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Carnitine levels in colon, muscle and serum of rats with experimental colitis
37
39 DUODENAL ULCER REBLEEDING M HELICOBACTER ERADICATED PATIENTS: OUR ESPElUENCE
PYLOIU
DIAGNOSTIC ACCURACY OF ANTI-SAfXHAROMYCES CiZEKCYL4E MA&WAN ANTIBODIES IN INFLAMMATORY BOWEL DISEASES F. Costa, M.G. MudQ, M. Bellini, M.R. Romano. L Lambresa, A. Romano. M. Manahetti. F. Cristiani. G. Maltinti S. Marchi Gsstroin~estinal &it- Dept. Inter&Medicine, I&t+ University, Pisa, Italy.
E. Cdiberto, G. MO&, C Frondma. Servizio dt Fastroenterolo8m ed Endoscopia Digesnva Ospedde ‘5 Giovmti di Dio” - Crotone Background: Peptic ulcer disease IS the most frequent cause of gastrointestinal haemorrhage in western countries The ulcer bleeding tends to be a recurring problem and, according to literature, rebleeding 1s sigoiticaatly reduced in Helicobacter Pylori (HP) eradicated patients @ts). Aim: To evaluate the occmce of duodenal ulcer (DU) reblee.din& in m exkded period of 24 months follow-up without maintenance therapy, in HP eradicated patients. Methods: 35 pts were recruited (23 M, mean age 53 yrs, range 25-62), u1 hospital for ulcer duodenal bleed& (8 pts Forrest la, 12 Forrest lb, 9 Forrest 2% 6 Forrest 2b) 6om Jatxmry 94 to January 96. EmoUment criteria were the following: a) no previous history of bleeding; b) no previous treatment with coticosteroids or NSAIDs; c) demoastndion of HP infection in multiple biopsies (3 in ~nttum, 3 in cotpus/tixtdns) collected during foUowin8 endosoopy (&et two we& by bleeding) and snalyzed for the presence of HP ( CP-test and histology). AU patents received omeptr&e (40 m&iay) + amox+llin (1 g x Z/day) + cltnithromycin (500 mg x Z/day) for one we& followed by omeptazole (20 &.%e) for 4 weeks. In case of not emdiatios a second ueebnent was carried out with omepramle (20 mghy), amoxycillin (1 g x Z/day), tidamle (500 mg x 3/day), colloidal bismuth (120 mg x 4/day ) for 2 weeks. Upper digestive cndoscow and colbxtion of am-al biopsies were jmfotmed after 2, 6, 12, 24 months In case of symptotns reamaxe, doscopy was performed immediately. ReseItx Eight weeks after treatmet$ duodenal tdcer was healed in 35135 pts (100%). The cradi~ared pts &et the tirst course of theqy were 29135 (82.9%). In the remaining 6 pts eradication was obtained in the second course. Atlet 12 months no patients showed ulcer rebleeding. In the following years, 2 pts showed nbleeding (1 pt was reinfected), correspondent to 5.7%ofrncpts. Conclusions: The occtmettce of duodenal ulcer rebleediag at 24 months in eradicated pts is 5.7% v&out maintcnaace thempy. Our data supports essentially other studies, according to which DU reblecding at 12 months inHPemdicatedptsvariesfrom0to2%.
A new immunoassay
for antibodies to oligomatmosidic epitopes of the (ASCA) has recently been developed, ASCA are considered a disease-specific marker for C&t’s disease (CD). The aim of our study was to evaluate: 1) the prevalence of ASCA IgG in 110 Wan patients (pts) affected with infletnmatoty bowel diseases; 2) the diagnostic accuracy of ASCA IgG for the diagnosis of CD. We analysed m.tm samples collected from 56 pts with CD, 54 with ulcerative colitis (UC), 14 with celiac disease (C) and 14 with irritable bowel sindrome (IBS). Set-a from 60 healthy donors (I-ID) were also investigated 8s control. ASCA determination wns perfomted by a commercially available ELISA (Medimu SAS, Milano, It&) on serum samples stored at - 20 ‘C for a period ranging 6om 1 week to 4 years. The results were interpreted on the basis of two different cut-off’values; according to manufacturer’s instructions, (OD at 450 nm <0.200 = negative, between 0.200 and 0.300 = indntertninate and > 0.300 = positive) ASCA positivity was found in 12 out of 56 pts (21.4%) with CD, in 2/54 of UC pts (3.7%). in 314 of C pts (14.3%), in O/14 of IBS pts (0%) and in l/60 of HD (1.7%). The ASCA sensitivity for the diagnosis of CD WBS 21.4% with a specificity of 96.5% and a positive predictive value (PPV) and s negative predictive value (NPV) of 70.6% and 75.7% respectively; the overall diagnostic accuracy (DA) was 75.3%. Conversely, when OD > 0.200 was adopted as cut-off, a marked improvement of the assay performance was observed: indeed, 34156 CD pts (60.7%), 4/54 UC pts (7.4%), 2/14 C pts (14.3%) O/14 HIS pts (0%) and 2160 HD (3.3%) tested ASCA positive. Therefore the new cut-off value allowed n significant gain in sensitivity (60.7% vs 21.4%) in PPV (81% vs 70.6%), in NPV (85.9% vs 757%) and in DA (84.8% vs 75.3%) with only a slight decrease in specificity (94.4% vs 96.5%) In conclusion our data confirm that ASCA are a highly specific serological marker for CD; nevertheless we believe that their low sensitivity limits the diagnostic role at least when performed alone. yeast L?accharont~es
cerevisine
38 CARNITINE LEVELS IN COLON, MUSCLE AND SERUM OF RATS WITH EXPERIMENTAL COLITIS D’Amenio G, Cosenza V, Della Valle N, *Petillo 0, Panariello F, “Calvani M. Mazzaoca G. ‘Peluso G. Gastroenterologta Univ Federico /I Napoli, ‘CNR Napoli, “Sigma-Tau Pomezia (RM). Backaround 6 Aims. The lack of carnitine impairs the ability to use fats as fuel during periods of fasting or stress. Reduced camitine in tissue and plasma may be caused by insufficient
HpSA IMMUNOASSAY FOR THE DETECTION AND FOLLOW-UP OF HRLICOBACTRR FYLORI INFECTION &&I, Orsini 8, OttanMli B, Ciancio G, lovi F, Surtenti C. Gastrcenterology Unit, University of Florence, Florence, Italy Background & Aim Several tests arc today avadable for diagnosmg Helicobacfer pylori (Hp) infection, nevertheless none of them is
suitable for all sttuations. To evaluate the sensitivtty and the specificity of HpSA test (Meridian Diagnostic, USA) for the detection of Hp infection on human stools compared to standardized techniques in the pre- and post-treatmat settings. Materio & Methods Stool specimens from 61 consecutive endoscoped patxnts
camitine uptake activity in the intestinal tract and/or impaired reabsorption in the kidney, respectively. In the present study we have evaluated the effect of colitis on the carnitine system in a rat model. Methods. Diierent degrees of colitis were obtained in 2 groups of 5 male Wistar rats by rectal administration of 10 or 20 mg trinitrobenzensulfonic acid (TNB) in 50% ethanol and animals were sacriiced one week later. Five normal rats were used as controls. The levels of free carnitine (LC) and acetil camitine (ALC) in colon, muscle and serum were evaluated by a mass-spectrometer technique. The carnitine translocase was also assessed by Western Blot. m. LC and ALC were decreased in colon of colitic rats; LC levels correlated with the degree of damage (r=O.77. p
”
(MIF:
I
Nom& 33.8+8.8 1 .5.7+x1 I 13.5+x6 I 4.7+1.1 I492i9.1 / 27.9+5.5 rats TN!3 12.4+*.4* 2.9il.l. 9.211.7. 4.3+07 S1.4i8.5 27 8Y.8 lomg 2.7+0.6’ 36 5+53 I? 7i6 3’ TNB 9.7+4.2. 2.7+1.3* 67?1 I’ 20mg ANOVA, Newman Keuls post-hoc analysis, * pa.05 vc normal rats Conchtalons. Our study describes for the first time the decrease of carnitine (as free and acetyl-carnitine) in the inflammed intestinal epithelium that is wall correlated to the degree of colitis. The intestinal damage is also able to induce a systemic secondary deficiency of carnitine. These resuks should emphasize the role of carnitine during colonic damage, which have potential significance in pathophisiology and therapy of
coltiis.
A106
27/34; age range 20.70 years. mean 53.6 years) were
examined. Exclusion criteria were eradication treatment during the previous 3 months, use of Hl-antagonists, proton pump inhibitors, or antiblotics in the last 10 days. Patients with previous gastric surgery and diarrhoea were excluded. Antmm and corpus biopsy specimens were obtained for histology (H & E and G~emsa) and rapid orease test (CL0 test, Delta West PtyLtd, Australia); “C-Urea Breath Test (“C-UBT).(Helicobacter Test lNFA1, Germany; “Curea 75 mg, cut-off 4 “;,,) was also performed (TJ. Hp infectlon was established by the concordance of 2/3 +ve tests. Hp+ve patientc were followed up after 2 (Tt) and 6 weeks (Tz) stopping eradicatton treatment comparing HpSA with ‘?-UBT. The cut-off for the test (HpSA), defined as optical density at 450 nm, was 0.140. Results At-the first diagnosis (T,), of 30 Hp-we panents by the pretined criteria, 24 were HpSA+ve (sensitivity 80 %) and of 31 patients without Hp infection, 30 were HpSA-ve (specificity 96.7 %). The test showed an accuracy, a positive and a negative predictive value of 88.5 W, 96 S and 83.3 %, rescectivelv. Since 4 H~+ve mtxnts resulted drop-out, we referred about 26Hp+ve pat&s at&T, and TX At two weeks (T,) of 4 Hp+ve pauents. 3 were HpSA+ve (sensitivity 75 %), while of 22 patients without Hp infection, 2 I resulted HpSA-ve (specificity 95.4 S). At Tz 22 of 26 pauentS (84.6 ‘?A)resulteh eradicated, while 4/26 (15.4 %) were still Hp+ve wth a sensmwv and a soecificw . . of 75 and 100 %, resoectivelv. Conclusion These results show that the new non-invasive t&t HpSA seems to have a poor sensitivity but a good specificity in the pm and post-treatment settings for detectloo of Hp infectIon even though it appears sufficiently accurate for monitoring Hp status.
.-.
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.11-_----.----1--
39 DUODENAL ULCER REBLEEDING M HELICOBACTER ERADICATED PATIENTS: OUR ESPElUENCE
PYLOIU
DIAGNOSTIC ACCURACY OF ANTI-SAfXHAROMYCES CiZEKCYL4E MA&WAN ANTIBODIES IN INFLAMMATORY BOWEL DISEASES F. Costa, M.G. MudQ, M. Bellini, M.R. Romano. L Lambresa, A. Romano. M. Manahetti. F. Cristiani. G. Maltinti S. Marchi Gsstroin~estinal &it- Dept. Inter&Medicine, I&t+ University, Pisa, Italy.
E. Cdiberto, G. MO&, C Frondma. Servizio dt Fastroenterolo8m ed Endoscopia Digesnva Ospedde ‘5 Giovmti di Dio” - Crotone Background: Peptic ulcer disease IS the most frequent cause of gastrointestinal haemorrhage in western countries The ulcer bleeding tends to be a recurring problem and, according to literature, rebleeding 1s sigoiticaatly reduced in Helicobacter Pylori (HP) eradicated patients @ts). Aim: To evaluate the occmce of duodenal ulcer (DU) reblee.din& in m exkded period of 24 months follow-up without maintenance therapy, in HP eradicated patients. Methods: 35 pts were recruited (23 M, mean age 53 yrs, range 25-62), u1 hospital for ulcer duodenal bleed& (8 pts Forrest la, 12 Forrest lb, 9 Forrest 2% 6 Forrest 2b) 6om Jatxmry 94 to January 96. EmoUment criteria were the following: a) no previous history of bleeding; b) no previous treatment with coticosteroids or NSAIDs; c) demoastndion of HP infection in multiple biopsies (3 in ~nttum, 3 in cotpus/tixtdns) collected during foUowin8 endosoopy (&et two we& by bleeding) and snalyzed for the presence of HP ( CP-test and histology). AU patents received omeptr&e (40 m&iay) + amox+llin (1 g x Z/day) + cltnithromycin (500 mg x Z/day) for one we& followed by omeptazole (20 &.%e) for 4 weeks. In case of not emdiatios a second ueebnent was carried out with omepramle (20 mghy), amoxycillin (1 g x Z/day), tidamle (500 mg x 3/day), colloidal bismuth (120 mg x 4/day ) for 2 weeks. Upper digestive cndoscow and colbxtion of am-al biopsies were jmfotmed after 2, 6, 12, 24 months In case of symptotns reamaxe, doscopy was performed immediately. ReseItx Eight weeks after treatmet$ duodenal tdcer was healed in 35135 pts (100%). The cradi~ared pts &et the tirst course of theqy were 29135 (82.9%). In the remaining 6 pts eradication was obtained in the second course. Atlet 12 months no patients showed ulcer rebleeding. In the following years, 2 pts showed nbleeding (1 pt was reinfected), correspondent to 5.7%ofrncpts. Conclusions: The occtmettce of duodenal ulcer rebleediag at 24 months in eradicated pts is 5.7% v&out maintcnaace thempy. Our data supports essentially other studies, according to which DU reblecding at 12 months inHPemdicatedptsvariesfrom0to2%.
A new immunoassay
for antibodies to oligomatmosidic epitopes of the (ASCA) has recently been developed, ASCA are considered a disease-specific marker for C&t’s disease (CD). The aim of our study was to evaluate: 1) the prevalence of ASCA IgG in 110 Wan patients (pts) affected with infletnmatoty bowel diseases; 2) the diagnostic accuracy of ASCA IgG for the diagnosis of CD. We analysed m.tm samples collected from 56 pts with CD, 54 with ulcerative colitis (UC), 14 with celiac disease (C) and 14 with irritable bowel sindrome (IBS). Set-a from 60 healthy donors (I-ID) were also investigated 8s control. ASCA determination wns perfomted by a commercially available ELISA (Medimu SAS, Milano, It&) on serum samples stored at - 20 ‘C for a period ranging 6om 1 week to 4 years. The results were interpreted on the basis of two different cut-off’values; according to manufacturer’s instructions, (OD at 450 nm <0.200 = negative, between 0.200 and 0.300 = indntertninate and > 0.300 = positive) ASCA positivity was found in 12 out of 56 pts (21.4%) with CD, in 2/54 of UC pts (3.7%). in 314 of C pts (14.3%), in O/14 of IBS pts (0%) and in l/60 of HD (1.7%). The ASCA sensitivity for the diagnosis of CD WBS 21.4% with a specificity of 96.5% and a positive predictive value (PPV) and s negative predictive value (NPV) of 70.6% and 75.7% respectively; the overall diagnostic accuracy (DA) was 75.3%. Conversely, when OD > 0.200 was adopted as cut-off, a marked improvement of the assay performance was observed: indeed, 34156 CD pts (60.7%), 4/54 UC pts (7.4%), 2/14 C pts (14.3%) O/14 HIS pts (0%) and 2160 HD (3.3%) tested ASCA positive. Therefore the new cut-off value allowed n significant gain in sensitivity (60.7% vs 21.4%) in PPV (81% vs 70.6%), in NPV (85.9% vs 757%) and in DA (84.8% vs 75.3%) with only a slight decrease in specificity (94.4% vs 96.5%) In conclusion our data confirm that ASCA are a highly specific serological marker for CD; nevertheless we believe that their low sensitivity limits the diagnostic role at least when performed alone. yeast L?accharont~es
cerevisine
38 CARNITINE LEVELS IN COLON, MUSCLE AND SERUM OF RATS WITH EXPERIMENTAL COLITIS D’Amenio G, Cosenza V, Della Valle N, *Petillo 0, Panariello F, “Calvani M. Mazzaoca G. ‘Peluso G. Gastroenterologta Univ Federico /I Napoli, ‘CNR Napoli, “Sigma-Tau Pomezia (RM). Backaround 6 Aims. The lack of carnitine impairs the ability to use fats as fuel during periods of fasting or stress. Reduced camitine in tissue and plasma may be caused by insufficient
HpSA IMMUNOASSAY FOR THE DETECTION AND FOLLOW-UP OF HRLICOBACTRR FYLORI INFECTION &&I, Orsini 8, OttanMli B, Ciancio G, lovi F, Surtenti C. Gastrcenterology Unit, University of Florence, Florence, Italy Background & Aim Several tests arc today avadable for diagnosmg Helicobacfer pylori (Hp) infection, nevertheless none of them is
suitable for all sttuations. To evaluate the sensitivtty and the specificity of HpSA test (Meridian Diagnostic, USA) for the detection of Hp infection on human stools compared to standardized techniques in the pre- and post-treatmat settings. Materio & Methods Stool specimens from 61 consecutive endoscoped patxnts
camitine uptake activity in the intestinal tract and/or impaired reabsorption in the kidney, respectively. In the present study we have evaluated the effect of colitis on the carnitine system in a rat model. Methods. Diierent degrees of colitis were obtained in 2 groups of 5 male Wistar rats by rectal administration of 10 or 20 mg trinitrobenzensulfonic acid (TNB) in 50% ethanol and animals were sacriiced one week later. Five normal rats were used as controls. The levels of free carnitine (LC) and acetil camitine (ALC) in colon, muscle and serum were evaluated by a mass-spectrometer technique. The carnitine translocase was also assessed by Western Blot. m. LC and ALC were decreased in colon of colitic rats; LC levels correlated with the degree of damage (r=O.77. p
”
(MIF:
I
Nom& 33.8+8.8 1 .5.7+x1 I 13.5+x6 I 4.7+1.1 I492i9.1 / 27.9+5.5 rats TN!3 12.4+*.4* 2.9il.l. 9.211.7. 4.3+07 S1.4i8.5 27 8Y.8 lomg 2.7+0.6’ 36 5+53 I? 7i6 3’ TNB 9.7+4.2. 2.7+1.3* 67?1 I’ 20mg ANOVA, Newman Keuls post-hoc analysis, * pa.05 vc normal rats Conchtalons. Our study describes for the first time the decrease of carnitine (as free and acetyl-carnitine) in the inflammed intestinal epithelium that is wall correlated to the degree of colitis. The intestinal damage is also able to induce a systemic secondary deficiency of carnitine. These resuks should emphasize the role of carnitine during colonic damage, which have potential significance in pathophisiology and therapy of
coltiis.
A106
27/34; age range 20.70 years. mean 53.6 years) were
examined. Exclusion criteria were eradication treatment during the previous 3 months, use of Hl-antagonists, proton pump inhibitors, or antiblotics in the last 10 days. Patients with previous gastric surgery and diarrhoea were excluded. Antmm and corpus biopsy specimens were obtained for histology (H & E and G~emsa) and rapid orease test (CL0 test, Delta West PtyLtd, Australia); “C-Urea Breath Test (“C-UBT).(Helicobacter Test lNFA1, Germany; “Curea 75 mg, cut-off 4 “;,,) was also performed (TJ. Hp infectlon was established by the concordance of 2/3 +ve tests. Hp+ve patientc were followed up after 2 (Tt) and 6 weeks (Tz) stopping eradicatton treatment comparing HpSA with ‘?-UBT. The cut-off for the test (HpSA), defined as optical density at 450 nm, was 0.140. Results At-the first diagnosis (T,), of 30 Hp-we panents by the pretined criteria, 24 were HpSA+ve (sensitivity 80 %) and of 31 patients without Hp infection, 30 were HpSA-ve (specificity 96.7 %). The test showed an accuracy, a positive and a negative predictive value of 88.5 W, 96 S and 83.3 %, rescectivelv. Since 4 H~+ve mtxnts resulted drop-out, we referred about 26Hp+ve pat&s at&T, and TX At two weeks (T,) of 4 Hp+ve pauents. 3 were HpSA+ve (sensitivity 75 %), while of 22 patients without Hp infection, 2 I resulted HpSA-ve (specificity 95.4 S). At Tz 22 of 26 pauentS (84.6 ‘?A)resulteh eradicated, while 4/26 (15.4 %) were still Hp+ve wth a sensmwv and a soecificw . . of 75 and 100 %, resoectivelv. Conclusion These results show that the new non-invasive t&t HpSA seems to have a poor sensitivity but a good specificity in the pm and post-treatment settings for detectloo of Hp infectIon even though it appears sufficiently accurate for monitoring Hp status.
.-.
----.--_--
.11-_----.----1--