Extraintestinal manifestations in a large series of Italian inflammatory bowel disease patients

AIM:To investigate prevalence,type and time of onset of extraintestinal manifestations(EIMs)in a series of Italian inflammatory bowel disease(IBD)patients.METHODS:Data of 811 IBD consecutive patients,first referred to our Centre from 2000 to 2011,were retrospectively evaluated.RESULTS:Eight hundred and eleven IBD patients(437M,374 F)were studied:595 ulcerative colitis(UC)(73.4%)and 216 Crohn’s disease(CD)(26.6%).Among these,329(40.6%)showed EIMs:210 UC(35.3%)and119 CD(55.1%)(P<0.0001).Considering the time of the diagnosis of IBD,37 EIMs(11.2%)were developed before,229(69.6%)after and 63(19.2%)were simultaneous.The type of EIM were as follows:240 musculoskeletal(29.6%),in 72 CD patients and in 168 UC(P<0.0001);47 mucocutaneous(5.8%),in 26 CD and in21 UC(P=0.0049);26 ocular(3.2%),in 16 CD and in10 UC(CD 7.4%vs UC 1.7%,P=0.0093);6 hepatobiliary(0.8%);10 endocrinological(1.2%).In particular,with regards to the involvement of the musculoskeletal system,arthritis Type 1 was found in 41 CD(19%)and in 61 UC(10.2%)(P=0.0012)and Type 2 in 25 CD(11.6%)and in 100 UC(16.8%)(P=0.0012).CONCLUSION:Mucocutaneous manifestations,arthritis Type 1 and uveitis were significantly more frequent in CD than UC.The complications of the musculoskeletal system were the mostly observed ones,often with symptoms more severe than intestinal ones,confirming the need for close cooperation with rheumatologists.

Hydrogen breath test for the diagnosis of lactose intolerance,is the routine sugar load the best one?

AIM: To evaluate the prevalence of lactose intolerance (LI) following a load of 12.5 g in patients diagnosed as high-grade malabsorbers using the hydrogen breath test (HBT)-25.METHODS: Ninety patients showing high-grade malabsorption at HBT-25 were submitted to a second HBT with a lactose load of 12.5 g.Peak hydrogen production,area under the curve of hydrogen excretion and occurrence of symptoms were recorded.RESULTS: Only 16 patients (17.77%) with positive HBT-25 proved positive at HBT-12.5.Hydrogen production was lower as compared to HBT-25 (peak value 21.55 parts per million (ppm) ± 29.54 SD vs 99.43 ppm ± 40.01 SD; P < 0.001).Symptoms were present in only 13 patients.The absence of symptoms during the high-dose test has a high negative predictive value (0.84) for a negative low-dose test.The presence of symptoms during the first test was not useful for predicting a positive low-dose test (positive predictive value 0.06-0.31).CONCLUSION: Most patients with a positive HBT-25 normally absorb a lower dose of lactose and a strict lactose restriction on the basis of a "standard" HBT is,in most instances,unnecessary.Thus,the 25 g lactose tolerance test should probably be substituted by the 12.5 g test in the diagnosis of LI,and in providing dietary guidelines to patients with suspected lactose malabsorption/intolerance.

Predictive factors of clinical response in steroid-refractory ulcerative colitis treated with granulocyte-monocyte apheresis

AIM:To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA). METHODS:Sixty-nine ulcerative colitis patients (39 F,30 M) dependent upon/refractory to steroids were treated with GMA. Steroid dependency,clinical activity index (CAI),C reactive protein (CRP) level,erythrocyte sedimentation rate (ESR),values at baseline,use of immunosuppressant,duration of disease,and age and extent of disease were considered for statistical analysis as predictive factors of clinical response. Univariate and multivariate logistic regression models were used. RESULTS:In the univariate analysis,CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission. In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390,95% Confidence interval (CI):0.176-0.865,Wald 5.361,P = 0.0160] and low CAI levels at baseline (4 < CAI <7) (OR = 0.770,95% CI:0.425-1.394,Wald 3.747,P = 0.028) proved to be effective as factors predicting clinical response. CONCLUSION:GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.