http://flr-journal.org/index.php/gh/issue/feedGastroenterology and Hepatology2015-09-02T08:30:38+00:00Yanni DINGgh@cscanada.netOpen Journal Systems<p><a title="Authors" href="/index.php/gh/author" target="_blank">Authors</a> <a title="Reviewers" href="/index.php/gh/reviewer" target="_blank">Reviewers</a> <a title="Editors" href="/index.php/gh/sectionEditor" target="_blank">Editors</a> <strong> <em><strong><a title="New Submission" href="/index.php/gh/author/submit/1" target="_blank">New Submission</a></strong></em></strong></p>http://flr-journal.org/index.php/gh/article/view/5288Intermittent Inflammatory Bowel Disease and Microscopic Colitis: Variant or Epiphenomenon?2015-09-02T07:34:44+00:00Hany Osmanjinglin@iupui.eduRao Watsonjinglin@iupui.eduRao Watsonjinglin@iupui.eduRong Fanjinglin@iupui.eduRong Fanjinglin@iupui.eduILKe Nalbantoglujinglin@iupui.eduILKe Nalbantoglujinglin@iupui.eduJingmei Linjinglin@iupui.eduJingmei Linjinglin@iupui.edu<p>Background: Idiopathic inflammatory bowel disease and microscopic colitis are distinct entities; however, some clinical features overlap. <br />Aims: To identify if these alternative diagnoses may direct clinical therapy more effectively.<br />Methods: We describe seven patients who had intermittent phases of either inflammatory bowel disease or microscopic colitis in at least two separate occasions with matching clinical and endoscopic pictures. <br />Results: Diarrhea was the presenting symptom in all cases. In two of seven cases, the initial diagnosis was microscopic colitis, and in five cases it was inflammatory bowel disease. Addition of medication specific to diagnosis had resulted in improvement in six out of seven cases. Among the seven patients we reported, three had used nonsteroidal antiinflammatory drugs, a well-known trigger, before the onset of microscopic <br />colitis. <br />Conclusions: Inflammatory bowel disease and microscopic colitis are distinct clinicopathologic entities that may coexist in the same patient. Triggering factors for microscopic colitis in the general population can also be the culprit in inflammatory bowel disease patients. Microscopic colitis may present as an epiphenomenon which is superimposed on predisposing inflammatory bowel disease patients. A thorough synthesis of all clinical, medication, endoscopic, radiology, and pathological data is crucial in these patients.</p>2015-02-28T00:00:00+00:00Copyright (c) http://flr-journal.org/index.php/gh/article/view/5459Effects of Preoperative Use of an Immune-Enhancing Diet on Postoperative Complications and Long-Term Outcome: A Randomized Clinical Trial in Colorectal Cancer Surgery in Japanese Patients2015-09-02T07:34:44+00:00Tomoyuki Moriyatmoriya@ndmc.ac.jpKazuhiko Fukatsutmoriya@ndmc.ac.jpChikara Uenotmoriya@ndmc.ac.jpYojiro Hashiguchitmoriya@ndmc.ac.jpYoshinori Maeshimatmoriya@ndmc.ac.jpJiro Omatatmoriya@ndmc.ac.jpKoichi Okamototmoriya@ndmc.ac.jpEiji Shintotmoriya@ndmc.ac.jpHideki Uenotmoriya@ndmc.ac.jpKazuo Hasetmoriya@ndmc.ac.jpJunji Yamamototmoriya@ndmc.ac.jp<p>Background: Despite recent advances in surgical techniques and perioperative management, postoperative infectious complications remain a problem in surgical patients. We performed a prospective randomized clinical trial to examine the effects of preoperative Immune Enhancing Diets (IEDs) on postoperative complications in Japanese patients who underwent curative colorectal cancer surgery. This study was also designed to evaluate the optimal dose of preoperative IEDs for the patients without malnutrition. Finally, we analyzed recurrence free survival (RFS) and disease-specific survival (DSS) after surgery in patients who did and did not receive IEDs<br />preoperatively.<br />Material and Methods: This was a prospective, randomized clinical trial conducted at the Department of Surgery, National Defense Medical College, from October 2002 to October 2005. The 88 patients undergoing colorectal surgery were enrolled and were randomly divided into 3 groups. The high- (High, N=26) and low- (Low, N=31) dose groups received normal food and, respectively, 750ml/day or 250ml/ day of IEDs for 5 days before the operation. The primary endpoint was the rates of surgical site infection (SSI) and non- infectious complications. We also evaluated the RFS and DSS rate, respectively. <br />Results: The patients were followed for 77±10 months (9-133 months) after surgery. Incisional SSI rates in the IEDs (High and Low) groups were significantly lower than in the Control group. (0%*, 0%* and 17%) (*P<0.01 vs. Control) The incidences of the infections not involving the surgical site (non-SSI) and the lengths of hospital stay were similar among the three groups. No significant differences were observed in RFS or DSS.<br />Conclusion: In Japanese patients undergoing colorectal cancer surgery, preoperative IEDs significantly reduced the rate of incisional SSI as compared with the control group. Very interestingly, in Japanese patients, preoperative 250ml/day IED intake may be adequate for colorectal cancer patients without malnutrition. However, with regard to the long term outcome, beneficial effects of preoperative IEDs are not evident.</p>2015-02-26T00:00:00+00:00Copyright (c) http://flr-journal.org/index.php/gh/article/view/5256Inflammatory Fibroid Polyps of Gastrointestinal Tract Rarely Show Increased IgG4 Expression2015-09-02T07:34:44+00:00Livia Macciogh@cscanada.orgSilvia Lonardigh@cscanada.orgFabio Facchettigh@cscanada.orgAnna Maria Cesinarogh@cscanada.org<p class="bodycopy">Inflammatory Fibroid Polyp (IFP) of gastrointestinal tract is characterized by concentric perivascular fibrosis and a mixed inflammatory infiltrate rich in eosinophils and also few plasma cells. IgG4-related sclerosing diseases (IgG4-RSD) are a heterogenous group of disorders described in many organs, characterized by a significant increased of IgG4+ plasma cells in a context of storiform fibrosis, obliterative vasculitis and mixed inflammatory infiltrate containing eosinophils. The histological similarities between IFP and IgG4-RSD prompted the present study in the attempt to find a possible link between IgG4 over-expression and IFP.</p><p class="body">The expression of IgG4 and IgG was evaluated in a series of 23 cases of IFP belonging to 23 patients. All cases were reviewed by two pathologists and the histological diagnosis confirmed. Immunohistochemistry for antibodies anti-IgG, anti-IgG4, and anti-IgA was performed on all cases and the results were evaluated by two observers.</p><p class="body">One case of IFP out of 23 (4.3%) fulfilled the IgG4-RSD histological criteria. The case did not differ histologically from the others. The patient did not present either a raised serological level of IgG4, nor other sign of IgG4-RSD.</p><p class="body">IgG4 increased expression can be rarely observed in IFP. Steroid therapy in cases of IFP with abundant IgG4+ plasma cells, especially in patients with multiple tumors, could be considered as an alternative to surgical treatment.</p><p> </p>2015-02-26T00:00:00+00:00Copyright (c) http://flr-journal.org/index.php/gh/article/view/5290Choledochocele: Choledochal Cyst Ora Distinct Entity?2015-09-02T07:34:44+00:00Francesca Pecchinigh@cscanada.orgBarbara Catellanigh@cscanada.orgSara Acciuffigh@cscanada.orgRoberta Gelminigh@cscanada.org<p>Choledochocele represents a cystic dilatation of the distal common bile duct and it’s included in Todani’s classification as type III choledochal cysts. We report a case of a 66-years-old man who presented a suspected gallbladder lithiasis with colic abdominal pain, vomit, fever, jaundice and abnormal liver function tests. However the endoscopic retrograde cholangio-pancreatography revealed the absence of stones in the common bile duct and the presence of a 15mm-wide choledochocele that was successfully treated with an endoscopic sphincterotomy. Additionally a comprehensive review of the literature of the last 15 years was performed, collecting 105 cases of choledochocele. The available data were classified in 10 variables and subsequently analysed. Summarizing all data, we noticed that choledochocele presents different characteristics if compared with other types of choledochal cysts: The population affected is older, there isn’t a strong female prevalence, the most frequent manifestation is pancreatitis instead of jaundice and cholangitis, the association with anomalous pancreato-biliary duct junction is rare and the risk of malignancy is lower. The standard for the diagnosis is endoscopic retrograde cholangio-pancreatography instead of magnetic resonance cholangio-pancreatography and the most accepted treatment is endoscopic sphincterotomy in order to allow the correct outflow of the biliary juice. In conclusion, even if choledochocele is commonly considered a type of cystic dilatation of the common biliary duct and it is usually included in the choledochal cysts classification, it has to be considered as a distinct entity with its own features.</p>2015-02-28T00:00:00+00:00Copyright (c) http://flr-journal.org/index.php/gh/article/view/6175PTHrP/PTHR1 and TGF-β Levels Are Inversely Associated in Liver Regeneration2015-09-02T07:34:44+00:00Yanna Caogh@cscanada.orgHongting Zhanggh@cscanada.orgGuohua Zhanggh@cscanada.orgXianghua Liugh@cscanada.orgNicholas Ferrarogh@cscanada.orgLindsey Jacksongh@cscanada.orgB Mark Eversgh@cscanada.orgMiriam Falzongh@cscanada.orgTien Kogh@cscanada.org<p class="bodycopy"><strong>Background. </strong>Transforming growth factor (TGF)-β provides growth control in liver regeneration. We have recently demonstrated that TGF-β induced parathyroid hormone-related protein (PTHrP) expression and secretion, and PTHrP mediated TGF-β-induced apoptosis in liver cells. However, whether PTHrP signaling pathway is altered during liver regeneration is unknown. Therefore we used a murine hepatectomy model in this study and tested the hypothesis that both PTHrP and TGF-β signaling pathways are upregulated during liver regeneration.</p><p class="bodycopy"> <strong>Methods.</strong> Swiss Webster mice received 70% hepatectomy or sham operation and euthanized at different time points post-surgery for analyses. Liver regeneration was determined by liver/body weight and proliferating cell nuclear antigen (PCNA) staining. mRNA levels of TGF-β1, TGF-β receptors, PTHrP, and PTHrP receptor 1 (PTHR1) were measured by real-time quantitative PCR. Protein levels of TGF-β1 were measured by ELISA and PTHrP and PTHR1 were measured by Western blotting.</p><p class="bodycopy"> <strong>Results. </strong>After 70% hepatectomy, the liver regeneration began at 24 hours and was restored to 82% of original liver mass at day 7. TGF-β1 and its receptor levels increased at 24 and 48 hours after hepatectomy, while PTHrP levels decreased at 12 hours and PTHR1 levels decreased at 12, 24 and 48 hours after hepatectomy. The levels of these molecules returned to similar levels as that in sham animals thereafter.</p><p> <strong>Conclusion</strong>. We demonstrated that an upregulation of the TGF-β and its receptors were associated with a down-regulation of PTHrP/PTHR1 expression during liver regeneration, which may contribute to hepatocyte proliferation and regeneration after hepatectomy.</p>2015-02-26T00:00:00+00:00Copyright (c) http://flr-journal.org/index.php/gh/article/view/6233Gastric Follicular Dendritic Cell Sarcoma: A Case Report of a Rare Entity2015-09-02T07:34:44+00:00Nikhil Sgh@cscanada.orgP. J. Haldergh@cscanada.orgS. Swapnilgh@cscanada.orgR. Santhoshgh@cscanada.org<p>Follicular Dendritic cell sarcoma arises from the follicular dendritic cells present in the lymphnode.Though are commonly seen in head and neck area but are extremely rare in the abdomen. Less than eighty cases are reported in the indexed literature. We herein describe a case of follicular dendritic cell sarcoma arising from the stomach wall with infiltration into pancreas in an 85 year old patient.</p>2015-03-26T00:00:00+00:00Copyright (c) http://flr-journal.org/index.php/gh/article/view/5234Primary Intestinal Follicular Lymphoma Diagnosed by Double Balloon Endoscopy: Endoscopic Features and Treatment Outcomes2015-09-02T07:34:44+00:00Kinichi Hottagh@cscanada.orgToshimi Mitsuishigh@cscanada.orgYoshinori Miyatagh@cscanada.orgAkihisa Tomorigh@cscanada.org<p>Objective: Little is known about the endoscopic features and clinical significance of small bowel (SB) lesions in primary intestinal follicular lymphoma (IFL). This study aimed to describe, based on a case series, detailed endoscopic features of SB lesions in IFLs and the relationship between clinical and histological stages. <br />Methods: This retrospective study included 14 patients (8 females, median age, 61.5 years) newly diagnosed with IFL of SB. All patients underwent double balloon endoscopy (DBE), with both anterograde and retrograde approaches.<br />Results: The distribution of IFLs in the GI tract were stomach 7%(1/14), duodenal bulb 7% (1/14), second part of the duodenum 93% (13/14), third part of the duodenum 86% (12/14), jejunum 93% (13/14), and ileum 43% (6/14). No colorectal lesions were detected. Multiple granules were the most frequently detected lesion, and were found in all patients. Nodule/mass lesions were detected in 5 patients. Nodule/mass lesions and ileal lesions were highly associated with the Lugano international classification. Eleven of 14 patients received chemotherapy plus Rituximab. Ten of 11 patients achieved complete response (CR). One patient achieved partial response (PR), but later exhibited disease progression. Four patients experienced grade 3 or 4 neutropenia, but all recovered without permanent side effects. One patient that achieved CR exhibited progressive disease after 54 months. All patients survived for a median of 35 months.<br />Conclusions: DBE was necessary for the precise diagnosis of IFL involving the SB. Endoscopic features included a nodule/mass and ileal lesions, which were related to the clinical stage.</p>2015-03-26T00:00:00+00:00Copyright (c) http://flr-journal.org/index.php/gh/article/view/4419Successful Treatment of Herpes Esophagitis With Ganciclovir in a Liver Transplant Patient2015-09-02T08:30:38+00:00Vildan Avkan-Oguzgh@cscanada.netTarkan Unekgh@cscanada.netMesut Akarsugh@cscanada.netVecihe Dursungh@cscanada.netMucahit Ozbilgingh@cscanada.netOzgul Sagolgh@cscanada.netHakan Abacioglugh@cscanada.netİbrahim Astarcioglugh@cscanada.netSedat Karademirgh@cscanada.net<p>The presence of Herpes Simplex Virüs-1 (HSV-1) esophagitis in patients with liver transplantation has been reported rarely. Among the reports that are accessible in the literature, none could have shown tissue positivity for Herpes virus-1 DNA via Polymerase Chain Reaction (PCR) in patients with liver transplantation. This case is presented as the patient was diagnosed with herpes esophagitis based on the histopathological findings and HSV-1 DNA positivity (detected by PCR) in the biopsy material and was treated with Ganciclovir. Due to the specific action of Ganciclovir against CMV infections, it is natural that the drug cannot use in the treatment of HSV infections. However it is reported that ganciclovir has been reduced the incidence of symptomatic HSV infections after liver transplantation. We report on a patient after liver transplantation with HSV-1 esophagitis, who was successfully treated with Ganciclovir. We assume that most transplant centers according to their protocols use ganciclovir for CMV prophylaxis, which may contribute to avoid HSV infection.</p>2015-02-20T00:00:00+00:00Copyright (c) 2015