Severe eosinophilic infiltration in colonic biopsies predicts patients with ulcerative colitis not responding to medical therapy.

AIM: Eosinophils are potent proinflammatory cells that are involved in the pathogenesis of ulcerative colitis (UC). We evaluated the infiltration of eosinophils into the lamina propria in patients with active and inactive ulcerative colitis (UC) and investigated its clinical significance, among other variables, in predicting the outcome of medical treatment in active disease. METHOD: We studied colorectal biopsy specimens from 18 UC patients with disease in long-standing remission, from 22 patients with active disease who responded to therapy (12 with complete response and 10 with partial response) and from 10 patients who were nonresponders. Demographic information was obtained at baseline, and clinical, endoscopic and laboratory data were obtained at baseline and 12 weeks post-treatment. We evaluated five histological features: mucosal ulceration; mucosal erosions; crypt abscesses; cryptitis; and eosinophilic infiltration of the lamina propria. The severity of these lesions was graded as: none or minimal; mild; moderate; or severe. Statistical analyses were performed between responders and nonresponders for differences in demographic, clinical, laboratory, endoscopic and histological parameters. RESULTS: Laboratory, endoscopic and histological parameters were significantly improved after treatment only in the complete responders group. Analyses of baseline data revealed no significant differences in parameters between complete or partial responders and nonresponders, except for a less severe eosinophilic infiltration of lamina propria in complete responders (P < 0.05). Multiple logistic regression analysis showed that severe eosinophilic infiltration in colonic biopsies was the most significant predictor of poor response to medical therapy. CONCLUSION: Assessing the severity of eosinophilic infiltration in the lamina propria of colonic biopsies in patients with ulcerative colitis could be a valuable predictive tool of response to medical therapy.

Low-molecular-weight heparin (enoxaparin) as adjuvant therapy in the treatment of active ulcerative colitis: a randomized, controlled, comparative study.

BACKGROUND: Heparin could be beneficial to the treatment of active ulcerative colitis because of its anticoagulant, anti-inflammatory and immunomodulatory properties. AIM: To evaluate the tolerability, safety and efficacy of low-molecular-weight heparin as adjuvant therapy in patients with active ulcerative colitis. METHODS: Thirty-four adult patients with active ulcerative colitis were consecutively included in a prospective, randomized, comparative study, and were treated for 12 weeks. Eighteen patients in the 'standard therapy' group were treated with aminosalicylates and weekly tapered corticosteroids. Sixteen patients in the 'heparin therapy' group were treated with standard therapy plus enoxaparin 100 Anti-Xa IU/kg/day subcutaneously. RESULTS: Seventeen patients in the 'standard therapy' group and 15 patients in the 'heparin therapy' group completed the study. Tolerability and compliance to therapy were excellent and no withdrawals were noted because of complications. There was a significant improvement in the disease severity in both groups (P<0.001), without any difference between them (P=not significant). Both treatment groups showed similar proportions of disease improvement (65% and 73%, respectively; P=not significant). There were no significant differences in inflammation (fibrinogen, ESR, CRP) and coagulation (thrombin-antithrombin complex, F1+2, D-dimers) parameters during and at the end of the study between treatment groups. CONCLUSION: Adjuvant administration of low-molecular heparin in patients with active ulcerative colitis is safe and well tolerated, but no additive benefit over standard therapy for ulcerative colitis was noted.

Carcinoid of the ampulla of Vater--report of two cases.

Carcinoid of the ampulla of Vater is extremely rare, accounting for less than 0.3% of all gastro-intestinal carcinoids. To our knowledge, only 80 cases of ampullary carcinoid have been reported in the literature to date. Ampullary carcinoid is more commonly presented with jaundice or upper abdominal discomfort and diagnosis is more often made postoperatively due to submucosal spread of the tumour. As metastatic potential cannot be predicted by tumour size, Whipple pancreatoduodenectomy rather than local excision is considered to be the treatment of choice. We report here two cases of ampullary carcinoid treated in our department.

Serum concentrations of insulin-like growth factor-I (IGF-I) in patients with liver cirrhosis.

BACKGROUND/AIMS: Insulin-like growth factor-I is an important anabolic polypeptide with various effects. The circulating insulin-like growth factor-I is mainly liver derived. The aim of this study was to determine insulin-like growth factor-I serum levels in patients with cirrhosis and to clarify their association with patients' clinical condition and the etiology of cirrhosis. METHODOLOGY: Forty patients with liver cirrhosis were enrolled. Cirrhosis was in 22 cases induced by virus, in 10 due to primary biliary cause and in the rest 8 of alcoholic origin. The Child score index was found as A (n = 26), B (n = 9), C (n = 5). Twenty, age-matched healthy subjects, were used as a control group. Serum insulin-like growth factor-I was measured by an immunoradiometric assay in all subjects. RESULTS: Serum insulin-like growth factor-I levels in liver cirrhosis were found very significantly lower than in healthy individuals (57.4 +/- 7.0 ng/mL vs. 198.8 +/- 16.3 ng/mL, p = 0.0000001). In liver cirrhosis insulin-like growth factor-I was negatively correlated with spleen enlargement (r = -0.46, p = 0.0031). Child B and C patients showed significantly reduced insulin-like growth factor-I levels in comparison to patients staged as Child A (28.9 +/- 3.0 ng/mL vs. 72.8 +/- 9.3 ng/mL, p = 0.0016). The comparison of 12 patients with viral induced cirrhosis (Child A) to 14 patients with non-viral cirrhosis, of the same clinical stage, showed non-significant difference (84.2 +/- 16 ng/mL vs. 63.1 +/- 10.3 ng/mL, p = 0.27). CONCLUSIONS: Insulin-like growth factor-I synthesis is disturbed in liver cirrhosis and reflects the severity of the clinical stage. It represents a good marker of hepatic function. The etiology of cirrhosis does not seem to influence its levels.