Advances in diagnostics of inflammatory bowel diseases (IBD) and improved treatment strategies allowed the establishment of new therapeutic endpoints. Currently, it is desirable not only to cease clinical symptoms, but mainly to achieve endoscopic remission, a macroscopic normalization of the bowel mucosa. However, up to one-third of IBD patients in remission exhibit persisting microscopic activity of the disease. The evidence suggests a better predictive value of histology for the development of clinical complications such as clinical relapse, surgical intervention, need for therapy escalation, or development of colorectal cancer. The proper assessment of microscopic inflammatory activity thus became an important part of the overall histopathological evaluation of colonic biopsies and many histopathological scoring indices have been established. Nonetheless, a majority of them have not been validated and no scoring index became a part of the routine bioptic practice. This review summarizes a predictive value of microscopic disease activity assessment for the subsequent clinical course of IBD, describes the most commonly used scoring indices for Crohn's disease and ulcerative colitis, and comments on current limitations and unresolved issues.
The adenoma detection rate (ADR) is the primary quality indicator for colonoscopies. The polyp detection rate (PDR) is available from administrative data and does not depend on histology verification. The correlation between PDR and ADR and the ADR/PDR conversion factor in preventive colonoscopies were evaluated. In the prospective study, asymptomatic individuals aged 45-75 years with preventive colonoscopy in 2012-2016 were included. Spearman's correlation coefficient was used to assess PDR/ADR for each endoscopist. Conversion factor predicting ADR from PDR was obtained by linear regression and subsequently compared with adenoma to polyp detection rate quotient. One thousand six hundred fourteen preventive colonoscopies performed by 16 endoscopists in 8 screening colonoscopy centres in the Czech Republic were analysed. Correlation between PDR and ADR in all preventive colonoscopies was high and statistically significant (Rs 0.82; P < 0.001). There was a strong correlation between PDR and ADR in men (Rs 0.74; P = 0.002) and in screening colonoscopies (Rs 0.85; P < 0.001). The conversion factor to convert ADR from PDR was 0.72 in all preventive colonoscopies, 0.76 in FOBT+ colonoscopies and 0.67 in screening colonoscopies. ADR may be replaced by PDR in the assessment of colonoscopy quality. The value of the conversion factor varies according to colonoscopy indication and gender of examined individuals; in this Czech study, it was 0.72 in all preventive colonoscopies. The minimum requested ADR of 25 % corresponds to a PDR of 35 %, when converted with the appropriate conversion factor.
- MeSH
- Adenoma diagnosis epidemiology pathology prevention & control MeSH
- Administrative Claims, Healthcare statistics & numerical data MeSH
- Early Detection of Cancer methods statistics & numerical data MeSH
- Risk Assessment methods statistics & numerical data MeSH
- Colon diagnostic imaging MeSH
- Colonoscopy statistics & numerical data MeSH
- Colorectal Neoplasms diagnosis epidemiology pathology prevention & control MeSH
- Middle Aged MeSH
- Humans MeSH
- Mass Screening methods statistics & numerical data MeSH
- Colonic Polyps diagnosis epidemiology pathology MeSH
- Prospective Studies MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Sex Factors MeSH
- Intestinal Mucosa diagnostic imaging pathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
- Geographicals
- Czech Republic MeSH
Here we characterized the development of the trypanosomatid Blastocrithidia raabei in the dock bug Coreus marginatus using light and electron microscopy. This parasite has been previously reported to occur in the host hemolymph, which is rather typical for dixenous trypanosomatids transmitted to a plant or vertebrate with insect's saliva. In addition, C. marginatus has an unusual organization of the intestine, which makes it refractory to microbial infections: two impassable segments isolate the anterior midgut portion responsible for digestion and absorption from the posterior one containing symbiotic bacteria. Our results refuted the possibility of hemolymph infection, but revealed that the refractory nature of the host provokes very aggressive behavior of the parasite and makes its life cycle more complex, reminiscent of that in some dixenous trypanosomatids. In the pre-barrier midgut portion, the epimastigotes of B. raabei attach to the epithelium and multiply similarly to regular insect trypanosomatids. However, when facing the impassable constricted region, the parasites rampage and either fiercely break through the isolating segments or attack the intestinal epithelium in front of the barrier. The cells of the latter group pass to the basal lamina and accumulate there, causing degradation of the epitheliocytes and thus helping the epimastigotes of the former group to advance posteriorly. In the symbiont-containing post-barrier midgut segment, the parasites either attach to bacterial cells and produce cyst-like amastigotes (CLAs) or infect enterocytes. In the rectum, all epimastigotes attach either to the cuticular lining or to each other and form CLAs. We argue that in addition to the specialized life cycle B. raabei possesses functional cell enhancements important either for the successful passage through the intestinal barriers (enlarged rostrum and well-developed Golgi complex) or as food reserves (vacuoles in the posterior end).
- MeSH
- Microscopy, Electron MeSH
- Hemolymph parasitology MeSH
- Heteroptera immunology parasitology MeSH
- Euglenozoa Infections immunology parasitology veterinary MeSH
- Host-Parasite Interactions physiology MeSH
- Disease Resistance MeSH
- Life Cycle Stages physiology MeSH
- Intestinal Mucosa diagnostic imaging parasitology ultrastructure MeSH
- Trypanosomatina growth & development pathogenicity ultrastructure MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVES: Owing to the invasiveness of endoscopy, the use of biomarkers, especially faecal calprotectin (FC), has become standard for remission assessment. This study aimed to compare the accuracy for detection of endoscopic activity using recently developed FC home test using smartphone application (FC-IBDoc) against standard enzyme-linked immunosorbent assay (ELISA). METHODS: In all, 102 consecutive observations (89 participants) were included in prospective observational study. FC-IBDoc was performed parallelly with FC-ELISA in paediatric patients with inflammatory bowel disease indicated for endoscopy. Both tests were performed by trained staff. Mucosal healing was defined using Simple Endoscopic Score for Crohn disease (CD) ≤2 in patients with CD (n = 44), ulcerative colitis (UC) Endoscopic Index of Severity ≤4 in patients with UC (n = 27) and Rutgeerts score i0 and i1 without colon involvement in patients with CD after ileocaecal resection (n = 19). RESULTS: Out of 102 endoscopic findings 23 were assessed as mucosal healing. We found an association of the mucosal healing scores of the entire group both with FC-ELISA (P = 0.002) and FC-IBDoc (P = 0.001). The area under the receiver operating characteristic curve for FC-ELISA was 0.883 (95% confidence interval 0.807-0.960), with optimal cut-off at 136.5 μg/g. The area under the receiver operating characteristic curve for FC-IBDoc was 0.792 (95% confidence interval 0.688-0.895) with optimal cut-off at 48 μg/g. The FC-ELISA was more accurate than FC-IBDoc when tested by a Delong test (P = 0.023). CONCLUSIONS: Standard FC-ELISA for FC evaluation is more reliable predictor of mucosal healing than the FC-IBDoc in paediatric patients with inflammatory bowel disease. The cut-off values for both tests were incongruous.
- MeSH
- Biomarkers analysis MeSH
- Smartphone MeSH
- Crohn Disease diagnostic imaging metabolism MeSH
- Child MeSH
- Enzyme-Linked Immunosorbent Assay MeSH
- Feces chemistry MeSH
- Endoscopy, Gastrointestinal MeSH
- Wound Healing MeSH
- Leukocyte L1 Antigen Complex analysis MeSH
- Humans MeSH
- Adolescent MeSH
- Mobile Applications MeSH
- Self Care MeSH
- Area Under Curve MeSH
- Prospective Studies MeSH
- Reagent Kits, Diagnostic standards MeSH
- Reproducibility of Results MeSH
- ROC Curve MeSH
- Intestinal Mucosa diagnostic imaging physiopathology MeSH
- Severity of Illness Index MeSH
- Colitis, Ulcerative diagnostic imaging metabolism MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
AIM: To evaluate risk factors for primary sclerosing cholangitis (PSC) recurrence (rPSC) after orthotopic liver transplantation (OLT) in patients with well-preserved colons. METHODS: We retrospectively evaluated the medical records of all patients transplanted for PSC in our center between July 1994 and May 2015 and selected 47 with follow-up of at least 60 mo for further analysis based on strict inclusion and exclusion criteria. rPSC was confirmed by magnetic resonance or endoscopic retrograde cholangiopancreatography and liver biopsy. All patients were evaluated by protocolary pre-OLT colonoscopy with randomized mucosal biopsies. Colonoscopy was repeated annually after OLT. Both organ donors and recipients were human leukocyte antigen (HLA) typed by serological and/or DNA methods. All input data were thoroughly analyzed employing relevant statistical methods. RESULTS: Altogether, 31 men and 16 women with a median (range) age of 36 (15-68) years at the time of OLT and a median follow-up of 122 (60-249) mo were included. rPSC was confirmed in 21/47 (44.7%) of patients, a median 63 (12-180) mo after transplantation. De novo colitis [rPSC in 11/12, P ≤ 0.05, hazard ratio (HR): 4.02, 95% confidence interval (CI): 1.58-10.98] and history of acute cellular rejection (rPSC in 14/25, P ≤ 0.05; HR: 2.66, 95%CI: 1.03-7.86) showed strong positive associations with rPSC. According to the univariate analysis, overlapping features of autoimmune hepatitis (rPSC in 5/5, P ≤ 0.05) and HLA-DRB1*07 in the donor (rPSC in 10/15, P ≤ 0.05) represent other potential risk factors for rPSC, while the HLA-DRB1*04 (rPSC in 0/6, P ≤ 0.05), HLA-DQB1*03 (rPSC in 1/11, P ≤ 0.05), and HLA-DQB1*07 (rPSC in 0/7, P ≤ 0.05) recipient alleles may have protective roles. CONCLUSION: De novo colitis and acute cellular rejection are clinical conditions significantly predisposed towards recurrence of PSC after liver transplantation.
- MeSH
- Cholangiopancreatography, Endoscopic Retrograde MeSH
- Tissue Donors statistics & numerical data MeSH
- Child MeSH
- Adult MeSH
- Risk Assessment methods MeSH
- Inflammatory Bowel Diseases diagnostic imaging epidemiology pathology MeSH
- Liver diagnostic imaging pathology MeSH
- Colon diagnostic imaging pathology MeSH
- Colonoscopy MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Adolescent MeSH
- Young Adult MeSH
- Follow-Up Studies MeSH
- Child, Preschool MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Cholangitis, Sclerosing diagnostic imaging pathology surgery MeSH
- Intestinal Mucosa diagnostic imaging pathology MeSH
- Liver Transplantation * MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Background: Celiac disease (CD) is one of the most common genetically based disease. Histological confirmation of the characteristic small bowel changes is currently considered the gold standard to establish diagnosis of CD in patients with positive antibody testing. The aim of this study is to determine the correlation between endoscopy manifestations and pathology outcome for diagnosis of CD. Materials & Methods: A total of 295 consecutive patients who were referred to our endoscopy section from March 2015 through March 2016 were enrolled into the study. All patients were underwent endoscopy, 4 biopsies were taken and their results were compared with pathology features. The relationship between age, sex, and pathology features and endoscopy manifestations were evaluated. Results: The mean age of the subjects was 46.7±15.5 years of which 147(49.8%) were female, and 148(50.2%) were male. No statistically significant correlation was showed between the age and gender with pathology features and endoscopy manifestations (p<0.05). Most patients with Marsh 1 and 2 had a normal endoscopy. CD was confirmed by serology in 3 cases (1%) with Marsh III. We did not observe significant correlation between endoscopy results and pathology features (P=0.674). Conclusions: Our data showed that endoscopy results are not specific for CD diagnosis, and biopsy should be collected in patients with suggested symptoms associated with the disease and regardless to endoscopic features.
- MeSH
- Biopsy MeSH
- Celiac Disease * diagnostic imaging diagnosis MeSH
- Adult MeSH
- Duodenoscopy MeSH
- Duodenum pathology MeSH
- Endoscopy, Gastrointestinal MeSH
- Middle Aged MeSH
- Humans MeSH
- Intestinal Mucosa diagnostic imaging MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Observational Study MeSH
- MeSH
- Biopsy methods MeSH
- Celiac Disease * diagnostic imaging pathology MeSH
- Endoscopy, Gastrointestinal methods MeSH
- Immunochemistry methods MeSH
- Immunohistochemistry methods MeSH
- Humans MeSH
- Intestinal Mucosa diagnostic imaging pathology MeSH
- Intestine, Small diagnostic imaging pathology MeSH
- Check Tag
- Humans MeSH
