Serum tumor markers are useful to evaluate a cancer's response to treatment, for early detection of cancer relapse, and, in some cases, to diagnose malignancy. In this paper, we present two... Show moreSerum tumor markers are useful to evaluate a cancer's response to treatment, for early detection of cancer relapse, and, in some cases, to diagnose malignancy. In this paper, we present two patients with significantly elevated serum tumor markers without evidence of malignant disease. An 18-year-old patient suffering from autoimmune hepatitis had markedly increased alpha-fetoprotein (aFP) levels (2,002 mu g/L; normal < 10 ug/L). Extensive imaging showed no signs of hepatocellular carcinoma or other cancer, and treatment with Prednisone led to rapid normalization of both liver enzymes and aFP. The second patient, a 60-year-old female with painless jaundice due to biliary stone disease, had very high serum levels of CA19-9 (18,000 kU/L, normal < 27 kU/L). Liver biochemistry and serum CA19-9 concentration decreased to almost normal values (45 kU/L) after biliary stenting. These cases demonstrate that serum tumor markers can be elevated in benign disease and are therefore not appropriate to diagnose cancer. Show less
Objective. Patients with ulcerative colitis in remission (UCR) frequently report irritable bowel syndrome (IBS)-like symptoms. Recent studies have pointed to the role of mast cells in mediating... Show moreObjective. Patients with ulcerative colitis in remission (UCR) frequently report irritable bowel syndrome (IBS)-like symptoms. Recent studies have pointed to the role of mast cells in mediating visceral hypersensitivity in IBS. We hypothesized that visceral hypersensitivity is frequently present in patients with UCR and is related to the quantity and activity of mast cells in the sigmoid mucosa. Material and methods. A group of 17 controls and 19 patients with UCR were studied. Rectal compliance and perception were measured by electronic barostat. Sigmoid biopsies were taken to quantify the amount of mast cells, degranulating mast cells and mast cells in close proximity to mucosal nerve endings. Results. Visceroperception significantly increased in UCR (p < 0.05) versus controls. Rectal perception correlated positively with IBS-like symptoms in UCR (r = 0.969; p < 0.05). The amount of mucosal mast cells (per 100 crypts) was significantly increased in UCR versus controls: 228 perpendicular to 20 versus 163 perpendicular to 18 (p < 0.05). In the UCR patients a higher percentage of mucosal mast cells was in close proximity to nerve endings (58 +/- 4 vs. 38 +/- 3% in controls; p < 0.05) or was degranulating (40 +/- 7 vs. 16 +/- 4% in controls; p < 0.05). There was a significant but weak correlation between quantity of mucosal mast cells and pain perception (r = 0.32; p < 0.05). Conclusion. Rectal hypersensitivity is associated with mucosal presence and activation of mast cells and with IBS-like symptoms in patients with UCR. Show less
Thijssen, A.Y.; Jonkers, D.M.A.E.; Leue, C.; Veek, P.P.J. van der; Vidakovic-Vukic, M.; Rood, Y.R. van; ... ; Masclee, A.A.M. 2010
Goals and Background: Patients with irritable bowel syndrome (IBS) have significantly impaired quality of life (QoL). We investigated the presence of dysfunctional cognitions, anxiety, and... Show moreGoals and Background: Patients with irritable bowel syndrome (IBS) have significantly impaired quality of life (QoL). We investigated the presence of dysfunctional cognitions, anxiety, and depression symptoms and their impact on daily symptoms and QoL in a large IBS cohort. Study: A total of 268 IBS patients (Rome II criteria, age 18 to 65 y) were included. Patients completed a 2-week daily symptom diary. The Short Form-36 was used to score QoL. The 31-items Cognitive Scale for Functional Bowel Disorders (CSFBD) and the Hospital Anxiety and Depression Scale (HADS) were used to analyze the psychological factors. Results: Possible anxiety and depression disorders were present in 30% and 22% of IBS patients, respectively. Patients with anxiety and depression had significantly higher mean symptom scores, impaired QoL, and higher CSFBD scores (P < 0.01). Physical and mental QoL were both affected by depression (HADS-D) and dysfunctional cognitions (P < 0.01). Only physical QoL, not mental QoL, was affected by referral type (hospital setting vs. community based; P< 0.01). Only mental QoL was affected by anxiety (HADS-A) (P< 0.01). Dysfunctional cognitions independently of anxiety and depression influenced QoL and IBS symptoms. Conclusions: In this IBS cohort, dysfunctional cognitions independently influence physical and mental QoL and symptom severity. Presence of possible anxiety and depression disorders resulted in higher symptoms, lower QoL, and higher CSFBD scores. The results point toward an important role of psychological factors, especially dysfunctional cognitions on QoL and symptom scores in IBS patients. Show less
Objective The pathogenesis of irritable bowel syndrome (IBS) is probably multifactorial with dysfunction at different levels of the brain-gut axis. The aim of this study was to evaluate an existing... Show moreObjective The pathogenesis of irritable bowel syndrome (IBS) is probably multifactorial with dysfunction at different levels of the brain-gut axis. The aim of this study was to evaluate an existing biobehavioral model of IBS symptom generation in a large group of patients. Material and methods In 104 IBS patients, we assessed symptom severity by a symptom diary, visceral hypersensitivity using a barostat, autonomic function by measuring arterial baroreflex sensitivity and psychological functioning using questionnaires. Structural equation modeling was used to calculate the reciprocal and chronological relationships between the model variables. Results Analysis of the adjusted original model indicated poor fit [Satorra-Bentler chi(2) = 28.47; degrees of freedom (df) = 11, P < 0.01; comparative fit index (CFI)= 0.78], which was caused by omission of two paths (illness behavior-IBS symptoms and trauma-IBS symptoms). The revised model yielded a reasonable fit (chi(2) = 13.88, df = 9, P = 0.13; CFI = 0.94). The model explained 18.7% of the variance in IBS symptoms. Illness behavior completely mediated the effect of cognitions on IBS symptoms and partly mediated the effect of trauma on IBS symptoms. The fit of this alternative model was good (chi(2) = 9.85, df = 8, P = 0.28; CFI = 0.98). The alternative model explained 20.0% of the variance in IBS symptoms. Conclusion The proposed biobehavioral model could not be validated. Although visceral hypersensitivity and IBS symptom severity significantly correlate, autonomic function and IBS symptoms do not. Cognitive-behavioral aspects are important in the clinical expression of IBS, with illness behavior playing an intermediate and central role. Eur J Gastroenterol Hepatol 22:412-419 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Show less
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by recurrent abdominal pain or discomfort accompanied by disturbed bowel habits. It is among the most frequently... Show moreIrritable bowel syndrome (IBS) is a functional bowel disorder characterized by recurrent abdominal pain or discomfort accompanied by disturbed bowel habits. It is among the most frequently occurring functional bowel syndromes, but the pathophysiology is poorly understood. A variety of mechanisms have been proposed in symptom generation, including enhanced visceral sensitivity, disturbed intestinal motility, autonomic dysfunction, mucosal inflammation, altered immune activity, altered processing of afferent sensory information, and psychological disturbances. These alterations probably reflect dysfunction at different levels of the brain-gut axis. The concept of the brain-gut axis as a model to improve our understanding of the pathophysiology of IBS has been the basis of research in IBS over the last decades and the framework for this thesis. In IBS patients, we demonstrate altered autonomic function by decreased baroreflex sensitivity, changes in proximal and distal gut hormone secretion, impaired postprandial rectocolonic reflex, and increased frequency of a high-producer TNF-alpha gene Single Nucleotide Polymorphism (SNP), compared to healthy individuals. Furthermore, results from a randomized controlled trial favour relaxation training over standard medical care for the treatment of IBS. Finally, we test the validity of a previously published comprehensive working model of IBS, based on the brain-gut axis. Show less
