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Altered pattern of lipoprotein (a), apolipoprotein A1 and apolipoprotein B100 in Crohn's disease; A relation to thrombosis?
greater (P
MIB-1 (%)
p53 (%)
BAX (%)
OCL-2(%)
2/4 1/3 3/7 (43)
1/4 0/3 1/7 (14)
0/4 0/3 0/7 (0)
114 0/3 1/7 (14)
procoagulantrisk factors in patientswith 18Dcomplicatedby VTE.Patients,Materials,Methods 31 patients with IBD (11 Crohn s, 19 ulcerative colitis) complicated by VTE were studied. Assays for protein S,C, anti-thrombin Ill, anti-phospholipid antibodies, and factor VIII were performed. Genomicanalysisfor G20210A (Prothrombin gene mutation), and G1691A(Factor V Leiden)was also performed using standardtechniquesfor PCRamplification and subsequent restriction analysis using HIND III or Mall respectively.Results 14 (45%) of the 31 patients had an identifiable coagulation defect predisposing to thrombosis. This comprised raised factor VIII levels (n =4), FactorV Leiden(n =2), ProteinC deficiency (n =2), lupus anticoagulant (n = 3), anti-thrombin III deficiency (n = 2), and prothrombin gene mutation (n = 1). One patient had muifipie coagulationdefects. ConclusionsA significant proportion of patients with IBD and venous thrombosis have abnormal procoagulantprofiles. A full thrombophilia screen should be measured in all patients with led complicated by venous thrombosis. 1391 Altorad Patlem of Upoprotoin (a), Apollpoproteth A1 and Apollpoprotoin 6100 in Czoiro's IHonaon; a Relation to Thrombosis? Ioannis E. Koutroubekie, Nild Malliaraki, Emmanouel M. Vardas, Emmanuel Ganotakis, Andreas Margioris, Elias A. Koumumalis, Univ Hosp Heraklion, Heraklion Greece Background: Upoprotein (a) [Lp(a)] is recognised as a risk factor for arterial and venous thrombosis, a property that might be relatedto its structural similarity to plasminogen.Since patients with inflammatory bowel disease(IBD) frequently suffer from thromboembolic events we studied the role of Lp(a) in conjunction with lipids and apolipopmteins in Greek patients with ulcerativecolitis (UC) and Crohn s disease(CD). Methods: Lp(a), total cholesterol, high° density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides (TG), apolipoprotein A1 (apoA1) and apolipoprntein B100 (apoBlOO)were determinedin sere from 129 consecutivefasting patients with leD (66 with UC and 63 with CD) and 66 matched for sex and age healthy controls (HC). Diseaseactivity in CO was evaluated by use of the COAl score and in UC by the simple clinical colitis activity index (Walmsleyet el). Comparisons between the three diagnostic groups in terms of continuous measurements were made by analysis of variance (one-wayANOVA)whereascomparisons betweentwo groups were made by t-tests. Results: In CD patients the mean serum Lp(a) level was significantly higher (41.2 mg/dL) in comparison to HC (22.9 mg/dl) (P =O.OO5). On the other hand the mean levels of apoA1 (118.9 mg/dl), apoBlO0 (85 mg/dl), cholesterol (181.5 mg/dl) and LDL-cholesterol (111.4 mg/dl) in CO, were significantly lower than in HC (136, 115.3, 135.2 & 158.9 mg/dl respectively). In UC patients the mean levels of Lp(a) (30.1 mg/dL), apoA1 (137,1 mg/dL), apoBlO0 (93.7 mg/dL) as well as and of the other parameters were not significant different to HC. Raisedlevels of I.p(a) >30 mg/dL was found in 29 CD patients (46 %), 15 UC patients (23 %), and 11 HC (17 %). Patientswith active CD had significantly higher mean Lp(a) (61.4 mg/dl) and lower apoA1 (110.8 mg/dl) than patients with non active disease (31.5 mg/dl & 135.5 mg/dl) (p = 0.04 & p = 0.009). Patientswith active UC had also higher mean Lp(a) and lower apoA1 than non active UC but not statistically significant (p=O.08 & p=O.06). Mean levels of apoBIO0 were not found associatedwith diseaseactivity. Conclusions: Our results suggestthat mainly in CO but not in UC patientsaltered lipoprotein and apolipoproteinpatterns exist that may possibly expose them to higher risk of thrombosis. The association between Lp(a) and diseaseactivity in CD points also to this suggestion.
1389 Seronegative Spondyladhrepathiosand Allergic Diseases Rarely Coexist in Patients with Ulcerative Colitis Agesilao D'Arienzo, FrancescoManguso, Raffaele Bennato, Gastroenterology,Univ Fed II, Naples Italy; Raffeele Scarpa, Rbeumatology,Univ Fed II; Corrado Astarita, Immunopefhology Unit, SUN, Naples Italy; FrancescoPaolo D'Armiento, Pathology, Univ Fed II, Naples Italy; Giovanni Vicinanza, Marco Sanges, Teresa Staiano, Gastroenterology, Univ Fed II, Naples Italy; Domenico Gargano, Immunopathology Unit, SUN, Naples Italy;, Anna Pisani, Gabrieie Mazzacca,Gastroenterology,Univ Fed I1, Naples Italy
13~
Background/Aim: seronegative spondylarthopathies (SPA) are frequently associated with Inflammatory Bowel Disease. Recently the association between Ulcerative Colitis (UC) and type-I allergy has been reported. The aim of this study was to evaluate in UC patients the contemporary presenceof SpA and allergic diseases. Patientsand Methods: fifty consecutive UC out-patients (M/F 32/18, mean age 38.3-+14 yrs, range 16-69 yrs), graded with clinical, endoscopicand histologic scores on the basis of Rachmilewitzand Truelove& Richardcriteria, were enrolled in this study. We excluded patients with other concomitant active diseasesand assuming drugs potentially interfering with the performanceof the aliergologictests. Arthritis was defined on the basis of clinical and laboratoryfeatures, radiographicstudy, and scintiscan examination. Diagnosis of SpA was made according to the European Spondyloarthropathy Study Group (ESSG) criteria, Allergic disease was defined on the basis of medical history, symptoms, prick exposition to airborne allergens, and was confirmed by specific provocation tests. Fifty healthy subjects (M/F 25/25, mean age 40-+12.2, range 21-65 yrs) were studied as control group. Results: in 23 cases (46%) a left-sided colitis was found, whereas a larger involvement was observed in the others. On the basis of CAI score 33 patients (66%) were in remission and 17 (34%) in mild-moderatediseaseactivity. 14 patients (28%) showed SpA: axial involvement occurred in all cases, whereas a peripheral localizationwas observed in 9. No control subject showed SpA. Diagnosis of allergic IgE-mediateddiseasewas made in 19 patients (38%) and 6 controls (12%): rhinitis and/or conjunctivitis in 16 casesand 6 controls, asthma only in 1 case, and an overlap of asthma and rhinitis in 2 cases. Only in two cases a co-occurrence of SpA and type-I allergy was demonstrated (p=O.03). No correlation was found between the presence of SpA or allergy and extension or flare-up degree of UC. Conclusions: our data confirm that UC patients frequently show type-I allergic diseases and SpA, but these conditions rarely coexist. This finding msy suggest the presenceof different subsets of UC patients or different T helper cell profiles that makethe contemporarypresence of type-I allergy and SpA in the same subject difficult.
Bismuth Sebealicylate (BSS) is Supedor to 5-amionselicylate (ASA) for the TreaimeM of Mieroosopie ColHis (MC) in a Large Community Based Series. John M. 8ozdech, Quincy Medical Group, Quincy, IL MC is an inflammatory colitis of unknown cause. Most reported pts with MC are derived from referral centers.In 1998 BSS was added to treament options for MC. We reviewed our consecutiveMC 1993-2000 from a single specialist in a small community to assessthe impact of BSS on the treatment of MC. Methods: We reviewed all cases of MC by record, clinic and phone followup,MC was defined by persistent diarrhea >4wk,without other cause, nl colonoscopy and typical biopsy.Collagendeposition was noted but no attempt was made to separate lymphocytic from collagenouscolitis. Prior to 1998 treatment was with mesalamine 2.4-3.69/d or suflacalazine3.0-4.59/d. After mid 1998 treatment was usually BSS 2.1-2.4(]/ d. Pts assessed at 2 wk; if improved tx was continued 8-12 weeks and drug discontinued. Response was defined as subjective normalization of BM, relapse as recurrent symptoms after a symptom and drug free interval>2wk. Pts were included only if followup available, completed >2wk drug and receivedeither ASA or BSS as initial therapy. Results-SeeTable Discussion: Although initial response similar, there were fewer relapses and fewer adverse events (4 vs 1)with BSS. Although F/U differed due to historical nature of study majority of relapses were early>90% before 12m. BSS is preferred therapy for MC seen in community practice. ASP, N (IWF) Age yrs. Duration moo. Bm/d x/d Response Rdalne Weeksto ~ A~/mlpt at f/u Folowup man.
1390 The importance Of Pracoaoelaof Screening in PatieMs Witk lidlaromatory Bowel Disease Complicated By Venous "llWmbosis Terence Wong, Jo Nightingale, Mark Winter, Kent and Canterbury Hosp, Canterbury United Kingdom Introduction Patientswith inflammatory bowel disease(IBD) have an increasedfrequency of venous thromboembolism (VIE), and microvascular thrombosis has been postulated in the pathogenesis of IBD. The pathogenesisof thrombosis in inflammatory bowel disease is not well characterised.The aim of the present study was to evaluatethe frequency of laboratory
A-268
41 (8/33) 52.9+ 18.6 55.3~118 5.3~6.4 25140 18/25 6.~8.8 27140 32.8~23
BSS 32 (11125) 60.3~17.1 63d:125 5.0~3.2 27/35 5/27 7.4+3.1 29/35 9.5-z8
p.~0.005 ns ns ns p~O.001 ns 21/23<12 m p~O.O001
MIB-1 (%)
p53 (%)
BAX (%)
OCL-2(%)
2/4 1/3 3/7 (43)
1/4 0/3 1/7 (14)
0/4 0/3 0/7 (0)
114 0/3 1/7 (14)
procoagulantrisk factors in patientswith 18Dcomplicatedby VTE.Patients,Materials,Methods 31 patients with IBD (11 Crohn s, 19 ulcerative colitis) complicated by VTE were studied. Assays for protein S,C, anti-thrombin Ill, anti-phospholipid antibodies, and factor VIII were performed. Genomicanalysisfor G20210A (Prothrombin gene mutation), and G1691A(Factor V Leiden)was also performed using standardtechniquesfor PCRamplification and subsequent restriction analysis using HIND III or Mall respectively.Results 14 (45%) of the 31 patients had an identifiable coagulation defect predisposing to thrombosis. This comprised raised factor VIII levels (n =4), FactorV Leiden(n =2), ProteinC deficiency (n =2), lupus anticoagulant (n = 3), anti-thrombin III deficiency (n = 2), and prothrombin gene mutation (n = 1). One patient had muifipie coagulationdefects. ConclusionsA significant proportion of patients with IBD and venous thrombosis have abnormal procoagulantprofiles. A full thrombophilia screen should be measured in all patients with led complicated by venous thrombosis. 1391 Altorad Patlem of Upoprotoin (a), Apollpoproteth A1 and Apollpoprotoin 6100 in Czoiro's IHonaon; a Relation to Thrombosis? Ioannis E. Koutroubekie, Nild Malliaraki, Emmanouel M. Vardas, Emmanuel Ganotakis, Andreas Margioris, Elias A. Koumumalis, Univ Hosp Heraklion, Heraklion Greece Background: Upoprotein (a) [Lp(a)] is recognised as a risk factor for arterial and venous thrombosis, a property that might be relatedto its structural similarity to plasminogen.Since patients with inflammatory bowel disease(IBD) frequently suffer from thromboembolic events we studied the role of Lp(a) in conjunction with lipids and apolipopmteins in Greek patients with ulcerativecolitis (UC) and Crohn s disease(CD). Methods: Lp(a), total cholesterol, high° density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides (TG), apolipoprotein A1 (apoA1) and apolipoprntein B100 (apoBlOO)were determinedin sere from 129 consecutivefasting patients with leD (66 with UC and 63 with CD) and 66 matched for sex and age healthy controls (HC). Diseaseactivity in CO was evaluated by use of the COAl score and in UC by the simple clinical colitis activity index (Walmsleyet el). Comparisons between the three diagnostic groups in terms of continuous measurements were made by analysis of variance (one-wayANOVA)whereascomparisons betweentwo groups were made by t-tests. Results: In CD patients the mean serum Lp(a) level was significantly higher (41.2 mg/dL) in comparison to HC (22.9 mg/dl) (P =O.OO5). On the other hand the mean levels of apoA1 (118.9 mg/dl), apoBlO0 (85 mg/dl), cholesterol (181.5 mg/dl) and LDL-cholesterol (111.4 mg/dl) in CO, were significantly lower than in HC (136, 115.3, 135.2 & 158.9 mg/dl respectively). In UC patients the mean levels of Lp(a) (30.1 mg/dL), apoA1 (137,1 mg/dL), apoBlO0 (93.7 mg/dL) as well as and of the other parameters were not significant different to HC. Raisedlevels of I.p(a) >30 mg/dL was found in 29 CD patients (46 %), 15 UC patients (23 %), and 11 HC (17 %). Patientswith active CD had significantly higher mean Lp(a) (61.4 mg/dl) and lower apoA1 (110.8 mg/dl) than patients with non active disease (31.5 mg/dl & 135.5 mg/dl) (p = 0.04 & p = 0.009). Patientswith active UC had also higher mean Lp(a) and lower apoA1 than non active UC but not statistically significant (p=O.08 & p=O.06). Mean levels of apoBIO0 were not found associatedwith diseaseactivity. Conclusions: Our results suggestthat mainly in CO but not in UC patientsaltered lipoprotein and apolipoproteinpatterns exist that may possibly expose them to higher risk of thrombosis. The association between Lp(a) and diseaseactivity in CD points also to this suggestion.
1389 Seronegative Spondyladhrepathiosand Allergic Diseases Rarely Coexist in Patients with Ulcerative Colitis Agesilao D'Arienzo, FrancescoManguso, Raffaele Bennato, Gastroenterology,Univ Fed II, Naples Italy; Raffeele Scarpa, Rbeumatology,Univ Fed II; Corrado Astarita, Immunopefhology Unit, SUN, Naples Italy; FrancescoPaolo D'Armiento, Pathology, Univ Fed II, Naples Italy; Giovanni Vicinanza, Marco Sanges, Teresa Staiano, Gastroenterology, Univ Fed II, Naples Italy; Domenico Gargano, Immunopathology Unit, SUN, Naples Italy;, Anna Pisani, Gabrieie Mazzacca,Gastroenterology,Univ Fed I1, Naples Italy
13~
Background/Aim: seronegative spondylarthopathies (SPA) are frequently associated with Inflammatory Bowel Disease. Recently the association between Ulcerative Colitis (UC) and type-I allergy has been reported. The aim of this study was to evaluate in UC patients the contemporary presenceof SpA and allergic diseases. Patientsand Methods: fifty consecutive UC out-patients (M/F 32/18, mean age 38.3-+14 yrs, range 16-69 yrs), graded with clinical, endoscopicand histologic scores on the basis of Rachmilewitzand Truelove& Richardcriteria, were enrolled in this study. We excluded patients with other concomitant active diseasesand assuming drugs potentially interfering with the performanceof the aliergologictests. Arthritis was defined on the basis of clinical and laboratoryfeatures, radiographicstudy, and scintiscan examination. Diagnosis of SpA was made according to the European Spondyloarthropathy Study Group (ESSG) criteria, Allergic disease was defined on the basis of medical history, symptoms, prick exposition to airborne allergens, and was confirmed by specific provocation tests. Fifty healthy subjects (M/F 25/25, mean age 40-+12.2, range 21-65 yrs) were studied as control group. Results: in 23 cases (46%) a left-sided colitis was found, whereas a larger involvement was observed in the others. On the basis of CAI score 33 patients (66%) were in remission and 17 (34%) in mild-moderatediseaseactivity. 14 patients (28%) showed SpA: axial involvement occurred in all cases, whereas a peripheral localizationwas observed in 9. No control subject showed SpA. Diagnosis of allergic IgE-mediateddiseasewas made in 19 patients (38%) and 6 controls (12%): rhinitis and/or conjunctivitis in 16 casesand 6 controls, asthma only in 1 case, and an overlap of asthma and rhinitis in 2 cases. Only in two cases a co-occurrence of SpA and type-I allergy was demonstrated (p=O.03). No correlation was found between the presence of SpA or allergy and extension or flare-up degree of UC. Conclusions: our data confirm that UC patients frequently show type-I allergic diseases and SpA, but these conditions rarely coexist. This finding msy suggest the presenceof different subsets of UC patients or different T helper cell profiles that makethe contemporarypresence of type-I allergy and SpA in the same subject difficult.
Bismuth Sebealicylate (BSS) is Supedor to 5-amionselicylate (ASA) for the TreaimeM of Mieroosopie ColHis (MC) in a Large Community Based Series. John M. 8ozdech, Quincy Medical Group, Quincy, IL MC is an inflammatory colitis of unknown cause. Most reported pts with MC are derived from referral centers.In 1998 BSS was added to treament options for MC. We reviewed our consecutiveMC 1993-2000 from a single specialist in a small community to assessthe impact of BSS on the treatment of MC. Methods: We reviewed all cases of MC by record, clinic and phone followup,MC was defined by persistent diarrhea >4wk,without other cause, nl colonoscopy and typical biopsy.Collagendeposition was noted but no attempt was made to separate lymphocytic from collagenouscolitis. Prior to 1998 treatment was with mesalamine 2.4-3.69/d or suflacalazine3.0-4.59/d. After mid 1998 treatment was usually BSS 2.1-2.4(]/ d. Pts assessed at 2 wk; if improved tx was continued 8-12 weeks and drug discontinued. Response was defined as subjective normalization of BM, relapse as recurrent symptoms after a symptom and drug free interval>2wk. Pts were included only if followup available, completed >2wk drug and receivedeither ASA or BSS as initial therapy. Results-SeeTable Discussion: Although initial response similar, there were fewer relapses and fewer adverse events (4 vs 1)with BSS. Although F/U differed due to historical nature of study majority of relapses were early>90% before 12m. BSS is preferred therapy for MC seen in community practice. ASP, N (IWF) Age yrs. Duration moo. Bm/d x/d Response Rdalne Weeksto ~ A~/mlpt at f/u Folowup man.
1390 The importance Of Pracoaoelaof Screening in PatieMs Witk lidlaromatory Bowel Disease Complicated By Venous "llWmbosis Terence Wong, Jo Nightingale, Mark Winter, Kent and Canterbury Hosp, Canterbury United Kingdom Introduction Patientswith inflammatory bowel disease(IBD) have an increasedfrequency of venous thromboembolism (VIE), and microvascular thrombosis has been postulated in the pathogenesis of IBD. The pathogenesisof thrombosis in inflammatory bowel disease is not well characterised.The aim of the present study was to evaluatethe frequency of laboratory
A-268
41 (8/33) 52.9+ 18.6 55.3~118 5.3~6.4 25140 18/25 6.~8.8 27140 32.8~23
BSS 32 (11125) 60.3~17.1 63d:125 5.0~3.2 27/35 5/27 7.4+3.1 29/35 9.5-z8
p.~0.005 ns ns ns p~O.001 ns 21/23<12 m p~O.O001