Background and aims:We previously demonstrated a significant colorectal neoplasia risk in inflammatory bowel disease(IBD)patients with mucosal changes indefinite for dysplasia(IND)and the potential diagnostic utility ...Background and aims:We previously demonstrated a significant colorectal neoplasia risk in inflammatory bowel disease(IBD)patients with mucosal changes indefinite for dysplasia(IND)and the potential diagnostic utility of p53 and cytokeratin 7 immunohistochemistry in IBD-associated neoplasia.The primary aim of this exploratory study was to determine the predictive value of the two markers for neoplasia risk in the IBD-IND population.Methods:We identified 44 eligible cases with IBD and IND in colon biopsy from our pathology database.We semi-quantified the expression of p53 and cytokeratin 7 in the colon biopsies by immunohistochemistry and correlated their expression,demographic information,and clinical features with colorectal neoplasia outcome.Results:The mean age of the cohort was 46.6615.1 years,with 25(56.8%)being male.The median follow-up was 101 months(range:6–247)after IND diagnosis.Among these 44 patients,11(25%)progressed to neoplasia(low-grade dysplasia¼6;high-grade dysplasia¼2;cancer 3)at a median follow-up of 66 months(range:19–145).Univariate analysis demonstrated that age and p53 overexpression were associated with progression to neoplasia.Conclusions:Twenty-five percent of patients with IBD and IND developed colorectal dysplasia or cancer.Overexpression of p53 and age are associated with neoplastic progression.展开更多
Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was...Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with IPAA.Methods:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014.The visceral fat area(VFA)was measured on CT images.The study group comprised patients with a significant VAT gain(>15%),and the control group was those without.The adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception CT.Results:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were included.Twenty-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control group.The median duration from the inception to the latest CT was 552(range:31–2598)days for the entire cohort.We compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two groups.Kaplan-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch comes.Conclusions:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated with poor long-term outcomes.展开更多
文摘Background and aims:We previously demonstrated a significant colorectal neoplasia risk in inflammatory bowel disease(IBD)patients with mucosal changes indefinite for dysplasia(IND)and the potential diagnostic utility of p53 and cytokeratin 7 immunohistochemistry in IBD-associated neoplasia.The primary aim of this exploratory study was to determine the predictive value of the two markers for neoplasia risk in the IBD-IND population.Methods:We identified 44 eligible cases with IBD and IND in colon biopsy from our pathology database.We semi-quantified the expression of p53 and cytokeratin 7 in the colon biopsies by immunohistochemistry and correlated their expression,demographic information,and clinical features with colorectal neoplasia outcome.Results:The mean age of the cohort was 46.6615.1 years,with 25(56.8%)being male.The median follow-up was 101 months(range:6–247)after IND diagnosis.Among these 44 patients,11(25%)progressed to neoplasia(low-grade dysplasia¼6;high-grade dysplasia¼2;cancer 3)at a median follow-up of 66 months(range:19–145).Univariate analysis demonstrated that age and p53 overexpression were associated with progression to neoplasia.Conclusions:Twenty-five percent of patients with IBD and IND developed colorectal dysplasia or cancer.Overexpression of p53 and age are associated with neoplastic progression.
文摘Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with IPAA.Methods:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014.The visceral fat area(VFA)was measured on CT images.The study group comprised patients with a significant VAT gain(>15%),and the control group was those without.The adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception CT.Results:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were included.Twenty-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control group.The median duration from the inception to the latest CT was 552(range:31–2598)days for the entire cohort.We compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two groups.Kaplan-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch comes.Conclusions:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated with poor long-term outcomes.
