Search

Byline: F. M. Ulivieri (1), L. P. Piodi (2), E. Taioli (3), D. Lisciandrano (1), T. Ranzi (2), M. Vezzoli (1), L. Cermesoni (2), P. Bianchi (2) Keywords: Key words:DXA -- Inflammatory bowel disease -- Longitudinal studies -- Osteoporosis Abstract: Reduced bone mineral density (BMD) has been reported in ulcerative colitis (UC), but there are no data concerning body composition (fat and lean mass) in such patients. We used whole body dual-energy X-ray absorptiometry (Hologic QDR 1000W) at baseline and after 6 years of follow-up to study bone density, and fat and lean mass in 43 outpatients with mild UC (21 men, mean age 36 years, range 21--57 years, and 22 women, mean age 35 years, range 23--45 years at baseline disease extent: 2 proctitis, 18 proctosigmoiditis, 8 left colitis, 5 substantial colitis, 10 pancolitis mean disease duration 8 years, range 2--18 years no hospitalization few relapses during the follow-up) and 111 healthy volunteers matched by sex, age and body mass index. There were 5 drop-outs. We observed no significant difference in BMD, or fat and lean mass between the male patients and controls at baseline or after 6 years. The total lean mass (Z-score =-3.2, p=0.001) and trunk lean mass (Z-score =-2.01, p=0.03) of the female patients were lower than those of the controls at baseline, whereas their limb lean mass was higher at both the beginning and the end of the study (Z-score = 2.14, p=0.03 Z-score = 2.8, p=0.004, respectively). At baseline there was a significant negative correlation between lifetime steroid intake (enteral and parenteral) and lumbar spine BMD, obtained as whole body subregion (r=-0.53, p=0.0006). After 6 years there was a significant negative correlation in women between whole body and lumbar spine BMD and both steroid intake (r=-0.53, p=0.01 and r=-0.62, p=0.003) and the number of relapses (r=-0.49, p=0.02 and r=-0.44, p=0.05). Mild UC thus does not represent a risk factor for osteopenia per se. The differences in lean mass between the female patients and controls do not seem to be clinically relevant. Author Affiliation: (1) Servizio di Radiologia, IT (3) Laboratorio Epidemiologico, Ospedale Maggiore di Milano IRCCS, IT (2) Cattedra di Gastroenterologia, Universita degli Studi di Milano, Milan, Italy, IT Article note: Received: July 2000 / Accepted: October 2000

A 40 year old man with dysphagia and a giant fibrovascular polyp of the oesophagus is reported. The patient was followed for two years before removal of the polyp. During this period the tumour markedly increased in size and the oesophagus reached a maximum diameter of 5.9 cm. In presence of the polyp the body of the oesophagus had no pressure activity after swallows and a 22 hour intraoesophageal pH record showed pH greater than 7 for 31.4% of the time and never pH less than 4. After excision of the tumour the oesophagus regained normal size and peristalsis. Intraoesophageal pH greater than 7 and less than 4 were recorded for 1.6% and 16.1% of the time respectively. Dysmotility was probably a contributing factor to the genesis of dysphagia induced by the giant fibrovascular polyp. Prolonged alkalinisation of intraoesophageal pH conceivably reflected altered oesophageal clearing of alkaline salivary and/or oesophageal secretions. [ABSTRACT FROM PUBLISHER]

Endoscopy with multiple biopsies of the upper gastrointestinal tract was repeated yearly over a two to six year period in nine patients with familial polyposis coli from three families. Adenomatous polyps, one to 20 in number and 2-8 mm in size, were detected in the antrum and the first and second duodenal portions in seven patients, while hyperplastic polyps were detected in four patients in the gastric body. In two patients adenomatous tubules were observed in the biopsies of endoscopically normal mucosa from the same area where adenomatous polyps later developed. Lymphoid polyps were detected in the antrum in three cases. Double contrast radiology correlated poorly with endoscopy in the gastric body; it allowed detection of polyps in the third duodenal portion in two more patients. These results confirm that the incidence of adenomas in the upper gastrointestinal tract in familial polyposis coli may be higher than previously suspected. [ABSTRACT FROM PUBLISHER]

Objective: To obtain precise data on the prevalence of oral lesions in inflammatory bowel disease (IBD). Methods: Oral lesions were carefully sought in a consecutive series of 198 Italian IBD outpatients, 77 with Crohn's disease (CD) and 121 with ulcerative colitis (UC); 89 subjects with functional intestinal motility disorders served as controls. Results: The oral lesions detected were angular cheilitis (in 7.8% of CD patients, 5% of UC patients, and 0% of controls (p < 0.05, patients vs controls), lichen (6.5, 5.8, and 3.3%, respectively, p = not significant), aphthous ulcers (5.2, 5.8, and 5.6%, respectively, p = not significant), candidiasis (5.2, 0.8, and 0%, respectively, p < 0.05, CD patients vs controls), benign tumors (5.2, 0, and 7.8%, respectively, p < 0.05, patients vs controls), leukoplakia (5.2, 11, and 3.3%, respectively, p = not significant), and, less frequently, glossitis and herpes labialis. No specific CD oral lesions were observed in this series. No correlation was found between clinical disease activity and frequency of oral lesions. Conclusions: Aphthous ulcers are not common in IBD patients. Oral candidiasis is more frequent in CD than UC patients and controls. [ABSTRACT FROM AUTHOR]

In intermittent acute porphyria there are no specific alterations in the ultrastructure of the liver. In contrast, the constant characteristic of porphyria cutanea tarda is siderosis of the hepatocytes and Kupffer cells. Therefore, between the two types of hepatic porphyria there are no similar ultrastructural lesions. It is still doubtful whether the presence of hepatosiderosis in porphyria cutanea tarda is connected with the hepatopathy or is secondary to an alteration in the porphyrinic metabolism. The role played by lysosomes is discussed. [ABSTRACT FROM PUBLISHER]

In six healthy subjects serum cholesterol was un-changed during a 2-wk period of controlled diet (2750 kcal) followed by a 2-wk period of free diet hut showed a 16% decrease (p < 0.05) during a further 2-wk period of controlled diet to which guar (5.7 g bid) was added. Stool weight, frequency and whole gut transit time did not differ in the diet periods with and without guar. Of guar ingested 82-95% was metabolized in the gut. Mouth to cecum transit of a meal measured by the hydrogen breath test in the same subjects was unaffected by the addition of 5.7 g of guar. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to a commentary on an article about Crohn's disease.

Objectives: To examine the association between early retirement and presence of chronic morbidity in an Italian working population approaching the statutory pension age., Methods: The study population consisted of men and women aged 45-59 years, employed at some time in the past (n = 18,547), who participated in a national cross-sectional survey, conducted in 2005. By means of a standardized questionnaire, information was collected on employment status, chronic diseases, and sociodemographics. The outcome was being retired as of the survey date. The association with number of diseases reported and specific long-term illnesses was assessed through multivariate Poisson regression models with robust standard errors, adjusted for potential confounders (p < 0.05)., Results: In the final multivariable models, people with poorer health were more likely to retire earlier. Diseases of the nervous system, malignant tumors, myocardial infarction, other cardiac diseases, and arthrosis/arthritis were the illnesses most strongly associated with early retirement; furthermore, the risk of retirement increased linearly as the number of diseases reported increased. Among other covariates, age, area of residence, educational level, and occupational social class were also significantly associated with the outcome. Occupational social class significantly modified the association between morbidity and retirement in men, among whom a higher risk of retirement associated with morbidity was observed in the highest, compared with lower social classes., Conclusions: A statistically significant and independent association between chronic morbidity and early retirement was observed among subjects approaching the statutory pension age, suggesting the need to develop interventions to improve prevention and treatment of chronic conditions.

Objective: Reduced bone mineral density (BMD) has been reported in ulcerative colitis (UC) patients, but body composition (fat and lean mass) has never been concomitantly studied. We sought to investigate BMD and body composition in a group of UC outpatients with the following characteristics: age 18-60 yr (men) and 18-45 yr (women); no intestinal resection; no immunosuppressive treatment; and regular menstruation., Methods: Whole body and subregional BMD and body composition in 43 UC patients (21 men, 22 women; male mean age, 36.5 [21-57] yr; female mean age, 35.3 [23-45] yr) and 121 healthy volunteers were studied by means of dual X-ray photon absorptiometry., Results: There were no differences in total and subregional BMD, or fat and lean mass between the patients and controls, except that the total and trunk lean mass of the UC women was lower than that in the normal controls. No correlation was found between lifetime steroid intake and BMD., Conclusions: UC outpatients do not differ from normal subjects in terms of BMD and fat mass. Mild and moderate UC does not represent a risk factor for osteopenia.

Background: Mesalazine enemas are of well proven efficacy for the topical treatment of distal ulcerative colitis. Although new rectal formulations of mesalazine are not expected to be superior in efficacy and tolerability to standard formulations, they may offer secondary advantages in terms of overall acceptability., Aim: To compare the efficacy, tolerability and overall acceptability of a new mesalazine rectal foam (Salofalk foam) with mesalazine enema in the treatment of active distal ulcerative colitis., Patients and Methods: A multicentre study was carried out in patients with active proctitis, proctosigmoiditis and left-sided ulcerative colitis as evaluated by the Clinical Activity Index (CAI > or =4) and Endoscopic Index (EI > or =6). Patients were randomly assigned to receive, in open-label fashion, either mesalazine foam 2 g twice a day or mesalazine enema (2 g/60 ml twice a day) for 3 weeks. Patients who did not achieve remission (defined as CAI <4 and EI <6) after 3 weeks continued the study receiving the alternative galenic formulation for a further 3 weeks., Results: A total of 195 patients were enrolled. Characteristics at baseline were similar except for concomitant therapy with oral 5-ASA products: during the 1st treatment phase, 41% of patients on enema received such treatment vs only 29% of those on foam. Patients with at least one post-treatment efficacy evaluation were included in the intent-to-treat analysis (n=89 foam, n=96 enema). After 3 weeks of treatment, 112 patients were in remission and only 59 patients entered the 2nd treatment phase thus providing data on acceptability. Remission was achieved after 3 weeks in 54% of patients treated with foam and in 67% of those treated with enema. The 90% confidence interval for the difference in remission rates was 0 to 24 and thus within the clinically acceptable range of therapeutic equivalence. At the end of the 2nd phase, 70% of patients switched to foam were in remission vs 65% to the enema. Two patients discontinued treatment with foam prematurely due to anal burning. No clinically important changes were seen in the laboratory tests., Conclusions: Salofalk foam and enema are equally effective for the treatment of proctitis, proctosigmoiditis and left-sided ulcerative colitis. The new foam preparation is as well tolerated and accepted as enemas and can be used as a therapeutic alternative to conventional mesalazine enema formulations.

Unlabelled: Ileorectal anastomosis (IRA) is a possible surgical treatment for hyperacute and drug-unresponsive forms of ulcerative colitis (UC). UC relapses in the rectal remnant usually are prevented by chronic administration of 5-aminosalicylic acid (5-ASA) in topical formulations. The relationships between intestinal absorption and pattern of luminal spread of 5-ASA enemas are still unknown in patients with IRA. We correlated the absorption of a 5-ASA enema with its spread in the distal bowel of patients with IRA as assessed by 99mTc radioenema imaging., Methods: Eight patients with UC in remission and previous IRA received a therapeutic 50-mL 5-ASA enema labeled with 99mTc-sulfer colloid. Absorbed 5-ASA and its major metabolite, acetyl 5-ASA, were measured in plasma, and dynamic images of radiolabeled enema were obtained for 6 h. The retrograde ileal spread (RIS) was determined and expressed as percentage of total enema radioactivity. Plasma levels of 5-ASA and acetyl 5-ASA were measured in six healthy volunteers after administration of the same enema volume with no radiolabeling., Results: The mean 5-ASA plasma level was 0.70 microg/mL (range 0.37-0.95 microg/mL) in patients and 0.96 microg/mL (range 0.78-1.16 microg/mL) in healthy volunteers (P = not significant), and the mean acetyl 5-ASA plasma levels were 0.89 microg/mL (range 0.44-1.19 microg/mL) and 0.84 microg/mL (range 0.51-1.02 microg/mL), respectively (P = not significant). Radioenema imaging allows RIS assessment of patients with IRA. The mean value was 8.5% (range 2%-19.3%) of administered radioactivity, which correlated significantly with the total absorption of 5-ASA in the IRA group (P = 0.033, linear correlation test). Rectal wall contractions recognized by dynamic radioenema imaging were defined as a common cause of RIS episodes., Conclusion: In IRA patients, 5-ASA plasma levels were similar to those in healthy volunteers after administration in enema. Only part of a 50-mL 5-ASA enema reaches the ileum, and radiolabeled imaging shows the degree and number of these RIS episodes. The absorption of 5-ASA can increase in patients compared with healthy volunteers, in the presence of either occasional but significant ileal spread associated with postural factors and abdominal wall contraction or multiple moderate episodes of radioenema backdiffusion related to rectal wall motility.

Objective: To determine the incidence and clinical characteristics at presentation of inflammatory bowel disease (IBD) in a defined area of north Italy., Design: A 4-year prospective population-based epidemiological study., Setting: An area in Lombardia defined by the National Health Service scheme with about 294,000 inhabitants, two referral hospitals and 259 general practitioners (GPs)., Patients: Subjects presenting to a GP with symptoms compatible with IBD underwent a diagnostic work-up at one of the referral hospitals. Those with ulcerative colitis (UC), Crohn's disease (CD) or indeterminate colitis diagnosed according to a defined protocol were included, as were residents of the area with IBD diagnosed elsewhere. Rigid case ascertainment methods were used. Patients were followed for one year; 125 patients were identified., Results: The patient ascertainment rate was constant over the 4 years; UC was diagnosed in 82 patients, CD in 40, and indeterminate colitis in three. The mean annual incidence of IBD for the whole period was 10.6/10(5) inhabitants (95% confidence limits, 7.2-15.1), 7.0/10(5) for UC (4.3-10.7) and 3.4/10(5) (1.6-6.3) for CD. The mean interval between onset of symptoms and diagnosis was under 6 months. The clinical characteristics of our patients were similar to those of north European and American series., Conclusion: The incidence of IBD was higher than previously observed in Italy but was still lower than in some north European countries and in the USA. Our data could be used as a basis for future longitudinal studies and in international comparative investigations.

We studied 267 consecutive Italian patients (146 male, 121 female) with Crohn's disease. Median time from the first symptom to diagnosis at our center was 21 months (range 1-372), whereas median follow-up from the first visit was 38 months (range 1-180). The disease affected the small bowel in 93 (35%) cases, the ileum and colon in 76 (28%), and the colon in 98 (37%). Forty-nine percent of the patients underwent major abdominal surgery for the disease at least once. The cumulative probability of abdominal surgery was 36% and 55%, 60 and 120 months after the onset of symptoms, respectively. Univariate analysis indicated that patients with colon involvement (p less than 0.0001), those with a longer interval between first symptom and diagnosis (p less than 0.0001), and those at an older age at diagnosis (p less than 0.0003) had a significantly greater probability of escaping abdominal surgery. The interval between first symptom and diagnosis, the site of disease, and the age at diagnosis were confirmed as risk factors for surgery, in decreasing order of importance, by multivariate analysis with Cox's proportional hazard model. A prognostic index for first operation based on these variables is proposed.

Twenty-six adult patients with histologically confirmed celiac disease on gluten-free diet after apparent disease remission were reexamined at 4-6 months intervals for a mean period of 55.4 months (range 13-137). Eight patients remained clinically well with normal blood tests. Eighteen patients had clinical or biological abnormalities. Eleven patients reported repeated episodes of meteorism and abdominal pain and/or diarrhea which disappeared in 2 after lactose withdrawal. Iron deficiency and macrocytic anemia were sometimes observed in 5 and 4 patients respectively. Altered plasma calcium, phosphorus and alkaline phosphatase and/or bone densitometry findings were detected in 7 patients. Seventeen patients (12 presenting some of the above findings) agreed to a repeat biopsy: 13 of these showed grade II and 4 grade III abnormalities. Although adult celiac patients may show marked improvement during gluten-free diet, minor clinical disturbances and biochemical abnormalities may still be present.

A radiologic study of 4 biopsy-proven cases of the solitary rectal ulcer (S.R.U.) syndrome was undertaken. The radiologic findings of S.R.U. were rectal stenosis (one with ulcer), polypoid rectal mass, and multiple sub-mucosal defects with shallow ulcers. The S.R.U., which is benign and requires only dietetic treatment, must be differentiated from other more serious entities such as neoplastic and inflammatory bowel disease.