RESUMEN
OBJECTIVES: Disease course in inflammatory bowel disease (IBD) is variable and difficult to predict. To optimize prognosis, it is of interest to identify phenotypic characteristics at disease onset and other prognostic factors that predict disease course. The aim of this study was to evaluate such factors in a population-based IBD group. METHODS: IBD patients diagnosed between 1 January 1991 and 1 January 2003 were included. A follow-up questionnaire was developed and medical records were reviewed. Patients were classified according to phenotype at diagnosis and risk factors were registered. Disease severity, cumulative medication use, and "surgical" and "nonsurgical" recurrence rates were calculated as outcome parameters. RESULTS: In total, 476 Crohn's disease (CD), 630 ulcerative colitis (UC), and 81 indeterminate colitis (IC) patients were diagnosed. In CD (mean follow-up 7.6 years), 50% had undergone resective surgery. In UC (mean follow-up 7 years), colectomy rate was 8.3%. First year cumulative recurrence rates per 100 patient-years for CD, UC, and IC were 53, 44, and 42%, respectively. In CD, small bowel localization and stricturing disease were negative prognostic factors for surgery, as was young age. Overall recurrence rate was increased by young age and current smoking. In UC, extensive colitis increased surgical risk. In UC, older age at diagnosis initially increased recurrence risk but was subsequently protective. CONCLUSIONS: This population-based IBD study showed high recurrence rates in the first year. In CD, small bowel localization, stricturing disease, and young age were predictive for disease recurrence. In UC, extensive colitis and older age at diagnosis were negative prognostic predictors.
Asunto(s)
Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Fenotipo , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Colitis Ulcerosa/terapia , Enfermedad de Crohn/terapia , Estudios de Seguimiento , Humanos , Incidencia , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Recurrencia , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
BACKGROUND: The use of 6-thioguanine has been proposed as a rescue drug for inflammatory bowel disease patients. Initial data on short-term efficacy and toxicity of 6-thioguanine were promising; however, these have been challenged by reports concerning its potential hepatotoxic effect (nodular regenerative hyperplasia). We proposed that these histological liver abnormalities may well be dose- or level-dependent. AIMS: We performed a prospective multi-centre study on the hepatotoxic potential of long-term and (as compared with prior studies) low-dose 6-thioguanine use. PATIENTS: Inflammatory bowel disease patients using 6-thioguanine for at least 30 consecutive months and consenting to undergo a liver biopsy were enrolled. METHODS: Liver biopsy specimens were scored by two pathologists, unaware of clinical data. Laboratory parameters, determined prior to initiation of 6-thioguanine therapy and prior to biopsy, were reviewed. RESULTS: Twenty-eight biopsies were analysed. The majority of patients (89%) were azathioprine and/or 6-mercaptopurine intolerant inflammatory bowel disease patients. In 26 patients (93%) no signs of nodular regenerative hyperplasia were detected; in two additional patients nodular regenerative hyperplasia could not be excluded due to inconclusive pathological findings. The mean 6-thioguanine dosage, 6-thioguaninenucleotides level, duration of use and cumulative dosage were 19.5mg, 564 pmol/8 x 10(8) RBC, 38 months and 22491 mg, respectively. CONCLUSIONS: We have demonstrated that low-dose 6-thioguanine maintenance therapy in inflammatory bowel disease patients is not likely to be associated with induction of nodular regenerative hyperplasia. The induction of nodular regenerative hyperplasia appears to be 6-thioguanine dose or 6-thioguaninenucleotides level dependent.
Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Hígado/efectos de los fármacos , Tioguanina/efectos adversos , Adulto , Anciano , Femenino , Humanos , Hiperplasia , Hígado/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tioguanina/administración & dosificación , Resultado del TratamientoRESUMEN
In a 23-year-old female with colonic Crohn's disease 6-mercaptopurine 100 mg daily (1.7 mg/kg) was added to mesalamine and prednisolone therapy because of ongoing disease activity. One month later she had fever and a pancytopenia. 6-methylmercaptopurine ribonucleotides levels were extremely elevated (57,000 pmol/8x10(8) red blood cells) and 6-thioguanine nucleotides levels were subtherapeutically (126 pmol/8x10(8) red blood cells). Genotyping showed a wildtype thiopurine S-methyltransferase TPMT(H/H) (*1/*1) genotype and a wildtype inosine triphosphate pyrophosphatase gene. TPMT and inosine triphosphate pyrophosphatase activity were normal. The pancytopenia recovered spontaneously within a few weeks, parallel with decreasing 6-methylmercaptopurine ribonucleotides levels after interrupting 6-mercaptopurine treatment. Epstein-Barrvirus, Cytomegalovirus and Herpesvirus infections were excluded by serology. This is the first report of pancytopenia due to extremely high 6-methylmercaptopurine ribonucleotides levels. No relation was found with the genotype of TPMT and inosine triphosphate pyrophosphatase enzymes, which play key roles in the thiopurine metabolic pathway. Apparently, 6-methylmercaptopurine ribonucleotides metabolites can cause pancytopenia, as was already known for 6-thioguanine nucleotides.
Asunto(s)
Enfermedad de Crohn/tratamiento farmacológico , Mercaptopurina/efectos adversos , Pancitopenia/inducido químicamente , Adulto , Femenino , Humanos , Mercaptopurina/sangre , Metiltransferasas/genética , Tioinosina/análogos & derivados , Tioinosina/sangre , Tionucleótidos/sangreRESUMEN
BACKGROUND: 6-Thioguanine is used in inflammatory bowel disease since 2001, with promising short-term results. In 2003, liver histology of some 6-thioguanine treated patients showed nodular regenerative hyperplasia. Recently, magnetic resonance imaging revealed nodular regenerative hyperplasia in patients with normal histology. AIMS: Investigating the presence of nodular regenerative hyperplasia in long-term 6-thioguanine treated patients. PATIENTS AND METHODS: Inflammatory bowel disease patients, using 6-thioguanine minimally 24 months, were asked to undergo liver biopsy and magnetic resonance imaging. RESULTS: Fourteen patients used 6-thioguanine minimally 24 months, 13 participated. Mean 6-thioguanine therapy duration, daily dose and 6-thioguanine nucleotide levels were: 36 months, 18.8 mg (0.28 mg/kg) and 705 pmol/8x10(8) erythrocytes, respectively. Liver histology and magnetic resonance imaging showed no nodular regenerative hyperplasia. DISCUSSION: Liver biopsy and magnetic resonance imaging showed no nodular regenerative hyperplasia in these long-term 6-thioguanine treated inflammatory bowel disease patients. 6-thioguanine dose and metabolite levels were lower compared with previous nodular regenerative hyperplasia reports, suggesting dose or metabolite level-dependent effects. Otherwise, nodular regenerative hyperplasia is related with inflammatory bowel disease itself and immunosuppressives, including azathioprine and 6-mercaptopurine. CONCLUSION: 6-Thioguanine is debated due to nodular regenerative hyperplasia. We found no nodular regenerative hyperplasia in inflammatory bowel disease patients with long-term, low dosed 6-thioguanine, suggesting metabolite level-dependent effects. Therefore, 6-thioguanine still seems useful, but in selected patients, intolerant for other immunosuppressives, low dosed and under close surveillance of metabolite levels and hepatotoxity.
Asunto(s)
Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Hígado/patología , Tioguanina/efectos adversos , Adulto , Biopsia , Enfermedad Hepática Inducida por Sustancias y Drogas , Estudios de Cohortes , Femenino , Humanos , Hiperplasia/inducido químicamente , Hígado/efectos de los fármacos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Hepatotoxicity, gastrointestinal complaints and general malaise are common limiting adverse reactions of azathioprine and mercaptopurine in IBD patients, often related to high steady-state 6-methylmercaptopurine ribonucleotide (6-MMPR) metabolite concentrations. AIM: To determine the predictive value of 6-MMPR concentrations 1 week after treatment initiation (T1) for the development of these adverse reactions, especially hepatotoxicity, during the first 20 weeks of treatment. METHODS: The cohort study consisted of the first 270 IBD patients starting thiopurine treatment as part of the Dutch randomised-controlled trial evaluating pre-treatment thiopurine S-methyltransferase genotype testing (ClinicalTrials.gov NCT00521950). Blood samples for metabolite assessment were collected at T1. Hepatotoxicity was defined by alanine aminotransaminase elevations >2 times the upper normal limit or a ratio of alanine aminotransaminase/alkaline phosphatase ≥5. RESULTS: Forty-seven patients (17%) presented hepatotoxicity during the first 20 weeks of thiopurine treatment. A T1 6-MMPR threshold of 3615 pmol/8 × 108 erythrocytes was defined. Analysis of patients on stable thiopurine dose (n = 174) showed that those exceeding the 6-MMPR threshold were at increased risk of hepatotoxicity: OR = 3.8 (95% CI: 1.8-8.0). Age, male gender and BMI were significant determinants. A predictive algorithm was developed based on these determinants and the 6-MMPR threshold to assess hepatotoxicity risk [AUC = 0.83 (95% CI: 0.75-0.91)]. 6-MMPR concentrations above the threshold also correlated with gastrointestinal complaints: OR = 2.4 (95% CI: 1.4-4.3), and general malaise: OR = 2.0 (95% CI: 1.1-3.7). CONCLUSIONS: In more than 80% of patients, thiopurine-induced hepatotoxicity could be explained by elevated T1 6-MMPR concentrations and the independent risk factors age, gender and BMI, allowing personalised thiopurine treatment in IBD to prevent early failure.
Asunto(s)
Azatioprina/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Mercaptopurina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Hepática Inducida por Sustancias y Drogas/genética , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Estudios de Cohortes , Diagnóstico Precoz , Femenino , Genotipo , Humanos , Enfermedades Inflamatorias del Intestino/genética , Enfermedades Inflamatorias del Intestino/metabolismo , Masculino , Mercaptopurina/análogos & derivados , Metiltransferasas/metabolismo , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Tioinosina/análogos & derivados , Tioinosina/metabolismo , Tionucleótidos/metabolismo , Resultado del Tratamiento , Adulto JovenRESUMEN
A case is described emphasising rare complication of gallstone disease: the Mirizzi syndrome in which an impacted gallstone in the Hartmann's pouch or cystic duct causes common hepatic duct obstruction and by eroding a fistula. Diagnosis is made by endoscopic retrograde cholangiopancreatography and treatment includes cholecystectomy.
Asunto(s)
Fístula Biliar/etiología , Colestasis Extrahepática/etiología , Cálculos Biliares/complicaciones , Conducto Hepático Común/patología , Adulto , Fístula Biliar/diagnóstico por imagen , Fístula Biliar/cirugía , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Colestasis Extrahepática/diagnóstico por imagen , Colestasis Extrahepática/cirugía , Femenino , Cálculos Biliares/cirugía , Conducto Hepático Común/diagnóstico por imagen , Conducto Hepático Común/cirugía , Humanos , SíndromeRESUMEN
BACKGROUND: In vitro studies suggest interactions between mesalazine (mesalamine) and thiopurines by thiopurine S-methyltransferase (TPMT) inhibition, influencing the balance of hepatotoxic 6-methylmercaptopurine ribonucleotide and immunosuppressive tioguanine (thioguanine) metabolites. AIM: To examine the in vivo pharmacokinetic interaction between mesalazine and mercaptopurine. METHODS: A prospective study was performed in quiescent inflammatory bowel disease patients using the combination of mercaptopurine and mesalazine. Laboratory parameters, 6-methylmercaptopurine ribonucleotide and tioguanine levels and thiopurine S-methyltransferase activity in erythrocytes were measured at stable medication, after mesalazine discontinuation and mesalazine reintroduction, further mercaptopurine was continued. RESULTS: Seventeen patients were participated. Mean mercaptopurine dose was 0.78 mg/kg/day and median of mesalazine dose was 3000 mg/day. After mesalazine discontinuation, mean tioguanine levels changed significantly from 262 to 209 pmol/8 x 10(8) red blood cell, increasing to 270 after reintroduction. Mean 6-methylmercaptopurine ribonucleotide levels were 1422, 2149 and 1503 pmol/8 x 10(8) red blood cell respectively. Mean 6-methylmercaptopurine ribonucleotide/tioguanine ratio increased significantly from 6.3 at baseline to 11.2. Mean baseline thiopurine S-methyltransferase activity was 0.58 pmol/10(6) red blood cell/h and stable. All patients had wild-type thiopurine S-methyltransferase genotypes however, leucocyte counts were stable. DISCUSSION: A significantly higher tioguanine levels and improving 6-methylmercaptopurine ribonucleotide/tioguanine ratio were found during mesalazine/mercaptopurine combination. Theoretically, mesalazine inhibits thiopurine S-methyltransferase activity. In vivo thiopurine S-methyltransferase activity did not change, however. CONCLUSION: Mesalazine has synergistic effects on mercaptopurine therapy, but the mechanism is unclear. Combining these drugs may be further indication for mesalazine in inflammatory bowel disease treatment.
Asunto(s)
Antiinflamatorios no Esteroideos/farmacología , Antimetabolitos/farmacocinética , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Mercaptopurina/farmacocinética , Mesalamina/farmacología , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Antimetabolitos/administración & dosificación , Antimetabolitos Antineoplásicos/metabolismo , Combinación de Medicamentos , Humanos , Enfermedades Inflamatorias del Intestino/metabolismo , Mercaptopurina/administración & dosificación , Mesalamina/administración & dosificación , Estudios Prospectivos , Tioguanina/metabolismoRESUMEN
Data are presented of a 5-day balance study for iron, zinc, and copper in seven patients with short bowel syndrome on oral nutrition. The small bowel remnant of these patients varied from 40 to 110 cm (mean 64 cm) and was radiologically normal in all patients. The study was carried out an average 2.7 yr (range 1 to 5 yr) after intestinal resection. Balance materials (diets, urine, and stools) were measured with neutron activation analysis. Mean iron balance was +28.6 mumol/day (+/- 10.6 SD). Mean zinc balance was +5.4 mumol/day (+/- 6.5 SD) and mean copper balance was +1.5 mumol/day (+/- 2.3 SD). These results are comparable to those reported in healthy controls. When taking into account integumentary losses of these substances, the balance of each individual trace element remained acceptable. It is concluded that a satisfying iron, zinc, and copper status can be achieved in patients after an extensive small bowel resection on oral nutrition.
Asunto(s)
Cobre/metabolismo , Ingestión de Alimentos , Hierro/metabolismo , Síndromes de Malabsorción/metabolismo , Síndrome del Intestino Corto/metabolismo , Zinc/metabolismo , Adolescente , Adulto , Anciano , Cobre/administración & dosificación , Heces/análisis , Femenino , Humanos , Hierro/administración & dosificación , Masculino , Persona de Mediana Edad , Síndrome del Intestino Corto/terapia , Zinc/administración & dosificaciónRESUMEN
Delayed gastric emptying, gastroparesis, is one of the sequelae of diabetes mellitus. Symptoms may include postprandial nausea, epigastric pain, bloating, vomiting, early satiety and unpredictable blood sugar fluctuations. Nowadays diagnosis is made by the measurement of gastric emptying with a radionuclide test meal. Using this technique some 50% of diabetic patients show signs of disordered gastric emptying. Relief is best delivered by agents promoting gastric emptying. In phase II single-dose studies metoclopramide, domperidone, cisapride, erythromycin and renzapride were all able to enhance gastric evacuation of solid and liquid meals in patients with diabetic gastroparesis. A few short term studies support the efficacy of domperidone and renzapride, but long term trials are lacking. Erythromycin, mimicking the potent gastrokinetic effect of motilin, may hold considerable promise for the future. Experience with erythromycin in diabetic gastroparesis is nonetheless very limited. To some extent the therapeutic effectiveness of metoclopramide and cisapride has been established in placebo-controlled trials. In trials with a placebo-controlled crossover design, however, only metoclopramide showed a sustained positive effect. Metoclopramide, which combines gastrokinetic and antiemetic properties seems, so far, the best therapeutic option in diabetic gastroparesis. Cisapride may be considered as a good alternative in cases where limited efficacy or side effects preclude the use of metoclopramide.
Asunto(s)
Compuestos Bicíclicos Heterocíclicos con Puentes , Complicaciones de la Diabetes , Vaciamiento Gástrico , Gastropatías/tratamiento farmacológico , Benzamidas/uso terapéutico , Compuestos Bicíclicos con Puentes/uso terapéutico , Cisaprida , Domperidona/uso terapéutico , Método Doble Ciego , Eritromicina/uso terapéutico , Humanos , Metoclopramida/uso terapéutico , Piperidinas/uso terapéutico , Gastropatías/fisiopatologíaRESUMEN
Calcium antagonist relax smooth muscle, a possible useful concept in treatment of diffuse oesophageal spasm. Therefore the effects of oral diltiazem (60 mg t.d.s.) and placebo were compared in eight patients with diffuse oesophageal spasm in a 10-week double-blind crossover study. The patients recorded the severity of chest pain and/or dysphagia in daily pain diaries using visual analogue scales. Chest pain index and dysphagia index were calculated by multiplying frequency with daily intensity of each individual symptom. When compared to placebo, diltiazem did not significantly change the overall dysphagia index and chest pain index. An individual sizeable reduction of dysphagia was attained on diltiazem in four out of six patients and in six out of eight patients suffering from chestpain. Side effects were not seen during diltiazem therapy. Diltiazem, in our study, did not yield in a significant improvement of symptoms in diffuse oesophageal spasm. Diltiazem, however, can offer relief in selected individual patients suffering from diffuse oesophageal spasm.
Asunto(s)
Diltiazem/uso terapéutico , Espasmo Esofágico Difuso/tratamiento farmacológico , Adulto , Diltiazem/efectos adversos , Método Doble Ciego , Espasmo Esofágico Difuso/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , PlacebosRESUMEN
BACKGROUND: Ursodeoxycholic acid (UDCA) prolongs transplantation-free survival in primary biliary cirrhosis (PBC). However, the optimal therapeutic dose has not been established. AIM: To compare the effects of UDCA administered in daily doses of 10 vs. 20 mg/kg on symptoms, liver biochemistry and biliary UDCA enrichment. METHODS: A 6-month multicentre randomized open controlled trial was conducted to assess the effects of an increase in the dose of UDCA to 20 mg/kg/day vs. continuation of 10 mg/kg/day for patients who had not achieved biochemical normalization during treatment for at least 6 months with the 10 mg/kg dose. Clinical and laboratory evaluations were performed at entry and at 3-month intervals. The percentage UDCA in duodenal bile was assessed at entry and at 6 months. RESULTS: Sixty-one patients were enrolled. No side-effects of UDCA were observed. Within the 20 mg/kg/day group significant decreases were found for alkaline phosphatase (- 8%; P = 0.003), aspartate aminotransferase (- 11%; P = 0.01), alanine aminotransferase (- 17%; P < 0.001), gamma-glutamyl transferase (- 34%; P < 0.001), immunoglobulin M (- 11%; P = 0.002) and cholesterol (- 8.1%; P < 0.001). In the 10 mg/kg group none of these parameters differed significantly from baseline. No significant differences between dose groups for symptom scores or serum bilirubin were found. Biliary enrichment with UDCA increased from 37% to 46% in the 20 mg/kg group (P = 0.02) while remaining stable in the 10 mg/kg group. CONCLUSIONS: Liver biochemistry improved in PBC patients receiving UDCA 20 mg/kg/day compared to a dose of 10 mg/kg/day. Both doses were equally well tolerated. These results indicate that UDCA 10 mg/kg/ day is a suboptimal dose for treating PBC.
Asunto(s)
Colagogos y Coleréticos/administración & dosificación , Cirrosis Hepática Biliar/tratamiento farmacológico , Ácido Ursodesoxicólico/administración & dosificación , Adulto , Anciano , Ácidos y Sales Biliares/análisis , Colagogos y Coleréticos/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Cirrosis Hepática Biliar/metabolismo , Masculino , Persona de Mediana Edad , Factores de Tiempo , Ácido Ursodesoxicólico/efectos adversosRESUMEN
By using a centriflo membrane cone filter it has become possible to obtain an ultrafiltrate from a 24-h stool specimen. In this faecal fluid several clinical chemical parameters were analysed, such as pH, osmolality, creatinine, sodium, potassium, calcium, magnesium, chloride, bicarbonate, phosphate and lactate. Reference intervals for these substances were obtained in healthy individuals. The data of this control group were compared to those of patients with diarrhoea due to active inflammatory bowel disease, irritable bowel syndrome, lactose intolerance and persons with an ileostomy.
Asunto(s)
Heces/análisis , Adolescente , Adulto , Anciano , Centrifugación , Enfermedades Funcionales del Colon/metabolismo , Diarrea/metabolismo , Femenino , Humanos , Concentración de Iones de Hidrógeno , Ileostomía , Inflamación/metabolismo , Enfermedades Intestinales/metabolismo , Intolerancia a la Lactosa/metabolismo , Masculino , Persona de Mediana Edad , Concentración Osmolar , Valores de Referencia , Manejo de Especímenes , UltrafiltraciónRESUMEN
After diluting faecal samples with a solution of Brij and saline and subsequently ultrafiltrating the faecal mixtures, lysozyme concentration can be reproducibly measured in the obtained faecal fluids, using a turbidimetric method. Measuring faecal lysozyme concentration enables discrimination normal individuals and patients with irritable bowel syndrome between patients with inflammatory bowel disease and colonic cancer. Lysozyme distribution in stools appears to be homogeneous. Faecal lysozyme concentration is stable when samples are stored during at least 1 wk at 6 degrees C. It appears that the lysozyme activity is directly correlated with the clinical status and severity of the disease. Faecal lysozyme may thus serve as an important tool both in diagnosis and in follow-up in the out-patients clinic for gastroenterology.
Asunto(s)
Heces/análisis , Enfermedades Gastrointestinales/enzimología , Muramidasa/análisis , Adenocarcinoma/enzimología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Funcionales del Colon/enzimología , Neoplasias del Colon/enzimología , Humanos , Inmunodifusión , Persona de Mediana Edad , Nefelometría y Turbidimetría , Estándares de ReferenciaRESUMEN
OBJECTIVE: The rising incidence of inflammatory bowel disease (IBD) since the Second World War coincides with profound changes of the dietary pattern. The aim of the study was to investigate the possible pathogenic role of some characteristic 'modern life' dietary factors in IBD. DESIGN: Case-control, studying risk factors in recently diagnosed cases, 290 with Crohn's disease and 398 with ulcerative colitis, compared with 616 population controls. Smoking, age, gender and education were taken into account by using logistic regression analysis. SETTING: Hospital cases and population controls. INTERVENTIONS: Questionnaires. MAIN OUTCOME MEASURES: Logistic regression-derived odds ratios. RESULTS: A positive association with cola drinks [OR: 2.2 (95% CI 1.5-3.1)], chewing gum [OR: 1.5 (95% CI: 1.1-2.1)] and chocolate consumption [OR: 2.5 (95% CI: 1.8-3.5)] and a negative association with citrus fruit consumption [OR: 0.5 (95% CI 0.3-0.7)] and the development of Crohn's disease were found. Consumption of cola drinks [OR: 1.6 (95% CI 1.1-2.3)] and chocolate consumption [OR: 2.5 (95% CI 1.8-3.5)] were positively associated with developing ulcerative colitis. There was a negative association between the intake of citrus fruits [OR: 0.5 (95% CI 0.4-0.8)] and 'having a stuffed pet' for a period longer than 5 years [OR: 0.6 (95% CI 0.4-0.9)] and developing the disorder. No association with the frequency of tooth brushing and developing IBD was found. CONCLUSION: All the nutritional items mentioned may be true risk factors or they just might be the expression of a modern life-style also involving other risk factors for the development of IBD which at the present are still unknown.
Asunto(s)
Colitis Ulcerosa/etiología , Enfermedad de Crohn/etiología , Dieta/efectos adversos , Adulto , Bebidas/efectos adversos , Cacao/efectos adversos , Estudios de Casos y Controles , Goma de Mascar/efectos adversos , Citrus/efectos adversos , Colitis Ulcerosa/epidemiología , Anticonceptivos/efectos adversos , Enfermedad de Crohn/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Oportunidad Relativa , Factores de Riesgo , Fumar/efectos adversosRESUMEN
Vascular access for home parenteral nutrition was achieved with arteriovenous fistulae during an average 14.3 months in seven patients. Two Cimino fistulae and six bovine grafts were used. The only complication was bovine graft thrombosis which occurred in six instances despite anticoagulant therapy. Thrombectomy could successfully be performed in three graft thrombosis. Considering complication rates arteriovenous fistulae are valuable alternatives for central venous catheters in long-term parenteral nutrition at home.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Nutrición Parenteral/métodos , Adolescente , Adulto , Anciano , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Masculino , Nutrición Parenteral/efectos adversos , Trombosis/etiologíaRESUMEN
A women with stage I-II primary biliary cirrhosis was treated with ursodeoxycholic acid (UDCA). During UDCA treatment a notable improvement in biochemical liver profile was achieved. Liver histology did not deteriorate after one year UDCA. UDCA offers a promising non-toxic alternative in the treatment of PBC.
Asunto(s)
Cirrosis Hepática Biliar/tratamiento farmacológico , Ácido Ursodesoxicólico/uso terapéutico , Alanina Transaminasa/sangre , Alanina Transaminasa/efectos de los fármacos , Fosfatasa Alcalina/sangre , Fosfatasa Alcalina/efectos de los fármacos , Femenino , Humanos , Cirrosis Hepática Biliar/sangre , Cirrosis Hepática Biliar/patología , Persona de Mediana Edad , Ácido Ursodesoxicólico/administración & dosificación , Ácido Ursodesoxicólico/farmacologíaRESUMEN
Sweet's syndrome is a rare clinical disorder consisting of eruptive skin lesions accompanied by malaise and high fever. It is often associated with an underlying disease. Dermal granulocytic infiltration without leukocytoclastic vasculitis is the pathological hallmark of the syndrome. The pathophysiology, diagnosis and therapy are illustrated by 2 cases.
Asunto(s)
Síndrome de Sweet/fisiopatología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/terapiaRESUMEN
We present 3 patients with Whipple's disease all characterized by a longstanding prodromal period with progressive weight loss, diarrhoea, lymphadenitis and arthralgia or arthritis. Sarcoid-like Whipple's disease was diagnosed in one patient. He was treated with antibiotics. Initially his condition improved; however, a cerebral relapse developed which was treated successfully by ceftriaxone and cefixime. Extraintestinal Whipple's disease (lymph node localisation) was diagnosed in another patient treated successfully with antibiotics. A third case of Whipple's disease was unexpectedly diagnosed by laparotomy and partial small bowel resection. He was not treated till 2 years later with tetracycline. After 1 year of treatment his condition had improved.
Asunto(s)
Enfermedad de Whipple/diagnóstico , Anciano , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Duodeno/patología , Femenino , Bacterias Grampositivas/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Whipple/tratamiento farmacológico , Enfermedad de Whipple/microbiología , Enfermedad de Whipple/patologíaRESUMEN
To elucidate the value of faecal lysozyme determination in the differential diagnosis of patients with atypical abdominal complaints, stool samples of healthy controls, patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) were analysed. Faecal lysozyme concentration in healthy controls ranged from 0 to 6 mg/l with a mean of 3 mg/l. Patients with IBS had similar faecal lysozyme levels. In contrast, faecal lysozyme concentrations in patients with IBD were increased (range 6 to 104 mg/l). The difference between patients with IBS and IBD was highly significant (P less than 0.001). The determination of faecal lysozyme concentration may provide a useful test in the work-up of patients with abdominal complaints. In addition, the faeces lysozyme concentration appeared to be an objective parameter of the inflammatory activity of IBD in 11 patients investigated.
Asunto(s)
Enfermedades Funcionales del Colon/enzimología , Heces/enzimología , Enfermedades Inflamatorias del Intestino/enzimología , Muramidasa/metabolismo , Colitis Ulcerosa/enzimología , Enfermedad de Crohn/enzimología , Diagnóstico Diferencial , HumanosRESUMEN
Serial abdominal scanning after the oral administration of sucralphate-99mTc was performed in order to determine the extent of active inflammatory bowel disease in 15 patients with Crohn's disease and in 8 patients with ulcerative colitis. Scintigraphic data were compared with those obtained by endoscopy and radiology in all patients. True positive scans were obtained in 6 (40%) patients with Crohn's disease and in 3 (38%) patients with ulcerative colitis. Overall, sensitivity was higher in colonic disease than that in ileal disease. In 4 (17%) patients, false negative scans were obtained and in the remaining 10 (44%) patients, localisation of the inflammatory bowel disease by the isotope was completely inaccurate. Since sensitivity of the sucralphate-99mTc scintigraphy appears to be low, its widespread use in the screening for inflammatory bowel disease or in assessing the extent of disease involvement cannot be advocated at this moment.