophy and inflammation in the gastric mucosa was performed with the subsequent determination of integral indicators — stage and degree of atrophy according to the OLGA system and metaplasia — according to the OLGIM system. According to the morphometric study of sections using a light microscope XSP-139TP (“Ulab“, Ukraine) calculated indicators: nuclear-cytoplasmic ratio, the ellipticity of the nuclei. The content of glycoproteins, sialic acids, fucose, hexosamines was determined in gastric juice and oral fluid. Results. Morphometric study showed a significant decrease in the nuclear-cytoplasmic ratio to (0.12 ± 0.04) % in patients of group III. The coefficient of ellipti­city of the nuclei of native cells decreased with the development of intestinal metaplasia: in group I it was equal to (0.76 ± 0.04) %, for group II it was (0.65 ± 0.11) %, and for group III — 0.41 ± 0.12) %. In patients with intestinal metaplasia in 82 % of cases with a 3-fold increase in the content of sialic acids in gastric juice was diagnosed with an increase in hexosamines by 35 %, while patients with only atrophic changes in the stomach showed a decrease in hexosamines 2 times compared to controls (p

Background. Inflammatory bowel disease (IBD) is a global problem today, with a growing prevalence in the world. It significantly increases the economic burden on the health care system. Recently, many studies indicate the important role of immunoglobulin G4 (IgG4) in the formation of chronic inflammation in IBD and the possibility of using it as a biomarker of the inflammatory process. The purpose was to improve the diagnosis of chronic inflammatory bowel diseases by studying the status of IgG4-positive plasma cells in the mucous membrane of the colon in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods. We have examined 34 patients with IBD, 25 with UC and 9 with CD, of them 20 women and 14 men, with an average age of (38.8 ± 3.0) and (38.2 ± 3.7) years, respectively. Patients were divided into groups depending on the noso­logy and severity of the disease. All patients underwent endoscopic examination of the colon to establish or clarify the diagnosis, and biopsy specimens were taken for histological and immunohistochemical examination. Results. In 13 (38.3 %) of 34 examined patients, a positive result for the presence of tissue IgG4 (≥ 10 cells in the field of view) was found. Among patients with UC, 48 % have a positive result of immunohistochemical examination of tissue IgG4, in people with CD, this figure is 11.1 %. This gives us reason to say that in UC, elevation of tissue IgG4 levels occurs 4.4 times more often. Positive tissue IgG4 in patients with moderate UC was found 1.1 times more often than in severe UC. Among patients with mildly active disease, tissue IgG4 was not detected. Conclusions. In UC, IgG4-positive cells in the mucous layer of the colon are more common than in CD, which makes it possible to use this indicator for the differential diagnosis of ulcerative colitis and Crohn’s disease. Positive tissue IgG4 is more common in moderate form than in severe one.

Background. The importance of the problem of chronic bowel diseases is beyond doubt today. This is confirmed by unknown origin, lack of specific treatment, the development of life-threa­tening complications, the need for long, often life-long, expensive therapy and adverse prognosis. The majority of patients are persons of young working age, whose average age is 20–35 years. But in 30–50 % of cases, the disease can manifest at any age. Purpose was to conduct morphological evaluation of the mucous membrane of the colon in patients with chronic inflammatory bowel diseases depending on the age and gender. Materials and methods. We have examined biopsy specimens of the mucous membrane of the colon in patients who were treated at the department of intestinal diseases of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” and were distri­buted by gender and age. Results. When analyzing the morphological and functional state of the mucous membrane of patients, signs of moderate and clearly pronounced chronic nonspecific inflammation were revealed in nonspecific ulcerative colitis. In Crohn’s disease, manifestations of chronic nonspecific inflammation of the first degree were observed in both men and women. The allergic component of inflammation represented by eosinophils was noted in all cases. An impaired crypt architectonics, depletion of the mucin layer and a breach in the integrity of the epithelium were also noted. Conclusions. Young patients had a more pronounced morphological picture of chronic inflammation of the mucous membrane of the colon in nonspecific ulcerative colitis. Men with nonspecific ulcerative colitis experience greater depletion of the mucin layer and impaired crypt architectonics in young and middle age, and with Crohn’s disease, such signs are more common in women. Also in patients with Crohn’s disease, fibrosis of the colon mucosa was noted.

In the Institute’s clinic during 2010–2012, 43 patients were operated for complicated forms of chronic pancreatitis. Based on the data of computed tomography and endoscopic retrograde cholangiopancreatography, the variants of pathology of the pancreas, which are significant for the selection of operation method, were chosen. Evaluation of intraoperative biopsies showed that the main manifestation of chronic pancreatitis in all cases was evident fibrosis of gland tissue. In this evaluation, in patients with III degree of fibrosis, fibrous tissue was 68.2–76.4 % of the area of pancreas, and exocrine one — 16.2–24.8 %, in patients with IV degree of fibrosis, respectively 79.5–95.5 and 2.3–10.8 %. Indications for organ-preserving resection, resection-draining interventions and isolated, draining pancreatic ductal system operations have been indicated. Specific weight of combined resection-draining interventions with preservation of the duodenum was 30.2 %, the overall mortality rate — 2.3 %, duration of postoperative bed-day (9.1 ± 0.8).