According to the case-control studies, colon adenomas are not more frequent as usual in patients with Barrett's oesophagus.Analysis of the relationship of Barrett's oesophagus with colon adenomas through a case presentation.The 62-years old male patient has been treated with pantoprazole for reflux oesophagitis and histologically proven short-segment Barrett's oesophagus. Pantoprazole treatment was started and the patient became symptom-free. In 1997 colonoscopy was performed for rectal bleeding and 4 recto-sigmoideal polyps were removed (tubular adenomas). After 4 years of PPI treatment, laparoscopic fundoplication was performed but after one year of symptom-free period, PPI was started again because of relapse. The patient was followed-up for 5 years. The histological examinations included also Ki67 and p53 antibody staining.On control colonoscopies, small rectal and sigmoid polyps were found. The retrospective histologic examination of the polyps revealed the increase of Ki-67-positive cells from 2-5% to 45-55% during the 5 years of follow-up, which is higher than the values found in controls and may express the increasing proliferative activity of the epithelium.Although according to the literature, Barrett's oesophagus does not increase the risk of colon adenomas, this may occur in individual cases, warranting close follow-up.
INTRODUCTION: According to the case-control studies, colon adenomas are not more frequent as usual in patients with Barrett's oesophagus. AIM: Analysis of the relationship of Barrett's oesophagus with colon adenomas through a case presentation. METHOD: The 62-years old male patient has been treated with pantoprazole for reflux oesophagitis and histologically proven short-segment Barrett's oesophagus. Pantoprazole treatment was started and the patient became symptom-free. In 1997 colonoscopy was performed for rectal bleeding and 4 recto-sigmoideal polyps were removed (tubular adenomas). After 4 years of PPI treatment, laparoscopic fundoplication was performed but after one year of symptom-free period, PPI was started again because of relapse. The patient was followed-up for 5 years. The histological examinations included also Ki67 and p53 antibody staining. RESULTS: On control colonoscopies, small rectal and sigmoid polyps were found. The retrospective histologic examination of the polyps revealed the increase of Ki-67-positive cells from 2-5% to 45-55% during the 5 years of follow-up, which is higher than the values found in controls and may express the increasing proliferative activity of the epithelium. CONCLUSION: Although according to the literature, Barrett's oesophagus does not increase the risk of colon adenomas, this may occur in individual cases, warranting close follow-up.
Aims: Duodenal biopsy is an important method to diagnose celiac disease (CD), however, the most reliable location of biopsy site is questionable. Claudins (CLDN), members of adherent junction proteins, regulate the integrity and function of tight junctions in the intestinal mucosa. CLDN expression in CD is unknown. Aim: To examine whether proximal or distal part of duodenum is better in diagnosing villous atrophy in CD and to detect CLDN 2, 3, and 4 expressions in the proximal and distal parts of the duodenum in children with celiac disease and in controls. Patients and methods: 16 children (9 girls, mean age, 6.6 y, range, 2–17 y) with newly diagnosed CD were enrolled. Biopsies from proximal (duodenal bulb) and distal part (duodeno-jejunal junction) of duodenum were taken for histological analysis. Severity of mucosal atrophy were determined by means of Marsh-scoring system. Immunohistochemistry was used to detect CD3+ intraepithelial lymphocytes and CLDN 2, 3, and 4 protein expressions. Results: Macroscopic picture and histology, and Marsh grading depicted no differences between biopsies taken from proximal or distal parts, however, the densities of CD3+ intraepithelial T lymphocytes were significantly higher in distal duodenum in comparison to the proximal part (P=0.0064). CLDN 2 and 3 expressions were significantly elevated in the duodeno-jejunal junction compared with controls (P=0.0049), and with the proximal part. Moreover, CLDN 2 and 3 expressions were correlated with severity of villous atrophy. Expression of CLDN 4 protein was similar in all groups studied. Conclusions: Both proximal and distal mucosal duodenal biopsies are suitable for diagnosing villous atrophy in patients with CD, however, the distal part of duodenum depicted earlier signs of mucosal deterioration. Therefore, to diagnose slight changes of mucosal abnormality the distal duodenum seems to be better location for intestinal biopsies. Increased expressions of CLDN 2 and 4 suggest structural changes of tight-junction may be responsible for increased permeability and proliferation observed in CD.
A szerzok a Controloc ureaz gyorsteszt es a polimeraz lancreakcio eredmenyesseget ertekelik ki 168 beteg adatait feldolgozva. A meghatarozasokat antrum es corpus szovetmintabol vegeztek. Arany standardkent a szovettani vizsgalatot (modositott Giemsa-festes) alkalmaztak. Mindharom teszt eseteben kiszamitottak a Helicobacter pylori fertozes gyakorisagat, illetve a Controloc gyorsteszt es a PCR szenzitivitasat, specificitasat, pozitiv es negativ prediktiv erteket. A szovettan az antrumban 62,1, a corpusban 53,2%-ban, a Controloc gyorsteszt 62,1 es 56,2%-ban, a polimeraz lancreakcio 65,0, illetve 64,4%-ban mutatta ki a korokozot.
A Controloc gyorsteszt szenzitivitasa 89,2%-os az antrumban es 96%-os a corpusban, specificitasa 87,9 es 93,7%-
os, a polimeraz lancreakcio szenzitivitasa 93,3 es 94,5%-os, specificitasa 81,0 es 87,3%-os. A szerzok a
Helicobacter-fertozes eradikacio elotti diagnosztikajaban elsosorban a szovettani vizsgalatot ajanljak, mivel pontos
es kettos, patologiai es bakteriologiai informaciot ad. A Controloc teszt pontossaga es gyorsasaga miatt rutin
diagnosztikai modszerkent kivaloan alkalmazhato. A polimeraz lancreakcio szinten pontos, de ido-, munka- es
koltsegigenyes, az eradikacio elotti diagnozisban akkor indokolt, ha egyeb modszerek nem eredmenyesek.
Background: Rectal bleeding is an alarming symptom and requires additional investigations. Hematochezia in infancy has been explained mainly by allergic colitis since usually these patients are otherwise asymptomatic.
A 10-year-old boy presented with a 2-month history of painless rectal bleeding. He had no fever, diarrhea, or weight loss. The patient had normal physical examination, normal laboratory testing including complete blood count, C-reactive protein, and stool cultures. Colonoscopy (Olympus PCF-Q180A1, Anamed KFT, Gyerekrak Foundation; Olympus, Tokyo, Japan) revealed a broad-based, multilobulated, inhomogeneous polypoid lesion 25 cm from the anus (Fig. 1). The polypoid lesion was removed piecemeal by oval electrosurgical snare (diameter 24 mm, Olympus) and standard cautery settings after its base was lifted with a 3-mL normal saline injection. Histology showed lobular capillary granuloma with small and dilated capillaries and a loose connective tissue stroma, which was consistent with pyogenic granuloma (Fig. 2). The patient developed abdominal pain the day following the procedure. Further investigation revealed free air on the abdominal x-ray, and he underwent surgical exploration. Colon perforation was diagnosed at the site of polypectomy and repaired. The patient recovered uneventfully and was discharged 5 days later.FIGURE 1: Broad-based, multilobulated, inhomogeneous polypoid lesion 25 cm from the anus.FIGURE 2: Polypoid area consists of hyperplastic colonic crypts and lobular capillary granuloma with small and dilated capillaries and a loose connective tissue stroma. Capillaries are surrounded by inflammatory cells. Hematoxylin and eosin stain, original magnification ×40.Pyogenic granuloma is a lobular capillary hemangioma that occurs mostly on the skin and on the mucosal surface of the oral cavity, but rarely in the gastrointestinal tract (1). There are only few reports of pyogenic granuloma in the colon of pediatric patients (2,3). The definitive diagnosis is made by histopathology, which shows granulation tissue, with endothelial-lined vascular spaces anastomosing with fibroblast proliferation. Postulated predisposing factors include trauma (solitary rectal ulcer), infection, microscopic arteriovenous anastomoses, and angiogenic growth factors. Endoscopic snare polypectomy or surgical resection is appropriate for definitive diagnosis and treatment. Recently, an obscure gastrointestinal bleeding due to pyogenic granuloma in the ileum was detected by capsule endoscopy and treated with double balloon enteroscopy (4).
