Long-term outcome of patients with enterocolitis complicating Hirschsprung’s disease

Enterocolitis remains the most serious complication of Hirschsprung’s disease (HD). The purpose of this study was to evaluate the risk factors in the development of enterocolitis and the long-term outcome in these patients. The hospital records of 259 consecutive patients with HD during 1975–2003 were examined. The data was analysed for age at presentation, associated anomalies, level of aganglionosis, clinical features, number of episodes of enterocolitis, type of pullthrough, necessity for post-pullthrough sphincterectomy. Follow up was carried out by personal interviews and interviews over the telephone with patients/parents. Enterocolitis was diagnosed on the basis of clinical features of diarrhoea, pyrexia, abdominal distention and vomiting. Of the 259 patients with HD, 74 patients (28.5%) were found to have enterocolitis. Out of 39 patients with Down’s syndrome and HD, 19 (48%) had enterocolitis. Fifteen (20%) patients had other associated anomalies. Fifty-six patients (75.6%) were male and 18 (24.3%) were female. In 30 patients enterocolitis was the presenting feature in the neonatal period, 22 of which presented in the first 2 weeks of life. Fifty-six patients (75.6%) had rectosigmoid disease and 18 (24.3%) had long segment disease or total colonic aganglionosis. Eighteen (24.3%) had only preoperative enterocolitis and 31(41.8%) had only postoperative enterocolitis. Twenty-five (33.7%) had both pre- and post-operative enterocolitis. Twenty (27%) patients had more than 2 episodes of enterocolitis. Various pullthrough procedures were performed. Twenty-six patients (35.1%) required internal sphinctermyectomy to treat the enterocolitis. At the time of follow-up, 16 patients were lost to follow-up. Of the remaining 58 patients, 3 patients died, 2 due to enterocolitis and 1 due to sepsis. Six patients remained with a stoma. Twenty-two patients were continent and were stooling normally, but 14 of these were on laxatives for several years after pullthrough procedure. The mean age at achieving full continence was 4.95 years in the 22 patients with normal bowel function. Nineteen patients are still on laxatives and 8 patients are soiling. Eight patients continue to have multiple recurrent episodes of enterocolitis at follow-up. Down’s syndrome is an important risk factor in the development of enterocolitis. The majority of patients with enterocolitis complicating HD continue to have disturbances of bowel function many years after surgery for HD.     

肝素结合性表皮生长因子样生长因子在坏死性小肠结肠炎新生大鼠线粒体途径细胞凋亡中的作用

目的 探讨肝素结合性表皮生长因子样生长因子(heparin-binding epidermal growth factor-like growth factor,HB-EGF)在新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)新生大鼠模型线粒体途径细胞凋亡中的作用. 方法 新生无特定病原体Sprague-Dawley大鼠随机分为3组,每组10只.NEC模型组:采用代乳品人工喂养,并给予100％氮气缺氧90 s,4℃冷刺激10 min,每天2次,连续3 d;HB-EGF干预组:在NEC模型组基础上予HB-EGF灌胃,每次800 μg/kg,每天4次,连续3d.正常对照组:鼠乳喂养3d,不予任何干预.大鼠生后72h禁食12h后处死.取回肠末端组织,HE染色观察病理改变并评分;电镜下观察线粒体超微结构变化;免疫组织化学方法检测细胞色素C含量;Western印迹技术检测凋亡诱导因子(apoptosis inducing factor,AIF)及凋亡肽酶激活因子-1(apoptotic protease activating factor-1,APAF-1)的表达.组间差异比较采用单因素方差分析,两两比较采用q检验,P＜0.05为差异有统计学意义. 结果 (1)HB-EGF干预组NEC发生率为2/10,低于模型组(9/10),差异有统计学意义(x2=7.27,P＜0.01);对照组未发生NEC.(2)NEC模型组线粒体在肠上皮细胞及肌层细胞中存在明显肿胀,基质内有多数电子透亮区,线粒体超微结构严重损伤.HB-EGF干预组有少量线粒体肿胀,损伤较NEC模型组减轻.(3)NEC模型组回肠组织细胞色素C表达较对照组增强,差异有统计学意义(0.030±0.018与0.002±0.001,q=6.15,P＜0.01),HB-EGF干预组回肠组织细胞色素C表达(0.014±0.018)较NEC模型组减弱,差异有统计学意义(q=3.53,P＜0.05).NEC模型组的APAF-1表达较对照组增强(1.364±0.299与0.215±0.033,q=15.31,P＜0.05),AIF表达也增强(0.181±0.050与0.127±0.045,q=3.71,P＜0.05);与NEC模型组比较,HB-EGF干预组APAF-1的表达(0.455±0.123)减低(q=4.04,P＜0.05),AIF的表达(0.289±0.045)则明显增强(q=7.32,P＜0.05). 结论 HB-EGF能降低新生大鼠NEC发生率,其机制之一可能是通过下调APAF-1表达而减少新生大鼠线粒体途径细胞凋亡.     

抗生素相关性肠炎并肠梗阻一例诊治分析

目的探讨抗生素相关性肠炎(antibiotic-associated coitis,AAC)临床特点,提高诊治水平。方法回顾分析1例AAC并肠梗阻临床资料。结果患者为老年女性,因急性肠炎使用头孢美唑钠、莫西沙星等抗感染治疗20 d后,出现腹泻、腹胀、高热及肛门停止排便排气等症状。影像学检查证实低位性肠梗阻,肠镜检查证实AAC。经胃肠减压、调节肠道菌群等综合治疗痊愈。结论临床医师对于具有老年、禁食、病情危重、抗生素使用多且时间长等危险因素的患者应警惕AAC的发生。对于病情的确需用者,应根据药敏结果选用抗生素。     

Protective Effect of Hydroalcoholic Root Extract of Rubia cordifolia in Indomethacin-Induced Enterocolitis in Rats

This study was undertaken to investigate the possible effect of hydroalcoholic root extract of Rubia cordifolia against indomethacin-induced enterocolitis in rats. Male Wistar rats received vehicle or hydroalcoholic root extract of Rubia cordifolia (300 and 600 mg/kg) for 11 consecutive days. Enterocolitis was induced by subcutaneous administration of indomethacin (7.5 mg/kg) on 8(th) and 9(th) day. The colonic mucosal injury was assessed by macroscopic scoring and histopathological examination. Furthermore, the serum lactate dehydrogenase activity was estimated. Indomethacin treatment to rats produced acute intestinal inflammation, manifested by a thickening of the bowel wall, mesenteric haemorrhage, mesentery adhesion and multiple mucosal ulcers of small intestine and colon. Treatment with hydroalcoholic root extract of Rubia cordifolia revealed less damage to intestinal tissue and decreased serum lactate dehydrogenase activity which was elevated by induction of colitis. The present data suggests protective effect of Rubia cordifolia in indomethacin-induced enterocolitis and may be beneficial in patients with inflammatory bowel diseases.     

新生儿坏死性小肠结肠炎术中的液体治疗

目的评价醋酸钠林格注射液和乳酸钠林格注射液用于新生儿坏死性小肠结肠炎术中液体治疗的有效性和安全性。方法以我院2010年6月—2011年10月收治的坏死性小肠结肠炎行手术治疗的新生儿作为研究对象,采用随机、对照、双盲方法,将患儿分为醋酸钠林格注射液组（AR组）和乳酸钠林格注射液组（LR组）,每组25例,所有患儿均接受全麻气管插管,术中维持药物为七氟醚,按照统一的标准进行液体输注,监测患儿术中的平均动脉压、心率、血氧饱和度（SaO2）、酸碱平衡、补液量、尿量等指标,并进行对比分析。结果两组性别、体重、手术时间、液体总量、尿量及患儿手术过程中各时点平均动脉压、心率、SaO2比较差异均无统计学意义（P〉0.05）;AR组NaHCO3的用量明显少于LR组,差异有统计学意义（P〈0.05）。结论醋酸钠林格注射液用于新生儿坏死性小肠结肠炎术中的液体治疗,能有效维持患儿血容量,保持血流动力学稳定,与乳酸钠林格注射液比较能显著改善代谢性酸中毒,在新生儿坏死性小肠结肠炎术中应用更具优势。     

重组人类促红细胞生成素对早产儿坏死性小肠结肠炎的预防作用

目的探讨重组人类促红细胞生成素(rhEpo)对早产儿坏死性小肠结肠炎(NEC)的预防作用。方法选择我院住院时间>2周的早产儿,常规预防早产儿贫血、接受rhEpo注射≥2周者为rhEpo组;未使用rhEpo或发生NEC以后才开始使用者为对照组;入院时已诊断NEC或其他胃肠道外科疾病者除外。对患儿易发生NEC的临床因素如窒息、呼吸窘迫综合征、呼吸机和肺表面活性物质的使用、动脉导管未闭和布洛芬的使用、小于胎龄儿、脐血管置管、先天性心脏病、脑室内出血、败血症与Ⅱ、Ⅲ级NEC的发生率进行回顾性分析。结果rhEpo组115例,对照组273例。rhEpo组呼吸窘迫综合征、呼吸机和肺表面活性物质的使用及脐血管置管的发生率均高于对照组(44%比26%,35%比19%,38%比14%,28%比4%,P均<0.05),而rhEpo组未发生NEC病例,对照组发生21例,其中Ⅱ级19例,Ⅲ级2例,两组总NEC和Ⅱ级NEC发生率,差异有统计学意义(P<0.05)。结论早产儿接受rhEpo预防和治疗贫血的同时,可能也保护了肠道,使其不发生NEC或减轻NEC的程度。     

Campylobacter jejuni enterocolitis presenting as inflammatory bowel disease

Abstract. We report a case of Campylobacter jejuni enterocolitis presenting as inflammatory bowel disease in a 19-year old woman. After a useless course of corticosteroids, ceftazidime and metronidazole, she was successfully treated with erythromicin. Campylobacter species represent an important cause of gastroenteritis in children and adults. The rate of Campylobacter isolation is 5–6 per 100 000 persons. This rate, however, grossly understimates the actual number of Campylobacter infections. In most cases, Campylobacter enteritis is a self-limiting disease, rarely associated with severe complications. Our case demonstrates the difficulty in distinguishing inflammatory bowel disease (Crohns disease or ulcerative colitis) at onset from atypical infectious colitis. Unfortunately, corticosteroids (necessary for the treatment of inflammatory bowel disease) may exacerbate infectious etiologies. Campylobacter jejuni should be ruled out when assessing inflammatory bowel diseases at onset (as during flare-ups), especially if corticosteroids or immunosuppressive therapies are required.     

Enterocolitis in immunocompromised patients

Diarrhea is a very common complaint among immunocompromised patients, and the most common causes of this and other gastrointestinal complaints in this population differ from those commonly seen in immunocompetent patients. Underlying immunodeficiencies may be associated with particular patterns of gastrointestinal tract injury, and particular immunodeficiencies may lead to increased susceptibility to infection by specific organisms depending upon the etiology of the immune compromise. It is important to become familiar with the causes of gastrointestinal disease in the immunocompromised patient population because prompt and proper treatment is of the essence in this patient group. This review focuses on common causes of enterocolitis in the immunocompromised with attention to primary immunodeficiency disorders, the post-transplant setting, chemotherapy-related injury, and a select group of common or emerging infections.