Lack of cellular and humoral immunological responses to oats in adults with coeliac disease.

OBJECTIVE: Recent research suggests that oats do not harm intestinal villi in adults with coeliac disease. As the immunological effects of oats have not been examined in detail, it was decided to compare the immunological responses of a gluten free diet including oats with those of a conventional gluten free diet. DESIGN: A randomised controlled intervention study over 6-12 months. SUBJECTS: Forty adults with newly diagnosed coeliac disease and 52 with coeliac disease in remission were examined. INTERVENTION: The effects of a gluten free diet including oats and a conventional gluten free diet were compared. MAIN OUTCOME MEASURES: Serum levels of gliadin and reticulin antibodies as well as numbers of intraepithelial lymphocytes (IELs) in intestinal mucosa were examined before and after the intervention. RESULTS: The rate of disappearance of gliadin and reticulin antibodies did not differ between the diet groups in patients with newly diagnosed coeliac disease. Oats also had no effect on gliadin or reticulin antibody levels in the patients with remission. The number of IELs decreased similarly regardless of the diet of newly diagnosed patients, and no increase in the number of IELs was found in the patients in remission with or without oats. CONCLUSIONS: These results strengthen the view that adult patients with coeliac disease can consume moderate amounts of oats without adverse immunological effects.

Effect of acetaldehyde and acetylsalicylic acid on HbA1c chromatography in the FPLC method with Mono S cation exchanger.

The effects of alcohol and aspirin on HbA1c chromatography in the Mono S method were studied in vitro and in vivo. A modified chromatography with enhanced resolution was used, making possible detailed examination of minor interfering peaks included in the routine HbA1c value. Incubation with acetylsalicylic acid increased a hemoglobin fraction separate from HbA1c. In vivo this fraction was elevated by 0.1% of the total hemoglobin during therapeutic aspirin ingestion for one month. In vitro acetaldehyde generated two labile hemoglobin fractions and slightly increased a minor stable fraction which was also elevated in vivo in both alcoholics and heavy drinkers. In relation to the HbA1c concentration, this stable fraction was equal in both alcoholic groups. We conclude that the in vivo effects of both aspirin and alcohol are negligible in routine HbA1c determination. Factors other than acetaldehyde might account for the unexpected HbA1c values in alcoholics.

Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet--association with the grade of mucosal villous atrophy.

No systematic studies have been carried out on the association of nutritional status with the severity of mucosal villous atrophy in newly diagnosed celiac disease patients. We examined the nutritional status of 40 adult patients with newly diagnosed celiac disease classified according to the grade of villous atrophy: partial, subtotal, and total. Nutritional status was determined by food records as well as by anthropometric and biochemical measurements. Anthropometric results did not differ among the three atrophy groups, but serum ferritin and erythrocyte folate were lower in patients with total villous atrophy than in the other groups. Most of the abnormal biochemical values were normalized during 1 y of a gluten-free diet; villous atrophy healed concomitantly. To conclude, patients with total mucosal villous atrophy at diagnosis had low erythrocyte folate and serum ferritin values, but no other major differences were found in nutritional status among celiac disease patients with different grades of villous atrophy.

Diagnostic methods in dyspepsia: the usefulness of upper abdominal ultrasound and gastroscopy.

OBJECTIVES: To examine the diagnostic value of gastroscopy and upper abdominal ultrasound, which are frequently used as primary tests in dyspeptic patients in general practice. To test the influence of age for accuracy of both diagnostic methods. DESIGN: Clinical study. SETTING: Four health centres in Kuopio Province, Finland. SUBJECTS: Four hundred unselected consecutive dyspeptic patients (91 less than 45 years of age) who consulted their general practitioners. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values (PV), efficiency and usefulness index (UI) were calculated for upper abdominal ultrasound and for gastroscopy in detecting the causes of dyspepsia in primary care. Final diagnosis was determined after one year follow-up. RESULTS: The sensitivity of upper abdominal ultrasound in detecting the cause of dyspepsia was 0.07, the specificity 0.91, PV+ 0.36, PV- 0.56, and UI -0.001. Ultrasound was not more efficient in older patients. Gastroscopy was the most efficient method with a sensitivity of 0.75, specificity 1.00, PV+ 0.99, PV- 0.83 and UI 0.56. The usefulness of gastroscopy was even better among patients over 45 years of age. CONCLUSIONS: The usefulness of upper abdominal ultrasound is low regardless of patient's age. Gastroscopy is superior to upper abdominal ultrasound as a first line diagnostic method in diagnosing dyspepsia, especially among patients over 45 years of age.

A comparison of diets with and without oats in adults with celiac disease.

BACKGROUND: Wheat, rye, and barley damage the small-intestinal mucosa of patients with celiac disease; maize and rice are harmless. The effects of a diet containing oats are uncertain. METHODS: In a randomized trial, we compared the effects of gluten-free diets without oats and with oats (with a goal of 50 to 70 g per day from three sources: two types of wheat-starch flour mixed with an equal amount of oats, muesli containing 60 percent oats, and rolled-oat breakfast cereal). Fifty-two adults with celiac disease in remission were followed for 6 months and 40 with newly diagnosed disease for 12 months. Endoscopy with duodenal biopsy was performed at the beginning and end of the study. RESULTS: The mean (+/- SD) oat intake in the oat group was 49.9 +/- 14.7 g per day at 6 months for patients in remission and 46.6 +/- 13.3 g per day at 12 months for patients with newly diagnosed disease. The oat and control groups did not differ significantly in nutritional status, symptoms, or laboratory measures. Patients in remission, regardless of diet, did not have worsening architecture of the duodenal villi or increased mononuclear-cell infiltration. All the patients with new diagnoses were in remission at one year, except for one in the control group. Six patients in the oat groups and five in the control group withdrew from the study. CONCLUSIONS: Moderate amounts of oats can be included in a gluten-free diet for most adult patients with celiac disease without adverse effects.

A comparison of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the differential diagnosis of benign and malignant jaundice and cholestasis.

OBJECTIVE: To assess the accuracy of ultrasonography (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in distinguishing between benign and malignant causes of jaundice and cholestasis without jaundice. DESIGN: Prospective study. SETTING: University Hospital in Finland. SUBJECTS: A consecutive series of patients with jaundice (n = 187) or cholestasis without jaundice (n = 33). MAIN OUTCOME MEASURES: Correlation between diagnosis on imaging and final diagnosis at follow up 6 months later. Final diagnoses made on histology (n = 79), cytology (n = 5), operative or endoscopic findings (n = 96), and clinical course or serology (n = 40). RESULTS: The most common benign disease was choledocholithiasis (n = 83) and the most common malignant disease was carcinoma of pancreas (n = 33). The benign nature of the extrahepatic obstruction was correctly defined by US, CT, and ERCP in 53%, 53%, and 90% of patients, respectively, and the corresponding figures for choledocholithiasis were 22%, 25%, and 79% (ERCP compared with each of the other techniques, p < 0.0001). Intrahepatic benign diseases were diagnosed by US and CT in a third of cases. Malignant extrahepatic obstruction was correctly diagnosed in 57%, 80%, and 83%, respectively and the corresponding figures for pancreatic cancer were 60%, 97%, and 89% (US compared with CT, p < 0.01, and with ERCP, p < 0.05). Intrahepatic malignant lesions were diagnosed by US, CT, and ERCP in 100%, 77%, and 60% of patients, respectively. CONCLUSIONS: When the obstruction was benign and extrahepatic ERCP was the most accurate, but when it was malignant CT was comparable. Intrahepatic disease was best diagnosed by US and CT. The results emphasise that the three methods of imaging are complementary.

Nuclear magnetic resonance spectroscopy of plasma to distinguish between malignant and benign diseases causing jaundice and cholestasis.

The sera of 51 patients with malignant (n = 25) and benign (n = 26) hepatopancreatobiliary disorders were analysed by 1H magnetic resonance spectroscopy (NMR) in order to distinguish between malignant and benign diseases causing jaundice and/or cholestasis. Macromolecular linewidths were determined both manually and automatically with a computed analysis, and both methylene (CH2) and methyl (CH3) resonances were evaluated. The mean linewidth of the CH3 peak was significantly narrower in the patients with malignant disease than in the patients with benign disease both in the manual and computed analyses, but no significant differences in the CH2 peak were detected. Diagnostic sensitivity and specificity of the CH3 peak determined in the computed analysis were 92% and 27% respectively. In the light of the current study, it seems obvious that because overlap between benign and malignant groups was too great, 1H NMR spectroscopy of plasma is not of practical value in distinguishing between benign and malignant causes of jaundice and/or cholestasis.

Effect of ethanol administration on the metabolism of ethanol in baboons.

To determine the mechanism whereby alcohol consumption accelerates ethanol metabolism, baboons were fed a diet containing ethanol (50% of calories) or an isocaloric control diet for 2 to 7 years. In alcohol-fed animals, the rate of ethanol metabolism per kilogram of body weight was accelerated by 34% at 50 mM concentrations of blood ethanol and liver size (estimated radiologically) increased by 23%. However, the rate of ethanol metabolism per gram of liver was not significantly increased. There was a 35% decrease in alcohol dehydrogenase (ADH) activity expressed per gram of liver and a 19% decrease per kilogram of body weight. Furthermore, the mitochondrial capacity to handle reducing equivalents was strikingly decreased as assessed by the rate of oxygen consumption at state 3 with glutamate and by the decrease in the activities of NADH and glutamate dehydrogenases. Thus, both factors presumed to be rate limiting for the ADH pathway (ADH activity and NADH reoxidation) were found to be decreased after chronic alcohol feeding. Therefore, even taking the increased liver size into consideration, the ADH pathway could not account for the rate of ethanol metabolism. By contrast, it was found that the activity of the microsomal ethanol-oxidizing system increased significantly after chronic alcohol consumption (by 22% expressed per gram of liver and by 54% expressed per kilogram of body weight). There were no significant changes in the content of cytochrome P-450.(ABSTRACT TRUNCATED AT 250 WORDS)

Concentration dependency of ethanol elimination rates in baboons: effect of chronic alcohol consumption.

Ethanol elimination rates were measured in 7 baboons fed alcohol for 2--7 yr (and their controls) by using a constant ethanol infusion to maintain blood ethanol at three different levels; 5, 10, and 50 mM. Ethanol elimination rates were significantly faster at a blood ethanol level of 50 mM than at 10 or 5 mM in both alcohol-fed and control animals. The difference between 50 mM and 5 mM concentration was 36% in alcohol-fed and 25% in control animals. In baboons fed ethanol chronically, the ethanol elimination rates were significantly faster than in pair-fed controls at 50 mM (179 +/- 10.0 mg/kg/hr versus 144 +/- 9.8) and at 10 mM (148 +/- 4.1 versus 114 +/- 8.2), but not at 5 mM. Even if one takes into account the extrahepatic losses, these differences cannot be explained solely by the elimination of ethanol through the low Km alcohol dehydrogenase pathway, and these observations indicate that a non-ADH system significantly contributes to ethanol elimination in vivo, especially in alcohol-fed baboons.

A method for the determination of "free" acetaldehyde in plasma.

A new method for measuring "free" acetaldehyde in plasma, the author's procedure avoids the precipitation of protein and almost completely eliminates the spontaneous formation of acetaldehyde from ethanol.