RESUMEN
BACKGROUND: Surgeons create a neorectum to repair patients with Hirschsprung's disease (HD), which should be formed from a normoganglionic bowel. However, the neorectum is occasionally created with a transition zone (TZ) bowel. A neorectum created with a TZ has been postulated as a cause of postoperative enterocolitis or constipation. This study compares the incidence of enterocolitis and constipation in patients with TZ neorectum and normoganglionic bowel. METHODS: We conducted a retrospective review of patients with rectosigmoid HD who underwent primary pull-through. Patients were divided into normoganglionic neorectum (NNR) and TZ neorectum. The diagnosis was based on the final histopathologic report of the proximal margin. The incidence of enterocolitis and constipation was compared between these two groups. RESULTS: A total of 98 HD patients were analyzed. Seventy-one patients fulfilled the inclusion criteria. 65 (92%) had a NNR, and six patients (8%) had a TZ neorectum. From these patients, 42 (59%) presented with enterocolitis or constipation. However, there was no significant difference between both groups. CONCLUSION: The present study showed no difference in the incidence of enterocolitis or postoperative constipation in HD patients with normoganglionic or TZ neorectum. These results suggest that TZ neorectum does not cause postoperative obstructive symptoms.
INTRODUCCIÓN: Los cirujanos crean un neo-recto para tratar a los pacientes con enfermedad de Hirschsprung (EH), que debe formarse con intestino normogangliónico; sin embargo, en ocasiones el neo-recto se forma con intestino de la zona de transición. Se ha postulado que un neo-recto en zona de transición causa enterocolitis o estreñimiento postoperatorio. El objetivo de este estudio fue comparar la frecuencia de enterocolitis y estreñimiento en pacientes con neo-recto en zona de transición y con neo-recto normogangliónico. MÉTODOS: Se llevó a cabo una revisión retrospectiva de pacientes con EH recto sigmoideo que se sometieron a descenso primario. Los pacientes se dividieron en el grupo neo-recto normogangliónico y el grupo con neo-recto en zona de transición. El diagnóstico del neo-recto se estableció con el informe histopatológico definitivo del margen proximal. Se comparó la frecuencia de enterocolitis y estreñimiento entre estos dos grupos. RESULTADOS: Se analizó un total de 98 pacientes con EH, de los cuales 71 pacientes cumplieron los criterios de inclusión; 65 (92%) con neo-recto normogangliónico y seis (8%) con neo-recto en zona de transición. Posteriormente, 42 (59%) pacientes presentaron enterocolitis asociada a Hirschsprung (HAEC) o estreñimiento; sin embargo, no hubo diferencia significativa entre ambos grupos. CONCLUSIONES: El presente estudio no demostró una diferencia en la frecuencia de HAEC o estreñimiento postoperatorio en pacientes con EH con neo-recto normogangliónico o en zona de transición. Estos resultados sugieren que un neo-recto en zona de transición no causa síntomas obstructivos postoperatorios.
Asunto(s)
Enterocolitis , Enfermedad de Hirschsprung , Humanos , Enfermedad de Hirschsprung/cirugía , Enfermedad de Hirschsprung/diagnóstico , Enfermedad de Hirschsprung/patología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Estreñimiento/etiología , Estreñimiento/complicaciones , Recto/cirugía , Recto/patología , Enterocolitis/epidemiología , Enterocolitis/etiología , Enterocolitis/patologíaAsunto(s)
Proteínas en la Dieta/inmunología , Enterocolitis/diagnóstico , Hipersensibilidad a los Alimentos/diagnóstico , Niño , Preescolar , Chile , Enterocolitis/inmunología , Enterocolitis/patología , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/patología , Tracto Gastrointestinal/patología , Humanos , Lactante , Recién Nacido , Estudios RetrospectivosRESUMEN
Reactive arthritis (ReA) is an inflammatory condition of the joints that arises following an infection. Salmonella enterocolitis is one of the most common infections leading to ReA. Although the pathogenesis remains unclear, it is known that IL-17 plays a pivotal role in the development of ReA. IL-17-producers cells are mainly Th17, iNKT, and γδT lymphocytes. It is known that iNKT cells regulate the development of Th17 lineage. Whether iNKT cells also regulate γδT lymphocytes differentiation is unknown. We found that iNKT cells play a protective role in ReA. BALB/c Jα18-/- mice suffered a severe Salmonella enterocolitis, a 3.5-fold increase in IL-17 expression and aggravated inflammation of the synovial membrane. On the other hand, activation of iNKT cells with α-GalCer abrogated IL-17 response to Salmonella enterocolitis and prevented intestinal and joint tissue damage. Moreover, the anti-inflammatory effect of α-GalCer was related to a drop in the proportion of IL-17-producing γδT lymphocytes (IL17-γδTcells) rather than to a decrease in Th17 cells. In summary, we here show that iNKT cells play a protective role against Salmonella-enterocolitis and Salmonella-induced ReA by downregulating IL17-γδTcells.
Asunto(s)
Artritis Reactiva/prevención & control , Enterocolitis/prevención & control , Interleucina-17/metabolismo , Linfocitos Intraepiteliales/metabolismo , Células T Asesinas Naturales/metabolismo , Salmonelosis Animal/inmunología , Salmonella/patogenicidad , Animales , Antiinflamatorios/farmacología , Enterocolitis/inmunología , Enterocolitis/microbiología , Enterocolitis/patología , Galactosilceramidas/farmacología , Regulación Bacteriana de la Expresión Génica/fisiología , Íleon/efectos de los fármacos , Íleon/patología , Inflamación , Interleucina-17/genética , Articulación de la Rodilla/efectos de los fármacos , Articulación de la Rodilla/patología , Activación de Linfocitos , Ratones , Ratones Endogámicos BALB C , Salmonelosis Animal/patología , Células Th17RESUMEN
Our previous study has shown that mangiferin (MGF), a glucosylxanthone from Mangifera indica, exerts gastrointestinal prokinetic action involving a cholinergic mechanism. Postoperative ileus (POI) is a temporary disturbance in gastrointestinal motility following surgery, and intestinal inflammatory response plays a critical role in the pathogenesis of POI. The present study investigated to know whether MGF having anti-inflammatory and prokinetic actions can ameliorate the intestinal inflammation and impaired gastrointestinal transit seen in the mouse model of POI. Experimental POI was induced in adult male Swiss mice by standardized small intestinal manipulation (IM). Twenty-four hours later, gastrointestinal transit was assessed by charcoal transport. MGF was administered orally 1 h before the measurement of GIT. To evaluate the inflammatory response, plasma levels of proinflammatory cytokines TNF-α, IL-1ß, IL-6, and chemokine MCP-1, and the myeloperoxidase activity, nitrate/nitrite level, and histological changes of ileum were determined in mice treated or not with MGF. Experimental POI in mice was characterized by decreased gastrointestinal transit and marked intestinal and systemic inflammatory response. MGF treatment led to recovery of the delayed intestinal transit induced by IM. MGF in ileum significantly inhibited the myeloperoxidase activity, a marker of neutrophil infiltration, and nitrate/nitrite level and reduced the plasma levels of TNF-α, IL-1ß, IL-6, and MCP-1 as well. MGF treatment ameliorates the intestinal inflammatory response and the impaired gastrointestinal motility in the mouse model of POI.
Asunto(s)
Enterocolitis/prevención & control , Fármacos Gastrointestinales/uso terapéutico , Motilidad Gastrointestinal/efectos de los fármacos , Ileus/prevención & control , Complicaciones Posoperatorias/prevención & control , Xantonas/uso terapéutico , Animales , Citocinas/sangre , Modelos Animales de Enfermedad , Enterocolitis/etiología , Enterocolitis/inmunología , Enterocolitis/patología , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/aislamiento & purificación , Íleon/efectos de los fármacos , Íleon/inmunología , Íleon/patología , Ileus/etiología , Ileus/inmunología , Ileus/patología , Masculino , Mangifera/química , Ratones , Corteza de la Planta/química , Raíces de Plantas/química , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/patología , Xantonas/administración & dosificación , Xantonas/aislamiento & purificaciónRESUMEN
In developing countries, one-third of reactive arthritis (ReA) cases are associated with Salmonella enterocolitis; nevertheless, there is no animal model for studying this pathology. Here we induced a self-limiting Salmonella enterica serovar Enteritidis enterocolitis in mice to analyze the onset of ReA. BALB/c mice received orally 20 µg of streptomycin 24 h before intragastric inoculation of a low dose (3 × 10(3) to 4 × 10(3) CFU) of S. Enteritidis. In response to Salmonella infection, a 30-fold increase in the expression of interleukin-17 (IL-17), measured by quantitative PCR, was observed in mesenteric lymph nodes 5 days postinfection. At this time synovitis was already evident, and concomitantly, a significant increase in joint tumor necrosis factor alpha (TNF-α) was detected by enzyme-linked immunosorbent assay (ELISA). The early development of joint lesions was accompanied by an increased expression of IL-17 in inguinal and popliteal lymph nodes. Infection with 10(7) CFU of an isogenic ΔinvG mutant bearing a defective type III secretion system of Salmonella encoded in the pathogenicity island 1 apparatus (TTSS-1) induced enterocolitis histologically similar to that triggered by the wild-type strain. Interestingly, despite the higher infective dose used, the mutant did not trigger intestinal IL-17. Moreover, no synovitis was observed in mice suffering ΔinvG enterocolitis. Neutralization of IL-17 in mice infected with S. Enteritidis prevented both synovitis and the increment of TNF-α in the joints, suggesting that IL-17 participates in the generation of Salmonella-induced ReA through the induction of TNF-α in the joints.
Asunto(s)
Artritis Infecciosa/etiología , Enterocolitis/microbiología , Interleucina-17/metabolismo , Ganglios Linfáticos/inmunología , Salmonelosis Animal/inmunología , Salmonella enterica/patogenicidad , Animales , Artritis Infecciosa/inmunología , Enterocolitis/inmunología , Enterocolitis/patología , Femenino , Perfilación de la Expresión Génica , Regulación Bacteriana de la Expresión Génica/fisiología , Interleucina-17/genética , Intestinos/patología , Ratones , Ratones Endogámicos BALB C , Salmonelosis Animal/patología , Factor de Necrosis Tumoral alfa/genética , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
La enterocolitis asociada a enfermedad de Hirschsprung (EAEH) se define como la presencia de diarrea, deposiciones explosivas, distensión abdominal y signos radiológicos de obstrucción intestinal o edema de la mucosa. Es la causa más común de mortalidad en pacientes con enfermedad de Hirschsprung (EH). Puede ocurrir en cualquier etapa de la enfermedad, con una incidencia media del 25 por ciento. La fisiopatología es poco conocida. Etiologías potenciales son la obstrucción mecánica, infecciones, barrera mucosa defectuosa, y un sistema inmunológico deficitario. Microscópicamente la EAEH se caracteriza por criptitis y abscesos en las criptas, seguida de ulceración de la mucosa progresiva conduciendo eventualmente a la necrosis transmural. Los pilares del tratamiento son la reanimación con fluidos, la descompresión del intestino y la terapia antibiótica. A veces se requiere de una estoma cuando estas medidas han fracasado. La mayoría de los pacientes con EAEH siguen teniendo trastornos de la función intestinal muchos años después de la cirugía para la enfermedad de Hirschsprung. Investigaciones en la fisiopatología de la EAEH pueden conducir a medidas preventivas y mejores modalidades de tratamiento.
Hirschsprungs-associated enterocolitis(HAEC) is defined as the presence of diarrhea, explosive stools, abdominal distension and radiologic evidence of bowel obstruction or mucosal edema. HAEC is the most common cause of mortality in patients with Hirschsprungs disease. This condition may occur in any stage of the Hirschsprungs disease, with a mean incidence of 25 percent. The pathophysiology is poorly understood. Potential etiologies are mechanical obstruction, infections, defective mucosal barrier, and impaired immunological system. Microscopically HAEC is characterized by cryptitis and crypt abscesses followed by progressive mucosal ulceration eventually leading to transmural necrosis. The mainstays of treatment are fluid resuscitation, decompression of the bowel and antibiotic therapy. Sometimes a stoma is required when such measures have failed. The majority of patients with HAEC continue to have disturbances of bowel function many years after surgery for Hirschsprungs disease. Researchs into the pathophysiology of HAEC can lead to better preventative measures and treatment modalities.
Asunto(s)
Humanos , Enfermedad de Hirschsprung/complicaciones , Enfermedad de Hirschsprung/fisiopatología , Enterocolitis/complicaciones , Enterocolitis/fisiopatología , Enfermedad de Hirschsprung/diagnóstico , Enfermedad de Hirschsprung/patología , Enfermedad de Hirschsprung/terapia , Enterocolitis/diagnóstico , Enterocolitis/patología , Enterocolitis/terapia , Factores de Riesgo , MucinasRESUMEN
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown etiology, probably immune-mediated. PSC is frequently associated with Inflammatory Bowel Disease, usually Ulcerative Colitis and less commonly with Crohn's disease. The small-duct PSC variant occurs in 5%of patients. Eosinophilic gastroenteritis (EG) is another chronic inflammatory disease, characterized by eosinophilic infiltration limited to the digestive tract, and probably of immunoallergic origin. EG is frequently observed in children but it's less commonly seen in adults. EG can affect any segment of the gastrointestinal tract, and recently it has been described an increase in the incidence of the esophagic variant, termed eosinophilic esophagitis.Ileocolonic involvement in EG is rare and clinical manifestations depend of the intestinal layer affected. Patients with mucosal infiltration complain of abdominal pain, fecal occult blood loss and/or protein-losing enteropaty, while signs and symptoms of obstruction are common in those with muscular EG, finally involvement of the serosal layer occurs in 10% and typically presents as eosinophil-rich ascitis. Response to steroids usually is excellent. There is a previous publication in the literature documenting the association of PSC and EG. Here we describe the first case of small-duct PSC associated to EG with ileocolonic involvement.
Asunto(s)
Colangitis Esclerosante/patología , Gastroenteritis/patología , Adulto , Conductos Biliares/patología , Colangitis Esclerosante/diagnóstico por imagen , Colangitis Esclerosante/etiología , Colon Sigmoide/patología , Enterocolitis/patología , Gastroenteritis/diagnóstico por imagen , Gastroenteritis/etiología , Humanos , Mucosa Intestinal/patología , Intestinos/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , RadiografíaAsunto(s)
Agricultura , Brotes de Enfermedades/veterinaria , Enterocolitis/epidemiología , Enterocolitis/veterinaria , Salmonelosis Animal/epidemiología , Sus scrofa/microbiología , Enfermedades de los Porcinos/epidemiología , Animales , Colon/patología , Enterocolitis/microbiología , Enterocolitis/patología , Salmonelosis Animal/patología , Enfermedades de los Porcinos/microbiologíaRESUMEN
Menina de 12 anos com doença de evoluçäo subaguda caracterizada por notável comprometimento do estado geral, envolvimentos linfático, digestivo severo (enterocolite), pulmonar e cutâneo, além de sinais clínicos de hipertensäo portal, que regrediram com a instituiçäo de anfotericina B. O P. braziliensis foi encontrado em biópsias de gânglio cervical, de lesöes cutâneas, de sigmóide e de reto, tendo sido as manifestaçöes digestivas de enterocolite as iniciais, acompanhadas de dor e aumento do volume abdominal, aliados ainda a febre e notável perda de peso.
Asunto(s)
Humanos , Femenino , Niño , Enterocolitis/patología , Paracoccidioidomicosis/patología , Biopsia , Colon Sigmoide/patología , Colonoscopía , Paracoccidioidomicosis/diagnóstico , Paracoccidioidomicosis/tratamiento farmacológico , Recto/patología , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Neutropenic enterocolitis (NE) is a serious complication in neutropenic patients; it often affects the cecum and the ascending colon. Most cases have been reported in neutropenic patients after chemotherapy for hematologic neoplasms, and some in association with conditions such as rheumatoid arthritis, benign cyclic neutropenia, and solid neoplasms. As far as we know, four cases of NE associated to AA (aplastic anemia, hypoplastic bone marrow) have been previously reported, two of them with autopsy studies. The macroscopic findings in the enterocolonic lesions were not illustrated. We report the first two cases in Mexico. The NE was neither clinically nor radiographically suspected initially, i.e. the morphologic diagnosis of their colonic lesions were amebic colitis in one and edematous ulcerated colitis in the other. Medical treatment without surgery was instituted. Both died. The macroscopic aspect of the enterocolonic lesions in NE associated to aplastic anemia in our two patients was similar to that in NE associated to hematologic neoplasms. In Mexico there is little experience in the clinical, radiographic or morphologic diagnosis of this rare association.