Collagenous colitis and lymphocytic colitis

The most recently recognized and least understood forms of inflammatory bowel disease are two types of idiopathic microscopic colitis-collagenous colitis and lymphocytic colitis. These disorders share many clinical and histologic features, but they have a few notable differences. Whether these are two distinct entities or different presentations of the same disease remains controversial. Bismuth subsalicylate is effective in some patients and treatment is symptomatic and empirical in others. Unlike ulcerative colitis and Crohn's disease, these forms of inflammatory bowel disease rarely require surgery. Ileostomy with or without colectomy is curative for the rare patient with severe symptoms that are refractory to medical measures. Collagenous and lymphocytic colitis are not associated with an increased risk of malignancy.     

Expression and significance of TIPE2 in ulcerative colitis

正Objective To investigate the expression of TIPE2 in peripheral blood and colonic mucosa of patients with ulcerative colitis(UC)and non-UC subjects,and to explore the role of TIPE2 in the initiation and development of UC.Methods Forty-two peripheral blood samples and30 colonic mucosa samples from patients with active UC were collected during Jan.2015 to Aug.2016 at the     

环氧合酶-2在溃疡性结肠炎中的作用

环氧合酶-2在溃疡性结肠炎的发生及预后有着重要的作用,首先表现在启动炎症反应过程,许多研究发现COX-2在溃结组织中的表达显著升高,在炎症反应的组织修复期,抑制COX-2则表现为使修复受阻,病情加重.另外COX-2介导的组织修复也需要在一定的严密系统调控下才能正常进行,在各种未知因素的作用下,这个平衡被打破,就有可能出现不典型增生,最终导致癌的发生.     

2 The differential diagnosis of Crohn's disease and ulcerative colitis

Most cases of inflammatory bowel disease (IBD) can be correctly labelled as Crohn's disease (CD) or ulcerative colitis (UC) with careful initial gross and microscopic examination of biopsy and resection specimens together with close clinical and radiological correlation. Until we understand more of the aetiology and immunology of IBD we should admit that there are limitations imposed by current diagnostic criteria, consider the use of reporting proforma to improve diagnostic accuracy, and accept that in a small number of patients clinicopathological features will overlap, and CD may masquerade as UC.     

Mucosal and plasma prostaglandin E2 in ulcerative colitis.

BACKGROUND/AIMS: Despite extensive studies, the role of prostaglandins in the course of inflammatory bowel diseases and their possible usefulness as predictive indicators of inflammation, remain largely speculative. The aim of this study was to determine whether mucosal and plasma concentrations of prostaglandin E2 (PGE2) are affected by the clinical course and degree of colonic injury in patients with ulcerative colitis. METHODOLOGY: PGE2 concentration was measured with an enzyme immunoassay (EIA) in biopsies of rectal mucosa and in the plasma of 38 patients with ulcerative colitis and 12 controls. Patients were divided into groups according to mild or severe clinical course of the disease, and with respect to scored endoscopical picture. RESULTS: Ulcerative colitis resulted in an increase of mucosal and plasma concentrations of PGE2, that was significantly elevated in patients with a severe clinical course of the disease. These concentrations increased depending on degree of mucosal injury. A significant, positive correlation with endoscopical score regarding plasma and mucosal PGE2 concentration, as well as between them, was found. CONCLUSIONS: Plasma and mucosal PGE2 rise simultaneously with degree of colonic injury. Because of a good correlation with mucosal injury and PGE2 content, measurement of plasma PGE2 could be considered as a possible surrogate marker of bowel inflammation.     

Expression of protease-activated receptor 2 in ulcerative colitis

Although tryptase released from mast cells might play a key role in the pathogenesis of ulcerative colitis (UC), the role of protease-activated receptor 2 (PAR2), tryptase receptor, remains unclear in the pathogenesis of this disease. The expressions of PAR2 and tumor necrosis factor (TNF) alpha in nine UC tissues and nine normal tissues were examined by immunohistochemistry. TNF-alpha levels secreted from human leukemic mast cell line (HMC-1) after the treatment of PAR2 agonists were also measured by enzyme-linked immunosorbent assay. The PAR2 and TNF-alpha proteins were more significantly detectable in UC tissues than in normal tissues. Furthermore, 65.2% of PAR2+ cells and 66.4% of TNF-alpha+ cells in UC tissues were tryptase-positive cells. In other words, 60.6% and 46.3% of tryptase-positive cells in UC tissues were PAR2+ cells and TNF-alpha+ cells, respectively. A chi2 analysis showed correlation (p < 0.007) between PAR2 and TNF-alpha in tryptase-positive mast cells. Moreover, PAR2 agonists significantly induced the TNF-alpha secretion from HMC-1. These results indicate that the activation of the mast cells through PAR2 may be involved in the pathogenesis of UC.     

缺血性结肠炎与溃疡性结肠炎的对比分析

目的:研究缺血性结肠炎(ischemic colitis,IC)与溃疡性结肠炎(ulcerative colitis,UC)临床及组织病理学的差异,有助两者的鉴别诊断,利于临床治疗.方法:收集20例IC和30例UC患者,对其临床及组织病理学等资料进行对比分析.结果:IC组发病时间[(5±7)d]明显较UC组发病时间[(953±1354)d]短.IC组中65%的患者伴有高血压、冠状动脉性心脏病、心房颤动、房性早搏、腹部手术史等疾病史中的一项或几项,明显高于UC组的20%;IC组以急性发病、腹痛(85%)、血便(60%)及腹泻(50%)多见,而UC且以腹痛(83%)、腹泻(63%)、黏液脓血便(57%)及里急后重(20%)为主要临床表现;在内镜表现方面,IC多以沿肠系膜侧分布的纵形溃疡为主(60%),且病变多仅累及肠腔的1/4～1/2周(80%),呈节段性分布(60%),与邻近正常黏膜分界清楚(75%),而UC则以弥漫性地图状溃疡为主(43%),病变多累及肠腔全周(90%),炎性息肉明显多见(37%).在组织病理学方面,血管扩张充血(90%)、间质严重水肿(95%)在IC中多见,血管壁增厚(50%)是其特征性表现,隐窝脓肿(47%)则在UC中多见.两组以上差异均有统计学意义(P<0.05).结论:组织病理学特点、肠镜下表现以及患者临床特征的差异,为IC和UC的鉴别提供了有力依据.     

缺血性结肠炎与溃疡性结肠炎临床特征、内镜特点比较分析

目的 提高缺血性结肠炎(IC)和与溃疡性结肠炎(UC)诊断的正确率.方法 选择2008年1月至2011年6月的住院患者,确诊IC 43例,UC 36例,对其临床特征、内镜特点进行回顾性比较分析.结果 组间性别、年龄、病程和基础疾病比较差异有统计学意义(P＜0.05),而主要临床表现比较,差异无统计学意义.IC组以老年女性多见,病程短,多伴发心脑血管等基础疾病(29/43,67.0％).IC组C反应蛋白高于UC组,血小板低于UC组(P＜0.05).IC多累及乙状结肠,直肠少见;病变为区域局限性,溃疡为纵形或不规则形,病灶愈合迅速,病理以黏膜炎症为主.UC组病变多起源于直肠,一般累及肠壁全周,病变为倒灌连续性,以散在针尖样地图状溃疡为主,病理表现为隐窝炎和脓肿.结论 年龄、病程、基础疾病、C反应蛋白、内镜及病理特征是鉴别诊断的要点.     

The Bcl-2/Bax system and apoptosis in ulcerative colitis

BACKGROUND/AIMS: Ulcerative colitis (UC) constitutes a chronic inflammatory process of the colon of unknown etiology. Current data support a pivotal role of apoptosis in the evolution of pathogenesis of UC. We performed a prospective study in order to determine the role of Bcl-2, Bax and Bcl-x in the apoptotic pathway in UC. METHODOLOGY: We included 23 patients with UC and 11 controls. Histological severity of the disease was assessed according to the Sidney classification system. Patients in the UC group were divided in 2 groups according to histological severity of the disease. The TUNEL method was used for the in situ evaluation of apoptosis. Immunohistochemical staining was used for the detection of Bax, Bcl-2, Bcl-x. For the assessment of cellular proliferation we used the monoclonal antibody Ki67. Appropriate statistical methods were applied. RESULTS: Overall 77 specimens were assessed; 57 from UC patients and 20 from controls. Bcl-2, Bax and Bcl-x were upregulated in the group of patients with UC compared to controls. Nevertheless, Bax in epithelial cells and Bcl-x in lymphocytes were downregulated in patients with moderate/severe disease (p = 0.029 and 0.04 respectively). A weak correlation between epithelial apoptosis and Bcl-x expression in lymphocytes (r = 0.31, p = 0.02) was found. An even weaker correlation was also noticed between the epithelial component apoptosis and Bax in lymphocytes (r = 0.02, p = 0.07). CONCLUSIONS: Bcl-2/Bax system does not appear to be involved in the induction of apoptosis in UC. Activation of intraepithelial lymphocytes may be associated with epithelial apoptosis or simply represent epiphenomena related to the inflammatory process.     

Synchronous occurrence of collagenous colitis and pseudomembranous colitis.

Synchronous collagenous and pseudomembranous colitis has not been previously reported. A 73-year-old woman presented with chronic watery diarrhea and abdominal cramping of six weeks' duration. Biopsies of the colon revealed findings of collagenous colitis involving the endoscopically normal right colon, and superimposed collagenous and pseudomembranous colitis involving the rectosigmoid colon. Endoscopically, the left colon revealed discrete ulcerative plaques, and Clostridium difficile toxin A assay was positive. The patient partially responded to a three-week regimen of metronidazole, and symptoms resolved completely with subsequent steroid therapy. At follow-up endoscopy four months later, colon biopsies demonstrated persistence of subepithelial collagen but no pseudomembranes. The patient remained asymptomatic during this interval. Collagenous colitis has been reported in association with other inflammatory bowel diseases, including lymphocytic colitis, sprue and idiopathic inflammatory bowel disease. This unique association of collagenous colitis with an endotoxigenic inflammatory bowel disease is presented with a review of related disease features.     

Metachronous occurrence of collagenous colitis and ulcerative colitis.

Collagenous colitis and ulcerative colitis are distinct disorders. A 67 year old woman with clinical and histological evidence of collagenous colitis had an abrupt symptomatic exacerbation while taking anti-inflammatory treatment with sulphasalazine and prednisone. Repeat colorectal endoscopy showed active mucosal inflammation and colonic biopsy specimens were consistent with active ulcerative colitis. After bowel rest, total parenteral nutrition, intensification of the anti-inflammatory regimen, and withdrawal of non-steroidal anti-inflammatory drugs (which she had taken continuously for osteoarthritis) diarrhoea abated. Colorectal biopsy specimens obtained when the patient's symptoms had improved showed inactive ulcerative colitis with no evidence of collagenous colitis. This may be the first case to be reported of the metachronous association of collagenous and ulcerative colitis.     

促肾上腺皮质激素释放因子受体2在溃疡性结肠炎中的表达

目的观察促肾上腺皮质激素释放因子受体2（CRFR2）在溃疡性结肠炎（UC）中的表达情况,及其与细胞间黏附分子-1（ICAM-1）、核因子-KB（NF-JcB）p65和白细胞介素-6（IL-6）的关系,探讨其在UC中的作用。方法免疫组织化学法检测UC活动组30例、缓解组30例和30例正常对照组的结肠黏膜中cRFR2、ICAM-1、NF-KBp65的表达情况,ELISA方法检测各组血清中IL-6水平。结果CRFR2在UC活动组肠黏膜组织中的表达明显高于缓解组和对照组（P〈0．05）,而在UC缓解组和对照组之间的表达差异无统计学意义（P〉0．05）。CRFR2在肠黏膜组织中的表达与NF-xBp65、ICAM-1的表达及血清中IL-6水平具有明显相关性（P〈0．05）。结论活动期UC患者的CRFR2的表达明显升高,提示其在UC发病中可能起促炎作用。