- Email: [email protected]
Feasibility and tolerability of transnasal gastroscopy (T-EGDS)
17
19 HIGHER PREVALENCE OF HFE GENE H83D HUTATlON IN anti- HCV POStTWE SUBJECTS VS HEALTHY POPULATlON L&& Mantovani V, Azzamli F. Farrara F, Nigm G, Jaboli MF, Miracolo A, Giovanelli S , Manao C. Colecchia A, F&i D’, Roda E and Mauella G. Dipartimento di Madicina I&ma a Gasboanterologia, Universitli di Madica, Univarsiti Bologna; ‘Istituto di Fisiopatologia “G.D’Annunzio”-Chieti - ltalia Background and aimsi Most patients with chmnic hepatitis C present hyparfanitinemia with or without increased sidaramia. Relationships batwaan HCV infection and ganatic mutations predisposing to imn metabolism disorders ara not WI knows The aim of this study was to evaluate. in anti-HCV positive and negative patients. tha prevalence of HFE allele mutations according to farritin serum levels. Pattenta and methods HFE mutations (C282Y, H63D, S65C) wara studied in 128 patients with liver diseases and in 256 healthy mntrois (blood donors) by PCRRFLP. Iron metabolism (i.e. iron and famitin swum levels, TIBC and transfatin satiation) was evaluated in all subjacts. According to swum fanitin values and infection status. patients ware divided into four gmqx: a) 61 anti-HCV + with hyparfanitinamia; b) 16 anti-HCV - with hyperfanitinemia; c) 31 antiiCV + with normal fan-kin; d) 20 anti-HCV - with normal farritin. Hyparfarritin8mia was defined as farritin serum levels above 400 ng/mL in man and 300 nglrnL in woman. Fisher’s exact test was usad for statistical analysis. Reaulbx S65C mutation was found just in ona patient. therefore it wasn’t taken into account in data analysis. Allele fraquencias for both the mutations ware higher in group b vs controls (C282Y 15% vs 1.9%, p= 0,0008; H63D 37.5% vs 16%, p= 0,005). Even though H63D allele frequency was higher in group c vs healthy controls (30.7% vs 16%, p=O,C07), overall prevalence of the mutation was not statistically different in antiHCV+ subjects and mntrols (25.5% vs 16%. p=ns). Conclusions: In group b both HFE gene mutations ware more prevalent than in anti-HCV positive subjects. In fact, in the anti-HCV positive subjects hyperferritinamia is an inflammatory marker, too. Since overall prevalence of both HFE gene mutations was comparable in anti-HCV+ subjects and healthy controls, irra&pactive of sarum ferritin values, there doesn’t seam to be an increased frequency of genetic predisposition for iron metabolism disorders in infected patients.
FEA!xBnATY
GASTROSCOPY
AN-ID
TOLERABILITY
OF
TRANSNASAL
(T-ECDS).
E. Ciliberto, C. Fmodina, 0. Moati. Servizio di &stmenterologia Digs&a - Ospedale “S. Giovanoi di Dio” - Crotone
ed Bodoscopia
Background: TransossaI gastro~ is P.new procedwa sltemative to traditional gasbwqy. Mrninsry expcriwce shows time and costs reduction, associe.ted to good compliance. Aim: Aimofoursmdywastolxnnpue thapgfomMocculdthetolarabiIiiof T-JXDS and umva&~I EGDS. MetboQ:InthetimebehrrmJanuary2ooO~May2001,24pptimts@tr), Previouslydiagoosedwithgasbiculcarthmughstrndardendoscopicprocadurc,
had a T-EGDS (Vidao-PaWax EG 1840) pefmmrd IoaIIpatiwtshiiawuatskal. sedstioawilhDiswpam(5 mgav)waspcrfon&ia12pts,thasamawhobsd lldCQOWredatiolilltbCppmiousmdoacopy.AIlthC~8fewdryllafta thcocam,whaeasLedtofilla~~rrgardiqgthe~~ilityandwill rqlealthewdoscapy. FurthamorqwecvlluatedthemcanleDghtofEGDsandthequalityoftbc
to
&“Udl&accordi4gtOtbeendorcopiStOpilliOll.
Rsllltr: a pt9~tktbc~sdidida’tshowmyprcfen~ aodll prefkredtkT-EGDS.AUpati&s~bettertolcmnceaRascdation. Themeank@toftheT-FlGDSwasaimilutothea&adatdE4+DS. In3curesofT-EGDS,tbc~rpsoi~rwcuasufficicmto~s. GmdosiewThe T-F!GDSisawGdc.ltahvetothestan&ni~aad showssomcdvmtagaqauchas tllcdlmccdlalkiagtothelpalieats~thc . . -Itwillpmbablybcincrcadaglyllwdi”tilc~. TbeT-EGDS,howvcr,isnotweIltoleratedbyadisa& mtmberofpaticnts. MoI-emr,tbemdlladaiwofthainsaummtcancompromiwtbc~oflhs pmcodum with mchnicfd diftiadtia (maI hiisy spwimms, long vdhing ad sspimtioa proetmues) and with the impossibility to peltixm some operative proaduns. Sedation improves the tolerabilii in both the T-EGDS and the standard WPY.
20
8
INTESTINAL PERMEABILITY AND SEROLOGICAL MARKERS IN COELIAC DISEASE (CD) PATIENTS AND THEIR FIRST DEGREE RELATIVES: A PILOT STUDY Secondulfo M, F$&f&M, deMagisbis L, Fisndra R, Sapone A, Familiari V, D’Angelo R, Generoso M*, Carteni M*, Carrati R. Gsstroentemlogy Unit: smbulatorio per la diagnosi e curs della malattia celiaca and ‘Istituto di Fannacologia, SUN, Napoli It is always difficult to the clinicians to know if the coelisc patients are compliant with the Gluten Free Diet (GFDpts). An even more uncertain field of investigation is represented by the submerged part of the iceberg: the first degree relatives of CD patients. Aim of the pnseot pilot study is to vetify which markers sre us&l in the investigation of CD, observing patients and in their tint degree relatives. Methods: IP wss investigated in 9 CD pts (6 were GFDpts sod 3 were on a Ike diet (FD); F=6, M=3) and in 12 of their asymptomatic first degree relatives (F-7, M=5), by means of the CEiMA test (normal range < 0.028). The tisnsglutaminase, tTG (serum IgA anti-hxnsglutaminase antibodies by immunoenzymatic-coloriimebic method Eu-tTG IgA, Eurohospital, Trieste) were studied in 25 CD pts (17 GFDpts, 8 FD; M=lO, F=I5) and in 23 oftheir asymptomatic first degree relatives (F=13, M=lO). The EMA (serum IgA anti-endomysium antibodies: indirect immuoofluorescence on monkey’s oesophsgus sections, Eurohospital, Trieste) were studied in 17 pts (9 GFDpts, 8 FD, F=7, M=IO ) and in 13 of their asymptomatic first degree relatives (F=6, M=7). None of the investigated subjects prose&d with s selective IgA deficit. ResulteIP was altered in 3/6 GFDpts and in 3/3 pts on free diet. The 3 GFDpts with augmented IP (EMA and tTG negative), to a closer snsmnestic investigation, showed s poor diet compliance. In the investigated first degree relatives, IP resulted altered in 5/l 1. tTG were negative in 17117 GFDpts, positive in 7/8 FDpts sod negative in 22/23 first degree relatives. EMA resulted negative in 9/9GFDpts, positive in only 318 FDpts and negative in l2/13 first degree relatives. Conclusions: A) IP could be an important test in the clinical screening of CD patients - being a signal of GFD compliance. B) IP couId well be a tool for evaluating the risk in first degree relatives; C) The evaluation of tTG and EMA are still very useful tools in the familial screening for CD and sk.0 -at least for the tTG _ in the evaluation of GFD compliance.
ATTAM AND PSYCXOLOQW .SUFENWPBDM~C~GE4L~
DLSIRW
IN
SLWECIS
1
M.Fsrinelli*, D.Ravaglia*, G.Matteo**, M.Bortolotti**, G.Trombini* *Dip. di Psicoiogia, Uniwrsit6 di Bologna l * Policlinico S. Or&a-Malpighi, University di Bologna In the onset and maintenance of somatic illnesses there is a significant concurrence of emotional , relational, cognitive and behsviowsl factors. of which the subject is often unaware. Psychological research hss at its M.Ercolani*,
M.Miglioli**,
disposal instruments which wit s qualitative and quantitative evaluation of these aspects. The attachment theory maintains that particularly in the early years of the individual’s development panieular psychological, relational and bchaviowsl contigurstions are formed in relationship to one or more figuns of reference. ‘&se are active during the worse of adult life and manifest themselves in situstions of daoger to psychophysical integrity, amongst which is illness. T&e tiy hae presented proposes sn evaluation of the relationship between style and experiences of attachment, discomfort and psyehologiesl &fences sad illness belwiour in subjects sutTeriog f+om chmnic ga5tmeqbagesl disorders. There were involved 100 subjects efferent to the “Laboratmio
di Motiliti Digestive”. for a medical examination and imtmmeatsl investigstion. The evaluation took pIace by meaos of a clinical interview and psychometric questionnaires (SCL4OR. IBQ, A&Q. PBI). The results of the partial elaboration regard s sample of 58 sabjcds affected by chronic gwtmeqhagcal disorders. The smtistical analysis of the SCL 9OR of the AASQ and of the PBI showed a pooitive anrelation between the high szores on the SCL 90R scsle and those relative to the swres on the SA scale. There exists, tbuefe+e, B relstic&ip between the style of sttaehment and the expression of psyehologicsl distress. To better evaluate these sspects the investigation WBSextended to s selected subset of patients by the administration of the AAI (Adult Attachment Interview) end three tables (purp~ly selected) of the TAT (Test of Thematic Apperception). From the study there emerge data wnceming the psychological profile of the subjects and the chamueristics of the attschment which might come into play also in the relationship with the
health ~arrr of reference. AII undustsnding of this can positiveIy influence the doctor-patient relationship, the progress of the tredtment, and the integration. in some eases. with adequate psychological hrat”le”ts.
AS5
19 HIGHER PREVALENCE OF HFE GENE H83D HUTATlON IN anti- HCV POStTWE SUBJECTS VS HEALTHY POPULATlON L&& Mantovani V, Azzamli F. Farrara F, Nigm G, Jaboli MF, Miracolo A, Giovanelli S , Manao C. Colecchia A, F&i D’, Roda E and Mauella G. Dipartimento di Madicina I&ma a Gasboanterologia, Universitli di Madica, Univarsiti Bologna; ‘Istituto di Fisiopatologia “G.D’Annunzio”-Chieti - ltalia Background and aimsi Most patients with chmnic hepatitis C present hyparfanitinemia with or without increased sidaramia. Relationships batwaan HCV infection and ganatic mutations predisposing to imn metabolism disorders ara not WI knows The aim of this study was to evaluate. in anti-HCV positive and negative patients. tha prevalence of HFE allele mutations according to farritin serum levels. Pattenta and methods HFE mutations (C282Y, H63D, S65C) wara studied in 128 patients with liver diseases and in 256 healthy mntrois (blood donors) by PCRRFLP. Iron metabolism (i.e. iron and famitin swum levels, TIBC and transfatin satiation) was evaluated in all subjacts. According to swum fanitin values and infection status. patients ware divided into four gmqx: a) 61 anti-HCV + with hyparfanitinamia; b) 16 anti-HCV - with hyperfanitinemia; c) 31 antiiCV + with normal fan-kin; d) 20 anti-HCV - with normal farritin. Hyparfarritin8mia was defined as farritin serum levels above 400 ng/mL in man and 300 nglrnL in woman. Fisher’s exact test was usad for statistical analysis. Reaulbx S65C mutation was found just in ona patient. therefore it wasn’t taken into account in data analysis. Allele fraquencias for both the mutations ware higher in group b vs controls (C282Y 15% vs 1.9%, p= 0,0008; H63D 37.5% vs 16%, p= 0,005). Even though H63D allele frequency was higher in group c vs healthy controls (30.7% vs 16%, p=O,C07), overall prevalence of the mutation was not statistically different in antiHCV+ subjects and mntrols (25.5% vs 16%. p=ns). Conclusions: In group b both HFE gene mutations ware more prevalent than in anti-HCV positive subjects. In fact, in the anti-HCV positive subjects hyperferritinamia is an inflammatory marker, too. Since overall prevalence of both HFE gene mutations was comparable in anti-HCV+ subjects and healthy controls, irra&pactive of sarum ferritin values, there doesn’t seam to be an increased frequency of genetic predisposition for iron metabolism disorders in infected patients.
FEA!xBnATY
GASTROSCOPY
AN-ID
TOLERABILITY
OF
TRANSNASAL
(T-ECDS).
E. Ciliberto, C. Fmodina, 0. Moati. Servizio di &stmenterologia Digs&a - Ospedale “S. Giovanoi di Dio” - Crotone
ed Bodoscopia
Background: TransossaI gastro~ is P.new procedwa sltemative to traditional gasbwqy. Mrninsry expcriwce shows time and costs reduction, associe.ted to good compliance. Aim: Aimofoursmdywastolxnnpue thapgfomMocculdthetolarabiIiiof T-JXDS and umva&~I EGDS. MetboQ:InthetimebehrrmJanuary2ooO~May2001,24pptimts@tr), Previouslydiagoosedwithgasbiculcarthmughstrndardendoscopicprocadurc,
had a T-EGDS (Vidao-PaWax EG 1840) pefmmrd IoaIIpatiwtshiiawuatskal. sedstioawilhDiswpam(5 mgav)waspcrfon&ia12pts,thasamawhobsd lldCQOWredatiolilltbCppmiousmdoacopy.AIlthC~8fewdryllafta thcocam,whaeasLedtofilla~~rrgardiqgthe~~ilityandwill rqlealthewdoscapy. FurthamorqwecvlluatedthemcanleDghtofEGDsandthequalityoftbc
to
&“Udl&accordi4gtOtbeendorcopiStOpilliOll.
Rsllltr: a pt9~tktbc~sdidida’tshowmyprcfen~ aodll prefkredtkT-EGDS.AUpati&s~bettertolcmnceaRascdation. Themeank@toftheT-FlGDSwasaimilutothea&adatdE4+DS. In3curesofT-EGDS,tbc~rpsoi~rwcuasufficicmto~s. GmdosiewThe T-F!GDSisawGdc.ltahvetothestan&ni~aad showssomcdvmtagaqauchas tllcdlmccdlalkiagtothelpalieats~thc . . -Itwillpmbablybcincrcadaglyllwdi”tilc~. TbeT-EGDS,howvcr,isnotweIltoleratedbyadisa& mtmberofpaticnts. MoI-emr,tbemdlladaiwofthainsaummtcancompromiwtbc~oflhs pmcodum with mchnicfd diftiadtia (maI hiisy spwimms, long vdhing ad sspimtioa proetmues) and with the impossibility to peltixm some operative proaduns. Sedation improves the tolerabilii in both the T-EGDS and the standard WPY.
20
8
INTESTINAL PERMEABILITY AND SEROLOGICAL MARKERS IN COELIAC DISEASE (CD) PATIENTS AND THEIR FIRST DEGREE RELATIVES: A PILOT STUDY Secondulfo M, F$&f&M, deMagisbis L, Fisndra R, Sapone A, Familiari V, D’Angelo R, Generoso M*, Carteni M*, Carrati R. Gsstroentemlogy Unit: smbulatorio per la diagnosi e curs della malattia celiaca and ‘Istituto di Fannacologia, SUN, Napoli It is always difficult to the clinicians to know if the coelisc patients are compliant with the Gluten Free Diet (GFDpts). An even more uncertain field of investigation is represented by the submerged part of the iceberg: the first degree relatives of CD patients. Aim of the pnseot pilot study is to vetify which markers sre us&l in the investigation of CD, observing patients and in their tint degree relatives. Methods: IP wss investigated in 9 CD pts (6 were GFDpts sod 3 were on a Ike diet (FD); F=6, M=3) and in 12 of their asymptomatic first degree relatives (F-7, M=5), by means of the CEiMA test (normal range < 0.028). The tisnsglutaminase, tTG (serum IgA anti-hxnsglutaminase antibodies by immunoenzymatic-coloriimebic method Eu-tTG IgA, Eurohospital, Trieste) were studied in 25 CD pts (17 GFDpts, 8 FD; M=lO, F=I5) and in 23 oftheir asymptomatic first degree relatives (F=13, M=lO). The EMA (serum IgA anti-endomysium antibodies: indirect immuoofluorescence on monkey’s oesophsgus sections, Eurohospital, Trieste) were studied in 17 pts (9 GFDpts, 8 FD, F=7, M=IO ) and in 13 of their asymptomatic first degree relatives (F=6, M=7). None of the investigated subjects prose&d with s selective IgA deficit. ResulteIP was altered in 3/6 GFDpts and in 3/3 pts on free diet. The 3 GFDpts with augmented IP (EMA and tTG negative), to a closer snsmnestic investigation, showed s poor diet compliance. In the investigated first degree relatives, IP resulted altered in 5/l 1. tTG were negative in 17117 GFDpts, positive in 7/8 FDpts sod negative in 22/23 first degree relatives. EMA resulted negative in 9/9GFDpts, positive in only 318 FDpts and negative in l2/13 first degree relatives. Conclusions: A) IP could be an important test in the clinical screening of CD patients - being a signal of GFD compliance. B) IP couId well be a tool for evaluating the risk in first degree relatives; C) The evaluation of tTG and EMA are still very useful tools in the familial screening for CD and sk.0 -at least for the tTG _ in the evaluation of GFD compliance.
ATTAM AND PSYCXOLOQW .SUFENWPBDM~C~GE4L~
DLSIRW
IN
SLWECIS
1
M.Fsrinelli*, D.Ravaglia*, G.Matteo**, M.Bortolotti**, G.Trombini* *Dip. di Psicoiogia, Uniwrsit6 di Bologna l * Policlinico S. Or&a-Malpighi, University di Bologna In the onset and maintenance of somatic illnesses there is a significant concurrence of emotional , relational, cognitive and behsviowsl factors. of which the subject is often unaware. Psychological research hss at its M.Ercolani*,
M.Miglioli**,
disposal instruments which wit s qualitative and quantitative evaluation of these aspects. The attachment theory maintains that particularly in the early years of the individual’s development panieular psychological, relational and bchaviowsl contigurstions are formed in relationship to one or more figuns of reference. ‘&se are active during the worse of adult life and manifest themselves in situstions of daoger to psychophysical integrity, amongst which is illness. T&e tiy hae presented proposes sn evaluation of the relationship between style and experiences of attachment, discomfort and psyehologiesl &fences sad illness belwiour in subjects sutTeriog f+om chmnic ga5tmeqbagesl disorders. There were involved 100 subjects efferent to the “Laboratmio
di Motiliti Digestive”. for a medical examination and imtmmeatsl investigstion. The evaluation took pIace by meaos of a clinical interview and psychometric questionnaires (SCL4OR. IBQ, A&Q. PBI). The results of the partial elaboration regard s sample of 58 sabjcds affected by chronic gwtmeqhagcal disorders. The smtistical analysis of the SCL 9OR of the AASQ and of the PBI showed a pooitive anrelation between the high szores on the SCL 90R scsle and those relative to the swres on the SA scale. There exists, tbuefe+e, B relstic&ip between the style of sttaehment and the expression of psyehologicsl distress. To better evaluate these sspects the investigation WBSextended to s selected subset of patients by the administration of the AAI (Adult Attachment Interview) end three tables (purp~ly selected) of the TAT (Test of Thematic Apperception). From the study there emerge data wnceming the psychological profile of the subjects and the chamueristics of the attschment which might come into play also in the relationship with the
health ~arrr of reference. AII undustsnding of this can positiveIy influence the doctor-patient relationship, the progress of the tredtment, and the integration. in some eases. with adequate psychological hrat”le”ts.
AS5