Presence Of Inflammatory Activity Research Articles

P289 Evaluation of the safety and effectiveness of direct-acting antiviral drugs in the treatment of hepatitis C in patients with inflammatory bowel disease: National multicenter study (ENEIDA registry). MIC project

Abstract Background The prevalence of hepatitis C virus infection (HCV) in patients with inflammatory bowel disease (IBD) ranges from 1–6%. Direct-acting antivirals (DAAs), with cure rates >90%, represent a radical change from interferon-based therapies. The ECCO guidelines (Kucharzik JCC 2021) warns about the risk of IBD reactivation due to the effect of DAAs, but HCV management in this situation is uncertain given the lack of evidence. AIMS: To evaluate: 1) Effectiveness and safety of DAAs in IBD; 2) Interaction of DAAs with IBD drugs, particularly immunosuppressants and/or biologics. Methods Multicenter retrospective study of patients with IBD and HCV treated with DAAs identified on the ENEIDA registry (January 2011-February 2021). Variables evaluated: age, gender, location, extent, phenotype and activity of IBD, treatments, anti-HCV and viral load, DAA treatment and duration, fibrosis and hepatic decompensations, adverse effects (AE) and interactions. Results We included 79 patients with IBD and HCV treated with DAAs (47 sofosbuvir, 28 ledipasvir, 7 daclatasvir, 8 velpatasvir, 1 simeprevir, 16 paritaprevir+ritonavir+ombitasvir, 14 dasabuvir, 3 grazoprevir+elbasvir, 13 glecaprevir+pibrentasvir). Clinical and demographic characteristics: mean age (years) 54+/-12.66SD; 62% male, 77.2% genotype 1, 32.6% advanced fibrosis (none Child B-C). A 78.5% (n=62) received IBD treatment (39 salicylates, 20 azathioprine, 1 methotrexate, 4 corticosteroids, 10 antiTNF, 2 vedolizumab, 2 ustekinumab, 1 apheresis). A 17.7% (n=14) had active IBD (64.3% remained unchanged, 21.4% improved and 14.3% worsened) and 82.3% (n=65) were inactive at the onset of ADD. Of these, 9.2% (n=6) developed mild-moderate activity (4 mild and 2 moderate). In 85% (n=67) no treatment changes were made, in 9% (n=7) it was intensified and in 6% (n=5) it was de-intensified. Adherence to DAAs and sustained virologic response was obtained in 96.2% (n=76). A total of 7 (8.9%) AE were notified, of which 5 were possibly/probably related to DAAs (100% mild) and 2 were unrelated (1 azathioprine withdrawal due to pancytopenia). The AE were unrelated with the presence of inflammatory activity, type of IBD, liver fibrosis, use of immunosuppressants, biologics, or with any DAA regimen. Conclusion This is the first reported series of IBD patients infected with HCV and treated with DAAs, we showed that DAA are effective and safe. They do not trigger IBD flare-ups, nor have more AE than in patients without IBD. Moreover, they do not have clinically significant pharmacological interactions with immunosuppressants and/or biologics. Thus, the eradication of HCV with DAA in IBD patients must be the same of the HCV infected patients without IBD, based on EASL recommendations.

P606 Adherence to endoscopic surveillance guidelines for advanced lesions and colorectal cancer in Inflammatory Bowel Disease in Spain: a collaborative study of AEG and GETECCU

Abstract Background Patients with colon Inflammatory Bowel Disease (IBD) have a higher risk of colorectal cancer (CRC) than general population. Current guidelines establish endoscopic surveillance recommendations; however, epidemiological studies show poor compliance. The main aim of our study was to analyse adherence to endoscopic surveillance guidelines. Secondary aim was to evaluate the prevalence and time-to advanced lesions or CRC. Methods Retrospective multicentre study of patients with IBD followed-up in the participating centres between 2005 and 2020, who were diagnosed of IBD between 2005 and 2008, with criteria for CRC surveillance. Patients with CRC before IBD diagnosis were excluded. The ECCO 2013–2017 guidelines were used to evaluate adherence. Adenomatous lesions with >25% of villous component, >1cm or with high-grade dysplasia or serrated lesions >1cm or with any degree of dysplasia were considered advanced lesions. Software used for all analysis was R in its 3.6.1 version. Normality was checked with the Shapiro-Wilks test. Mean comparison was carried out using t-Student test while normality assumptions held true, otherwise, Mann-Whitney test. Time-to advanced lesions or CRC event between patients that had adherence to ECCO guidelines versus those who did not was performed through Kaplan-Meier and Log-rank test. P-values below 0.05 were considered significant. Results A total of 1004 (713 Ulcerative Colitis, 252 Crohn’s disease and 39 Indeterminate Colitis; 52% male) patients from 25 centres were recruited with a median age of 36 (26–47) years. 87% of all patients were included in the endoscopic surveillance programme. The main reasons for non-inclusion were the absence of indication by the physician (38%) and the presence of inflammatory activity (37%). Adherence to the first or subsequent surveillance colonoscopies was 45% and 61%, respectively, with a total adherence rate of 32%. Prevalence of advanced lesions or CRC was 4% and 7 cases of CRC were detected. Time-to-detection of these lesions since IBD diagnosis was significantly longer in non-adherent patients (13.4 + 1.3 vs13.04 + 1.7; p<0.001). Adherence was associated to a higher detection of advanced lesions or CRC compared to non-adherent patients (HR: 1.97; IC: 1.02–3.79; p=0.043) (Figure 1). Conclusion Adherence to ECCO guidelines for endoscopic surveillance is low in this Southern European population. A higher and earlier detection of advanced lesions or CRC was identified in the adherent group. The results of this study highlight the need to improve compliance with the recommendations to obtain better outcomes.

Evaluation of Changes in Gut Microbiota in Patients with Crohn's Disease after Anti-Tnfα Treatment: Prospective Multicenter Observational Study.

Background: Crohn’s disease is believed to result from the interaction between genetic susceptibility, environmental factors and gut microbiota, leading to an aberrant immune response. The objectives of this study are to evaluate the qualitative and quantitative changes in the microbiota of patients with Crohn’s disease after six months of anti-tumor-necrosis factor (anti-TNFα) (infliximab or adalimumab) treatment and to determine whether these changes lead to the recovery of normal microbiota when compared to a control group of healthy subjects. In addition, we will evaluate the potential role of the Faecalibacterium prausnitzii/Escherichia coli and Faecalibacterium prausnitzii/Clostridium coccoides ratios as indicators of therapeutic response to anti-TNFα drugs. Methods/Design: This prospective multicenter observational study will comprise a total of 88 subjects: 44 patients with Crohn’s disease scheduled to start anti-TNFα treatment as described in the drug specifications to control the disease and 44 healthy individuals who share the same lifestyle and eating habits. The presence of inflammatory activity will be determined by the Harvey-Bradshaw index, analytical parameters in blood, including C-reactive protein, and fecal calprotectin levels at commencement of the study, at three months and at six months, allowing the classification of patients into responders and non-responders. Microbiota composition and the quantitative relationship between Faecalibacterium prausnitzii and Escherichia coli and between Faecalibacterium prausnitzii and Clostridium coccoides group as indicators of dysbiosis will be studied at inclusion and six months after initiation of treatment using ultra sequencing with Illumina technology and comparative bioinformatics analysis for the former relationship, and digital droplet PCR using stool samples for the latter. Upon inclusion, patients will complete a survey of dietary intake for the three days prior to stool collection, which will be repeated six months later in a second collection to minimize dietary bias. Discussion: In this study, massive sequencing, a reliable new tool, will be applied to identify early biomarkers of response to anti-TNF treatment in patients with Crohn’s disease to improve clinical management of these patients, reduce morbidity rates and improve efficiency.

THU0110 DIAGNOSTIC ISSUES IN DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: PRELIMINARY RESULTS OF A SYSTEMATIC LITERATURE REVIEW INFORMING THE 2020 EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS

Background:Rheumatoid arthritis (RA) patients treated according to European League Against Rheumatism (EULAR) recommendations failing ≥2 biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) with a different mode of action who still have complaints which may be suggestive of active disease may be defined as suffering from ‘difficult-to-treat RA’. Before switching to another DMARD in these patients, the diagnosis of RA and the presence of inflammatory activity should be verified to prevent possible over- and under treatment.Objectives:To systematically summarise evidence in the literature on diagnostic issues regarding (mis-)diagnosis of RA and mimicking diseases, and assessment of inflammatory disease activity in difficult-to-treat RA patients, informing the 2020 EULAR recommendations for the management of difficult-to-treat RA.Methods:A systematic literature search was performed: PubMed and Embase databases were searched up to December 2018. Relevant papers were selected and appraised (Figure 1).Results:Regarding (mis-)diagnosis of RA and its differential diagnoses, four studies were selected (Figure 1a): one assessed the diagnosis of RA and three focused on coexisting mimicking diseases (fibromyalgia and bacterial infection). No diagnostic tests were replicated. For evaluation of inflammatory activity in RA, and specifically the effect of comorbidities on assessing inflammatory activity, 63 and five studies, respectively, were included (Figure 1b). At patient level, ultrasonography (US) scores were related to composite indices (range of correlations (r): 0.25-0.70) and swollen joint counts (range r: 0.33-0.78). A multi-biomarker disease activity score (range r with composite indices: 0.41-0.52) and optical spectral transmission measures (range r with US: 0.54-0.64) were promising measures, but cut-offs are preliminary. At joint level, US was related to MRI (range of sensitivity 64-91% and specificity 60-94% for synovitis) and histology (range r: 0.52-0.65 for inflammation). Concomitant obesity and fibromyalgia may lead to overestimation of disease activity according to composite indices, US may be used to assess inflammatory activity in these patients.Conclusion:This SLR highlights the gap of knowledge in the optimal confirmation of a (mis-)diagnosis of RA or diagnosis of mimicking diseases in difficult-to-treat RA patients. Current evidence for optimal assessment of inflammatory activity when there is doubt based on clinical assessment and composite indices is limited. Most studies reported correlations which are not directly useful in clinical practice to determine presence or absence of inflammatory activity. The evidence will be updated up to December 2019. Currently, US seems the most accurate measure to evaluate the presence of inflammation in difficult-to-treat RA patients, including those with concomitant obesity or fibromyalgia.Disclosure of Interests:Nadia M. T. Roodenrijs: None declared, Melinda Kedves: None declared, Attila Hamar: None declared, György Nagy: None declared, Jacob M. van Laar Grant/research support from: MSD, Genentech, Consultant of: MSD, Roche, Pfizer, Eli Lilly, BMS, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Paco Welsing: None declared

Prevalencia de déficit de hierro sin anemia en la enfermedad inflamatoria intestinal y su impacto en la calidad de vida

IntroductionIron deficiency without anaemia (IDWA) is commonly found in outpatients with inflammatory bowel disease (IBD) in an even higher proportion than anaemia. However, its true prevalence and possible impact on health-related quality of life (HRQoL) are unknown. The objectives of this study were: to establish the prevalence of IDWA, identify possible associated factors and measure their impact on HRQoL. Material and methods127 patients with IBD in an outpatient setting were consecutively included in an observational, descriptive, cross-sectional study. IDWA was defined as ferritin levels of <100 ng/ml with inflammatory activity or ≤30 ng/ml without it, with transferrin saturation of ≤16%, and with normal haemoglobin levels. HRQoL was assessed using two questionnaires: the IBDQ-9 for symptoms related to IBD and the FACIT-F to measure the presence of fatigue. Fatigue was considered extreme with a score of ≤30 points. ResultsThe prevalence of IDWA was 37%. Variables associated with its occurrence were female gender (OR=2.9; p=.015) and the presence of inflammatory activity (OR=9.4; p=.001). Patients with IDWA presented HRQoL questionnaires with lower overall scores; decreases of 6.6 (p<.001) and 4.3 (p=.037) points in the IBDQ-9 and the FACIT-F were recorded, respectively. In addition, an increase of 29.4% in the presence of extreme fatigue was observed. ConclusionThe prevalence of IDWA is considerable in outpatients with IBD. IDWA is associated with female gender and inflammatory activity. It has a clear negative impact on HRQoL. A more active approach is needed to treat this complication.

Sarcoidosis: Follow-up With 18f-FDG PET/CT After Different Therapy

SESSION TITLE: Imaging SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The purpose of this study was to assess the utility of 18F-FDG PET/CT (PET/CT scan) for detection of inflammation in granulomatous sites and management of sarcoidosis patients with different therapy. The specific aims were to compare PET/CT scan findings with x-ray score, serum levels of chitotriosidase (CTO), serum angiotensin converting enzyme (sACE) at the time of diagnosis and at different SUV-Max activity in different organs in body and to evaluate therapies with glucocorticoid and antimicotic. METHODS: The study comprises 86 sarcoidosis patients who underwent PET/CT scan between March 2010 and April 2015, at the time of diagnosis and at the end of therapy and follow-up without therapy. The presence of inflammatory activity was assessed using PET/CT scan. Correlations between PET/CT scan findings (MaxSUV, MaxSUV in lung parenchyma, MaxSUV in lymph nodes), CTO, sACE, radiological evaluation (X-ray score) and pulmonary function at the time of diagnosis and at follow-up were calculated for all patients and separately for patients without therapy and patients receiving antifungal and/or corticosteroid therapy. RESULTS: PET/CT scan findings at the time of diagnosis MaxSUV1 10.8±1.1; MaxParenhim1 2.2±0.4; MaxLymphN1 8.3±1.1. MaxSUV1 were correlated with X-ray score-1 (r=0.369, p=0.001; with sACE (r=0.266, p=0.017) with CTO (r=0.483, p=0.000). MaxSUV2 was 6.2±1.1 in whole group without correlations with markers except X-ray score-2 (p=0.055). Correlations with MaxSUV2 were only present in the group with antifungal therapy (CTO2, r=0.509, p=0.003) and X-ray score-2 (r=0.533, p=0.001). In the group without therapy and follow-up without therapy, MaxSUV2 correlated with X-ray score-2 (r=0.567, p=0.014). No correlations were found between first and second PET/CT scan and pulmonary function tests. CONCLUSIONS: The results show that PET/CT scan is useful as a diagnostic method for detecting active inflammatory granulomatous sites at the time of diagnosis sarcoidosis, especially those with normal level of sACE and normal DLco. It is also useful to determine the spread of active disease through the body and to assist in the decision to adjust the therapy. For the follow-up the effectiveness of therapy or for evaluate the activities of the disease, only after antifungal treatment the PET/CT scan correlated with other biomarkers of the activity of sarcoidosis. PET/CT scan had different information about the activity of disease comparing the other markers of sarcoidosis. The results suggest that follow up PET/CT is not needed after antifungal therapy, as the biomarker CTO and X-ray score correlate well with SUVMAX. PET/CT scan should be considered in case of treatment with corticosteroids, if there is clinical suspicion of recurrence or progress of the disease. CLINICAL IMPLICATIONS: The utility of PET/CT scan is useful for detection of granuloma inflammation. For the follow-up is better than serum markers of inflammation. DISCLOSURE: The following authors have nothing to disclose: Marjeta Tercelj-Zorman, Nadja Koren, Kaja Šifer, Maša Bizjak, Marina Hodolić, Barbara Salobir No Product/Research Disclosure Information

Autologous hematopoietic stem cell transplantation in multiple sclerosis: 20years of experience.

Intense immunosuppression followed by autologous hematopoietic stem cell transplantation (AHSCT) has been widely used in the last 20years for the treatment of aggressive forms of autoimmune disorders, especially multiple sclerosis (MS). All clinical studies, although small and uncontrolled, demonstrate a great efficacy of this procedure in halting inflammation and disease activity, even in those patients affected by "malignant forms" of MS. The long-term follow-up has also revealed the possible maintenance of positive results in the course of time, and this evidence is supported by immunological data that suggest the possibility of a resetting of the immune system after AHSCT. The safety of AHSCT has improved in the last years, but the transplant related mortality is still nowadays of about 1-2%, pointing out that a careful selection of patients to submit to AHSCT is mandatory. The long clinical experience allowed to identify the ideal candidate: a young patient, with a short disease duration, with recurring and disabling relapses and the presence of inflammatory activity on brain magnetic resonance scans, unresponsive to approved therapies. A large, randomized clinical study comparing AHSCT with the best approved therapies is still necessary to confirm the role of transplantation in MS treatment.

Acoustic radiation force impulse elastography, FibroScan®, Forns'index and their combination in the assessment of liver fibrosis in patients with chronic hepatitisB, and the impact of inflammatory activity and steatosis on these diagnostic methods.

The aim of the present study was to investigate the combination of certain serological markers (Forns’ index; FI), FibroScan® and acoustic radiation force impulse elastography (ARFI) in the assessment of liver fibrosis in patients with hepatitis B, and to explore the impact of inflammatory activity and steatosis on the accuracy of these diagnostic methods. Eighty-one patients who had been diagnosed with hepatitis B were recruited and the stage of fibrosis was determined by biopsy. The diagnostic accuracy of FI, FibroScan and ARFI, as well as that of the combination of these methods, was evaluated based on the conformity of the results from these tests with those of biopsies. The effect of concomitant inflammation on diagnostic accuracy was also investigated by dividing the patients into two groups based on the grade of inflammation (G<2 and G≥2). The overall univariate correlation between steatosis and the diagnostic value of the three methods was also evaluated. There was a significant association between the stage of fibrosis and the results obtained using ARFI and FibroScan (Kruskal-Wallis; P<0.001 for all patients), and FI (t-test, P<0.001 for all patients). The combination of FI with ARFI/FibroScan increased the predictive accuracy with a fibrosis stage of S≥2 or cirrhosis. There was a significant correlation between the grade of inflammation and the results obtained using ARFI and FibroScan (Kruskal-Wallis, P<0.001 for all patients), and FI (t-test; P<0.001 for all patients). No significant correlation was detected between the measurements obtained using ARFI, FibroScan and FI, and steatosis (r=−0.100, P=0.407; r=0.170, P=0.163; and r=0.154, P=0.216, respectively). ARFI was shown to be as effective in the diagnosis of liver fibrosis as FibroScan or FI, and the combination of ARFI or FibroScan with FI may improve the accuracy of diagnosis. The presence of inflammatory activity, but not that of steatosis, may affect the diagnostic accuracy of these methods.

A predictive tool for an effective use of 18F-FDG PET in assessing activity of sarcoidosis

Background18F-FDG PET/CT (PET) is useful in assessing inflammatory activity in sarcoidosis. However, no appropriate indications are available. The aim of this study was to develop a prediction rule that can be used to identify symptomatic sarcoidosis patients who have a high probability of PET-positivity.MethodsWe retrospectively analyzed a cohort of sarcoidosis patients with non organ specific persistent disabling symptoms (n = 95). Results of soluble interleukin-2 receptor (sIL-2R) assessment and high-resolution computed tomography (HRCT) were included in the predefined model. HRCT scans were classified using a semi-quantitative scoring system and PET findings as positive or negative, respectively. A prediction model was derived based on logistic regression analysis. We quantified the model’s performance using measures of discrimination and calibration. Finally, we constructed a prediction rule that should be easily applicable in clinical practice.ResultsThe prediction rule showed good calibration and good overall performance (goodness-of-fit test, p = 0.78, Brier score 20.1%) and discriminated between patients with positive and negative PET findings (area under the receiver-operating characteristic curve, 0.83). If a positive predictive value for the presence of inflammatory activity of ≥90% is considered acceptable for clinical decision-making without referral to PET, PET would be indicated in only 29.5% of the patients. Using a positive predictive value of 98%, about half of the patients (46.3%) would require referral to PET.ConclusionsThe derived and internally validated clinical prediction rule, based on sIL-2R levels and HRCT scoring results, appeared to be useful to identify sarcoidosis patients with a high probability of inflammatory activity. Using this rule may enable a more effective use of PET scan for assessment of inflammatory activity in sarcoidosis.

A Clinical Significance of High-Sensitivity C-reactive Protein Level in Alzheimer's Disease and Vascular Dementia

Background: There is increasing evidence about inflammatory processes in the development of demen tia. Therefore, inflammation has been believed to play a pivot role in cognitive decline, Alzheimer’s dis ease (AD), and vascular dementia. High-sensitivity C-reactive protein (hs-CRP) is a sensitive systemic marker of inflammation, and increased levels of hs-CRP are associated with inflammatory reactions. It is important to identify modifiable risk factors, which could be used in preventing or delaying the onset of dementia. Therefore, we studied to clarify a clinical role of hs-CRP in AD and VaD. Methods: This study population consisted of a sample of 102 patients with dementia (54 patients of AD and 48 patients of VaD) and 91 controls. We have investigated hs-CRP levels and cognitive function of each group. Cognitive function was evaluated with Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), Clinical Dementia Rating (CDR) with Sum of Box and Activities of Daily Living (ADL). Results: All subjects with dementia showed higher hs-CRP levels than subjects without dementia. But, there was no significant difference of hs-CRP levels between patients with AD and those with VaD. The odds ratio of patients with AD and VaD by hs-CRP is 2.250 (95% Cl 1.670-3.032) for Alzheimer’s disease and 4.0 (95% Cl 2.451-6.529) for vascular dementia. Conclusions: The result of our study suggests the presence of inflammatory activity is related with dementia, not only AD known to degenerative disease but also VaD associated with cerebrovascular disease. However, we could suggest that dementia with cerebrovascular lesions is more related with inflammatory activity than AD.

A Rheumatoid arthritis study using Raman spectroscopy

Rheumatoid arthritis (RA) is characterized by chronic inflammation of the joints and can lead to a progressive destruction of articular cartilage and bone. In this study, the specificity and sensitivity of the RA diagnostic methods based on the receiver-operating characteristic curves for monitoring C-reactive protein (CRP) and rheumatoid factor (RF) were compared with the Raman spectroscopic diagnostic method developed in this work. Sera from 24 patients with rheumatoid arthritis and from 16 healthy individuals were analyzed to assess the biochemical composition and presence of inflammatory activity by the aforementioned methods. By comparing with the clinical results for specificity and sensitivity from the RF and CRP tests, we show that the overall results from the newly developed Raman method were significantly better, with a specificity of 96%, a sensitivity of 88%, and correctly identifying 92% of the RA and healthy individuals, while the RF test gave a specificity of 100% and a sensitivity of 54%, and the CRP test gave a specificity of 87% and a sensitivity of 58%, respectively.

W1150 Endorectal Ultrasound and Magnetic Resonance Imaging in Staging of Rectal Cancer in Routine Daily Practice

G A A b st ra ct s in 10,9% (7/64) and mild activity in 11,9% (8/64). From a total amount of 64 non-explored segments by endoscopy in 36 patients (39,1%), MRI showed 1 affected segment in 18/36 (50%), 2 affected segments in 8/36 (22,2%) and 3 affected segments in 2/36 (5,6%). MRI detected extraintestinal complications in 28,3% (26/92) such as fistulae in 18,5% (17/92), fibrotic stenosis in 9,8% (9/92), abscess in 8,7% (8/92) and inflammatory mass in 5,4% (5/ 92). Therefore MRI was the only exploration which showed the presence of inflammatory activity and/or severe lesions in 6,5% (6/92) and/or extraintestinal complications in 28,3% (26/92) and therefore globally MRI could change the management of these patients in 30,4% (28/92). CONCLUSIONS: this study confirms the high diagnostic accuracy of MRI for evaluation of disease activity in CD and demonstrates for the first time its impact on management, suggesting a key role of this technique in clinical practice.

W1151 EUS Predicts Local Resection for Rectal Cancer

G A A b st ra ct s in 10,9% (7/64) and mild activity in 11,9% (8/64). From a total amount of 64 non-explored segments by endoscopy in 36 patients (39,1%), MRI showed 1 affected segment in 18/36 (50%), 2 affected segments in 8/36 (22,2%) and 3 affected segments in 2/36 (5,6%). MRI detected extraintestinal complications in 28,3% (26/92) such as fistulae in 18,5% (17/92), fibrotic stenosis in 9,8% (9/92), abscess in 8,7% (8/92) and inflammatory mass in 5,4% (5/ 92). Therefore MRI was the only exploration which showed the presence of inflammatory activity and/or severe lesions in 6,5% (6/92) and/or extraintestinal complications in 28,3% (26/92) and therefore globally MRI could change the management of these patients in 30,4% (28/92). CONCLUSIONS: this study confirms the high diagnostic accuracy of MRI for evaluation of disease activity in CD and demonstrates for the first time its impact on management, suggesting a key role of this technique in clinical practice.

Interobserver variations in histopathological assessment of gastric pathology

Considering the fact that histology and its grading systems are accepted gold standards in diagnosis of diverse clinical disorders, assessing the accuracy and reliability of this method of diagnosis is of utmost importance. Thus, this study was performed to measure the agreement values between four independent histopathology readings for identical indices under one scoring guideline using three different approaches. Four independent pathologists participated in this study and were blinded to the clinical diagnosis of patients. Various histological features were examined on gastric tissue specimens according to the updated Sydney system. Statistical analysis revealed that our null hypothesis about the existing agreement between different histopathological observations is rejected for chronic gastritis, the presence of inflammatory activity, atrophy and Helicobacter pylori, whereas there were significant inter-observation agreements in regard to the presence of lymphoid follicles, intestinal metaplasia and dysplasia. Pairwise analysis showed that different grading scales resulted in different kappa values ranging from poor to excellent agreements. The best kappa values were observed for the evaluation of dysplasia between two independent pathologists. This assessment has demonstrated that standardisation of less quantitative grading scales resulting in consistent readings is essential for affirmative clinical diagnosis and devising effective treatment strategies.

Inflammation and Overweight in Peritoneal Dialysis: Is There an Association?

More than 30% of the patients on peritoneal dialysis show chronic systemic inflammatory activity with high levels of C-reactive protein. The purpose of this cross-sectional study was to investigate the influence of the inflammatory state on clinical and nutritional markers in patients on peritoneal dialysis. Twenty-seven patients were included: mean age was 57.6 ± 19 years, 48% were male, and median time on peritoneal dialysis was 16.0 (8.3; 35.8) months. Clinical, dialytic, laboratory, anthropometric and electric bioimpedance data were collected with the sample stratified for C-reactive protein. In patients, the levels of Interleukin-6 and tumor necrosis factor-α were higher, while adiponectin levels were lower than in healthy individuals (p ≤ 0.001), indicating the presence of inflammatory activity in the sample. When compared to patients with C-reactive protein <1 mg/dL, those with ≥1mg/dL showed higher body mass index (29.4 ± 6.1 vs. 24.4 ± 4.5 kg/m2; p = 0.009), percent of standard body weight (124.5 ± 25.4 vs. 106.8 ± 17.9 %; p = 0.012), and percent of body fat as assessed by both anthropometry (31.3 ± 9.9 vs. 23.9 ± 9.1%; p = 0.056) and bioimpedance (38.9 ± 6.3 vs. 26.2 ± 12.6 %; p < 0.001). Patients with C-reactive protein ≥1mg/dL also exhibited higher levels of ferritin (701 ± 568 vs. 532 ± 356 ng/mL; p =0.054) and lower total lymphocyte count (median 1838 vs. 1638 mm3; p = 0.001). In conclusion, higher body mass index and body fat markers were associated with C-reactive protein ≥ 1mg/dL, and higher C-reactive protein was associated with immunocompetence impairment evidenced by the lower total lymphocyte count. Our findings confirm the relationship between inflammation, body fat, and immunocompetence, which may be superimposed potentializing the inflammatory status.

Tc-99 HMPAO Labeled Leukocyte Imaging in a Renal Transplant in a Patient with Ulcerative Colitis

A 46-year-old female with ulcerative colitis was studied with Tc-99m HMPAO leukocyte imaging to establish the presence of inflammatory activity. She had a kidney transplantation because of terminal renal chronic failure in 1994. A renal function study was performed with 3 mCi of Tc-99m MAG3, and it was compared with a previous study performed three years earlier.

Inflammation rather than nutritional depletion determines glutamine concentrations and intestinal permeability

Aim: Nutritional depletion has been correlated with low plasma and mucosal glutamine concentrations and with increased intestinal permeability. Since nutritional depletion often is associated with (chronic) inflammatory stress, this study was designed to establish the influence of depletion and inflammation on glutamine concentrations and gut barrier function. Methods: Anthropometric parameters were calculated from 26 patients who required artificial nutrition. Glutamine concentrations in plasma and gut mucosa, gut permeability and mucosal morphology were assessed. For determination of the degree of inflammation erythrocyte sedimentation rates and (pre)albumin concentrations were measured. On the basis of these parameters patients were divided into two groups having significant inflammatory stress or not. Similarly, a depleted and a non-depleted group was formed based on percentage ideal body weight, fat-free mass index (FFMI) and percentage weight loss. Glutamine concentrations, gut permeability and villus morphology were compared between the groups. Results: The presence of inflammatory activity had significant negative effects on glutamine concentrations in contrast to the presence or absence of nutritional depletion. Similarly, intestinal permeability increased during active inflammation but not in depleted patients. FFMI but not inflammation was related to villus height. Conclusions: The presence of inflammation significantly affects glutamine concentrations and gut permeability, in contrast to the presence of depletion of body cell mass per se. On the other hand, villus morphology is not influenced by changes in systemic inflammatory activity whereas nutritional status possibly does affect villus height.

Linfocitos T y monocitos activados en la reestenosis coronaria. ¿Reflejan la persistencia de un mecanismo inflamatorio?

This study was made to determine if restenosis after percutaneous coronary angioplasty is associated with acute or chronic inflammatory/immunologic activity, and explored possible relationships with latent infection. Forty-six consecutive patients underwent elective PTCA and 6 months of angiographic follow-up. Peripheral venous blood samples were obtained at baseline, 24-48 h, and 4-6 months post-intervention. Flow-cytometric methods were used to measure early and late circulating leukocyte activation status. Il-6 and TNF-alpha cytokines, and Il-2 soluble receptor concentrations were determined in all plasma samples. Chlamydia pneumoniae and Cytomegalovirus antibody assays were performed to detect infectious disease. Angiographic coronary stenosis developed in 27 out of 46 patients. At 6 months of follow-up, these patients showed a significant increase in circulating cytotoxic T-lymphocytes CD3+/CD56+ (18.8 7.1 vs 6.12 2.7%; p = 0.005) and activated monocytes (CD11b: 1,383 624 vs 990 484 MFI, p = 0.025; CD64: 76.0 28.7 vs 56.7 21.8 MFI; p = 0.014), with no apparent relation to increased cytokines or latent infectious disease. Restenosis appears to be associated to inflammatory and immunological activity that persists 6 months after coronary intervention. No relationship was found with the infections studied. The presence of inflammatory activity 4-6 months after PTCA suggess that pharmacological therapeutic interventions to prevent restenosis should be maintained for months.

Derrame pleural: uma complicação extra-intestinal da doença de Crohn

Paciente de 34 anos, portadora de doença de Crohn (DC) havia oito anos, foi atendida queixando-se de dor torácica e febre, sem manifestações gastrointestinais. Testes laboratoriais mostraram atividade inflamatória (VHS = 45mm, PCR positivo). O exame físico revelou derrame pleural na base do hemitórax esquerdo, confirmado pela radiografia de tórax. A análise do líquido pleural mostrou 100% de linfócitos, com BAAR negativo. A biópsia pleural evidenciou granuloma não caseoso. Foi instituída terapia para tuberculose, sem sucesso, com regressão dos sintomas apenas após reintrodução de altas doses de corticosteróide, sugerindo atividade da DC como causa do derrame pleural.