[Granulocytapheresis in inflammatory bowel disease. Efficacy of an induction plus maintenance sessions protocol at 32 weeks]. / Granulocitoaféresis en la enfermedad inflamatoria intestinal. Eficacia a 32 semanas con protocolo de inducción y sesiones de mantenimiento.

INTRODUCTION: Granulocytapheresis (GCAP) eliminates activated granulocytes-monocytes from peripheral blood, thus modifying the circulating pool of leukocytes and reducing intestinal inflammation. OBJECTIVE: To evaluate the efficacy of GCAP in inflammatory bowel disease (IBD) using an induction and maintenance protocol. MATERIAL AND METHOD: A retrospective study including patients with active corticosteroid-dependent or refractory IBD. Induction included 5 sessions in ulcerative colitis (UC) and 7 sessions in Crohn's disease (CD); one monthly session was used thereafter until week 32. Clinical activity indices and use of corticosteroids were monitored. RESULTS: Eighteen patients were included (10 with UC, 8 with CD), 10 of them dependent on and 8 refractory to corticosteroids. Fourteen of them were refractory and a further 4 were intolerant to immunosuppressants (IS). Induction was not completed in 2 UC (severe relapses) and 1 CD (side-effects) patients. One UC and 3 CD patients withdrew during maintenance. Among patients who completed induction, response or remission was achieved in 87.5% of UC cases (2 and 5 patients) and 71.4% of CD cases (1 and 4 patients), respectively. At week 32 response-remission rates reached 75% in CU (3 and 3 patients) and 42.8% in CD (1 and 2 patients) cases, respectively. Corticosteroid withdrawal was possible in 14.2% of CD and in 62.5% of UC patients (25% in remission and 37.5% with response). There were two major side effects (thrombophlebitis and syncope). No colectomies were performed for UC patients who completed GCAP induction after a mean follow-up of 97.6 weeks (range: 72-128). CONCLUSIONS: both UC and CD respond well to GCAP induction. At 32 weeks UC patients maintain similar response-remission rates (87.5 vs. 75%), whereas almost one-third of CD patients lose response. Granolocytapheresis is an alternative, steroid-sparing treatment modality to induce and maintain remission in UC, while good patient selection and a maintenance protocol not well defined yet are needed for CD.

Thyroid function in acute pancreatitis.

OBJECTIVES: To analyze changes in the thyroid function in patients with acute pancreatitis. METHODS: Admission serum levels of triiodothyronine (T3), reverse triiodothyronine (rT3), thyroxine (T4) and thyrotropin (TSH) were determined in 20 patients with pancreatitis and 20 healthy control patients. Another group of 20 patients with upper digestive haemorrhage was included to study possible changes in the pattern of thyroid function in hemodynamic alterations. In addition, laboratory indicators of liver, renal and pancreatic functions were measured in all groups. RESULTS: Our results demonstrated low levels of T3 in 20% of patients with pancreatitis and increased rT3 levels in 75% of them. Thyrotropin was always among reference ranges and only one case presented a low level of T4. No significant alterations were detected in patients with upper digestive haemorrhage. CONCLUSIONS: These results suggest that pancreatitis may play a role in the genesis of these changes, since other factors such as diet and cellular hepatic alteration appear to have had no effect on the levels of thyroid hormones in these patients. In other studies those changes in the thyroid function can be relationed with the prognosis in acute pancreatitis.

[Comparison of the indexes of serologic activity with endoscopy in intestinal inflammatory disease]. / Comparación de los índices de actividad serológicos con la endoscopia en la enfermedad inflamatoria intestinal.

The correlation of the most commonly used clinical and serologic parameters in clinical practice were studied with an endoscopic model for inflammatory bowel disease (IBD). Eighty patients diagnosed with IBD with colic involvement (40 patients with ulcerous colitis [UC] and 40 with Crohn's disease [CD]) were prospectively studied. The CDAI was used as a clinical index of activity in the cases of CD and the True-love and Witts index was used in those with UC. The analytical parameters studied were erythrocyte sedimentation rate (ESR), hemoglobin (Hb), platelets (Th), iron (Fe), protein-C-reactive (PCR), albumin (Ab), orosomucoid (Oro), and alpha-1-antitrypsin (AAT). An excellent correlation was found in the UC in both the clinical index and serologic parameters. However, the correlation in CD was poor and only significant with iron and albumin.

Intraepithelial and lamina propria leucocyte subsets in inflammatory bowel disease: an immunohistochemical study of colon and rectal biopsy specimens.

AIMS: To gain new insights into the pathogenesis and differential diagnosis of ulcerative colitis and colonic Crohn's disease. METHODS: Immunohistochemistry for different leucocyte subsets was performed in biopsy specimens of the sigmoid colon and rectum from 55 patients with inflammatory bowel disease and 11 healthy controls. RESULTS: Colonic biopsy specimens from patients with active ulcerative colitis had significantly higher numbers of CD45+ and CD3+ leucocytes compared with those from patients with inactive disease, and higher numbers of total leucocytes and macrophages than those from patients with Crohn's disease. Rectal biopsy specimens from patients with Crohn's disease had greater numbers of intraepithelial leucocytes (CD45, CD3 and CD8 cells) than specimens from patients with active or inactive ulcerative colitis, or from healthy controls. CONCLUSIONS: Because of the phenotypic differences in the inflammatory infiltrate in the mucosa from the sigmoid colon and the rectum, the segment of the intestine to be biopsied should be specified. Assessment of the leucocytic component of the intraepithelial infiltrate in rectal biopsy specimens was more useful than examination of colonic biopsy specimens in the differential diagnosis of ulcerative colitis and Crohn's disease.

[The effect of environmental factors in inflammatory bowel disease]. / Influencia de factores ambientales en la enfermedad inflamatoria intestinal.

In an attempt to elicit risk factors in inflammatory bowel disease in Spain, we have carried out a case-control study in which we conducted personal interviews asking marital status, place of residence, economic status, use of tobacco and contraceptives, and the method of lactation in infancy. IBD was more common in patients with a low economic level; UC was predominantly found in rural population. No differences were found in the remaining categories. Our results differ from those reported from North and Central Europe.

Epidemiology of inflammatory bowel disease in the Province of Granada, Spain: a retrospective study from 1979 to 1988.

An epidemiological study of inflammatory bowel disease in the Province of Granada, Spain, was conducted between 1979 and 1988. Altogether, 257 cases were identified: 167 ulcerative colitis, 79 Crohn's disease, and 11 indeterminate colitis. The mean incidence of ulcerative colitis in the 10 year period was 2/10(5) and 0.9/10(5) for Crohn's disease. This is the first epidemiological study in Spain of the incidence of ulcerative colitis and corroborates the results of an earlier population based study on the incidence of Crohn's disease in Spain.

[Esophageal stenosis due to a dissecting intramural hematoma following the endoscopic sclerotherapy of esophageal varices]. / Estenosis esofágica por hematoma intramural disecante tras escleroterapia endoscópica de varices esofágicas.

The dissecting intramural hematoma of the esophagus (DEH) is a rare complication of endoscopic variceal sclerotherapy (EVS). We present a 37 years male with Laennec's cirrhosis who developed a submucosal hematoma with complete obstruction of the esophagus 24 h. after the second session of EVS diagnosed by endoscopy. After conservative treatment the patient recovered well with complete resolution of the lesion. The review of the literature shows no correlation between DEH and type or volume of sclerosant, site of injection or previous number of sessions. Unknown in children. Most of these patients had abnormal hemostasis. We have performed EVS in 227 patients (879 sessions), with only a case of DEH (rate 0.13%). In this case the bad tolerance and movements during of EVS were very important.