Dan M. Livovsky

A prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy

Abstract Background: Capsule endoscopy (CE) is often used to investigate small bowel Crohns disease (CD). Aim: The aim of this study is to prospectively assess the value of fecal calprotectin and lactoferrin to predict CE findings. Patients and methods: Sixty-eight consecutive patients that were referred for CE were included. Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. Correlation between fecal markers and CE findings was assessed and receiver operating characteristic (ROC) curves were built to determine the predictive values of fecal markers for the diagnosis of CD. Results: Fecal calprotectin data was available for all the patients and lactoferrin data for 38. CE findings compatible with CD were found in 23 (33%) patients and 45 (67%) were negative for CD. The average age of the CD group was 34 compared to 46 in the non-CD group (p = .048). Median calprotectin and lactoferrin in the CD group and in the control group were 169 mg/kg vs. 40 (p = .004) and 6.6 mg/kg vs. 1 (p = .051), respectively. The area under the ROC curve was 0.767 for calprotectin and 0.70 for lactoferrin. A fecal calprotectin concentration of 95 mg/kg and fecal lactoferrin of 1.05 mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77 and 73%, 60 and 65%, 50 and 50%, and 84 and 84% in predicting CE findings compatible with CD. Conclusions: Fecal markers are simple and noninvasive surrogates for predicting CE findings compatible with CD. Fecal markers can help determine which patients should be referred for CE. ClinicalTrials.gov Identifier: NCT01266629

The Importance of Intestinal Eotaxin-1 in Inflammatory Bowel Disease: New Insights and Possible Therapeutic Implications.

BackgroundInvolvement of eotaxin-1 in inflammatory bowel disease has been previously suggested and increased levels of eotaxin-1 have been described in both ulcerative colitis and in Crohn’s disease. The association between serum levels of eotaxin-1 and that within the colonic mucosa has not been well defined, as is the potential therapeutic value of targeting eotaxin-1.AimsTo characterize serum and intestinal wall eotaxin-1 levels in various inflammatory bowel disease patients and to explore the effect of targeting eotaxin-1 by specific antibodies in dextran sodium sulfate-induced colitis model.MethodsEotaxin-1 levels were measured in colonic biopsies and in the sera of 60 ulcerative colitis patients, Crohn’s disease patients and healthy controls. We also followed in experimental colitis the effect of targeting eotaxin-1 by a monoclonal antibody.ResultsColon eotaxin-1 levels were significantly increased in active but not in quiescent ulcerative colitis and Crohn’s disease patients compared to healthy controls. Levels of eotaxin-1 in the colon were correlated with eosinophilia only in tissues from active Crohn’s disease patients. Our results did not show any statistically significant change in serum eotaxin-1 levels among ulcerative colitis, Crohn’s disease and healthy controls. Moreover, we demonstrate that in dextran sodium sulfate-induced colitis, targeting of eotaxin-1 with 2 injections of anti eotaxin-1 monoclonal antibody ameliorates disease activity along with decreasing colon weight and improving histologic inflammation.ConclusionEotaxin-1 is increasingly recognized as a major mediator of intestinal inflammation. Our preliminary human and animal results further emphasize the value of targeting eotaxin-1 in inflammatory bowel disease.

Massive Polyposis of the Sigmoid Colon

DIS 5.2.0 DTD YGAST58996_proof 24 May 2014 10:53 am ce Gastr 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Question: A 59year-old, generally healthy, white man presented to our clinic in May 2006 for a second opinion. He has positive family history of colon cancer (mother at age 58) and personal history of diverticulosis. Two weeks before presentation, colonoscopy was performed at another institution after 86 87 88 89 90 91 92 an episode of acute diverticulitis.Multiple, large, sessile polyps alongwithdiverticulosiswere detected in the sigmoid colon. The endoscopists on site recommended partial colectomy. Histopathology at the other hospital revealed hyperplastic polys. A full colonoscopywas repeatedat ourdepartment; huge sessile polyps (w3 cm)were foundat thedistal colonbetween20 and40cm from the anal verge (Figure A, B), multiple biopsies were collected. What is the diagnosis? Look on page 000 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. 93 94 95 96 97 98 99 Conflicts of interest The authors disclose no conflicts.

Pregnancy-Onset Inflammatory Bowel Disease: A Subtle Diagnosis

Background Inflammatory bowel diseases (IBDs) are commonly diagnosed during the reproductive years. IBD first manifested during pregnancy (pregnancy-onset IBD [POIBD]) is still an undescribed entity. The aim of the study was to evaluate the characteristics and maternal and neonatal outcomes of patients with POIBD. Methods Data of all pregnant women with IBD within a single multidisciplinary referral clinic, IBD-MOM, between 2011-2016, were analyzed. Maternal and neonatal characteristics and outcomes were compared between the POIBD group and those diagnosed before pregnancy (non-POIBD). Results We identified 237 women, 31 (15%) from the POIBD group and 206 (85%) from the non-POIBD group. Eight (3.5%) patients experienced early spontaneous pregnancy loss, all in the non-POIBD group. The POIBD diagnosis occurred in 16 (52%) patients during the first trimester, 10 (32%) in second trimester, and 5 (16%) during third trimester. Diagnosis of ulcerative colitis (UC) was significantly more common in the POIBD group compared with the non-POIBD group (22/31, 71% vs 50/206, 24%, respectively, P < 0.001). More UC than Crohns disease patients had active disease during pregnancy (69% vs 50%, P = 0.03, respectively). POIBD patients experienced vaginal delivery in 100% of births, compared with 164 (79.6%) in the non-POIBD group (P = 0.017). The mean gestational age at birth and the neonatal weight were similar among the study groups; 38.6 weeks and 3040 g for POIBD patients, compared with 38.7 weeks and 3055 g in the non-POIBD group. Conclusions POIBD is a unique clinical entity, and the diagnosis is mostly UC. However, the maternal and neonatal outcomes are similar.

Chronic use of statins and their effect on prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

Background and Aims: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the major complications of ERCP. Thus, several non-invasive as well as invasive strategies have been investigated as preventative therapies for PEP with various efficacy. Methods: We enrolled any patients who underwent ERCP both at the Shaare Zedek Medical Center in Jerusalem and EMMS Nazareth hospital. Association between use of statins and different variables were assessed with univariate tests (chi-squared for categorical variables). Predictors of incidence of PEP and severity of pancreatitis were computed using conditional logistic regression, correcting for potential confounding factors. Results: 958 subjects were analyzed. Average age was 62.04 ± 21.18 years (median 68 years). Most of the patients were female (n = 558, 58.2%), Jewish (n = 827, 86.3%), and inpatients (n = 631, 65.9%). Only few ERCPs were performed emergently (n = 40, 4.2%). Twenty-Seven patients repeated the exam. Overall incidence of PEP/hyperamylasemia was 16.8% (n = 161); with a 5.6% (n = 54) incidence of hyperamylasemia and a 11.2% (n = 107) incidence of pancreatitis. Overall, 6 cases of severe pancreatitis were identified. The logistic regression analysis demonstrated that chronic use of statins is a protective factor in preventing development of PEP/hyperamylasemia [OR 0.436 [95%CI 0.303–0.627], p < 0.001]; Particularly, the PEP OR was of 0.318 [95%CI 0.169–0.597], p < 0.001 and the hyperamylasemia OR was of 0.565 [95%CI 0.372–0.859], p = 0.008. No significant predictor could be found for the risk of developing severe PEP. Conclusions: Our data support the possibility of exploiting statins as preventive agents for PEP. However, further studies, mainly RCTs, are warranted in order to replicate our findings.

Correction to: Antenatal Management for Women with Inflammatory Bowel Disease: Experience from Our ‘IBD MOM’ Clinic

The original version of the article unfortunately contained tagging error in first and family name of authors Ariella Bar-Gil Shitrit and Ami Ben Ya’acov. This has been corrected with this erratum.

Tricyclic antidepressants for the treatment of tenesmus associated with rectal prolapse.

Tenesmus in rectal prolapse leads to a vicious circle of straining with deterioration of prolapse. The primary phenomenon triggering this may be rectal hypersensitivity. We aimed to assess whether treatment with tricyclic antidepressants (TCAs) may break the vicious circle and improve tenesmus.

Sa1878 Individuals With Portal Hypertension Have an Increased Propensity to Develop Hyperplastic Gastric Polyps

Background and goals: Recently we observed patients with chronic liver diseases (CLD) (n= 16) and chronic reflux symptoms (CRS) (n=38) that developed gastric polyps (GPs) while undergoing repeated esophagogastroduodenoscopy (EGD). The indications for repeated EGD were: persistent reflux symptoms (CRS patients) and monitoring of esophageal varices development (CLD patients). Herewith we identify risk factors for GP development and estimate the gastric polyp development time (GPDT). Methods: Data was retrospectively analyzed. GPDT was defined as days, since the first gastroscopy until polyp discovery. The presence of portal hypertension (PHT) in CLD patients was determined by the presence of esophageal varices with or without gastric varices. Results: CLD patients developed more hyperplastic gastric polyps (HGPs) than CRS patients (p= 0.021). CLD patients with PHT developed HGPs at a younger age (p=0.023) and had a tendency for a shorter GPDT than CLD patients without PHT: mean GPDT was 1184 ±787 days (for CLD patients with PHT) vs.2634 ±2345 days (for CLD patients without PHT). In order to further study the effect of PHT on the GPDT, Kaplan-Meier curves, indicating the individual GPDT, for all patients with HGPs, from the CRS and CLD groups, were constructed. A trend for shorter GPDT for CLD patients with PHT was demonstrated (Figure 1). In the CLD patients (irrespective to the presence PHT), a positive correlation between the GPDT and age was found; the older the patient, the longer the GPDT (p=0.014). In patients with CLD, Ki-67 labeling index values of HGPs were independent to the presence PHT, the patients gender, to infection with Helicobacter Pylori and to PPI exposure. However, a negative correlation between the patients age and the Ki-67 values was found; the younger the patient, the higher the Ki-67 value (p= 0.042).The histopathology features that were previously reported to be specific for GP tissue in patients with PHT were not detected more often in the CLD patients with HGPs, irrespective to the presence or absence of PHT. Conclusions: Compared to CRS patients, CLD patients with PHT, appear to develop HGPs at a greater number, at a younger age and in a shorter GPDT.