ABSTRACT
BACKGROUND/AIMS: Our aims were to establish the clinical utility of assessing the intraepithelial lymphocyte (IEL) density in intestinal biopsies from a large series of individuals and to determine the best threshold discriminating celiac disease (CD) patients and controls in two populations with different pre-test prevalence. METHODS: We prospectively performed intestinal biopsy and CD-related serology in 349 subjects undergoing upper GI endoscopy. While 116 had symptoms suggestive of a small bowel disorder (high prevalence), 233 individuals were randomly selected from patients referred to endoscopy because upper GIsymptoms (low prevalence). Diagnosis of CD was based on the concordance of classical histological features and a positive CD serology. RESULTS: While 58 patients had a newly diagnosed CD (52 in the high and 6 in the low prevalence groups), 291 subjects did not meet diagnostic criteria of the disorder. Patients had a highly significant greater IEL density than controls (p < 0.00001). Based on the ROC curve, a count of 22.8 IEL/100 epithelial cells had the highest performance for diagnosing CD in the overall population and for subjects in the high pre-test probability subgroup and 22.5% was ,he best cut-off for those diagnosed in the low risk population (area under the curves: 0.979, 0.979 and 0.993, respectively). An abnormal CD serology confirmed the diagnosis of CD in all the four patients with counts below 22.8%. CONCLUSIONS: Our study confirms that an IEL density of 22.8% is an adequate threshold to discriminate CD patients and controls in individuals irrespective of the prevalence of the disorder.
Introducción: El recuento elevado de linfocitos intraepiteliales (LIEs) es un rasgo destacado aunque inespecífico de la enteropatía de la enfermedad celíaca (EC). Un recuento mayor a 40 LIEs/100 células epiteliales ha sido considerado por mucho tiempo esencial para el diagnóstico. Sin embargo, estudios recientes con escaso número de muestras han cuestionado este valor de corte. Objetivos: Determinar el rango normal de LIEs en biopsias intestinales y establecer su capacidad diagnóstica de EC en dos poblaciones con diferente prevalencia. Métodos: Realizamos prospectivamente biopsias de duodeno distal y serología para EC en 349 pacientesconsecutivos a quienes se les realizó una videoendoscopia digestiva alta. El grupo A consistió en 116 pacientes derivados a biopsia intestinal por síntomas sugestivos de malabsorción (considerados de alta prevalencia de EC) y el grupo B consistió en 233 pacientes randomizados entre quienes fueron derivados a endoscopía alta por síntomas gastrointestinales no sugestivos de EC (baja prevalencia de EC). El diagnóstico de EC se basó en criterios histológicos clásicos y serología positiva. Resultados: Cincuenta y ocho pacientes tuvieron EC (52 en el grupo de alto riesgo y 6 en el de baja prevalencia) y 291 individuos no tuvieron criterios de la enfermedad. Los pacientes tuvieron una densidad de LIEs significativamente mayor que los controles (p<0.00001). Basado en las curvas ROC, el conteo de 22.8 LIEs/100 células epiteliales tuvo la mejor sensibilidad y especificidad para el diagnóstico de EC en la población general y entre los sujetos con alta probabilidad y 22.5% fue el mejor valor de corte para la población de bajo riesgo (áreas bajo las curvas: 0.979, 0.979 y 0.993, respectivamente). Todos aquellos pacientes celíacos con recuento de LIEs por debajo de 22% (n=4), tuvieron serología positiva para EC. El clásico valor de 40% tuvo una sensibilidad del 55%. Conclusiones: Nuestro estudio confirma que una...
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Celiac Disease/diagnosis , Intestinal Mucosa/cytology , Biopsy , Lymphocyte Count , ROC Curve , Celiac Disease/immunology , Prospective Studies , Case-Control Studies , Sensitivity and Specificity , Predictive Value of TestsABSTRACT
BACKGROUND/AIM: Smooth muscle antibody (SMA) specific for the protein actin, a major component of the cytoskeleton of epithelial cells, is one of the most prevalent non-organ specific autoantibodies in the serum of celiac disease (CD) patients. Our aim was to explore the clinical relevance of the presence of IgA type anti-actin antibody (AAA) and SMA in a series of patients with CD. METHODS: We evaluated frozen serum samples collected at diagnosis from 92 adult patients with CD and 52 control individuals in whom CD was excluded. Patients were re-evaluated a median time of 5 yr after treatment. IgA type AAA was detected using a modified commercial ELISA assay and IgA SMA was detected using indirect immunofluorescence on primate esophagus substrate. RESULTS: At diagnosis, samples from CD patients had significantly higher AAA values than controls (p<0.00001). While all active CD patients had serum AAA values over the cut-off for healthy controls, we observed a very significant reduction of these antibodies after treatment (p>0.0001). AAA had a highly significant correlation with both, tissue, transglutaminase (r=0.62) and antigliadin (r=0.60, p<0.00001) antibodies as well as the severity of the intestinal injury (p<0.05). SMA was detected in sera of 35 consecutive CD patients. At diagnosis, SMA positive patients had significantly higher values of AAA (p<0.0002), increased number of autoimmune disorders (p<0.04), delayed menarche (p<0.04), lower hemoglobin levels (p<0.01), increased fecal a-I antitrypsin clearance (p<0.01) and more severe diarrhea (p<0.06). We also detected a trend to more severe complications at follow-up (p=0.059). CONCLUSIONS: Based on our findings we suggest that the presence of increased IgA AAA serum levels is a highly sensitive marker of the disturbed architecture of intestinal epithelial cells of CD patients with a potential relevance to diagnosis and follow-up. The presence of SMA seems to define a distinct subset of CD patients with ...
Introduccion/objetivo: El anticuerpo anti-musculo liso (SMA) dirigido contra la proteína actina, un componente mayor del citoesqueleto de las células epiteliales, es el anticuerpo no-órgano específico más prevalente en enfermedad celíaca (EC). Nuestro objetivo fue explorar la importancia clínica de los anticuerpos anti-actina (AAA) y SMA en una serie de pacientes con EC. Métodos: Evaluamos 92 muestras serológicas de pacientes celíacos adultos recolectadas al momento del diagnóstico y la de 52 individuos controles no celíacos. Los pacientes fueron re-evaluados luego de un tiempo medio de 5 años en tratamiento. Evaluamos AAA tipoIgA mediante ELISA empleando un equipo commercial modificado y SMA IgA por inmunofluorescencia indirecta sobre sustrato de esófago de mono. Resultados: Al momento del diagnóstico, los pacientes celíacos tuvieron valores de AAA significativamente más elevados que los controles (p<0.00001). Todos los pacientes con EC activa presentaron niveles de AAA por encima del valor de corte determinado para el grupo control sano y se evidenció una reducción significativa de los nivelesluego del tratamiento (p>0.0001). Los AAA presentaron una correlación significativa con los anticuerpos anti-transglutaminasa tisular (r=0.62) y anti-gliadina (r=0.60) (p<0.00001), de igual modo que con la severidad del daño intestinal (p<0.05). Al momento del diagnóstico, se detectó SMA en el suero de 35 pacientes no controles. Los pacientes SMA positivos tuvieron valores significativamente mayores de AAA (p<0.002), un incremento del número de enfermedades autoinmunes asociadas (p<0.04), menarca tardía (p<0.04), niveles bajos de hemoglobina (p<0.01), incremento del clearance de a-1 antitripsina fecal (p<0.01) y mayor severidad de la diarrea (p<0.06).En ellos se evidenció una tendencia al desarrollo de complicaciones más severas durante el seguimiento (p=0.059). Conclusiones: Sugerimos que la presencia de un valor sérico aumentado de AAA tipo IgA...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Autoantibodies , Actins/immunology , Celiac Disease/immunology , Immunoglobulin A/blood , Muscle, Smooth/immunology , Enzyme-Linked Immunosorbent Assay , Celiac Disease/diagnosis , Celiac Disease/diet therapy , Case-Control Studies , Biomarkers/blood , Follow-Up Studies , Fluorescent Antibody Technique, Indirect , Severity of Illness IndexABSTRACT
Peripheral blood mononuclear cells (monocytes) from patients with Whipple's disease in long-term remission were tested for their ability to handle intracellular microorganisms. Phagocytosis and lysis of Candida tropicalis by monocytes of patients (n=12) andcontrols (n=8) were quantified after 30 min of incubation. Phagocytosis was similar in both groups but intracellular Killing of Candida tropicalis was significativily lower in patients (p<0.001). We concluded that our study showed an in vitro defect in the intracellular Killing function of monocytes in subjects in remission many years after diagnosis of Whipple's disease. The defective function did not seem to be related to relapse or to the susceptibility to other infections.
Subject(s)
Humans , Male , Female , Middle Aged , Whipple Disease/blood , Macrophages/physiology , Monocytes/physiology , Aged, 80 and over , Whipple Disease/drug therapy , Macrophages , Monocytes/drug effects , PhagocytosisABSTRACT
Botulinum toxin (BoTox) is a potent inhibitor of the release of acetylcholine from terminal nerves and has been used succesfully in spastic disorders of skeletal muscle. Its used for the treatment of disorders of gastrointestinal smooth muscle has recently been explored. In this study we evaluated the efficacy of transendoscopic injection of BoTox in 13 symptomatic patients with achalasia G II (Siewert classification) without previous treatment of an angoing randomized-controlled trial. Patients were blindy randomized to administrate: a) 8OU of BoTox were injected in four quadrants (1 ml in each quadrant-20 U/ml) (n=8) normal saline solution as placebo injected in the same way (n=5). Patientes who did not respond were retreated in an open design with the same schedule of BoTox. BoTox or placebe were injected directly into the lower esophageal sphincter (LES), located by manometric and endoscopic procedures, via sclerotherapy injector. Response to treatment was assessed by changes in symptoms score, weight, LES pressure, barium esophagograms and endoscopy. All determinations were repeated at basal and after 7-30-60 and 90 days of treatment. Post treatment response was considered positive if at one month, 3 of 4 parameters were improved. No evidence of response to BoTox were assessed in 3 patients. At 90 days, 10 patients remain well and data are as follows: (X + SD) symptoms score: (Pre: 3.23 + 0.44) (Post: 1.31 + 0.95); LES pressure (mmHg) (Pre: 53,15 + 66.31 + 7.49); per cent reduction of esophageal diameter 55 per cent (p< 0.0001) (pair T-test). Relaxation of LES did not change after treatment. There were no side effects related to BoTox injection. Conclusions: Endoscopic intrasphincteric BoTox injection is safe, simple and effective in the short term treatment for achalasia. Further studies are necessary for evaluation of long term effects.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Botulinum Toxins, Type A/therapeutic use , Esophageal Achalasia/drug therapy , Aged, 80 and over , Injections , Prospective StudiesABSTRACT
Motility disorders of the digestive tract have long been implicated in the pathophysiology of diarrhea in patients with celiac sprue. However, the contribution of the colon to the intestinal transit of celiac sprue has not been reported. Our aim was to determine whether sprue alters gut transit and whether differences in the clinical status of the disease influences colonic transit. We prospectively studied 25 patients with untreated celiac sprue, 15 treated patients and 15 healthy controls. Oro-cecal transit time, measured by the lactulose breath H2 test, was significantly delayed in untreated patients compared with treated patients and controls (p<0.001 and p<0.01 respectively). The delayed transit through the stomach and small bowel was not related to the presence of the steatorrhea. Transit of radiopaque makers, a measure of total colonic tansit, was significantly faster in untreated patients (p<0.05). The major finding was that this abnormal colonic behavior was principally due to a subpopulation of untreated patients with very fast transit times (<18 hours). A weakly significant inverse correlation between transit and fecal weight (r:-0.55, p<0.01), and between transit and steatorrhea (r:-0.38, p<0.05), was observed. We confirm previous descriptions of delayed oro-cecal transit time in untreated patients, and also provide the first evidence that disordered colonic transit contributes to the pathophysiology of the diarrhea in sprue.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Colon/physiopathology , Diarrhea/physiopathology , Celiac Disease/physiopathology , Gastrointestinal Transit/physiology , Analysis of Variance , Breath Tests , Contrast Media , Gastrointestinal Motility , Prospective StudiesABSTRACT
Efectuamos la revisión de la excreción de grasa fecal y el Clearance de alfa1-antitripsina (CLalfa1-AT) de 160 pacientes con esteatorrea en quienes el diagnóstico final se obtuvo basado en la historia clínica, examen físico, estudios radiológicos, funcionales y morfológicos. Veintedós pacientes tenían enfermedades pancreáticas y 138 tuvieron esteatorrea debido a enfermedades gastrointestinales. La combinación de esteatorrea y CL alfa1-AT normal fue una guía de utilidad para el diagnóstico de malabsorción pancreática. El CL alfa1-AT fue normal en todos nuestros pacientes con pancreatitis crónica. Sin embargo, cuando la combinación de esteatorrea y CL alfa1-AT normal estuvo presente, el diagnóstico etiológico correcto fue posible en el 23 al 50% de los casos
Subject(s)
Humans , alpha 1-Antitrypsin/pharmacokinetics , Celiac Disease/diagnosis , Feces/chemistry , Metabolic Clearance RateABSTRACT
Se presentan 15 pacientes portadores de enfermedades inflamatorias del colon (14 rectocolitis ulcerosas inespecificas y 1 enfermedad de Crohn) que se complicaron con afectacion de grandes articulaciones y columna vertebral (espondilitis anquilosante). Se comenta la incidencia de estas manifestaciones, la clinica, la radiologia, la patologia, la serologia y evolucion con relacion a la enfermedad inflamatoria
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Colitis , Osteoarthritis , Spondylitis, AnkylosingSubject(s)
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Celiac Disease , Blood Group Antigens , HLA Antigens , Lymphocytes , ImmunityABSTRACT
Se presenta un caso de la infrecuente asociacion de pioderma gangrenoso y enfermedad granulomatosa del colon (enfermedad de Crohn del colon). Se realiza una revision de la literatura acerca de la asociacion del mismo con otras afecciones gastrointestinales. Se actualizan los probables mecanismos etiopatogenicos y resultados terapeuticos
Subject(s)
Colitis , Crohn Disease , PyodermaABSTRACT
Los autores presentan un caso de asociacion de ulcera necrotica de cavidad bucal durante un brote agudo de rectocolitis ulcerosa inespecifica que evoluciono hacia la curacion con el tratamiento de la enfermedad de base. Se realiza una revision de las enfermedades gastrointestinales que pueden asociarse a ulceras bucales, y se detalla su diagnostico diferencial con otras ulceras bucales especificas e inespecificas
Subject(s)
Colitis, Ulcerative , Mouth Diseases , UlcerABSTRACT
Se presenta un caso de la infrecuente asociacion de pioderma gangrenoso y enfermedad granulomatosa del colon (enfermedad de Crohn).Se realiza una revision de la literatura acerca de las asociaciones del mismo con otras afecciones gastrointestinales. Se actualizan los probables mecanismos etiopatogenicos y resultados terapeuticos