Licury Cake in Diets for Lactating Goats: Intake, Digestibility, Feeding Behavior, Milk Production and Composition, and Nitrogen Metabolism.

The objective of this study was to determine the effects of licury cake (LC) inclusion in the diets of lactating goats on productive and metabolic performance. Twelve lactating goats, eight Saanen and four Anglo-Nubian, were distributed in a triplicate 4 × 4 Latin square design, with four treatments (0, 66.7, 133.3, and 200 g kg-1 of dry matter-DM). On the one hand, the LC inclusion increased neutral detergent fiber, indigestible neutral detergent fiber, and potentially digestible neutral detergent fiber (p < 0.001) intake. On the other hand, LC inclusion reduced ether extract and non-fibrous carbohydrate (p < 0.001) intake. There was a reduction in dry matter digestibility (p = 0.018) and an increase in neutral detergent fiber digestibility (p = 0.036). Feeding (p = 0.005) and rumination (p < 0.001) efficiencies increased with LC inclusion. The nitrogen balance was similar for all tested diets; however, we observed recycling metabolism. Based on the studied parameters, mainly milk production and composition, we recommend the LC inclusion of up to 200 g kg-1 DM in diets for lactating goats.

Palm Kernel Cake in Diets for Lactating Goats: Intake, Digestibility, Feeding Behavior, Milk Production, and Nitrogen Metabolism.

This study was carried out to determine the optimal inclusion rate of palm kernel cake (PKC) in diets for lactating goats based on intake, digestibility, feeding behavior, milk production and nitrogen metabolism. Twelve goats were used, eight Saanen and four Anglo Nubian, with a body weight of 46.0 ± 9.4 kg and 105 ± 5 days of lactation, distributed in a 4 × 4 Latin square design in triplicate. The diets were composed of increasing levels of PKC; 0, 80, 160 and 240 g kg−1 of dry matter (DM). The DM, crude protein, neutral detergent fiber and non-fibrous carbohydrates intakes decreased (p < 0.01) with the PKC inclusion. Milk production and milk protein decreased (p = 0.001), and milk production efficiency was not affected (p > 0.05) by the PKC inclusion. The ether extract intake varied quadratically (p < 0.01). Feeding and rumination efficiencies of dry matter and NDF were reduced (p < 0.001). The fat and total solids contents of the milk were influenced quadratically (p < 0.05). Nitrogen excretion (feces and milk), and retained nitrogen decreased (p < 0.001). Moderate use of up to 80 g kg−1 DM of PKC in the diet of lactating goats is recommended since at these levels milk production or body weight are significantly affected.

Inclusion Prosopis juliflora Pod Meal in Grazing Lambs Diets: Performance, Digestibility, Ingestive Behavior and Nitrogen Balance.

Prosopis juliflora is an arboreal legume that concentrates its nutritive value in pods (fruits), constituting a rich source of carbohydrates and with a crude energy concentration comparable to ground corn. Therefore, we aimed to evaluate the effect of inclusion of Prosopis juliflora pod meal (0 or control, 250, 500 and 750 g/kg total DM) as a replacement for ground corn in the diet of lambs on performance, digestibility, ingestive behavior, and nitrogen balance of lambs grazing in the Megathyrsus maximus pasture. Forty Santa Inês uncastrated lambs with an average body weight (BW) of 24.2 ± 0.55 kg were distributed in a completely randomized design. There was a linear increase in the non-fiber carbohydrates (NFC), ether extract (EE) and neutral detergent fiber (NDF) digestibility with Prosopis juliflora pod meal supplementation in the diet of the lambs. Dry matter (DM), crude protein (CP) and total digestible nutrients (TDN) intake, and digestibility and time spent ruminating were not affected by Prosopis juliflora meal supplementation. Prosopis juliflora pod meal inclusion increased time spent feeding and idling of lambs, however, without affecting spent time ruminating. Lambs fed with Prosopis juliflora pod meal presented greater final BW, gain: feed ratio, N-balance, microbial protein production ef-ficiency, N-urea urinary (NUU) and blood urea nitrogen (BUN). However, the average daily weight (ADG), total weight gain and hot carcass yield as well as N ingested, N excreted in feces and urine, total purines, ab-sorbed purines and N microbial production in lambs were not influenced by Prosopis juliflora pod meal inclusion. The Prosopis juliflora pod meal inclusion up to the 750 g/kg level in the concentrate supplement totally replace ground corn in the diet of grazing lambs improving the NFC intake and NDF digestibility, supplement acceptability, microbial protein production efficiency and consequently the performance. The addition of Prosopis juliflora pod meal as a replacement for ground corn in the concentrate does not influence the microbial protein production; however, there was an improvement in the efficiency of microbial synthesis.

Licury Cake in Diets for Lactating Goats: Qualitative Aspects of Milk and Cheese.

The study was carried out to evaluate the effects of licury cake (LC) inclusion in diets for lactating goats on milk chemical composition and fatty acid profile, and physicochemical composition and sensory attributes of Minas Frescal cheese. Twelve lactating goats were used (eight Saanen and four Anglo Nubian goats, with 35 ± 5 days in lactation and average body weight of 37.93 ± 9.22 kg), distributed in a triplicate 4 × 4 Latin Square design. The increasing levels of LC studied were: 0, 67, 133 and 200 g/kg of dry matter (DM). The analyses were adjusted using orthogonal polynomial contrasts, in which the probability level of 5% was considered. For sensory attributes, principal component analysis was performed. The LC inclusion promoted the reduction in moisture (p = 0.013) and mineral matter (p < 0.001) content in cheese. The ether extract content in cheese showed a quadratic effect (p = 0.021). Lauric acid showed a linear (p = 0.002) increasing effect, and myristic (p < 0.001) and rumenic (p = 0.018) acids showed quadratic effects. The sensory attributes analysis in cheese indicated that the inclusion of 133 and 200 g/kg of LC improve its texture. Flavor was improved with the inclusion of 67 and 133 g/kg. The inclusion of up to 133 g/kg of LC in the diet of lactating goats is recommended because it promotes improvements in flavor and texture of Minas Frescal cheese.

Palm Kernel Cake in Diets for Lactating Goats: Qualitative Aspects of Milk and Cheese.

We investigated the effect of including palm kernel cake (PKC) at the levels of 0, 80, 160 and 240 g kg-1 in the diet of lactating goats on the quality and sensory parameters of Minas Frescal cheese. Twelve goats were used in a triple 4 × 4 Latin square design. The dietary addition of PKC was associated with a reduction in moisture (p = 0.004), which compromised the cheese yield (p = 0.030). The ether extract content showed a quadratic response. There was a decrease in caproic (p = 0.014), caprylic (p = 0.011), capric (p = 0.003) and palmitic (p = 0.049) acids and an increase in lauric (p = 0.012) and myristic (p = 0.02) acids. Monounsaturated fatty acids increased (p = 0.008), whereas the ratio of polyunsaturated to saturated fatty acids (p = 0.022) and thrombogenicity index (p = 0.023) decreased. Principal component analysis indicated that control treatment and the treatment with 80 g kg-1 PKC were the most acceptable to the cheese tasters. The use of palm kernel cake is a good alternative for lactating goats when added to the diet at levels up to 80 g kg-1.

Preservation of sugarcane silage with urea and calcium oxide: performance and metabolic efficiency of dairy cows / Conservación del ensilaje de caña de azúcar con urea y óxido de calcio: rendimiento y eficiencia metabólica en vacas lecheras / Preservação da silagem de cana-de-açúcar com ureia e óxido de cálcio: desempenho e eficiência metabólica de vacas leiteiras

Abstract Background: Inclusion of urea and calcium oxide (CaO) during sugarcane ensilage has been hypothesized to improve dairy cow performance. Objective: To evaluate the use of urea and calcium oxide as additives to preserve sugarcane silage quality and determine whether they improve dairy cow performance and metabolic efficiency. Methods: Four diets were used: sugarcane silage without additive (SS), sugarcane silage with 10 g/kg urea (SU), sugarcane silage with 5 g/kg urea + 5 g/kg CaO (SUC), and sugarcane silage with 10 g/kg CaO (SC). Eight crossbred cows at approximately 100 days of lactation were distributed in two 4x4 Latin squares, and their diets were formulated to reach an average milk production of 15 kg/day. Results: Dry matter, non-fibrous carbohydrates, organic matter, total carbohydrates, and total digestible nutrient intake were the highest (p<0.05) for the cows fed SC. Urinary excretion of nitrogen was higher (p<0.05) for cows fed diets based on SUC than those fed diets with SC. Milk urea nitrogen content was the highest (p<0.05) in animals fed SU diets. Nitrogen balance was positive in all treatments; however, the microbial protein synthesis was low for all diets. Conclusions: The diet with SU showed the highest nitrogen loss through the milk. Among the evaluated silages, those with SC and SUC are recommended to promote a high intake of nutritional components.

Resumen Antecedentes: La hipótesis fue que una dieta con combinación de urea y óxido de calcio (CaO) para el ensilaje de caña de azúcar, puede mejorar la producción de vacas lecheras cruzadas. Objetivo: Evaluar la urea y el óxido de calcio como aditivos para preservar la calidad del ensilaje de caña de azúcar y determinar si mejoran el rendimento y la eficiencia metabólica de vacas lecheras. Métodos: Cuatro dietas fueron utilizadas: ensilaje de caña de azúcar sin aditivo (SS), ensilaje de caña de azúcar con 10 g/kg de urea (SU), ensilaje de caña de azúcar con 5 g/kg de urea + 5 g/kg de CaO (SUC) y ensilaje de caña de azúcar con 10 g/kg de CaO (SC). Ocho vacas cruzadas fueron evaluadas con una producción media de leche de 15 kg/día y aproximadamente 100 días de lactación, distribuidas en dos cuadrados latinos 4x4. Resultados: El consumo de materia seca, carbohidratos no fibrosos, materia orgánica, carbohidratos totales y nutrientes digestibles totales fue mayor (p<0,05) cuando las vacas fueron alimentadas con dietas conteniendo SC. La excreción de nitrógeno en la orina fue mayor (p<0,05) cuando las vacas fueron alimentadas con dietas basadas en SUC que las alimentadas con dietas SC. El nitrógeno ureico de la leche fue mayor (p<0,05) en animales alimentados con dietas con SU. El balance de nitrógeno fue positivo en todos los tratamientos, sin embargo, la síntesis de proteína microbiana fue baja para todas las dietas. Conclusión: La dieta con SU presentó la mayor pérdida de nitrógeno por medio de la leche. Entre los ensilajes evaluados, aquellos con SC y SUC son recomendados por promover un mayor consumo de componentes nutricionales.

Resumo Antecedentes: A hipótese foi que uma dieta com a mistura de ureia e óxido de cálcio (CaO) para a ensilagem de cana de açúcar, poderia melhorar a produção de vacas leiteiras mestiças. Objetivo: Avaliar ureia e óxido de cálcio como aditivos para preservar a qualidade da silagem de cana de açúcar: melhoria da produção e eficiência metabólica de vacas leiteiras. Métodos: Quatro dietas foram utilizadas: silagem de cana de açúcar sem aditivo (SS), silagem de cana de açúcar com 10 g/kg de ureia (SU), silagem de cana de açúcar com 5 g/kg de ureia + 5 g/kg de CaO (SUC) e silagem de cana de açúcar com 10 g/kg de CaO (SC). Oito vacas mestiças foram avaliadas com uma produção media de 15 kg/dia e aproximadamente 100 dias de lactação, distribuídas em dois quadrados latinos 4x4. Resultados: O consumo de matéria seca, carboidratos não fibrosos, matéria orgânica, carboidratos totais e nutrientes digestíveis totais foi maior (p<0,05) quando as vacas foram alimentadas com dietas contendo SC. A excreção de nitrogênio na urina foi maior (p<0,05) quando as vacas foram alimentadas com dietas baseadas em SUC do que aqueles animais alimentados com dietas SC. O nitrogênio ureico do leite foi maior (p<0,05) em animais alimentados com dietas com SU. O balanço de nitrogênio foi positivo em todos os tratamentos, no entanto, a síntese de proteína microbiana foi baixa para todas as dietas. Conclusão: A dieta com SU apresentou maior perda de nitrogênio por meio do leite. Entre as silagens avaliadas, aquelas com SC e SUC são recomendadas por promover maior consumo de componentes nutricionais.

Protected or Unprotected Fat Addition for Feedlot Lambs: Feeding Behavior, Carcass Traits, and Meat Quality.

This study aimed to evaluate the effect of the inclusion of protected or unprotected fats in the diet of feedlot lambs on feeding behavior, productive characteristics, carcass traits, and meat quality. Forty male Dorper × Santa Inês lambs (22.27 ± 2.79 kg) were randomly assigned to treatments in a completely randomized design. The experimental treatments consisted of five diets: no added fat (NAF), whole soybeans (WSB), calcium salts of fatty acids (CSFA), soybean oil (SO), and corn germ (CG). The total intake of dry matter (DMI) (p < 0.001) and neutral detergent fiber (NDFI) (p = 0.010) were higher in the CSFA and NAF diets. Feeding behavior, morphometric measurements, physicochemical characteristics, and centesimal composition of the Longissimus lumborum muscle were similar between treatments (p > 0.05). The CSFA diet provided higher production (p < 0.05) and better-quality carcasses. The inclusion of fat sources increased the concentration of polyunsaturated fatty acids (p < 0.05). The use of calcium salts of fatty acids in feedlot lambs' diets provides better quantitative and qualitative characteristics of the meat and carcass.

Ruminal fatty acid outflow in dry cows fed different sources of linoleic acid: reticulum and omasum as alternative sampling sites to abomasum.

This study was designed to determine the rumen outflow of fatty acids (FA) and biohydrogenation (BH) extent using alternative sampling sites (reticulum and omasum) to abomasum in dry cows fed different sources of FA. Four Holstein non-pregnant dry cows (≥3 parturitions, and 712 ± 125 kg BW), cannulated in the rumen and abomasum, were randomly assigned to a 4 × 4 Latin square design experiment, containing the following treatments: 1) control (CON); 2) soya bean oil (SO), dietary inclusion at 30 g/kg; 3) whole raw soya beans (WS), dietary inclusion at 160 g/kg; and 4) calcium salts of FA (CSFA), dietary inclusion at 32 g/kg. Rumen outflow of nutrients was estimated using the three markers reconstitution system (cobalt-EDTA, ytterbium chloride, and indigestible neutral detergent fibre [NDF]). Diets with FA sources decreased feed intake and increased FA intake. No differences in nutrient intake and digestibility were detected among cows fed diets supplemented with different FA sources. Diets with FA sources reduced the rumen outflow of DM and NDF, hence decreasing their passage rates. In addition, SO diet reduced the ruminal outflow of DM and NDF in comparison with WS and CSFA. Omasal sampling yielded the highest values of rumen outflow of NDF and potentially degradable NDF (pdNDF), whereas the reticular and abomasal samplings yielded intermediate and least values, respectively. The interaction effect between diet and sampling site was observed for rumen outflow of majority FA (except for C16:0, C18:0, and C18:2 trans-10, cis-12) and BH extension of C18:1 cis, C18:2, and C18:3. Calculations derived from abomasal sampling revealed that WS and CSFA diets had lower BH extent of C18:1 cis and C18:2 in comparison with SO, whereas cows fed CSFA had greater BH extent of C18:3 and lower BH extent of C18:1 cis compared to those fed WS. However, the latter results were not similar when calculations were performed based on the reticular and omasal samplings. Thus, there is evidence that neither reticular nor omasal samplings are suitable for estimating rumen outflow of FA in dry cows. In addition, WS and CSFA diets can increase the abomasal flow of polyunsaturated FA in dry cows.

Effects of pearl millet silage ammoniation with urea on carcass and meat quality of lambs.

This study aimed to evaluate the effect of pearl millet silage ammoniated with urea on lamb carcass characteristics and meat quality. Thirty-two noncastrated crossbred lambs at 4-5 months of age, with an average initial body weight of 17.39 ± 2.16 kg, were distributed into four treatments in a randomized block experimental design with eight animals per treatment. Experimental diets were composed of pearl millet silage ammoniated with four levels of urea (0%, 2%, 4% and 6%, on dry matter basis (DM). Carcass conformation and fatness decreased linearly (p < 0.05). Except for the fat content, the proximate composition was not influenced (p < 0.05) by the diets. Meat lightness and yellowness increased linearly (p < 0.05). There was no effect of diets (p > 0.05) on cooking losses or shear force. The levels of oleic and erucic fatty acid levels in the meat decreased linearly (p < 0.05), whereas linoleic and eicosadienoic acids, polyunsaturated fatty acids, PUFA:SFA ratio and ω6 contents increased (p < 0.05). Pearl millet silage ammoniated with urea allows for the production of good-quality lamb meat, with greater concentrations of polyunsaturated fatty acids. However, lambs fed diets with pearl millet ammoniated with up to 6% lead to a reduction of carcass characteristics without significantly affecting loin-eye area possibly associated with low palatability of the additive used. The lower acceptance of the silages with higher levels of urea is due to the ammonia retention in the material is attributed to the ammonization process. Thus, in spite of the benefits on lamb meat quality, it is suggested that the use of this additive in the ammonization of tropical forages be carried out with care, in limits of up to 6%.

Clinical and molecular features of attenuated adenomatous polyposis in northern Italy.

BACKGROUND: Attenuated familial adenomatous polyposis (AFAP) is characterized by the presence of 10-99 colorectal adenomas. The disease may be associated with mutations in either APC or MUTYH genes. We purposed to evaluate the contribution of adenomatous polyposis coli (APC) and MutY homologue (MUTYH) germline alterations to the AFAP phenotype and to identify genotype/phenotype correlations. METHODS: During counselling for familial adenomatous polyposis (FAP), 91 probands (and 107 affected individuals) who met the criteria of AFAP were identified. Eighty-two families were screened for constitutional mutations of the APC and MUTYH genes. RESULTS: MUTYH mutations were detected in 21 families (25.6 % of the 82 tested), and APC mutations in 7 (8.5 %). Overall, constitutional alterations were found in 34.1 % of the probands. Patients with APC mutations were younger at cancer onset and had a higher mean number of polyps (48.5 ± 33.0 in APC+ individuals vs. 35.7 ± 24.9 in MUTYH+ individuals, and 33.2 ± 18.4 in the "no mutation" group). Clinical features rendered the "no mutation" group closer to MUTYH+ than to the APC+ group. Colorectal cancer at diagnosis was detected in 40 % of AFAP individuals. CONCLUSIONS: AFAP is a new clinical entity with its frequency in the general population still undefined. The number of adenomas varies greatly, with an average of 30-40 lesions. The molecular basis of AFAP can be established in approximately 1/3 of the patients. Both MUTYH and APC genes are implicated in AFAP, though the role of MUTYH is of considerably greater relevance.

Reproducibility of bowel ultrasonography in the evaluation of Crohn's disease.

BACKGROUND: Bowel ultrasonography is increasingly used in the detection and follow-up of patients with Crohn's disease, but a limitation to its further diffusion is the lack of standardisation of ultrasonography parameters. AIMS: This study aimed to standardise the most common bowel ultrasonography parameters in order to develop an unequivocal imaging interpretation and to assess bowel ultrasonography reproducibility. PATIENTS: Twenty patients with Crohn's disease were examined. METHODS: Six ultrasonographers (mean bowel ultrasonography experience=16 years) performed the study. They chose and discussed a common assessment methodology concerning eight ultrasonography parameters: bowel wall thickness, bowel wall pattern, bowel wall blood flow, enlarged mesenteric lymph nodes, mesenteric hypertrophy, abdominal free fluid, and stenosis or fistulae at four preliminary meetings. The day of the study operators were randomised to two rooms where they independently and in turn performed ultrasonography scans. Interobserver agreement was scored by kappa statistics. RESULTS: Excellent k values were observed for bowel wall thickness (0.72-1). k Values were poor for bowel wall pattern (-0.22-0.85) and good for bowel wall blood flow (0.53-0.89). The presence of lymph nodes was reproducible (0.56-0.90) except in one case (0.25). Concordance on free fluid was excellent (0.85-1), whereas that on mesenteric hypertrophy was generally poor (0.14-0.69). Agreement was excellent for stenosis (0.81-1) whereas that for fistula was fair in room abscesses (0.31-0.48) and very good in room B (0.87-1). CONCLUSION: Bowel ultrasonography signs used in Crohn's disease can be standardised as most of them showed a fair to good reproducibility. In particular, bowel wall thickness, the most relevant parameter for Crohn's disease detection, showed an excellent reproducibility.

CT colonography: screening in individuals at high risk for colorectal cancer.

The use of computed tomographic colonography (CTC) as a screening test for colorectal cancer is being advocated with growing enthusiasm by physicians and the public as stronger evidence of its validity and limited invasiveness emerges from the literature. Because the approach to surveillance of colorectal cancer depends on an individual's degree of risk category, which depends on familial and personal histories, it seems logical that the diagnostic performance and cost efficacy of screening CTC may differ according to the characteristics of the target population. Although CTC seems a valid option in low- to average-risk populations, pending a careful assessment of its cost and estimates of its cost efficacy, there are some important issues that should be addressed when it comes to considering its use in high-risk patients. The expected larger number of induced colonoscopies and higher false-positive rates are likely to have a great influence on CTC costs, but if its implementation causes a dramatic increase in the number of patients willing to undergo screening, thanks to its acceptability, then the cost efficacy ratio may ultimately become competitive with all other screening strategies for colorectal cancer. We strongly feel that large and well-conducted trials are needed to clarify the role of CTC in screening patients at increased risk of developing colorectal cancer.

Alcohol abstinence does not offset the strong negative effect of lifetime alcohol consumption on the outcome of interferon therapy.

Heavy alcohol consumption has been reported to negatively affect the outcome of interferon therapy. We studied the impact of lifetime alcohol consumption in patients with chronic hepatitis C treated with interferon after 6 months of alcohol withdrawal. Alcohol intake was measured when patients with chronic hepatitis C were referred to us for the first time, and from that moment complete abstinence was recommended. After 6 months of abstinence, 150 patients with persistent elevated serum alanine aminotransferase (ALT) have been treated with interferon (IFN)-alpha, 3 or 6 microU three times per week for 12 months. Univariate and multivariate analysis were performed to identify the predictors of treatment response. Carbohydrate-deficient transferrin was employed to assess alcoholic abstinence. The sustained response rate felt from 33% in nondrinkers to 20% of mild-drinkers and to only 9% in heavy drinkers. Drinker patients showed a relapse rate twice as high as that of nondrinkers. According to the multivariate analysis, the strongest independent predictors of nonresponse were genotype 1b infection, age of the patients and their lifetime alcohol intake. Carbohydrate-deficient transferrin detected at baseline, at 3 months of therapy and at the end of follow-up gave a positive result only in eight determinations (1.77%), confirming the compliance of patients to our recommendation of alcohol abstinence. Lifetime alcohol consumption has a strong negative effect on the outcome of interferon treatment, mainly in heavy drinkers. A 6-month period of abstinence may not be sufficient to offset this negative effect on treatment outcome.

Interferon and amantadine in combination as initial treatment for chronic hepatitis C patients.

BACKGROUND/AIMS: To evaluate the efficacy and tolerance of amantadine in combination with interferon in the treatment of chronic hepatitis C. METHODS: Multi-centre trial including 180 chronic hepatitis C patients without cirrhosis, randomly enrolled to receive interferon 6 MU every other day for 6 months followed by 3 MU for further 6 months (group A, 90 patients), or the same schedule plus amantadine 200 mg/day (group B, 90 patients). Primary end-point was a sustained virological and biochemical response, secondary end-points were on-treatment (third month) and end-of-treatment response rates. RESULTS: The two groups had similar demographic, biochemical and virological characteristics. A sustained response after 6 months follow-up was observed in 17% of group A and 24% of group B patients (P not significant), an end-of-treatment response was observed in 37% in group A and 47% in group B (P not significant), an on-treatment response was observed in 46% in group A and 61% in group B patients (P < 0.05). No major side effects due to amantadine administration were observed. CONCLUSIONS: Adding amantadine to interferon did not improve the sustained treatment efficacy. However, the rate of early response at the third month of therapy was significantly higher in the combination therapy group.

Genotype-phenotype relationship in inflammatory bowel disease.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases of unknown etiology. Much effort has been made in the last years to clarify the pathogenesis of inflammatory bowel disease (IBD). Data are not conclusive at the moment, but the most important known risk factor for developing IBD is a positive familial history. Genetic analyses have shown a linkage between loci on several chromosomes and IBD (IBD1 gene on chromosome 16 for CD and on chromosome 12 for UC). The association of genotype to specific phenotypes of disease could be hypothesized by the concordance of clinical characteristics in familial IBD, by the association of specific HLA haplotypes to clinically different groups of patients, and by different responses to treatment related to different polymorphisms of other chromosome 6 genes. The clinical heterogeneity of IBD has led to classifications of patients with Crohn's disease based upon clinical features (e.g. Rome and Vienna classifications) that allow the identification of subgroups of patients with similar clinical behavior. The possible drawbacks of these classifications are the lack of validation of intra-interobserver concordance, the absence of prospective evaluations, and stratification into too many subgroups. Furthermore, in our experience, clinical presentation (surgical or medical) seems to have a good correlation with prognosis, is easy identifiable, and can be applied at the time of diagnosis. In UC, extension of disease and clinical behavior correlate with prognosis. For these reasons, studies correlating genotype to phenotype should be performed to improve our knowledge of the diseases and possibly to stratify patients into different subgroups for more personalized treatments, in clinical trials and for research purposes.

Fecal pancreatic elastase 1 in the work up of patients with chronic diarrhea.

BACKGROUND: Quantitative determination of pancreatic elastase-1 (E1) in stools has been proposed as a novel, noninvasive test of pancreatic function. The aim of the study was to verify its role in the differential diagnosis of chronic diarrhea. METHODS: E1 was measured in spot stool samples of 50 patients with pancreatic disease (PD), 62 with inflammatory bowel disease (IBD), 45 with chronic diarrhea (CD), 34 with other gastroduodenal and liver disease (gastrointestinal; GI), and in 18 normal controls, by a commercial kit (Schebo-Tech., Wettemburg, Germany). RESULTS: In PD, patients with severe damage and diarrhea displayed E1 levels below 100 microg/g; normal values were found in mild-moderate disease. Abnormal values were detected in 4 CD and in 14 IBD patients, either in the presence of severe protein malnutrition or in patients with previous ileo-anal pouch anastomosis and pouchitis. In nine cases, values reverted to normal after adequate treatment. Diagnostic accuracy of E1 in discriminating diarrhea of pancreatic and nonpancreatic origin was: SS, 97%; SP, 84%; VP+, 66%; VP-, 100%. CONCLUSION: 1) The finding of a normal E1 value rules out a malabsorption of pancreatic origin. 2) in CD and IBD, decreased E1 might be owing to bacterial elastase degradation (pouchitis) or transient defective pancreatic enzyme secretion.