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Bile acid handling in primary biliary cirrhosis: Effect of ursodeoxycholic acid treatment
Abstracts
39
37 COLONOSCOPIC MALFORMATION.
REMOVAL OF A POLYPOID CASE REPORT
ARTERIOVENOUS
A D’ Anenzo, F Manguso, ‘F P D‘Armlento, R Bennato,‘P.Somma,G V~cmanzq M.Sanges, APuu, A Panarese, G Mazacca Umt of Gastroenterology and ‘Pathology,Faculty of Medune, Fedenco ll Umvers~ty of Naples, Italy Vascular les,ons of the gastromtertlnrd (GI) tract arc bemg recogmzed wtb mcreasmg frequency as a cause ofG1 bleedmg The primary vascular lesmnsofthe GI tract mclude the arterrovenous malformation (AVM) Usually this term 1s sponymous with vascular ectraa, but Lawn prefer to reserve the term arterwenous malformatmn for those cases m which the vascular lesmns have a hamartomatousappearance,namely,large arteries andvents d&huted throughout all layers of the bowel wall, and the term of vascular ectasm m the presence of mumxa and submuwsa vascular abnormahhes ulth no involvement of the musculans propna AVMs can mvolve any put ofthe Gl tract andusually appear to the endorcoplst ather as flat or elevateddiscrete bnght red mucosal lesmns A pedunculatedpolypmd appearance1sextremely uncommon Only 2 authors have described large bowel and gastric stalked polp’old AVMs occurrmg m patxnts wth Gl bleedmg A 53.year-old man was admrtted to our lnstwute for 3.month hlstoryoflntermlaentmlldrectal bleedmgandalargestalkedpolypIden~fied mthe slgmoid colon at double contrast banum enema The complete exploration of the largebowel showed anormal mwosa and confirmed thepresence of a polyp wth astalk 3 cm long and aheadwe of2 cm Endoscoplc removal by dwhemuc snafe was performed usmg coagulahoncurrent. wtb only shght bleeding followmg the procedure Hutologrcally the slgmold ~019 revealed the presence of ddated and tortuous vascular strucfllres m the mucosa and submucosa ‘I&e findmg was cowlstent wth a colomc arteriovenous malformation vntb an aspect of pedunculatedpolyp The current class~ficatmnsof gatromtestmal malformations do not take mto account the AVMs wth a polypold appearance Accordmg to Lewm, our lesmn should be classdied as vascular ectaa, but ,ts polypold aspect makes the mdivlduauon of a proper nomenclature mdlspensable In our and m Kozwa’s experience, the endoscoplc resectton of large pedunculated colomc AVMs was not complicated bv animmediate or delayedbleedme. whereasm Tie’s case the endoscoplc veatmenf of an AVM m a 4.cm gasmc polyp determmed a profuse bleedmg from the remnant stalk ln conclusion, our experience confirms that colomc AVMs may have a polypold appearance macroscoplcally indwmgushable from other common pedunculated les,ons Although the endoscopic treatment of theseparocular AVMs IS potenhally at mcreared risk of bleedmg, m our patmnt wth a 2-cm colo~c polyp, snare polypectomy wth appropriatestalk coagulationwas revealed to be a safe procedure
38
40 BILE ACID HANDLING IN PRIMARY BILIARY CIRRHOSIS: EFFECT OF URSODEOXYCHOLIC ACID TREATMENT R Scagliormi, p S Gamberini, M Prondinr, A. Pezzolr, S Guliini Deparrmenls of Gasfroenrerologv and Nuclear Medmne. S Anna Hospital, Ferrora, Italy Backeround: Bile acid (BA) handling is speatic to the liver, and it 1s deranged .%uI~~in the process of liver disease The introductmn of the y-labelled BA SeHCAT has allowed direct meawrement of hepatic BA uptake, excretion and intmhepatic transit to be carried on. Using these measurements we have previously demonstrated that patients with chronic cholestatic liver disease have impaired hepatic BA excretion and prolonged intrahepatic transit. Since intravenous “SeHCAT is no longer available, we have carried out several studies comparing kinetic hepatic functions measured by 99”Tc-BrHIDA to those measured by “SeHCAT and we showed that ““TcBrHIDA is handled efficiently by the liver similarly to “SeHCAT. &. To investigate the effect of ursodeoxycholate (UDCA) administration on the kinetics of hepatic BA handling in patients with early stage primary biliary cirrhosis (PBC). Materials & Methods: 8 patients with PBC stage l-11were studied before and during UDCA treatment (IS mg&$day) and compared with 6 healthy controls. Following iv injection of “Tc-BrHIDA (I 48 Mbq) the followmg parameters were calculated: plasma disappearance rates (early KI, and late Kz) from serial blood samples; hepatic uptake, excretion and intrahepatic transit from simultaneous dynamic abdominal y-camera scanning over a 90.min period. &ul&x Before UDCA, PBC patients showed a sigmficant excretory defect compared to controls: they had a lower excretion rate @
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THE HETEROZYGOSIS IN THE GElriETlC MUTATION FOR HFE IS NOT ASSOCIATED WITH AN INCREASED RISK OF LIVER DAMAGE IN ALCOHOLICS T Benx, G. Sardeo*, D Infantolindf, MR Biasin#, U. Lorenzoni, M. Rigato, A D’ Alessandro, M Salvagnini U 0 Medicina Getter& 2, Ospedale S Bortolo, Vioenza and # U 0. Medicina I Ospedale Civile, Montebelluna, * U 0 lstologia ed Anatomia Patologica, Ospedale Civile Castelfianco Veneto AIM Aim of the present study was to identify the prevalence of the Senetlc mutation for hemocromatosis in patients with alcohol related diseases, and to correlate it with the presence of liver cirrhosis and iron overload index iest PATIENTS 92 patients, with alcohol intake exceding 80 g/die (85 M, 7 F) consecutively admitted to two departments of general medicine for alcoholrelated disease were included 26 had clinical or bioptic diagnosis of liver wrhosis The genetic mutation for hemocromathosis (C282Y and H63D) and serum iron lFe), ferritin (Ft) and transferrin saturation (TS) were determined RESULTS 9 patients (9.7%) had heterozygotic mutation for hemocromathosis (6 C282Y and 3 H63D) but none for omozygote form No patvats of this group had liver cirrhosis Of 83 patients with normal HFE genotype 26 had liver cirrhosis, the mean age in the two group (HFE mutated and HFE normal) was similar (53 and 52 respectivity).In patients with HFE eterozygosis the mean values of Fe, Ft, SF were 149 2 ugjdl, 8?!l “g/ml and 52 6% respectively In patients with normal genotypes without cirrhosis I22 ugfdl, 426 ngiml and 38 6%, in patients with normal HFE and with liver cirrhosis 128 mgidl, 567 &ml and 46 8% The frequence of abnormal value of Ft was 100 % in eterozygotx patients and 62 % in the non HFE mutate ( p<@ 025), the TS was higher than 60 % in 33 ?& of HFE mutate vs 16 % of non HFE mutate ( p n s ) CONCLUSIONS in our population of alcoholics the prevalence of hemocromatosis mutation is similar to what reported in the general population The eterozvgotic form is not associated with B higher orevalence r of liver cirrhosis, even ;f more pronounced biochemical &dence of iron overload seems to be present Probably etorozygotic status does not play a major role in the development of hepatic damage or more prolonged period of exposure to the toxic 1s needed
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A149
39
37 COLONOSCOPIC MALFORMATION.
REMOVAL OF A POLYPOID CASE REPORT
ARTERIOVENOUS
A D’ Anenzo, F Manguso, ‘F P D‘Armlento, R Bennato,‘P.Somma,G V~cmanzq M.Sanges, APuu, A Panarese, G Mazacca Umt of Gastroenterology and ‘Pathology,Faculty of Medune, Fedenco ll Umvers~ty of Naples, Italy Vascular les,ons of the gastromtertlnrd (GI) tract arc bemg recogmzed wtb mcreasmg frequency as a cause ofG1 bleedmg The primary vascular lesmnsofthe GI tract mclude the arterrovenous malformation (AVM) Usually this term 1s sponymous with vascular ectraa, but Lawn prefer to reserve the term arterwenous malformatmn for those cases m which the vascular lesmns have a hamartomatousappearance,namely,large arteries andvents d&huted throughout all layers of the bowel wall, and the term of vascular ectasm m the presence of mumxa and submuwsa vascular abnormahhes ulth no involvement of the musculans propna AVMs can mvolve any put ofthe Gl tract andusually appear to the endorcoplst ather as flat or elevateddiscrete bnght red mucosal lesmns A pedunculatedpolypmd appearance1sextremely uncommon Only 2 authors have described large bowel and gastric stalked polp’old AVMs occurrmg m patxnts wth Gl bleedmg A 53.year-old man was admrtted to our lnstwute for 3.month hlstoryoflntermlaentmlldrectal bleedmgandalargestalkedpolypIden~fied mthe slgmoid colon at double contrast banum enema The complete exploration of the largebowel showed anormal mwosa and confirmed thepresence of a polyp wth astalk 3 cm long and aheadwe of2 cm Endoscoplc removal by dwhemuc snafe was performed usmg coagulahoncurrent. wtb only shght bleeding followmg the procedure Hutologrcally the slgmold ~019 revealed the presence of ddated and tortuous vascular strucfllres m the mucosa and submucosa ‘I&e findmg was cowlstent wth a colomc arteriovenous malformation vntb an aspect of pedunculatedpolyp The current class~ficatmnsof gatromtestmal malformations do not take mto account the AVMs wth a polypold appearance Accordmg to Lewm, our lesmn should be classdied as vascular ectaa, but ,ts polypold aspect makes the mdivlduauon of a proper nomenclature mdlspensable In our and m Kozwa’s experience, the endoscoplc resectton of large pedunculated colomc AVMs was not complicated bv animmediate or delayedbleedme. whereasm Tie’s case the endoscoplc veatmenf of an AVM m a 4.cm gasmc polyp determmed a profuse bleedmg from the remnant stalk ln conclusion, our experience confirms that colomc AVMs may have a polypold appearance macroscoplcally indwmgushable from other common pedunculated les,ons Although the endoscopic treatment of theseparocular AVMs IS potenhally at mcreared risk of bleedmg, m our patmnt wth a 2-cm colo~c polyp, snare polypectomy wth appropriatestalk coagulationwas revealed to be a safe procedure
38
40 BILE ACID HANDLING IN PRIMARY BILIARY CIRRHOSIS: EFFECT OF URSODEOXYCHOLIC ACID TREATMENT R Scagliormi, p S Gamberini, M Prondinr, A. Pezzolr, S Guliini Deparrmenls of Gasfroenrerologv and Nuclear Medmne. S Anna Hospital, Ferrora, Italy Backeround: Bile acid (BA) handling is speatic to the liver, and it 1s deranged .%uI~~in the process of liver disease The introductmn of the y-labelled BA SeHCAT has allowed direct meawrement of hepatic BA uptake, excretion and intmhepatic transit to be carried on. Using these measurements we have previously demonstrated that patients with chronic cholestatic liver disease have impaired hepatic BA excretion and prolonged intrahepatic transit. Since intravenous “SeHCAT is no longer available, we have carried out several studies comparing kinetic hepatic functions measured by 99”Tc-BrHIDA to those measured by “SeHCAT and we showed that ““TcBrHIDA is handled efficiently by the liver similarly to “SeHCAT. &. To investigate the effect of ursodeoxycholate (UDCA) administration on the kinetics of hepatic BA handling in patients with early stage primary biliary cirrhosis (PBC). Materials & Methods: 8 patients with PBC stage l-11were studied before and during UDCA treatment (IS mg&$day) and compared with 6 healthy controls. Following iv injection of “Tc-BrHIDA (I 48 Mbq) the followmg parameters were calculated: plasma disappearance rates (early KI, and late Kz) from serial blood samples; hepatic uptake, excretion and intrahepatic transit from simultaneous dynamic abdominal y-camera scanning over a 90.min period. &ul&x Before UDCA, PBC patients showed a sigmficant excretory defect compared to controls: they had a lower excretion rate @
_I___--
THE HETEROZYGOSIS IN THE GElriETlC MUTATION FOR HFE IS NOT ASSOCIATED WITH AN INCREASED RISK OF LIVER DAMAGE IN ALCOHOLICS T Benx, G. Sardeo*, D Infantolindf, MR Biasin#, U. Lorenzoni, M. Rigato, A D’ Alessandro, M Salvagnini U 0 Medicina Getter& 2, Ospedale S Bortolo, Vioenza and # U 0. Medicina I Ospedale Civile, Montebelluna, * U 0 lstologia ed Anatomia Patologica, Ospedale Civile Castelfianco Veneto AIM Aim of the present study was to identify the prevalence of the Senetlc mutation for hemocromatosis in patients with alcohol related diseases, and to correlate it with the presence of liver cirrhosis and iron overload index iest PATIENTS 92 patients, with alcohol intake exceding 80 g/die (85 M, 7 F) consecutively admitted to two departments of general medicine for alcoholrelated disease were included 26 had clinical or bioptic diagnosis of liver wrhosis The genetic mutation for hemocromathosis (C282Y and H63D) and serum iron lFe), ferritin (Ft) and transferrin saturation (TS) were determined RESULTS 9 patients (9.7%) had heterozygotic mutation for hemocromathosis (6 C282Y and 3 H63D) but none for omozygote form No patvats of this group had liver cirrhosis Of 83 patients with normal HFE genotype 26 had liver cirrhosis, the mean age in the two group (HFE mutated and HFE normal) was similar (53 and 52 respectivity).In patients with HFE eterozygosis the mean values of Fe, Ft, SF were 149 2 ugjdl, 8?!l “g/ml and 52 6% respectively In patients with normal genotypes without cirrhosis I22 ugfdl, 426 ngiml and 38 6%, in patients with normal HFE and with liver cirrhosis 128 mgidl, 567 &ml and 46 8% The frequence of abnormal value of Ft was 100 % in eterozygotx patients and 62 % in the non HFE mutate ( p<@ 025), the TS was higher than 60 % in 33 ?& of HFE mutate vs 16 % of non HFE mutate ( p n s ) CONCLUSIONS in our population of alcoholics the prevalence of hemocromatosis mutation is similar to what reported in the general population The eterozvgotic form is not associated with B higher orevalence r of liver cirrhosis, even ;f more pronounced biochemical &dence of iron overload seems to be present Probably etorozygotic status does not play a major role in the development of hepatic damage or more prolonged period of exposure to the toxic 1s needed
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A149