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Abstract Figure (1): Pyruvate kinase M2: Regulation of its expression and role within the glycolytic sequence 9 Figure (2): The Bristol Stool Form Scale (BSFS) 19 Figure (3): Proposed model of interactions between different potential pathogenetic factors involved in the development of IBS 23 Figure (4): Etiologic theories of inflammatory bowel diseases 39 Figure (5): Common Cellular Pathways of Activation in Inflammatory Bowel Disease 40 Figure (6): Role of the gut microbiota in immunity and inflammatory bowel disease 41 Figure (7): Diagnostic approach of UC. 47 Figure (8): Diagnostic approach of CD 52 Figure (9): Common and distinct features of IBD 54 Figure (10): Mangement of UC 61 Figure (11): Mangement of CD 62 Figure (12): Colonoscopic view of colorectal polyps and microscopic picture of tubular and villous adenoma 68 Figure (13): Algorithm for the management of malignant colon polyps. 78 Figure (14): Endoscopic Sub mucosal Dissection 79 Figure (15): The Category of Hereditary Nonpolyposis Colorectal Cancer 87 Figure (16): Multiple Pictures from Different Cases of the Study 116 Figure (17): Plasma M2-Pyruvate Kinase (M2-PK) Kits 118 Figure (18): Reagent Preparation 119 Figure (19): Column chart showing Comparison between the Studied Groups as Regard age 124 Figure (20): Column chart showing Comparison between the Studied Groups as Regard sex 124 Figure (21): Column chart showing Comparison between the Studied Groups as regard abdominal pain 126 Figure (22): Column chart showing Comparison between the Studied Groups as regard bleeding per rectum 126 Figure (23): Column chart showing Comparison between the Studied Groups as regard constipation 127 Figure (24): Column chart showing Comparison between the Studied Groups as regard diarrhea 127 Figure (25): Column chart showing Comparison between the Studied Groups as Regard weight loss 128 Figure (26): Column chart showing Comparison between the Studied Groups as Regard pallor 128 Figure (27): Box plot chart showing the Comparison between the studied groups as regard ESR 130 Figure (28): Box plot chart showing the Comparison between the studied groups as regard CRP 130 Figure (29): Column chart showing Comparison between the Studied Groups as Regard Hb 132 Figure (30): Column chart showing Comparison between the Studied Groups as Regard platelets 132 Figure (31): Box plot chart showing the Comparison between groups as regard CEA 134 Figure (32): Column chart showing Comparison between the Studied Groups as Regard plasma M2 PK 134 Figure (33): Column chart showing Comparison between the Studied Groups as Regard FOBT 136 Figure (34): Column chart showing Comparison between the Studied Groups as Regard stool analysis 136 Figure (35): Scatter plot diagram showing the correlation between plasma M2 PK and age 140 Figure (36): scatter plot diagram showing the correlation between plasma M2 PK and ESR 141 Figure (37): scatter plot diagram showing the correlation between plasma M2 PK and CRP 141 Figure (38): scatter plot diagram showing the correlation between plasma M2 PK and Hb 142 Figure (39): scatter plot diagram showing the correlation between plasma M2 PK and CEA 142 Figure (40): Column chart showing the correlation between plasma M2 PK and IBD group as regard colonoscopy finding 144 Figure (41): Column chart showing the relation between plasma M2 PK and IBD, colorectal polyps and CRC groups as regard histopathological finding. 146 Figure (42): Column chart showing the relation between plasma M2 PK and (colorectal polyps and CRC groups) as regard grading 147 Figure (43): Roc curve of CEA and Plasma M2 PK between IBS and IBD group in predicting of IBD group 148 Figure (44): Roc curve of CEA and Plasma M2 PK between IBS and Colorectal polyps group in predicting of Colorectal polyps group 149 Figure (45): Roc curve of CEA and Plasma M2 PK between IBS and CRC group in predicting of CRC group 150 Figure (46): Roc curve of Plasma M2 PK between IBD and Colorectal polyps group in predicting of Colorectal polyps group 151 Figure (47): Roc curve of CEA and Plasma M2 PK between IBD and CRC groups in predicting of CRC group 152 Figure (48): Roc curve of CEA and Plasma M2 PK between Colorectal polyps and CRC groups in predicting of CRC group 153 Figure (49): Box plot chart showing the Comparison between functional and organic groups as regard CEA 154 Figure (50): Column chart showing Comparison functional and organic groups as regard plasma M2 PK 155 Figure (51): Column chart showing Comparison functional and organic groups as regard CA19-9 155 Figure (52): Column chart showing Comparison functional and organic groups as regard stool analysis 156 Figure (53): Column chart showing Comparison functional and organic groups as regard FOBT 156 Figure (54): Roc curve of CEA and Plasma M2 PK between functional and organic groups in predicting of organic group 157 Abstract Background: Differentiating between functional bowel disorders and organic colonic disorders can often be difficult as they may be present with similar symptoms. Aim of the Work: to evaluate the diagnostic value of plasma M2-pyruvate kinase level in differentiating functional colonic disorders (e.g: IBS) from organic colonic disorders (e.g: IBD, colorectal polyps and colorectal cancer) and to assess its use as screening tools for inflammatory bowel disease, pre-malignant and malignant colorectal lesions. Patients and Methods: This study was conducted on 80 patients who divided into four groups: group I: included 20 patients, representing functional bowel disorders (as a control group). group II: included 20 patients with inflammatory bowel diseases; group III: included 20 patients with colorectal polyps; group IV: included 20 patients with colorectal cancer. Results: The current study showed that plasma M2 - PK can be used to differentiate functional from organic colonic lesions at a cut-off point > 3 U/mL, with 93.33% sensitivity, 100% specificity, 100% PPV and 83.3% NPV. Also, plasma M2-PK can be used to discriminate between benign (colorectal polyp) and malignant colonic lesions (CRC) with a cut-off level of > 12 U/ml, with 100% sensitivity, 100% specificity, 100% PPV and 100% NPV. Also, In the present study there was a highly significant + ve correlations between Plasma M2 PK level and CEA as (r = 0.787, p value = 0.000) and their combination can give higher sensitivity and specificity. Conclusion: Plasma M2-PK can differentiate between functional and organic colonic disorders as it is more elevated in organic than functional colonic disorders. Also, it is considered a promising rapid noninvasive biomarker for organic colonic disorders early detection and screening to reduce unnecessary endoscopic intervention. |