2015 · Article · Case-Control

Unexpected reduction in polyp numbers in Chronic Inflammatory conditions of the Colon

Tubular_adenoma_4_low_magI have read this article back in July, and immediately found it interesting.  One reason is that it is (albeit a poor one) an example of the use of “Big Data” type analysis where a large database of patient biopsy specimens can be searched.

Second reason – is the actual clinical finding – less polyps than expected in those with microscopic colitis – prevalence of ALL types of polyps was reduced.

Summary:  130,000 patients with symptoms of diarrhea had a colonoscopy with biopsies.  Compared with 97,000 control cases.  So, in this CASE-CONTROL study for patients with workup of diarrhea – less polyps (Odds ratios = 0.46 for hyperplastic, 0.24for serrated adenomas, and 0.35 for tubular adenomas).

Criticism: It would have been nice if the authors have age-matched the cases one for one from the beginning, even though these were adjusted for. There is no duration of disease, so the mechanism would remain elusive. Although it would be interesting to have someone do a database review of patients whose clinical history is known. It can even be compared to the current study, if the data is available, i.e. authors had 14% of colons have polyps in normals, and 8.3% in microscopic colitis,  is there an influence of disease duration or is this an all or none phenomenon?

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Right-sided colonic ischemia with and without acute mesenteric ischemia

One of the most frustrating calls that I remember getting from ED was related to general confusion between colonic ischemia and acute mesenteric ischemia. It would be a resident calling stating that the Lactate is normal, but “all signs point to mesenteric ischemia” even though there is no abdominal pain, stable vitals, and more often than not no co-morbidities, and reassuring imaging. Which drew my attention to this article, which examined patients with biopsy-proven Right-sided Colonic Ischemia alone or in combination with Acute Mesenteric Ischemia(confirmed by imaging or surgical evaluation of small bowel).

Summary:

  1. IRCI + AMI = disaster. Mortality of ~90%.
  2. BUN and WBC count can be used to differentiate those with acute mesenteric ischemia to those without ( BUN would be high – above 35, and WBCs will be high as well  – above 20). Nothing new here, but nice to see this in another study. We already know that CT alone can be used as well.
  3. 15% of cases of Right-sided Colon ischemia will have Acute Mesenteric Ischemia as well – so look for it, since it is such a disaster, with almost all patients undergoing surgical resection of some sort.
  4.  COPD  may be associated with development of AMI, and poor outcomes in Colonic Ischemia in general.

The article is written by the folks from Connecticut as well as Montefiore Hospital, which bailed out my Medical School recently.