Gammadelta T cells as a predictor of surgical relapse of Crohn's disease.

BACKGROUND: We recently demonstrated a decrease in the overall lymphocyte population in the peripheral blood of patients with CD compared to healthy controls and this decrease is more evident in γδ T lymphocytes. The percentages of T cell subsets could reflect the risk of surgical relapse in CD patients. The aim of this study is to study the correlation between αß and γδ T cell subsets in the peripheral blood of patients with CD and the risk for surgery during follow up. METHODS: A prospective study of 102 patients with CD compared with 102 healthy subjects (control group) matched by age and sex was conducted. Lymphocytic populations of CD3+, CD4+, CD8+, CD56+, and αß and γδ T cell subsets were measured in the peripheral blood of all participants. RESULTS: We found evidence of a relationship between lower γδ T cell levels and risk of surgical relapse in CD. The lowest subsets observed in CD patients with surgical relapse were CD3+γδ, CD3+CD8+γδ and CD3+CD56+γδT cells. We observed a relationship between a decrease in γδ T cells and the most severe forms of the disease. The lowest levels of CD3+γδ and CD3+CD8+γδT cells were observed in the fistulizing phenotype. CONCLUSIONS: The deficit of γδ T cells was related with the severity and the risk for surgical relapse in CD patients. Patients with CD3+γδ deficit were more prone to surgery than patients without this deficit. These results suggest that γδ T cells could be used as markers of poor prognosis of CD following the diagnosis of the disease.

Determination of Anti-Anisakis Simplex Antibodies and Relationship with αß and γδ Lymphocyte Subpopulations in Patients with Crohn's Disease.

BACKGROUND: The etiology of Crohn's disease (CD) is still unknown although new theories are based on defects in innate immunity. We have previously shown a decrease in γδ T cells in CD patients. Previous studies have shown a high prevalence of anti-A. simplex immunoglobulins in CD patients. The diminution of γδ T cells in the peripheral blood and intestinal mucosa of CD patients may create a state of immunosuppression that would facilitate A. simplex infection. AIMS: To study the antibody responses to Anisakis antigens in Crohn's disease patients and its relationship with αß and γδ T cell subsets. METHODS: We recruited 81 CD patients and 81 healthy controls. αß and γδ T cell subsets and anti-A. simplex antibodies were measured. RESULTS: Levels of anti-A. simplex IgG and IgM were significantly increased in CD patients. Almost 20% of CD patients were positive for IgG and IgM anti-A. simplex versus only 3.7 and 2.5%, respectively, in normal subjects. However, lower specific IgA levels were observed in the group of CD patients versus healthy subjects. We found an association between CD3 + CD8 + Î³Î´ subset and IgM anti-A. simplex levels. In ileal cases and stricturing behavior of CD, we observed the highest levels of specific antibodies with the exception of anti-A. simplex IgA. CONCLUSIONS: The relationship of specific antibodies with a γδ T cell deficiency makes these cell candidates to play a role in the immune response against Anisakis. In addition, anti-Anisakis antibodies could be considered as markers of risk of progression in CD.

Crohn's disease and Sweet's syndrome: an uncommon association.

Sweet's syndrome or acute febrile neutrophilic dermatosis (SS) is characterized by the sudden onset of painful erythematous lesions (papules, nodules, and plaques) together with fever and neutrophilia. The lesions are typically located on hands, arms, upper trunk, neck and face, showing an asymmetric distribution. Acute phase reactants are usually elevated and dermal infiltration of neutrophils without vasculitis is seen on skin biopsies. It is considered as a marker of systemic disease in over half of the cases, and is associated with infections, inflammatory bowel disease, autoimmune connective tissue disorders and various neoplasias. Its association with Crohn's disease (CD) is unusual and it appears mainly in association with colonic involvement. Fewer than 50 cases have been published in the medical literature since its first description in 1964, some concurrent with the first episode of CD. We present two patients with Crohn's disease and Sweet's syndrome diagnosed in our department at the time of CD diagnosis, as well as their response to treatment, subsequent course of the disease, and a review of the scientific literature.

Enfermedad de Crohn y síndrome de Sweet: una asociación infrecuente / No disponible

El síndrome de Sweet o dermatosis neutrofílica febril aguda(SS) se caracteriza por la aparición brusca de lesiones eritematosas,(pápulas, nódulos y placas) dolorosas, junto con fiebre y neutrofilia,siendo de presentación poco frecuente. Las lesiones se localizanpreferentemente en manos, brazos, parte superior deltronco, cuello y cara, con distribución asimétrica. Suele haber elevaciónde reactantes de fase aguda y en las biopsias cutáneas seidentifica una infiltración dérmica de neutrófilos sin vasculitis. Seconsidera un marcador de enfermedad sistémica en más de la mitadde los casos, asociándose a infecciones, enfermedad inflamatoriaintestinal, conectivopatías autoinmunes y diversas neoplasias.Su asociación con la enfermedad de Crohn (EC) es poco habitual,asociado sobre todo a afectación colónica. Se han publicadomenos de 50 casos en la literatura médica desde su primera descripciónen 1964, algunos de ellos simultáneos con el primer brotede la EC. Presentamos dos pacientes con enfermedad deCrohn y síndrome de Sweet diagnosticados en nuestro servicio enel momento del diagnóstico de la EC, así como su respuesta al tratamiento,evolución posterior y revisión de la literatura científica(AU)

The uncommon Sweet’s syndrome or acute febrile neutrophilicdermatosis (SS) is characterized by the sudden onset of painfulerythematous lesions (papules, nodules, and plaques) togetherwith fever and neutrophilia. The lesions are typically located onhands, arms, upper trunk, neck and face, showing an asymmetricdistribution. Acute phase reactants are usually elevated and dermalinfiltration of neutrophils without vasculitis is seen on skinbiopsies. It is considered as a marker of systemic disease in overhalf of the cases, and is associated with infections, inflammatorybowel disease, autoimmune connective tissue disorders and variousneoplasias.Its association with Crohn’s disease (CD) is unusual and it appearsmainly in association with colonic involvement. Fewer than50 cases have been published in the medical literature since itsfirst description in 1964, some concurrent with the first episodeof CD. We present two patients with Crohn’s disease and Sweet’ssyndrome diagnosed in our department at the time of CD diagnosis,as well as their response to treatment, subsequent course ofthe disease, and a review of the scientific literature(AU)

[Effectiveness, safety, and tolerability of intragastric balloon in association with low-calorie diet for the treatment of obese patients]. / Efectividad, seguridad y tolerancia del balón intragástrico asociado a una dieta hipocalórica para la reducción de peso en pacientes obesos.

INTRODUCTION: the endoscopic placement of an intragastric balloon (IGB) in association with a low-calorie diet is an option for the treatment of obesity. The aim of the present study was to evaluate its effectiveness, safety, and tolerance. MATERIAL AND METHODS: thirty-eight patients with no contraindications for IGB were included in this prospective study from March 2004 to January 2007. Balloon removal was performed 6 months later. Weight and body mass index (BMI) were evaluated after IGB removal and at 6 months and 1 year thereafter. Tolerance and complications during treatment were evaluated. Patients filled out a questionnaire to evaluate their subjective perception of treatment. RESULTS: mean weight loss after 6 months on balloon treatment was 14.10 kg (0-46), and mean BMI reduction was 5.23 kg/m2 (0-18). At 12 months after balloon removal 48.4% of patients maintained their weight loss or kept loosing weight. Most common early symptoms included nausea (71.1%) and vomiting (57.9%) with a good response to symptomatic treatment. Complications were seen in 7 patients (18.4%): digestive intolerance in 4 patients, with early removal in 3 of them; moderate esophagitis in 2 patients; and gastric perforation complicated with septic shock and death in 1 patient. CONCLUSIONS: 1. IGB in association with low-calorie diet is an effective, safe, and well tolerated treatment for morbid obese patients.2. Almost half of patients maintained their weight loss after one year from balloon removal.

Efectividad, seguridad y tolerancia del balón intragástrico asociado a una dieta hipocalórica para la reducción de peso en pacientes obesos / No disponible

Introducción: la implantación de un balón intragástrico (BI)por vía endoscópica asociado a una dieta hipocalórica es una alternativaen el tratamiento de la obesidad. El objetivo de nuestroestudio es evaluar su efectividad, seguridad y tolerancia.Material y métodos: se incluyen de manera prospectiva 38pacientes sin contraindicaciones para la implantación del BI, desdemarzo de 2004 hasta enero de 2007. La retirada del balón serealizó 6 meses después de la implantación. Evaluamos el peso eíndice de masa corporal (IMC) tras la retirada del balón, a los 6 y12 meses postretirada, así como la tolerancia y aparición de complicacionesdurante el tratamiento. Tras la retirada del balón serealizó un cuestionario a cada paciente evaluando la percepciónsubjetiva al tratamiento.Resultados: después de 6 meses de tratamiento la pérdida depeso media fue de 14,10 kg (0-46) y la reducción media del IMCfue de 5,23 kg/m2 (0-18). A los 12 meses postretirada del balónel 48,4% de pacientes mantiene o sigue perdiendo peso. Los síntomasprecoces más frecuentes fueron náuseas (71,1%) y vómitos(57,9%), con buena respuesta a tratamiento sintomático. Presentaroncomplicaciones 7 pacientes (18,4%): intolerancia digestivaen 4 pacientes, requiriendo retirada precoz del balón en 3 deellos; esofagitis moderada en 2 pacientes; y perforación gástricacomplicada con shock séptico y exitus en 1 paciente.Conclusiones:1. El balón intragástrico asociado a una dieta hipocalórica puedeconsiderarse un tratamiento efectivo, seguro y bien toleradopara el tratamiento de pacientes con obesidad mórbida.2. La pérdida de peso se mantiene en casi la mitad de los pacientesal año tras la retirada del balón

Introduction: the endoscopic placement of an intragastricballoon (IGB) in association with a low-calorie diet is an option forthe treatment of obesity. The aim of the present study was to evaluateits effectiveness, safety, and tolerance.Material and methods: thirty-eight patients with no contraindicationsfor IGB were included in this prospective study fromMarch 2004 to January 2007. Balloon removal was performed 6months later. Weight and body mass index (BMI) were evaluatedafter IGB removal and at 6 months and 1 year thereafter. Toleranceand complications during treatment were evaluated. Patientsfilled out a questionnaire to evaluate their subjective perception oftreatment.Results: mean weight loss after 6 months on balloon treatmentwas 14.10 kg (0-46), and mean BMI reduction was 5.23kg/m2 (0-18). At 12 months after balloon removal 48.4% of patientsmaintained their weight loss or kept loosing weight. Mostcommon early symptoms included nausea (71.1%) and vomiting(57.9%) with a good response to symptomatic treatment. Complicationswere seen in 7 patients (18.4%): digestive intolerance in 4patients, with early removal in 3 of them; moderate esophagitis in2 patients; and gastric perforation complicated with septic shockand death in 1 patient.Conclusions:1. IGB in association with low-calorie diet is an effective, safe,and well tolerated treatment for morbid obese patients.2. Almost half of patients maintained their weight loss after one year from balloon removal (AU)