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6 P Venous thromboembolism, hyperhomocysteinemia and silent coeliac disease: A case report
Small bowel diseases
5OP ASSOCIATION BETWEEN MIGRAINE AND COELIAC DISEASE M Gabnelb*, G Fiore’, G Addolorato’, C Pad&o*, M Candelli*, ME De Leo’, I: C Kim*, L Fini’, I A Cauato’, M Giacovauo”, G Gasbarrini’, P Pala*, A Gasbarnm* -Un~versaBCattobca del Sacra Cuore-Roma, ‘Unwerslta La SaplenraRoma Introduction A previous study of our group showed an high prevalence(4/90,4 4%) of subclinical cebac disease(CD) in patients affected by primary migraine A disordered vascular tone of particular arterial distributions have been invoked in the pathogenesxsof migraine. Studier on cerebral regional blood flow in migraineurs obtained by SPECT techniquerevealed clear interhemispherx asymmetry in the upper frontal and ocapntal regions. The aim ofthe study was to assess a) whether regionalcerebral blood flow abnormalitieswere present in the 4 patients affected by migraine and CD, b) the effects of a gluten-free diet on migraine symptoms and SPECT alterations Methods The 4 migraine patientswith CD and 5 patients without evidenceof CD underwent a bram SPECT study, performed in a headachefree-period. The migmme patientswith CD were treated wth a eluten-t&-diet A self-evaluationtest wa.sused in order to assessthe clinical character&s of migraine at the enrollmentand during a follow-up Periodof 6 months Seroloaic tests (TKA EmA) and ieiunal bioow were re-evaluated at the end of the follow-up period in all the-tigraine pat&& with CI? Results During the 6 months of gluten-free-diet, I of the 4 patientswith CD hadno migrame attacks andin the other 3 there was a remarkable imorovement of freouencv,. duratlon and intensity of migraine The first SPECT study showeda regionalred&on of tracer uptake into brain in all the 4 patients,stmilar for intensity andd>stributionto that observed in patients without CD The cerebral regloxd hypoperfusion completely desappearedat the end of follow-up period Conclustons Our results suggestthat, in patientswth migrameand evidence of CD, a glutenfree diet may led to an unprovement of migraine symptoms, probably via a disappearanceof bypoper&ion ofparticular cerebral arterial distributions
7P FAMILlAL OCCURRENCE OF INFLAMMATORY BOWEL DISEASE IN CELIAC DISEASE C MARRONE’, L OLIVA’, G MARTORANA*, E CALABRESE”, A CASA”. A ORLANDO’, M COTTONE’ *CLINICA mDICAR SAPIENZA ROMA
OSPEDALE CERELLO
PALERMO, ‘UNIVERSITA LA
Background We have previously reported a possible mcreasedrisk of famdial occurrence 01 CD m coebac panems(I) Aim to evaluatem a casecontrol studv the familial occurrence of IBD in first dearee relatives of coebac patients. Patientsand methods 108 consecutwe patientswith biopsy proven co&c diseasewere mterviewed on the presenceof intlammato~ bowel diseasem the first degreerelatrves The number of relatives, the age and the possibleIBD were collected in a questxonnaire When a familial diagnosisof IBD was reported the diagnosiswas checked m the hospital records 108 controls matchedfor ageand sex from the general populationwere also interviewed on the possible occurrence of IBD in first degreerelatives X2 was used to evaluatethe difference m ~ropation Results among 592 first degree relatwes of coebac patients9 first degreerelatives were identified (5 caseswith ulcerative colitn and 4 oatients with Crohn ‘s disease) whereas no cases of GD were identified among the 588 fikst degreerelatives of controipatients (X2 =8211p=OOO2) Conclusions thtr case control study shows that there IS increasedsigmficant prevalence of familial IBD occurrence m pattents with coebac disease The possible role ofthis association is discussed Cottone M et al Famdml association of Crohn ‘s diseaseand coebac dasease Lana 1989.2 338
6P VENOUS THROMBOEMBOLISM. HYPERHOMOCYSTEMEMIA AND SILENT COELIAC DISEASE A CASE REPORT M GabrieIIi, A. Santoliquido,L. Santarelb,L Fml, M C Andnsani,P Pala, G Gasbarnm, A Gasbarnm University Cattolica del SacroCuore-Rome
RlFAXIMlN PROTECTSAGAINST COLITlS DEVELOPMENT BY REDUCING LOCAL IMMUNE RESPONSETO BACTERIAL ANTIGEN S F~omcc,*. E. D,itrutt~*, A. Mencare,,,*, B. PaIazzett,*.M. Barbant,“. E. Palazm,“, A M”dP. ‘“mvers~h’ dl Perogle:‘Alfa-Wasserman”
Hyperhomocystememn is a well known risk factor for venous thrombosis Elevations in serum homocysteine levels is often cawed by detiaencies of folates,vitamins 86 andBI2. which are cofactors ofthe most important enzymesof its metabolicpathway. A vltaminic malabsorptaonis common in celiac disease(CD), either m the classy or m the oligosymptomatic type. We presentthe caseof a 53-year-old man,admitted to our Division for suddenappearanceof edemaand pain of the left leg A duplexultrasound confirmed the presenceof deepvenous thrombosis An angio-CT scan of tboracic and abdominal regions showed smns of acute wlmonarv embohsm andthe thrombus headIII n&renal inferior vena cave At admission&patient r.&rted to have beensuffered of recurrent leg thromboflebites in the past years The most common risk factors for venous thrombosis (homocysteine, C andS proteins,antithrombineIII, C protein resistaxe, lupus anticoagulant,anticardiolipineantibodies,G202IOA genemutation) were investigated. resulting all negative, except homocysteinemiaresulting elevated(60 micromoI&.) The routinary laboratory tests showed hyporideremia and low plasmaticlevels of folates The patientdidn ‘t repat weight loss, dyarroeq stestorroea, bloating or adbominal pain Antiendomysial antibodies(EmA) were present Jeiunalbiopsy showed villoue atrophy A&r 2 weeks of gluten-free diet the pat&t showed nomm~v&es of iro& folate add homocyndnemia (IO 8 micromot’l.) Six months after EmA were negatweandjejunal biopsy showed normal villi No recurrence ofvenous thrombosis were observed in this follow-up period These findings suggestthat silent CD may be associatedto occurrence of deep venous tbrombosys causing folate malabsorptionand concomitant elevationin serum bomocysteinelevels Further studiesappearto be necessary in order to assessthe prevalence of CD in patleas wzth deepvenous thrombosis ofunknown origin and if a successfull gluten-freediet may prevent recurrence ofthe tbrombosts
Background andawns A modificationofthe mtestmal “ora and an mcreasedbactermltranslccat~on1sa common findmg m p&ems with mflammatory bowei dxease and as well as m aumal model of cobtw Rifaxmin is anon-absorbablederivative ofrifamycin an effective antibiotic, that acts by inhibiting bacterial nbonuclac acld (RNA) synthesis Methodsand results In the presentstudy we demonstratedthat admimstrat~onof rifaxlmm, IO,30 Or 50 mgikgiday for 7 days, to mice renderedcob& by intmrectal admimstmtionof 2,4.6triniuobenzenesulfonic acld (TNBS) protects againstcolitn developmentand reduces calms seventy m once with establisheddisease. The beneficialeffect of rifaximin was reflected by increasedsurvival rates, an improvementof macroscopic and histologic scores, a decreax m colon interleukm (IL)-& IL-K mtcrfcron (IFN)- a (protcm and mRNA) levels, and donbushedcolon mycloperoxidase activity Rifaximin administrationcauseda significant reductionofcolon bacterial flora andits translocat~ontowards mesentericlymph nodes. Lamina prapna mononuclearcells obtainedfrom colitic nuce treatedwith rifaxmdn releasedsigntticantly lower amountof IFN- y m responseto ex-vwo stnnulationwtb agonistlcanhCD3 and anti-CD28 antibodies. Rtfaximm, addeddirecdy to lamma pmpria cells had no effect on cymkme production inducedby CDKd28. Adminrstration ofrifaximin from day 21-15 in mice with cstablishcdcolitis (70 @kg/d) $gmlicantly improvedwasting diseacc and diarrheaandcolon mflammatian score In an anothermodel of colitis, admimstratmnof r~Saxmm30 m@d to IL-IO KO mice, from month 3 to 6 ofage, significantly reducedcobtn developmentfrom 65% to 21% (n=l2,gmup, P
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5OP ASSOCIATION BETWEEN MIGRAINE AND COELIAC DISEASE M Gabnelb*, G Fiore’, G Addolorato’, C Pad&o*, M Candelli*, ME De Leo’, I: C Kim*, L Fini’, I A Cauato’, M Giacovauo”, G Gasbarrini’, P Pala*, A Gasbarnm* -Un~versaBCattobca del Sacra Cuore-Roma, ‘Unwerslta La SaplenraRoma Introduction A previous study of our group showed an high prevalence(4/90,4 4%) of subclinical cebac disease(CD) in patients affected by primary migraine A disordered vascular tone of particular arterial distributions have been invoked in the pathogenesxsof migraine. Studier on cerebral regional blood flow in migraineurs obtained by SPECT techniquerevealed clear interhemispherx asymmetry in the upper frontal and ocapntal regions. The aim ofthe study was to assess a) whether regionalcerebral blood flow abnormalitieswere present in the 4 patients affected by migraine and CD, b) the effects of a gluten-free diet on migraine symptoms and SPECT alterations Methods The 4 migraine patientswith CD and 5 patients without evidenceof CD underwent a bram SPECT study, performed in a headachefree-period. The migmme patientswith CD were treated wth a eluten-t&-diet A self-evaluationtest wa.sused in order to assessthe clinical character&s of migraine at the enrollmentand during a follow-up Periodof 6 months Seroloaic tests (TKA EmA) and ieiunal bioow were re-evaluated at the end of the follow-up period in all the-tigraine pat&& with CI? Results During the 6 months of gluten-free-diet, I of the 4 patientswith CD hadno migrame attacks andin the other 3 there was a remarkable imorovement of freouencv,. duratlon and intensity of migraine The first SPECT study showeda regionalred&on of tracer uptake into brain in all the 4 patients,stmilar for intensity andd>stributionto that observed in patients without CD The cerebral regloxd hypoperfusion completely desappearedat the end of follow-up period Conclustons Our results suggestthat, in patientswth migrameand evidence of CD, a glutenfree diet may led to an unprovement of migraine symptoms, probably via a disappearanceof bypoper&ion ofparticular cerebral arterial distributions
7P FAMILlAL OCCURRENCE OF INFLAMMATORY BOWEL DISEASE IN CELIAC DISEASE C MARRONE’, L OLIVA’, G MARTORANA*, E CALABRESE”, A CASA”. A ORLANDO’, M COTTONE’ *CLINICA mDICAR SAPIENZA ROMA
OSPEDALE CERELLO
PALERMO, ‘UNIVERSITA LA
Background We have previously reported a possible mcreasedrisk of famdial occurrence 01 CD m coebac panems(I) Aim to evaluatem a casecontrol studv the familial occurrence of IBD in first dearee relatives of coebac patients. Patientsand methods 108 consecutwe patientswith biopsy proven co&c diseasewere mterviewed on the presenceof intlammato~ bowel diseasem the first degreerelatrves The number of relatives, the age and the possibleIBD were collected in a questxonnaire When a familial diagnosisof IBD was reported the diagnosiswas checked m the hospital records 108 controls matchedfor ageand sex from the general populationwere also interviewed on the possible occurrence of IBD in first degreerelatives X2 was used to evaluatethe difference m ~ropation Results among 592 first degree relatwes of coebac patients9 first degreerelatives were identified (5 caseswith ulcerative colitn and 4 oatients with Crohn ‘s disease) whereas no cases of GD were identified among the 588 fikst degreerelatives of controipatients (X2 =8211p=OOO2) Conclusions thtr case control study shows that there IS increasedsigmficant prevalence of familial IBD occurrence m pattents with coebac disease The possible role ofthis association is discussed Cottone M et al Famdml association of Crohn ‘s diseaseand coebac dasease Lana 1989.2 338
6P VENOUS THROMBOEMBOLISM. HYPERHOMOCYSTEMEMIA AND SILENT COELIAC DISEASE A CASE REPORT M GabrieIIi, A. Santoliquido,L. Santarelb,L Fml, M C Andnsani,P Pala, G Gasbarnm, A Gasbarnm University Cattolica del SacroCuore-Rome
RlFAXIMlN PROTECTSAGAINST COLITlS DEVELOPMENT BY REDUCING LOCAL IMMUNE RESPONSETO BACTERIAL ANTIGEN S F~omcc,*. E. D,itrutt~*, A. Mencare,,,*, B. PaIazzett,*.M. Barbant,“. E. Palazm,“, A M”dP. ‘“mvers~h’ dl Perogle:‘Alfa-Wasserman”
Hyperhomocystememn is a well known risk factor for venous thrombosis Elevations in serum homocysteine levels is often cawed by detiaencies of folates,vitamins 86 andBI2. which are cofactors ofthe most important enzymesof its metabolicpathway. A vltaminic malabsorptaonis common in celiac disease(CD), either m the classy or m the oligosymptomatic type. We presentthe caseof a 53-year-old man,admitted to our Division for suddenappearanceof edemaand pain of the left leg A duplexultrasound confirmed the presenceof deepvenous thrombosis An angio-CT scan of tboracic and abdominal regions showed smns of acute wlmonarv embohsm andthe thrombus headIII n&renal inferior vena cave At admission&patient r.&rted to have beensuffered of recurrent leg thromboflebites in the past years The most common risk factors for venous thrombosis (homocysteine, C andS proteins,antithrombineIII, C protein resistaxe, lupus anticoagulant,anticardiolipineantibodies,G202IOA genemutation) were investigated. resulting all negative, except homocysteinemiaresulting elevated(60 micromoI&.) The routinary laboratory tests showed hyporideremia and low plasmaticlevels of folates The patientdidn ‘t repat weight loss, dyarroeq stestorroea, bloating or adbominal pain Antiendomysial antibodies(EmA) were present Jeiunalbiopsy showed villoue atrophy A&r 2 weeks of gluten-free diet the pat&t showed nomm~v&es of iro& folate add homocyndnemia (IO 8 micromot’l.) Six months after EmA were negatweandjejunal biopsy showed normal villi No recurrence ofvenous thrombosis were observed in this follow-up period These findings suggestthat silent CD may be associatedto occurrence of deep venous tbrombosys causing folate malabsorptionand concomitant elevationin serum bomocysteinelevels Further studiesappearto be necessary in order to assessthe prevalence of CD in patleas wzth deepvenous thrombosis ofunknown origin and if a successfull gluten-freediet may prevent recurrence ofthe tbrombosts
Background andawns A modificationofthe mtestmal “ora and an mcreasedbactermltranslccat~on1sa common findmg m p&ems with mflammatory bowei dxease and as well as m aumal model of cobtw Rifaxmin is anon-absorbablederivative ofrifamycin an effective antibiotic, that acts by inhibiting bacterial nbonuclac acld (RNA) synthesis Methodsand results In the presentstudy we demonstratedthat admimstrat~onof rifaxlmm, IO,30 Or 50 mgikgiday for 7 days, to mice renderedcob& by intmrectal admimstmtionof 2,4.6triniuobenzenesulfonic acld (TNBS) protects againstcolitn developmentand reduces calms seventy m once with establisheddisease. The beneficialeffect of rifaximin was reflected by increasedsurvival rates, an improvementof macroscopic and histologic scores, a decreax m colon interleukm (IL)-& IL-K mtcrfcron (IFN)- a (protcm and mRNA) levels, and donbushedcolon mycloperoxidase activity Rifaximin administrationcauseda significant reductionofcolon bacterial flora andits translocat~ontowards mesentericlymph nodes. Lamina prapna mononuclearcells obtainedfrom colitic nuce treatedwith rifaxmdn releasedsigntticantly lower amountof IFN- y m responseto ex-vwo stnnulationwtb agonistlcanhCD3 and anti-CD28 antibodies. Rtfaximm, addeddirecdy to lamma pmpria cells had no effect on cymkme production inducedby CDKd28. Adminrstration ofrifaximin from day 21-15 in mice with cstablishcdcolitis (70 @kg/d) $gmlicantly improvedwasting diseacc and diarrheaandcolon mflammatian score In an anothermodel of colitis, admimstratmnof r~Saxmm30 m@d to IL-IO KO mice, from month 3 to 6 ofage, significantly reducedcobtn developmentfrom 65% to 21% (n=l2,gmup, P
A27