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P.05.15 A NEW TEST FOR GLUTEN SENSITIVITY IS BORN?
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218 positive results have been detected in 12 out of 16 (75%) patients, whereas 13 out of 16 (81.3%) patients presented anti t-TG positive results. In group B none of 17 patients presented positive results both in duodenal and sigmoid biopsy culture. In group C all of the 11 cases presented EMA negative results in sigmoid organ culture. Only one case presented anti t-TG positive results in sigmoid organ culture, as expected in course of IBD. Conclusions: These data confirm that in CD, the gluten dependent immunological activation affects all gastrointestinal tract with different degrees of involvement, suggesting that organ culture of colonic biopsies could represent a new site where opportunistically detect CD.
P.05.13 PERIPHERAL ARTERY DISEASE IN COELIAC DISEASE P.I. Bianchi ∗ , F. Biagi, E. Borsotti, A. Marchese, C. Vattiato, F. Ferretti, D. Balduzzi, L. Trotta, A. Schiepatti, G.R. Corazza Centro per lo studio e la cura della malattia celiaca, Medicina Generale 1, Fondazione IRCCS Policlinico San Matteo, Universita’ degli Studi di Pavia, Pavia, Italy Background and aim: There is a lack of agreement upon mortality and morbidity by cardiovascular diseases in coeliac disease (CD), particularly distinguishing untreated (UCD) and treated (TCD) patients [1,2]. Recently, inflammation by autoimmune disorders has been shown to be atherogenic by itself [3]. Moreover, in CD a life-long gluten-free diet (GFD) can significantly impact on body weight and nutritional parameters. Our aim was to study whether UCD and TCD patients present early signs of peripheral artery disease as other classic cardiovascular risk factors. Material and methods: We compared 9 UCD patients, (8 F, mean age 34.4±12.6 years), 21 TCD patients in GFD for at least 5 years (18 F, mean age 37.6±11.8 years, mean duration of GFD 11.5±6.5 years), and 7 voluntary healthy controls (5 F, mean age 31.7±6.8 years). The patients were enrolled consecutively from our adult outpatient clinic. Patients with diagnosis of potential or complicated CD were excluded, as patient in whom CD diagnosis was reached by screening in dilatative cardiomyopathy. Ankle-brachial index (ABI) was measured by two operators trained together with a portable Doppler instrument, to highlight early signs of peripheral artery disease (i.e. ABI <1). Body mass index, waist-hip ratio were measured as anthropometric parameters. Total cholesterol, triglycerides, glucose, uric acid blood levels were collected when available. History of smoking, leg traumata, physical activity and familiar history of cardiovascular diseases was asked. Results: The results are shown in the table below: Conclusions: ABI measurement did not highlight a peripheral artery disease in any group of patients, as expected in a young population (<40 years-old). Patients with a long-standing GFD are still in a normal range regarding all the investigated parameters, however they show a trend of gain weight and increase in triglyceride blood levels. These findings may confirm the risk of GFD to add to other common atherogenic factors. Doctors and dieticians dedicated to CD should make an effort to encourage patients in choosing a healthy GFD. References: [1] Ludvigsson JF et al. Circulation 2011;123:483–90. [2] West J et al. Aliment Pharmacol Ther 2004;20:73–9. [3] Pitocco D et al. Atherosclerosis 2011;217:531–5.
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P.05.14 IS PLASMA CITRULLINE CONCENTRATION A RELIABLE MARKER IN THE LONG TERM MANAGEMENT OF COELIAC DISEASE? C. Papadia ∗ ,1 , F. Fornaroli 1 , A. Di Sabatino 2 , M. Salemme 3 , F. Lanzarotto 3 , V. Villanacci 3 , G.L. De Angelis 1 , G.R. Corazza 2 , A. Forbes 4 1 Parma
University Hospital, Parma, Italy; 2 San Matteo, Pavia, Italy; Civili Brescia, Brescia, Italy; 4 University College London, London, United Kingdom 3 Spedali
Background and aim: In chronic villous atrophy plasma citrulline concentration (PCC) is decreased at the same severity and extent of mucosal lesions of villous architecture. Marsh-Oberhuber classification is conventionally used for grading villous atrophy in coeliac disease and a correlation with plasma citrulline concentrations has been found in pioneering studies. The Corazza-Villanacci classification gives better inter-observer agreement then Marsh-Oberhuber classification. Our primary aim was to correlate PCC to Corazza-Villanacci classification in coeliac disease. We aimed also to yield information in respect of PCC after one year of gluten free diet. Material and methods: Forty subjects with a diagnosis of acute celiac disease have been studied. All patients underwent OGD with multiple biopsies and a blood test for plasma citrulline concentration at baseline and after one year of gluten free diet (GFD). Routine haematological and biochemical investigations were performed including, IgA tTG, IgA EMA and IgA/G antigliadin, ESR, haemoglobin and haematinics, albumin, liver function tests and creatinine. BMI and clinical symptoms were monitored. Histology was interpreted according to Marsh-Oberhuber and Corazza-Villanacci Classification. Plasma citrulline concentration was analysed by High Performance Liquid Chromatography Results: Overall mean plasma citrulline concentration was lower (15.12 μmol/l) at baseline, in patients with active celiac disease, than in the same group of patients after one year of GFD (16.47 μmol/l) (P<0.001). All patients were only partially histopathologically and clinically responsive to one year of GFD. Plasma citrulline concentrations correlated with both Marsh-Oberhuber and Villanacci-Corazza classification grading (P<0.001) at baseline and after one year of GFD. Conclusions: Plasma citrulline concentration may be considered a reliable marker of severity and extent of small bowel villous atrophy in acute coeliac disease as well as in the long term management.
P.05.15 A NEW TEST FOR GLUTEN SENSITIVITY IS BORN? R. Borghini ∗ ,1 , C. Urciuoli 1 , M. Di Tola 1 , M.C. Marino 1 , R. Casale 1 , C. Isonne 1 , M. Puzzono 1 , F. Ventura 1 , C. Rizzo 2 , A. Picarelli 1 1 Dip Int Med and Medical Specialities–CRS Celiac disease-Università Sapienza, Roma, Italy; 2 AINUC, Roma, Italy
Background and aim: Celiac disease (CD) and gluten sensitivity disease (GSD) are two distinct gluten-related conditions. CD diagnosis is based on the presence of duodenal mucosa villous atrophy and serological antibodies positive results (EMA, anti t-TG). GSD is characterized by symptoms that recede on gluten free diet and by AGA IgG positive results in 56.4%. Former literature showed that CD immunological activation can also be found in the oral mucosa biopsy cultures of CD patients; therefore oral mucosa is a possible site where food adverse effects can be reproduced by specific oral mucosa patch test. We studied patients affected by GSD by means of a gluten oral mucosa patch test to demonstrate a macroscopic specific inflammatory reaction.
Abstract P.05.13 – Table 1
UCD males UCD females TCD males TCD females Controls
ABI
Total Cholesterol (mg/dL)
Triglycerides (mg/dL)
Glucose (mg/dL)
Uric acid (mg/dL)
BMI
Abdominal circumference (cm) (cm)
Waist-hip ratio
1.29±0.16
182±40
68±1
87±5
4±0
19.3±3.7
1.18±0.13
187±38
107±33
84±8
4±1
21.92±3
76.5 77±7.2 86±5 76±9
0.90 0.80±0.04 0.87±0.06 0.81±0.06
1.28±0.11
21.1±4.5
S124
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
Material and methods: We enrolled 20 patients with gluten-related gastrointestinal symptoms: swelling, abdominal pain, diarrhea, constipation, weight loss, oral ulcers. EMA, anti t-TG, AGA and AGA DGP IgA and IgG were investigated. All patients underwent HLA DQ2 DQ8 typing. RAST tests for wheat, barley, gluten and rye were used to exclude allergies. We performed a gluten oral mucosa patch test to test gluten sensitivity. Results: We found AGA IgG positivity in 2 out of 20 patients (10%); none presented positive results for AGA IgA, AGA DGP IgA and IgG, EMA IgA and IgG, anti tTG IgA and IgG. Concerning genetics, 7 out of 18 (38%) were both HLA DQ2 and DQ8 negative; 2 out of 18 (11%) were HLA DQ2 negative and DQ8 positive; 9 out of 18 (50%) were HLA DQ2 positive and DQ8 negative; none presented positivity for both HLA DQ2 and DQ8; 2 tests were not performed. RAST tests were negative in all patients. Finally, 2 hours after the administration of gluten oral mucosa patch test, we observed in 16 out of 20 patients (80%) gingival hyperemia, wheal, blister, localized burning; some of them presented also abdominal swelling (56%) with diarrhea (11%) in the following 12/24 hours. 4 out of 20 (20%) were negative to a gluten oral mucosa patch test. Conclusions: This study documented, in gluten sensitive patients, the presence of inflammatory local lesions triggered by oral mucosa gluten stimulation. Systemic effects were observed only in some cases. Surprisingly, all signs and symptoms receded after gluten patch removal.
P.05.16 PREVALENCE OF TREMOR IN PATIENTS WITH CELIAC DISEASE R. Tortora ∗ ,1 , M. Moccia 1 , C. Vitale 2 , P. Capone 1 , N. Imperatore 1 , T. Russo 1 , M. Leo 1 , N. Caporaso 1 , A. Rispo 1 1 Federico
II Università di Napoli, Napoli, Italy; 2 Università Partenope, Napoli, Italy Background and aim: Coeliac disease (CD) is a chronic immune-mediated disorder that primarily affects the gastrointestinal tract. Anyway there is an increasing number of reports describing neurological complications of coeliac disease, especially ataxia, peripheral neuropathy, restless legs syndrome and epilepsy. Aim: To investigate the prevalence and characteristics of tremor in CD. Material and methods: From February 2012 to June 2012 all patients attending our third-level center for CD diagnosis were consecutively evaluated at Movement Disorder Unit. CD diagnosis was based in accordance with current guidelines. Exclusion criteria were uncertain CD diagnosis, history of neuroleptic exposure, other neurological or medical conditions know to be causative of tremor, alcohol or drug abuse. All patients underwent a complete neurological examination. In particular we investigated prevalence and clinical features of tremor. Results: 50 patients (M: 11, F: 39) were included in the study. The average age was 34.4 year. Gluten free diet was followed by 28 of them, while 22 with a recent diagnosis of CD were on free diet. Postural tremor was found in 13 patients (26%; M: 1; F: 11) with an average age of 29.1 years. Three of them were found as having both postural and kinetic tremor (6%; M: 1; F: 2). No one was found as having symptoms or signs of neuropathy, or additional elements of cerebellar impairment. No relation was found between presence of tremor and gluten free diet adherence. Conclusions: This is the first study indicating a high prevalence of tremor in CD and, as a consequence, tremor should be sought in all CD patients. Two different mechanisms could be proposed: a) malabsorption-related deficiency of neurotrophic and/or neuroprotective factors; b) autoimmune disregulation. Anyway further studies are needed to increase our knowledge on “celiac tremor” and, in particular, to find out the exact mechanisms determining this neurological manifestation.
P.05.17 LABORATORY TESTS IN COMPLICATED COELIAC PATIENTS VS. COELIAC CONTROLS F. Biagi ∗ ,1 , A. Marchese 1 , F. Ferretti 1 , P. Gobbi 1 , R. Ciccocioppo 1 , U. Volta 2 , G. Caio 2 , C. Ciacci 3 , F. Zingone 3 , A. D’Odorico 4 , A. Carroccio 5 , G. Ambrosiano 5 , A. Gasbarrini 6 , A.C. Piscaglia 6 , A. Andrealli 7 , M. Astegiano 7 , S. Segato 8 , M. Neri 9 , A. Meggio 10 , G. De Pretis 10 , I. De Vitis 11 , G.R. Corazza 1 1 University
of Pavia, Pavia, Italy; 2 St Orsola-Malpighi University Hospital, Bologna, Italy; 3 University of Salerno, Salerno, Italy; 4 University of Padua, Padua, Italy; 5 University of Palermo, Palermo, Italy; 6 University of Sacred Heart, Rome, Italy; 7 University of Turin, Turin, Italy; 8 Fondazione Macchi, Varese, Italy; 9 Università G DAnnunzio, Chieti, Italy; 10 APSS Trento, Trento, Italy; 11 UCSC CIC, Rome, Italy Background and aim: Coeliac disease (CD) is a very frequent chronic enteropathy characterized by an increased mortality, mainly due to its complications. Thanks to Fondazione Associazione Italiana Celiachia that funded the study, 11 Italian centres participated in a case-control study. Laboratory data from 87 cases (55 females, mean age at diagnosis of CD 51±14 years) and 136 sex- and age-matched controls (89F, 49±13) were collected. Material and methods: Thanks to Fondazione Associazione Italiana Celiachia that funded the study, 11 Italian centres participated in a case-control study. Laboratory data from 87 cases (55 females, mean age at diagnosis of CD 51±14 years) and 136 sex- and age-matched controls (89F, 49±13) were collected. Results: Haemoglobin, albumin, Na+, K+, Ca++, and total cholesterol levels were significantly lower in cases than controls, while ESR and CRP were higher. RDW, glucose, and triglycerides did not differ. Conclusions: We have already shown that the cases we studied were more likely to be affected by a classical form of CD then controls. This is likely to be the reason why nutritional parameters were lower in them. On the other hand, the increased levels of ESR and CRP we found in cases suggest that an increased systemic inflammatory response, likely to be linked to the onset of the complication, was already present at the time of diagnosis of CD.
P.05.18 BOWEL ULTRASOUND (B-US) IN THE ASSESSMENT OF GASTROINTESTINAL DISORDERS IN CYSTIC FIBROSIS (CF) R. Pozzi ∗ ,1 , M. Fraquelli 2 , S. Della Valle 2 , S. Massironi 2 , M. Russo 1 , B. Conti 1 , M. Giunta 1 , D. Conte 1 , F. Corti 1 , C. Colombo 2 1 IRCCS
Fondazione Cà Granda Policlinico, Università degli Studi di Milano, Milano, Italy; 2 IRCCS Fondazione Cà Granda Policlinico, Milano, Italy Background and aim: (B-US) is a non-invasive technique for the detection and follow up of gastrointestinal diseases. Improved life-expectancy in patients with cystic fibrosis (CF) has increased the Bowel ultrasonography observation of several gastrointestinal disorders such as distal intestinal obstruction syndrome (DIOS) and intussusception. The aim of this study is to assess the rate and clinical correlation of some predefined US signs in CF patients, presenting with or without gastrointestinal symptoms. Material and methods: A cross-sectional case-control study was performed in 35 CF patients (20 male, 15 female; median age 16 years, range 2–30) and 32 controls (17 male, 15 female; median age 10 years, range 4–27). Clinical history and treatment data were collected in both group. Predefined US signs were: bowel wall thickness, pattern and doppler signal; the presence of mesenteric hypertrophy, enlarged lymph nodes and abdominal fluid; the presence of stenosis or intussusception with consequent bowel distention; motility impairment. Student t-test and Spearman correlation coefficients were used to assess mean differences and possible correlations between clinical and US findings. Results: In CF patients motility impairment was observed in 9%, bowel wall thickness in 23% (75% terminal ileum-cecum), increased bowel wall blood flow in 34%, mesenteric hypertrophy in 20%, small bowel intussusceptionin 26%. None of these signs was observed in the control group. In both groups, but with different rate, there were: enlarged mesenteric lymph nodes (patients
P.05.13 PERIPHERAL ARTERY DISEASE IN COELIAC DISEASE P.I. Bianchi ∗ , F. Biagi, E. Borsotti, A. Marchese, C. Vattiato, F. Ferretti, D. Balduzzi, L. Trotta, A. Schiepatti, G.R. Corazza Centro per lo studio e la cura della malattia celiaca, Medicina Generale 1, Fondazione IRCCS Policlinico San Matteo, Universita’ degli Studi di Pavia, Pavia, Italy Background and aim: There is a lack of agreement upon mortality and morbidity by cardiovascular diseases in coeliac disease (CD), particularly distinguishing untreated (UCD) and treated (TCD) patients [1,2]. Recently, inflammation by autoimmune disorders has been shown to be atherogenic by itself [3]. Moreover, in CD a life-long gluten-free diet (GFD) can significantly impact on body weight and nutritional parameters. Our aim was to study whether UCD and TCD patients present early signs of peripheral artery disease as other classic cardiovascular risk factors. Material and methods: We compared 9 UCD patients, (8 F, mean age 34.4±12.6 years), 21 TCD patients in GFD for at least 5 years (18 F, mean age 37.6±11.8 years, mean duration of GFD 11.5±6.5 years), and 7 voluntary healthy controls (5 F, mean age 31.7±6.8 years). The patients were enrolled consecutively from our adult outpatient clinic. Patients with diagnosis of potential or complicated CD were excluded, as patient in whom CD diagnosis was reached by screening in dilatative cardiomyopathy. Ankle-brachial index (ABI) was measured by two operators trained together with a portable Doppler instrument, to highlight early signs of peripheral artery disease (i.e. ABI <1). Body mass index, waist-hip ratio were measured as anthropometric parameters. Total cholesterol, triglycerides, glucose, uric acid blood levels were collected when available. History of smoking, leg traumata, physical activity and familiar history of cardiovascular diseases was asked. Results: The results are shown in the table below: Conclusions: ABI measurement did not highlight a peripheral artery disease in any group of patients, as expected in a young population (<40 years-old). Patients with a long-standing GFD are still in a normal range regarding all the investigated parameters, however they show a trend of gain weight and increase in triglyceride blood levels. These findings may confirm the risk of GFD to add to other common atherogenic factors. Doctors and dieticians dedicated to CD should make an effort to encourage patients in choosing a healthy GFD. References: [1] Ludvigsson JF et al. Circulation 2011;123:483–90. [2] West J et al. Aliment Pharmacol Ther 2004;20:73–9. [3] Pitocco D et al. Atherosclerosis 2011;217:531–5.
S123
P.05.14 IS PLASMA CITRULLINE CONCENTRATION A RELIABLE MARKER IN THE LONG TERM MANAGEMENT OF COELIAC DISEASE? C. Papadia ∗ ,1 , F. Fornaroli 1 , A. Di Sabatino 2 , M. Salemme 3 , F. Lanzarotto 3 , V. Villanacci 3 , G.L. De Angelis 1 , G.R. Corazza 2 , A. Forbes 4 1 Parma
University Hospital, Parma, Italy; 2 San Matteo, Pavia, Italy; Civili Brescia, Brescia, Italy; 4 University College London, London, United Kingdom 3 Spedali
Background and aim: In chronic villous atrophy plasma citrulline concentration (PCC) is decreased at the same severity and extent of mucosal lesions of villous architecture. Marsh-Oberhuber classification is conventionally used for grading villous atrophy in coeliac disease and a correlation with plasma citrulline concentrations has been found in pioneering studies. The Corazza-Villanacci classification gives better inter-observer agreement then Marsh-Oberhuber classification. Our primary aim was to correlate PCC to Corazza-Villanacci classification in coeliac disease. We aimed also to yield information in respect of PCC after one year of gluten free diet. Material and methods: Forty subjects with a diagnosis of acute celiac disease have been studied. All patients underwent OGD with multiple biopsies and a blood test for plasma citrulline concentration at baseline and after one year of gluten free diet (GFD). Routine haematological and biochemical investigations were performed including, IgA tTG, IgA EMA and IgA/G antigliadin, ESR, haemoglobin and haematinics, albumin, liver function tests and creatinine. BMI and clinical symptoms were monitored. Histology was interpreted according to Marsh-Oberhuber and Corazza-Villanacci Classification. Plasma citrulline concentration was analysed by High Performance Liquid Chromatography Results: Overall mean plasma citrulline concentration was lower (15.12 μmol/l) at baseline, in patients with active celiac disease, than in the same group of patients after one year of GFD (16.47 μmol/l) (P<0.001). All patients were only partially histopathologically and clinically responsive to one year of GFD. Plasma citrulline concentrations correlated with both Marsh-Oberhuber and Villanacci-Corazza classification grading (P<0.001) at baseline and after one year of GFD. Conclusions: Plasma citrulline concentration may be considered a reliable marker of severity and extent of small bowel villous atrophy in acute coeliac disease as well as in the long term management.
P.05.15 A NEW TEST FOR GLUTEN SENSITIVITY IS BORN? R. Borghini ∗ ,1 , C. Urciuoli 1 , M. Di Tola 1 , M.C. Marino 1 , R. Casale 1 , C. Isonne 1 , M. Puzzono 1 , F. Ventura 1 , C. Rizzo 2 , A. Picarelli 1 1 Dip Int Med and Medical Specialities–CRS Celiac disease-Università Sapienza, Roma, Italy; 2 AINUC, Roma, Italy
Background and aim: Celiac disease (CD) and gluten sensitivity disease (GSD) are two distinct gluten-related conditions. CD diagnosis is based on the presence of duodenal mucosa villous atrophy and serological antibodies positive results (EMA, anti t-TG). GSD is characterized by symptoms that recede on gluten free diet and by AGA IgG positive results in 56.4%. Former literature showed that CD immunological activation can also be found in the oral mucosa biopsy cultures of CD patients; therefore oral mucosa is a possible site where food adverse effects can be reproduced by specific oral mucosa patch test. We studied patients affected by GSD by means of a gluten oral mucosa patch test to demonstrate a macroscopic specific inflammatory reaction.
Abstract P.05.13 – Table 1
UCD males UCD females TCD males TCD females Controls
ABI
Total Cholesterol (mg/dL)
Triglycerides (mg/dL)
Glucose (mg/dL)
Uric acid (mg/dL)
BMI
Abdominal circumference (cm) (cm)
Waist-hip ratio
1.29±0.16
182±40
68±1
87±5
4±0
19.3±3.7
1.18±0.13
187±38
107±33
84±8
4±1
21.92±3
76.5 77±7.2 86±5 76±9
0.90 0.80±0.04 0.87±0.06 0.81±0.06
1.28±0.11
21.1±4.5
S124
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
Material and methods: We enrolled 20 patients with gluten-related gastrointestinal symptoms: swelling, abdominal pain, diarrhea, constipation, weight loss, oral ulcers. EMA, anti t-TG, AGA and AGA DGP IgA and IgG were investigated. All patients underwent HLA DQ2 DQ8 typing. RAST tests for wheat, barley, gluten and rye were used to exclude allergies. We performed a gluten oral mucosa patch test to test gluten sensitivity. Results: We found AGA IgG positivity in 2 out of 20 patients (10%); none presented positive results for AGA IgA, AGA DGP IgA and IgG, EMA IgA and IgG, anti tTG IgA and IgG. Concerning genetics, 7 out of 18 (38%) were both HLA DQ2 and DQ8 negative; 2 out of 18 (11%) were HLA DQ2 negative and DQ8 positive; 9 out of 18 (50%) were HLA DQ2 positive and DQ8 negative; none presented positivity for both HLA DQ2 and DQ8; 2 tests were not performed. RAST tests were negative in all patients. Finally, 2 hours after the administration of gluten oral mucosa patch test, we observed in 16 out of 20 patients (80%) gingival hyperemia, wheal, blister, localized burning; some of them presented also abdominal swelling (56%) with diarrhea (11%) in the following 12/24 hours. 4 out of 20 (20%) were negative to a gluten oral mucosa patch test. Conclusions: This study documented, in gluten sensitive patients, the presence of inflammatory local lesions triggered by oral mucosa gluten stimulation. Systemic effects were observed only in some cases. Surprisingly, all signs and symptoms receded after gluten patch removal.
P.05.16 PREVALENCE OF TREMOR IN PATIENTS WITH CELIAC DISEASE R. Tortora ∗ ,1 , M. Moccia 1 , C. Vitale 2 , P. Capone 1 , N. Imperatore 1 , T. Russo 1 , M. Leo 1 , N. Caporaso 1 , A. Rispo 1 1 Federico
II Università di Napoli, Napoli, Italy; 2 Università Partenope, Napoli, Italy Background and aim: Coeliac disease (CD) is a chronic immune-mediated disorder that primarily affects the gastrointestinal tract. Anyway there is an increasing number of reports describing neurological complications of coeliac disease, especially ataxia, peripheral neuropathy, restless legs syndrome and epilepsy. Aim: To investigate the prevalence and characteristics of tremor in CD. Material and methods: From February 2012 to June 2012 all patients attending our third-level center for CD diagnosis were consecutively evaluated at Movement Disorder Unit. CD diagnosis was based in accordance with current guidelines. Exclusion criteria were uncertain CD diagnosis, history of neuroleptic exposure, other neurological or medical conditions know to be causative of tremor, alcohol or drug abuse. All patients underwent a complete neurological examination. In particular we investigated prevalence and clinical features of tremor. Results: 50 patients (M: 11, F: 39) were included in the study. The average age was 34.4 year. Gluten free diet was followed by 28 of them, while 22 with a recent diagnosis of CD were on free diet. Postural tremor was found in 13 patients (26%; M: 1; F: 11) with an average age of 29.1 years. Three of them were found as having both postural and kinetic tremor (6%; M: 1; F: 2). No one was found as having symptoms or signs of neuropathy, or additional elements of cerebellar impairment. No relation was found between presence of tremor and gluten free diet adherence. Conclusions: This is the first study indicating a high prevalence of tremor in CD and, as a consequence, tremor should be sought in all CD patients. Two different mechanisms could be proposed: a) malabsorption-related deficiency of neurotrophic and/or neuroprotective factors; b) autoimmune disregulation. Anyway further studies are needed to increase our knowledge on “celiac tremor” and, in particular, to find out the exact mechanisms determining this neurological manifestation.
P.05.17 LABORATORY TESTS IN COMPLICATED COELIAC PATIENTS VS. COELIAC CONTROLS F. Biagi ∗ ,1 , A. Marchese 1 , F. Ferretti 1 , P. Gobbi 1 , R. Ciccocioppo 1 , U. Volta 2 , G. Caio 2 , C. Ciacci 3 , F. Zingone 3 , A. D’Odorico 4 , A. Carroccio 5 , G. Ambrosiano 5 , A. Gasbarrini 6 , A.C. Piscaglia 6 , A. Andrealli 7 , M. Astegiano 7 , S. Segato 8 , M. Neri 9 , A. Meggio 10 , G. De Pretis 10 , I. De Vitis 11 , G.R. Corazza 1 1 University
of Pavia, Pavia, Italy; 2 St Orsola-Malpighi University Hospital, Bologna, Italy; 3 University of Salerno, Salerno, Italy; 4 University of Padua, Padua, Italy; 5 University of Palermo, Palermo, Italy; 6 University of Sacred Heart, Rome, Italy; 7 University of Turin, Turin, Italy; 8 Fondazione Macchi, Varese, Italy; 9 Università G DAnnunzio, Chieti, Italy; 10 APSS Trento, Trento, Italy; 11 UCSC CIC, Rome, Italy Background and aim: Coeliac disease (CD) is a very frequent chronic enteropathy characterized by an increased mortality, mainly due to its complications. Thanks to Fondazione Associazione Italiana Celiachia that funded the study, 11 Italian centres participated in a case-control study. Laboratory data from 87 cases (55 females, mean age at diagnosis of CD 51±14 years) and 136 sex- and age-matched controls (89F, 49±13) were collected. Material and methods: Thanks to Fondazione Associazione Italiana Celiachia that funded the study, 11 Italian centres participated in a case-control study. Laboratory data from 87 cases (55 females, mean age at diagnosis of CD 51±14 years) and 136 sex- and age-matched controls (89F, 49±13) were collected. Results: Haemoglobin, albumin, Na+, K+, Ca++, and total cholesterol levels were significantly lower in cases than controls, while ESR and CRP were higher. RDW, glucose, and triglycerides did not differ. Conclusions: We have already shown that the cases we studied were more likely to be affected by a classical form of CD then controls. This is likely to be the reason why nutritional parameters were lower in them. On the other hand, the increased levels of ESR and CRP we found in cases suggest that an increased systemic inflammatory response, likely to be linked to the onset of the complication, was already present at the time of diagnosis of CD.
P.05.18 BOWEL ULTRASOUND (B-US) IN THE ASSESSMENT OF GASTROINTESTINAL DISORDERS IN CYSTIC FIBROSIS (CF) R. Pozzi ∗ ,1 , M. Fraquelli 2 , S. Della Valle 2 , S. Massironi 2 , M. Russo 1 , B. Conti 1 , M. Giunta 1 , D. Conte 1 , F. Corti 1 , C. Colombo 2 1 IRCCS
Fondazione Cà Granda Policlinico, Università degli Studi di Milano, Milano, Italy; 2 IRCCS Fondazione Cà Granda Policlinico, Milano, Italy Background and aim: (B-US) is a non-invasive technique for the detection and follow up of gastrointestinal diseases. Improved life-expectancy in patients with cystic fibrosis (CF) has increased the Bowel ultrasonography observation of several gastrointestinal disorders such as distal intestinal obstruction syndrome (DIOS) and intussusception. The aim of this study is to assess the rate and clinical correlation of some predefined US signs in CF patients, presenting with or without gastrointestinal symptoms. Material and methods: A cross-sectional case-control study was performed in 35 CF patients (20 male, 15 female; median age 16 years, range 2–30) and 32 controls (17 male, 15 female; median age 10 years, range 4–27). Clinical history and treatment data were collected in both group. Predefined US signs were: bowel wall thickness, pattern and doppler signal; the presence of mesenteric hypertrophy, enlarged lymph nodes and abdominal fluid; the presence of stenosis or intussusception with consequent bowel distention; motility impairment. Student t-test and Spearman correlation coefficients were used to assess mean differences and possible correlations between clinical and US findings. Results: In CF patients motility impairment was observed in 9%, bowel wall thickness in 23% (75% terminal ileum-cecum), increased bowel wall blood flow in 34%, mesenteric hypertrophy in 20%, small bowel intussusceptionin 26%. None of these signs was observed in the control group. In both groups, but with different rate, there were: enlarged mesenteric lymph nodes (patients