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Increased plasma levels of antibodies to tissue-type plasminogen activator in patients with inflammatory bowel diseases
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121 US B-MODE IN THE MILD FORM OF lNFLAMMA TORY BOWEL DISEASES(IBD): OUR EXPERIENCE Dieillo M., DeIl’Aquila P.*, CanteD., Amati E., Reale L., Gmndolfo A. Dept. of Gastmenterolagy;“San Paalo’Hospital Dept. of Ultmsonography “S. Rim” Hospital * Ban (Italy) P.O. San Pa010 In recent years, ulbasonography(US) has beenproposedas a diagnosticmethodin associationwith endoscopyand radiology, for the identificationand follow-up of IBD(1). A direct ratio can be observedbetweense&ivi~/specificity of US andgradeof the disease,of which can be evaluated by C&n’s diseaseactivity index (CDAI) andulcerative diseaseactivity index (IJDAI) (I&3). The aim of thep-t study was to evaluatethe sensitivity/specificity of US in patientswith the mild form of IBD. Thirty-five pts., obsewedin last 6 mtbs, and in which mild activity phaseof IBD was diagnosedby clinical (CDAI: 150-200;UDAl: 3-6) endoscopicalandhistological evaluations,were studiedusing US. The lwaliration of the diseasewas iliac (8 pts.); ilm-colic (I pts.); colic (I2 pts.) andrectal (14 pts.). US evaluationswere carried-out with an ESAOTE AU5 ukrasonograph equippedwtb convex 3,5-SMHz and linear7,7-IO MHz probes. Patientswere not submittedto any preparativeprocedurebefore US. Our datashows high ssnsitiviw of the techniquein the mild form of IBD, wit& the exceptionof I4 pts. with exclusively rectal l&Iisation. Howe&, in all 21 pts. with ileo-colic localisation,it was possibleto evaluatepathologicalaspects,such as a light concmhic thickening of the bowel wall (4-6 mm) with a recngnisablestratification; contracted appearanceof the intestine(looseningof ausfmtue in tie colon), a slowing-down of pdstaltic movements.No infomtion could be obtainedregardingthe mild form of IBD with rectal localisahon(I4 pts.) due to a limited tmns-abdominalapproach.The specificity of information pmvided by US in thesecaseswas pax, dueto thefact that similar US aspectscan be observedin other vascular and inflammatorybowel diseases.In conclusion, our dataconfirms the validity of the US B-mode methodeven in the study of mild form of IBD. In our opinion, tbis methodcan be pmpacd in associationwith endoscopy,even in the follow-up of this pathology. I. Arienti V.: Ecogmlia clinica del tmtto gastmentico. Athena 1999.2. Arienti V. et al: Mangemen of severe AIG 1996;91: 2163-69.3. Maconi G. et al: Abdominal US A,G ,996; 9,(S): 1604.08.
123 ASSESSMENTOF QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE WITH SHORT QUESTIONNAIRE
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A. Martin, M.Dinca. Dipartimento di ScicnzeChimrgxhe e Gastmentcmlogiche,Universiti di Padova,Italia. Diparhmentodi ScienceCbimrgiche e Gastmentemlaglche CMLE PADOVA Backgrw,,d Commonly employedresearchinstmments for the measureme”t of health-related quality of life (HRQOL) take a long time to completeand aretherefore not useful for thetreatment of thepatient.Shorter instruments may still give relevant information and be usedin the outpatient settingfor thebenefit of the patient.The aims were to developa short instrument (S-hQPD) and comparethe results with those obtainedwith a well establishedinshument l . Patientsandmethods Two different questionnaires(a long anda short msbument) were usedto evaluatethe QOL in lBD patients.The long questionnaireconsists of 29 questionsandexplore four sspects of QOL (intestinaland systemic symptoms-IS, SS; emotionaland social IimctiowEF, SF). S-MIPD questionnaireconsists of 8 questionswith answers on a 4-point scalewhich explore the sameareas ofthe establishedinsmunent (2 questionsfor every areas). ‘Ihe short questiomtaircwas validated for sensitivity and reliability. ‘Ihe two questionnaireswere administeredto 90 IBD patients:60 with Ulcerative Colitis (UC), mean age41tl2 years, 38 males,22 females,24 in clinical remission,9 wth mild dtsease,27 vnth moderate-severedisease;30 with Cmhn’sDisease(CD), mea age 32+9 yean, I9 males, I I females,7 in clinical remission, I3 with mild disease,IO with moderate-severe disease.Results A significant correlatkm was found betweenthe total scores of the short and long questioluLlirein both UC ( p< O.Mx)l; 1=0.897) andCD ( p
122 VITAMIN B6 STATUS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES:A POSSIBLE DETERMINANT OF THROMBOEMBOLIC COMPLICATIONS. SimoneSaibeni,Mauizio Vecchi, Marco Cattsnea, RossannLomb&i, hiaddalena Loredana Zighetti , Anna Lecchi , Roberto deFran&is. Gastmentemlogy andGastminwtinal Endoscopy Service and Haemophilia andThrombosis Center,IRCCS OspedaleMaggiore and University of Milan, ITALY. IRCCS OspedaleMaggiore BACKGROUND: inflammatory bowel dxeancs (IBD) areat increasedrisk for thmtnbasis and vitamin deficiencies. No data exist aboutthe relationshipbetweenIBD andthe status ofvitamin B6, animpoxtmt cofactor of severalemymatic reactions.Vitamin B6 deiidency is an independerdrisk factor for arterial and venous thmmbasis andmay lead to hyperbomocysteinemia,snother lmown risk factor for thrombosis, which is frequently obsewed in IBD patients.AIM: to evaluatevitamin B6 semm level in lBD patientsandits possible eorrclationswith patients’clinical featuresand hyperhomocysteincmia.PATIENTS AND METHODS: we studied 61 IBD patients previously ewhmted for hypshomocysteinemia: 32 with Cmbn’s disease(15 men, mean age37.3 + 11.1 years) and 29 with ulcerative colitis (IS men,mean age45.5 + 17.8years). For each patients,3 gender-and agematchedhealthy controls were studied. Total plasmahomwysteine was detetmined by meansof HPLC. Vitamin B6 set-a levelswere evabxaedby mw of amdioenzymaic assay. Statisticaldysis was pcrfomcd by meansof Mann-Whitney andFishds exact tests. RESULTS: hyporhomccysteinemia was observed in I2 out of 61 IBD patie& (19,7%) and in 9 out of 183 healthy controls (4.9%) (p
INCREASED PLASMA LEVELS OF ANTIBODIES TO TYSSUE-TYPE PLASMINOGEN ACTIVATOR IN PATtENTS WITH INFLAMMATORY BOWEL DISEASES, Simone Saibeni*.M&o Cunno . Mamizio Vexhi*. Ewa Kawmamk Carla Valsschi”. Robertode Fran&is*. Gaslm&mloey and Gasuviniestinsl Endo.wp; Sawice, Dep&,e,,t of Internal Medicine and^Haemopbilia snd Thrombosis Center.IRCCS OspedaleMatime and Universiry of Milan, ITALY. IRCCS ospedaleMaggiore BACKGROUND: Inllammatory Bowel Diseases(IBDl arecharacterized bv an increased prevalenceof tbmmbaemb.alicevents. Among s&al mechanismspop&d in ihe pathogalesisof thesecomplications,a reduced tibrbmlysis and a0increased~mvs.lmce of antiphwpholipid antibodies(haps anti~agulant and anti-cardiolipinan+ibc&) havebeen de&bed. R&tIy, the presenceof sntibadics to Tissue-type PlasminogenActivator (t-PA), an important enzyme of the fibtiolytic system, has beenpmwsed as a wssible caw of the motbmmbotic statein oatients with theprimary antiphospholipidsyndrm,,~.AIMS: to evaluateihe presence of eat&A antibaiics in IBD patientsandtheir possibleconelation with antiphospholipidantibodiesand previous tbmmbosis.METHODS: 52patientswith IBD, 24 with Ulcerative Colitis (UC) [I4 men, 10 women;mean age+ SD, 41.3 l 15.2years] and28 with Crows disease(CD) [lo mm I8 womm; 39.1+ 13.8years1 were pmspaively emulIed. 12UC oatienrs hadat¢ disease.6 had mildly active d&se and g had &d&tely a&e disease,according to Tmeiove andWitts c&a Among CD patients,22 hadquiescentdisease(CDAI < 150) and6 badactive disease(CDAI > 150). 52gender andwe matchedhealthv subiccts sewed BSnormal contmls. Anti&PA antibcdies were n&&d by anELISA which d&s p&ma immunogb,btdinsspeciEally binding immobilized t-PA. The presenceof Lupus anticoagulantwand&wed accordingto rexntly publishedguidelines.IgG and IgM anticadiolipin antibodieswere measuredby BLISA. RESULTS: IBD patientshad higher anti-t-PA aotobodiesplasmalevels (6.83 -t I .gl U/ml, mean * SD) than normal subjects (5.48 l I.57 U/ml) w.036). 15out of 52 (29%) IBD patimtr bad anti-t-PA antibodiesplasmalevels bigber tlmn the 95thpercentileof normal contmls. The 2 patientswith a history of deepvenous tbmmbosis badhigh plasmalevels of anti-t-PA antibodies(IO.3 U/ml and 20.3U/ml). Antiphospholipid antibodieswe& pnscnt in 5 out of 52 IBD patients{9.6%), one of themhad bigb levels of anti-t-PA antibodies(20.3 U/ml) anda ptwoiw episodeof deepvenous thrombosis.Plasmalevels of anti-t-PA antibodieswere not correlatedwith the activity, the location andthe type of IBD. CONCLUSIONS: our trsults suggestthat high levels of anti-t-PA ant&dies could conhibute to the pmthmmLmticstateobservedin IBD patients.
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121 US B-MODE IN THE MILD FORM OF lNFLAMMA TORY BOWEL DISEASES(IBD): OUR EXPERIENCE Dieillo M., DeIl’Aquila P.*, CanteD., Amati E., Reale L., Gmndolfo A. Dept. of Gastmenterolagy;“San Paalo’Hospital Dept. of Ultmsonography “S. Rim” Hospital * Ban (Italy) P.O. San Pa010 In recent years, ulbasonography(US) has beenproposedas a diagnosticmethodin associationwith endoscopyand radiology, for the identificationand follow-up of IBD(1). A direct ratio can be observedbetweense&ivi~/specificity of US andgradeof the disease,of which can be evaluated by C&n’s diseaseactivity index (CDAI) andulcerative diseaseactivity index (IJDAI) (I&3). The aim of thep-t study was to evaluatethe sensitivity/specificity of US in patientswith the mild form of IBD. Thirty-five pts., obsewedin last 6 mtbs, and in which mild activity phaseof IBD was diagnosedby clinical (CDAI: 150-200;UDAl: 3-6) endoscopicalandhistological evaluations,were studiedusing US. The lwaliration of the diseasewas iliac (8 pts.); ilm-colic (I pts.); colic (I2 pts.) andrectal (14 pts.). US evaluationswere carried-out with an ESAOTE AU5 ukrasonograph equippedwtb convex 3,5-SMHz and linear7,7-IO MHz probes. Patientswere not submittedto any preparativeprocedurebefore US. Our datashows high ssnsitiviw of the techniquein the mild form of IBD, wit& the exceptionof I4 pts. with exclusively rectal l&Iisation. Howe&, in all 21 pts. with ileo-colic localisation,it was possibleto evaluatepathologicalaspects,such as a light concmhic thickening of the bowel wall (4-6 mm) with a recngnisablestratification; contracted appearanceof the intestine(looseningof ausfmtue in tie colon), a slowing-down of pdstaltic movements.No infomtion could be obtainedregardingthe mild form of IBD with rectal localisahon(I4 pts.) due to a limited tmns-abdominalapproach.The specificity of information pmvided by US in thesecaseswas pax, dueto thefact that similar US aspectscan be observedin other vascular and inflammatorybowel diseases.In conclusion, our dataconfirms the validity of the US B-mode methodeven in the study of mild form of IBD. In our opinion, tbis methodcan be pmpacd in associationwith endoscopy,even in the follow-up of this pathology. I. Arienti V.: Ecogmlia clinica del tmtto gastmentico. Athena 1999.2. Arienti V. et al: Mangemen of severe AIG 1996;91: 2163-69.3. Maconi G. et al: Abdominal US A,G ,996; 9,(S): 1604.08.
123 ASSESSMENTOF QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE WITH SHORT QUESTIONNAIRE
A
A. Martin, M.Dinca. Dipartimento di ScicnzeChimrgxhe e Gastmentcmlogiche,Universiti di Padova,Italia. Diparhmentodi ScienceCbimrgiche e Gastmentemlaglche CMLE PADOVA Backgrw,,d Commonly employedresearchinstmments for the measureme”t of health-related quality of life (HRQOL) take a long time to completeand aretherefore not useful for thetreatment of thepatient.Shorter instruments may still give relevant information and be usedin the outpatient settingfor thebenefit of the patient.The aims were to developa short instrument (S-hQPD) and comparethe results with those obtainedwith a well establishedinshument l . Patientsandmethods Two different questionnaires(a long anda short msbument) were usedto evaluatethe QOL in lBD patients.The long questionnaireconsists of 29 questionsandexplore four sspects of QOL (intestinaland systemic symptoms-IS, SS; emotionaland social IimctiowEF, SF). S-MIPD questionnaireconsists of 8 questionswith answers on a 4-point scalewhich explore the sameareas ofthe establishedinsmunent (2 questionsfor every areas). ‘Ihe short questiomtaircwas validated for sensitivity and reliability. ‘Ihe two questionnaireswere administeredto 90 IBD patients:60 with Ulcerative Colitis (UC), mean age41tl2 years, 38 males,22 females,24 in clinical remission,9 wth mild dtsease,27 vnth moderate-severedisease;30 with Cmhn’sDisease(CD), mea age 32+9 yean, I9 males, I I females,7 in clinical remission, I3 with mild disease,IO with moderate-severe disease.Results A significant correlatkm was found betweenthe total scores of the short and long questioluLlirein both UC ( p< O.Mx)l; 1=0.897) andCD ( p
122 VITAMIN B6 STATUS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES:A POSSIBLE DETERMINANT OF THROMBOEMBOLIC COMPLICATIONS. SimoneSaibeni,Mauizio Vecchi, Marco Cattsnea, RossannLomb&i, hiaddalena Loredana Zighetti , Anna Lecchi , Roberto deFran&is. Gastmentemlogy andGastminwtinal Endoscopy Service and Haemophilia andThrombosis Center,IRCCS OspedaleMaggiore and University of Milan, ITALY. IRCCS OspedaleMaggiore BACKGROUND: inflammatory bowel dxeancs (IBD) areat increasedrisk for thmtnbasis and vitamin deficiencies. No data exist aboutthe relationshipbetweenIBD andthe status ofvitamin B6, animpoxtmt cofactor of severalemymatic reactions.Vitamin B6 deiidency is an independerdrisk factor for arterial and venous thmmbasis andmay lead to hyperbomocysteinemia,snother lmown risk factor for thrombosis, which is frequently obsewed in IBD patients.AIM: to evaluatevitamin B6 semm level in lBD patientsandits possible eorrclationswith patients’clinical featuresand hyperhomocysteincmia.PATIENTS AND METHODS: we studied 61 IBD patients previously ewhmted for hypshomocysteinemia: 32 with Cmbn’s disease(15 men, mean age37.3 + 11.1 years) and 29 with ulcerative colitis (IS men,mean age45.5 + 17.8years). For each patients,3 gender-and agematchedhealthy controls were studied. Total plasmahomwysteine was detetmined by meansof HPLC. Vitamin B6 set-a levelswere evabxaedby mw of amdioenzymaic assay. Statisticaldysis was pcrfomcd by meansof Mann-Whitney andFishds exact tests. RESULTS: hyporhomccysteinemia was observed in I2 out of 61 IBD patie& (19,7%) and in 9 out of 183 healthy controls (4.9%) (p
INCREASED PLASMA LEVELS OF ANTIBODIES TO TYSSUE-TYPE PLASMINOGEN ACTIVATOR IN PATtENTS WITH INFLAMMATORY BOWEL DISEASES, Simone Saibeni*.M&o Cunno . Mamizio Vexhi*. Ewa Kawmamk Carla Valsschi”. Robertode Fran&is*. Gaslm&mloey and Gasuviniestinsl Endo.wp; Sawice, Dep&,e,,t of Internal Medicine and^Haemopbilia snd Thrombosis Center.IRCCS OspedaleMatime and Universiry of Milan, ITALY. IRCCS ospedaleMaggiore BACKGROUND: Inllammatory Bowel Diseases(IBDl arecharacterized bv an increased prevalenceof tbmmbaemb.alicevents. Among s&al mechanismspop&d in ihe pathogalesisof thesecomplications,a reduced tibrbmlysis and a0increased~mvs.lmce of antiphwpholipid antibodies(haps anti~agulant and anti-cardiolipinan+ibc&) havebeen de&bed. R&tIy, the presenceof sntibadics to Tissue-type PlasminogenActivator (t-PA), an important enzyme of the fibtiolytic system, has beenpmwsed as a wssible caw of the motbmmbotic statein oatients with theprimary antiphospholipidsyndrm,,~.AIMS: to evaluateihe presence of eat&A antibaiics in IBD patientsandtheir possibleconelation with antiphospholipidantibodiesand previous tbmmbosis.METHODS: 52patientswith IBD, 24 with Ulcerative Colitis (UC) [I4 men, 10 women;mean age+ SD, 41.3 l 15.2years] and28 with Crows disease(CD) [lo mm I8 womm; 39.1+ 13.8years1 were pmspaively emulIed. 12UC oatienrs hadat¢ disease.6 had mildly active d&se and g had &d&tely a&e disease,according to Tmeiove andWitts c&a Among CD patients,22 hadquiescentdisease(CDAI < 150) and6 badactive disease(CDAI > 150). 52gender andwe matchedhealthv subiccts sewed BSnormal contmls. Anti&PA antibcdies were n&&d by anELISA which d&s p&ma immunogb,btdinsspeciEally binding immobilized t-PA. The presenceof Lupus anticoagulantwand&wed accordingto rexntly publishedguidelines.IgG and IgM anticadiolipin antibodieswere measuredby BLISA. RESULTS: IBD patientshad higher anti-t-PA aotobodiesplasmalevels (6.83 -t I .gl U/ml, mean * SD) than normal subjects (5.48 l I.57 U/ml) w.036). 15out of 52 (29%) IBD patimtr bad anti-t-PA antibodiesplasmalevels bigber tlmn the 95thpercentileof normal contmls. The 2 patientswith a history of deepvenous tbmmbosis badhigh plasmalevels of anti-t-PA antibodies(IO.3 U/ml and 20.3U/ml). Antiphospholipid antibodieswe& pnscnt in 5 out of 52 IBD patients{9.6%), one of themhad bigb levels of anti-t-PA antibodies(20.3 U/ml) anda ptwoiw episodeof deepvenous thrombosis.Plasmalevels of anti-t-PA antibodieswere not correlatedwith the activity, the location andthe type of IBD. CONCLUSIONS: our trsults suggestthat high levels of anti-t-PA ant&dies could conhibute to the pmthmmLmticstateobservedin IBD patients.
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