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Virus Detection in Adult Diarrhea; Recognition of High Prevalence in Ischemic Colitis
Abstracts
T1379 Analysis of Factors Associated with Bleeding After Endoscopic Treatment of Colon Tumor Kazuko Beppu, Takeshi Terai, Satoshi Abe, Naoto Sakamoto, Tomoyoshi Shibuya, Taro Osada, Oasmu Kobayashi, Akihito Nagahara, Toshifumi Ohkusa, Tatsuo Ogihara, Hiroto Miwa, Nobuhiro Sato Aim: Endoscopic resection has become the most popular and most promising treatment for polyps and early colorectal cancers. Although endoscopic resection is generally safe, bleeding, in addition to perforation, is the most serious complications arising from endoscopic resection. The proportion of bleeding after endoscopic resection may occurred up to 0.1-2.2% of cases. It is important to examine factors that may predict clinically bleeding after endoscopic resection. To evaluate the clinical characteristics of colon tumor which has high incidences of bleeding after endoscopic treatment, we performed case-control study in which tumor morphology, size, location and method of endoscopic treatment were examined. Methods: There were 40 post-endoscopic treatment bleeding cases in our database consisting of 14,381 polyps which were removed by hot biopsy, polypectomy and endoscopic mucosal resection (EMR) from June 1995 to September 2002 at our hospital. In addition, we randomly selected no-bleeding cases as a controls (n Z 160) matching age and gender to bleeding cases from our database. We investigated the morphology, the size, the location of lesions (rectum, sigmoid, descending, transvers, ascending and cecum) and resection technique in these two groups and analyzed which of these factors are associated with the risk of bleeding. In addition, we studied days from endoscopic treatment to bleeding for bleeding cases. Results: From these bleeding cases, 85% were male with a median age of 57. The proportion of pedunculated polyps in the bleeding group was significantly higher than those in control group (p ! 0.05). The size of lesions in the bleeding group was significantly larger than those in control group (p ! 0.01). Lesions located in the ascending colon has the higher incidence of bleeding than those of control group (p ! 0.05). The proportion of lesions which were removed by EMR in the bleeding group was significantly higher than those in control group (p ! 0.01). Multivariate analysis of factors influencing the bleeding revealed that the significant factors was size (p ! 0.0001). Bleeding occurred within 3 days (55.0%) in most cases and within 9 days in all cases. Conclusions: The size of the lesion was the most important factor for bleeding. Therefore, clips or coagulation forceps on the cut surface or vessels after endoscopic resection might be useful to prevent the bleeding. In addition, we should monitor the patients for at least 9 days after endoscopic resection.
T1380 Direct Microscopic Examination of Mucosal Biopsy Tissues Is Useful for Diagnosing Amebic Colitis Shigeaki Mizuno, Kimitoshi Kato, Maho Iwamoto, Toshiki Uehara, Shunpachi Miyamoto, Hideki Sato, Satoshi Hasunuma, Ryuichi Kurihara, Noriko Nakajima, Yukimoto Ishii, Ariyoshi Iwasaki, Yasuyuki Arakawa Background and Aim: Amebic colitis causes repeated bloody stools, diarrhea and abdominal pain, and has been increasing in recent years in Japan. It is important for the diagnosis of amebic colitis to take the patient’s medical and social history, and especially to recognize the possibility of amebic colitis when performing colonoscopy. Serum antibody tests, stool tests and histo-pathological examinations of biopsy specimens are widely used for differential diagnosis of amebic colitis. However, these tests are not always positive for Entamoeba histolytica and are timeconsuming. We investigated the usefulness of direct microscopic examination of mucosal biopsy tissues in making a definitive diagnosis of amebic colitis. Methods: Two to three colonic mucosal biopsy tissues were obtained using ordinary biopsy forceps from colonic lesions in nine patients suspected of having amebic colitis based on colonoscopic findings. These tissues were immediately put into saline, placed on a slide-grass and examined directly under light-microscopy. Results: The positive ratios for the serum antibody test, stool test and formalin-fixed paraffinembedded histo-pathological examination of biopsy specimens were 75.0, 50.0 and 62.5%, respectively. However, the existence of either cysts or trophozoites of Entamoeba histolytica was proven in 100% of patients within 30 min by direct microscopic examination of mucosal biopsy tissues. Erythrophagocytic Entamoeba histolytica trophozoites were easily observed microscopically, confirming the diagnosis of amebic colitis. Thus, therapy could be initiated promptly, on the same day as colonoscopy. Conclusion: Direct microscopic examination of mucosal biopsy tissues obtained with biopsy forceps during colonoscopy is a rapid, simple and sensitive method of definitively diagnosing amebic colitis.
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T1381 Virus Detection in Adult Diarrhea; Recognition of High Prevalence in Ischemic Colitis Hitoshi Nakajima, Terumi Kamisawa Background/Aim: We have kept our eyes on pathogenesis of ischemic colitis. It is well known that there is a wide range of age distribution (from twenties to seventies) among the ischemic colitis patients. We have speculated there is some trigger at the start of the illness. We focused on the intestinal infection because it could occasionally cause acute severe diarrhea. We suppose that an abrupt increase of intraluminal pressure due to severe diarrhea might start ischemic colitis. We already presented preliminary data about Rotavirus infection in ischemic colitis (GIE vol. 55. No.5. AB265). We have been thinking about some enteric virus infection including Rotavirus, and aim to investigate whether viruses could be related to ischemic colitis. Methods/Subjects: Four kinds of enteric viruses Astrovirus, Adenovirus, Norovirus, and Sapovirus were evaluated by RT-PCR method and Rotavirus were by ELISA, in consecutive 301 patients (M/F; 117/184, mean age; 58) of acute sporadic diarrhea (including bloody diarrhea), during the four years from 2001-2005. At the same time, stool culture was carried out for enteropathogenic bacteria. Statistic analysis was performed by Woolf ’s procedure. Results: Enteric viruses were detected in 99 out of 301 patients (32.9%). Twenty-six out of 33 with ischemic colitis (M/F; 10/23, mean age; 52 years) revealed viral infection (78.8%). Detected viruses are 11 Rotavirus, 9 Adenovirus, 9 Astrovirus, and 1 Norovirus; there were combined infections. The result of viral infection among other conditions were as follows; acute gastroenteritis is 43.8% (74/169), diarrhea after BMT (bone marrow transplantation) is 23.1% (12/52), IBD (inflammatory bowel disease) is 15.4% (4/26), chronic diarrhea is 23.5% (4/17). Odds ratio of viral infection in ischemic colitis is 0.21 [ln (OR) 95% CI; 0.21 - 0.32]. Conclusion: Frequency of virus infection in iscehmic colitis was significantly high and not only Rotavirus but also other enteric viruses were detected. It has been strongly suggested that there could be a close relationship between viral infection and ischemic colitis. Besides, its recognition would be turned out much important at the young aged than the senior aged. We propose that we should remember viral infection in ischemic colitis.
T1382 Microscopic Colitis Is Not So Rare Disease in the Japanese Population Kinichi Hotta, Tsuneo Oyama Background and study Aim: Microscopic colitis (MC) is recognized as a common cause of chronic diarrhea in the Western countries. However, in Japan, few cases of MC had been reported in the past and frequency of MC has not been clarified yet. The aim of this study is to clarify the frequency of MC in patients with chronic diarrhea in the Japanese population due to take biopsies during colonoscopies if there is no obvious finding of colitis. Methods: A total of 27 (male 11, female 16, mean age 56.4 years old) Japanese patients with chronic diarrhea underwent colonoscopies with biopsies during the period from April 2003 to January 2005. We retrospectively investigated frequency of cause of chronic diarrhea in the basis of pathological findings. Furthermore clinical and endoscopic characteristics of patients with MC were analyzed dividing into collagenous colitis (CC) and lymphocytic colitis (LC). In this study, pathological definitions of CC and LC were thickening of the subepithelial collagen band more than 7 mm and intraepithelial lymphocytosis more than 10 lymphocytes for every 100 epithelial cells, respectively (Am J Gastroenterol 2002:97;794-802). Results: 1. Frequency of cause of chronic diarrhea: CC 29.6% (8/27), LC 14.8% (4/27), Eosinophilic enterocolitis 3.7% (1/27), Infectious colitis 3.7% (1/37), Ischemic colitis 3.7% (1/37), Normal 44.5% (12/37), 2. Clinical and endoscopic characteristics of CC (n Z 8) and LC (n Z 4): a) Mean age: CC 66.3 yrs. LC 45.8 yrs. b) Gender (male:female): CC 1:1, LC 1:3, c) Frequency of diarrhea per day (mean): CC 5.9 G 2.9, LC 7.8 G 2.6, d) Mean duration of diarrhea (months): CC 2.0 G 2.0, LC 3.3 G 1.5, e) Past illness: CC; chronic renal failure 3, collagen disease 3, diabetes 1, LC; diabetes 1, f) Drug history: CC; lansoprazole 6, loxoprofen sodium 4, LC; none, g) Endoscopic feature: i) slight thickening of colonic mucosa; CC 75% (6/8), LC 75% (3/4), ii) proliferation of capillary vessels; CC 37.5% (3/8), LC 0% (0/4), iii) contact bleeding; CC 12.5% (1/8), LC 50% (2/4). Conclusions: MC (CC and LC) was major cause of chronic diarrhea in the Japanese population in our investigation. We could observe endoscopically slight mucosal abnormalities in most of CC and LC patients.
Volume 63, No. 5 : 2006 GASTROINTESTINAL ENDOSCOPY AB209
T1379 Analysis of Factors Associated with Bleeding After Endoscopic Treatment of Colon Tumor Kazuko Beppu, Takeshi Terai, Satoshi Abe, Naoto Sakamoto, Tomoyoshi Shibuya, Taro Osada, Oasmu Kobayashi, Akihito Nagahara, Toshifumi Ohkusa, Tatsuo Ogihara, Hiroto Miwa, Nobuhiro Sato Aim: Endoscopic resection has become the most popular and most promising treatment for polyps and early colorectal cancers. Although endoscopic resection is generally safe, bleeding, in addition to perforation, is the most serious complications arising from endoscopic resection. The proportion of bleeding after endoscopic resection may occurred up to 0.1-2.2% of cases. It is important to examine factors that may predict clinically bleeding after endoscopic resection. To evaluate the clinical characteristics of colon tumor which has high incidences of bleeding after endoscopic treatment, we performed case-control study in which tumor morphology, size, location and method of endoscopic treatment were examined. Methods: There were 40 post-endoscopic treatment bleeding cases in our database consisting of 14,381 polyps which were removed by hot biopsy, polypectomy and endoscopic mucosal resection (EMR) from June 1995 to September 2002 at our hospital. In addition, we randomly selected no-bleeding cases as a controls (n Z 160) matching age and gender to bleeding cases from our database. We investigated the morphology, the size, the location of lesions (rectum, sigmoid, descending, transvers, ascending and cecum) and resection technique in these two groups and analyzed which of these factors are associated with the risk of bleeding. In addition, we studied days from endoscopic treatment to bleeding for bleeding cases. Results: From these bleeding cases, 85% were male with a median age of 57. The proportion of pedunculated polyps in the bleeding group was significantly higher than those in control group (p ! 0.05). The size of lesions in the bleeding group was significantly larger than those in control group (p ! 0.01). Lesions located in the ascending colon has the higher incidence of bleeding than those of control group (p ! 0.05). The proportion of lesions which were removed by EMR in the bleeding group was significantly higher than those in control group (p ! 0.01). Multivariate analysis of factors influencing the bleeding revealed that the significant factors was size (p ! 0.0001). Bleeding occurred within 3 days (55.0%) in most cases and within 9 days in all cases. Conclusions: The size of the lesion was the most important factor for bleeding. Therefore, clips or coagulation forceps on the cut surface or vessels after endoscopic resection might be useful to prevent the bleeding. In addition, we should monitor the patients for at least 9 days after endoscopic resection.
T1380 Direct Microscopic Examination of Mucosal Biopsy Tissues Is Useful for Diagnosing Amebic Colitis Shigeaki Mizuno, Kimitoshi Kato, Maho Iwamoto, Toshiki Uehara, Shunpachi Miyamoto, Hideki Sato, Satoshi Hasunuma, Ryuichi Kurihara, Noriko Nakajima, Yukimoto Ishii, Ariyoshi Iwasaki, Yasuyuki Arakawa Background and Aim: Amebic colitis causes repeated bloody stools, diarrhea and abdominal pain, and has been increasing in recent years in Japan. It is important for the diagnosis of amebic colitis to take the patient’s medical and social history, and especially to recognize the possibility of amebic colitis when performing colonoscopy. Serum antibody tests, stool tests and histo-pathological examinations of biopsy specimens are widely used for differential diagnosis of amebic colitis. However, these tests are not always positive for Entamoeba histolytica and are timeconsuming. We investigated the usefulness of direct microscopic examination of mucosal biopsy tissues in making a definitive diagnosis of amebic colitis. Methods: Two to three colonic mucosal biopsy tissues were obtained using ordinary biopsy forceps from colonic lesions in nine patients suspected of having amebic colitis based on colonoscopic findings. These tissues were immediately put into saline, placed on a slide-grass and examined directly under light-microscopy. Results: The positive ratios for the serum antibody test, stool test and formalin-fixed paraffinembedded histo-pathological examination of biopsy specimens were 75.0, 50.0 and 62.5%, respectively. However, the existence of either cysts or trophozoites of Entamoeba histolytica was proven in 100% of patients within 30 min by direct microscopic examination of mucosal biopsy tissues. Erythrophagocytic Entamoeba histolytica trophozoites were easily observed microscopically, confirming the diagnosis of amebic colitis. Thus, therapy could be initiated promptly, on the same day as colonoscopy. Conclusion: Direct microscopic examination of mucosal biopsy tissues obtained with biopsy forceps during colonoscopy is a rapid, simple and sensitive method of definitively diagnosing amebic colitis.
www.giejournal.org
T1381 Virus Detection in Adult Diarrhea; Recognition of High Prevalence in Ischemic Colitis Hitoshi Nakajima, Terumi Kamisawa Background/Aim: We have kept our eyes on pathogenesis of ischemic colitis. It is well known that there is a wide range of age distribution (from twenties to seventies) among the ischemic colitis patients. We have speculated there is some trigger at the start of the illness. We focused on the intestinal infection because it could occasionally cause acute severe diarrhea. We suppose that an abrupt increase of intraluminal pressure due to severe diarrhea might start ischemic colitis. We already presented preliminary data about Rotavirus infection in ischemic colitis (GIE vol. 55. No.5. AB265). We have been thinking about some enteric virus infection including Rotavirus, and aim to investigate whether viruses could be related to ischemic colitis. Methods/Subjects: Four kinds of enteric viruses Astrovirus, Adenovirus, Norovirus, and Sapovirus were evaluated by RT-PCR method and Rotavirus were by ELISA, in consecutive 301 patients (M/F; 117/184, mean age; 58) of acute sporadic diarrhea (including bloody diarrhea), during the four years from 2001-2005. At the same time, stool culture was carried out for enteropathogenic bacteria. Statistic analysis was performed by Woolf ’s procedure. Results: Enteric viruses were detected in 99 out of 301 patients (32.9%). Twenty-six out of 33 with ischemic colitis (M/F; 10/23, mean age; 52 years) revealed viral infection (78.8%). Detected viruses are 11 Rotavirus, 9 Adenovirus, 9 Astrovirus, and 1 Norovirus; there were combined infections. The result of viral infection among other conditions were as follows; acute gastroenteritis is 43.8% (74/169), diarrhea after BMT (bone marrow transplantation) is 23.1% (12/52), IBD (inflammatory bowel disease) is 15.4% (4/26), chronic diarrhea is 23.5% (4/17). Odds ratio of viral infection in ischemic colitis is 0.21 [ln (OR) 95% CI; 0.21 - 0.32]. Conclusion: Frequency of virus infection in iscehmic colitis was significantly high and not only Rotavirus but also other enteric viruses were detected. It has been strongly suggested that there could be a close relationship between viral infection and ischemic colitis. Besides, its recognition would be turned out much important at the young aged than the senior aged. We propose that we should remember viral infection in ischemic colitis.
T1382 Microscopic Colitis Is Not So Rare Disease in the Japanese Population Kinichi Hotta, Tsuneo Oyama Background and study Aim: Microscopic colitis (MC) is recognized as a common cause of chronic diarrhea in the Western countries. However, in Japan, few cases of MC had been reported in the past and frequency of MC has not been clarified yet. The aim of this study is to clarify the frequency of MC in patients with chronic diarrhea in the Japanese population due to take biopsies during colonoscopies if there is no obvious finding of colitis. Methods: A total of 27 (male 11, female 16, mean age 56.4 years old) Japanese patients with chronic diarrhea underwent colonoscopies with biopsies during the period from April 2003 to January 2005. We retrospectively investigated frequency of cause of chronic diarrhea in the basis of pathological findings. Furthermore clinical and endoscopic characteristics of patients with MC were analyzed dividing into collagenous colitis (CC) and lymphocytic colitis (LC). In this study, pathological definitions of CC and LC were thickening of the subepithelial collagen band more than 7 mm and intraepithelial lymphocytosis more than 10 lymphocytes for every 100 epithelial cells, respectively (Am J Gastroenterol 2002:97;794-802). Results: 1. Frequency of cause of chronic diarrhea: CC 29.6% (8/27), LC 14.8% (4/27), Eosinophilic enterocolitis 3.7% (1/27), Infectious colitis 3.7% (1/37), Ischemic colitis 3.7% (1/37), Normal 44.5% (12/37), 2. Clinical and endoscopic characteristics of CC (n Z 8) and LC (n Z 4): a) Mean age: CC 66.3 yrs. LC 45.8 yrs. b) Gender (male:female): CC 1:1, LC 1:3, c) Frequency of diarrhea per day (mean): CC 5.9 G 2.9, LC 7.8 G 2.6, d) Mean duration of diarrhea (months): CC 2.0 G 2.0, LC 3.3 G 1.5, e) Past illness: CC; chronic renal failure 3, collagen disease 3, diabetes 1, LC; diabetes 1, f) Drug history: CC; lansoprazole 6, loxoprofen sodium 4, LC; none, g) Endoscopic feature: i) slight thickening of colonic mucosa; CC 75% (6/8), LC 75% (3/4), ii) proliferation of capillary vessels; CC 37.5% (3/8), LC 0% (0/4), iii) contact bleeding; CC 12.5% (1/8), LC 50% (2/4). Conclusions: MC (CC and LC) was major cause of chronic diarrhea in the Japanese population in our investigation. We could observe endoscopically slight mucosal abnormalities in most of CC and LC patients.
Volume 63, No. 5 : 2006 GASTROINTESTINAL ENDOSCOPY AB209