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USEFULNESS OF ANTIBODIES TO DEAMIDATED GLIADIN PEPTIDES (DGP) IN COELIAC DISEASE (CD)
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 Material and methods: The study was made on 20 patients (13 women, 7 men, mean age at diagnosis 54.4 yrs, range 40-70 yrs) who were positive for anti-parietal antibodies and/or had histological features compatible with AG and total atrophy of gastric glands. Endoscopy and biopsies were repeated almost every two years. Data on therapy for H pylori were incomplete and were not evaluated. Patients were followed-up for an average time of 155 months (range 120-180). Results: At 10 years or more after the diagnosis all patients were alive. No patient had adenomatoid ECL hyperplasia, endocrine tumor or gastric cancer. 2 patients (10%), at the 14th year of follow-up, showed gastric low grade dysplasia. 3 patients (15%) had hyperplastic polyps. Conclusions: AG is a progressive disease; the progression rate is very low. Advanced histologic lesions are uncommon in a long follow up period. There are insufficient data to suggest definite endoscopic surveillance including biopsies in these patients. # B. Gastric diseases 5. Pre-cancerous lesions
P.32 CAN ADVANCED ENDOSCOPY DETECT FOCAL LESIONS IN PATIENTS WITH GASTRIC DYSPLASIA AFTER RANDOM BIOPSIES? A. Simone, A. Casadei, I. Manzi, L. Saragoni, P. Morgagni, E. Ricci Ospedale Morgagni Pierantoni, Forlì Background and aim: Few study have evaluated the correlation between convenctional endoscopy and histological findings, but results seem poor so that many authors have proposed in high risk patients a lot of random biopsies to detect gastric dysplasia. In the last years advanced endoscopy (chromoendoscpy, FICE and zoom endoscopy) has been proposed for detection of minimal changes in gastric mucosa and focal lesions with dysplastic changes. Material and methods: From 2003 to 2008 we have studied 39 patients, (21 women and 18 man), mean age 75 years (range 50-87), affected from early gastric cancer (EGC) or gastric high grade dysplasia. Fourteen of them were referred from other institution to our Unit for histological findings of high grade dysplasia in random biopsies at convenctional endoscopy, without identification of focal lesion. All patients underwent upper endoscopy with chromoscopic analysis using indigo carmine, computed virtual chromoendoscopy (FICE) and zoom endoscopy. The mocosal lesion detected by advanced endoscopy were described by Paris classification and histologically by Vienna classification. Results: Advanced endoscopy has identified focal lesions in all patients. Lesions were classified as follows: 7IIa-IIc, 5 IIa, 1 IIc, 1 Is. Thirteen lesions were located in gastric antrum, one in gastric body and mean diameter was 1.6 cm (range 1-3). Lesions were resected en-block and histological findings were early gastric cancer (EGC) in 8 patients and high grade dyspalsia in the others. Six patients were referred to surgery according to Japanese guide lines. Conclusions: In our experience advanced endoscopy employing indigo carmine and FICE chromoendoscopy plus magnifyng vision has been effective for identification of focal dysplastic lesions. # B. Gastric diseases 5. Pre-cancerous lesions
P.33 IN VIVO HISTOPATHOLOGY WITH PORTABLE CONFOCAL MINIPROBES ENDOMICROSCOPY IN THE DIAGNOSIS OF CELIAC DISEASE (CD) E. Dabizzi ∗ , R. Manta, H. Bertani, M. Manno, A. Mussetto, P. Trande, R. Conigliaro Nuovo Ospedale Civile S. Agostino Estense di Baggiovara, Modena Background and aim: Endoscopic duodenal biopsy is still critical in
S87
the diagnosis of CD, but often sampling errors and poor quality specimens may generate false-negative results. Confocal endomicroscopy (CEM) allows an in vivo histologic assessment of the mucosal layer during routine endoscopy. Aim: To evaluate the application of CEM in the diagnosis of CD and the potential benefit in the management of patients. Material and methods: CEM (Cell-vizio, Mauna Kea Technologies, Paris, France), using portable confocal mini probes (Type Z, Type MiniO) was performed in 12 patients (8 F/4 M; mean age: 31 yrs; range 19-44 yrs) underwent an upper gastointestinal endoscopy for either suspected CD or malabsorption symptoms. Endoscopy was performed under conscious sedation (i.v. meperidine and midazolam) with standard video gastroscopes (Pentax EG 2970 F, Pentax, Tokyo, Japan). We used endovenous fluorescein dye (2,5-5 mL), to enhance the diagnostic power of CEM. Real time video sequences were digitally recorded. Multiple biopsies were taken from the same examined area. All stored sequences were put into a random order and assessed by a gastroenterologist blinded to any histopathological data. Biopsies were analized by experts pathologists blinded to CEM data, too. Traditional histology was considered as the gold standard. Villous atrophy (VA) (presence of 5 or fewerblunt-shaped villi seen on superficial scans) and crypt hypertrophy (CH) (>1 crypt on imaging of the deep mucosa) were defined as CEM features of CD. Results: The patient’s clinical-pathological characteristics are shown in the table. PTS 1 2 3 4 5 6 7 8 9 10 11 12
SEX
AGE
EMA*/tTGA†
Endoscopy#
CEM
Histology
F F M F M F F F F M F M
19 31 19 39 25 27 35 23 42 26 44 36
+ + + – + + – + + – + –
4 1-2 2 2 1-3 1 1 3 4 1 2-3 1-4
VA+CH VA+CH VA+CH Normal VA+CH VA VA+CH VA+CH Normal Normal VA+CH VA+CH
3a 3b 3a Normal 3b 1 3b 3b 1 Normal 3b 3b
*EMA: Endomisium antibodies; † tTGA: tissue Transglutaminase Antibodies. # Endoscopy: 1) Reduction of duodenal folds; 2) Scalloping of folds; 3) Mosaic pattern; 4) Nodularity of the mucosa.
Comparing the CEM data with histology, we can assess a sensibility of 90%, a specificity of 100%, and an accuracy of 92%. Conclusions: This is our preliminary experience with CEM applied to the diagnosis of CD. It allows a real time in vivo histological improving histology itself, reducing the number of biopsy, guiding a better tissue sampling. # C. Small bowel diseases 1. Celiac disease
P.34 USEFULNESS OF ANTIBODIES TO DEAMIDATED GLIADIN PEPTIDES (DGP) IN COELIAC DISEASE (CD) R. Ciccocioppo ∗ ,1 , M. De Amici 1 , M. Valli 2 , G. Mantegna 1 , G. Zanellati 2 , E. Betti 1 , C. Alvisi 1 , G.R. Corazza 1 1 Fondazione
IRCCS Policlinico San Matteo, Pavia; 2 Università degli
Studi, Pavia Background and aim: Antibodies reactive with DGP have been recently shown to be more sensitive and specific than conventional anti-gliadin antibodies and comparable to anti-transglutaminase and anti-endomysium testing in diagnosing CD. Based on these observations, we evaluated the prevalence and accuracy of these antibodies in CD. Material and methods: The study population included 86 adult subjects of both sexes grouped as follows: 18 anti-endomysium positive
S88
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
and histologically proven untreated CD, 20 treated CD following a gluten-free diet from at least 12 months, 4 potential CD, 2 refractory CD, 11 healthy controls suffering from functional dyspepsia, 22 blood donors, and 9 Crohn’s disease patients used as diseased controls. Serum samples were collected from each participant in the study. IgG and IgA DGP-antibodies were detected in a blind manner with the ELISA kit QUANTA LiteTM Gliadin IgG and IgA II (Inova Diagnostics). Results: 12/18 untreated CD resulted IgA positive (66.6%) and 11/18 IgG positive (61.1%). In the group of treated CD, 2/20 were IgA positive (10%), and 4/20 IgG positive (20%). Interestingly, only 1/4 potential CD resulted positive for both IgA and IgG, while both refractory CD showed positivity for IgA. 3/11 healthy controls were positive for both IgA and IgG antibodies (27.2%), even though at low level, whilst in the group of blood donors 2/22 were positive for both IgA and IgG (9.0%), 1/22 IgA positive (4.5%), 4/22 IgG positive (18.1%). In the Crohn’s disease group, only a patient displayed positivity for IgA antibodies. Sensitivity and specificity for active CD were 66.6 and 72.0% for IgA, and 61.1 and 72% for IgG, respectively. Conclusions: In our hands, the new test did not display a high accuracy (0.68) in diagnosing CD. However, it may be useful for monitoring adherence to gluten-free diet since those treated patients who were positive, resulted non-compliant. In addition, GDP antibodies might be of interest in following the development of enteropathy since a difference within potential CD has been found. # C. Small bowel diseases 1. Celiac disease
P.35 IMPACT OF GLUTEN-FREE DIET ON QUALITY OF LIFE IN CELIAC DISEASE PATIENTS A. Picarelli, E. Salvi, M. Di Tola, A. Vallecoccia, A. Saponara, F. Paris, S. Turriziani, A. De Pascale Department of Clinical Sciences, University Sapienza, Roma Background and aim: Over the last years, the diagnosis of celiac disease (CD) has become more and more frequent using highly sensitive and specific diagnostic tools. Although the small bowel is the main target organ of CD, its clinical manifestations may frequently to be of extra-intestinal type too. This well-known disorder may be therefore able to largely affect the patient’s well-being. Our aim was to assess the quality of life and depression of newly diagnosed CD patients, as well as the impact of a gluten-free diet (GFD) over time. Material and methods: A total of 210 adult CD patients (40M/170F, median age 36, range 18-60 years) were consecutively recruited and divided into 3 groups: 70 patients newly diagnosed (group A), 70 patients on GFD from 6-12 months (group B), and 70 patients on GFD from more than 12 months (group C). A further series of patients, called group D, included 210 volunteers (90M/120F, median age 35, range 18-60 years) randomly selected as healthy controls. Psychological General Well-Being Index (PGWBI) and Beck Depression Inventory (BDI) questionnaires were administered to all patients being studied. Results: The groups A and B showed lower PGWBI questionnaire scores (p<0.001) compared with both group C and healthy controls. At the same time, the groups A and B showed higher BDI questionnaire scores (p<0.001) compared with both group C and healthy controls. Conclusions: Our data show that a large part of adult CD patients presents a high degree of depression, as well as a quality of life significantly inferior to normal population suggesting that, in this pathological condition, the psychological problems are more common than previously thought. The introduction of a GFD induces a substantial improvement of the outcome measures, especially after more than 12 months of treatment. The latter finding emphasize that, despite the changes in social habit consequent to dietary restriction, the quality of life dramatically improves. # C. Small bowel diseases 1. Celiac disease
P.36 CHARACTERIZATION OF ANANDAMIDE METABOLISM IN COELIAC DISEASE A. Di Sabatino ∗ ,1 , N. Battista 2 , M. Pucci 3 , P. Biancheri 1 , L. Rovedatti 1 , P. Cazzola 1 , M. Guerci 1 , G.R. Corazza 1 , M. Maccarrone 2 1 Clinica Medica I, Fondazione IRCCS Policlinico S. Matteo, Centro Per Lo Studio e La Cura Della Malattia Celiaca, Università di Pavia, Pavia; 2 Dipartimento di Scienze Biomediche, Università di Teramo, Teramo; 3 European Center for Brain Research (CERC)/Fondazione S. Lucia, Roma
Background and aim: The involvement of the endogenous cannabinoid system in chronic inflammatory bowel disorders, such as Crohn’s disease and ulcerative colitis, has been already described. However, there is still little evidence on its role in coeliac disease (CD). In order to investigate potential changes of the major endocannabinoid anandamide (AEA) metabolism in CD, we examined the activity of enzymes responsible for AEA synthesis and degradation both in in vivo and ex vivo experiments. Material and methods: Multiple perendoscopic duodenal biopsies were collected from 7 untreated CD patients, 7 CD patients on a glutenfree diet for at least 12 months, and 7 control subjects. Biopsies from treated CD patients were placed on iron grids in the central well of an organ culture dish located in a tight container with 95% O2/5% CO2 at 37°C, and cultured for 24h with or without 1 mg/ml peptic-tryptic digest of gliadin (PT-gliadin). The synthesis of AEA through the activity of N-acylphosphatidylethanolamine phospholipase D (NAPE-PLD) was assayed on mucosal tissue homogenates by measuring the amount of [3H]AEA formed from [3H]NArPE, whereas the hydrolysis of AEA by fatty acid amide hydrolase (FAAH) was assessed by measuring the release of [3H]ethanolamine from [3H]AEA. Results: Our in vivo study showed that NAPE-PLD activity is significantly (p<0.05) higher in active CD mucosa than in treated CD mucosa and normal mucosa. No significant difference was found between treated CD patients and controls. In keeping with the in vivo data, the activity of the AEA-synthesizing enzyme NAPE-PLD was significantly (p<0.05) enhanced when organ culture biopsies were incubated with PT-gliadin. On the contrary, levels of FAAH activity did not change both in in vivo and ex vivo experiments. Conclusions: The present findings, which are in agreement with a previous report showing higher AEA levels in active CD mucosa, strengthen the involvement of AEA metabolism in CD. # C. Small bowel diseases 1. Celiac disease
P.37 CELIAC DISEASE AND SARCOIDOSIS: A DESIO HOSPITAL EXPERIENCE G. Casella ∗ ,1 , E. De Marco 1 , A.R. Cambareri 2 , G.L. Corti 2 , C. Di Bella 3 , V. Baldini 1 1 Medical
Dept., Desio Hospital, Desio, Milano; 2 Surgical Dept., Desio Hospital, Desio, Milano; 3 Pathology Dept., Desio Hospital, Desio, Milano Background and aim: Few studies in literature have reported the association between Celiac Disease (CD) and Sarcoidosis, and mostly as case reports (1). We report our experience about this association. Material and methods: From June 1997 to May 2008, we have studied 165 pts with CD (138 females and 27 males, mean age 43 years). Inclusion criteria were: anti endomysial IgA positivity and duodenal histology compatible with the diagnosis of CD. In all patients a history of Sarcoidosis was researched. Results: We found 3 patients (2 females, respectively, 32 and 52 years old, and 1 male 30 years old) (1.8%) with a histological diagnosis of
P.32 CAN ADVANCED ENDOSCOPY DETECT FOCAL LESIONS IN PATIENTS WITH GASTRIC DYSPLASIA AFTER RANDOM BIOPSIES? A. Simone, A. Casadei, I. Manzi, L. Saragoni, P. Morgagni, E. Ricci Ospedale Morgagni Pierantoni, Forlì Background and aim: Few study have evaluated the correlation between convenctional endoscopy and histological findings, but results seem poor so that many authors have proposed in high risk patients a lot of random biopsies to detect gastric dysplasia. In the last years advanced endoscopy (chromoendoscpy, FICE and zoom endoscopy) has been proposed for detection of minimal changes in gastric mucosa and focal lesions with dysplastic changes. Material and methods: From 2003 to 2008 we have studied 39 patients, (21 women and 18 man), mean age 75 years (range 50-87), affected from early gastric cancer (EGC) or gastric high grade dysplasia. Fourteen of them were referred from other institution to our Unit for histological findings of high grade dysplasia in random biopsies at convenctional endoscopy, without identification of focal lesion. All patients underwent upper endoscopy with chromoscopic analysis using indigo carmine, computed virtual chromoendoscopy (FICE) and zoom endoscopy. The mocosal lesion detected by advanced endoscopy were described by Paris classification and histologically by Vienna classification. Results: Advanced endoscopy has identified focal lesions in all patients. Lesions were classified as follows: 7IIa-IIc, 5 IIa, 1 IIc, 1 Is. Thirteen lesions were located in gastric antrum, one in gastric body and mean diameter was 1.6 cm (range 1-3). Lesions were resected en-block and histological findings were early gastric cancer (EGC) in 8 patients and high grade dyspalsia in the others. Six patients were referred to surgery according to Japanese guide lines. Conclusions: In our experience advanced endoscopy employing indigo carmine and FICE chromoendoscopy plus magnifyng vision has been effective for identification of focal dysplastic lesions. # B. Gastric diseases 5. Pre-cancerous lesions
P.33 IN VIVO HISTOPATHOLOGY WITH PORTABLE CONFOCAL MINIPROBES ENDOMICROSCOPY IN THE DIAGNOSIS OF CELIAC DISEASE (CD) E. Dabizzi ∗ , R. Manta, H. Bertani, M. Manno, A. Mussetto, P. Trande, R. Conigliaro Nuovo Ospedale Civile S. Agostino Estense di Baggiovara, Modena Background and aim: Endoscopic duodenal biopsy is still critical in
S87
the diagnosis of CD, but often sampling errors and poor quality specimens may generate false-negative results. Confocal endomicroscopy (CEM) allows an in vivo histologic assessment of the mucosal layer during routine endoscopy. Aim: To evaluate the application of CEM in the diagnosis of CD and the potential benefit in the management of patients. Material and methods: CEM (Cell-vizio, Mauna Kea Technologies, Paris, France), using portable confocal mini probes (Type Z, Type MiniO) was performed in 12 patients (8 F/4 M; mean age: 31 yrs; range 19-44 yrs) underwent an upper gastointestinal endoscopy for either suspected CD or malabsorption symptoms. Endoscopy was performed under conscious sedation (i.v. meperidine and midazolam) with standard video gastroscopes (Pentax EG 2970 F, Pentax, Tokyo, Japan). We used endovenous fluorescein dye (2,5-5 mL), to enhance the diagnostic power of CEM. Real time video sequences were digitally recorded. Multiple biopsies were taken from the same examined area. All stored sequences were put into a random order and assessed by a gastroenterologist blinded to any histopathological data. Biopsies were analized by experts pathologists blinded to CEM data, too. Traditional histology was considered as the gold standard. Villous atrophy (VA) (presence of 5 or fewerblunt-shaped villi seen on superficial scans) and crypt hypertrophy (CH) (>1 crypt on imaging of the deep mucosa) were defined as CEM features of CD. Results: The patient’s clinical-pathological characteristics are shown in the table. PTS 1 2 3 4 5 6 7 8 9 10 11 12
SEX
AGE
EMA*/tTGA†
Endoscopy#
CEM
Histology
F F M F M F F F F M F M
19 31 19 39 25 27 35 23 42 26 44 36
+ + + – + + – + + – + –
4 1-2 2 2 1-3 1 1 3 4 1 2-3 1-4
VA+CH VA+CH VA+CH Normal VA+CH VA VA+CH VA+CH Normal Normal VA+CH VA+CH
3a 3b 3a Normal 3b 1 3b 3b 1 Normal 3b 3b
*EMA: Endomisium antibodies; † tTGA: tissue Transglutaminase Antibodies. # Endoscopy: 1) Reduction of duodenal folds; 2) Scalloping of folds; 3) Mosaic pattern; 4) Nodularity of the mucosa.
Comparing the CEM data with histology, we can assess a sensibility of 90%, a specificity of 100%, and an accuracy of 92%. Conclusions: This is our preliminary experience with CEM applied to the diagnosis of CD. It allows a real time in vivo histological improving histology itself, reducing the number of biopsy, guiding a better tissue sampling. # C. Small bowel diseases 1. Celiac disease
P.34 USEFULNESS OF ANTIBODIES TO DEAMIDATED GLIADIN PEPTIDES (DGP) IN COELIAC DISEASE (CD) R. Ciccocioppo ∗ ,1 , M. De Amici 1 , M. Valli 2 , G. Mantegna 1 , G. Zanellati 2 , E. Betti 1 , C. Alvisi 1 , G.R. Corazza 1 1 Fondazione
IRCCS Policlinico San Matteo, Pavia; 2 Università degli
Studi, Pavia Background and aim: Antibodies reactive with DGP have been recently shown to be more sensitive and specific than conventional anti-gliadin antibodies and comparable to anti-transglutaminase and anti-endomysium testing in diagnosing CD. Based on these observations, we evaluated the prevalence and accuracy of these antibodies in CD. Material and methods: The study population included 86 adult subjects of both sexes grouped as follows: 18 anti-endomysium positive
S88
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
and histologically proven untreated CD, 20 treated CD following a gluten-free diet from at least 12 months, 4 potential CD, 2 refractory CD, 11 healthy controls suffering from functional dyspepsia, 22 blood donors, and 9 Crohn’s disease patients used as diseased controls. Serum samples were collected from each participant in the study. IgG and IgA DGP-antibodies were detected in a blind manner with the ELISA kit QUANTA LiteTM Gliadin IgG and IgA II (Inova Diagnostics). Results: 12/18 untreated CD resulted IgA positive (66.6%) and 11/18 IgG positive (61.1%). In the group of treated CD, 2/20 were IgA positive (10%), and 4/20 IgG positive (20%). Interestingly, only 1/4 potential CD resulted positive for both IgA and IgG, while both refractory CD showed positivity for IgA. 3/11 healthy controls were positive for both IgA and IgG antibodies (27.2%), even though at low level, whilst in the group of blood donors 2/22 were positive for both IgA and IgG (9.0%), 1/22 IgA positive (4.5%), 4/22 IgG positive (18.1%). In the Crohn’s disease group, only a patient displayed positivity for IgA antibodies. Sensitivity and specificity for active CD were 66.6 and 72.0% for IgA, and 61.1 and 72% for IgG, respectively. Conclusions: In our hands, the new test did not display a high accuracy (0.68) in diagnosing CD. However, it may be useful for monitoring adherence to gluten-free diet since those treated patients who were positive, resulted non-compliant. In addition, GDP antibodies might be of interest in following the development of enteropathy since a difference within potential CD has been found. # C. Small bowel diseases 1. Celiac disease
P.35 IMPACT OF GLUTEN-FREE DIET ON QUALITY OF LIFE IN CELIAC DISEASE PATIENTS A. Picarelli, E. Salvi, M. Di Tola, A. Vallecoccia, A. Saponara, F. Paris, S. Turriziani, A. De Pascale Department of Clinical Sciences, University Sapienza, Roma Background and aim: Over the last years, the diagnosis of celiac disease (CD) has become more and more frequent using highly sensitive and specific diagnostic tools. Although the small bowel is the main target organ of CD, its clinical manifestations may frequently to be of extra-intestinal type too. This well-known disorder may be therefore able to largely affect the patient’s well-being. Our aim was to assess the quality of life and depression of newly diagnosed CD patients, as well as the impact of a gluten-free diet (GFD) over time. Material and methods: A total of 210 adult CD patients (40M/170F, median age 36, range 18-60 years) were consecutively recruited and divided into 3 groups: 70 patients newly diagnosed (group A), 70 patients on GFD from 6-12 months (group B), and 70 patients on GFD from more than 12 months (group C). A further series of patients, called group D, included 210 volunteers (90M/120F, median age 35, range 18-60 years) randomly selected as healthy controls. Psychological General Well-Being Index (PGWBI) and Beck Depression Inventory (BDI) questionnaires were administered to all patients being studied. Results: The groups A and B showed lower PGWBI questionnaire scores (p<0.001) compared with both group C and healthy controls. At the same time, the groups A and B showed higher BDI questionnaire scores (p<0.001) compared with both group C and healthy controls. Conclusions: Our data show that a large part of adult CD patients presents a high degree of depression, as well as a quality of life significantly inferior to normal population suggesting that, in this pathological condition, the psychological problems are more common than previously thought. The introduction of a GFD induces a substantial improvement of the outcome measures, especially after more than 12 months of treatment. The latter finding emphasize that, despite the changes in social habit consequent to dietary restriction, the quality of life dramatically improves. # C. Small bowel diseases 1. Celiac disease
P.36 CHARACTERIZATION OF ANANDAMIDE METABOLISM IN COELIAC DISEASE A. Di Sabatino ∗ ,1 , N. Battista 2 , M. Pucci 3 , P. Biancheri 1 , L. Rovedatti 1 , P. Cazzola 1 , M. Guerci 1 , G.R. Corazza 1 , M. Maccarrone 2 1 Clinica Medica I, Fondazione IRCCS Policlinico S. Matteo, Centro Per Lo Studio e La Cura Della Malattia Celiaca, Università di Pavia, Pavia; 2 Dipartimento di Scienze Biomediche, Università di Teramo, Teramo; 3 European Center for Brain Research (CERC)/Fondazione S. Lucia, Roma
Background and aim: The involvement of the endogenous cannabinoid system in chronic inflammatory bowel disorders, such as Crohn’s disease and ulcerative colitis, has been already described. However, there is still little evidence on its role in coeliac disease (CD). In order to investigate potential changes of the major endocannabinoid anandamide (AEA) metabolism in CD, we examined the activity of enzymes responsible for AEA synthesis and degradation both in in vivo and ex vivo experiments. Material and methods: Multiple perendoscopic duodenal biopsies were collected from 7 untreated CD patients, 7 CD patients on a glutenfree diet for at least 12 months, and 7 control subjects. Biopsies from treated CD patients were placed on iron grids in the central well of an organ culture dish located in a tight container with 95% O2/5% CO2 at 37°C, and cultured for 24h with or without 1 mg/ml peptic-tryptic digest of gliadin (PT-gliadin). The synthesis of AEA through the activity of N-acylphosphatidylethanolamine phospholipase D (NAPE-PLD) was assayed on mucosal tissue homogenates by measuring the amount of [3H]AEA formed from [3H]NArPE, whereas the hydrolysis of AEA by fatty acid amide hydrolase (FAAH) was assessed by measuring the release of [3H]ethanolamine from [3H]AEA. Results: Our in vivo study showed that NAPE-PLD activity is significantly (p<0.05) higher in active CD mucosa than in treated CD mucosa and normal mucosa. No significant difference was found between treated CD patients and controls. In keeping with the in vivo data, the activity of the AEA-synthesizing enzyme NAPE-PLD was significantly (p<0.05) enhanced when organ culture biopsies were incubated with PT-gliadin. On the contrary, levels of FAAH activity did not change both in in vivo and ex vivo experiments. Conclusions: The present findings, which are in agreement with a previous report showing higher AEA levels in active CD mucosa, strengthen the involvement of AEA metabolism in CD. # C. Small bowel diseases 1. Celiac disease
P.37 CELIAC DISEASE AND SARCOIDOSIS: A DESIO HOSPITAL EXPERIENCE G. Casella ∗ ,1 , E. De Marco 1 , A.R. Cambareri 2 , G.L. Corti 2 , C. Di Bella 3 , V. Baldini 1 1 Medical
Dept., Desio Hospital, Desio, Milano; 2 Surgical Dept., Desio Hospital, Desio, Milano; 3 Pathology Dept., Desio Hospital, Desio, Milano Background and aim: Few studies in literature have reported the association between Celiac Disease (CD) and Sarcoidosis, and mostly as case reports (1). We report our experience about this association. Material and methods: From June 1997 to May 2008, we have studied 165 pts with CD (138 females and 27 males, mean age 43 years). Inclusion criteria were: anti endomysial IgA positivity and duodenal histology compatible with the diagnosis of CD. In all patients a history of Sarcoidosis was researched. Results: We found 3 patients (2 females, respectively, 32 and 52 years old, and 1 male 30 years old) (1.8%) with a histological diagnosis of