Fumitoshi Kuroki

Multiple vitamin status in Crohn's disease. Correlation with disease activity.

We measured serum, blood, or red cell concentrations of various vitamins in 24 patients with Crohns disease who had been free from any nutritional treatment, and compared them with those in 24 healthy controls. Twelve of the patients were affected in the small bowel only, two in the large bowel only, and the remaining 10 in both the small and large bowel. The fat-soluble vitamins A and E were significantly decreased in patients with Crohns disease compared to controls. Among the water-soluble vitamins, vitamins B1, B2, and B6, and folic acid were more depleted in patients with Crohns disease than in the controls, whereas vitamins B12 and C, nicotinic acid, and biotin were not different between the two groups, and pantothenic acid was increased in patients with Crohns disease. In addition, vitamin B2 and nicotinic acid showed a negative correlation with the Crohns disease activity index. These findings suggest that there is a variety of vitamin deficiencies in Crohns disease prior to treatment and also that concentrations of some vitamins, such as vitamin B2 and nicotinic acid, may reflect the severity of the disease.

Application of magnifying chromoscopy for the assessment of severity in patients with mild to moderate ulcerative colitis

BACKGROUND A magnifying colonoscope that enables high-power observation of the colorectal mucosa has been recently developed. The aim of this study was to investigate the value of the magnifying instrument in determining the severity of ulcerative colitis. METHODS Magnifying colonoscopy was performed in 41 patients with ulcerative colitis, and the findings in the rectum were graded according to network pattern and cryptal openings. These findings were correlated with endoscopic, clinical, and histologic severity of the disease. RESULTS Magnifying colonoscopy did not detect network pattern in 37% and cryptal opening in 24% of the subjects. The clinical, endoscopic, and histologic grades of activity were not different between groups divided by the presence or absence of each finding. However, when the two features were coupled, patients with visible network pattern and cryptal opening had a lower clinical activity index and lower grade of histologic inflammation than those in whom both findings could not be visualized. CONCLUSIONS Observation under magnifying colonoscopy can be another clue to determining the severity of disease in patients with ulcerative colitis.

Serum n3 Polyunsaturated Fatty Acids Are Depleted in Crohn's Disease

To determine fatty acid patterns in Crohnsdisease, we measured various serum fatty acids by gaschromatography in 20 patients with the disease andcompared them with those in 18 healthy controls. All the patients had been free from any nutritionalsupplementation during preceding six months or had nohistory of intestinal resection. Eight of the patientswere affected in the small bowel only, three in the large bowel only, and the remaining ninein both the small and large bowel. Both serumconcentrations and percentages of C20:4n6,C20:5n3, C22:0,C22:6n3, total n3 polyunsaturated fattyacids, and total polyunsaturated fatty acids were lower in the patients than inthe controls. Both essential fatty acids(C18:2n6, C18:3n3) andC20:3n9 levels were not different between thetwo groups. Among nine fatty acids that correlated with the Crohns disease activity index,C20:5n3 and total n3 polysaturated fattyacids showed the most significant negative correlations.These findings suggest that essential fatty aciddeficiency rarely occurs in Crohns disease and alsothat n3 polyunsaturated fatty acids may be relevantto the activity of the disease.

Selenium Is Depleted in Crohn’s Disease on Enteral Nutrition

Backgroud/Aims: Selenium is an important trace element and its deficiency has been reported to be associated with cardiomyopathy or gastrointestinal cancer. The aim of this study is to clarify the selenium status in Crohn’s disease (CD) on enteral nutrition. Methods: We measured serum selenium concentrations in 53 patients with CD and compared them with those in 21 healthy controls. Twenty-nine patients were under the treatment by enteral nutrition (EN group), and the remaining 24 patients were free from formulated enteral nutrition (non-EN group). Results: While the serum selenium concentration in the non-EN group was not decreased when compared to controls, the value in the EN group was significantly lower than those in the non-EN group and in controls. Clinical manifestations of selenium deficiency were found in a patient on exclusive enteral nutrition. In the EN group, the serum selenium concentration showed an inverse correlation with the duration and the daily dose of enteral nutrition. In the non-EN group, the serum selenium concentrations were inversely correlated with the Crohn’s disease activity index. Conclusion: These findings suggest that patients with CD on enteral nutrition are at risk for selenium deficiency and that even patients without enteral nutrition may develop selenium deficiency at the active phase of the disease.

Breath hydrogen test using water-diluted lactulose in patients with gastrointestinal amyloidosis.

To investigate small bowel motility in gastrointestinal amyloidosis, lactulose breath hydrogen tests were performed on 16 patients with histologically proven amyloidosis and 12 age- and sex-matched controls. Fasting breath hydrogen concentration (FBHC) was not significantly different between the two groups, but there was a tendency for FBHC in symptomatic amyloidosis patients (median 31.5, range 3–78 ppm) to be higher than in asymptomatic amyloidosis patients (4, 0–34 ppm, 0.05<P<0.1) and controls (6, 1–19 ppm, 0.05<P<0.1). Orocecal transit time (OCTT) was significantly delayed in the amyloidosis group (median 150, range 40–220 min) when compared to the controls (60, 20–110 min,P<0.01), but OCTT was not statistically different between symptomatic and asymptomatic amyloidosis patients. These data suggest an impaired motility of the stomach and small intestine in gastrointestinal amyloidosis and the possible role of small intestinal dysfunction such as bacterial overgrowth and malabsorption in the occurrence of symptoms in this disorder.

Preventive effect of immunosuppressive agents against indomethacin-induced small intestinal ulcers in rats

The mechanism of nonsteroidal antiinflammatory drug-induced intestinal ulcers is not clearly understood. To evaluate whether immunosuppressants have a preventive effect against indomethacin-induced gastrointestinal damage, we investigated the effects of prednisolone, cyclosporin, and the newly developed immunosuppressant FK-506 in intracolonically indomethacin-treated rats: 24 mg/kg of indomethacin, administered intracolonically for two days, caused gastric ulcers and two types of small intestinal ulcers (longitudinal ulcers and scattered small ulcers). Pretreatment with intraperitoneal immunosuppressants reduced the size of gastric ulcers. Both cyclosporin (10 mg/kg) and FK-506 (1 mg/kg, 2 mg/kg) treatments significantly reduced the incidence and the length of the longitudinal ulcers of the small intestine when compared to the vehicle-treated controls, whereas prednisolone (20 mg/kg) did not show any preventive effect. Furthermore, the number of small scattered ulcers of the small intestine was significantly reduced by the high dose of FK-506 (2 mg/kg), but not by cyclosporin or prednisolone. These findings indicate that immunosuppressants have protective and antiinflammatory effects in indomethacin-induced gastroenteropathy, suggesting that cytokines may be important mediators in the pathogenesis of enteropathy induced by nonsteroidal antiinflammatory drugs.

Is Vitamin E Depleted in Crohn’s Disease at Initial Diagnosis?

We measured serum and red blood cell concentrations of vitamin E and serum lipid concentrations in 13 inpatients at the initial diagnosis of Crohns disease and compared them with those of 12 healthy controls. Although the serum concentrations of vitamin E were significantly lower in the patients with Crohns disease than in the controls, the red blood cell concentrations of this vitamin did not differ between the two groups. The serum concentrations of total lipids and total cholesterol were decreased in the patients with Crohns disease. A significant correlation was found between the red blood cell concentration of vitamin E and the serum vitamin E/serum total lipids ratio in both the groups. There was no correlation between the Crohns disease activity index and serum or red blood cell levels of vitamin E. These findings suggest that the lowered serum vitamin E levels in patients with Crohns disease are a symptom of hypolipidemia, and that vitamin E deficiency may not actually become a serious problem in patients diagnosed with Crohns disease.

An animal model of longitudinal ulcers in the small intestine induced by intracolonically administered indomethacin in rats

SummaryThe ulcerogenic effect of intracolonically administered indomethacin was evaluated in rats. Conventionally fed rats aged from 5 to 10 weeks were treated by 8, 16, 24, or 32 mg/kg of intracolonic indomethacin for two days, and any damage to the stomach, small intestine and the colon was investigated. Longitudinal ulcers and scattered small ulcers were found in the small intestine at all doses of indomethacin, and the length of the longitudinal ulcers increase dose-dependently, but this was unrelated to the body weight of the rats. The cecum was frequently affected by irregularly shaped ulcers, and the incidence increased as the dose of indomethacin increased. The colon, other than the cecum, was not involved macroscopically. In contrast, the stomach was affected by only large doses of indomethacin (24 or 32 mg/kg), and the size of gastric ulcers increased according to the body weight of the rats. These findings suggest that intracolonic indomethacin in relatively young rats causes ulcers predominantly in the small intestine and the cecum, which are the frequent site of involvement of human Crohn’s disease, and that this animal model may be suitable for investigation of the pathophysiology of inflammatory bowel disease.

A case of systemic malignant lymphoma with intestinal involvement of lymphomatous polyposis type

Multiple lymphomatous polyposis is a rare type of intestinal lymphoma characterized by non-Hodgkins lymphoma of follicular mantle cell origin and extremely poor prognosis. We report a case of systemic lymphoma with the intestinal involvement of multiple lymphomatous polyposis. Although radiographic and endoscopic features of the case were compatible with multiple lymphomatous polyposis, histologic evidence suggested the diagnosis of diffuse large cell lymphoma rather than mantle cell lymphoma. Our case seems to be unique in its histologic findings and also in its prognosis, because the patient has been alive for more than 50 months after diagnosis.