Dimitrios Sigounas

Association of Helicobacter pylori infection with cardiovascular disease—Is it just a myth?

OBJECTIVE To test the hypothesis that Helicobacter pylori infection is associated with a higher rate of documented cardiovascular disease (CVD) in subjects undergoing elective upper gastrointestinal endoscopy. METHODS 202 consecutive patients (median age 60 years, 101 men) were studied. H. pylori infection was established by a rapid urease test in a gastric tissue sample (CLO test) and by histological examination of gastric mucosa from the stomach antrum and body. CVD was documented by completion of the Rose questionnaire. The association of H. pylori infection with CVD was determined by multivariate logistic regression modelling after adjusting for potential confounding factors. RESULTS A total of 104 (51.5%) subjects were found H. pylori positive. Forty patients had a confirmed history of CVD. Multiple logistic regression analysis verified the strong associations of CVD with established risk factors of atherosclerotic disease but not with H. pylori infection. CONCLUSION Our findings suggest that there is no association of H. pylori infection with CVD. Eradication of H. pylori to prevent CVD is not warranted.

Small bowel parasitosis as cause of obscure gastrointestinal bleeding diagnosed by capsule endoscopy

Hookworm infection is a relatively common cause of anemia in endemic areas. However, it is rarely encountered in Europe. In this report we describe the case of a 24-year old patient originating from an endemic area who was admitted due to severe anemia, with an Hct of 15.6% and eosinophilia (Eosinophils: 22.4%). While both esophagogastroduodenoscopy and colonoscopy were non-diagnostic, capsule endoscopy revealed a large number of hookworms infesting his small bowel and withdrawing blood. The patient was successfully treated with Albendazole. Capsule endoscopy was proven an important tool in diagnosing intestinal parasitosis.

Changes of serum adhesion molecules and cytokines in post-ERCP pancreatitis: Adhesion molecules and cytokines in acute pancreatitis

OBJECTIVES To assess the early changes of soluble IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF-α, TNF-β, IL-17A, IL-22, soluble (s) P-Selectin, sE-Selectin and sICAM-1 in post-ERCP pancreatitis (PEP). METHODS Single center, prospective study of 318 ERCP procedures. Serum samples were acquired from all patients prior to ERCP, 6 hours and 24 hours after the procedure. For every PEP case, another patient was chosen as a control, matched for gender, age and time period in which ERCP took place. RESULTS Totally, 28 cases and 28 controls were studied. Except for significantly higher IL-1b levels in cases at baseline, no significant differences were observed between cases and controls after Bonferroni corrections. An increase in IL-6 was noted between baseline and 6 h in cases alone (p=0.016). There was a significant fall in sP-selectin levels at 6 and 24 hours compared to baseline in all patients (corrected p=0.008 and 0.016 for cases and 0.016 and 0.048 for controls respectively). An increase of sE-selectin in cases was observed between 6 and 24 hours post-ERCP (corrected p=0.03). CONCLUSIONS Soluble forms of cytokines and adhesion molecules studied seem not to play a major role in PEP.

Pancreatitis potentially associated drugs as a risk factor for post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective cohort study.

Objectives The aim of this study was to assess the role of known risk factors and specifically evaluate the role of pancreatitis potentially associated drugs as potential risk factors for post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods This was a prospective, single-center cohort study conducted in a tertiary university hospital. All eligible ERCP procedures within a 16-month period were evaluated, and all interventions, patient characteristics, and medications used were documented. The association of potential risk factor with PEP was investigated with univariable analyses. Those statistically significant were entered in a multivariable regression model. Results Three hundred eighteen ERCP procedures were studied. Post-ERCP pancreatitis occurred in 28 patients (8.8%). Twenty-three potential risk factors were studied in univariable analyses, and 3 of them were found to be nominally statistically significant. These 3 factors were independently associated with PEP in the multivariable model and included the use of pancreatitis potentially associated drugs, belonging to Badalov classes I or II, during the last month before ERCP (odds ratio [OR], 4.39; 95% confidence interval [CI], 1.70–5.47; P = 0.003), more than 1 guide-wire insertions in the pancreatic duct (OR, 5.00; 95% CI, 1.97–12.81; P = 0.001) and bile duct stone extraction (OR, 0.12; CI, 0.05–0.32; P < 0.001). Conclusions Pancreatitis potentially associated drugs used before ERCP seem to increase the risk for PEP.

Adult-onset Still's disease preceding Crohn's disease.

Concomitant diagnosis of Crohns disease and juvenile or adult-onset idiopathic arthritis is rare. It is possible that both conditions share some genetic or immunological defects although sufficient data are lacking. We describe herein the first case of a patient with adult-onset Stills disease who was diagnosed on follow up with concomitant Crohns disease. A 38-year-old man diagnosed with adult onset Stills disease from the age of 24 was admitted in our hospital because of bloody diarrhea. On admission physical examination was unremarkable and all routine laboratory tests were normal except of Hg at 11.3 gr/dl, erythrocyte sedimentation rate at 27 mm/h and C-reactive protein at 14 mg/dl. Ileocolonoscopy revealed small aphthoid ulcers in the terminal ileum and capsule endoscopy revealed the source of bleeding and small aphthoid ulcers starting from the distal jejunum up to the terminal ileum. Terminal ileum biopsies were diagnostic of Crohns disease and patient had started on therapy with mesalamine 2 gr/day and azathioprine 2mg/kg and is currently on multidisciplinary follow up. We review all literature on co-existence of Crohns disease with chronic idiopathic arthritis and we discuss the possible difficulties in diagnosis and therapy of those patients also in the view of the new biological agents.

P249 Endoscopic extension of inflammation progresses more frequently in ulcerative colitis compared to Crohn's disease patients

P248 Endoscopic evaluation of colonic mucosa in ulcerative colitis patients in clinical remission O. Shchukina1 *, E. Kondrashina2, O. Orlov3, A. Vladimirova4, A. Botina5, E. Markova6, A. Kharitidis7. 1North-West State Medical University, Chair of Gastroenterology and Dietology, Saint-Petersburg, Russian Federation, 2North-West State University, Chair of Gastroenterology and Dietology, SaintPetersburg, Russian Federation, 3City clinical hospital #3, Saint-Petersburg, Russian Federation, 4Irkutsk Diagnostic Center, Irkutsk, Russian Federation, 5Saint-Petersburg state medical university named after I.P. Pavlov, Saint-Petersburg, Russian Federation, 6City clinical hospital #31, SaintPetersburg, Russian Federation, 7City Clinical Hospital #31, City Centre of IBD, Saint-Petersburg, Russian Federation

P565 Clinically significant safety issues during long-term azathioprine use in patients with ulcerative colitis

V0 to 83.0% in V12. The CDAI decreased from 194 (21 269) to 48 (10 122) (p < 0.001). The PDAI decreased from 4.0 (0.0 4.0) to 0.0 (0.0 4.0) (p < 0.001). The quality of life measured by the EQ-5D improved from 0.735 (0.633 0.790) to 0.797 (0.726 1.000) (p < 0.001). The IBDQ-9 score increased (p < 0.001) from 56.7 (51.6 61.5) to 66.5 (60.1 73.6) (p < 0.001). The work hours lost by the EC in the previous week decreased from 2.0 (0.0 27.0) at V0 to 0.0 (0.0 1.0) at V12 (p = 0.004) and the work productivity (0 10 scale) decreased from 3.0 (0.3 5.8) to 1.0 (0.0 to 2.0) (p = 0.006). Conclusions: In clinical practice, ADAhas proven to be effective with a statistically significant improvement in clinical variables, quality of life, and work productivity.

P223 Dermatological surveillance of inflammatory bowel disease patients treated with biological therapy

P222 Methotrexate use in inflammatory bowel disease: A referral centre’s 30 years of experience K.H. Katsanos1 *, D.E. Sigounas1, K. Strogyli1, A. Tatsioni2, E. Panagiotou1, I. Vagias1, V.E. Tsianos1, D.K. Christodoulou1, E.V. Tsianos1. 1Medical School of Ioannina, University of Ioannina, 1st Division of Internal Medicine and HepatoGastroenterology Unit, Ioannina, Greece, 2Tufts University School of Medicine and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Boston, United States

P222 Methotrexate use in inflammatory bowel disease: A referral centre's 30 years of experience

P222 Methotrexate use in inflammatory bowel disease: A referral centre’s 30 years of experience K.H. Katsanos1 *, D.E. Sigounas1, K. Strogyli1, A. Tatsioni2, E. Panagiotou1, I. Vagias1, V.E. Tsianos1, D.K. Christodoulou1, E.V. Tsianos1. 1Medical School of Ioannina, University of Ioannina, 1st Division of Internal Medicine and HepatoGastroenterology Unit, Ioannina, Greece, 2Tufts University School of Medicine and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Boston, United States