炎症性肠病的内镜活检诊断问题

为探讨炎症性肠病内镜活检组织的病理特点以及其与细菌性感染性肠炎的鉴别诊断，收集了６３例炎症性肠病和３２例细菌性肠炎的内镜活检病理片，镜下观察对比分析组织学特征。１４例溃疡性结肠炎的活检诊断与其手术诊断符合率相同（１００％）；手术证实的１８例克隆病，活检诊断只有１４例（７８％）。炎症性肠病组织学的显著特征为隐窝结构紊乱，粘膜面呈宽绒毛样改变，杯状细胞减少，固有层单个核细胞并中性粒细胞大量浸润，基底层淋巴细胞聚集以及上皮样肉芽肿。对比细菌性肠炎，这些特征具有显著性鉴别意义。     

炎症性肠病内镜黏膜活检诊断方法

炎症性肠病内镜下以肠道黏膜糜烂、溃疡病变为特征，主要包括克罗恩病（CD）和溃疡性结肠炎（UC）。虽然一般根据内镜下形态特点可提供这2种疾病的诊断和鉴别诊断依据，但临床上一些不典型病例如IBD中间型病变（即所谓不确定性结肠炎）、肠道其他炎症、血管或肿瘤性病变也可表面为肠黏膜糜烂溃疡等病变，使鉴别诊断变得较为困难。[第一段]     

炎症性肠病内镜诊断标准及评估

内镜及活检是炎症性肠病不可或缺的诊断手段,在活动度判断、疗效观察、随访等方面的重要性逐步提高。不同学者对IBD内镜表现有不同的评价,制定了相应的诊断标准,但仅靠内镜无法确诊IBD,必须结合临床,正确认识内镜下表现,而新技术的逐步应用,使得IBD的诊断水平不断提高。1溃疡性     

消化内镜在炎症性肠病诊治中的应用

炎症性肠病(IBD)的诊断与治疗仍有不少悬而未决的问题,加强消化内镜在IBD的诊断、鉴别诊断、指导治疗和随访中的应用,具有重要的临床应用价值。     

炎症性肠病的诊断与鉴别诊断

炎症性肠病(IBD)包括溃疡性结肠炎(UC)和克罗恩病(CD),随着其患病率在我国的增高,其诊断相关问题日显复杂,已引起同行的高度重视[1].     

炎症性肠病的临床表现及诊断

溃疡性结肠炎(溃结)与克隆病(Crohn病)共称为炎症性肠病(IBD),均可见于儿童及成年人,以20～40岁为多见.IBD的起病多缓渐、隐匿、病史常数月或数年,活动期与缓解期交替出现,亦有持续活动而不缓解者.少数急性起病。     

炎症性肠病癌变的内镜筛查及化学预防

炎症性肠病患者发生癌变的风险是正常人群的2~5 倍,随着病程的延长其癌变的累积风险逐渐增加。白光 内镜结合随机活检是癌变筛查的通用方法,染色内镜结合靶向活检可以减少活检块数,增加不典型增生和癌变的检 出率。多数研究认为,5- 氨基水杨酸可以降低癌变风险,但仍有争议,而免疫抑制剂、熊去氧胆酸等其他药物预防癌 变的风险并不确切。     

炎症性肠病的诊治进展概述

炎症性肠病（IBD）从广义上讲,是以肠道炎症为主要表现的不同疾病的总称,如感染性肠炎、中毒性肠炎、缺血性肠病、放射性肠炎、自身免疫性肠炎以及慢性非特异性肠炎等;狭义上的IBD是指一组病因不明的慢性肠道炎症性疾病,由两个独立的疾病组成,包括克罗恩病（CD）和溃疡性结肠炎（UC）,因发病机制、临床表现及治疗相似,故多数文献、书籍一并叙述。     

炎症性肠病肝脏损害的临床分析

本文对过去8年间炎症性肠病住院患者87例进行研究，发现10例伴发肝损害，占11．5％，其中5例为肝组织学证实。此发生率较国外报道为低，但高于国内以往的报道。国人炎症性肠病时，不论肝脏损害的类型，抑或肝脏受损的程度均与国外患者不同，随肠道病变范围的扩大，肝损害发生率有增高的趋势。     

胃镜检查在胃癌诊断有关问题中的价值

为提高胃癌的胃镜检查诊断水平，对我院１９７４年～１９９４年内胃镜检查的２６１８８例和病理证实的胃癌２２７５例资料每３年为一阶段统计并进行分析。结果胃镜检查例数、内镜活检率和早期胃癌检出率均呈逐年明显升高趋势（Ｐ＜０．０１，Ｐ＜０．０５），而胃癌检出率、内镜活检阳性率和胃潜隐癌所占比率均呈逐年显著下降趋势（Ｐ＜０．０１），说明提高对胃镜检查和内镜活组织检查适应证的认识水平和分辨能力非常重要。     

MICROBIOTA INSIGHTS IN CLOSTRIDIUM DIFFICILE INFECTION AND INFLAMMATORY BOWEL DISEASE

ABSTRACT

Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation that includes Crohn´s disease (CD) and ulcerative colitis (UC). Although the etiology is still unknown, some specific factors have been directly related to IBD, including genetic factors, abnormal intestinal immunity, and/or gut microbiota modifications. Recent findings highlight the primary role of the gut microbiota closely associated with a persistent inappropriate inflammatory response. This gut environment of dysbiosis in a susceptible IBD host can increasingly worsen and lead to colonization and infection with some opportunistic pathogens, especially Clostridium difficile. C. difficile is an intestinal pathogen considered the main cause of antibiotic-associated diarrhea and colitis and an important complication of IBD, which can trigger or worsen an IBD flare. Recent findings have highlighted the loss of bacterial cooperation in the gut ecosystem, as well as the pronounced intestinal dysbiosis, in patients suffering from IBD and concomitant C. difficile infection (CDI). The results of intestinal microbiota studies are still limited and often difficult to compare because of the variety of disease conditions. However, these data provide important clues regarding the main modifications and interrelations in the complicated gut ecosystem to better understand both diseases and to take advantage of the development of new therapeutic strategies. In this review, we analyze in depth the gut microbiota changes associated with both forms of IBD and CDI and their similarity with the dysbiosis that occurs in CDI. We also discuss the metabolic pathways that favor the proliferation or decrease in several important taxa directly related to the disease.     

胃镜检查在胃癌诊断有关问题中的价值

为提高胃癌的胃镜检查诊断水平，对我院１９７４年－１９９４年内胃镜检查的２６１８８例和病理证实的胃癌２２７５例资料每３年为一阶段统计并进行分析。结果胃镜检查例数、内镜活检率和早期胃癌检出率均呈逐年明显升高趋势（Ｐ＜０．０１，Ｐ＜０．０５），而胃癌检出率、内镜活检阳性率和胃潜隐癌所占比率均呈逐年显著下降趋势（Ｐ＜０．０１），说明提高对胃镜检查和内镜活组织检查适应证的认识水平和分辨能力非常重要。     

CLINICAL AND ENDOSCOPIC FEATURES OF AMYLOIDOSIS SECONDARY TO CROHN'S DISEASE: DIAGNOSTIC VALUE OF DUODENAL OBSERVATION AND BIOPSY

Aim: Recent reports have focused on the development of secondary amyloidosis (AMY) as a complication of Crohn's disease (CD). The present study was carried out to investigate the frequency of AMY secondary to CD, its clinical and endoscopic features, and the importance of duodenal biopsy in detecting this disease. Methods: This study involved 408 patients diagnosed with CD who were endoscopically and histologically examined at our hospital. At follow up, we analyzed the incidence of AMY complications, the clinical features of AMY and the methods to diagnose AMY. Results: The incidence of AMY was 2.5% (10/408). The disease type at the time of CD diagnosis was small and large bowel type (SL) in eight patients, small bowel type in one and large bowel type in one. The incidence of AMY was significantly higher in patients with SL than in patients with other disease types. The length of time from onset of CD to diagnosis of AMY was 14.1 ± 8.0 years. The cumulative incidence of AMY was 1.0% at 10 years and 5.7% at 20 years after onset. In terms of the method used to diagnose AMY, the positive rate of AMY diagnosis was 100% with endoscopic duodenal biopsy. Conclusion: The incidence of AMY as a complication of CD was low (2.5%). However, because this complication adversely affects patients' prognoses, it is important to check for the presence of AMY, particularly in the duodenum, in patients for whom more than 10 years have elapsed since the development of CD.     

SUBTLE VILLOUS CHANGES DETECTED AT ENDOSCOPY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Dysplastic areas in flat mucosa in patients with inflammatory bowel disease (IBD) are difficult to detect at endoscopic examination. We describe the endoscopic and clinicopathological characteristics of colorectal mucosa with subtle villous changes (SVC) detected by endoscopy and chromoscopy in patients with IBD. The present study consists of 18 IBD patients. The age at onset of the disease, duration and extent of disease, endoscopic features, and clinical follow up were noted. Of the 18 patients, 12 had ulcerative colitis and six had Crohn's colitis. The mean duration from onset of disease to the detection of SVC was 25.4 years (range 4–50 years). All patients had extensive colitis. All SVC areas were present in colorectal segments having absent vascular pattern and decrease or loss of normal folds. Mucosal redness was frequently observed. Following indigo carmine dye spraying the SVC were characterized by a subtle villous surface resembling small intestinal mucosa. Biopsies taken from SVC areas showed dysplasia in nine of the 18 patients (50.0%): LGD in seven and HGD in two. SVC can be identified with endoscopy and chromoscopy. The endoscopic identification of SVC areas may increase the accuracy in detecting epithelial dysplasia in biopsies from patients with IBD.     

RELATIONSHIP BETWEEN ENDOSCOPIC FINDINGS OF THE POUCH AND BOWEL FREQUENCY AFTER RESTORATIVE PROCTOCOLECTOMY IN ULCERATIVE COLITIS

Background and aim: Pouchitis is one of the late complications of restorative proctocolectomy in ulcerative colitis (UC) and is associated with increased bowel frequency. The present study aimed to clarify the endoscopic findings that are associated with bowel frequency. Patients and methods: The macroscopic and microscopic features in the ileum proximal to the pouch, the pouch, and the remnant short rectum in 100 endoscopies on 63 patients were studied retrospectively. Results: Four of 28 (14%) patients had inflammatory changes in the proximal ileum. Sixty‐seven percent of patients showed an abnormal appearance of the pouch. Granularity, friability, presence of mucus, erythema, and erosions were significantly related to bowel frequency. ‘Endoscopic pouch activity index’ (EPAI), which is the number of positive findings of diffuse erythema, mucus, friability, ulcer, erosion, and granularity, was strongly associated with bowel frequency (P < 0.0001). Patients without macroscopic inflammation in the rectum had significantly lower bowel frequency than those with mild or moderately active inflammation (P = 0.0294 and 0.0183, respectively). Multivariate analysis revealed that ‘endoscopic pouch activity index’ and histological grade of pouch inflammation were significant factors (P = 0.0004 and P = 0.0429, respectively) influencing bowel frequency. Time–course study demonstrated that changes in EPAI and macroscopic grade of the rectum were significantly related to alteration in bowel frequency (P = 0.0120 and 0.0244, respectively). Conclusion: Erythema, mucus discharge and granularity were significantly related to bowel frequency. EPAI may be useful to evaluate endoscopic pouch inflammation.