Celiac Sprue and Abdominal Lymphoma: Studies on the Cell-Mediated Immune Response of Peripheral Blood Lymphocytes

The development of primary abdominal lymphoma is a recognized complication of gluten-sensitive enteropathy (GSE). ln five patients with GSE plus lymphoma, the distribution and function of peripheral blood lymphocytes were determined and compared with 13 patients with GSE without lymphoma and with 28 normal control subjects. The percentage of T cells was lower in patients with GSE and GSE with lymphoma than in controls, whereas patients with GSE plus lymphoma had a significantly increased number of peripheral blood B lymphocytes when compared with GSE patients or controls. There was no difference in K cell activity or lymphocyte responses to mitogens and antigens between controls, GSE or GSE plus lymphoma patients. Prospective studies are needed in patients with GSE co investigate whether this fall in peripheral blood T cells and rise in B lymphocytes is a marker of concurrent lymphoma

Economic Impact of Inflammatory Bowel Disease in Alberta

This paper attempts to estimate the cost of inflammatory bowel disease (IBO) to the health care system of Alberta. In the 1015 patients responding to a questionnaire, two types of direct costs were compared to provincial averages; physicians' fees and hospital costs. Costs were calculated using the Alberta Health Care Insurance Plan prescribed billing races. The 15-to 24-year-old age group exhibited the highest annual physician fees. This was probably due to the high incidence rate of IBD in this group. The mean cost per patient-year for Crohn's disease was estimated to be $4400 and the mean cost for ulcerative colitis was estimated to be$3020; this did not include outpatient laboratory or radiological investigations, and as such represents an underestimation of the total costs to the health care system. However, only a small minority of the patients were using a large majority of the resources: for example, for both Crohn's and ulcerative colitis, 7% of the patients accounted for 69% of hospital days. The average hospital and physician associated costs declined markedly with duration of the disease. It is estimated that the future cost of IBO to the provincial health care system (the percentage of the provincial health care budget used to diagnose and treat IBO) will double from 1985 to 2000. This underscores the need for continued and expanded research into the cause and treatment of IBO, and the importance of maintaining a health care system which can respond to the needs of these patients

Disorders of Mineral and Bone Metabolism in Patients with Crohn's Disease

Crohn's disease is known to produce malabsorption of calcium and vitamin D which affect the skeleton. A variety of techniques were used to assess the prevalence of mineral and bone abnormalities in 53 consecutive patients with Crohn's disease. Twenty healthy controls were compared with 28 men and 25 women with Crohn's disease. In males, the mean corrected serum calcium concentration was elevated, the mean winter plasma 25-hydroxyvitamin D was low, as was the bone volume on biopsy and the fractional absorption of {7Ca. In females, the corrected serum calcium was also higher than in controls, as was the serum alkaline phosphatase activity. The female patients had significant decreases in both summer and winter plasma vitamin D levels, metacarpal cortical thickness and fractional absorption of 47Ca. The disturbances in bone and mineral metabolism were generally mild and were not associated with use of glucocorticosteroids but were more severe in patients with a history of bowel resection. Thus, patients with Crohn's disease are at risk of developing metabolic bone disease and consideration should be given for an assessment of the skeleton in patients with Crohn's disease. especially in women and in patients with previous ilea! resection. A battery of tests may be needed to exclude the diagnosis of metabolic bone disease but a 25-hydroxyvitamin D assay and hand x·rays using industrial grade film are recommended as a valuable preliminary assessment