Subclinical intestinal inflammation: an inherited abnormality in Crohn's disease relatives?

BACKGROUND & AIMS: One approach to unraveling the genetics of complex inherited disease, such as Crohn's disease, is to search for subclinical disease markers among unaffected family members. We assessed the possible presence, prevalence, and inheritance pattern of subclinical intestinal inflammation in apparently healthy relatives of patients with Crohn's disease. METHODS: A total of 49 patients with Crohn's disease, 16 spouses, and 151 (58%) of 260 available first-degree relatives underwent a test for intestinal inflammation (fecal calprotectin concentration). The mode of inheritance was assessed from 36 index patients (by variance component analysis) when more than 50% of relatives were studied. RESULTS: Fecal calprotectin concentrations in patients with Crohn's disease (47 mg/L; confidence interval [CI], 27-95 mg/L) and relatives (11 mg/L; CI, 9-14 mg/L) differed significantly (P < 0.0001) from controls (4 mg/L; CI, 3-5 mg/L), whereas that of the spouses did not (4 mg/L; CI, 3-6 mg/L; P > 0.5). Fecal calprotectin concentration was increased in 49% of all relatives studied. The increased fecal calprotectin concentration among the relatives of the 36 index patients had an inheritance pattern that was most consistent with an additive inheritance pattern. CONCLUSIONS: There is a high prevalence of subclinical intestinal inflammation in first-degree relatives of patients with Crohn's disease that conforms best to an additive inheritance pattern. The genetic basis for this abnormality may represent a risk factor for Crohn's disease.

[Prevalence of Helicobacter pylori and Cag-A strains in patients with duodenal ulcer in Iceland.].

OBJECTIVE: The prevalence of Helicobacter pylori infection and related gastric diseases is rapidly changing in western societies. H. pylori has been associated with gastritis, gastric and duodenal ulcer and gastric cancer. This association applies in particular to H. pylori strains which are Cag-A positive. H. pylori is naturally disappearing from western populations in particular Cag-A positive strains which are selectively eradicated due to their association with peptic ulcer. The aim of the study was to assess the prevalence of H. pylori in duodenal ulcer disease and its Cag-A status before the eradication of H. pylori was routinely applied. MATERIAL AND METHODS: Antibodies for H. pylori and Cag-A were investigated by Western blot method in serum samples from 62 patients with duodenal ulcer. The samples were collected during the period 1993-1996 and should represent the Cag-A prevalence before it was changed by active eradication. No subject had received H. pylori eradication before the study. RESULTS: Of the 62 samples 54 (87.1%) were positive for H. pylori specific antigen and of the 54 positive samples 53 (98.1%) were positive for Cag-A. CONCLUSION: H. pylori strains associated with duodenal ulcer in Iceland were predominantly (98.1%) Cag-A positive.