Oral 5-aminosalicylic acid for maintenance of surgically-induced remission in Crohn's disease

Background Crohn’s disease (CD) is a chronic inflammatory disorder that can involve any part of the gastrointestinal tract. 5‐Aminosalicylates (5‐ASAs) are locally acting, anti‐inflammatory compounds that reduce inflammation of the colonic mucosa with release profiles that vary among various commercially available formulations. This updated Cochrane review summarizes current evidence on the use of 5‐ASA formulations for maintenance of surgically‐induced remission in CD. Objectives To assess the efficacy and safety of 5‐ASA agents for the maintenance of surgically‐induced remission in CD. Search methods We searched MEDLINE, Embase, CENTRAL, the Cochrane IBD Group Specialized Register from inception to 16 July 2018. We also searched references, conference abstracts, and trials registers. Selection criteria Randomised controlled trials (RCTs) that included participants with CD in remission following surgery and compared 5‐ASAs to no treatment, placebo or any other active intervention with duration of at least three months were considered for inclusion. Data collection and analysis We used standard methodological procedures expected by Cochrane. The primary outcome was clinical relapse. Secondary outcomes included endoscopic recurrence, radiologic and surgical relapse, adverse events, serious adverse events and withdrawal due to adverse events. Main results Fourteen RCTs (1867 participants) were included in the review. Participants (15 to 70 years) were recruited from gastroenterology hospitals and medical clinics in Europe and North America and followed up between 3 and 72 months. The risk of bias was assessed as 'low' in one study, 'unclear' in seven and as 'high' in six. At 12 months, 36% (20/55) of participants in the 5‐ASA group experienced clinical relapse compared to 51% (28/55) in the no treatment control group (RR 0.71, 95% CI 0.46 to 1.10; low certainty evidence). Moderate certainty evidence suggests that 5‐ASAs are more effective for preventing clinical relapse than placebo. During a follow‐up period of 12 to 72 months, 36% (131/361) of 5‐ASA participants relapsed compared to 43% (160/369) of placebo participants (RR 0.83, 95% CI 0.72 to 0.96; I² = 0%; moderate certainty evidence). At 12 months, 17% (17/101) of the 4 g/day mesalamine group relapsed compared to 26% (27/105) of the 2.4 g/day group (RR 0.65, 95% CI 0.38 to 1.13; moderate certainty evidence). There was no evidence of a difference in clinical relapse rates when 5‐ASA compounds were compared to purine antimetabolites. At 24 months, 61% (103/170) of mesalamine participants relapsed compared to 67% (119/177) of azathioprine participants (RR 0.90, 95% CI 0.76 to 1.07; I² = 28%; low certainty evidence). During 24 months, 50% (9/18) of 5‐ASA participants had clinical relapse compared to 13% (2/16) of adalimumab participants (RR 4.0, 95% CI 1.01 to 15.84; low certainty evidence). The effects of sulphasalazine compared to placebo on clinical relapse rate is uncertain. After 18 to 36 months, 66% (95/143) of participants treated with sulphasalazine relapsed compared to 71% (110/155) in the placebo group (RR 0.88, 95% CI 0.56 to 1.38; I² = 38%; low certainty evidence). The effect of 5‐ASA drugs on safety was uncertain. During 24 months follow‐up, 4% (2/55) of 5‐ASA participants experienced adverse events compared to none (0/55) in the no treatment control group (RR 5.00, 95% CI 0.25 to 101.81; very low certainty evidence). An equal proportion of 5‐ASA participants (10%; 23/241) and placebo (9%; 20/225) groups experienced an adverse event during a follow‐up of 3 to 72 months (RR 1.07, 95% CI 0.60 to 1.91; I² = 0%; low certainty evidence). Adverse event rates were similar in the 5‐ASA and purine analogues groups. However, serious adverse events and withdrawals due to adverse events were more common in participants who received purine analogues than 5‐ASA. At 52 weeks to 24 months, 52% (107/207) of 5‐ASA participants had an adverse event compared to 47% (102/218) of purine analogue participants (RR 1.11, 95% CI 0.97 to 1.27, I² = 0%; low certainty evidence). Four per cent (6/152) of 5‐ASA participants had a serious adverse event compared to 17% (27/159) of purine analogue participants (RR 0.30, 95% CI 0.11 to 0.80; very low certainty evidence). Eight per cent (17/207) of 5‐ASA participants withdrew due to an adverse event compared to 19% (42/218) of purine analogue participants (RR 0.48, 95% CI 0.28 to 0.83; low certainty evidence). Adverse event rates were similar in high and low dose mesalamine participants. After 12 months, 2% (2/101) of 4 g/day mesalamine participants had an adverse event compared to 2% (2/105) of 2.4 g/day participants (RR 1.04, 95% CI 0.15 to 7.24; low certainty evidence). The proportion of participants who experienced adverse events over a 24 month follow‐up in the mesalamine group was 78% (14/18) compared to 69% (11/16) of adalimumab participants (RR 1.13, 95% CI 0.75 to 1.71; very low certainty evidence). None (0/32) of the sulphasalazine participants had an adverse event at 18 months follow‐up compared to 3% (1/34) of the placebo group (RR 0.35, 95% CI 0.01 to 8.38; very low certainty evidence). Commonly reported adverse events in the included studies were diarrhoea, nausea, increased liver function tests, pancreatitis, and abdominal pain. Authors' conclusions 5‐ASA preparations are superior to placebo for the maintenance of surgically‐induced clinical remission in patients with CD (moderate certainty). The number needed to treat to prevent one relapse was 13 patients. The evidence for endoscopic remission is uncertain. The sulphasalazine class of 5‐ASA agents failed to demonstrate superiority against placebo, 5‐ASAs failed to demonstrate superiority compared to no treatment (very low and low certainty). The efficacy of two different doses of the same 5‐ASA and the efficacy of 5‐ASA compared to purine antimetabolites (azathioprine or 6‐mercaptopurine) in maintaining surgically‐induced remission of CD remains unclear. However, purine analogues lead to more serious adverse events and discontinuation due to adverse events. There is a low certainty that 5‐ASA is inferior for maintaining surgically‐induced remission of CD compared to biologics (anti TNF‐ɑ). 5‐ASA formulations appear to be safe with no difference in the occurrence of adverse events or withdrawal when compared with placebo, no treatment or biologics

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Ο ρόλος των νευροπεπτιδίων στη φλεγμονή των εντερικών νευρικών πλεγμάτων σε ασθενείς με νόσο Crohn

Υπόβαθρο και Σκοπός. Ο κίνδυνος μετεγχειρητικής υποτροπής έπειτα από ειλεοκολική εκτομή για νόσο Crohn (NC) είναι υψηλός. Η μυεντερική πλεγματίτιδα τους εγγύς ορίου εκτομής θεωρείται ένας αναγνωρισμένος παράγοντας κινδύνου. Ο πρωταρχικός σκοπός αυτής της μελέτης ήταν η διερεύνηση της συσχέτισης των επιπέδων έκφρασης του νευροπεπτιδίου P (NPY), του αγγειοδραστικού εντερικού πεπτιδίου (VIP), και της ουσίας P (SP) με την παρουσία και τη βαρύτητα της πλεγματίτιδας στο εγγύς όριο εκτομής. Δευτερεύοντες στόχοι ήταν η εκτίμηση της προγνωστικής αξίας της ανοσοϊστοχημικής έκφρασης των συγκεκριμένων νευροπεπτιδίων και η αναγνώριση παραγόντων κινδύνου για μετεγχειρητική υποτροπή. Υλικά και Μεθοδολογία. Πραγματοποιήθηκε αναδρομική, μονοκεντρική μελέτη ασθενών με ΝC που υποβλήθηκαν σε ειλεοκολική εκτομή από τον Ιανουάριο 2010 έως και τον Δεκέμβριο 2016. Καταγράφηκαν τα δημογραφικά, κλινικά και χειρουργικά δεδομένα των ασθενών, όπως επίσης και η ύπαρξη ενδοσκοπικής, κλινικής και χειρουργικής υποτροπής. Η αξιολόγηση της παρουσίας και βαρύτητας της πλεγματίτιδας έγινε με χρώση αιματοξυλίνης-ηωσίνης, ξεχωριστά για το μυεντερικό και υποβλεννογόνιο πλέγμα. Η χρώση Giemsa χρησιμοποιήθηκε για την εκτίμηση της συμμετοχής μαστοκυττάρων. Η ανίχνευση Τ λεμφοκυττάρων και των ΝΡΥ-, VIP- και SP-εργικών νευρώνων πραγματοποιήθηκε με ανοσοϊστοχημικές μεθόδους. Η ανοσοέκφραση των πεπτιδίων ποσοτικοποιήθηκε χρησιμοποιώντας πρόγραμμα ψηφιακής ανάλυσης εικόνας. Αποτελέσματα. Συμπεριλήφθηκαν 79 ασθενείς (44 άνδρες) με διάμεση ηλικία τα 35 έτη και διάμεση παρακολούθηση 71 μηνών. Μυεντερική και υποβλεννογόνια πλεγματίτιδα διαπιστώθηκε στο 83.5% και 73.4% των περιπτώσεων, αντίστοιχα. Δεν ανιχνεύθηκε συσχέτιση μεταξύ της ανοσοέκφρασης των NPY, VIP και SP και της παρουσίας ή της βαρύτητας της πλεγματίτιδας. Παρομοίως, ο αριθμός των εμπλεκόμενων Τ λεμφοκυττάρων ή μαστοκυττάρων δεν συσχετίστηκε με την έκφραση των συγκεκριμένων νευροπεπτιδίων. Από τη μονοπαραγοντική και πολυπαραγοντική ανάλυση επιβίωσης (παλινδρόμηση αναλογικών κινδύνων Cox), το κάπνισμα (hazard ratio [HR] 4.07, 95% confidence interval [CI] 2.08–7.94, p&lt;0,001), η μέτρια (HR 3.68, 95%CI 1.06–12.73, p=0.040) και σοβαρή μυεντερική πλεγματίτιδα (HR 7.36, 95%CI 1.12–48.30, p=0.037) αναδείχθηκαν ανεξάρτητοι παράγοντες κινδύνου για ενδοσκοπική υποτροπή, ενώ το κάπνισμα (HR 2.78, 95%CI 1.01–7.67, p=0.049), η σοβαρή μυεντερική πλεγματίτιδα (HR 20.09, 95%CI 1.09–368.28, p=0.044) και το θετικό εγγύς όριο εκτομής (HR 3.45, 95%CI 1.33–8.96, p=0.011) για κλινική υποτροπή. Συμπεράσματα. Στην παρούσα μελέτη δεν αναγνωρίστηκε κάποια συσχέτιση μεταξύ της πλεγματίτιδας και της έκφρασης συγκεκριμένων νευροπεπτιδίων. Το κάπνισμα, η μυεντερική πλεγματίτιδα και το θετικό εγγύς όριο εκτομής αναδείχθηκαν ως ανεξάρτητοι παράγοντες κινδύνου για μετεγχειρητική υποτροπή.Background and Aim. The risk for postoperative recurrence following ileocolonic resection for Crohn&apos;s disease (CD) is high. Myenteric plexitis at the proximal resection margin is considered an established risk factor. Our primary purpose was to investigate the correlation of neuropeptide P (NPY), vasoactive intestinal peptide (VIP), and substance P (SP) levels of expression with the presence and severity of plexitis at the proximal resection margin. Secondary aims were to assess the predictive value of the above peptides’ immunohistochemical expression and to identify risk factors for postoperative recurrence. Materials and Methods. A retrospective, single-center study on patients with CD who underwent ileocolonic resection from January 2010 to December 2016 was conducted. Patients’ demographic, clinical, and surgical data were recorded, as well as the incidence of endoscopic, surgical and clinical recurrence. The presence and severity of plexitis was assessed by hematoxylin &amp; eosin stain, separately for the myenteric and submucosal plexus. Giemsa stain was used to assess mast cell involvement. The detection of T lymphocytes and NPY-, VIP-, and SP-ergic neurons was performed by immunohistochemical methods. The expression of the examined peptides was digitalized and quantified by image analysis. Results. Seventy-nine patients (44 men) with a median age of 35 years and a median follow-up of 71 months were included. Myenteric and submucosal plexitis was present in 83.5% and 73.4% of cases, respectively. No correlation was found between the quantified expression of NPY, VIP and SP and the presence or severity of plexitis. Similarly, the number of involved T lymphocytes or mast cells was not related to the expression of the examined neuropeptides. Univariable and multivariable survival analysis (Cox proportional hazards regression) identified smoking (hazard ratio [HR] 4.07, 95% confidence interval [CI] 2.08–7.94, p&lt;0.001), moderate (HR 3.68, 95%CI 1.06–12.73, p=0.040) and severe myenteric plexitis (HR 7.36, 95%CI 1.12–48.30, p=0.037) as independent risk factors for endoscopic recurrence. Smoking (HR 2.78, 95%CI 1.01–7.67, p=0.049), severe myenteric plexitis (HR 20.09, 95%CI 1.09–368.28, p=0.044) and involved proximal resection margin (HR 3.45, 95%CI 1.33–8.96, p=0.011) were independent predictors of clinical recurrence. Conclusions. In this study, no associations were detected between plexitis and the expression of specific neuropeptides. Smoking, myenteric plexitis, and a positive proximal resection margin were identified as independent risk factors for postoperative recurrence

Risk factors for postoperative recurrence of crohn’s disease with emphasis on surgical predictors

Intestinal resection for Crohn’s disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early endoscopy at 6-12 months is the “gold standard” procedure, whereas other modalities such as fecal calprotectin and imaging techniques can contribute to the diagnosis of recurrence. The purpose of this review is to summarize current data regarding risk factors correlated with postoperative relapse. Smoking is a well-established, modifiable risk factor. There are sufficient data that correlate penetrating disease, perianal involvement, extensive resections, prior surgery, histological features (plexitis and granulomas), and improper management after resection with high rates for recurrence. The literature provides conflicting data for other possible predictors, such as age, sex, family history of inflammatory bowel disease, location of disease, strictureplasties, blood transfusions, and postoperative complications, necessitating further evidence. On the other hand, surgical factors such as anastomotic configuration, open or laparoscopic approach, and microscopic disease at specimen margins when macroscopic disease is resected, seem not to be related with an increased risk of recurrence. Further recognition of histological features as well as gene-related factors are promising fields for research. © 2017 Hellenic Society of Gastroenterology

The role of neuropeptides in intestinal nerve plexuses inflammation in patients with Crohn's disease

Background and Aim: The risk for postoperative recurrence following ileocolonic resection for Crohn's disease (CD) is high. Myenteric plexitis at the proximal resection margin is considered an established risk factor. Our primary purpose was to investigate the correlation of neuropeptide P (NPY), vasoactive intestinal peptide (VIP), and substance P (SP) levels of expression with the presence and severity of plexitis at the proximal resection margin. Secondary aims were to assess the predictive value of the above peptides’ immunohistochemical expression and to identify risk factors for postoperative recurrence. Materials and Methods: A retrospective, single-center study on patients with CD who underwent ileocolonic resection from January 2010 to December 2016 was conducted. Patients’ demographic, clinical, and surgical data were recorded, as well as the incidence of endoscopic, surgical and clinical recurrence. The presence and severity of plexitis was assessed by hematoxylin & eosin stain, separately for the myenteric and submucosal plexus. Giemsa stain was used to assess mast cell involvement. The detection of T lymphocytes and NPY-, VIP-, and SP-ergic neurons was performed by immunohistochemical methods. The expression of the examined peptides was digitalized and quantified by image analysis. Results: Seventy-nine patients (44 men) with a median age of 35 years and a median follow-up of 71 months were included. Myenteric and submucosal plexitis was present in 83.5% and 73.4% of cases, respectively. No correlation was found between the quantified expression of NPY, VIP and SP and the presence or severity of plexitis. Similarly, the number of involved T lymphocytes or mast cells was not related to the expression of the examined neuropeptides. Univariable and multivariable survival analysis (Cox proportional hazards regression) identified smoking (hazard ratio [HR] 4.07, 95% confidence interval [CI] 2.08–7.94, p<0.001), moderate (HR 3.68, 95%CI 1.06–12.73, p=0.040) and severe myenteric plexitis (HR 7.36, 95%CI 1.12–48.30, p=0.037) as independent risk factors for endoscopic recurrence. Smoking (HR 2.78, 95%CI 1.01–7.67, p=0.049), severe myenteric plexitis (HR 20.09, 95%CI 1.09–368.28, p=0.044) and involved proximal resection margin (HR 3.45, 95%CI 1.33–8.96, p=0.011) were independent predictors of clinical recurrence. Conclusions: In this study, no associations were detected between plexitis and the expression of specific neuropeptides. Smoking, myenteric plexitis, and a positive proximal resection margin were identified as independent risk factors for postoperative recurrence.Υπόβαθρο και Σκοπός: Ο κίνδυνος μετεγχειρητικής υποτροπής έπειτα από ειλεοκολική εκτομή για νόσο Crohn (NC) είναι υψηλός. Η μυεντερική πλεγματίτιδα τους εγγύς ορίου εκτομής θεωρείται ένας αναγνωρισμένος παράγοντας κινδύνου. Ο πρωταρχικός σκοπός αυτής της μελέτης ήταν η διερεύνηση της συσχέτισης των επιπέδων έκφρασης του νευροπεπτιδίου P (NPY), του αγγειοδραστικού εντερικού πεπτιδίου (VIP), και της ουσίας P (SP) με την παρουσία και τη βαρύτητα της πλεγματίτιδας στο εγγύς όριο εκτομής. Δευτερεύοντες στόχοι ήταν η εκτίμηση της προγνωστικής αξίας της ανοσοϊστοχημικής έκφρασης των συγκεκριμένων νευροπεπτιδίων και η αναγνώριση παραγόντων κινδύνου για μετεγχειρητική υποτροπή. Υλικά και Μεθοδολογία: Πραγματοποιήθηκε αναδρομική, μονοκεντρική μελέτη ασθενών με ΝC που υποβλήθηκαν σε ειλεοκολική εκτομή από τον Ιανουάριο 2010 έως και τον Δεκέμβριο 2016. Καταγράφηκαν τα δημογραφικά, κλινικά και χειρουργικά δεδομένα των ασθενών, όπως επίσης και η ύπαρξη ενδοσκοπικής, κλινικής και χειρουργικής υποτροπής. Η αξιολόγηση της παρουσίας και βαρύτητας της πλεγματίτιδας έγινε με χρώση αιματοξυλίνης-ηωσίνης, ξεχωριστά για το μυεντερικό και υποβλεννογόνιο πλέγμα. Η χρώση Giemsa χρησιμοποιήθηκε για την εκτίμηση της συμμετοχής μαστοκυττάρων. Η ανίχνευση Τ λεμφοκυττάρων και των ΝΡΥ-, VIP- και SP-εργικών νευρώνων πραγματοποιήθηκε με ανοσοϊστοχημικές μεθόδους. Η ανοσοέκφραση των πεπτιδίων ποσοτικοποιήθηκε χρησιμοποιώντας πρόγραμμα ψηφιακής ανάλυσης εικόνας. Αποτελέσματα: Συμπεριλήφθηκαν 79 ασθενείς (44 άνδρες) με διάμεση ηλικία τα 35 έτη και διάμεση παρακολούθηση 71 μηνών. Μυεντερική και υποβλεννογόνια πλεγματίτιδα διαπιστώθηκε στο 83.5% και 73.4% των περιπτώσεων, αντίστοιχα. Δεν ανιχνεύθηκε συσχέτιση μεταξύ της ανοσοέκφρασης των NPY, VIP και SP και της παρουσίας ή της βαρύτητας της πλεγματίτιδας. Παρομοίως, ο αριθμός των εμπλεκόμενων Τ λεμφοκυττάρων ή μαστοκυττάρων δεν συσχετίστηκε με την έκφραση των συγκεκριμένων νευροπεπτιδίων. Από τη μονοπαραγοντική και πολυπαραγοντική ανάλυση επιβίωσης (παλινδρόμηση αναλογικών κινδύνων Cox), το κάπνισμα (hazard ratio [HR] 4.07, 95% confidence interval [CI] 2.08–7.94, p<0,001), η μέτρια (HR 3.68, 95%CI 1.06–12.73, p=0.040) και σοβαρή μυεντερική πλεγματίτιδα (HR 7.36, 95%CI 1.12–48.30, p=0.037) αναδείχθηκαν ανεξάρτητοι παράγοντες κινδύνου για ενδοσκοπική υποτροπή, ενώ το κάπνισμα (HR 2.78, 95%CI 1.01–7.67, p=0.049), η σοβαρή μυεντερική πλεγματίτιδα (HR 20.09, 95%CI 1.09–368.28, p=0.044) και το θετικό εγγύς όριο εκτομής (HR 3.45, 95%CI 1.33–8.96, p=0.011) για κλινική υποτροπή. Συμπεράσματα: Στην παρούσα μελέτη δεν αναγνωρίστηκε κάποια συσχέτιση μεταξύ της πλεγματίτιδας και της έκφρασης συγκεκριμένων νευροπεπτιδίων. Το κάπνισμα, η μυεντερική πλεγματίτιδα και το θετικό εγγύς όριο εκτομής αναδείχθηκαν ως ανεξάρτητοι παράγοντες κινδύνου για μετεγχειρητική υποτροπή

Quality of life of ulcerative colitis patients treated surgically with proctocolectomy and J-pouch formation: a comparative study before surgery and after closure of the defunctioning ileostomy

Background Ulcerative colitis (UC) is a lifelong disease with a relapse-remission pattern that affects patients&apos; social and psychological wellbeing. Restorative proctocolectomy and J-pouch formation is the gold-standard surgical procedure in cases where symptoms are refractory to currently available medical treatment. The aim of this study was to assess patients&apos; quality of life (QoL) in order to evaluate the efficiency of surgery and patients&apos; symptomatology. Methods We performed a prospective comparative study of the QoL of 47 patients with UC, treated surgically. As research tools, we used the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Cleveland Global Quality of Life (CGQL) questionnaire. Parametric and nonparametric tests were used in order to correlate areas of QoL and other selected factors, such as marital status, sex, age, and education. Results The mean scores before and after closure of the ileostomy were 153.29 and 178 for the IBDQ (P=0.0025), and 17.4 and 23.42 for the CGQL (P&lt;0.001), suggesting an overall improvement in QoL. The research showed that there was no specific QoL factor, such as intestinal, systemic, emotional or social life symptoms, that improved significantly more than the others (P=0.99). The IBDQ showed that patients aged less than 20 years (P&lt;0.001), female patients (P=0.03) and patients with secondary education (P&lt;0.001) reported the greatest improvement. Conclusions The QoL in UC patients treated surgically improved following closure of the defunctioning ileostomy. QoL studies are encouraged to optimize and maintain high standards of surgical care, and they could potentially be used for assessment of therapeutic efficacy