- Email: [email protected]
32 P Serological markers (ASCA and ANCA) in the diagnosis of IBD a double blinded study
lnllammatory
bowel diseases
31 P
29 P POSTOPERATIVE RECURRENCE OF CROHN’S DISEASE IN A MESALAZINE TREATED GROUP OF PATIENTS G Avapim’, M Astegiano”, B Demarcbi”, N Sapone”,M Garino’, L. BeriolussoO,M Rizzetto”, S Martini”, A Resegotti’, G Fronda-, F Bresso” ‘UOA Chin@ 7 A0 S. Giovanni BattflstaMolinette, ‘UOADU GastroepatologiaA0 S clovanni Bat&a Molinetfe BACKGROW Crolm’s diseaserecurs after surgery; many factors that could influence recmren~e have beens~died in the literatue, witbout coming to firm conclusions A recent progress in recwrenw prevention is postoperative mesalazinetreatment [I], as many hrdies involved patientswho did not receive therapy ai& surgery, we do not know if recurrence fanors are dii?‘erentin those patients receiving mesaltine AIM to evahate a selectedgroup of patients, receiving mesaltine after surgery. METHODS: t?om l/WI993 to l/1/2001, 149 patientsunderwem surgery for Croho’s diseaseat our department; as a preliminary study, we made a selection of patientsbasedon strict criteria: swgery (all patientsunderwent ileoceoalresection), postoperative treatment (all assumedmesaladm, 2g per day, for 1 year) sod follow-up (all underwent intestinal ultrasound at every follow-“p visit); so we selecteda sub-group of 40 patients,with complete complianceto treatment and reliable follow-up Twenty-nine patients were male and 11were female, average follow-up was 46 8 months Overall diseaserecurreoce was detected in 42 5% of patients, averagedistance from surgery to recurrence was 21 6 months Ultrasound detectedrecurrence rate was 47 8% in smokers and 35.2% in non-smokers Recurrence rate w 51.7% in malesand 18.1% in females CONCLUSIONS: these data are preliminary, m a VW selectedgroup of patients, but we tbiok that the wide difference in r&enc.e ;ates be&en males&d f&es deserves f”rther investigation:a completeevaluation of recurrence rates in our whole series is “ndergmng References I) Caprilli 9 Aodreoli 4 Capurso L et al. Oral mesakuine for the prevention of postoperative reaurence ofcrobn’s disease Aliment PharmacolTher 1994,s. 35-43
RAPID RESPONSE TO BWLlxIMAB TN A PATlENT WITH SEVERE POLWEUROPATHY ASSOCIATED TO CROHN’SDISEASE S Rodino’,N Sacca’,A De Medici, T D’Amiw, A Fragomeoi,A G&o Unita’ Operative di Gastroenterologw edEndoscopiaDigestive, AziendaOspedaliera Pugliese-CiwcioCATANZARO Treatmentwith a cbimeric anti-tumor necrosisfactor (TNF) antibody(IoJliximab) has been shownto behighly e&ient for patientswith steroid-refractory Crobo’sdisease(CD) However the &cbanism of action remainslargeb unlolown. Receot$ a favorableresponse to I&k&nab treatmenthas beendemonstratedin acuteidiopathic pancreatitiscomplicating active Crohn’s diseaseWe describea case of a middle-agedfemale with Crobo’sdiseasewho developedM agressiveform of polyoeuritis resistemto corticosteroids. Her condition has got progressively worse dueto the appearanceof a right arm andright leg limctional impotencewith worsening of the intestinalsymptomsof CD The patientwas admitted to hospitalin ths nearology “nit anda diagnosisofmixed (motor and sensitive)polinemitis involving medial andulnar nerves of the right arm was fomulated by ao electromyography examinationThe lesionswere progressive and animportant myopathy with muscleatrophy of right arm developed This condition hadbeenunresponsiveto systemic corticosteroids andmummosoppressive Administrationof Iotlitimdmab (Remicade)readted in a rapid clinical responsewith subjectiveimprovementsin m”sck pain and generalwell-being,and ao objeotivebnprovememin right arm movements.The patientrespondedextremely well to three 5 “g/Kg infusionsof Infliximab with marked improvementafter the intiuion clinically andcolonscopically An electromyograpby@omwd a&r the third infusionof lntliximab resultedin a net improvementof nerve conduction andmuscle function A 5 mg!Kg infusion of ltiiximab two months later was admmisteredandsystemic conicosteroids badbeen stopped Iotliximabmay be a suitabletherapnrtw option in patientswith rare extraintestinal mmifenations of CD non respondingto conventionaltherapy
30 oc SEROLOGICAL
MARKERS
(ASCA
AND
ANCA,
IN THE
DlAGNOSlS
OF LBD
CB’ROFLOXACM VERSUS MESALMME IN THE PREVENTION OF POSTOPERATWE RECURRRNCEOF CROWS DISEASE PRELIMINARY RESULTS A Resegoni*.B Demchi”, GI Avama,* N Sapone”,A Giustetto’, L Bertolusso”, M Rwzetto’=,F Brew”, M. Astegiano”,G Fronda*
A DOUBLE BLINDED STUDY A MONTANELLI~, V VLLLANACW, H QAWASMEH”, G MISSALE’, G P CENGIA’, L MINELLI’, D DELLA CASA’. E CANCELLIEW E MAINAI(DI§, R CESTART’
‘UOA Chimrgia7 A0 S GiovanniBattista Molioene; ‘UOADU GastroepatologiaA0 S GiovanniBattista Molinette
~DlPART,MENTODI PATOLOGIA CLINIC& OSPEDALEMA’XXORE Dl CP.EMA,‘II SERVlZIODI ANATOMA ED ISTOLOGIA PATOLOGlC& SPBDALICIVILI, BRESCIA,‘CATTEDKA DI CHIRURGIA GENERALEDELL’UNRERSITA DEGLI STUD,, CENTRO DI ENDOSCoPIADIGESTIVA SPEDALl CIVIL1DI BRESCIA
BACKGROUND Croho ‘s diseaseahvaysroan+ atler mrgery, recently it has been suggestedthat me&.&e could delayrwxreoce [I] On the other handsomeantibioticsare used io thetreatment of Crobo ‘s diseaseandmetrooidazolevas shown to beeffective in recwrmce preventionin one shuiy [Z]. As aproflaxacin is also“sod in therapy andit is better tolerated,we aimedto evaluateifciprofloxwin could be effective m delayingCrobo ‘S diseaserecwrence. METHODS: tweotytdne patients,who undenventileocolonicresec~on from l/l/l998 to l/l/2001, were randomizedto mesaltine 2g per day for 1 year or to ciprofloxacin Ig per day for 3 months Twenty receivedmeal&e and9 ciprofloxaoin The two groups were comparablein ageand sex dintributioq andin smokers ’ percentages(66% ciprofloxacin and 60% tiwioe group). RESULTS avcrape follow-“D was 31 7 moothsfor ciorofloxacio and 28 8 for mesakume group Intestinal&mso”od ias regularly performedduring follow-up, in order to detect reammc+? We detectedanultrasoundrecurrence rate of 22,2%in ciprofloxacin-treatedgroup andof 40% in mesaltine-treated emu0 CONCLUSION thesere&s ie preliminaryand numbersaretoo smallto draw anyfirm conclusiot, as statistics are impossible.However our datasuggestthat ciprofloxacin could be mm eiTedve than mesaltine in the preveotionof Crobe ‘I d&easerecurrence after surgery If&is is the case, cipmflotin Shouldbe preferred,becauseit is effectwe m the treatmentof bacteriaJpoWion, which cao inducediarrhoeaa&r ileocolonicresection Ret&tlW 1) CamiUiR Andrmli A C*wrso L et al Oral mesalarinefor the oreveotionof pbstobcrativi recurreoce’of&obo ‘s disease AlimentPharmacoliher 1994.8 35-43 2) RutgeertsP. Hi& M, GebaesK, PeetersM, Peooiockx,Aerts R, KerremaesR Controlledtrial of metrooidazoletreatmentfor ~reveotionof Crohn’srecwrence after ileal resection Gastroeoterology 1995, 108 3617-1621
Thedefmmveanddiffereottaldiagnosisof InRammtory Bowel DiseaseWDI UlcerativeColitis(UC) andCrobo ‘Sdisease(CD), “sually estabkshedby dmical,&olo&al, endoscopicandhistologicalcriteria,cannot beachievedm 10.15%of cases Recentlyagreatinteresfis gainingin oewserologicalmarkers for IBD that could supportandcompletethe mostfrequeotlyusedlaboratoryparameterskke C-reaotiveprotein (CRP), erytbrocytesedimentation rate (BSR) andotheracme-phaseproteinin diagnosisof IBD Aim of tlus study is to evaluatetheanalyuealperformanceandthediagnosticrole of ASCA (Anti-SaccharomycerCerwisiaeAntibodies)IgG andIgA andANCA (AotiNemropbilCpoplasmAntibodies)IgG. 56 consecutivepatients,unrolledfor clinicalsuspect of IBD, were evaluatedin a doubleblindedf&ion by serologicalandhistological mvemgationASCA andANCA were detectedby two methods.iodieet imm”nofluore~cence (OF) sod Eozyme-LinkedImm”“osorbeot Assay(ELISA) The histologicaldia@oslswas basedonmtemationalg&d&es criteriaCaseswereclassifiedasCD (o=l3), UC (~24) and non-idiopathiccolios(o=l9) by birtopatbologicalinvestigationTable1 andtable2 shows accuracyof ASCA andANCA determinatiinsLiteraturedataare stillpoor andextremely variableto considertheseparametersasdngnostic criteria In our experienceantibodies measuremeotwith two-stepprocedureinvolvingaoIIF test (high sensitivity)followed by ELISA (highspecificity) havedemonstratedagwd dmgnost,cperformanceto IdentifyMC andCU that suggesta posublerole - m theszreeoiogof LBD (non-mvasiveapproachwith high patlentcompliance)-in definitivediagnosis(particularlyas supponto thepathdogjst in phenotypeclassificationof doubtfulcases) Table1 Analyticalperformanceof ASCA for ditTaentmtm8CD from non-CD
87%
36%
54%
58%
i
77 % 86 %
/
61 % 80%
Table2 Analyticalperformaomof ANCA for ddferentiatmgUC from non-UC
A84
bowel diseases
31 P
29 P POSTOPERATIVE RECURRENCE OF CROHN’S DISEASE IN A MESALAZINE TREATED GROUP OF PATIENTS G Avapim’, M Astegiano”, B Demarcbi”, N Sapone”,M Garino’, L. BeriolussoO,M Rizzetto”, S Martini”, A Resegotti’, G Fronda-, F Bresso” ‘UOA Chin@ 7 A0 S. Giovanni BattflstaMolinette, ‘UOADU GastroepatologiaA0 S clovanni Bat&a Molinetfe BACKGROW Crolm’s diseaserecurs after surgery; many factors that could influence recmren~e have beens~died in the literatue, witbout coming to firm conclusions A recent progress in recwrenw prevention is postoperative mesalazinetreatment [I], as many hrdies involved patientswho did not receive therapy ai& surgery, we do not know if recurrence fanors are dii?‘erentin those patients receiving mesaltine AIM to evahate a selectedgroup of patients, receiving mesaltine after surgery. METHODS: t?om l/WI993 to l/1/2001, 149 patientsunderwem surgery for Croho’s diseaseat our department; as a preliminary study, we made a selection of patientsbasedon strict criteria: swgery (all patientsunderwent ileoceoalresection), postoperative treatment (all assumedmesaladm, 2g per day, for 1 year) sod follow-up (all underwent intestinal ultrasound at every follow-“p visit); so we selecteda sub-group of 40 patients,with complete complianceto treatment and reliable follow-up Twenty-nine patients were male and 11were female, average follow-up was 46 8 months Overall diseaserecurreoce was detected in 42 5% of patients, averagedistance from surgery to recurrence was 21 6 months Ultrasound detectedrecurrence rate was 47 8% in smokers and 35.2% in non-smokers Recurrence rate w 51.7% in malesand 18.1% in females CONCLUSIONS: these data are preliminary, m a VW selectedgroup of patients, but we tbiok that the wide difference in r&enc.e ;ates be&en males&d f&es deserves f”rther investigation:a completeevaluation of recurrence rates in our whole series is “ndergmng References I) Caprilli 9 Aodreoli 4 Capurso L et al. Oral mesakuine for the prevention of postoperative reaurence ofcrobn’s disease Aliment PharmacolTher 1994,s. 35-43
RAPID RESPONSE TO BWLlxIMAB TN A PATlENT WITH SEVERE POLWEUROPATHY ASSOCIATED TO CROHN’SDISEASE S Rodino’,N Sacca’,A De Medici, T D’Amiw, A Fragomeoi,A G&o Unita’ Operative di Gastroenterologw edEndoscopiaDigestive, AziendaOspedaliera Pugliese-CiwcioCATANZARO Treatmentwith a cbimeric anti-tumor necrosisfactor (TNF) antibody(IoJliximab) has been shownto behighly e&ient for patientswith steroid-refractory Crobo’sdisease(CD) However the &cbanism of action remainslargeb unlolown. Receot$ a favorableresponse to I&k&nab treatmenthas beendemonstratedin acuteidiopathic pancreatitiscomplicating active Crohn’s diseaseWe describea case of a middle-agedfemale with Crobo’sdiseasewho developedM agressiveform of polyoeuritis resistemto corticosteroids. Her condition has got progressively worse dueto the appearanceof a right arm andright leg limctional impotencewith worsening of the intestinalsymptomsof CD The patientwas admitted to hospitalin ths nearology “nit anda diagnosisofmixed (motor and sensitive)polinemitis involving medial andulnar nerves of the right arm was fomulated by ao electromyography examinationThe lesionswere progressive and animportant myopathy with muscleatrophy of right arm developed This condition hadbeenunresponsiveto systemic corticosteroids andmummosoppressive Administrationof Iotlitimdmab (Remicade)readted in a rapid clinical responsewith subjectiveimprovementsin m”sck pain and generalwell-being,and ao objeotivebnprovememin right arm movements.The patientrespondedextremely well to three 5 “g/Kg infusionsof Infliximab with marked improvementafter the intiuion clinically andcolonscopically An electromyograpby@omwd a&r the third infusionof lntliximab resultedin a net improvementof nerve conduction andmuscle function A 5 mg!Kg infusion of ltiiximab two months later was admmisteredandsystemic conicosteroids badbeen stopped Iotliximabmay be a suitabletherapnrtw option in patientswith rare extraintestinal mmifenations of CD non respondingto conventionaltherapy
30 oc SEROLOGICAL
MARKERS
(ASCA
AND
ANCA,
IN THE
DlAGNOSlS
OF LBD
CB’ROFLOXACM VERSUS MESALMME IN THE PREVENTION OF POSTOPERATWE RECURRRNCEOF CROWS DISEASE PRELIMINARY RESULTS A Resegoni*.B Demchi”, GI Avama,* N Sapone”,A Giustetto’, L Bertolusso”, M Rwzetto’=,F Brew”, M. Astegiano”,G Fronda*
A DOUBLE BLINDED STUDY A MONTANELLI~, V VLLLANACW, H QAWASMEH”, G MISSALE’, G P CENGIA’, L MINELLI’, D DELLA CASA’. E CANCELLIEW E MAINAI(DI§, R CESTART’
‘UOA Chimrgia7 A0 S GiovanniBattista Molioene; ‘UOADU GastroepatologiaA0 S GiovanniBattista Molinette
~DlPART,MENTODI PATOLOGIA CLINIC& OSPEDALEMA’XXORE Dl CP.EMA,‘II SERVlZIODI ANATOMA ED ISTOLOGIA PATOLOGlC& SPBDALICIVILI, BRESCIA,‘CATTEDKA DI CHIRURGIA GENERALEDELL’UNRERSITA DEGLI STUD,, CENTRO DI ENDOSCoPIADIGESTIVA SPEDALl CIVIL1DI BRESCIA
BACKGROUND Croho ‘s diseaseahvaysroan+ atler mrgery, recently it has been suggestedthat me&.&e could delayrwxreoce [I] On the other handsomeantibioticsare used io thetreatment of Crobo ‘s diseaseandmetrooidazolevas shown to beeffective in recwrmce preventionin one shuiy [Z]. As aproflaxacin is also“sod in therapy andit is better tolerated,we aimedto evaluateifciprofloxwin could be effective m delayingCrobo ‘S diseaserecwrence. METHODS: tweotytdne patients,who undenventileocolonicresec~on from l/l/l998 to l/l/2001, were randomizedto mesaltine 2g per day for 1 year or to ciprofloxacin Ig per day for 3 months Twenty receivedmeal&e and9 ciprofloxaoin The two groups were comparablein ageand sex dintributioq andin smokers ’ percentages(66% ciprofloxacin and 60% tiwioe group). RESULTS avcrape follow-“D was 31 7 moothsfor ciorofloxacio and 28 8 for mesakume group Intestinal&mso”od ias regularly performedduring follow-up, in order to detect reammc+? We detectedanultrasoundrecurrence rate of 22,2%in ciprofloxacin-treatedgroup andof 40% in mesaltine-treated emu0 CONCLUSION thesere&s ie preliminaryand numbersaretoo smallto draw anyfirm conclusiot, as statistics are impossible.However our datasuggestthat ciprofloxacin could be mm eiTedve than mesaltine in the preveotionof Crobe ‘I d&easerecurrence after surgery If&is is the case, cipmflotin Shouldbe preferred,becauseit is effectwe m the treatmentof bacteriaJpoWion, which cao inducediarrhoeaa&r ileocolonicresection Ret&tlW 1) CamiUiR Andrmli A C*wrso L et al Oral mesalarinefor the oreveotionof pbstobcrativi recurreoce’of&obo ‘s disease AlimentPharmacoliher 1994.8 35-43 2) RutgeertsP. Hi& M, GebaesK, PeetersM, Peooiockx,Aerts R, KerremaesR Controlledtrial of metrooidazoletreatmentfor ~reveotionof Crohn’srecwrence after ileal resection Gastroeoterology 1995, 108 3617-1621
Thedefmmveanddiffereottaldiagnosisof InRammtory Bowel DiseaseWDI UlcerativeColitis(UC) andCrobo ‘Sdisease(CD), “sually estabkshedby dmical,&olo&al, endoscopicandhistologicalcriteria,cannot beachievedm 10.15%of cases Recentlyagreatinteresfis gainingin oewserologicalmarkers for IBD that could supportandcompletethe mostfrequeotlyusedlaboratoryparameterskke C-reaotiveprotein (CRP), erytbrocytesedimentation rate (BSR) andotheracme-phaseproteinin diagnosisof IBD Aim of tlus study is to evaluatetheanalyuealperformanceandthediagnosticrole of ASCA (Anti-SaccharomycerCerwisiaeAntibodies)IgG andIgA andANCA (AotiNemropbilCpoplasmAntibodies)IgG. 56 consecutivepatients,unrolledfor clinicalsuspect of IBD, were evaluatedin a doubleblindedf&ion by serologicalandhistological mvemgationASCA andANCA were detectedby two methods.iodieet imm”nofluore~cence (OF) sod Eozyme-LinkedImm”“osorbeot Assay(ELISA) The histologicaldia@oslswas basedonmtemationalg&d&es criteriaCaseswereclassifiedasCD (o=l3), UC (~24) and non-idiopathiccolios(o=l9) by birtopatbologicalinvestigationTable1 andtable2 shows accuracyof ASCA andANCA determinatiinsLiteraturedataare stillpoor andextremely variableto considertheseparametersasdngnostic criteria In our experienceantibodies measuremeotwith two-stepprocedureinvolvingaoIIF test (high sensitivity)followed by ELISA (highspecificity) havedemonstratedagwd dmgnost,cperformanceto IdentifyMC andCU that suggesta posublerole - m theszreeoiogof LBD (non-mvasiveapproachwith high patlentcompliance)-in definitivediagnosis(particularlyas supponto thepathdogjst in phenotypeclassificationof doubtfulcases) Table1 Analyticalperformanceof ASCA for ditTaentmtm8CD from non-CD
87%
36%
54%
58%
i
77 % 86 %
/
61 % 80%
Table2 Analyticalperformaomof ANCA for ddferentiatmgUC from non-UC
A84