Perinatal events and the risk of developing primary sclerosing cholangitis

AIM: To investigate whether perinatal events, intrauterine or postpartum, are associated with the development of primary sclerosing cholangitis (PSC) later in life. METHODS: Birth records from 97 patients with adult PSC in Sweden were reviewed. Information on perinatal events including medications and complications during pregnancy, gestation length, birth weight and length were collected. Two control children of the same sex were selected for each subject. Conditional multiple logistic regression was used to assess associations of the perinatal measures with development of PSC. RESULTS: No significant associations were found between gestational age, birth length, breastfeeding, and the majority of medical complications including infections or medication during pregnancy for the mothers or postpartum for the children. Vaginal bleeding and peripheral oedema showed associations with PSC, with matched odds ratios of 5.70 (95% CI, 1.13-28.83) and 2.28 (95% CI, 1.04-5.03), respectively. CONCLUSION: The associations of vaginal bleeding and oedema with subsequent PSC cannot readily beexplained, so our fi ndings do not strongly support the hypothesis of a signifi cant role of perinatal events as a risk for the development of PSC later in life.

Rectal nitric oxide as biomarker in the treatment of inflammatory bowel disease: Responders versus nonresponders

AIM： To explore rectal nitric oxide （NO） as biomarker of treatment response in ulcerative colitis （UC） and Crohn＇s disease （CD）, and examine relationships between rectal NO, mucosal expression of NO synthases （NOS）, and pro-inflammatory cytokines. METHODS： Twenty-two patients with UC and 24 with CD were monitored during steroid treatment. Rectal NO levels were measured and clinical activities were assessed on days 1, 3, 7 and 28. Mucosal presence of NOS and pro-inflammatory cytokines were analyzed by immunohistochemistry and RT-PCR. RESULTS： Active UC and CD displayed markedly increased rectal NO levels （10950 ± 7610 and 5 040 ± 1 280 parts per billion （ppb）, respectively） as compared with the controls （154 ± 71 ppb, P 〈 0.001）. Rectal NO correlated weakly with disease activity in both UC and CD （r = 0.34 for UC and r = 0.48 for CD, P 〈 0.01）. In 12 patients, a steroid-refractory course led to colectomy. These patients had only slightly increased NO levels （UC： 620 ± 270 ppb; CD： 1260 ± 550 ppb） compared to those with a therapeutic response （UC： 18860 ± 530 ppb, P 〈 0.001, CD： 10060 ± 3200 ppb, P 〈 0.05）. CONCLUSION： Rectal NO level is a useful biomarker of treatment response in IBD as low NO levels predicts a poor clinical response to steroid treatment.

Alcohol consumption in patients with primary sclerosing cholangitis

AIM:To assess the alcohol drinking patterns in a cohort of primary sclerosing cholangitis(PSC) patients and the possible influence on the development of fibrosis.METHODS:Ninety-six patients with PSC were evaluated with a validated questionnaire about a patient's lifetime drinking habits:the lifetime drinking history(LDH) questionnaire.In addition,clinical status,transient elastography and biochemistry values were analysed and registered.Patients were defined as having either significant or non-significant fibrosis.Significant fibrosis was defined as either an elastography value of ≥ 17.3 kPa or the presence of clinical signs of cirrhosis.Patients were divided into two groups depending on their alcohol consumption patterns;no/low alcohol consumption(one drink or unit/d) and moderate/high alcohol consumption(≥ 1 drink or unit/d).LDH data were calculated to estimate lifetime alcohol intake(LAI),current alcohol intake,drinks per year before and after diagnosis of PSC.We also calculated the number of episodes of binge-drinking(defined as consuming ≥ 5 drinks per occasion) in total,before and after the diagnosis of PSC.RESULTS:The mean LAI was 3882 units of alcohol,giving a mean intake after onset of alcohol consumption of 2.6 units per week.Only 9% of patients consumed alcohol equal to or more than one unit per day.Current alcohol intake in patients with significant fibrosis(n = 26) was less than in patients without significant fibrosis(n = 70),as shown by lower values of phosphatidylethanol(B-PEth)(0.1 mol/L vs 0.33 mol/L,respectively,P = 0.002) and carbohydrate-deficient transferrin(CDT)(0.88% vs 1.06%,respectively,P = 0.02).Self-reported LAI was similar between the two groups.Patients with significant fibrosis reduced their alcohol intake after diagnosis from 103 to 88 units per year whereas patients without fibrosis increased their alcohol intake after PSC diagnosis from 111 to 151 units/year.There were no correlations between elastography values and intake of alcohol(units/year)(r =-0.036).CONCLUSION:PSC patients have low alcohol consumption.The lack of correlation between fibrosis and alcohol intake indicates that a low alcohol intake is safe in these patients.