[Cutaneous and mucosal manifestations of inflammatory bowel diseases]. / Gyulladásos bélbetegségek bór- és nyálkahártyatünetei.

The rheumatological, ophthalmological- and dermatological complications are the most common ones among the extraintestinal manifestations of inflammatory bowel diseases (IBD). The incidence of skin manifestations is estimated to be 15-20% in case of Crohn's disease and 10% in case of ulcerative colitis. The so called specific lesions (perianal fissures, metastatic Crohn's disease), which are part of the skin symptoms associated with IBD, show a intimate connections with the bowel disease itself, as they histologically show granulomatous inflammation with epitheloid cells, similar to the ones seen in the intestines. The reactive lesion (erythema nodosum, pyoderma gangraenosum), that form the second main group of skin changes, can also be found is other systemic diseases, but they are more frequently associated with IBD than the average. Cutaneous manifestations may occur due to malabsorption or drug therapy. Finally, there are dermatoses (epidermolysis bullosa acquisitia, acne fulminans) which have a still questionable connection with IBD. Authors present an overview of the IBD's possible skin and mucosal symptoms and their prognostic significance and they demonstrate some rare common skin manifestations found among the IBD patients of Borsod Country (580 ulcerative colitis, 265 Crohn's disease) in the last 25 years.

The GU-MACH study: the effect of 1-week omeprazole triple therapy on Helicobacter pylori infection in patients with gastric ulcer.

AIMS: To study the efficacy of omeprazole triple therapy in the eradication of Helicobacter pylori in patients with active gastric ulcer, and to assess healing and relapse of gastric ulcer. METHODS: A double-blind, randomized study was carried out in 18 centres in Germany, Hungary and Poland. Patients (n = 160) with gastric ulcer and a positive H. pylori screening test were randomized to a 7-day twice daily treatment with omeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1000 mg (OAC) or omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg (OMC), or with omeprazole 20 mg once daily (O). After completion of this 1-week treatment, patients were treated with omeprazole until healing (maximum 12 weeks), and followed for 6 months. H. pylori was assessed by urea breath test (UBT) and histology. RESULTS: Eradication rates ITT were OAC 79% (95% CI: 65-90%), OMC 86% (95% CI: 73-94%) and O 4% (95% CI: 0-14%). Eradication rates PP were OAC 83% (95% CI: 68-93%), OMC 93% (95% CI: 80-98%) and O 3% (95% CI: 0-13%). Gastric ulcer relapses occurred in 5, 0 and 11 patients in the groups, respectively. CONCLUSIONS: The results from the study demonstrate that OMC and OAC 1-week regimens are safe and effective for eradication of H. pylori in gastric ulcer patients, and that ulcer relapse is infrequent after successful eradication.

Presymptomatic diagnosis of familial colon polyposis.

The gene responsible for familial adenomatous polyposis (FAP) has recently been mapped, identified and this makes the presymptomatic molecular diagnosis of the disease possible. It can be performed by direct mutation analysis or indirect haplotype analysis. In families where several affected individuals are available the indirect haplotype analysis is the easiest way for performing presymptomatic diagnosis of persons at risk. Among Hungarian families we have performed haplotype analysis using D5S346, a highly polymorphic dinucleotide CA repeat marker located 30-70 kb downstream from APC gene with the combination of restriction endonuclease Rsal site polymorphism. Marker regions were amplified by polymerase chain reaction (PCR) and basen on the above-mentioned polymorphic systems, the haplotype at the APC locus was determined. We believe that haplotype analysis of individuals at risk in large FAP families containing several affected members is a rapid, efficient, and highly valuable method for presymptomatic diagnosis of familial colon polyposis.

[Complex screening of family members at risk for familial adenomatous polyposis]. / Familiáris adenomatosus polyposisos családok praesymptomás diagnosztikán alapuló komplex gondozása.

151 members of 10 affected families with FAP have been registered at the authors' regional polyposis registry, among them 51 FAP patients were verified histologically. The disorder is autosomal dominant thus the chance for the inheritance of the mutated allele is fifty percent in the offspring of an affected patient. Because of the high risk the registration and regular control of family members is recommended. They can be divided into high risk and low risk group based on presymptomatic tests. The examination of retina pigmentepithel was the only possibility for presymptomatic diagnosis earlier. After localization and identification of APC gene responsible for the disease molecular genetic methods have been introduced for presymptomatic diagnosis. The authors performed presymptomatic tests based on ophthalmologic and molecular genetic methods among family members at risk. Ophthalmologic examination was done in 53 while molecular genetic investigation in 54 cases. All the results of endoscopic, ophthalmological and molecular genetic examinations were available in 35 persons, among them 19 FAP have been found. Ophthalmological examination were informative in 33 out 35 cases (unequivocal positive or negative) while results of molecular genetic methods and sigmoidoscopy were correlated in every case. Authors stress the significance of complex screening of affected families with FAP in the prevention of colorectal cancer and extracolonic malignant processes.

Screening for colorectal cancer in a Hungarian county.

An initial screening for colorectal cancer in asymptomatic adults was performed with Haemoccult in 26,357 persons, rigid rectoscopy in 10,673 and flexible sigmoidoscopy in 3,963 persons. The rate of cancer detection was 4.4% in screenees with a positive Haemoccult test, 0.08% using rigid rectoscopy and 0.28% using flexible sigmoidoscopy. The respective frequency of patients discovered to have polyps was 16.2%, 1.32% and 8.49%. 77% of the 36 colorectal cancers detected due to the Haemoccult test program were either Dukes A or B. A comparison of these screening results indicates that Haemoccult screening markedly increases the yield of colorectal neoplasms when asymptomatic persons are examined. This screening should be repeated annually to reduce the morbidity and mortality of colorectal cancer.

Therapeutical experiments in ulcerative colitis and Crohn's disease.

In the period 1963-82 among the patients with aspecific inflammatory bowel disease, the incidence of ulcerative colitis was 3.1 per 100 000 per year, while the frequency of Crohn's disease has doubled during the observation period and now its incidence is 0.58 per 100 000 per year. During the past 20 years, 404 patients with ulcerative colitis were treated. The average follow-up of the patients lasted for 6.6 years. During this period, 40% of the patients could be kept in balance permanently with salicylazosulfapyridine (SASP) monotherapy. A further 34% reacted to SASP plus steroid. The rate of regression was increased by a further 14% when the combination was occasionally completed with a short-term antibiotic or prolonged azathioprine therapy. The inestimable cases and those refractory to treatment made up the other 12% and among them are also the 23 colectomized patients. During the two decades 40 patients with Crohn type ileocolitis were treated. SASP administration by itself was sufficient in only one case among them. In 6 cases steroid, in 4 antibiotics, in 7 azathioprine and in 2 cases metronidazole treatment had to be introduced complementarily. The fact that 21 of the 40 patients had to be subjected to bowel resection in some phase of the disease, shows how impossible it is to evaluate the different therapeutic interventions.

Carcinoid tumours of the rectum.

Carcinoid tumours of the rectum occur relatively seldom. The personal experience was 11/20,0000 rectoscopies. The symptoms are not characteristic. Such tumours can mostly be detected by chance. The basic diagnosis can only be achieved through thorough histological examinations. The tumours are usually not larger than 1 1/2 cm in diameter. Usually are restricted to the mucosa and submucosa, are solitary and can be treated perfectly with endoscopic excision. In case the tumour either invades the muscular layer, reaches or exceeds the diameter of 2 cm, or occurs in a multiple form a radical surgical approache is needed, resection should be performed.

Colitis carcinoma in ulcerative colitis.

During the period from 1963 till 1981 altogether 342 patients suffering from ulcerative colitis were treated. In their material authors found 6 patients (1.7%) who achieved cancer of the colon beginning 7, 9, 14, 18, 18 und 21 years after the onset of ulcerative colitis symptoms. According to the clinical data their ulcerative colitis could be considered to belong to the severe or the moderate type. From the anatomical point of view the extension of the process exceeded the sigmoid colon in all but one. Respecting the clinical course of the disease, malignant transformation took place in 3 patients of the relapsing-remitting type, in 2 instances the clinical course could not be classified, the sixth case proved to the chronic continuous type. Colonic tissue was gained and diagnosis stated with traditional methods within 4 instances, while in 2 it was gained from tissue specimens passing through the stool. In 3 cases the tumour was multiple. From the morphological point of view the features had a plaque form in 2 cases, a polypous nature in other 2 cases, while among each one patient a fibrous stricture and ordinary colorectal cancer occurred. The tumour was identified as well differentiated and poorly differentiated adenocarcinoma in identically 3 instances. All the patients underwent an operation, only one of them is still alive. In sake of detecting colitis carcinoma earlier, they suggest yearly endoscopic and biopsy survey of ulcerative colitis patients.