Effect of a selective nonsteroidal anti-inflammatory inhibitor of cyclooxygenase-2 on the small bowel of rats

The pathogenesis of nonsteroidal anti-inflammatory drug (NSAID) enteropathy is a complex process involving the uncoupling of mitochondrial oxidative phosphorylation and inhibition of cyclooxygenase (COX). Rofecoxib, a selective inhibitor of COX-2, has shown less gastric damage, but the same beneficial effect is not clear in the case of the small bowel. Fifty-seven male Wistar rats (250-350 g) were divided into three groups (N = 19 each) to evaluate the effect of this NSAID on the rat intestine. The groups received 2.5 mg/kg rofecoxib, 7.5 mg/kg indomethacin or water with 5 percent DMSO (control) given as a single dose by gavage 24 h before the beginning of the experiment. A macroscopic score was used to quantify intestinal lesions and intestinal permeability was measured using [51Cr]-ethylenediaminetetraacetic acid ([51Cr]-EDTA). The extent of intestinal lesion, indicated by a macroscopic score, was significantly lower when rofecoxib was administered compared to indomethacin (rofecoxib = 0.0 vs indomethacin = 63.6 ± 25.9; P < 0.05) and did not differ from control. The intestinal permeability to [51Cr]-EDTA was significantly increased after indomethacin (control = 1.82 ± 0.4 vs indomethacin = 9.12 ± 0.8 percent; P < 0.0001), but not after rofecoxib, whose effect did not differ significantly from control (control = 1.82 ± 0.4 vs rofecoxib = 2.17 ± 0.4 percent; ns), but was significantly different from indomethacin (indomethacin = 9.12 ± 0.8 vs rofecoxib = 2.17 ± 0.4 percent; P < 0.001). In conclusion, the present data show that rofecoxib is safer than indomethacin in rats because it does not induce macroscopic intestinal damage or increased intestinal permeability.

Lack of evidence for the pathogenic role of iron and HFE gene mutations in Brazilian patients with nonalcoholic steatohepatitis

The hypothesis of the role of iron overload associated with HFE gene mutations in the pathogenesis of nonalcoholic steatohepatitis (NASH) has been raised in recent years. In the present study, biochemical and histopathological evidence of iron overload and HFE mutations was investigated in NASH patients. Thirty-two NASH patients, 19 females (59 percent), average 49.2 years, 72 percent Caucasians, 12 percent Mulattoes and 12 percent Asians, were submitted to serum aminotransferase and iron profile determinations. Liver biopsies were analyzed for necroinflammatory activity, architectural damage and iron deposition. In 31 of the patients, C282Y and H63D mutations were tested by PCR-RFLP. Alanine aminotransferase levels were increased in 30 patients, 2.42 + or - 1.12 times the upper normal limit on average. Serum iron concentration, transferrin saturation and ferritin averages were 99.4 + or - 31.3 g/dl, 33.1 + or - 12.7 percent and 219.8 + or - 163.8 æg/dl, respectively, corresponding to normal values in 93.5, 68.7 and 78.1 percent of the patients. Hepatic siderosis was observed in three patients and was not associated with architectural damage (P = 0.53) or with necroinflammatory activity (P = 0.27). The allelic frequencies (N = 31) found were 1.6 and 14.1 percent for C282Y and H63D, respectively, which were compatible with those described for the local population. In conclusion, no evidence of an association of hepatic iron overload and HFE mutations with NASH was found. Brazilian NASH patients comprise a heterogeneous group with many associated conditions such as hyperinsulinism, environmental hepatotoxin exposure and drugs, but not hepatic iron overload, and their disease susceptibility could be related to genetic and environmental features other than HFE mutations

Intestinal permeability in strongyloidiasis

The objective of the present study was to assess intestinal permeability in patients with infection caused by Strongyloides stercoralis. Twenty-six patients (16 women and 10 men), mean age 45.9, with a diagnosis of strongyloidiasis were evaluated. For comparison, 25 healthy volunteers (18 women and 7 men), mean age 44.9, without digestive disorders or intestinal parasites served as normal controls. Intestinal permeability was measured on the basis of urinary radioactivity levels during the 24 h following oral administration of chromium-labeled ethylenediaminetetraacetic acid (51Cr-EDTA) expressed as percentage of the ingested dose. The urinary excretion of 51Cr-EDTA was significantly reduced in patients with strongyloidiasis compared to controls (1.60 + or - 0.74 and 3.10 + or - 1.40, respectively, P = 0.0001). Intestinal permeability is diminished in strongyloidiasis. Abnormalities in mucus secretion and intestinal motility and loss of macromolecules could explain the impaired intestinal permeability

Protein-losing enteropathy in systemic lupus erythematosus

Enteropatia perdedora de proteina no lupus eritematoso sistemico. O caso de uma jovem de 23 anos com lupus eritematoso sistemico e enteropatia perdedora de proteina e descrito. A biopsia de delgado revelou linfangiectasia. O quadro regrediu com o uso de prednisona. A enteropatia perdedora de proteina deve ser suspeitada nos casos de lupus eritematoso sistemico com hipoalbuminemia e funcoes hepatica e renal preservadas. A revisao da literatura e apresentada salientando-se os aspectos fisiopatologicos envolvidos.

Condicoes imunoproliferativas do intestino delgado e linfoma do Mediterraneo. / Immunoproliferative conditions of the small intestine and Mediterranean lymphoma

Os autores estudam cinco pacientes portadores de malabsorcao e diarreia que melhoraram com o emprego de antibioticos. Os referidos pacientes foram estudados atraves de tecnicas imunologicas, determinacao da perda enterica de proteinas (51Cr), avaliacao da concentracao bacteriana no delgado superior e prova da pentagastrina, ao lado de exames clinicos rotineiros.Quatro dos pacientes chegaram a laparotomia, atingindo-se os seguintes diagnosticos: tres casos de doenca de cadeia alfa, um de linfoma misto do delgado situado paraproteina IgG em um deles. Os dados clinicos, laboratoriais e histopatologicos foram comparados, formulando-se a hipotese, tendo por base essa comparacao, que a doenca de cadeia alfa ocorre em individuos com deficiencia imunologica previa. Admitem tambem, em termos hipoteticos, que a doenca, o paciente apresenta melhores condicoes imunologicas. A doenca de cadeia alfa nao corresponde sempre ao linfoma plasmocitico tendo como orientacao a classificacao de Rappaport adaptada

Analise critica da dieta elementar e da nutricao parenteral nas enteropatias graves. / Critical analysis of elemental diet and parenteral feeding in severe enteropathies

As dietas elementares tem sido empregadas como substituto da nutricao parenteral exclusiva, em certas situacoes de falencia da funcao digestiva e absortiva do trato gastrointestinal. Tendo-se em vista o menor custo e a maior tolerabilidade atribuidas aquela dieta, os autores analisaram criticamente os efeitos de uma preparacao elementar provida de elevado teor de nitrogenio, em quatro pacientes acometidos de grave enteropatia perdedora de proteinas, dois dos quais haviam sido submetidos previamente a hiperalimentacao parenteral.A resposta nutricional foi avaliada com auxilio de parametros antropometricos, exames laboratoriais, e a excrecao urinaria de ureia e creatinina. A dieta elementar foi infundida pela tecnica de gavagem, com auxilio de uma delgada sonda de silicone, a fim de assegurar uma constancia e regularidade na oferta de nutrientes. Nao houve complicacoes metabolicas ou infecciosas do tratamento, tendo havido boa tolerancia a dieta elementar, ao lado de regressao dos fenomenos de diarreia e disenteria. Tambem os efeitos nutricionais da dieta enteral foram equivalentes aqueles proporcionados com a alimentacao intravenosa, incluindo-se sintese de massa muscular, regressao de edemas e manutencao ou melhora dos demais parametros de controle estudados. Conclui-se que a dieta elementar constitui uma alternativa importante para o manejo de enfermos com dificuldades digestivas graves, porem sem interrupcao da continuidade e do transito gastrointestinal