Colonoscopy in inflammatory bowel disease. Diagnostic accuracy and proposal of an endoscopic score.

Colonoscopy is used in the differential diagnosis of inflammatory bowel disease but its accuracy and the "weight" of the various endoscopic signs have not been assessed. In a prospective study 357 patients with 606 colonoscopies, in whom the endoscopic appearances were those of ulcerative colitis, Crohn's colitis, or indeterminate colitis, were followed-up for an average period of 22 mo. A final, definite, endoscopy-independent diagnosis was reached by means of autopsy, surgery, or histology on biopsy in 71% of patients. Accuracy of colonoscopy was 89%, with 4% errors and 7% indeterminate diagnoses. Errors were more frequent in severe inflammatory activity (9%). The most useful endoscopic features in this differential diagnosis were discontinuous involvement, anal lesions, and cobblestoning of mucosa for Crohn's disease, and erosions or microulcers and granularity for ulcerative colitis. After selecting the endoscopic features with best predictive value, an "endoscopic score" was calculated by means of "likelihood ratios."

Primary biliary cirrhosis and rheumatic diseases: a clinical, immunological and immunogenetical study.

Clinical investigation of Primary Biliary Cirrhosis (PBC) patients showed an elevated frequency of rheumatic disorders, as well as their frequent appearance in asymptomatic PBC. Anticentromere region antibodies in PBC patients were pathognomonic for concomitant complete or incomplete CREST syndrome. These antibodies were only found on the HEp2 cell substrate. The constant finding of immune-complexes (IC) with IgM antibody component suggests that they play a role in the pathogenesis of PBC. No statistically significant correlation was found between the amount and classes of circulating IC, HLA class I antigens and rheumatic disorders during PBC.

Treatment of chronic delta hepatitis with alpha-2 recombinant interferon.

The Hepatitis Delta Virus (HDV), a defective ribonucleic acid virus dependent on the Hepatitis B Virus (HBV) is a cause of severe liver disease that often leads to cirrhosis and death. Since the HDV finds in the HBV infection a biological niche in which to thrive indefinitely, the major victims of its infection are the carriers of HBsAg. Spontaneous resolution of chronic HDV hepatitis has been observed rarely and therapeutic attempts with steroids or azathioprine and levamisole have been discouraging. With the advent of recombinant DNA technologies several human alpha-interferons (IFNs) have been synthesized by genetic engineering and the availability of large amounts of the drug has dramatically altered the therapeutic prospects of viral hepatitis. In view of the wide range of biological activities of IFN, including inhibition of viral nucleic acid replication, we have tested the tolerance and the efficacy of this drug in chronic HDV hepatitis. The preliminary results of this study are reported.

[Somatostatin in severe peptic ulcer hemorrhage]. / La somatostatina nelle severe emorragie da ulcera peptica.

Somatostatin was compared with intensive antacid and thrombin in a randomised controlled study on 15 patients with severe haemorrhages of the upper digestive tract deriving from peptic ulcers and identified endoscopically in order to assess the efficacy of the two drugs. The results in both groups were similar but somatostatin appeared more effective than antacids and thrombin in terms of blood transfusions required and the average time it took to stop the bleeding. The insignificance of these results is in contrast with the data from similar studies using other drugs (anti-H2) and reported by others. This shows the need for controlled polycentric studies conducted on large groups of homogeneous patients.

[Echotomography in the diagnosis of Crohn's disease]. / L'esame ecotomografico nella diagnosi del morbo di Crohn.

The diagnostic accuracy of abdominal ultrasonography in Crohn's disease has been assessed in a prospective, randomized, simple-blind controlled study. A group of 181 out-patients (89 with accertained Crohn's disease and 92 controls) was studied. Considering "target sign" and/or "probable signs" of Crohn's disease, ultrasonographic sensitivity in diagnosing Crohn's disease was 84% and specificity 83%. Abdominal ultrasonography is indicated in the differential diagnosis of inflammatory bowel diseases, in the screening and follow-up of patients with Crohn's disease and in cases with contraindications to X-Ray examinations.