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Biomedical subjects

K Geboes

Publications and source records attributed to K Geboes.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Contribution of morphology for the comprehension of mechanisms of fibrosis in inflammatory enterocolitis.

Strictures are a common complication of Crohn's disease and an indication for surgery in approximately 50% of patients. Morphologic studies have shown that fibrosis of the submucosa and muscularis propria are common in Crohn's disease, especially in strictures. Immunohistochemical and in situ hybridization studies have demonstrated a marked increase of various subtypes of collagens in Crohn's disease. Collagens type I and III are present in ulcerated areas where they appear around capillaries and in a linear deposition at the junction between the granulation tissue and the necrotic debris. Collagens type IV and V show a prominent perivascular expression, increased deposition in the muscularis propria and increased expression around ganglia. Initiation and maintenance of the connective tissue changes are related with the inflammatory infiltrate. Inflammatory cells can further alter smooth muscle proliferation and migration and promote the formation of myofibroblasts. These alterations together with increased collagen deposition are involved in the complex process of strictures and bowel wall alterations in Crohn's disease.

Collagen↗
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Crohn's disease, ulcerative colitis or indeterminate colitis--how important is it to differentiate?

In most patients coming to the general practitioner or specialist with a history of bloody diarrhoea, bacteria or drugs are the most likely causative agents and it will be possible to make a diagnosis fairly easily. Because of differences in treatment, ulcerative colitis (UC) and Crohn's disease (CD) must however seriously be considered especially in younger patients, with severe symptoms and whenever the history is prolonged. A variety of colitides may indeed be clinically confused with UC and CD. Pathological mimics that should not be missed include infectious diseases such as Campylobacter colitis, yersiniosis, amoebiasis and others; drug-induced diseases (due to nonsteroidal antiinflammatory drugs...); diverticular disease-associated colitis; intestinal endometriosis; intestinal vasculitis and Behçet's disease and iatrogenic conditions such as graft-versus-host-disease and radiation colitis. In most situations a precise diagnosis of these conditions should be possible when all data are available. The term "indeterminate colitis" is used, when a diagnosis of chronic idiopathic inflammatory bowel disease (IBD) is suggested, but the differential diagnosis between UC and CD can not be solved. This occurs in approximately 5% of all patients with IBD. Diagnostic problems can occur in acute fulminant colitis, acute prolonged colitis, chronic relapsing disease and pouchitis. Indeterminate colitis is essentially a temporary diagnosis. Surgical and medical treatment of these patients can be difficult. When surgical treatment is indicated, the type of surgery must be seriously considered. The clinical course of patients with indeterminate colitis is usually more severe when compared with classical UC and these patients require often more severe medical treatment. Diagnostic problems can also arise in longstanding IBD, either UC and CD. Relapse of symptoms can be due to intercurrent infection (CMV is one of the candidates). Medical treatment can influence the microscopic features and induce a discontinuous inflammation in UC, reminiscent of CD. In cases of doubt, the original biopsies should be reviewed to ascertain the diagnosis, and orient treatment.

Colitis↗
PubMedDate not supplied

Vasculitis and the gastrointestinal tract.

Vasculitis, defined as a non-infectious inflammatory disorder of blood vessels, can affect vessels of any type in any organ. The gastrointestinal (GI) tract may thus also be involved. In systemic disorders as mixed connective tissue disease (MCTD) and systemic lupus erythematodes (SLE), patients may present with symptoms of gastrointestinal disfunction such as motility disorders, caused by alterations in the connective tissue. True vasculitis however also occurs in the GI tract. Severe, occlusive damage often leads to ischemia that may result in ulceration and perforation. Non-occlusive vascular disease may lead to vascular leakage resulting in oedema and haemorrhage. Those patients often present with diarrhoea or symptoms of bleeding. GI involvement is frequent in Henoch-Schönlein purpura and also often noted in polyarteritis nodosa (PAN), microscopic polyangiitis, Wegener's syndrome and Churg-Strauss syndrome. Furthermore, GI vasculitis has also been described in giant cell arteritis, Takayasu's disease, Buerger's disease and leucocytoclastic vasculitides as essential mixed cryoglubulinemia, lupus vasculitis, rheumatoid disease, MCTD, drug-induced vasculitis and Behçet's disease. The diagnosis and classification of vasculitis relies upon a combination of clinical, serological, haematological, radiological and histological findings. Establishing a precise diagnosis can be difficult but is important because treatment and prognosis can be highly variable.

Digestive System↗
PubMedDate not supplied

Vascular lesions of the gastrointestinal tract.

Vascular lesions of the gastrointestinal (GI) tract include arterio-venous malformations as angiodysplasia and Dieulafoy's lesion, venous ectasias (multiple phlebectasias and haemorroids), teleangiectasias which can be associated with hereditary hemorrhagic teleangiectasia (HHT), Turner's syndrome and systemic sclerosis, haemangioma's, angiosarcoma's and disorders of connective tissue affecting blood vessels as pseudoxanthoma elasticum and Ehlers-Danlos's disease. As a group, they are relatively rare lesions that however may be a major source of upper and lower gastrointestinal bleeding. Clinical presentation is variable, ranging from asymptomatic cases over iron deficiency anaemia to acute or recurrent bleeding that may be life-threatening. Furthermore, patients may present with other symptoms, e.g. pain, dysphagia, odynophagia, the presence of a palpable mass, intussusception, obstruction, haemodynamic problems resulting from high cardiac output, lymphatic abnormalities with protein loosing enteropathy and ascites, or dermatological and somatic features in syndromal cases. Diagnosis can usually be made using endoscopy, sometimes with additional biopsy. Barium radiography, angiography, intraoperative enteroscopy, tagged red blood cell scan, CT-scan and MRI-scan may offer additional information. Treatment can be symptomatic, including iron supplements and transfusion therapy or causal, including therapeutic endoscopy (laser, electrocautery, heater probe or injection sclerotherapy), therapeutic angiography and surgery. The mode of treatment is of course depending on the mode of presentation and other factors such as associated disorders. If endoscopic or angiographic therapy is impossible and surgical intervention not indicated, pharmacological therapy may be warranted. Good results have been reported with different drugs, albeit most of them have not been tested in large trials.

Connective Tissue Diseases↗
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Whipple's disease: the value of upper gastrointestinal endoscopy for the diagnosis and follow-up.

Due to the systemic nature of Whipple's disease the clinical presentation may be highly variable. The diagnosis may therefore be unduly delayed. If untreated, Whipple's disease is still potentially lethal. In contrast, the endoscopic findings as they are observed in the postbulbar small intestine and the light microscopic picture of small intestinal biopsies are almost pathognomonic. Out of a group of 18 patients (14 male, 4 female, mean age = 45 yrs), 12 patients were diagnosed using upper gastrointestinal endoscopy and duodenal biopsy, while six patients were diagnosed only by a small intestinal capsule biopsy. The clinical history prior to diagnosis lasted from 1 m to 22 yrs (mean = 3 yrs 6 m) in the first group and from 4 yrs to 21 yrs (mean = 12 yrs 6 m) in the second group. The endoscopic findings at the time of diagnosis were: oesophagitis (1/12), erosive gastritis (4/12), atrophic gastritis (2/12), severe erosive bulbitis (3/10), pathognomonic post-bulbar duodenal lesions (9/12). In 20% of the patients the endoscopic lesions had disappeared 6 m after antibiotics while the lesions had disappeared in all cases 9 m after therapy, despite the fact that PAS positive macrophages remained present in the endoscopic biopsies for years. All patients were treated with antibiotics (8 tetracycline alone, 4 tetracycline, streptomycin and penicillin, 6 trimethoprim). Five patients (27%-4 of the tetracycline group) relapsed within 2 to 20 yrs after the initial diagnosis. Three of these patients (3/5) had typical duodenal lesions on endoscopy at that time.

Adult↗
PubMedDate not supplied

Is histology useful for the assessment of the efficacy of immunosuppressive agents in IBD and if so, how should it be applied ?

Crohn's disease and ulcerative colitis are two chronic relapsing inflammatory bowel diseases of unknown etiology. Both conditions are characterized by a considerable morbidity and have an impact upon the social and economic aspects of the patients life. At present, medical treatment is mainly aiming at the control of the inflammation. Drugs used for ulcerative colitis can induce microscopic healing of the mucosa. Similar results have been obtained recently with immunomodulatory drugs in Crohn's disease. The cost of these drugs is however high and the use of these drugs can be associated with side effects. Furthermore, many of the drugs need to be given for a long period. Therefore it is appropriate to assess the efficacy of the drugs before commercial use and even when used in routine practice. For both ulcerative colitis and Crohn's disease, clinical parameters combined in indices and endoscopy are commonly used together with some laboratory tests for the assessment of disease activity. In ulcerative colitis, histology has been used along with the other instruments for the measurement of disease activity because it was shown that the mucosal lesions could improve. More recently, histology has also been used for Crohn's disease. Routinely, disease activity when assessed with microscopy, should be divided into mild, moderate and severe. For drug trials and study purposes, more objective scoring systems should be used. Preferentially, a generally accepted score is used. This allows comparisons between different studies. Different scoring systems have been designed for ulcerative colitis and Crohn's disease. For the latter, multiple biopsies should be analysed. Most scoring systems still need validation.

Biopsy↗
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Coeliac disease "anatomic pathology".

The microscopic diagnosis of coeliac disease is discussed. The small intestinal mucosal lesions observed in coeliac disease consist of a combination of epithelial alterations and inflammatory lesions starting with pre-infiltrative changes. In the early (?) changes an increase of lymphocytes is noted. The interactions probably finally lead to destruction or atrophy of the villi.

Biopsy↗
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Small bowel amyloidosis, pathology and diagnosis.

The authors describe clinical findings, radiological aspects and histological characteristics of small bowel amyloidosis in 8 patients. Pathogenesis of the small bowel related symptoms and diagnostic procedures are discussed.

Adult↗
PubMedDate not supplied

Colorectal cancer in colonic Crohn's disease--high frequency of DNA-aneuploidy.

BACKGROUND: The risk of colorectal cancer (CRC) in colonic Crohn's disease (CCD) seems to be of the same magnitude as in extensive, longstanding ulcerative colitis (UC) and colonoscopic surveillance has been advocated. Mucosal dysplasia and DNA-aneuploidy are early warning markers of malignant transformation in UC. Data concerning the occurrence of such premalignant lesions in CCD are scarce. AIMS: The objective of this study was to investigate the DNA ploidy pattern in CCD-patients with manifest CRC, both in the tumour, as well as in the adjacent and distant colorectal mucosa. The results from DNA-flow cytometry analyses (FCM) prior to the development of a CRC in CCD were also investigated. MATERIALS AND METHODS: Biopsies obtained at colonoscopy and surgical specimens from 43 patients with colonic or ileocolonic CD developing CRC between 1988 and 1998 were reviewed. The CRC histological phenotype, and the occurrence of dysplasia were registered. CRC-tissue and tissue from areas with dysplasia adjacent to and/or distant from the tumour were obtained from paraffin-embedded blocks and were analysed by FCM after preparation. RESULTS: Twenty-four CRCs in 21 patients (14 men) were suitable for FCM-analyses. The median age at CRC-diagnosis was 53 years (21-73) and the median CCD-duration was 14.5 years (1-50). A predominance of CRC was found either in the cecum (9124) or in the rectum (7/24). DNA-aneuploidy was found in 62.5% (15/24) of the tumours, in 25% (2/8) in adjacent and/or distant mucosa, and in 50% (2/4) of the patients that had been subjected to colonoscopic surveillance prior to the CRC-diagnosis. In 7patients (29%), definite dysplasia was detected adjacent to andlor distant from the tumour. Of the 6 patients undergoing colonoscopic surveillance, 3 (50%) displayed definite dysplasia prior to the colectomy. CONCLUSION: Since DNA- aneuploidy is a' common feature in CRCs in CCD and precede the development of invasive carcinoma, inclusion of FCM-analyses of colorectal biopsies may enhance the sensitivity of identifying high-risk CCD-patients prone to develop CRC within the frame of colonoscopic surveillance programs.

Adult↗
PubMedDate not supplied

Miliary tuberculosis following infliximab therapy for Crohn disease: A case report and review of the literature.

We present a case of miliary tuberculosis diagnosed 15 months after infliximab treatment despite negative screening for previous exposure to Mycobacteria on skin PPD and chest X-ray. This case shows that--although screening for TB with a skin PPD and a chest X-ray should be performed in all patients--this is not 100% effective and may be a problem in patients on concomitant immunosuppression. The clinical course of this patient further shows that in a patient treated with anti-TNF antibodies who's condition does not improve one should always be aware of the possibility of a tuberculosis infection. Even though tuberculosis is usually not rapidly fatal, the disease may show a fulminant course in immunocompromised patients.

Aged↗
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Direct and indirect evidence for the involvement of prostaglandins in the secretagogue action of rhein anthrone in the small intestine.

The present study was undertaken to investigate the involvement of prostaglandins in the secretagogue action, observed after intraduodenal administration of rhein anthrone and rhein in rats. After intraduodenal administration of rhein anthrone (50 mg/kg), the active metabolite of sennosides, a very marked increase of secretion was observed compared to control. The amount of secretion was calculated by dividing the total weight of the small intestine, obtained 30 minutes after administration of the drug, by the total length. The effect seen with rhein (50 mg/kg) is far less pronounced than that with rhein anthrone and is not significant when compared with control. Pretreating the animals with indomethacin (15 mg/kg, p.o., 1 hour in advance) or with ibuprofen (15 mg/kg, p.o., 1 hour in advance) largely prevents the secretagogue effect of rhein anthrone, suggesting that prostaglandins play an important role in the observed pharmacological action. This idea is reinforced by the observation that pretreatment with hydrocortisone (50 mg/kg, p.o., 6 hours in advance) is also able to counteract the effect of rhein anthrone. After administration of rhein anthrone, an almost tenfold increase of the tissue content of prostaglandin E2 was observed. Here again, the results with rhein were far less pronounced. It is concluded that prostaglandins play an important role in the secretagogue action of rhein anthrone.

Animals↗
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[Vascularization of the pharyngo-esophageal transition zone].

The arterial blood supply and the venous drainage of the area around the pharyngo-oesophageal sphincter are still virtually unknown. We performed vascular injections with a gelatin-india ink solution on autopsy specimens. After fixation the specimens were dissected under a stereomicroscope. From our anatomic studies we conclude that the inferior thyroid artery gives rise to a special branch, the "laryngopharyngeal artery", that supplies the pharyngo-oesophageal sphincter through numerous transversal branches. This density can be explained by the oxidative metabolism of the cricopharyngeal muscle. This structural adaptation is necessary for the maintainance of a continuous tone within the pharyngo-oesophageal sphincter. The pharyngo-oesophageal venous plexus in the laryngopharynx and cervical oesophagus provides rigidity to the surrounding corium and so ensures the integrity of the corium during sphincter relaxation.

Adult↗
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Pharyngo-oesophageal diverticulum (Zenker's). Clinical, therapeutic and morphological aspects.

In a series of 100 surgically treated patients, Zenker's diverticulum (ZD) appeared mostly as a typical geriatric disorder (50% over 70 years) in which not only oesophageal symptoms but also pulmonary symptoms (37%) may lead to a life-threatening situation. In 60% of the patients, associated upper gastrointestinal pathology was observed, most frequently being gastro-oesophageal reflux (30 patients). In 30% of the manometric studies of the oesophageal body and lower oesophageal sphincter, clear pathological patterns were observed. Morphological examinations, enzymohistochemistry, immunohistochemistry showed clear pathological changes not only at the level of the cricopharyngeal muscle but also at the level of the striated muscles of the cervical oesophagus. These clinical, manometric and morphological changes suggest that ZD is one expression of a more complex neurogenic disorder. They also justify the extramucosal myotomy of the cricopharyngeal wall and the striated muscle wall of the cervical oesophagus as well, as the cardinal step of operation. This myotomy was combined with a diverticulopexy resulting in no post-operative mortality and a minimum of morbidity. The mean longterm follow-up in this series is 4 years, showing excellent and very good results in 96% of the patients for the oesophageal symptoms and in 92% for the full spectrum of oesophageal and pulmonary symptomatology. With this single step operation, no recurrence has been seen seen as opposed to the endoscopic procedure.

Adult↗
PubMedDate not supplied

Endoscopy as a diagnostic tool in inflammatory bowel disease.

Endoscopy has become an important technique for the evaluation of patients with inflammatory bowel disease. It is used for the diagnosis as well as for the follow up of the disease. The present article reviews different aspects of intestinal endoscopy with their specific indications in inflammatory bowel diseases (IBD). Furthermore some new endoscopic findings are shortly described.

Cholangiopancreatography, Endoscopic Retrograde↗
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[Benign stomach tumors: histology, diagnosis and surgical experience].

Benign neoplasms of the stomach lead to atypical symptoms. Radiological and endoscopic investigations are always recommended. Our surgical experience with 11 epithelial and 26 mesenchymal benign neoplasms is discussed. A local excision could be carried out in 24 patients, of whom 4 developed postoperative complications and one deceased. Ten cases required a partial and 3 cases a total gastrectomy. This was mainly due to the localisation or the extent of the lesions. One surgical complication occurred and one patient died. Relapse was never observed in the long-term (i.e. 6 years) follow-up of 29 patients. Nonetheless, a yearly radiological or endoscopical control is advocated since hyperplastic polyps can relapse as exaggerated healing of an ulcer, and because especially leiomyomas, neurilemmomas en lipomas carry a substantial risk of malignant degeneration.

Adolescent↗