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Gastrointestinal distension in severe ulcerative colitis (UC)
MICI
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113 INFLIXIMAB TREATMENT IN PATIENTS WITH ACfIV!? CROHN DISEASE: TRANSABDOMINAL BOWEL SONOGRAI’HY MODIFICATION BEFORE AND AFTER THERAPY Carla Serm Laura Volpe, Pa010Gionchetti, FernandoRizzello, Me&no Campieri, Mario Miglioli. D~pxtimento di Medtcma Interna e Gastroentemlogia,Universita degli Stndi di Bologna s.Orw1a Background. Severalstudies suggestthe valueoftmnsebdominal bowel sonwaphy (TABS) in diaenosinnand follow-uo of C&n’s disease.Recently, it was demonstmtedthat Inflixbnab therepy is able to induce bnprov~ent of endoscopiclesions&td histological innemmatory tilhation. Objectives. The aim of this study was to evaluatethe smtogmphicmodifications dueto Jnflhimab therapy in patientswith active Cmhn’s disease.Methods. 30 pts with active Cmbn’s disease (CDAI> ZOO),steroid-refmctory or steroid-dependentendintolerantto azathioprine,u&went TABS immediatelybefore anda month after the iv. info&n of IntIiximab (Smgjkg). An Hitachi ElJB 525(Tokyo, Japan)with two electronicprobe operatingat a frequency of 3.5-2.5 and7.5-5 MHz was wed. The following parameterswere analyzed:gut wall thickening, presenceor absence of thenortnal wall stratification, preface of creepingf& presenceof mesent& lymph nodes. Results.After In8*imab therapy the presenceof the nmmal stratification of the bowel well was seenin 90% ofpatients (before therapy the petwntage was only 25%, p
BCL-2 EXPRESSION AND LAMINA PROPRIA MONONUCLEAR CELL APOPTOSIS lN MACROSCOPICALLY INVOLVED AREAS OF CROHN’S DISEASE PATIENTS Di SebatinoA, Ricewti L, CiccociopDo R. Morera R. D’Al6 S. Luinetti 0. Tinozzi FP. Tinoti S. CifoneMC, Corazza GR. Gestmenterology Unit, Depts of Pathologyand Surgery, !RCCS Policlinico S. Matteo, University of Pavia;Dept of ExperimentalMedicine, University of L’Aquila, Italy. Policlinico S.Metteo Background & Aims: To evaluatethe role of theantiapaptoticBcl-2 protein in regulatingthe susceptibility of lemina pmpria mononuclearcells (LPMCs) to apaptosisin Cmbn’s disease(CD), we studiedB&2 expressionend wptosis of LPMCs in tbis condition. Patients& Methods: Endoscopicileal andcolonic biop&~&&mem were calleetedfrom mecmmopically involved areas of 16 CD patients(meanage 33.4yrs, range I-), end from 16contml subjects (mean age34.8 ITS,range20.62) undergoingendoscopyfor investigationof persistent dietrhoeaandirritable bowel syndrome.The clinical severity of diseasewas assessedby the evaluationof the C&n’s disease activity index (CDAl). Bcl-2 expression wes evaluatedby bnmunohistochemistrywith the mouse ,no,,oclonalanti.hunan Bcl-2 antibody (DAKO) at I:50 dilution. For the “in situ” detectionof apoptoticcells, terminal deoxynucleotidyl transferase-mediateddigoxigenindeoxywidine triphosphatenick endlabelling (TUNEL) v/as used,by a pemxidaseApopTag Kit (Oncor). Results: The percentageofBcl-2+ LMPCs was significantly @
114 THE RESPONSESTO LOW DOSE AZATHIOPRINE IN PATIENTS WITH HETEROZYGOUS TPMT DEFICIENCY. A&w Ansari. CesareHessan Anzelo Zullo. Michael Escudier. El-Mcnscw Showob.wa.l-Barkre. Tony Msdmii, John Duley z&d &emy Se&son Gestmentemlogy“Guy’s And St Thomas’Hospitals” London United Kingdom Gestmentemlogyend Endoscopy ‘?rTuovoRegina Mugherita” Hospital,Rome, Italy.
Background: Appmxbnately onein ten Caucasianshave heterozygous thiopurinemethyl trensfemse (TPMl? emsme deticiemv. Theseindividuals are at hieh risk of side effects on treatmentwith &bio&ne~b”t should, idtheory, toleratee lower dose-ofazatbioprine.Our aim was to examine theouteotneof low-dose wathioprine txeebnentin a gmup of patientswith hetemzygous TPM? deficiency. Methods: Fmm a databaseof TPMTdeficient pet&its, 24 (IS female,median age45 yin) were identified who had received a&hioprine as a steroid-sparingagent at a reduceddoseof lmaka (initially O.Jmtie) acwtdine to dec@mentaltidelines. Caserecmds were examinedto identify advcrs~effect~and clinical &pats, deft& biability to withdraw stemids (complete, partial (prednisolonedose<5mg daily) or non-respatse). Results: I7 patientswere treatedfor i~ammatoty bowel disease(I2 C&n’s disease,5 ulcerative colitis). 2 autoinmumehepatitisend one bdeaibmIvaseulitis. 4 received azatbioptinefor chmnic oral disease(2 lichen planus, 1 Bechet’s diseaseend 1 oral ulceration). 5 of 24 (21%) patientsbed side effects requiring azatbioprinewithdrawal (2 pancreatitis, 3 namea and malaise).4 additionalpatients developedside. effects which resolved on doseredwtion to OSm&. Of the I9 patientswho tolerated azathioptie, I7 respondedfbvoumbly to azetbioprine(89%). IS (79%) withdrew stemids completely.2 patientshad no naponse. Conolwion: hi easwementof TPMT enzyme activity definesa group of patientswith hetemzygousTPMT deficiency who can be successfullv treated with low-dose azathioprine.
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GASTROINTESTINAL DISTENSION IN SEVERE ULCERATIVE COLITIS (UC). G. Latella”, P. Vemia, A. V&do, G. Frien”, G. Cadau, A. Cossu, R. Caprilli. Gastroenterology Unit I, University “La Sapienza” of Rome and “University of L’Aqutla, Italy Background: In previous retrospective studies we have found that small bowel distension characterizes a subgroup of patient with severe UC at higher risk for both toxic megacolon (TMC) and multiple organ dysfunction syndrome (MODS). Aim: To evaluate, in a prospective study, the prevalence of gastrointestmal (Cl) distension and its relationship to clinical outcome in patients with severe UC. Methods: Of 109 consecutive in-patients with acute UC (penod 1995~ZOOO),45 had severe colitis (Truelove & Witts). Routine blood test, acid-base balance, and plain abdominal films were performed upon admission and repeated every l-3 days. The gas content of stomach, small and large intestine was evaluated on plain abdominal films. All patients were submitted to the standard Oxford intensive medical regimen. Clmical improvement, occurrence of major complications, need for surgery, and mortality were considered. Statistical analysis was carried out using Student’t, chi-square, Fisher’ exact, and Wilcoxon rank sum tests, when appropriate. Results: Of 45 patients with severe UC, 24 (53%) had GI distension. Three of these 24 patients had colonic dilatation (TM0 on admission (all underwent surgery and survived), 21 showed i&&d GI gas content (4 developed TMC l-4 days after the detection of GI distension and were operated, 2 developed MODS and died; 8 did not improve, underwent surgery and survived). Four of the 21 (19%) patients with increased intestinal gas content had a concomitant abnormal distension of the stomach. None of the 21 patients with normal GI gas content had complications and all survived (5 dtd not improve and required surgery). Thus, only patients with increased GI gas content upon admission developed TMC during hospitalization. The need for surgery was higher in patients with increased GI gas (12/2 I, 57%) compared with those with normal GI gas content (5121, 24%) (p
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113 INFLIXIMAB TREATMENT IN PATIENTS WITH ACfIV!? CROHN DISEASE: TRANSABDOMINAL BOWEL SONOGRAI’HY MODIFICATION BEFORE AND AFTER THERAPY Carla Serm Laura Volpe, Pa010Gionchetti, FernandoRizzello, Me&no Campieri, Mario Miglioli. D~pxtimento di Medtcma Interna e Gastroentemlogia,Universita degli Stndi di Bologna s.Orw1a Background. Severalstudies suggestthe valueoftmnsebdominal bowel sonwaphy (TABS) in diaenosinnand follow-uo of C&n’s disease.Recently, it was demonstmtedthat Inflixbnab therepy is able to induce bnprov~ent of endoscopiclesions&td histological innemmatory tilhation. Objectives. The aim of this study was to evaluatethe smtogmphicmodifications dueto Jnflhimab therapy in patientswith active Cmhn’s disease.Methods. 30 pts with active Cmbn’s disease (CDAI> ZOO),steroid-refmctory or steroid-dependentendintolerantto azathioprine,u&went TABS immediatelybefore anda month after the iv. info&n of IntIiximab (Smgjkg). An Hitachi ElJB 525(Tokyo, Japan)with two electronicprobe operatingat a frequency of 3.5-2.5 and7.5-5 MHz was wed. The following parameterswere analyzed:gut wall thickening, presenceor absence of thenortnal wall stratification, preface of creepingf& presenceof mesent& lymph nodes. Results.After In8*imab therapy the presenceof the nmmal stratification of the bowel well was seenin 90% ofpatients (before therapy the petwntage was only 25%, p
BCL-2 EXPRESSION AND LAMINA PROPRIA MONONUCLEAR CELL APOPTOSIS lN MACROSCOPICALLY INVOLVED AREAS OF CROHN’S DISEASE PATIENTS Di SebatinoA, Ricewti L, CiccociopDo R. Morera R. D’Al6 S. Luinetti 0. Tinozzi FP. Tinoti S. CifoneMC, Corazza GR. Gestmenterology Unit, Depts of Pathologyand Surgery, !RCCS Policlinico S. Matteo, University of Pavia;Dept of ExperimentalMedicine, University of L’Aquila, Italy. Policlinico S.Metteo Background & Aims: To evaluatethe role of theantiapaptoticBcl-2 protein in regulatingthe susceptibility of lemina pmpria mononuclearcells (LPMCs) to apaptosisin Cmbn’s disease(CD), we studiedB&2 expressionend wptosis of LPMCs in tbis condition. Patients& Methods: Endoscopicileal andcolonic biop&~&&mem were calleetedfrom mecmmopically involved areas of 16 CD patients(meanage 33.4yrs, range I-), end from 16contml subjects (mean age34.8 ITS,range20.62) undergoingendoscopyfor investigationof persistent dietrhoeaandirritable bowel syndrome.The clinical severity of diseasewas assessedby the evaluationof the C&n’s disease activity index (CDAl). Bcl-2 expression wes evaluatedby bnmunohistochemistrywith the mouse ,no,,oclonalanti.hunan Bcl-2 antibody (DAKO) at I:50 dilution. For the “in situ” detectionof apoptoticcells, terminal deoxynucleotidyl transferase-mediateddigoxigenindeoxywidine triphosphatenick endlabelling (TUNEL) v/as used,by a pemxidaseApopTag Kit (Oncor). Results: The percentageofBcl-2+ LMPCs was significantly @
114 THE RESPONSESTO LOW DOSE AZATHIOPRINE IN PATIENTS WITH HETEROZYGOUS TPMT DEFICIENCY. A&w Ansari. CesareHessan Anzelo Zullo. Michael Escudier. El-Mcnscw Showob.wa.l-Barkre. Tony Msdmii, John Duley z&d &emy Se&son Gestmentemlogy“Guy’s And St Thomas’Hospitals” London United Kingdom Gestmentemlogyend Endoscopy ‘?rTuovoRegina Mugherita” Hospital,Rome, Italy.
Background: Appmxbnately onein ten Caucasianshave heterozygous thiopurinemethyl trensfemse (TPMl? emsme deticiemv. Theseindividuals are at hieh risk of side effects on treatmentwith &bio&ne~b”t should, idtheory, toleratee lower dose-ofazatbioprine.Our aim was to examine theouteotneof low-dose wathioprine txeebnentin a gmup of patientswith hetemzygous TPM? deficiency. Methods: Fmm a databaseof TPMTdeficient pet&its, 24 (IS female,median age45 yin) were identified who had received a&hioprine as a steroid-sparingagent at a reduceddoseof lmaka (initially O.Jmtie) acwtdine to dec@mentaltidelines. Caserecmds were examinedto identify advcrs~effect~and clinical &pats, deft& biability to withdraw stemids (complete, partial (prednisolonedose<5mg daily) or non-respatse). Results: I7 patientswere treatedfor i~ammatoty bowel disease(I2 C&n’s disease,5 ulcerative colitis). 2 autoinmumehepatitisend one bdeaibmIvaseulitis. 4 received azatbioptinefor chmnic oral disease(2 lichen planus, 1 Bechet’s diseaseend 1 oral ulceration). 5 of 24 (21%) patientsbed side effects requiring azatbioprinewithdrawal (2 pancreatitis, 3 namea and malaise).4 additionalpatients developedside. effects which resolved on doseredwtion to OSm&. Of the I9 patientswho tolerated azathioptie, I7 respondedfbvoumbly to azetbioprine(89%). IS (79%) withdrew stemids completely.2 patientshad no naponse. Conolwion: hi easwementof TPMT enzyme activity definesa group of patientswith hetemzygousTPMT deficiency who can be successfullv treated with low-dose azathioprine.
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GASTROINTESTINAL DISTENSION IN SEVERE ULCERATIVE COLITIS (UC). G. Latella”, P. Vemia, A. V&do, G. Frien”, G. Cadau, A. Cossu, R. Caprilli. Gastroenterology Unit I, University “La Sapienza” of Rome and “University of L’Aqutla, Italy Background: In previous retrospective studies we have found that small bowel distension characterizes a subgroup of patient with severe UC at higher risk for both toxic megacolon (TMC) and multiple organ dysfunction syndrome (MODS). Aim: To evaluate, in a prospective study, the prevalence of gastrointestmal (Cl) distension and its relationship to clinical outcome in patients with severe UC. Methods: Of 109 consecutive in-patients with acute UC (penod 1995~ZOOO),45 had severe colitis (Truelove & Witts). Routine blood test, acid-base balance, and plain abdominal films were performed upon admission and repeated every l-3 days. The gas content of stomach, small and large intestine was evaluated on plain abdominal films. All patients were submitted to the standard Oxford intensive medical regimen. Clmical improvement, occurrence of major complications, need for surgery, and mortality were considered. Statistical analysis was carried out using Student’t, chi-square, Fisher’ exact, and Wilcoxon rank sum tests, when appropriate. Results: Of 45 patients with severe UC, 24 (53%) had GI distension. Three of these 24 patients had colonic dilatation (TM0 on admission (all underwent surgery and survived), 21 showed i&&d GI gas content (4 developed TMC l-4 days after the detection of GI distension and were operated, 2 developed MODS and died; 8 did not improve, underwent surgery and survived). Four of the 21 (19%) patients with increased intestinal gas content had a concomitant abnormal distension of the stomach. None of the 21 patients with normal GI gas content had complications and all survived (5 dtd not improve and required surgery). Thus, only patients with increased GI gas content upon admission developed TMC during hospitalization. The need for surgery was higher in patients with increased GI gas (12/2 I, 57%) compared with those with normal GI gas content (5121, 24%) (p
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