Coping strategies, satisfaction with life, and quality of life in Crohn's disease: A gender perspective using structural equation modeling analysis.

OBJECTIVE: To identify coping strategies and socio-demographics impacting satisfaction with life and quality of life in Crohn's disease (CD). METHODS: 402 patients completed the Patient Harvey-Bradshaw Index, Brief COPE Inventory, Satisfaction with Life Scale (SWLS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We performed structural equation modeling (SEM) of mediators of quality of life and satisfaction with life. RESULTS: The cohort comprised: men 39.3%, women 60.1%; P-HBI 4.75 and 5.74 (p = 0.01). In inactive CD (P-HBI≤4), both genders had SWLS score 23.8; men had SIBDQ score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men. In active CD, SWLS and SIBDQ scores were reduced, without gender differences; men and women used coping strategies equally. A SEM model (all patients) had a very good fit (X2(6) = 6.68, p = 0.351, X2/df = 1.114, SRMR = 0.045, RMSEA = 0.023, CFI = 0.965). In direct paths, economic status impacted SWLS (ß = 0.39) and SIBDQ (ß = 0.12), number of children impacted SWLS (ß = 0.10), emotion-focused coping impacted SWLS (ß = 0.11), dysfunctional coping impacted SWLS (ß = -0.25). In an indirect path, economic status impacted dysfunctional coping (ß = -0.26), dysfunctional coping impacted SIBDQ (ß = -0.36). A model split by gender and disease activity showed that in active CD economic status impacted SIBDQ in men (ß = 0.43) more than women (ß = 0.26); emotional coping impacted SWLS in women (ß = 0.36) more than men (ß = 0.14). CONCLUSIONS: Gender differences in coping and the impacts of economic status and emotion-focused coping vary with activity of CD. Psychological treatment in the clinic setting might improve satisfaction with life and quality of life in CD patients.

Unexpectedly low prevalence rates of IBS among adult Israeli Jews.

The irritable bowel syndrome (IBS) and other functional bowel disorders (FBDs) are common functional gastrointestinal disorders. The prevalence of IBS using Rome II criteria is generally lower than with previous criteria. The aim of this study was to determine the prevalence of IBS and other FBDs in the adult Israeli Jewish population, which has not been surveyed to date. A telephone survey was conducted on a representative sample of the study population provided by the Israel Ministry of the Interior. IBS and other FBDs were diagnosed by Rome II criteria. The study population was 981 individuals and the overall response rate was 54%. The mean age was 45.0 years and 55% were females. In all, 2.9% had IBS (females: 3.7%, males: 1.8%, P = 0.08). The rate increased to 4.1% when the Rome II diagnostic criteria were amended to include some chronic alternators who are not picked up by the original scoring system. Approximately 26% of the respondents had a functional lower gastrointestinal (GI) disorder (females: 32.1%, males: 17.7%, P < 0.0001). Prevalence rates for IBS among Israeli Jewish adults are lower than rates reported from most countries, despite the high level of stress resulting from Israel's geopolitical circumstances. Possible reasons for this low prevalence are discussed.

Familial progressive neuronal disease and chronic idiopathic intestinal pseudo-obstruction.

Chronic idiopathic intestinal pseudo-obstruction (CIIP) is characterized by recurrent episodes of bowel obstruction without mechanical cause. In five members of two Jewish-Iranian families, CIIP was associated with progressive neuronal disease, starting before age 30, with ophthalmoplegia, sensorimotor peripheral neuropathy, and hearing loss. There was no evidence of CNS involvement. The pattern suggested autosomal recessive inheritance.

The association between smoking and inflammatory bowel disease among israeli jewish patients.

: Our objective was to assess the association between smoking status before the onset of disease and inflammatory bowel disease (IBD) in Israeli Jewish patients through a case-control study conducted at the Hadassah University Hospital in Jerusalem, Israel, and a periodic health examination center. The cases included 71 patients with ulcerative colitis (UC) and 91 with Crohn's disease. Patients younger than 18 years at onset of disease were excluded. The controls included 162 healthy, asymptomatic individuals, matched with the patients with IBD by age at onset of disease and gender. Fewer patients with UC were current smokers (9.8%) than were controls (25.0%; p < 0.05). More patients with UC were former smokers (21.0%) than were controls (14.0%; p < 0.05). The odds ratio for UC in smokers compared with ex-smokers was 0.26 (95% CI, 0.13-0.53), and for smokers compared with never-smokers was 0.34 (95% CI, 0.21-0.54). No significant associations were found between smoking status and Crohn's disease. The results for UC are consistent with most reports and probably reflect a true association between smoking status and disease. The lack of association between smoking and Crohn's disease is in agreement with a previous Israeli study but differs from other reports. This may reflect a genetic predisposition among Jews that obscures the effects of smoking.

Does Helicobacter pylori colonize the gastric mucosa of Meckel's diverticulum?

Helicobacter pylori (formerly, Campylobacter pylori) is a highly adapted organism that seems to infect only gastric-type mucosa. In this study, we attempted to determine whether gastric epithelium at a site distant from the stomach, the heterotopic gastric mucosa of Meckel's diverticulum, was susceptible to colonization by H. pylori. Retrospectively, we examined biopsy specimens from 23 patients who had undergone resection of Meckel's diverticulum that contained heterotopic gastric mucosa. As a methodologic control, we also reviewed antral biopsy specimens from 18 patients with chronic duodenal ulcer who had undergone antrectomy. Heterotopic gastric mucosa in Meckel's diverticulum was of antral type in 13 patients and fundic type in 10 patients. Six patients had an ulcer in the diverticulum. No evidence of chronic or active chronic gastritis was detected in the heterotopic gastric mucosa. H. pylori was not found in any Meckel's diverticula but was present in the antrum of 89% of patients with duodenal ulcer. These results suggest that H. pylori may not colonize the heterotopic gastric mucosa of Meckel's diverticulum and has no role in the development of ulceration at this site.

No correlation between indomethacin-induced gastroduodenal damage and inhibition of gastric prostanoid synthesis.

The effect of 1 week of treatment with indomethacin 150 mg/day on human gastric prostanoid synthesis was correlated with its effect on gastric and duodenal mucosa. Before and following 1 week of treatment, endoscopic appearance of the mucosa was evaluated and scored. Following 1 week of treatment with indomethacin, antral PGE2 and 6-keto-PGF1 alpha were significantly lower than in normal subjects, but similar in patients with significant or with no mucosal damage. Co-treatment with ranitidine 150 mg b.d. or with cimetidine 400 mg b.d. reduced the mean mucosal damage score but did not affect gastric prostanoid synthesis, which was similar irrespective of the presence or absence of mucosal damage. It is therefore suggested that there is no correlation between indomethacin-induced inhibition of gastric prostanoid synthesis and its induction of mucosal damage.

Prolactin concentration in prostates with benign hypertrophy.

Twenty-two hypertrophied prostates removed in surgery were checked for prolactin concentration by the radioimmunoassay method. The mean concentration in the prostatic tissue was found to be 38.2 +/- 1.9 ng./Gm. while the mean basal serum level was 11.9 +/- 1.3 ng./ml. It is concluded that serum prolactin levels do not reflect prostatic prolactin concentration. The possibility that interrelationship in action exists between androgens and prolactin affecting each other's concentration, both influencing prostatic metabolism is discussed.

Effect of chronic nicotine administration on trinitrobenzene sulphonic acid-induced colitis.

BACKGROUND: Smoking, probably due to nicotine, has a bivalent effect on inflammatory bowel disease, ameliorating disease activity in ulcerative colitis and with a deleterious effect on Crohn's disease. The effect of nicotine patches in ulcerative colitis is controversial. AIM: To investigate the effect of chronic nicotine use in a rat model of colitis. METHODS: Colitis was induced in Sprague-Dawley rats by rectal administration of 30 mg trinitrobenzene sulphonic acid (TNBS) in 50% ethanol. Nicotine was dissolved in drinking water (2.5, 12.5, 25 and 250 microg/ml), with rats drinking ad libitum. Nicotine administration started 10 days prior to damage induction and had no effect on weight gain or daily food intake of rats. Rats were sacrificed 1 and 5 days after TNBS administration, their colons resected, rinsed, weighed, damage assessed macroscopically (mm2) and microscopically and tissue processed for myeloperoxidase (MPO) and nitric oxide synthase (NOS) activities, leukotriene B4 (LTB4), prostaglandin E2 (PGE2) generation and interleukin-1 (IL-1) serum levels. RESULTS: Nicotine, by itself, caused no damage to the colon. Nicotine had a dose-dependent bivalent effect on colitis, significantly reducing macroscopic damage from 983 +/- 10 mm2 on TNBS alone to 429 +/- 118 mm2 on TNBS plus 12.5 microg/ml of nicotine, and escalating to 1086 +/- 262 mm2 on 250 microg/ml of nicotine. Segmental weight declined significantly (from 2.4 +/- 0.2 to 1.65 +/- 0.20 g/10 cm), on 12.5 microg/ml nicotine, as did MPO activity (from 3.2 +/- 0.4 to 0.7 +/- 0.1 units/g). All these parameters returned to the levels of TNBS alone when the dose of nicotine was increased to 250 microg/ml. Nicotine had no effect on NOS activity, PGE2 generation and serum IL-1 levels, but increased LTB4 generation. CONCLUSIONS: Nicotine has a dose-dependent bivalent effect on TNBS-induced colitis which is not due to reduction in IL-1 serum levels or PGE2 generation, and is not NOS-mediated.

Passive smoking in patients with inflammatory bowel disease: an Israeli multicentre case-control study.

BACKGROUND: The association between smoking and inflammatory bowel disease (IBD) is well established. There are, however, no large scale studies of passive smoking in inflammatory bowel disease and this has never been surveyed in the Jewish population of Israel. AIM: To study the passive smoking exposure of Jewish IBD patients in Israel in a large scale multicentre study. METHODS: Patients with established IBD, aged 18-70 years, were interviewed regarding smoking and other habits. Two controls, one clinic and one neighbourhood, matched by age, sex, community group, and education, were sought for each subject. RESULTS: Five hundred and thirty-four patients (273 ulcerative colitis (UC) and 261 Crohn's disease (CD)), 478 clinic controls and 430 community controls were interviewed. There were no significant differences in the passive smoking habits between IBD patients and their controls. Fifty-one percent of UC patients, 50% of the clinic controls and 58% of the community controls were exposed to passive smoking at home (NS); similar results were found among CD patients (50%, 55% and 56%, respectively). When a quantitative exposure index was used UC patients were significantly less exposed to passive smoking than were their community controls (7.46 +/- 8.40 vs 9.36 +/- 9.46, n = 229, P< 0.031). There was no difference in the exposure to passive smoking among CD patients and their controls. No differences in exposure to passive smoking were found when UC patients who had never smoked were compared with their controls. When the quantitative index was used 'never-smoked' CD patients tended to be less exposed to passive smoking at home than their community controls (5.40 +/- 7.60 vs 8.04 +/- 8.72, P < 0.05). CONCLUSION: There is a lack of association between passive smoking and IBD in Jewish patients in Israel. When a quantitative exposure index was used UC patients were found to be less exposed to passive smoking than their community controls.

Measles is more prevalent in Crohn's disease patients. A multicentre Israeli study.

The question whether there is a transmissible pathogenetic agent as a cause for Crohn's disease, remains unanswered. Measles virus has been the subject of many intensive studies, in the attempt to find a role for it in the pathogenesis of inflammatory bowel disease. Whether an early infection with measles virus may predispose to Crohn's disease in later life is still not clear. We conducted a large scale multicentre study, in order to obtain sufficient data to answer this question. To do so, we compared inflammatory bowel disease patients, with Crohn's disease or ulcerative colitis, with two matched control groups: clinical controls, and community controls. A total of 531 patients, 271 with ulcerative colitis and 260 with Crohn's disease were interviewed, as well as 903 matched controls. Blood from 104 inflammatory bowel disease patients and 50 controls was tested for antibodies to measles virus. We did not find any differences related to measles vaccination, either in Crohn's disease or in ulcerative colitis. Exposure to measles in childhood was more frequent in Crohn's disease patients than in their controls, the difference being statistically significant (p < 0.05) in relation to community controls. The presence of IgG antibodies to measles virus was higher in patients with Crohn's disease than in patients with ulcerative colitis or controls (p = 0.084). Another observation of interest was the finding that Crohn's disease patients who had measles in childhood, more frequently had large bowel disease than those who had not had measles. These data lead us to postulate that there may be a role for measles infection in Crohn's disease, even if, at present, this role remains unclear.

Detection of tumor mutant APC DNA in plasma of patients with sporadic colorectal cancer.

The aim of this study was to detect mutant APC DNA of tumor origin in the plasma of patients with sporadic colorectal carcinomas. The polymerase chain reaction (PCR) and the single strand conformation polymorphism (SSCP) procedures were employed to detect DNA alterations using primers to amplify the mutation cluster region of the APC gene. APC mutations were observed in 7 out of 11 archival colonic tumor specimens examined. Matching mutations in free plasma DNA of tumor origin were detected in 3 of the 7 patients (42.8%). The results of this preliminary report indicated the presence of APC DNA in plasma harboring the identical abnormal molecular signature of tumor APC DNA. Detection methods of mutant APC DNA in blood may prove useful in the screening and monitoring of patients at risk of or with colorectal cancer.

[Secondary achalasia].

Achalasia is usually a primary disorder of esophageal motility, but has been described in association with other pathological processes, such as malignancy. A 79-year-old man with achalasia secondary to gastric adenocarcinoma is presented. The differential diagnosis of secondary achalasia includes infectious and infiltrative disease and neuropathy, but mainly malignant diseases. The clinical criteria found for achalasia secondary to malignancy included older age at diagnosis, brief duration of symptoms, and weight loss. While upper gastrointestinal x-rays and computerized tomographic scanning may be helpful, the most reliable diagnostic tool is esophago-gastro-duodenoscopy. This is a terminal disease with short life expectancy. Yet making the correct diagnosis can save the patient from futile treatment with muscle relaxants and endoscopic balloon dilatation, the accepted therapeutic measures in primary achalasia.

[Rubber-band ligation of esophageal and cardiac varices].

Esophageal sclerotherapy was the treatment of choice for bleeding esophageal varices in the past decade. It is effective for treating acute variceal bleeding, as well as eradicating esophageal varices for secondary prevention of bleeding. However, in more than 20% of patients sclerotherapy involves complications, some of which are serious. The high complication rate suggested the development of a new method that should be at least as effective and as easy to perform as sclerotherapy, but with fewer complications and side-effects. Endoscopic variceal ligation was developed at the University of Colorado and described in 1986. It is reported to control active variceal bleeding in about 90% of patients, and to eradicate varices in about 80% of surviving patients. Complications are rare. We have adapted the method in our unit and here describe out preliminary experience in 11 patients.