A. Scarcelli

New insights into the brain involvement in patients with Crohn's disease: a voxel-based morphometry study.

Background  Crohn’s disease (CD) is a chronic intestinal disorder characterized by overproduction of inflammatory cytokines and recurrent abdominal pain. Recently, brain morphological abnormalities in the pain matrix were found in patients with chronic pain disorders including irritable bowel syndrome. To investigate potential structural brain changes associated with CD, we used magnetic resonance imaging (MRI). Furthermore, we tested whether in patients gray matter (GM) volumes correlated with disease duration.

Proposal of a new clinical index predictive of endoscopic severity in ulcerative colitis.

Assessment of disease activity by clinical parameters in ulcerative colitis is still controversial. Different clinical indexes have been proposed. Colonoscopy provides detailed information on mucosal damage. The aim of this study was to identify, among 21 clinical and laboratory parameters, which were predictive of endoscopic activity. We included 137 consecutive patients with ulcerative colitis who underwent colonoscopy, clinical examination, and blood tests within 4 weeks. Endoscopic severity was recorded using a simple score (range, 0–30). The multiple stepwise regression coefficient of each significant variable predictive of mucosal damage was used to develop a new activity index predictive of endoscopic appearance (Endoscopic–Clinical Correlation Index; ECCI). We tested the ability of our score to discriminate patients with severe endoscopic disease, calculating the area under the receiver operator characteristic curve, and we compared it to activity indexes proposed by other authors. Endoscopic severity was significantly influenced by four parameters: bloody stool, nocturnal bowel movements, body temperature >37.5°C, and serum albumin. The new scoring system was calculated as ECCI = {[serum albumin × (−26)] + (bloody stool × 17) + (nocturnal bowel movements × 16) + [fever (0 or 1) × 39]} + 107. The ECCI accurately identified patients with severe endoscopic disease in our sample (sensitivity = 81%, specificity = 95%). In conclusion, the ECCI should be useful in clinical practice because it is simple and strongly related to endoscopic activity.

Functional magnetic resonance imaging study reveals differences in the habituation to psychological stress in patients with Crohn’s disease versus healthy controls

In patients with Crohn’s disease (CD) stress is believed to increase the incidence of disease relapse. The brain processes stressful stimuli and triggers the stress-evoked responses. Habituation to stress is an adaptive process that allows minimizing these responses. We hypothesized inadequate habituation to stress in CD patients. The aim of this study was to compare the neural habituation between CD patients and controls. Twenty CD patients and eighteen controls underwent a functional magnetic resonance imaging while performing two repeated runs of a stress-evoking task. The task elicited different neural activity between the groups across runs in (1) amygdala, hippocampus, (2) insula, putamen (3) cerebellar regions, suggesting altered habituation to stress in patients. These structures regulate the neuroendocrine and autonomic stress-evoked responses that control the proinflammatory responses. The inadequate habituation to stress that we found in patients could play a role in the relationship between stress and inflammatory exacerbations in CD.

Absence of change in the gray matter volume of patients with ulcerative colitis in remission: a voxel based morphometry study

BackgroundRecent neuroimaging studies have investigated the brain involvement in patients with Crohns disease (CD) and Ulcerative Colitis (UC). Functional studies found abnormalities in cognitive and emotional functions in CD and UC, while a voxel based morphometry (VBM) study found morphological changes in CD. We conducted a VBM study to compare the gray matter (GM) volume of UC patients and controls.MethodsEighteen UC patients in remission and eighteen healthy controls underwent structural MRI. VBM is a fully automated technique allowing identification of regional differences in the amount of GM, which enables an objective analysis of the whole brain. VBM was used for comparisons between patients and controls.ResultsUC patients were all in remission and had a mild clinical course. There were no differences between patients and controls in GM volume.ConclusionThe brain morphology of patients with UC in remission is similar to controls. The lack of GM abnormalities in UC patients might reflect the mild clinical course of the inflammatory bowel disorder. Further research involving patients with different degrees of disease severity or during flares could shed more light on potential brain structural changes in UC.

Stress and brain functional changes in patients with Crohn's disease: A functional magnetic resonance imaging study

In Crohns disease (CD) patients, stress is believed to influence symptoms generation. Stress may act via central nervous system pathways to affect visceral sensitivity and motility thus exacerbating gastrointestinal symptoms. The neural substrate underpinning these mechanisms needs to be investigated in CD. We conducted an explorative functional magnetic resonance imaging (fMRI) study in order to investigate potential differences in the brain stress response in CD patients compared to controls.

4706 The rockall score is a useful prognostic tool in gastroduodenal ulcer haemorrhage.

Background and aim. Gastroduodenal ulcer bleeding is the major cause of endoscopic examination on emergency. Patients with acute upper gastrointestinal haemorrhage (UGIH) are routinely hospitalized regardless of the clinical status or the stigmata of bleeding. The Rockalls score (1) was recently tested for its prognostic value after UGIH. The aim of the present study was to validate Rockalls score in a set of patients with gastroduodenal ulcer bleeding in an Italian teaching hospital and to prove his usefulness in improving quality of care. Material and methods. From May/96 to May/97 100 consecutive patients, admitted as emergencies for UGIH, underwent endoscopy within 6 hours of admission and were found affected by gastroduodenal ulcer (peptic or malignant). All the patients with active bleeding (42) and most of the ones with stigmata of recent haemorrhage were treated endoscopically by injection of 10-20 ml 1:10,000 adrenaline. Initial Rockalls score (iR - based on age and presence of shock and comorbidity) and total Rockalls score (tR - sum of iR and a score related to endoscopic findings) were calculated for each patient. Results. Initial haemostasis was achieved in all cases, but 19 patients recurred; 12 died, 9 after at least one rebleeding. Median iR and median tR were 2 (range 0-6) and 4 (1-9) for non-rebleeders vs. 3 (0-7) and 6 (3-10) for rebleeders ( p 8 rebled and died. The average length of hospital stay was 10.3 days for all patients and 4.4 for the group with tR