Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®. METHODS: Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The 'switch cohort' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the 'non-switch' cohort [NC] patients remained under Remicade®. RESULTS: A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]. CONCLUSIONS: Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe.

Pancreatitis aguda recidivante con enteropatía por gluten asociada. Características clínico-analíticas y evolutivas en 34 pacientes / No disponible

Objetivos: describir la frecuencia y características clínico-analíticasde la pancreatitis aguda (PA) recidivante con enteropatíapor gluten (EG) asociada.Pacientes y métodos: estudiamos de forma prospectiva loscasos de pancreatitis agudas ingresados en nuestro Servicio duranteel año 2006. Registramos un total de 185 pacientes. A lasformas recurrentes que fueron 40 en total (22%), les aplicamos unprotocolo clínico-analítico consistente en la determinación demarcadores serológicos, genéticos y biopsias duodenales, paradescartar una EG asociada.Resultados: un total de 34 pacientes (18%) cumplían criteriosclínico-biológicos de EG asociada (grupo 1) y se compararon conel resto de las PA no-EG (n = 161) (grupo 2). La edad media en laEG fue de 54 ± 25 años, ligeramente inferior al grupo 2, (61 ±14) (NS). Existía un ligero predominio de mujeres (50%) en el grupo1, respecto al grupo 2 (38,5%) (NS). Siete pacientes del grupo1 (20%) presentaron una PA grave, frente a 27 (17%) en el grupo2 (NS). La presencia de colelitiasis en el grupo 1, fue de 6 casos(18%), significativamente inferior a la del grupo 2, de 72 casos(45%) (p < 0,05). Cuatro pacientes con EG desarrollaron seudoquistes(12%) frente a 13 (8%) en el grupo 2 (NS).La transglutaminasa tisular (TGt) estaba elevada únicamente en3 casos (9%). Nueve pacientes (34%) fueron DQ2 (+) y 4 (12%)DQ8 (+), siendo el resto (54%), negativos para ambos marcadores.Existía una duodenitis difusa desde el punto de vista endoscópicoen 32 pacientes (95%). Las biopsias duodenales, mostraronatrofia vellositaria (Marsh 3) en 2 casos (6%); infiltración inflamatoriade la submucosa (Marsh 2) en 10 casos (29,4%); aumento delos linfocitos intraepiteliales (Marsh 1) en 8 casos (23,5%) y mucosanormal (Marsh 0) en 14 casos (41,2%). La respuesta a la DSGal año, fue excelente en 30 pacientes (88%).Conclusiones: la PA recidivante con EG, constituye una asociaciónrelativamente frecuente, indistinguible desde el punto devista clínico y evolutivo del resto de PA, excepto por una menorpresencia de colelitiasis (p < 0,05)

Objectives: to describe the frequency and the clinical and laboratorycharacteristics of relapsing acute pancreatitis (AP) associatedwith gluten enteropathy (GE).Patients and methods: we prospectively examined all acutepancreatitis cases admitted to our Department in 2006. Werecorded a total of 185 patients. With recurring forms, 40 (22%)in all, we used a clinical-lab protocol including serologic and geneticmarkers, and duodenal biopsy to rule out GE.Results: a total of 34 patients (18%) met clinical-biological criteriafor GE (group 1), and were compared to the remaining non-GE AP cases (n = 161) (group 2). Mean age in the GE group was54 ± 25 years, slightly younger than group 2 (61 ± 14) (NS).There was a mild predominance of women (50%) in group 1 versusgroup 2 (38.5%) (NS). Seven patients in group 1 (20%) hadsevere AP, as compared to 27 (17%) in group 2 (NS). The presenceof cholelithiasis in group 1 involved 6 cases (18%), whichwas significantly lower than in group 2 – 72 cases (45%) (p <0.05). Four patients with GE developed pseudocysts (12%) versus13 (8%) in group 2 (NS).Tissue transglutaminase (tTG) was elevated only in 3 patients(9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); therest (54%) were all negative for both markers. From an endoscopicperspective there was diffuse duodenitis in 32 patients (95%).Duodenal biopsies revealed villous atrophy (Marsh 3) in 2 patients(6%); submucosal inflammatory infiltration (Marsh 2) in 10(29.4%); increased intraepithelial lymphocytes (Marsh 1) in 8 cases(23.5%), and normal mucosa (Marsh 0) in 14 patients (41.2%).Response to GFD after 1 year was excellent in 30 patients (88%).Conclusions: relapsing AP with GE represents a relativelycommon association that is indistinguishable from other APs froma clinical-evolutive stand point, except for a lower presence ofcholelithiasis (p < 0.05) (AU)

Higher constitutive IL15R alpha expression and lower IL-15 response threshold in coeliac disease patients.

The IL-15 triggering effect of gliadin is not exclusive to coeliac disease (CD) patients, whereas the secondary response is CD specific. We have studied the expression of the IL-15 receptor, and the IL-15 response upon stimulation, in non-CD and CD patients, and the possible existence of a lower immunological threshold in the latter. Forty-two CD patients (20 on a gluten-containing diet, GCD, and 22 on gluten-free diet, GFD) and 24 non-CD healthy individuals were studied. IL15R alpha mRNA expression, and tissue characterization, were assayed in the duodenum. Biopsies from six CD patients on GFD and 10 non-CD individuals were studied in vitro using organ culture in basal conditions, as well as after IL-15 stimulation discarding basal IL-15 production. Secretion of immune mediators was measured in the culture supernatants. IL15R alpha mRNA expression was increased in CD patients, as compared with non-CD controls (on GFD P = 0.0334, on GCD P = 0.0062, respectively), and confirmed also by immunofluorescence. No differences were found between CD patients on GFD and on GCD. After in vitro IL-15 stimulation, IL15R alpha expression was only triggered in non-CD controls (P = 0.0313), though it remained increased in CD patients. Moreover, IL-15 induced a more intense immunological response in CD patients after triggering the production of both nitrites and IFN gamma (P = 0.0313, P = 0.0313, respectively). Gliadin-induced IL15 has a lower response threshold in CD patients, leading to the production of other immune mediators and the development of the intestinal lesion, and thus magnifying its effects within the CD intestine.

Factors that impact health-related quality of life in adults with celiac disease: a multicenter study.

AIM: To evaluate the factors involved in the impairment of health-related quality of life (HRQOL) in patients with celiac disease. METHODS: A multicenter, cross-sectional prospective study was performed in patients with celiac disease who completed two HRQOL questionnaires: the gastrointestinal quality of life index (GIQLI) and the EuroQol-5D (EQ). RESULTS: Three hundred and forty patients (163 controlled with a gluten-free diet, and 177 newly diagnosed with a normal diet) were included. The GIQLI score was significantly better in patients on a gluten-free diet (GFD) than in non-treated patients on their usual diet, both in terms of the overall score (3.3 vs 2.7, respectively; P < 0.001), as well as on the individual questionnaire dimensions. Both the preference value of the EQ as the visual analogue scale were significantly better in treated than in non-treated patients (0.93 vs 0.72 P < 0.001 and 80 vs 70 P < 0.001, respectively). Variables significantly associated with a worse HRQOL score were female gender, failure to adhere to a GFD, and symptomatic status. CONCLUSION: In untreated celiac disease, the most important factors that influence patient perception of health are the presence of symptoms and a normal diet. HRQOL improves to levels similar to those described in the general population in celiac disease patients well controlled with a GFD.

[Relapsing acute pancreatitis associated with gluten enteropathy. Clinical, laboratory, and evolutive characteristics in thirty-four patients]. / Pancreatitis aguda recidivante con enteropatía por gluten asociada, Características clínico-analíticas y evolutivas en 34 pacientes.

OBJECTIVES: To describe the frequency and the clinical and laboratory characteristics of relapsing acute pancreatitis (AP) associated with gluten enteropathy (GE). PATIENTS AND METHODS: We prospectively examined all acute pancreatitis cases admitted to our Department in 2006. We recorded a total of 185 patients. With recurring forms, 40 (22%) in all, we used a clinical-lab protocol including serologic and genetic markers, and duodenal biopsy to rule out GE. RESULTS: A total of 34 patients (18%) met clinical-biological criteria for GE (group1), and were compared to the remaining non-GE AP cases (n=161) (group2). Mean age in the GE group was 54 +/- 25 years, slightly younger than group 2 (61 +/- 14) (NS). There was a mild predominance of women (50%) in group 1 versus group 2 (38.5%) (NS). Seven patients in group 1 (20%) had severe AP, as compared to 27 (17%) in group 2 (NS). The presence of cholelithiasis in group 1 involved 6 cases (18%), which was significantly lower than in group 2--72 cases (45%) (p < 0.05). Four patients with GE developed pseudocysts (12%) versus 13 (8%) in group 2 (NS). Tissue transglutaminase (tTG) was elevated only in 3 patients (9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); the rest (54%) were all negative for both markers. From an endoscopic perspective there was diffuse duodenitis in 32 patients (95%). Duodenal biopsies revealed villous atrophy (Marsh 3) in 2 patients (6%); submucosal inflammatory infiltration (Marsh 2) in 10 (29.4%); increased intraepithelial lymphocytes (Marsh 1) in 8 cases (23.5%), and normal mucosa (Marsh 0) in 14 patients (41.2%). Response to GFD after 1 year was excellent in 30 patients (88%). CONCLUSIONS: Relapsing AP with GE represents a relatively common association that is indistinguishable from other APs from a clinical-evolutive standpoint, except for a lower presence of cholelithiasis (p < 0.05). A specific diagnostic protocol is much needed in the identification of these patients since GFD is the only effective therapy to prevent new AP events from developing.

Las mutaciones del gen CARD15 presentan escasa relación con los fenotipos de la enfermedad de Crohn en Asturias / CARD15 mutations are poorly related to Crohn´s disease phenotypes in Asturias

Introducción: la asociación entre las mutaciones del genCARD15 y la susceptibilidad genética para la enfermedad deCrohn (EC) se ha confirmado en diversos estudios, con ampliasvariaciones observadas a nivel mundial, tanto geográficas comoétnicas.Objetivos: analizar la prevalencia de gen CARD 15 y sus polimorfismosen pacientes con EC en Asturias y su posible correlacióncon los diversos fenotipos de la enfermedad.Métodos: estudiamos la frecuencia de las tres mutaciones delgen CARD15 (R702W, G908R, L1007fs) usando cebadores específicos,en un total de 216 pacientes con EC y 86 controlesprocedentes del área de Oviedo. Los pacientes fueron clasificadosde acuerdo con la edad al diagnóstico, localización la enfermedady su comportamiento clínico (clasificación de Viena).Resultados: la frecuencia global de portadores de las mutacionesdel gen CARD15 en los pacientes con EC fue del 17,3%frente a un 17,6% en controles (NS). Al analizar separadamentelos polimorfismos R702, G908R y L1007fs los pacientes mostrabanfrecuencias del 8,8, 3 y 6% respectivamente, mientras quelos controles las presentaban en el 11,6, 2,3 y 3,5%, sin encontrardiferencias significativas para ninguna de ellas (NS). Las frecuenciasobservadas en controles, fueron similares a las encontradasen otras regiones españolas.Conclusiones: la prevalencia de mutaciones en CARD15 enpacientes con EC en Asturias es menor a la reportada en otrostrabajos publicados en población española. Otros factores ambientales,además de los genéticos, parecen tener mayor importanciaen el desarrollo de EC en nuestra área

Background: the association between the three commonCARD15 gene mutations (R702W, G908R, L1007fs) and the geneticsusceptibility to Crohn’s disease (CD) have been confirmedby several studies, with some differences found, in relation to geographicareas and ethnic groups.Objectives: To analyze the prevalence of CARD15 gen andits polymorphisms in patients with CD in Asturias and its possiblecorrelation with the different genotypes of the disease.Methods: a total of 216 CD patients recruited from Asturias(North of Spain) and 86 ethnically matched healthy controls, weretyped using Hybprobes on a LightCycler instrument for CARD15mutations. Patients were subdivided according to Vienna classification.We have studied the frequency of these mutations in thedifferent subgroups of CD patients and analyzed its contributionto the disease clinical characteristics and progression.Results: carrier frequencies for CARD15 mutations in ourCD patients were similar to controls (17.8 vs. 17.4%) respectively(NS). CD patients exhibited frequencies of 8.8, 3.0 and 6.0% forthe R702, G908R and L1007fs polymorphisms respectively,whereas our control population had allele frequencies of 11.6,2.3 and 3.5% for the three mutations respectively (NS).We did not find any relationship between CARD15 mutationsand the different phenotypes of Crohn’s disease, according to Viennaclassification.Conclusions: in our CD population, other factors (i.e. environmental),in addition to genetics, must be mainly involved in thedevelopment of the disease

[Increased prevalence of celiac disease in first and second-grade relatives. A report of a family with 19 studied members]. / Prevalencia aumentada de enfermedad celiaca en familiares de primer y segundo grado: descripción de una familia con 19 miembros estudiados.

INTRODUCTION: celiac disease (CD) is an autoimmune condition that is triggered by the ingestion of gluten, a substance present in most cereals, and that affects genetically predisposed individuals. As a result, this condition is clearly familial, and mainly associated with HLA class II markers. OBJECTIVES: in this work we set out to analyze the prevalence of CD in an extensive family based on an index subject who had already died from this disease a few years ago, where CD had been complicated by the development of a small-bowel malignancy, namely an adenocarcinoma. METHODS: nineteen members were studied. They all were subjected to a diagnostic protocol including a detailed medical history, hemogram, coagulation tests, and blood biochemistry (including liver function tests, serum iron metabolism, circulating folic acid and vitamin B12 levels, thyroid function tests, tissue transglutaminase measurement, and genetic markers (DQ2 and DQ8). Suspect cases underwent gastroscopy plus multiple duodenal biopsy for confirmation. RESULTS: overall we encountered CD in 9/19 studied members, which represents 47.4% with the following distribution according to degree of kinship -four of seven siblings (57%); one of three children (33.3%); three of eight nephews and nieces (37.5%), and the only grandnephew, who was 9 years old. CONCLUSIONS: from all this it may be seen that family studies are needed every time a patient is diagnosed with celiac disease; these studies should include both first- and second-degree relatives, given the high prevalence encountered and the fact that these tests are relatively straighforward to perform.

Dieta y cáncer de colon / Diet and colon cancer

No disponible

Prevalencia aumentada de enfermedad celiaca en familiares de primer y segundo grado: descripción de una familia con 19 miembros estudiados / Increased prevalence of celiac disease in first-grade relatives. A report of a family with 19 studied members

Introducción: la enfermedad celiaca (EC) es un proceso autoinmune, desencadenado por la ingesta del gluten contenido en la mayor parte de los cereales, que afecta a individuos genéticamente predispuestos. Por todo ello, muestra una clara tendencia familiar, centrada fundamentalmente en marcadores del sistema HLA de clase II. Objetivos: nos propusimos en el presente trabajo analizar la prevalencia de EC en una familia extensa, a partir de un caso índice fallecido hacía unos años, como consecuencia de padecer la misma enfermedad, complicada además con el desarrollo de un tumor maligno del intestino delgado, del tipo del adenocarcinoma. Métodos: se estudiaron un total de 19 miembros. Se les realizó un protocolo diagnóstico que incluía un historia clínica detallada, junto con una hemograma y estudio de coagulación, una bioquímica amplia incluyendo pruebas de función hepática, estudio sérico del metabolismo del hierro, niveles circulantes de ácido fólico y vitamina B12, pruebas de función tiroidea, determinación de la transglutaminasa tisular y marcadores genéticos (DQ2 y DQ8). En los casos sospechosos y para su confirmación se realizó gastroscopia completada con toma de biopsias duodenales múltiples. Resultados: encontramos una prevalencia global de EC en 9/19 de los familiares estudiados, lo que representa un 47,4%, distribuidos de la siguiente manera en función del parentesco con el caso índice: cuatro de siete hermanos (57%); uno de tres hijos (33,3%); tres de ocho sobrinos (37,5%); y el único sobrino-nieto estudiado de nueve años de edad, también estaba afecto. Conclusiones: de todo ello se deduce la necesidad de hacer estudios amplios familiares, cada vez que se diagnostica un paciente de enfermedad celiaca, incluyendo familiares de primero y segundo grado, dada la relativa facilidad actual para llevarlos a cabo y la elevada prevalencia encontrada

Introduction: celiac disease (CD) is an autoimmune condition that is triggered by the ingestion of gluten, a substance present in most cereals, and that affects genetically predisposed individuals. As a result, this condition is clearly familial, and mainly associated with HLA class II markers. Objectives: in this work we set out to analyze the prevalence of CD in an extensive family based on an index subject who had already died from this disease a few years ago, where CD had been complicated by the development of a small-bowel malignancy, namely an adenocarcinoma. Methods: nineteen members were studied. They all were subjected to a diagnostic protocol including a detailed medical history, hemogram, coagulation tests, and blood biochemistry (including liver function tests, serum iron metabolism, circulating folic acid and vitamin B12 levels, thyroid function tests, tissue transglutaminase measurement, and genetic markers (DQ2 and DQ8). Suspect cases underwent gastroscopy plus multiple duodenal biopsy for confirmation. Results: overall we encountered CD in 9/19 studied members, which represents 47.4% with the following distribution according to degree of kinship –four of seven siblings (57%); one of three children (33.3%); three of eight nephews and nieces (37.5%), and the only grandnephew, who was 9 years old. Conclusions: from all this it may be seen that family studies are needed every time a patient is diagnosed with celiac disease; these studies should include both first- and second-degree relatives, given the high prevalence encountered and the fact that these tests are relatively straighforward to perform

Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease.

AIM: To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS: A 15 year-trend (1990 to 2004) in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS: Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies (7.6%); an increase in the use of such was observed over the study period (1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004). Celiac disease was diagnosed in 22 patients (2.2%), this being more frequent in women than in men (3% and 1% respectively). Fourteen out of 514 (2.7%) patients with anaemia, 12 out of 141 (8.5%) with chronic diarrhoea and 8 out of 42 (19%) with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION: Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

Hepatitis B surface antigen detection using pooled sera. A cost-benefit analysis.

OBJECTIVES: To examine the feasibility and to perform a cost benefit analysis of a 5-sample pooling strategy using an enzyme immunoassay (EIA) for the screening of hepatitis B surface antigen (HBsAg). MATERIAL AND METHODS: To assess the sensitivity and specificity of the pooling method, each of the 40 positive sera (from weak to intensely HBsAg-positive) and 250 negative sera were tested in a pool with 4 HBsAg-negative sera. The limit of detection for HBsAg/ad and HBsAg/ay was evaluated using sera from a panel of purified subtypes. A study under real conditions was conducted using pools from 340 pregnant women. RESULTS: The sensitivity and specificity of this technique were 100%. The correlation coefficient among the sample/cutoff ratios of 40 samples studied in single and in pooled conditions was 0.792 (p < 0.005). The pooling method has lower levels of detection for HBsAg/ad and HBsAg/ay at 0.20 ng/mL and 0.12 ng/mL, and the single method at 0.34 ng/mL and 0.29 ng/mL, respectively. The pooling method loses no sensitivity for values up to 100 IU/L of anti-HBs in the four sera mixed with a positive serum. The cost-benefit analysis showed that the pooling method could save from 30% up to 75% of the cost of HBsAg determination, according to whether seroprevalences were 10% or 1%, respectively. CONCLUSIONS: The pooled HBsAg EIA yielded no worse than the single EIA test, and was a cost-effective and valid strategy in areas with a high, medium or low prevalence.

Detección de HBsAg usando mezcla de sueros. Estudio coste-beneficio / Hepatitis B surface antigen detection using pooled sera. A cost-benefit analysis

Objetivos: examinar la fiabilidad y realizar un estudio coste beneficio de una estrategia de mezcla de 5 muestras usando un enzimainmunoanálisis (EIA) para el cribado del HBsAg. Material y métodos: para evaluar la sensibilidad y especificidad del método de mezcla de sueros se determinaron 40 sueros HBsAg positivos (de débil a intensamente positivos) y 250 sueros HBsAg negativos en mezcla con 4 sueros HBsAg negativos. El límite de detección para el HBsAg/ad y HBsAg/ay se evaluó usando suero de un panel de subtipos purificados. Se llevó a cabo un estudio en condiciones reales usando mezcla de sueros de 314 mujeres gestantes. Resultados: la sensibilidad y especificidad de esta técnica fue del 100%. El coeficiente de correlación entre los ratios muestra / punto de corte de las 40 muestras estudiadas en determinación simple y en mezcla fue 0,792 (p < 0,005). El método de mezcla de sueros detectó niveles más bajos de HBsAg/ad y HBsAg/ay (0,20 ng/mL y 0,12 ng/mL) que el método simple (0,34 ng/mL y 0,29 ng/mL, respectivamente). Un análisis coste-beneficio mostró que el método de mezcla puede ahorrar de un 30 a un 75% de el coste de la determinación de HBsAg para seroprevalencias de un 10 y 1%, respectivamente. Conclusiones: el método de determinación de HBsAg en mezcla de sueros no muestra peor rendimiento diagnóstico que el método simple y es una estrategia coste efectiva válida en áreas de baja prevalencia

Objectives: to examine the feasibility and to perform a cost benefit analysis of a 5-sample pooling strategy using an enzyme immunoassay (EIA) for the screening of hepatitis B surface antigen (HBsAg). Material and methods: to assess the sensitivity and specificity of the pooling method, each of the 40 positive sera (from weak to intensely HBsAg-positive) and 250 negative sera were tested in a pool with 4 HBsAg-negative sera. The limit of detection for HBsAg/ad and HBsAg/ay was evaluated using sera from a panel of purified subtypes. A study under real conditions was conducted using pools from 340 pregnant women. Results: the sensitivity and specificity of this technique were 100%. The correlation coefficient among the sample/cutoff ratios of 40 samples studied in single and in pooled conditions was 0.792 (p < 0.005). The pooling method has lower levels of detection for HBsAg/ad and HBsAg/ay at 0.20 ng/mL and 0.12 ng/mL, and the single method at 0.34 ng/mL and 0.29 ng/mL, respectively. The pooling method loses no sensitivity for values up to 100 IU/L of anti-HBs in the four sera mixed with a positive serum. The cost-benefit analysis showed that the pooling method could save from 30% up to 75% of the cost of HBsAg determination, according to whether seroprevalences were 10% or 1%, respectively. Conclusions: the pooled HBsAg EIA yielded no worse than the single EIA test, and was a cost-effective and valid strategy in areas with a high, medium or low prevalence

Enfermedad celiaca (EC), colitis ulcerosa (CU) y colangitis esclerosante primaria (CEP) asociadas en el mismo paciente: estudio familiar / Celiac disease (CD), ulcerative colitis (UC), and primary sclerosing cholangitis (PSC) in one patient: a family study

Presentamos el caso de un varón de 17 años, que a la edad de 7 años fue diagnosticado de enfermedad celiaca (EC) junto con una colitis ulcerosa (CU) y una colangitis esclerosante primaria (CEP) asociadas. Fue tratado con DSG e inmuno-supresores tipo azatioprina y se encuentra asintomático en la actualidad. Su hermana menor de 12 años, fue diagnosticada de EC cuando tenía 1,5 años y a los 7 años desarrolló una DM tipo 1 de difícil control.Se realizó un estudio familiar y ambos padres están afectos de una EC silente. Todos ellos son DQ2 (+). A propósito del caso y estudio familiar, se hacen una serie de consideraciones sobre la enfermedad celiaca y el desarrollo de complicaciones

We discuss the case of a 17-year-old male who at the age of 7 was diagnosed with celiac disease (CD) together with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC). The patient was treated with gluten-free diet and immunosuppressive drugs (azathioprine), and currently remains asymptomatic. The patient’s younger, 12-year-old sister was diagnosed with CD when she was 1.5 years old, and at 7 years she developed type-I diabetes mellitus, which was difficult to control. A family study was made, and both parents were found to be affected with silent CD. All were DQ2 (+). In relation to the case ;;and family study, we provide a series of comments related to CD and its complications

Celiac disease (CD), ulcerative colitis (UC), and primary sclerosing cholangitis (PSC) in one patient: a family study.

We discuss the case of a 17-year-old male who at the age of 7 was diagnosed with celiac disease (CD) together with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC). The patient was treated with gluten-free diet and immunosuppressive drugs (azathioprine), and currently remains asymptomatic. The patient's younger, 12-year-old sister was diagnosed with CD when she was 1.5 years old, and at 7 years she developed type-I diabetes mellitus, which was difficult to control. A family study was made, and both parents were found to be affected with silent CD. All were DQ2 (+). In relation to the case and family study, we provide a series of comments related to CD and its complications.

Diverse clinical presentations of celiac disease in the same family.

We performed a family study to evaluate a total of 34 extended family members (8 siblings, 23 children and nephews, and 3 grandchildren) of an adult patient with celiac disease (CD), a 58- year-old male with severe neurologic involvement manifested as myoclonias. We found 3 other members affected with CD (a 44-year old sister, a 39-year old niece, and a 26-year old nephew). Two of them were completely asymptomatic and all had hypertransaminasemia. All exhibited a villous atrophy pattern of the duodenal mucosa (1 mild, 1 moderate, 1 severe). Overall family involvement was 11.8% (4/14). We wish to emphasize the need to perform extended family studies when diagnosing a case of CD, since risk is not restricted to only first-degree relatives.

A population-based study on the incidence of inflammatory bowel disease in Oviedo (Northern Spain).

OBJECTIVE: to assess the incidence of inflammatory bowel disease in Oviedo (Northern Spain), and to describe the clinical features of new patients. PATIENTS AND METHODS: a prospective population-based study was made at the Health Area IV, Principality of Asturias (Oviedo, 312,324 inhabitants). All new diagnosed patients with inflammatory bowel disease were registered over a 2-year period. RESULTS: a total of 85 patients were included, 47 of these with ulcerative colitis (UC), 37 with Crohns disease (CD), and 1 with undetermined colitis. The overall adjusted incidence rate of UC and CD per 105 inhabitants between 15-64 years was 9.1 (95% CI: 5-13.1) and 7.5 (95% CI: 3.8-11.2), respectively. The global male/female ratio was 0.9, without significant differences between both diseases. CD patients were younger than those with UC (33 +/- 15 years vs 45 +/- 20 years; p < 0.05). Mostly, CD patients were diagnosed at an age younger than 35 years (65%), while UC patients were diagnosed at an age between 25 and 64 years (81%). Disease extension in UC was proctitis in 11%, left-side colitis in 53% and extensive colitis in 36%. With respect to CD, the ileo-colonic form predominated (49%), followed by the ileal (40%) and colonic (11%) forms; an inflammatory, stenotic and fistulous pattern was seen in 54, 22 and 24% of patients, respectively. CONCLUSIONS: in our area, the incidence of CD is similar to that in other Northern European countries, while UC has a lower incidence. CD mainly affects young people, while UC predominates in middle-aged patients. At diagnosis, UC is predominantly localized, the ileo-colonic form and an inflammatory pattern being most frequent in CD patients.

MHC class I chain related gene A (MICA) modulates the development of coeliac disease in patients with the high risk heterodimer DQA1*0501/DQB1*0201.

BACKGROUND AND AIMS: Coeliac disease (CD) is an enteropathic disorder characterised by a strong association with major histocompatibility complex (MHC) heterodimer HLA-DQ2. It has been suggested that other HLA class I genes in combination with DQ may also contribute to CD susceptibility. The aim of this study was to investigate whether other candidate genes modify the risk of developing different clinical forms of CD. PATIENTS AND METHODS: We studied 133 Spanish coeliac patients, divided according to their clinical presentation into typical and atypical groups, and 116 healthy controls. All were typed by polymerase chain reaction-sequence specific primers (PCR-SSP) at HLA-B, DRB1, DQA1, and DQB1 loci and for exon 5 of the MHC class I chain related gene A (MICA). RESULTS: No differences were found in the frequency of the DQA1*0501/DQB1*0201 heterodimer in either group. The risk of typical CD was significantly associated with the DR7/DQ2 haplotype (p(c)=0.02, odds ratio (OR)=3.4, ethiological fraction (EF)=0.4). Extended haplotype (EH) 8.1 (B8/DR3/DQ2) was found to be overrepresented in the atypical form compared with the typical form (p(c)=0.001, OR=4.19, EF=0.56). The trinucleotide repeat polymorphism MICA-A5.1 was found to be increased in the atypical group of patients compared with the typical group (p(c)=0.00006, OR=8.63, EF=0.81). This association was independent of linkage disequilibrium with EH8.1 as this was also found to be increased in EH8.1 negative atypical patients compared with the typical group (p(c)=0.004, OR=6.66, EF=0.56). CONCLUSIONS: Our results showed that the risk of developing typical forms of CD was associated with DR7/DQ2 haplotype, and the presence of B8/DR3/DQ2 was significantly increased in atypical patients. In these, the MICA-A5.1 allele confers an additive effect to the DR3/DQ2 haplotype that may modulate the development of CD.