methane lactulose breath test

Abstracts

185

187 Inflammatory Bowel Disease (IBD) in Children Five Yesra of Age and Younger; a Diagnostic Dilemma. P&r Mamula’, Almee E. Christian’. Grzegorz W. Telega’, Jonathan E. Markowitz’. David A. Piccoli’ and Robert N. Baldassano’ ‘All the authors are from the Children’s Hospital of Philadelphia, Philadelphia, USA &&wound; Clinicians are increasingly aware that inflammatory bowel disease (IBD) can affect all age groups. although incidence of this disease in infants and young children has not been well documented. The diagnosis of a specific type of IBD is very challenging in this age group. Aims: To evaluate diagnoses and assess the usefulness of serology and presenting symptoms in IBD patients five years of age or younger. Methods: Medical records were retrospectively reviewed in patients diagnosed with IBD at The Children’s Hospital of Philadelphia between 1984-1999. The criteria included clinical, endoscopic. histologic and radiologic evidence of IBD. Patients were divided in four categories: Crohn’s disease (CD), ulcerative colitis (UC), indeterminant colitis (IC) and microscopic colitis (MC). Resuns: Sixty-five patients fulfilled the criteria and were included in the study. Twenty-eight patients were diagnosed with CD, 18 with UC, 13 with IC and 6 with MC. The majority of patients initially diagnosed with CD and UC (90 and 82%, respectively) maintained that diagnosis upon followup (1-15 years). However, thirtythree percent of patients initially diagnosed with IC had the diagnosis ultimately changed to CD. None of the patients with MC progressed to UC or CD. Most common presenting symptoms were diarrhea, abdominal pain and rectal bleeding. None of these symptoms were significantly prevalent in any specific disease group (CD, UC, or IC). Failure to thrive (FTT) was more frequent in CD (43%) and IC (37%) as opposed to UC (5%). Nine patients diagnosed with CD had a negative result for the antiSaccharomyces cerevisiae antibody (ASCA). Seven of the eighteen Datients diagnosed with UC had a oositive result for the Derinuclear (~1 antineutrophil cytoplasmic antibody (ANCA). Conclusions:‘1 .) CD is the most common form of IBD in this aoe arouo. 2.1 IC often Orwresses to CD, not UC. 3.) MC appears not to progres; to CD o; UC. 4.) The antibody panel for Crohn’s disease seems to have little clinical relevance in terms of providing definitive diagnostic information in this population of patients.

SMOKING AND INFLAMMATORY BOWL DESEASES (IBD) GUGLIELMI V., TUTINO M., GUERRA V. IRCCS “S. DE BELLIS” - CASTELLANA GROTTE (BA) - ITALY BACKGROUND

In the literature smoking is associated positively with Crohn’ s Desease(CD) and negatively with Ulcerative Colitis (UC). AIMS We wanted to know if this is true in our experience. MFXIODS

From May 89 to November 99 we have examined 209 patients @s) about smoking, who were discharged for the first time with diagnosis of IBD from our hospital. Of these 209, 169 ps were affected with UD, 39 with CD. RESULTS Only 20 (11%) of the 169 ps with UC (61 females, 108 males,

mean age 42 years, range 12-77) smoked. Instead 18 (46%) of fhe 39 ps with CD (19 females, 20 males, mean age 39 years, range 23-77) smoked. StJMMARY CONCLUSIONS

This work confirms that smoking is associated positively and negatively with CD and UC respectively @
188

186 TREATMENT OF BACTERIAL METRONIDAZOLE OVERGROWTH IN PATIENTS WITH CROIIN’S DISEASE: ASSESSMENTBY IIYLIROGEN/METHANE LACTULOSE BREATH TEST CastialioneF, Del Vecchio Blanco G, Rispo A, CozzolinoA, Di GirolamoE, CuccaroI, MazzaccaG. Cattedradi Gastroenterologia, Facolti di Medicins,

Universiti

“Federico II”, Naples, Italy. Bacterial overgmwth (BO) is frequent in pts with Crohn’s Disease (CD), particularly in those with stricture, fistalas or previous surgery, sad can contribute to symptoms. To which extent malabsorption sad other symptoms are due to CD or BO is not always clear. The detection of BO is important because it is treatable, although the antibiotic selection sad the lengthof therapyare uncertain.Metronidazoleis active against anserobes sad is often given to pts with CD. The hydrogen (Hz) and methane (C&) lactulose breath test is a sensitive tool for the diagnosis of BO. The Hz and CH, produced after latilose ingestion derive from colonic bacteria A high fasting breath concentration or sn early increase in the breath indicates the presence of ileal BO. Aim To evaluate the prevalence of BO and the efficacy of the prevalence of antibiotics in patients with CD. Methods We investigated BO in 57 consecutive pts with CD. If BO was detected, the test was repeated after metronidszole treatment (250 mg t.i.d., for IO days). Tbrce symptoms (pain, bloating, sotI stools) ware recorded at baseline and after antibiotics, on a 4-point severity scale (severe, moderate, mild, absent). We performed the test using a gas analyzer that offers the opportunity of measuring both H2 and CH4 Twenty pts had undergonean ileocolic resectionbefore the test, with ablation of the ileocecal valve. Fifteen pts had active CD at the time of the test. ResultsThirteen patients out of 57 (23%) had 80. The prevalence of BO was higher in patients with previous surgery (30%) than in non-operated pts (18%). In all the non-operated pts BO wss associated with stenosis and/or

Background

enterictistula. All I3 pts with BO receivedmetmnidazole,that in IO cases induced a normalization of the test sad sn improvement of the symptoms. One patient stopped treatment because of nausea and in 2 cases the test remained

abnormal:in these 3 patientsthe test normalizedafter a further antibiotic treatment with ciprofloxacin (500 mg b.i.d., for 10 days). Conclusion We found

that

a significant

proportion

of

unselected

pts with

CD

has BO.

Metronidazolenormalizesbreathtest and improvessymptomsin the majority of pts and ciprotloxacineis a valid alternative.The lactulosebreathtest is a simple method

that csn be more widely

used in patients

with CD.

HWI-1 EXPRESSION IN EXPERIMENTAL MODEL OF INFLAMMATORY BOWEL DISEASE IN RATS. Trzcindci R’, Dziki A.‘, Brys M.2, Chojnacki J.’ ‘Military Medical Academy, Lodz and 2Dept. of CytobiocheW, Universitvof Lodz, Poland Background: Ulcerative colitis (UC) and Crohn’s disease(CD) belong to inflammatory bowel disease(IBD). The etiology of IBD LSstill unknown Therapy remains empiric or is used for the rehefofspecttic symptoms. UC and CD are regarded as precancerousconditions.The erbB-I oncogenecodingepidermal

growth fktor receptor(EGFR)is typedas a prognosticmarker in severalbenignand cancertissues. The aim of our studieswas to 6nd out the erbB-I expressionin experimentsI surgically perfomwd model of IBD in rats. Methods AAer imh,ring an experimental colitis aruq+ werp taken from different pam of the intestine RT-PCR was performed using RNA PCR Kit ver.2.I. (TakaraShuzoCo..

1.M, Japan)accordingto manufacturer.PCR productswere separatedon a 1,5% TBE-agsrose gel and visual&d witb ethidium bromide The integrated optical density (IOD) of electroforetically separatedamplification products, in digital&d picture, was measuredusing a video deusitometer and Gel-Pro

3 0 software None of the parametersrecordedin samplespassed te- for beingnormallydistributed(Smimow-Kolmogorovtest) andhencenonparametrical statisticaltesthas beenused throughoutin am&singthe results.RelativeerbB-I exoression was determinedby comparingto cyclophdine expression Rest&v MicrosEnoic changeswere imilnr tn thne nhFprVprt in IBD. Results showed StatisticallYa&i&ant higher expre&-m nf erhR-

I in inflammPA

tissues

of&a

bowal

rnnclusinn. OvPrpxpressionof EGFR can plaY a role in the pathogenesisof IBD

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