6 research outputs found
Eicosanoids, endotoxins and liver disease
Endotoxins are cell wall lipopolysacharides of gram negative
bacteria. The gut contains large numbers of bacteria and is
generally accepted to be a large reservoir of endotoxins. In the
normal state absorbed endotoxins are rapidly removed from the portal
blood by especially the reticulo-endothelial cells of the liver. In
patients with liver disease there is a diminished function of the
reticulo-endothelial system, resulting in a raised frequency of
systemic endotoxemia. Systemic endotoxemia in liver disease, as
measured by the Limulus lysate test, correlates with a higher
frequency of clotting disorders, renal failure and a high mortality
rat
Severe hypokalaemic paralysis and rhabdomyolysis due to ingestion of liquorice
Chronic ingestion of liquorice induces a syndrome with findings similar to
those in primary hyperaldosteronism. We describe a patient who, with a
plasma K+ of 1.8 mmol/l, showed a paralysis and severe rhabdomyolysis
after the habitual consumption of natural liquorice. Liquorice has become
widely available as a flavouring agent in foods and drugs. It is important
for physicians to keep liquorice consumption in mind as a cause for
hypokalaemic paralysis and rhabdomyolysis
Computerisation of endoscopy reports using standard reports and text blocks
BACKGROUND: The widespread use of gastrointestinal endoscopy for diagnosis
and treatment requires effective, standardised report systems. This need
is further increased by the limited storage of images, and by the need for
structured databases for surveillance and epidemiology. We therefore aimed
for a report system which would be quick, easy to learn, and suitable for
use in busy daily practice. METHODS: Endobase III is an endoscopy
information system offering three different ways of report writing, i.e.
standard reports, text blocks and Minimal Standard Terminology (MST). A
working group of two university and four general hospitals worked as a
reference group for the development of standard reports and text blocks.
Guidelines from various gastrointestinal endoscopy societies were followed
to compose the reports. RESULTS: Standard reports were based on a list of
distinct diagnoses; text blocks were based on anatomic landmarks and
individual procedures. As such, 316 standard reports were developed for
upper and lower gastrointestinal endoscopy, and endoscopic retrograde
cholangiopancreatography (ERCP). In this way selecting one diagnosis
produces a complete report. A total of 1571 different text blocks were
additionally developed for each part of the gastrointestinal tract and for
procedures during endoscopy. This module allowed generation of a full
report on the combination of text blocks. Reports could be composed and
printed within two minutes for 90% of cases. CONCLUSION: Standard reports
and text blocks are a quick, user-friendly way of report writing accepted
and used by a number of gastroenterologists in the Netherlands
B-cell dysregulation in Crohn's disease is partially restored with infliximab therapy
Background: B-cell depletion can improve a variety of chronic inflammatory diseases, but does not appear beneficial for patients with Crohn's disease. Objective: To elucidate the involvement of B cells in Crohn's disease, we here performed an 'in depth' analysis of intestinal and blood B-cells in this chronic inflammatory disease. Methods: Patients with Crohn's disease were recruited to study B-cell infiltrates in intestinal biopsies (n = 5), serum immunoglobulin levels and the phenotype and molecular characteristics of blood B-cell subsets (n = 21). The effects of infliximab treatment were studied in 9 patients. Results: Granulomatous tissue showed infiltrates of B lymphocytes rather than Ig-secreting plasma cells. Circulating transitional B cells and CD21low B cells were elevated. IgM memory B cells were reduced and natural effector cells showed decreased replication histories and somatic hypermutation (SHM) levels. In contrast, IgG and IgA memory B cells were normally present and their Ig gene transcripts carried increased SHM levels. The numbers of transitional and natural effector cells were normal in patients who responded clinically well to infliximab. Conclusions: B cells in patients with Crohn's disease showed signs of chronic stimulation with localization to granulomatous tissue and increased molecular maturation of IgA and IgG. Therapy with TNFα-blockers restored the defect in IgM memory B-cell generation and normalized transitional B-cell levels, making these subsets candidate markers for treatment monitoring. Together, these results suggest a chronic, aberrant B-cell response in patients with Crohn's disease, which could be targeted with new therapeutics that specifically regulate B-cell function
Phenotype of inflammatory bowel disease at diagnosis in the Netherlands: A population-based inception cohort study (the Delta Cohort)
Background: To describe the clinical characteristics of inflammatory bowel disease (IBD) at diagnosis in Netherlands at the population level in the era of biologics. Methods: All patients with newly diagnosed IBD (diagnosis made between January 1, 2006 and January 1, 2007) followed in 9 general hospitals in the southwest of the Netherlands were included in this population-based inception cohort study. Results: A total of 413 patients were enrolled, of which 201 Crohn's disease (CD) (48.7%), 188 ulcerative colitis (UC) (45.5%), and 24 IBD unclassified (5.8%), with a median age of 38 years (range, 14-95). Seventy-eight patients with CD (38.8%) had ileocolonic disease and 73 patients (36.3%) had pure colonic disease. In 8 patients (4.0%), the upper gastrointestinal tract was involved. Nineteen patients with CD (9.5%) had perianal disease. Thirty-nine patients with CD (19.4%) had stricturing phenotype. Of the patients with UC and IBDU, 39 (18.4%) suffered from pancolitis and 61 (29%) from proctitis. Severe endoscopic lesions at diagnosis were seen in 119 patients (28.8%, 68 CD, 49 UC, and 2 IBDU), whereas 98 patients (23.7%) had severe histological disease activity. Thirteen patients (3.1%, 10 CD and 3 UC) had extraintestinal manifestations at diagnosis. Twenty-three patients (5.6%, 20 CD and 3 UC) had fistula at diagnosis. Conclusions: In this cohort, 31% of the patients with CD had complicated disease at diagnosis, 39% had ileocolonic disease, 9.5% had perianal disease, and in 4% the upper gastrointestinal tract was involved. Most patients with UC suffered from left-sided colitis (51%). Severe endoscopic lesions were reported in 34% of the patients with CD and 26% of the patients with UC. Three percent of the patients with IBD had extraintestinal manifestations. Copyrigh
Benefit of earlier anti-TNF treatment on IBD disease complications?
Background: Anti-tumour necrosis factor [anti-TNF] treatment was demonstrated to have disease-modifying abilities in inflammatory bowel disease [IBD]. In this study, we aimed to determine the effect of anti-TNF treatment timing on IBD disease complications and mucosal healing [MH]. Methods: The following IBD-related complications were tested in relation to timing of anti-TNF therapy start in newly diagnosed IBD patients [n = 413]: Fistula formation, abscess formation, extra-intestinal manifestations [EIM], surgery, referral to academic centre, and MH. Results: A total of 85 patients [21%] received anti-TNF (66 Crohn's disease [CD], 16 ulcerative colitis [UC], 3 inflammatory bowel disease unclassified [IBDU]) of whom 57% [48 patients] were treated 16 months] regarding gender, age, smoking status, and familial IBD. More importantly, patients receiving anti-TNF early did not suffer less IBD-related complications during follow-up as compared with patients started on anti-TNF late, nor was more MH observed. Similar results were obtained when anti-TNF treated patient were stratified more stringently, ie 2 4 months [24 patients]. Cox regression analysis showed no beneficial correlations between anti-TNF timing and IBD-related complications. Anti-TNF treated patients achieving MH were 11 times less likely to develop EIMs compared with patients who did not achieved MH while on anti-TNF. Conclusions: This study was unable to confirm a benefit of earlier anti-TNF treatment on IBD disease complications. This could be explained by more aggressive treatment earlier in disease, resulting in fewer IBD complications. However, it seems more likely that inappropriate selection of patients for therapy leads to suboptimal treatment and subsequently suboptimal outcome