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Colonic Diseases PDF

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COLONIC DISEASES COLONIC DISEASES Edited by R. TIMOTHY KOCH, MD Medical College ofWisconsin, Milwaukee, WI Foreword by jOSEPH B. KIRSNER, MD, PhD, DSci (Hon) The Louis Block Distinguished Service Professor o[M edicine, Department o[M edicine, The University o[ Chicago Pritzker School o[M edicine, Chicago, IL ~ ~ SPRINGER SCIENCE+BUSINESS MEDIA, LLC © Springer Science+Business Media New York 2003 Originally published by Humana Press Inc. in 2003 Softcover reprint ofthe hardcover Ist edition 2003 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com AII rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical. photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work ofthe authors and editors, who have warranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or omissions or for any conequences arising fom the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Cover illustrations: Fig. IA from Chapter 16, "Colonoscopy," by Donald G. Seibert; Fig. 6 from Chapter 17, "Interpretation of Colonic Biopsies in Patients with Diarrhea," by Sarah M. Dry, Galen R. Cortina, and Klaus J. Lewin; Figs. 2C and 3E from Chapter 22, "Cross-Sectional Imaging ofthe Large Bowel," by Diego R. Martin, Ming Yang, and Paul Hamilton; Fig. 1 from Chapter 24, "Acute Megacolon, Acquired Megacolon, and Volvulus," by Marc Stauffer and Timothy R. Koch; and Fig 4. from Chapter 31, "Ischemic Colitis," by Peter Grtibel and David R. Cave. Production Editor: Tracy Catanese Cover design by Patricia F. Cleary. For additional copies, pricing for bulk purchases, and/or information about other Humana titles. contact Humana at the above address or at any ofthe following numbers: Tel: 973-256-1699; Fax: 973-256-8341; E-mail: [email protected] or visit our website at http://www.humanapress.com Due diligence has been taken by the publishers, editors, and authors of this book to assure thc aceuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in aceord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions eonstantly oecurs, the reader is advised to check the product information provided by the manufac turer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to aseertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application ofthe information presented in this book and make no warranty, express ar implied, with respect to the contents in this publication. This publication is printed on acid-free paper.@ ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization PoIicy: Authorization to photocopy items for internal or personal use, or the interna! or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $20.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [0-89603-961-7/03 $20.001. Library of Congress Cataloging-in-Publication Data Main entry under title: Colonic diseases / edited by Timothy R. Koch p. ;cm. IncIudes bibliographica! references and index. ISBN 978-1-4684-9740-3 ISBN 978-1-59259-314-9 (eBook) DOI 10.1007/978-1-59259-314-9 1. Colon (Anatomy)--Diseases. 2. Colon (Anatomy)--Pathophysiology. 1. Koch, Timothy R. [DNLM: 1. Colonic Diseases. 2. Rectal Diseases. 3. Colon--physiology. 4. Rectum--physiology. WI 520 C7177 2003] RC860 .C656 2003 616.3'4--dc21 2002032857 Foreword The Scientification of Gastroenterology During the 20th Century * Science contributes to medicine in three ways: It provides a body of relatively secure knowl edge. Some of that knowledge has been applied to develop technologies which have had a major impact upon the practice and effectiveness ofm edicine. Last, science offers to medicine a way of thinking. - 1. McCormick [(1993) The Contribution of Science to Medicine. Perspect. Bioi. Med. 16,315.] Awareness of the digestive system began with the dawn of civilization, when man, observing the feeding habits of animals in the surrounding environment, experimented with foods, edible and inedible. Identity came with discoveries of the digestive organs during the 16th and 17th centuries. Function was revealed by physiologic studies of digestion, absorp tion and secretion, metabolism, and motility during the 18th and 19th centuries. Diagnostic access improved with the technological advances of the 20th century. Understanding of gas trointestinal (GI) disease followed the growth of the basic sciences and gastroenterology's involvement in scientific research during the latter half of the 20th century. Early in the 20th century, gastroenterology was yet an undefined activity without clinical or scientific guidelines. Diagnostic approach to the digestive tract was minimal. Valid con cepts of disease were lacking. Visceroptosis, sitophobia, and "colonic autointoxication" were common "diagnoses." Therapeutic resources were scarce. The scientification of medicine began during the latter part of the 19th century with the discovery of bacterial causes of disease, and when the dogma of the past began to yield to perceptive observation and investigation. Additional impetus came from A. Flexner's 1910 report on Medical Education, documenting the necessity for a scientific foundation in medi cine. Funds for gastroenterologic investigation remained small, but research was in progress in the physiology laboratories of academic medical centers. During the 1920s, organized clinical gastroenterology programs, led by outstanding phy sicians (1. Friedenwald, W. L. Palmer, H. L. Bockus, C. M. Jones, G. Eusterman), were established at several institutions. The entry of scientifically oriented young physicians into gastroenterology during the 1930s and 1940s energized laboratory and clinical research. Specialization in medicine was underway in the United States, and in 1940 Gastroenterol ogy was certified as a medical and academic specialty. Further progress was interrupted by World War II (1941-1945). Post-World War II was the most productive period in history for the basic and biomedi cal sciences. Wartime discoveries had demonstrated the unlimited potential of research and motivated the public, charitable foundations, and government to support "basic research." 'Based in part on 100 Years of American Gastroenterology (1900-2000). Medscape Gastroen terology January 4, 2000. Available at Website: hup:llwww.medscape.com/medscape/gastrol journa1/2000/v02.nO 1I mgeO 10 3.kirs/mgeO 10 3 .kirs-Ol.html v VI Foreword This trend was accelerated at the end of World War II (August 1945), when the office of Scientific Research and Development (US War Department) transferred 44 military-ori ented research contracts with universities to the National Institutes of Health (NIH). The General Medicine Study Section of the National Institute of Arthritis and Metabolic Dis eases (NIH), established in 1955, became a major support of research and training in medi cine and in gastroenterology. During the 1960s, 1970s, and 1980s, university medical center faculties enlarged, training programs proliferated, and research activities increased, creat ing new technologies and new disciplines. Because science represented knowledge and prestige, Gastroenterology sought to become more "scientific," incorporating basic science into its research. By 1980, gastrointestinal etiopathogenetic concepts had advanced significantly. Because Colonic Diseases deals with the colon, the following selected observations relate to this area of GI. Innovative research on CNS-neurohumoral and neuroimmune interactions of the GI tract, mediating colonic motility, and visceral sensitivity replaced psychogenic hypotheses of the irritable bowel. Physiologic studies modified the process of colon diver ticular formation from pulsion by intraluminal gases to sustained colonic musculature con traction, compartmentalizing the colon into high-pressure segments and forcing mucosa through weaknesses in the bowel wall. Studies of gastrointestinal immunology, including the gut mucosal immune system and the molecular mechanisms of inflammation, generated new etiologic concepts and therapeutic resources in IBD. Advancing fiberoptic methodol ogy expanded access to the GI tract, including the colon. Laser-scanning confocal micros copy enabled study of epithelial cells and intracellular protein processing. Microbiological and chromatographic studies of the enteric flora facilitated the diagnosis of bacterial over growth responsive to antibacterial therapy. Gas chromatographic techniques, breath H2 excretion, and measurement of colonic CH and CO production elevated the study of intes 4 2 tinal gas to a scientific discipline. Quantitative measurements of GI blood flow including laser Doppler velocimetry and the Stromuhr blood-flow technique facilitated recognition of colonic vascular impairment. Neurogastroenterology introduced methods of electrophysiology and cellular neurophysi ology, identified the enteric nervous system as a "minibrain with intelligent circuits," and provided new understanding of "physiologic" GI disorders. Transgenic methodology cre ated innovative animal models, enabling multidisciplinary studies of intestinal inflamma tion. Molecular genetics established the genetic basis of colorectal cancer, identified a colorectal cancer marker among Ashkenazi Jews, and demonstrated the possible preven tion of colorectal cancer via the modulation of APC gene function. Many favoring circumstances converged to bring gastroenterology into the mainstream of advancing scientific thought: l. An enlarging body of basic scientific know ledge and its translation to clinical problems. 2. Technological advances permitting safer and more precise human studies. 3. Public, pharmaceutical, and governmental support of research. 4. The adoption of controlled studies. 5. The contribution of philanthropic organizations (e.g., Rockefeller). 6. The growth and influence of academic medical centers. 7. NIH-supported research and training. 8. The impact of research-oriented societies (e.g., AGA, Gastroenterology Research Group). 9. The enlarging global scientific communication network (journals, databases, and electronic and com puter systems). lO. Increasing awareness of the significant health problems represented in digestive diseases. Foreword vii Karl Popper said "The more we learn ... and the deeper is our learning, the more conscious, specific and articulate will be our knowledge of what we do not know." Gastroenterology's scientific progress notwithstanding, the etiology and pathogenesis of colonic diseases remain incompletely understood and stand as challenges for the 21st century. The expanding fron tiers of gastroenterologic research now include the immunogenetic biology of the intestinal epithelium and the molecular disciplines (microbiology, cell biology, immunology, genetics) mediating colonic physiology and the expression of disease, as reflected in Timothy Koch's well-designed and authoritative book. These remarkable resources form the basis of our opti mism for the future. Joseph B. Kirsner, MD, PhD, DSci (Hon) The Louis Block Distinguished Service Professor of Medicine Department of Medicine The University of Chicago Pritzker School of Medicine, Chicago, IL Preface Colorectal disorders are common diseases that are often chronic in nature. Weare now working with an increasingly older population. This population trend increases the number of individuals with colorectal neoplasia, inflammatory bowel disease, diverticular disease, and constipation. We therefore thought that the beginning of the new millennium was an extremely relevant and timely period to prepare a new book about colorectal disorders. The purpose of Colonic Diseases is to provide a bridge between basic and clinical research and the present clinical care of individuals with colonic disorders. Colonic Dis eases examines the origins and treatment of common colorectal disorders, and it blends new outcomes and epidemiological research with molecular mechanisms of disease to improve our present and future understanding of colonic diseases and their management. Colonic Diseases has been divided into three parts: Colorectal Physiology, Investigation of Disease Processes, and Colorectal Disease. Part I provides an extensive overview of normal colonic physiology. Part II utilizes the expertise of active investigators who are studying the pathophysiology of colonic disorders, and includes a survey of techniques that are used in clinical research of colonic diseases. Understanding the mechanisms of disease development may provide important clues for future therapy. In Part III potential symp toms, pathological and radiological findings, the differential diagnosis, presently recom mended evaluation and therapy, and potential future alternative therapies for common colorectal diseases are reviewed. Colonic Diseases is intended for gastroenterologists, gastrointestinal fellows, and scien tists in gastrointestinal research who are interested in bridging basic and clinical research and diseases processes. This book will be a useful reference resource for primary care phy sicians who care for patients with chronic colonic disorders, and may also prove of interest to colorectal surgeons, although it is not designed to be a textbook for the performance of colorectal surgery. I wish to dedicate this book to Dr. Joseph B. Kirsner, who inspired our great interest in colonic diseases at the University of Chicago, and to Dr. Joseph Szurszewski, who pro moted a strong quantitative approach to basic colonic physiology at the Mayo Clinic in Rochester. I would like to acknowledge the great patience of my wife, Nancy, and my daughter, Kristina, during the preparation of this book. I wish to thank Ms. Debbie Williams for her excellent secretarial and managerial assistance. Timothy R. Koch, MD IX Contents Foreword ............................................................................................................................................... v Preface .................................................................................................................................................. ix Contributors ....................................................................................................................................... xiii Color Plates ....................................................................................................................................... xvii I. PART COLORECTAL PHYSIOLOGY 1 Absorption-Secretion and Epithelial Cell Function.................................................... 3 Pradeep K. Dudeja, Ravinder Gill, and K. Ramaswamy 2 Normal Motility and Smooth Muscle Function .......................................................... 25 Mary Francis Otterson 3 Neural Regulation of Colonic Motor Function .......................................................... 35 Kenton M. Sanders and Terence K. Smith 4 Mucin and Goblet Cell Function ................................................................................ 53 Samuel B. Ho and Laurie L. Shekels 5 Endocrine Cells of the Colon ............................................................................... ' ...... 73 Sebastian G. de la Fuente, Christopher R. Mantyh, and Theodore N. Pappas 6 Micronutrients ................................................ ' ............................................................ 85 Emmanuel C. Opara 7 Aging ........................................................................................................................... 95 Emmanuel C. Opara and Timothy R. Koch 8 Immunology of the Gastrointestinal Tract................................................................ 105 Jonathan R. Fulton, Cynthia A. Cunningham, and Christopher F. Cuff 9 Colonic Lymphatics .................................................................................................. 123 Stacey A. Weiland and Yang K. Chen 10 Probiotics and the Colon: Therapeutic and Prophylactic Uses ............................... 141 Thomas J. Borody and Patricia L Conway 11 Physiology and Pathophysiology of Colorectal Sensory Processes ........................ 163 Michael D. Crowell and Brian E. Lacy II. PART INVESTIGATION OF DISEASE PROCESSES 12 Oxidative Stress ......................................................................................................... 179 Emmanuel C. Opara 13 Genetic Testing for Colon Cancer.................... ................................... ..................... 191 Russell F. Jacoby and Carolyn E. Cole 14 Inflammation ............................................................................................................. 211 Cynthia A. Cunningham, Jonathan R. Fulton, and Christopher F. Cuff Xl xu Contents 15 Epidemiologic Studies and Outcomes Research in Colonic Diseases ..................... 227 John F. Johanson 16 Colonoscopy .............................................................................................................. 243 Donald G. Seibert 17 Interpretation of Colonic Biopsies in Patients with Diarrhea .................................. 275 Sarah M. Dry, Galen R. Cortina, and Klaus J. Lewin 18 Anorectal Manometry ............................................................................................... 297 Devang N. Prajapati and Walter J. Hogan 19 Endoanal and Endorectal Ultrasound ....................................................................... 321 Lisa M. Gangarosa 20 Colonic Transit and Motility ..................................................................................... 335 William J. Snape, Jr. 21 Defecography and Related Radiologic Techniques ................................................. 345 Vincent H. S. Low 22 Cross-Sectional Imaging of the Large Bowel .......................................................... 357 Diego R. Martin, Ming Yang, and Paul Hamilton III. PART COLO RECTAL DISEASE 23 Hirschsprung's Disease and Neonatal Disorders ..................................................... 383 Carol Lynn Berseth 24 Acute Megacolon, Acquired Megacolon, and Volvulus .......................................... 395 Marc Stauffer and Timothy R. Koch 25 Diverticular Disease .................................................................................................. 409 Gordon L. Telford, Susan W. Telford, and Mary F. Otterson 26 Current Understanding of Colorectal Neoplasia ...................................................... 423 Melanie B. Thomas and Robert A. Wolff 27 Constipation ............................................................................................................... 441 Anne Lutz-Vorderbruegge and Arnd Schulte-Bockholt 28 Crohn's Disease ......................................................................................................... 459 Amit G. Shah and Stephen B. Hanauer 29 Ulcerative Colitis ....................................................................................................... 479 Bret A. Lashner 30 Irritable Bowel Syndrome ......................................................................................... 491 Michael Camilleri 31 Ischemic Colitis ......................................................................................................... 505 Peter Griibel and David R. Cave 32 Surgical Treatments for Colonic Diseases ................................................................ 523 Joseph P. Muldoon and Steven J. Stryker 33 Anorectal Disorders ................................................................................................... 535 Mohammed M. H. Kalan and Bruce A. Orkin Index .................................................................................................................................................. 545 Contributors CAROL LYNN BERSETH, MD, Director, Medical Affairs, North America, Mead Johnson Nutritionals, Evansville, IN THOMAS J. BORODY, MD, Centre for Digestive Diseases, Sydney, Australia MICHAEL CAMILLERI, MD, Professor of Medicine and Physiology, Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, MN DAVID R. CAVE, MD, Chief of Gastroenterology, St. Elizabeth Medical Center, Brighton, MA YANG K. CHEN, MD, Professor of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, CO CAROLYN E. COLE, MSN, MM, Associate Director, Colon Cancer Prevention Program, University of Wisconsin, Madison, WI PATRICIA L. CONWAY, MSC, PhD, School of Microbiology and Immunology, University of New South Wales, Sydney, Australia GALEN R. CORTINA, MD, PhD, Department of Pathology and Laboratory Medicine, UCLA Center for the Health Sciences, Los Angeles, CA MICHAEL D. CROWELL, PhD, Senior Director of Scientific Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Marvin M. Schuster Center for Digestive and Motility Disorders, The Johns Hopkins University School of Medicine, Baltimore, MD CHRISTOPHER F. CUFF, PhD, Department of Microbiology, Immunology, and Cell Biology, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV CYNTHIA A. CUNNINGHAM, PhD, Department of Microbiology, Immunology, and Cell Biology, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV SEBASTIAN G. DE LA FUENTE, MD, Fellow, Gastrointestinal Surgery Research, Duke University Medical Center, Durham NC SARAH M. DRY, MD, Department of Pathology and Laboratory Medicine, UCLA Center for the Health Sciences, Los Angeles, CA PRADEEP K. DUDEJA, PhD, Associate Professor of Physiology in Medicine, Department of Medicine, Chicago Westside Veterans Affairs System, University of Illinois at Chicago, Chicago, IL JONATHAN R. FULTON, PhD, Department of Microbiology and Immunobiology, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV LISA M. GANGAROSA, MD, Division of Digestive Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC RAVINDER GILL, PhD, Research Associate, Department of Medicine, Chicago Westside Veterans Affairs System, University of Illinois at Chicago, Chicago, IL PETER GRUBEL, MD, Division of Gastroenterology, New England Medical Center, Boston, MA PAUL HAMILTON, MD, Sunnybrook and Women's College of Health Sciences Center, University of Toronto, Toronto, Canada STEPHEN B. HANAUER, MD, Chief, Division of Gastroenterology, University of Chicago, Chicago,IL SAMUEL B. Ho, MD, Gastroenterology Division, Department of Medicine, Veterans Affairs Medical Center and University of Minnesota, Minneapolis, MN Xlll

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