Features of cytokine balance with the progression of structural changes in the gastric mucosa in patients with atrophic gastritis

Background. Until now, the issue of the correlation between the cytokine balance and the progression of structural changes in the gastric mucosa remain completely uncertain. At the same time, the determination of the role of cytokine ba­lance as a component of gastric carcinogenesis will make it possible to substantiate new approaches to managing patients with atrophic gastritis. The purpose was to assess the level of pro- and anti-inflammatory cytokines, vascular endothelial growth factor (VEGF) at the stages of progression of structural changes in the gastric mucosa of patients with atrophic gastritis. Materials and methods. The study included 79 individuals with atrophic gastritis who underwent narrow band imaging endoscopic examination. The patients were divided into groups taking into account the revealed structural changes in the gastric mucosa: group I — 7 people with gastric mucosal atrophy without intestinal metaplasia (IM); group II — 16 individuals with gastric mucosal atrophy with IM limited by the antrum; group III — 45 people with diffuse IM against the background of gastric mucosal atrophy; group IV — 10 individuals with gastric mucosal dysplasia. In all patients, we assessed the level of interleukins (IL-8, IL-10, IL-18), tumor necrosis factor alpha (TNF-α), VEGF. Results. In patients of group IV, the concentration of IL-8 in the blood serum was 18.6 (11.3; 23.9) pg/ml that was significantly higher than in group I (by 5.0 times, p < 0.05), group II (by 3.6 times, p < 0.05) and group III (by 3.4 times, p < 0.05). According to the results of the Kruskal-Wallis test, the probability of a difference in the IL-8 level between the groups was 0.0260. The level of VEGF in the blood serum of patients with gastric mucosal dysplasia was significantly increased compared to that in people with gastric mucosal atrophy without IM (by 1.8 times, p < 0.05) and those with gastric mucosal atrophy with IM (by 1.7 times, p < 0.05). Changes in the cytokine balance towards proinflammatory cytokines were most pronounced in patients of groups III and IV; according to the results of the Kruskal-Wallis test, the probability of a difference in the IL-8/IL-10 ratio between the groups was 0.0207. Conclusions. With the progression of structural changes in the gastric mucosa of patients with atrophic gastritis, an increase in the level of proinflammatory cytokines (IL-8, IL-18 and TNF-α) in the blood serum does not induce the secretion of anti-inflammatory cytokines (IL-10). According to the results of the ROC analysis, the diagnostic criteria for the formation of the risk group for detecting dysplastic changes in the gastric mucosa are VEGF level of more than 341.4 mU/ml (sensitivity — 90.0 %, specificity — 77.2 %) and the level of IL-8 above 14.4 pg/ml (sensitivity — 80.0 %, specificity — 78.3 %).

Asymmetric crypt fission in colectomy specimens in patients with ulcerative colitis

AimsWe previously found colonic crypts with asymmetric fission bordering regenerating ulcers in ulcerative colitis (UC). The present objective was to assess the frequency of asymmetric crypt-fission in colectomy specimens from patients with long-lasting UC.MethodsH&E-stained sections from seven colectomies from patients with UC without dysplasia or carcinoma were investigated. Symmetric fission was characterised by branched colon crypts showing ≥2 identical crypts, whereas asymmetric fission exhibited branched colon crypt portraying ≥2 dissimilar crypts, differing in diameter, length and/or shape.ResultsThe number of crypts in fission in the 89 sections was 3586; of those, 2930 (81.7%) were asymmetric and the remaining 656 (18.3%), symmetric. Out of 927 vertically-cut crypts (in well-oriented sections), 912 (98.4%) were asymmetric, and the remaining 14 (1.6%), symmetric, and out 2660, cross-cut (transected) crypts in fission, 2018 (75.9%) were asymmetric and the remaining 642 (24.1%), symmetric.ConclusionCrypt fission is rarely found in the normal colon in adults. Symmetric crypt fission found in UC is possibly triggered by a compensatory homeostatic mechanism of crypt production in mucosal areas replaced by chronic inflammation. But asymmetric crypt fission is a pathological aberration that affects crypts in patients with a particular predisposition to develop mucosal dysplasia. It is suggested that this previously unattended histological parameter be included in the pathological descriptions of colectomy specimens from patients with UC.

P167 Changes of diagnosis after colectomy: a single-center experience

Background Total proctocolectomy (TPC) is relatively common in inflammatory bowel diseases (IBD), occurring more in ulcerative colitis (UC) as compared with Crohn’s disease (CD) (20.3% vs. 10.5% of patients). Among IBD patients undergoing colectomy, a major complication affecting the clinical outcome is the change of diagnosis. In clinical practice, approximately 5% to 20.9% of UC patients develop CD of the pouch or of the neo-small intestine. The incidence of UC diagnosis after colectomy for complicated colonic CD is less clear. Drugs and progression of the disease can dramatically change the histological findings in this patients; endoscopy after baseline can be atypical and doesn’t provide cross-sectional informations about bowel wall. Aim of the study is to assess the rate of diagnosis change after colectomy in our center. Methods All the IBD patients who consecutively underwent TPC with ileal pouch–anal anastomosis (IPAA) or permanent ileostomy from January 2015 to December 2018 in our IBD Unit were included in this observational, retrospective study. Results Thirty-one patients (22 UC; 22 Males) were included in the study. Among UC patients 14 had pancolitis and 8 a left-sided colitis. Seven were steroid-resistant, 8 were steroid-dependant, 14 experienced failure to medical treatment (one or more biologics) and 8 patients had dysplasia. Mayo endoscopic score was 3 in all patients, but 3. In 5 out of 22 UC patients (22%), diagnosis changed in colonic CD after evaluation of the surgical specime by the pathologist. Four of these patients were referred to our institution by peripheral hospitals with a severe disease, requiring urgent/emergent colectomy and was therefore performed only a proctosigmoidoscopy. Permanent ileostomy was performed in all 5 patients. Among the 8 colonic CD patients 2 were steroid-resistant, 2 were steroid-dependant, 7 failed to one or more biologics, 1 showed mucosal dysplasia and two had bowel stenosis. Two patients (20%) were diagnosed as UC after TPC and IPAA could therefore be performed. Conclusion The change of diagnosis leads to a different surgical outcome, resulting in a worsening in former UC patients and in an improvement in former CD patients. An accurate clinical, endoscopic and histological re-evaluation of the patients is therefore mandatory before TPC. Providing an elevated number of specimens to dedicated pathologists is advisable to avoid potential complications especially in UC patients.

Technology of liquid chromatographic serum spectral images fixation in the diagnosis of colonic mucosal dysplasia

Aim. To demonstrate the possibility of use of technology of liquid chromatographic serum spectral images fixing for the diagnosis of colonic epithelial dysplasia in patients with ulcerative colitis. Methods. 49 patients with ulcerative colitis were examined. Colonoscopy with Mayo index evaluation and biopsy of the intestinal mucosa were carried out using OLYMPUS CV-170 device (Japan). Biopsies were taken from the most affected areas of the colonic mucosa (from 3 to 10 biopsies). Morphological study included an assessment of histological activity of ulcerative colitis and colonic mucosal dysplasia. The results of histological studies were evaluated by two experts. High performance liquid chromatography of serum was performed by a standard technique in the chromatograph «Milichrom A-02» (CJSC «EcoNova», Novosibirsk). Statistical analysis of serum chromatograms was performed with the use of chromatograph combined with a PC, the end result was construction of spectral images of the disease. Results. In 13 patients with ulcerative colitis the results of histological examination revealed various degrees of dysplasia. The set of spectral images of different patients, obtained in the processing of chromatograms, composed the diagnostic cloud of a pathological condition. The study revealed complete differentiation of liquid-chromatographic spectral images of serum of patients with ulcerative colitis with and without colonic mucosal dysplasia according to the results of multivariate cluster analysis. The diagnostic accuracy of the method was 88%. Conclusion. The possibility of using the technology of construction and analysis of liquid-chromatographic spectral images of serum for the diagnosis of colonic epithelial dysplasia in patients with ulcerative colitis was demonstrated.