Capsule endoscopy in the diagnosis of small bowel disease

Capsule endoscopy (CE) is a method for examining the small bowel by means of an ingested encapsulated video camera, propelled by peristalsis, to continuously take images during its passage through the gastrointestinal tract. The method has been in clinical use in Sweden since 2002 and is considered user-friendly and well tolerable by patients. CE is used to diagnose obscure small-bowel bleeding, Crohn´s disease (CD) and suspected small-bowel tumors. It is known for having a high sensitivity but a lower specificity. In study I CE was performed in 18 patients with chronic intestinal dysmotility (CID), in which a high frequency of mucosal breaks (89%) was observed. There were signs of motility disturbances but the small-bowel transit time did not differ significantly between the two types of CID or to a control group. This was the first study to use CE in CID patients. CE was shown to be feasible for the examination of small bowel mucosa in patients with CID. When CE is used to find a bleeding source in the small bowel, the most common finding are vascular malformations; angioectasias. These can also be found in non-bleeding patients but what triggers bleeding in some patients is not fully understood. In study II a group of 25 patients with bleeding from gastrointestinal angioectasias were tested for bleeding disorders with special focus on acquired von Willebrand syndrome (AVWS), a condition previously identified as a possible explanation for bleeding. Compared to a control group, no significant differences between groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels. These results did not support the need for routine bleeding tests in cases of bleeding from angioectasias and do not demonstrate an overall increased risk of AVWS among these patients. Inflammatory lesions in the small bowel showed by CE may be due to CD but also to other conditions. Since biopsies from the small bowel might be difficult to obtain the relevance of the lesions may remain unclear. In study III 30 patients with small bowel lesions were tested for inflammatory markers in blood (CRP) and faeces (calprotectin). Harvey-Bradshaw Index (HBI) was used to grade patient symptoms. The patients were followed up after nine months with a second capsule endoscopy, CRP, calprotectin and HBI. A significant correlation was found between endoscopic inflammation and calprotectin that persisted over time. A correlation between endoscopic inflammation and CRP was found at inclusion but did not persist at follow up. Symptoms did not correlate with endoscopic findings of inflammation at any time. Study IV aimed to evaluate complications of capsule endoscopy, specifically incomplete examinations and capsule retention and to determine the risk factors for these. In this consecutive study 2300 CE examinations - performed at four different hospitals in Stockholm, Sweden from 2003 to 2009 - were included. The frequency of incomplete examinations was 20%. Older age, male gender and suspected or known CD were risk factors for an incomplete examination. Capsule retention occurred in 1.3%. Risk factors for capsule retention were known CD and a suspected tumor. CE was concluded to be an overall safe procedure, although obstructive symptoms and serious complications due to capsule retention can be found in large patient series

Capsule Retentions and Incomplete Capsule Endoscopy Examinations: An Analysis of 2300 Examinations

Aim. To evaluate capsule endoscopy in terms of incomplete examinations and capsule retentions and to find risk factors for these events. Material and Methods. This retrospective and consecutive study includes data from 2300 capsule enteroscopy examinations, performed at four different hospitals in Stockholm, Sweden from 2003 to 2009. Results. The frequency of incomplete examinations was 20%. Older age, male gender, suspected, and known Crohn's disease were risk factors for an incomplete examination. The PillCam capsule had the highest rate of completed examinations. Capsule retention occurred in 1.3% (n = 31). Risk factors for capsule retention were known Crohn's disease and suspected tumor. Complications of capsule retention were acute obstructive symptoms in six patients and one death related to complications after acute surgical capsule retrieval. Conclusion: Capsule endoscopy is considered a safe procedure, although obstructive symptoms and serious complications due to capsule retention can be found in a large series of patients

CD49a Expression Defines Tissue-Resident CD8+ T Cells Poised for Cytotoxic Function in Human Skin

Tissue-resident memory T (Trm) cells form a heterogeneous population that provides localized protection against pathogens. Here, we identify CD49a as a marker that differentiates CD8(+) Trm cells on a compartmental and functional basis. In human skin epithelia, CD8(+)CD49a(+) Trm cells produced interferon-γ, whereas CD8(+)CD49a(−) Trm cells produced interleukin-17 (IL-17). In addition, CD8(+)CD49a(+) Trm cells from healthy skin rapidly induced the expression of the effector molecules perforin and granzyme B when stimulated with IL-15, thereby promoting a strong cytotoxic response. In skin from patients with vitiligo, where melanocytes are eradicated locally, CD8(+)CD49a(+) Trm cells that constitutively expressed perforin and granzyme B accumulated both in the epidermis and dermis. Conversely, CD8(+)CD49a(–) Trm cells from psoriasis lesions predominantly generated IL-17 responses that promote local inflammation in this skin disease. Overall, CD49a expression delineates CD8(+) Trm cell specialization in human epithelial barriers and correlates with the effector cell balance found in distinct inflammatory skin diseases

Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study

n/aOriginal Publication:Charlotte M Hoog, Olle Brostrom, Tomas Lindahl, Andreas Hillarp, Gerd Larfars and Urban Sjoqvist, Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study, 2010, BMC GASTROENTEROLOGY, (10), 113.http://dx.doi.org/10.1186/1471-230X-10-113Licensee: BioMed Centralhttp://www.biomedcentral.com

Systemic Chemokine Levels with “Gut-Specific” Vedolizumab in Patients with Inflammatory Bowel Disease—A Pilot Study

Vedolizumab, a gut-specific biological treatment for inflammatory bowel disease (IBD), is an antibody that binds to the α4β7 integrin and blocks T-cell migration into intestinal mucosa. We aimed to investigate chemokine levels in serum of IBD-patients treated with vedolizumab. In this pilot study, we included 11 IBD patients (8 Crohn’s disease, 3 ulcerative colitis) previously non-respondent to anti-tumor necrosis factor (TNF)-agents. Patients received vedolizumab at week 0, 2 and 6 and were evaluated for clinical efficacy at week 10. Clinical characteristics and routine laboratory parameters were obtained and patients were classified as responders or non-responders. Expression of 21 chemokines in serum was measured using Proximity Extension Assay and related to clinical outcome. At week 10, 6 out of 11 patients had clinically responded. Overall expression of CCL13 increased after treatment. In non-responders, expression of CCL13 and CXCL8 increased after treatment, and CCL20 and CXCL1 expressions were higher compared to responders. In responders, CCL28 decreased after treatment. C-reactive protein (CRP) correlated negatively with 6 chemokines before therapy, but not after therapy. Systemic CCL13 expression increases in IBD-patients after vedolizumab therapy and several chemokine levels differ between responders and non-responders. An increased CCL13-level when starting vedolizumab treatment, might indicate potential prognostic value of measuring chemokine levels when starting therapy with vedolizumab. This study provides new information on modulation of systemic chemokine levels after vedolizumab treatment

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Bleeding from gastrointestinal angioectasias is not related to bleeding disorders -a case control study Hoog, Charlotte M.; Brostrom, Olle; Lindahl, Tomas L.; Hillarp, Andreas; Larfars, Gerd; Sjoqvist, Urban General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 07. Oct. 2016 R E S E A R C H A R T I C L E Open Access Bleeding from gastrointestinal angioectasias is not related to bleeding disorders -a case control study Abstract Background: Angioectasias in the gastrointestinal tract can be found in up to 3% of the population. They are typically asymptomatic but may sometimes result in severe bleeding. The reasons for why some patients bleed from their angioectasias are not fully understood but it has been reported that it may be explained by an acquired von Willebrand syndrome (AVWS). This condition has similar laboratory findings to congenital von Willebrand disease with selective loss of large von Willebrand multimers. The aim of this study was to find out if AVWS or any other bleeding disorder was more common in patients with bleeding from angioectasias than in a control group. Methods: We compared bleeding tests and coagulation parameters, including von Willebrand multimers, from a group of 23 patients with anemia caused by bleeding from angioectasias, with the results from a control group lacking angioectasias. Results: No significant differences between the two groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels. Conclusion: These results do not support a need for routine bleeding tests in cases of bleeding from angioectasias and do not show an overall increased risk of AVWS among these patients

RESEARCH ARTICLE Open Access

from gastrointestinal angioectasias is not related to bleeding disorders- a case control stud