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Concept: Ileostomy


To investigate the survival of individuals with colorectal cancer (CRC) with inflammatory bowel disease (IBD-associated CRC) compared to that of individuals without IBD diagnosed with CRC.

Concepts: Cancer, Colorectal cancer, Ulcerative colitis, Crohn's disease, Colon, Constipation, Inflammatory bowel disease, Ileostomy


Ulcerative colitis (UC) is a chronic relapsing-remitting form of inflammatory bowel disease (IBD) that increases the risk of colorectal cancer, the third most common malignancy in humans. Oxidative stress is a risk factor for the development of UC. The Keap1-Nrf2-ARE pathway is one of the most important defensive mechanisms against oxidative and/or electrophilic stresses. In this study, we identified CPUY192018 as a potent small-molecule inhibitor of the Keap1-Nrf2 PPI, investigated the cyto-protective effects of CPUY192018 on the NCM460 colonic cells and evaluated whether treatment with the inhibitor of the Keap1-Nrf2 PPI exerts protection on an established experimental model of UC induced by dextran sodium sulfate (DSS). Our study clearly demonstrated that CPUY192018 had a cytoprotective effect against DSS in both NCM460 cells and mouse colon via the activation of Nrf2 signaling. These results suggested that activation of Nrf2 by directly inhibiting the Keap1-Nrf2 PPI may be beneficial as a treatment for UC.

Concepts: Cancer, Ulcerative colitis, Crohn's disease, Colon, Large intestine, Inflammatory bowel disease, Ileostomy, Toxic megacolon


Aim  Current guidelines recommend annual surveillance for colorectal cancer (CRC) in all patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). The aim of our study was to validate the need for annual surveillance for colon neoplasia in patients ≤ 45 of age with a combined diagnosis of PSC and IBD. Method  We identified patients, ≤ 45 years of age with a combined diagnosis of PSC and IBD, who were seen at the Mayo Clinic between 1995 and 2010. We then reviewed the medical records of the patients who developed colonic neoplasia defined as cancer, high-grade dysplasia (HGD) or dysplasia-associated lesion or mass (DALM). Results  In the population of 784 patients ≤ 45 years of age with a combined diagnosis of PSC and IBD, 10 (1.3%) of 784 developed colonic neoplasia during the follow-up period. Seven patients had colon cancer, one had HGD and two had a DALM. Conclusion  Colonic neoplasia is uncommon in young patients (≤ 45 years of age) with a combined diagnosis of PSC and IBD. We suggest delaying surveillance in young patients and propose that studies should be carried out to clarify the cost-effectiveness of annual or biannual surveillance colonoscopies according to patient age.

Concepts: Cancer, Colorectal cancer, Ulcerative colitis, Colon, Constipation, Inflammatory bowel disease, Primary sclerosing cholangitis, Ileostomy


PURPOSE: This study evaluated the risk factors influencing permanent stoma after curative resection of rectal cancer and compared the long-term survival of patients according to the stoma state. METHODS: From January 2004 to December 2010, 895 consecutive rectal cancer patients with histological-confirmed adenocarcinoma who received low anterior resection with curative intent at the Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, were evaluated retrospectively. Patient demographics, times of stoma reversal, and number/reason of permanent stoma were evaluated. RESULTS: Three hundred fifteen patients (35.2 %) had a diverting stoma of temporary intent among 895 rectal adenocarcinoma patients. Loop ileostomy was performed in 271 patients (86.0 %). A total of 256 (81.3 %) of 315 stoma patients received stoma closure. The mean period between primary surgery and stoma closure was 5.6 months (range, 1-44 months). Seventy-three patients (23.2 %) were confirmed with permanent stoma. Multivariate analysis showed stage IV (hazard ratio (HR), 3.380; 95 % confidence interval (CI), 1.192-18.023; p = 0.027), anastomosis-related complication (HR, 3.299; 95 % CI, 1.397-7.787; p = 0.006), colostomy type (HR, 7.276, 95 % CI, 2.454-21.574; p = 0.000), systemic metastasis (HR, 2.698; 95 % CI, 1.1.288-5.653; p = 0.009), and local recurrence (HR, 4.231; 95 % CI, 1.724-10.383; p = 0.002) were independent risk factors for permanent stoma. CONCLUSIONS: On postoperative follow-up, in patients with anastomotic complication, tumor progression with local recurrences and systemic metastasis may cause permanent stoma.

Concepts: Cancer, Oncology, Risk, Surgery, Colorectal cancer, Ileostomy, Colostomy, Ostomy pouching system


Introduction: Colon-specific drug delivery systems have recently gained importance for delivering a variety of therapeutic agents via oral route. This mode offers the feasibility of treating colonic pathologies with less risk of bioburden to other organs/tissues and has been widely researched for the delivery of challenging drugs. Microspheres targeted to colon have occupied central position on drug delivery due to their small size that offers characteristic intrinsic properties attributable to the carrier. Areas covered: The present deliberation precariously covers the capacious usage of microspheres for the treatment of local colonic pathologies like colon carcinomas, inflammatory bowel disease and parasitic diseases using natural as well as synthetic carriers. The write up also encompasses clinical application of microspheres. Expert opinion: Microspheres have comprehensive potential to be marketed as the patient-friendly formulation, as it would provide direct treatment at the disease site and, consequently, lower dosing and reducing systemic side effects. Wherefore, the major obstacles in delivering drugs to the colon like the absorption and degradation pathways in the proximal part of GIT could be easily overcome, and also a range of pathologies from constipation and diarrhea to the exhaustive inflammatory bowel diseases and colon carcinoma could be cured.

Concepts: Inflammation, Cancer, Biopsy, Ulcerative colitis, Crohn's disease, Gastroenterology, Inflammatory bowel disease, Ileostomy


The body image perceptions of persons with a stoma and their partners are rarely examined and have yet to be evaluated in a Turkish sample. Using convenience sampling methods, a descriptive, cross-sectional study was conducted among individuals receiving treatment at the authors' stomatherapy unit between March 1, 2012 and May 31, 2012 to assess the effect of the stoma on self-image and partner perception. Eligible participants had to be >18 years of age, married, and with an abdominal stoma (colostomy, urostomy, or ileostomy) for at least 2 months. Data were obtained through separate (patient or partner), face-to-face, 30-minute to 45-minute interviews using the appropriate questionnaire. Questionnaire items assessed demographic variables and patient/partner feelings toward the ostomate’s body using the Body Cathexis Scale (BCS) and author-developed questionnaires comprising statements eliciting individual responses (agree, disagree, undecided) regarding their feelings toward the stoma. Data were tabulated and analyzed using percentile distributions, and Mann Whitney U and Kruskal Wallis H tests were performed (Bonferroni correction was applied). Sixty (60) patients (25 women, 35 men, mean age 56.01 ± 10.1 years; 25 with an ileostomy, 30 with a colostomy, 5 with an ileostomy) participated, along with their 60 heterosexual partners (mean age 54.56 ± 10.25 years) married a mean of 33.06 ± 11.03 years. Mean patient BCS score was 133.15 ± 20.58 (range 40 - low perception - to 200 - high perception). Mean BCS score of patients whose partner helped in stoma care was significantly higher (136.04) than those whose partners did not (120.27) (P = 0.033). Patients who consulted their partners' opinions on stoma creation and participation in care had significantly higher BCS scores (P <0.05), and BCS scores of patients whose partners thought the stoma had a negative effect on their relationship were significantly lower (P = 0.040); patients' perceptions toward their bodies were parallel to their partners'. Mean BCS score of patients experiencing physical and psychosocial problems was significantly lower than those of patients who did not experience such problems. The results of this study show a number of factors, including involving patient partners before surgery, affect body perception of persons following stoma surgery.

Concepts: Psychology, Surgery, Perception, Mind, Stoma, Ileostomy, Colostomy, Ostomy pouching system


Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear.

Concepts: Medical terms, Hospital, Surgery, Physician, Gastroenterology, Familial adenomatous polyposis, Gastrointestinal bleeding, Ileostomy


The objective was to study morbidity and mortality associated with early closure (8-13 days) of a temporary stoma compared with standard procedure (closure after > 12 weeks) after rectal resection for cancer.

Concepts: Epidemiology, Cancer, Mortality rate, Randomized controlled trial, Colorectal cancer, Ileostomy


Persistent activation of the inflammatory response contributes to development of inflammatory bowel diseases, which increase the risk of colorectal cancer. We aimed to identify microRNAs that regulate inflammation during development of ulcerative colitis (UC) and progression to colitis-associated colon cancer (CAC).

Concepts: Inflammation, Cancer, Colorectal cancer, Ulcerative colitis, Crohn's disease, Colon, Inflammatory bowel disease, Ileostomy


Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes.

Concepts: Inflammation, Patient, Hospital, Physician, Ulcerative colitis, Gastroenterology, Inflammatory bowel disease, Ileostomy