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Type I allergic disease and seronegative spondyloarthropathy rarely coexist in patients affected by ulcerative colitis
93 TYPE I ALLERGIC DISEASE AND SBRONEGATIVE SPONDYLOARTHROPATHY RARELY COEXIST IN PATIENTS AFFECTED BY ULCERATIVE COLITIS A. D’Arienzo. F. Mamaso. l R Scama R. B-to. M. Sattees.G. Vicinanza T. St&no. “C A&vita, **D: Gag&, *~*F.P.D’A&tto, G. M&acca. i$ts ofGastmen;erology, l Rheumatoloev.Patholoev.Facultv of Medicine. Fed&co II Universih, ofNaples, Italy; **Institute of&mal Medicine, b&mopatb&gy Unit, SecondUniversity ofNaples (SUN), Italy Policlinico Fed&a II Background andAim: in recent studieswe have docummted semnegativespondylotibmpathy (SPA) andatopy in 62% and 54% of patientsaffected by ulcerative colitis (UC), respectively. Accordiily, we have hypothesizedthat SpA andatopy are the ~mmmtest extraintestinalfeatures of our UC population.The aim of this research was to study the presenceof IgE-mediatedallergic disease(AD), allergic contact dermatitis (ACD) and SpA in patientstiected by UC, evaluating possiblerelationshipsbehveenthe diseases.PatientsandMethods: 45 consecutive UC 0uQaticnts (M/F 30/15,mean age3wl4 yrs), were gradedaccording to clinical, endoscopicand histologic activity scams. SpA was diagnosedacwrding to theEuropean SpondyloartbmpathyStudy Group criteria. AD was detectedby skin prick tests and coniirmed by specific pmvocation tests, while ACD was diamwsedusing the Eumwm standardseries of oatch tests. 37 patients’sspousesor partners (M/F14/23, m& age356ti9.98 yrs) served as c&ols. Results: 22 pat& (48.9%) bad l&sided colitis and23 (51.1%) uancolitis.30 patients (66.7%) were classified in remission end 15 (33.3%) in mild-m&rate disc& activity. I4 &ent, (jl .l%) and 1 contml subject (2.7%) showed SpA @==O.OOl). Diagnosis of rhinitis, conjunctivitis or asthmawas made in 19patients (42.2%) andin 5 contmls (13.5%) @=O.G04),while ACD was found in 9 (26%) and in 4 (10.3%) (p=O.26),respectively. Only 2 patientshad a cm~cmrentSpA andAD @=o.Ol), while SpA and ACD coexistedin 5 @=O.lI). Conclusiot~~:nohvithsbmdingthe bigb frequency of AD and SpA found in UC. the concurrence of AD andSpA or ACD is an mumal finding, while SpA andACD may ofim coexist. These datasuggestthat AD and SpA, as well as AD and ACD, are strongly polarizedconditions tending to mutual exclusion. In one group, the associationof UC with AD but not with SpA or ACD seemsto indicatea predominantT-helper-2 cell response,whereas,in anothergroup, the presenceof SpA or ACD without AD seemsto indicate a predominantT-belperI cell response.
95 ROLE OF INFLIXMAB IN THE TREATMENT OF REFRACTORY SEVERE ULCERATIVE COLITIS: AN OPEN STUDY. SastegaiR, DapemoM, Iaudi C, Ercole E, Rigazio C, Masoem G, Rccca R, Pen A. GastmenterologyDepartment,OspedaleMamiziatto ‘Umberto I”, Turin, Italy BACKGROUND: Severeulcerative colitis (UC) representsa lifethreateningevent, especiallyin steroid-resistantpatients.Cyclosporine A, tacmlimus and infliximab have beenpmposedwith this indication. AIM OF THE STUDY: To evaluatethe role ofintliximab in steroid-m&tory severe ulcerative colitis. PATIENTS AND METHODS: An openstudy hasbeencarried out on 6 consecutiveUC inpatientsadmittedto GastmentemlogyUnit with acute UC (according to Truelove-Witts criteria) refinctory to a standardsteroidtreatment.lnfliximab Smgf’Kgwas administeredat time 0, and after 2 weeks in respandns. The absenceof clear evidenceof clinical responsewithin 5 days was assumedas indication for surgery RESULTS: All patientshad endoscopicfeaturesof severe diseaseat distal calonoscopy. 416showeda dramatic impmvement of clinical, biochemic& andendoscopicsigns witbin 48-72 hours afler intitsion. Tbe remaining 2 patientsundenventtotal colectomy becauseof clinical worsening. Mean values of responderswere: CRP 92 mgil at infusion, 23.5 s.tkr 48 hours and5.7 at day 7; albumin 27.4 g’l at infusion, 31.1 at day 7. Non-respondersmean pretreatment values were: CRP 60 mgll and albumin 26 gil. CONCLUSION: Preliminary results of this pilot study show a good responsein 315refractmy severe ulcerative colitis.
94 VAL34LEU FACTOR XIII POLYMORPHISM IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES. SimoneSaibeni,Mamizio Vecchi, ElenaM. Faioni , Franca Franchi , EmanueleRondonotti, Robertode Franchis. Gastmcntemlogy and GastmintestinalEndoscopy Service and Haemophilia andThrombosis Center,lRCCS OspedaleMaggiom and University of Milan, ITALY. IRCCS OmdaIe Mannion BACKGRbUNDz cc&d&ion Factor XIII is implicated in fibrin stabilizationand wound healing Severalreports described reducedFactor Kill plasma levels in patients with Intlammatory Bowel Diseases(IBD); such deficiency may be attributableto consmnption andmay petpetuatethe bleedingtendency, MIthat someautbomsuggestedFactor XIlI substitution as a possible therapy for selectedIBD patienbxP.ecently,a valine 34 to leucinepolymc+ism, resulting from a G to T tnnsition in man II of the Factor XIII-A subunit gene,hasbeen described.This polymorphism s appearsto have protective effect againstthmmbotic events. AIM: to evaluatethe prevalenceof Val34Leu Factor XIB polymorphism in IBD patientscomparedwith acontrol population of patientswith Gluten-SensitiveEntempathy (GSE) and healthy subjects. PATIENTS AND METHODS: 152IBD patients, 90 ofwhom with ulcerative colitis (47 men; mean age44.7 + 15.3 years) and 62 with Cmhn’s discpw (37 mea, mean age42.3 + 14.2 years), 90 GSE patients(53 men) (46 with Dermatitis Herpctiform and 44 with coeliac disease,mean age43.1 + 13.6 yeas), and 130 healthy subjects (61 mea, mean age 34.0+ 10.2years) were nuolled in the study. The Val34Leu polymorphism was detated by RFLP with BsaHI. Statisticalanalysis was perfmmed by meansof Fisher’sexact test. RESULTS: in lBD, 57.2% ofpatienta &owed the wild type status, 37.5% were heterozygousand 5.3% were homozygow for the 34Leuallele; the frequency of the mutated allele wss 24.0%. In GSE, 54.4% of patientsshowedthe wild type status,44.5% were hetemzygousand I .I% were homozygow for the 34Leuallele; the frequency of the mutatedallele was 23.3%. In healthypopulation 66.1% of subjects &aved the wild type status,28.5% were heterczygous and 5.4% were homozygous for the 34Leu allele; tie frequency of the mutatedallele was 19.7%.The prevalenceof the mutated alleledid not show differenceabetweenIBD patients andcontrol subjects.No difference in the frequency ofthe mutatedallele was observed among IBD patients whenthey were stratified according to diagnosis,diseaseactivity, extmsiowlocation of the disease andtherapy. CONCLUSIONS: our datado not show diITezencesin Val34Leu Factor WI polymorphism distdbvtion betweenlBD patientsandcontrols. The pmthmmbotic stated&bed in IBD pat&,,@doesnot d-d on a lack of theprotective effect generatedby “al34Leu Factm WI pOl~OQbiS”l.
A30
Prognostic factors in severe ulcerative colitis andCyclospai~Azathioprine efficacy in preventing COICCfO*y L. Benazzato,G.C. Stmmolo, R. Dlncl. V. Medici, A. Fermttato, I. Angnman Dept of Surgicaland GastmentemlogicalSciences,University of Padua,Italy p&W* Background.About 15% ofulcemtwe colitis (UC) patients suffer from an acutesevere attack.. Cyclospotin (CyA) followed by Azathioptitte(Aza) are currently the choice treatment for patients unresponsiveto high dosesteroids. Aims. To identify clinical and laboratory variablesthat could predict the outcome in patientswith severe UC.To evaluatethe efficacy of CyA andAza in preventingcolectomy andmaintainingremission.Patients.54 consecutivepatients admitted for severeUC bshvem Ian 1996andJuly 2ooO.Materials endmethods.Prospective momtoringof clinical (age, gender,diseaseonset, diseaseduration,temperature,pulserate, number of daily steals, nocturnalditiea, visible blood in stool) andlaboratory (Hb. leukocytes, PLT, ESR. CRP, Albumin, alGPA) parametersat day I, 3 and 5. All patientswere treated with oral prednisone0.6-l *g/Kg/die for a mm of 7 +2 days; 21 patients,failed to respondto steroids andwere switched to CyA e.v. 2-4mmdie. End points were consideredcolectomy or remission. Cokctomy within day 30 was considereda failure of medicaltbempy. Studentt test was usedto comparecontinuous data, cbi squareteatwas used to ~mpare categmicd variables. Logistic regressionanalysis was sppbed to chamctcrizs variablesable to predict the responseto medicaltherapy. Results. 31% of the patientsrequiredc&ctomy, I1 during the sameadmission.43 patients achievedremission(17 after CyA). while on CyA, 4 patientafailed to respond early (colectomy witbin day 30) and 17 went into remission. Six patientshad surgery tier 8.3i 2.2 months and 1I maintained remission on Am for 26 months(range 6-46 months). Patientswho underwentsurgery had significantly increased body tempemtue andCRP levels at day I and3. At day 5, pulse rate,body temper&we, number of daily stc&, Hb, ESR CRP andalbm& levels were significantly different in colectomizedVI unopmtd patients.Logistic regressionanalFin identified BSR>I4 mm/h andfever at day 5, as ableto c&act& patientsneeding surgery. BSR>54 was associatedwith 15.3 fold increasedrisk of colectomy, fever with 28.8 fold risk. No clinical or labaatory parameterWBSpredictive at day 1 and3. Concltions. Clinical andlaboratory findings can predict therisk of wlectomy in patients with severeUC. BSR and fever at day 5 identified patientsneedingsurgery. CyA is effective for acutesevereUC andAm could maintainCyA-induced remission in 64% of the patients.
95 ROLE OF INFLIXMAB IN THE TREATMENT OF REFRACTORY SEVERE ULCERATIVE COLITIS: AN OPEN STUDY. SastegaiR, DapemoM, Iaudi C, Ercole E, Rigazio C, Masoem G, Rccca R, Pen A. GastmenterologyDepartment,OspedaleMamiziatto ‘Umberto I”, Turin, Italy BACKGROUND: Severeulcerative colitis (UC) representsa lifethreateningevent, especiallyin steroid-resistantpatients.Cyclosporine A, tacmlimus and infliximab have beenpmposedwith this indication. AIM OF THE STUDY: To evaluatethe role ofintliximab in steroid-m&tory severe ulcerative colitis. PATIENTS AND METHODS: An openstudy hasbeencarried out on 6 consecutiveUC inpatientsadmittedto GastmentemlogyUnit with acute UC (according to Truelove-Witts criteria) refinctory to a standardsteroidtreatment.lnfliximab Smgf’Kgwas administeredat time 0, and after 2 weeks in respandns. The absenceof clear evidenceof clinical responsewithin 5 days was assumedas indication for surgery RESULTS: All patientshad endoscopicfeaturesof severe diseaseat distal calonoscopy. 416showeda dramatic impmvement of clinical, biochemic& andendoscopicsigns witbin 48-72 hours afler intitsion. Tbe remaining 2 patientsundenventtotal colectomy becauseof clinical worsening. Mean values of responderswere: CRP 92 mgil at infusion, 23.5 s.tkr 48 hours and5.7 at day 7; albumin 27.4 g’l at infusion, 31.1 at day 7. Non-respondersmean pretreatment values were: CRP 60 mgll and albumin 26 gil. CONCLUSION: Preliminary results of this pilot study show a good responsein 315refractmy severe ulcerative colitis.
94 VAL34LEU FACTOR XIII POLYMORPHISM IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES. SimoneSaibeni,Mamizio Vecchi, ElenaM. Faioni , Franca Franchi , EmanueleRondonotti, Robertode Franchis. Gastmcntemlogy and GastmintestinalEndoscopy Service and Haemophilia andThrombosis Center,lRCCS OspedaleMaggiom and University of Milan, ITALY. IRCCS OmdaIe Mannion BACKGRbUNDz cc&d&ion Factor XIII is implicated in fibrin stabilizationand wound healing Severalreports described reducedFactor Kill plasma levels in patients with Intlammatory Bowel Diseases(IBD); such deficiency may be attributableto consmnption andmay petpetuatethe bleedingtendency, MIthat someautbomsuggestedFactor XIlI substitution as a possible therapy for selectedIBD patienbxP.ecently,a valine 34 to leucinepolymc+ism, resulting from a G to T tnnsition in man II of the Factor XIII-A subunit gene,hasbeen described.This polymorphism s appearsto have protective effect againstthmmbotic events. AIM: to evaluatethe prevalenceof Val34Leu Factor XIB polymorphism in IBD patientscomparedwith acontrol population of patientswith Gluten-SensitiveEntempathy (GSE) and healthy subjects. PATIENTS AND METHODS: 152IBD patients, 90 ofwhom with ulcerative colitis (47 men; mean age44.7 + 15.3 years) and 62 with Cmhn’s discpw (37 mea, mean age42.3 + 14.2 years), 90 GSE patients(53 men) (46 with Dermatitis Herpctiform and 44 with coeliac disease,mean age43.1 + 13.6 yeas), and 130 healthy subjects (61 mea, mean age 34.0+ 10.2years) were nuolled in the study. The Val34Leu polymorphism was detated by RFLP with BsaHI. Statisticalanalysis was perfmmed by meansof Fisher’sexact test. RESULTS: in lBD, 57.2% ofpatienta &owed the wild type status, 37.5% were heterozygousand 5.3% were homozygow for the 34Leuallele; the frequency of the mutated allele wss 24.0%. In GSE, 54.4% of patientsshowedthe wild type status,44.5% were hetemzygousand I .I% were homozygow for the 34Leuallele; the frequency of the mutatedallele was 23.3%. In healthypopulation 66.1% of subjects &aved the wild type status,28.5% were heterczygous and 5.4% were homozygous for the 34Leu allele; tie frequency of the mutatedallele was 19.7%.The prevalenceof the mutated alleledid not show differenceabetweenIBD patients andcontrol subjects.No difference in the frequency ofthe mutatedallele was observed among IBD patients whenthey were stratified according to diagnosis,diseaseactivity, extmsiowlocation of the disease andtherapy. CONCLUSIONS: our datado not show diITezencesin Val34Leu Factor WI polymorphism distdbvtion betweenlBD patientsandcontrols. The pmthmmbotic stated&bed in IBD pat&,,@doesnot d-d on a lack of theprotective effect generatedby “al34Leu Factm WI pOl~OQbiS”l.
A30
Prognostic factors in severe ulcerative colitis andCyclospai~Azathioprine efficacy in preventing COICCfO*y L. Benazzato,G.C. Stmmolo, R. Dlncl. V. Medici, A. Fermttato, I. Angnman Dept of Surgicaland GastmentemlogicalSciences,University of Padua,Italy p&W* Background.About 15% ofulcemtwe colitis (UC) patients suffer from an acutesevere attack.. Cyclospotin (CyA) followed by Azathioptitte(Aza) are currently the choice treatment for patients unresponsiveto high dosesteroids. Aims. To identify clinical and laboratory variablesthat could predict the outcome in patientswith severe UC.To evaluatethe efficacy of CyA andAza in preventingcolectomy andmaintainingremission.Patients.54 consecutivepatients admitted for severeUC bshvem Ian 1996andJuly 2ooO.Materials endmethods.Prospective momtoringof clinical (age, gender,diseaseonset, diseaseduration,temperature,pulserate, number of daily steals, nocturnalditiea, visible blood in stool) andlaboratory (Hb. leukocytes, PLT, ESR. CRP, Albumin, alGPA) parametersat day I, 3 and 5. All patientswere treated with oral prednisone0.6-l *g/Kg/die for a mm of 7 +2 days; 21 patients,failed to respondto steroids andwere switched to CyA e.v. 2-4mmdie. End points were consideredcolectomy or remission. Cokctomy within day 30 was considereda failure of medicaltbempy. Studentt test was usedto comparecontinuous data, cbi squareteatwas used to ~mpare categmicd variables. Logistic regressionanalysis was sppbed to chamctcrizs variablesable to predict the responseto medicaltherapy. Results. 31% of the patientsrequiredc&ctomy, I1 during the sameadmission.43 patients achievedremission(17 after CyA). while on CyA, 4 patientafailed to respond early (colectomy witbin day 30) and 17 went into remission. Six patientshad surgery tier 8.3i 2.2 months and 1I maintained remission on Am for 26 months(range 6-46 months). Patientswho underwentsurgery had significantly increased body tempemtue andCRP levels at day I and3. At day 5, pulse rate,body temper&we, number of daily stc&, Hb, ESR CRP andalbm& levels were significantly different in colectomizedVI unopmtd patients.Logistic regressionanalFin identified BSR>I4 mm/h andfever at day 5, as ableto c&act& patientsneeding surgery. BSR>54 was associatedwith 15.3 fold increasedrisk of colectomy, fever with 28.8 fold risk. No clinical or labaatory parameterWBSpredictive at day 1 and3. Concltions. Clinical andlaboratory findings can predict therisk of wlectomy in patients with severeUC. BSR and fever at day 5 identified patientsneedingsurgery. CyA is effective for acutesevereUC andAm could maintainCyA-induced remission in 64% of the patients.