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Query: UMLS:C0021390 (inflammatory bowel disease)
 23,302 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Observer variation in the grading of dysplasia in 100 colorectal adenomas has been analysed by kappa statistics. Intraobserver agreement was only 70% and 67% for the two principal observers, and, as would be expected, interobserver agreement was even lower at 59% and 66%. Although the kappa values were significantly different from chance at the 0.1% level, there were substantial disagreements. When the study was extended to four observers, agreement between observer pairings was considerably worse (as low as 34%), and in four pairings the kappa values did not differ significantly from those expected by chance alone even at the 5% level. In an endeavour to improve agreement we adopted a percentage estimation grading method; but this failed to achieve any improvement when comparing overall grades. The percentage estimates of the two observers, however, showed a highly significant correlation. To identify the cytological features given most weight by the principal observers in assessing dysplasia we undertook morphometry on 30 adenomas using an image analysis computer. The nuclear to cytoplasmic ratio, variation in nuclear area, and variation in nuclear height above the basement membrane showed significant differences between mild, moderate, and severely dysplastic epithelia. While evaluation of these parameters therefore appears to be most important in the subjective interpretation of dysplasia, this study has shown that such evaluation is poorly standardised between observers and poorly reproduced within observers. Our findings of poor agreement in the grading of dysplasia in colorectal adenomas has serious implications for the assessment of dysplasia in inflammatory bowel disease, where the added problem of reactive cellular atypia brings greater complexity to these subjective judgments.
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PMID:Assessment of dysplasia in colorectal adenomas: an observer variation and morphometric study. 396 16

The risk of cancer in inflammatory bowel disease (IBD) is increased although it remains low. A clinical subgroup of patients with extensive or total ulcerative colitis and a history of symptoms for more than 10 yr is at greatest risk. In these patients biopsy evidence of epithelial dysplasia has successfully been used as a marker for increased cancer risk. A classification system for dysplasia has recently been devised, consisting of 3 categories: negative, indefinite and positive for dysplasia. The criteria for each category are discussed. For patients at high risk who decline prophylactic colectomy, a cancer surveillance programme involving periodic clinical assessment, sigmoidoscopy, colonoscopy and rectal and colonic biopsies has provided a reasonable alternative.
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PMID:Precancer and cancer in inflammatory bowel disease. 404 22

A case of carcinoma of the small intestine arising in a patient with regional enteritis (Crohn's disease) of the ileum is reported. The patient, a 54-year-old woman, had a 21-year history of regional enteritis which was treated intermittently with sulfasalazine and prednisone. Segmental resections of the ileum had been performed on two previous occasions. Because of recurrent low-grade intestinal obstruction, another segment of ileum was resected. The bowel demonstrated the typical gross and histologic appearance of regional enteritis. Histologic examination also disclosed a carcinoma that was confined to the ileal mucosa. This case is the first reported in which a small bowel carcinoma arising in regional enteritis has been found only in the mucosa. Adjacent to the carcinoma, the mucosa showed varying degrees of dysplasia consistent with the "precancerous" changes that have been described in inflammatory bowel disease. Using a peroxidase-antiperoxidase immunoperoxidase technique, carcinoembryonic antigen was identified in normal, hyperplastic, dysplastic, and carcinomatous mucosa, but the most intense staining was seen in hyperplastic and dysplastic cells. Carcinoembryonic staining, however, did not aid in differentiating between hyperplasia, dysplasia, and carcinoma because of an overlap in staining frequency and intensity.
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PMID:Intramucosal carcinoma of the small intestine arising in regional enteritis (Crohn's disease). Report of a case studied for carcinoembryonic antigen and review of the literature. 637 85

Enzyme activity was studied in relationship to histological changes in biopsy specimens removed after resection from patients with inflammatory bowel disease. Glucose-6-phosphate dehydrogenase (G6-PDH) and lactate dehydrogenase activities were measured in homogenates from 276 large-intestinal biopsy specimens, classified histologically in accordance with grade of inflammation and dysplasia. The mean activity of both enzymes was highest in the presence of dysplasia; however, only G6-PDH activity seemed independent of inflammatory changes. In the seven patients with dysplasia both enzyme activities were significantly raised in segments with dysplasia, compared with those without. The results support the use of dysplasia as a marker of premalignancy and may suggest a role for measurements of enzyme activity in the evaluation of patients with ulcerative colitis.
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PMID:Measurement of enzyme activity in colonic biopsies: a test for premalignancy in ulcerative colitis? 653 57

Assessment of epithelial dysplasia in ulcerative colitis has been hindered by inconsistencies in and disagreements about nomenclature and interpretation. To resolve these issues, pathologists from ten institutions participated in three exchanges of multiple slides and, following each exchange, in discussions of the results. A classification system for the epithelial changes that occur in ulcerative colitis was developed, which should be applicable to other forms of inflammatory bowel disease as well. The classification makes use of standardized terminology, addresses specific problem areas, and offers practical solutions. The reproducibility of the system was studied by means of examinations of both inter- and intra-observer variations. The clinical implications of the findings were incorporated into suggestions for patient management. The basis of the classification is that the term "dysplasia" is reserved for epithelial changes that are unequivocally neoplastic and may therefore give rise directly to invasive carcinoma. Specimens are categorized as negative, indefinite, or positive for dysplasia. The negative category includes all inflammatory and regenerative lesions and indicates that only continued regular surveillance is required. The indefinite category is applied to epithelial changes that appear to exceed the limits of ordinary regeneration but are insufficient for an unequivocal diagnosis of dysplasia or are associated with other features that prevent such unequivocal diagnosis. Clinically, it indicates that early repeat biopsy is often required to assess the changes more accurately. The positive category is divided into two subcategories: 1) high-grade dysplasia, for which colectomy should be strongly considered after confirmation of the diagnosis, and 2) low-grade dysplasia, which also requires confirmation and early repeat biopsy or colectomy, depending on other findings.
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PMID:Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. 662 68

Meticulous attention to the techniques of taking and processing both rectal and colonic biopsies is emphasised because this makes interpretation easier for the pathologist and more productive of useful information. The biopsy appearances of ulcerative colitis are described and distinguished from those seen in Crohn's disease and the various types of infective colitis. Comparison of sequential biopsies gives valuable information about the histology of the different phases of the disease in response to treatment. The criteria are described for distinguishing between active colitis, resolving colitis and ulcerative colitis in remission. Reference is also made to the development of epithelial dysplasia in patients with longstanding disease. The histological criteria for the diagnosis of Crohn's disease and the various types of infective colitis are summarised. Attention is drawn to the important condition known as "the solitary ulcer syndrome of the rectum" because this is a common condition not widely recognised by pathologists. Disorders of the mesenteric circulation can produce mucosal changes in the colon or rectum which mimick inflammatory bowel disease. The biopsy appearances are distinctive and can be distinguished from other causes of colitis. The increasing use of fibreoptic endoscopic biopsy is providing pathologists with a valuable opportunity to contribute to the differential diagnosis of colorectal disease.
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PMID:[Colorectal biopsy in inflammatory intestinal diseases]. 668 Apr 14

The source of bleeding from the rectum is extremely difficult to specify in many patients with moderate to severe bleeding. Lesions may be located anywhere along the gastrointestinal tract. On the basis of the available literature and reported clinical data, we conclude that moderate to severe rectal bleeding originates from the upper gut in up to 10% of patients, from the small bowel in up to 5%, and from the colon in the remaining 85%. Diverticulosis and vascular dysplasia account for 30-50% of colonic bleeding, and inflammatory bowel disease and ischemic colitis for another 5-15%. No diagnosis is made in 20-30% of patients with moderate to severe rectal bleeding. Patients with rectal bleeding can be classified as those whose bleeding stops spontaneously, those whose bleeding stops and then recurs, and those whose bleeding continues despite conventional treatment. Based on these classifications, we present an approach to the diagnosis and therapy of rectal bleeding.
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PMID:A current approach to rectal bleeding. 697 85

A prospective study was designed to evaluate multiple rectal biopsy examinations for dysplasia in 34 patients who had ileorectal anastomosis performed, following colectomy for inflammatory bowel disease. Although all but eight patients had persistent inflammatory activity on histologic examination, only one patient who demonstrated villous transformation of the mucosa clinically, showed carcinoma in situ in the excised rectal specimen. A protocol for surveillance of preserved rectums in inflammatory bowel disease is offered.
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PMID:Prospective surveillance by rectal biopsy following ileorectal anastomosis for inflammatory disease. 708 77

The clinical course of 37 patients who underwent 46 liver transplantations for primary (n = 33) and secondary (n = 4) sclerosing cholangitis was reviewed. The median follow-up was 37 months. The patient and graft survivals for patients with primary sclerosing cholangitis at 1, 2, and 5 years were 96.9%, 91.6%, 87.9%, and 83.1%, 74.2%, 65.2%, respectively. In the patients with primary sclerosing cholangitis (PSC), prior surgery except for simple cholecystectomy was associated with significantly greater operative time and blood loss. No cholangiocarcinoma was identified at the time of transplantation. Human leukocyte antigen typing for PSC patients was heavily weighed toward B8 (58.8%) compared with control (11.8%). Sixty-two percent of patients with PSC also had inflammatory bowel disease. Moderate or severe rejection requiring OKT3, "rescue therapy" with FK506, or retransplantation was relatively higher in patients with inflammatory bowel disease (70%) versus patients without inflammatory bowel disease (36.4%) and a matched control group (37.5%). Progressive inflammatory bowel disease was seen in 6 of 19 patients, with 3 developing cancer and a dysplasia. Two patients in the entire group died of sepsis and 3 of colon cancer (2 recurrent and 1 primary). These data demonstrate that excellent survival results can be achieved in this group of patients. Rejection is frequent and often severe and steroid refractory. Colon cancer represents the most frequent cause of death in PSC patients after liver transplantation and demands constant attention.
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PMID:Liver transplantation for sclerosing cholangitis. 763 12

Squamous cell carcinoma of the colon and rectum, originating proximal to the transitional zone, is a rare complication of idiopathic inflammatory bowel disease (IIBD). To date there are only 15 single case reports of such an occurrence. This carcinoma develops more commonly in females and in patients with pancolonic disease of more than 8 years' duration. The rectum is affected in two thirds of the cases. Squamous cell changes, in the vicinity of the primary adenocarcinoma, are present in 27% of cases. The carcinoma is in a pathologically advanced stage in one third of the cases. Colectomy is the main therapeutic modality. Survival following surgical resection ranged from 7 months to 21 years. We present an additional case of rectal squamous cell carcinoma (SCC) complicating chronic ulcerative colitis in a 33-year-old woman who had the disease for 15 years. Multiple biopsies of a gross lesion located 5 cm above the dendate line were consistent with invasive basaloid cell carcinoma. The patient received 5-FU, mitomycin C, and radiotherapy prior to a proctocolectomy and ileostomy. The only histopathologic finding at pathologic review of the surgical specimen was severe squamous dysplasia.
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PMID:Squamous cell carcinoma complicating idiopathic inflammatory bowel disease. 774 78


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