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73 P Alkaline sphingomyelinase (SMase) activity is decreased in inflamed areas of ulcerative colitis
Inflammatory
73 P
bowel diseases
75 OP
ALKALINE SPHINGOMYFLINASE (SMase) ACTlWTY IS DECREASED IN lNFLAMED AREAS OF ULCERATIVE COLITTIS A Di Sabatino’, R. Ciccocioppo”. B CinqueO.L DI Mar&“, L Ricewti’, R Moteta’, M G Cnfone’,G.R Coraza’ Gestroenterology Lhut, IRCCS Pokhico San Memo, Utiversiti di Pavia;“Dept of Internal Medicme, University of L’Aquila, ‘Dept of ExperimentalMedicine.University of L’Aquda Background B Aims Alkaline SMaseis a key enzymein triggering a signaltransduction pathway leadinglo inhibition of cellprolifemtion andto apoptosis,thus protecting the intestineImucosa againstcercinogenesis To explorewheeler alkalineSMaseactivity IS alteredin ulcerative cohtis (UC), we measuredits sctitity in the intestinalmucosa of UC patients PatientsBr Methods. Endoscopiccolonic biopsy specimenswere collected from macroscopicallyinvolved andtminvoived intestinalareasof 7 UC patients(meanage 34 8 yr, rangeZO-70). and from 10SubJeds(meanage39 2 yr, range28.62) who proved to have timctioneldiartboea Diagnosiswas establishedby clittical andpatb&gical criteria After tissuesamplehomogetdmtioq centrifug&m andprotein amountdeterminatioq SMese activity wes essayedmt the supcsnatantsby incubatingthe sampleswith sphgomyeh in e buffet containing50 mM Ttis-HCI, 2 mM EDTA, 0 I5 M NaCl p” 9 0 and 3 mM bile salt mixture of taurocholate taurcdeoxychole.te gkxocholate glycachenodeoxycholatewith a molarratio of 3 2 1.8 1, for I br at 37 ‘C A&t the addition of a reaction buffer containing50 mM Tris-HCl pH 7 4, 10mM b-glycerophosphate,750 mM ATP, 5 mM EDTA, 5 mM EGTA, 100mM Amplex Red, 8 U/ml alkalinephosphate, 0 2 U/ml cholineoxidase,2 U/ml horsuadisb peroxidasefor 1-2 hrr at 37 “C, the fluorescence was measuredin a microplatereaderusing excitation in the range of 530-560 mtt and emissiondetectionat 590 nm Results.Alkaline Smashactivity was sign&xdly decreased in mvolved areas(median8.03 mu/ml, range 6 10-9.87) comparedto tmittvolvedareas of LBD patients(median12 53 mU/ml, range9 48-15.85, p
H2 FASTING BREATH CONCENTRATION SHOWS GOOD CORRELATION WTH POWELL-TUCK ACTIVITY ,NDEX M PATIENTS WTH “LCERATlVE COLlTlS A PILOT sTUDY G Caravelli,LI Caserta, F Bossa, F R De Filippo, I Esposito,G Riegler SecondaUrdversda di Napoli Background Patientswith active ulcerative cohus (UC), aswe reported, seemto haveratsedHZ concemmtionin exhaledair that could be wnbed to the increasedcatabolismof colomc mucm by intestinalflora Aim ofthis studv was to evaluateH2 &tine breath(H2 FBI in natiemswith UC andto relateit with some clitticalpenmeters andwith e cli&J &is activity index Petientsand methods.The study includeda consecutiveseriesof 53 outpatients(M=29, F=24; medianage38 years, range8 76). Median diseaseduratmnwas 5 years (range 1 26), 64 2% of patientshad a short-standingdisclw (= 7 years) Regard to the extension, 18 9% were proctitis, 37.7% were left-sidedcolitis (distal andlet?c&a) and43 4% were proximalto the splenicflexwe (extewivc/total colitis) The Powell-Tuck Activity Scorewas used es anestablishedindexfor evabmtbtgdiseaseactivity The73 6% of patientswere an clinicalremission,definedas a Powell-Tuck index = 3 H2 breathconcentrationwas determinedby meansofgas-chromatography (Quintron microlyzer) andrepotted as mean fastm8value of threesamples Data were attelysedby meansof non-parametricalstatistical tUtdYSrS Results Results areshowedin the table H2 FB was expressedasmedianof valuesreported for each subsetof patients There was an statisticallysignificantincreasingpositive correlation betweenthe Powell-Tuck index andthe H2 concemmtmnin exhaledair (r=O 35, p
H2FB w* (range) P=
74 P
Duration Short Lag 85 60 1-25 1-32 n.s.
Proctitir 100 Z-32
Erteosion Clinirsl retivily M-sided Pm-colitis Rcmisrion Rdaprc 65 80 60 II 5 I-24 I 32 I-32 2-32 n .r.
H.9
1
76 P
A CASE OF CYTOhiEGALOVIRUS (WV) INFECTION Ii-4SEVERE ULCEBATWE COLITIS (“C) AT ONSET C Vshtini, C Spada,I De Vitis, G Ghittoni, GA Pirozi, L Guidi, N Meg&a”, G Gasbtini, G Fedeli Institute of Internal Medtcme,CatholicUniversity of SacredHear$ Rome, ‘Institute of PathologwI Anatomy. CatholicUniverstty of SacredHeart, Rome. In immunocompetents,ittfecttonis usually &ttptom& or manifestsas mild mononucleosis-likesyndrome GastrointestinalChW infectionis rare, however it can and dots cause&tic& simtilicatttdiseasesA connectionbetweenIBD. in mrtictdat UC. and CMV colitis has ban suggested.CMV infectionhas beendescribedin p&ems with tiD as a eattszof relapse,mainlyin those with steroid ret&tory disease A patient(73 yr old) was referred to out unit with il3-month history of watery bowel movements(up to 15 times deiiy) bloody, fatigue andfever His past medicalhistory was no significant A barium enema anda colonoscopy perfotmed at the onset of symptomsrevealeddivetticulas of the sigmoid colon On our admissionthe patienthad fever, white blood cell 8 98xlO3/ml(48 6% neutropbils,42.6% lymphocitesand 8 2% monocytes; no lymphocitosis), ESR 94, C ReactiveProtein 154 mgidl, fibrinogen 508 mg/dl. Stool culture, stwl ova andparasitetests negattve The patientundetwenta colo~s~py that showed,from rexurn to distal trettsvm.e don difise, muwsd chatgeeof edema,superficialerosions, mucoselbridgesand pseudopolypsthat causeda completealterationof the otgan mggestive for let?-limitedUC in moderateactivity, some divezticulaswere observed Distal tmttsverse andcecum wete normal Rectaland simnoidbiopsiesdemonstratedfocal ulcerations lvmaboalasmacellular mtiltmte in lamina p&pria, pe&riptitis and imn,criptitis changes.CMV incl&ions were fwnd and immtmohisttochemical stainswere positive for CMV cell infection CMVIgM were positive Iv Foscametwas started- in 10days the patientbecameafebrile,the stools normal endhe was discbargedfrom the hospitalin gaod condittons A wlonoscopy 20 days after the dimissionrevealedetytkmatous andfriable mucosain a ~ntinuous disttibutmn wtth evidenceofnumerous pseudopolyps,histologicalexaminationshowedchronic itdlammatotychanges No evidenceof CMV infection was found We discuss the needof consideringthe diagnosisof CMV colitis tmt only in pts with a past histoty of UC but also m pts with UC xt onset,especiallyin there prewtting wtb severe signsand symptoms II
r
RISK OF COLORECTA,. CANCER IN “LCEP.ATl”E COLITIS IN ITALY A C&d*, L Oliva’, A Or,a,,do*, G Martorana*, M Traina’, A R&o”, M Cottane* ‘Divisione dl MedicinaIntenta OspedaleV Cewello - Palermo,‘Se&a OspedaleV Cetvello - Palermo
di AnatomiaPatologica
Background. The risk of c&rectal cancer (CRC) is increasedin patientswith exstensiveand long standingulcerative colitis (UC) The only population-basedstudy in a cohon of 689 patientswith RCU in Florence showedthat &et a medianfollow up of I1 years, the cumulativerisk ofcancer expressed as S I R (standardizedmcidenceratio) was 1.79(95% CI 0 85-3 28) (1) Aim: to evaluatethe risk of colorectal cancer m a population of patientswtb UC in the mediterraneanarea. Patientsandmethods.From 1975to 1995, 1058patxents(pts) (571 men,487 women) with UC were observed in out department The distribution of site at diagnosiswas as fonows 263 rectum. 387 simnoidcolon. 189lefi colon. 74 traverse colon and 145nancolitil Amon* them mfon&tions abouttheir e&al condition of health were obtainedm 9~~$&ts (90%) The medianfoUow up was I I yeas The risk of CRC was valuatedin all pts and then stmtifiedby incident(628 pm) andprevalent(430 pts) cases usingthe Ke&t Meier ‘s method Results: In 1058 pts wtth UC followed for a medianfollow up of 1I years, I5 cancers were observed, 5 among incidentand 10 among prevalentcases The Dukes ’ stageofcancer at diagnosiswes the following. 1 Dukes A, 6 Dukes B, 7 Dukes C and I Dukes D The overall cumulativerate of CRC w.es0,4 % at 10years and 7 2 % at 25 years The cumulativerate of CRC in incidentcaseswas 0.3 % at 10years and5 7 % at 25 years, in prevalentcases was 0 6 % et IO years and7 4 % at 25 years The overall cumulativerate of surgery in our populationwas 22 % at 25 years The initial extent of cohtis in the I5 casesof cancer was the followmg 4 slgmoidcolon, 2 let?colon, 5 wasverse colon, 4 total calms Conclusions In our geographicareathe cumulativensk of CRC anUC is comparableto that observedin the cohort ofFlorence (1) Comparisonwth the generalpopulationIS under evaluation (1) Palli D, Tralloti G, Bagnob S, SaievaC, Tarammo 0 et al “Hodgkin ‘s diseaserisk is mcreasedin panemswith ulceratwe colitts ” Gastroenterology2000, 119. 647-653
A95
73 P
bowel diseases
75 OP
ALKALINE SPHINGOMYFLINASE (SMase) ACTlWTY IS DECREASED IN lNFLAMED AREAS OF ULCERATIVE COLITTIS A Di Sabatino’, R. Ciccocioppo”. B CinqueO.L DI Mar&“, L Ricewti’, R Moteta’, M G Cnfone’,G.R Coraza’ Gestroenterology Lhut, IRCCS Pokhico San Memo, Utiversiti di Pavia;“Dept of Internal Medicme, University of L’Aquila, ‘Dept of ExperimentalMedicine.University of L’Aquda Background B Aims Alkaline SMaseis a key enzymein triggering a signaltransduction pathway leadinglo inhibition of cellprolifemtion andto apoptosis,thus protecting the intestineImucosa againstcercinogenesis To explorewheeler alkalineSMaseactivity IS alteredin ulcerative cohtis (UC), we measuredits sctitity in the intestinalmucosa of UC patients PatientsBr Methods. Endoscopiccolonic biopsy specimenswere collected from macroscopicallyinvolved andtminvoived intestinalareasof 7 UC patients(meanage 34 8 yr, rangeZO-70). and from 10SubJeds(meanage39 2 yr, range28.62) who proved to have timctioneldiartboea Diagnosiswas establishedby clittical andpatb&gical criteria After tissuesamplehomogetdmtioq centrifug&m andprotein amountdeterminatioq SMese activity wes essayedmt the supcsnatantsby incubatingthe sampleswith sphgomyeh in e buffet containing50 mM Ttis-HCI, 2 mM EDTA, 0 I5 M NaCl p” 9 0 and 3 mM bile salt mixture of taurocholate taurcdeoxychole.te gkxocholate glycachenodeoxycholatewith a molarratio of 3 2 1.8 1, for I br at 37 ‘C A&t the addition of a reaction buffer containing50 mM Tris-HCl pH 7 4, 10mM b-glycerophosphate,750 mM ATP, 5 mM EDTA, 5 mM EGTA, 100mM Amplex Red, 8 U/ml alkalinephosphate, 0 2 U/ml cholineoxidase,2 U/ml horsuadisb peroxidasefor 1-2 hrr at 37 “C, the fluorescence was measuredin a microplatereaderusing excitation in the range of 530-560 mtt and emissiondetectionat 590 nm Results.Alkaline Smashactivity was sign&xdly decreased in mvolved areas(median8.03 mu/ml, range 6 10-9.87) comparedto tmittvolvedareas of LBD patients(median12 53 mU/ml, range9 48-15.85, p
H2 FASTING BREATH CONCENTRATION SHOWS GOOD CORRELATION WTH POWELL-TUCK ACTIVITY ,NDEX M PATIENTS WTH “LCERATlVE COLlTlS A PILOT sTUDY G Caravelli,LI Caserta, F Bossa, F R De Filippo, I Esposito,G Riegler SecondaUrdversda di Napoli Background Patientswith active ulcerative cohus (UC), aswe reported, seemto haveratsedHZ concemmtionin exhaledair that could be wnbed to the increasedcatabolismof colomc mucm by intestinalflora Aim ofthis studv was to evaluateH2 &tine breath(H2 FBI in natiemswith UC andto relateit with some clitticalpenmeters andwith e cli&J &is activity index Petientsand methods.The study includeda consecutiveseriesof 53 outpatients(M=29, F=24; medianage38 years, range8 76). Median diseaseduratmnwas 5 years (range 1 26), 64 2% of patientshad a short-standingdisclw (= 7 years) Regard to the extension, 18 9% were proctitis, 37.7% were left-sidedcolitis (distal andlet?c&a) and43 4% were proximalto the splenicflexwe (extewivc/total colitis) The Powell-Tuck Activity Scorewas used es anestablishedindexfor evabmtbtgdiseaseactivity The73 6% of patientswere an clinicalremission,definedas a Powell-Tuck index = 3 H2 breathconcentrationwas determinedby meansofgas-chromatography (Quintron microlyzer) andrepotted as mean fastm8value of threesamples Data were attelysedby meansof non-parametricalstatistical tUtdYSrS Results Results areshowedin the table H2 FB was expressedasmedianof valuesreported for each subsetof patients There was an statisticallysignificantincreasingpositive correlation betweenthe Powell-Tuck index andthe H2 concemmtmnin exhaledair (r=O 35, p
H2FB w* (range) P=
74 P
Duration Short Lag 85 60 1-25 1-32 n.s.
Proctitir 100 Z-32
Erteosion Clinirsl retivily M-sided Pm-colitis Rcmisrion Rdaprc 65 80 60 II 5 I-24 I 32 I-32 2-32 n .r.
H.9
1
76 P
A CASE OF CYTOhiEGALOVIRUS (WV) INFECTION Ii-4SEVERE ULCEBATWE COLITIS (“C) AT ONSET C Vshtini, C Spada,I De Vitis, G Ghittoni, GA Pirozi, L Guidi, N Meg&a”, G Gasbtini, G Fedeli Institute of Internal Medtcme,CatholicUniversity of SacredHear$ Rome, ‘Institute of PathologwI Anatomy. CatholicUniverstty of SacredHeart, Rome. In immunocompetents,ittfecttonis usually &ttptom& or manifestsas mild mononucleosis-likesyndrome GastrointestinalChW infectionis rare, however it can and dots cause&tic& simtilicatttdiseasesA connectionbetweenIBD. in mrtictdat UC. and CMV colitis has ban suggested.CMV infectionhas beendescribedin p&ems with tiD as a eattszof relapse,mainlyin those with steroid ret&tory disease A patient(73 yr old) was referred to out unit with il3-month history of watery bowel movements(up to 15 times deiiy) bloody, fatigue andfever His past medicalhistory was no significant A barium enema anda colonoscopy perfotmed at the onset of symptomsrevealeddivetticulas of the sigmoid colon On our admissionthe patienthad fever, white blood cell 8 98xlO3/ml(48 6% neutropbils,42.6% lymphocitesand 8 2% monocytes; no lymphocitosis), ESR 94, C ReactiveProtein 154 mgidl, fibrinogen 508 mg/dl. Stool culture, stwl ova andparasitetests negattve The patientundetwenta colo~s~py that showed,from rexurn to distal trettsvm.e don difise, muwsd chatgeeof edema,superficialerosions, mucoselbridgesand pseudopolypsthat causeda completealterationof the otgan mggestive for let?-limitedUC in moderateactivity, some divezticulaswere observed Distal tmttsverse andcecum wete normal Rectaland simnoidbiopsiesdemonstratedfocal ulcerations lvmaboalasmacellular mtiltmte in lamina p&pria, pe&riptitis and imn,criptitis changes.CMV incl&ions were fwnd and immtmohisttochemical stainswere positive for CMV cell infection CMVIgM were positive Iv Foscametwas started- in 10days the patientbecameafebrile,the stools normal endhe was discbargedfrom the hospitalin gaod condittons A wlonoscopy 20 days after the dimissionrevealedetytkmatous andfriable mucosain a ~ntinuous disttibutmn wtth evidenceofnumerous pseudopolyps,histologicalexaminationshowedchronic itdlammatotychanges No evidenceof CMV infection was found We discuss the needof consideringthe diagnosisof CMV colitis tmt only in pts with a past histoty of UC but also m pts with UC xt onset,especiallyin there prewtting wtb severe signsand symptoms II
r
RISK OF COLORECTA,. CANCER IN “LCEP.ATl”E COLITIS IN ITALY A C&d*, L Oliva’, A Or,a,,do*, G Martorana*, M Traina’, A R&o”, M Cottane* ‘Divisione dl MedicinaIntenta OspedaleV Cewello - Palermo,‘Se&a OspedaleV Cetvello - Palermo
di AnatomiaPatologica
Background. The risk of c&rectal cancer (CRC) is increasedin patientswith exstensiveand long standingulcerative colitis (UC) The only population-basedstudy in a cohon of 689 patientswith RCU in Florence showedthat &et a medianfollow up of I1 years, the cumulativerisk ofcancer expressed as S I R (standardizedmcidenceratio) was 1.79(95% CI 0 85-3 28) (1) Aim: to evaluatethe risk of colorectal cancer m a population of patientswtb UC in the mediterraneanarea. Patientsandmethods.From 1975to 1995, 1058patxents(pts) (571 men,487 women) with UC were observed in out department The distribution of site at diagnosiswas as fonows 263 rectum. 387 simnoidcolon. 189lefi colon. 74 traverse colon and 145nancolitil Amon* them mfon&tions abouttheir e&al condition of health were obtainedm 9~~$&ts (90%) The medianfoUow up was I I yeas The risk of CRC was valuatedin all pts and then stmtifiedby incident(628 pm) andprevalent(430 pts) cases usingthe Ke&t Meier ‘s method Results: In 1058 pts wtth UC followed for a medianfollow up of 1I years, I5 cancers were observed, 5 among incidentand 10 among prevalentcases The Dukes ’ stageofcancer at diagnosiswes the following. 1 Dukes A, 6 Dukes B, 7 Dukes C and I Dukes D The overall cumulativerate of CRC w.es0,4 % at 10years and 7 2 % at 25 years The cumulativerate of CRC in incidentcaseswas 0.3 % at 10years and5 7 % at 25 years, in prevalentcases was 0 6 % et IO years and7 4 % at 25 years The overall cumulativerate of surgery in our populationwas 22 % at 25 years The initial extent of cohtis in the I5 casesof cancer was the followmg 4 slgmoidcolon, 2 let?colon, 5 wasverse colon, 4 total calms Conclusions In our geographicareathe cumulativensk of CRC anUC is comparableto that observedin the cohort ofFlorence (1) Comparisonwth the generalpopulationIS under evaluation (1) Palli D, Tralloti G, Bagnob S, SaievaC, Tarammo 0 et al “Hodgkin ‘s diseaserisk is mcreasedin panemswith ulceratwe colitts ” Gastroenterology2000, 119. 647-653
A95