Guido Basilisco

Oral naloxone antagonizes loperamide-induced delay of orocecal transit

Orocecal transit time was determined by the lactulose hydrogen breath test in nine healthy volunteers after administration of placebo, loperamide (16 mgper os), and loperamide (16 mgper os) followed by oral naloxone at doses of 16 and 32 mg. The four tests were performed in double-blind conditions and in random sequences. Transit time (mean,sd) after loperamide (128.8 min, 32.9) was significantly increased (P<0.05) compared with placebo (85.5 min, 35.7), loperamide followed by naloxone 16 mg (88.8 min, 46.2), and loperamide followed by naloxone 32 mg (84.4 min, 40.6). These results show that the peripheral opioid agonist loperamide delays orocecal transit in healthy subjects and that naloxoneper os at adequate doses antagonizes this effect.

Epstein-Barr virus-associated lymphoma in Crohn's disease

Although no increased risk of developing lymphoproliferative disorders has been observed in population-based studies of patients with Crohns disease, the possibility has been suggested in the subset of patients previously treated with thiopurine metabolites and suffering from concomitant Epstein-Barr virus infection. A few cases of lymphomas have occurred in patients with Crohns disease treated with infliximab, only one of whom showed the presence of the Epstein-Barr virus genome. We here describe the case of a patient with steroid-dependent ileal Crohns disease treated with azathioprine and a single infusion of infliximab, who developed a diffuse large B cell ileal lymphoma. Epstein-Barr virus genome was detected in the neoplastic cells by means of polymerase chain reaction. Epstein-Barr virus may be detected in the neoplastic tissues of lymphomas of patients with Crohns disease treated with immunosuppressants and infliximab. The identification of such cases may help to define the frequency of this association and how to manage the lymphoproliferative disorder.

Rectal hyperreactivity to distention in patients with irritable bowel syndrome: role of distention rate

BACKGROUND AND AIMSnRectal motor hyperreactivity to distention may be involved in the pathophysiological course of defecatory symptoms in patients with irritable bowel syndrome (IBS), but results of patient studies are conflicting, possibly because of differences in the applied distention rate. Because a fast rate of distention increases the rectal motor response in healthy subjects, it also may show hyperreactivity in patients with IBS. The aim of this study is to compare the effects of 2 distention rates on rectal motor responses and sensations in 16 patients with IBS and 12 healthy subjects.nnnMETHODSnRectal distensibility and the frequency of rectal contractions and sensations were recorded during volume-controlled rectal distentions at 2 distention rates (10 and 100 mL/min).nnnRESULTSnRecta of patients with IBS were significantly less distensible than those of healthy subjects during fast distention (P = 0.0006), but this difference was not statistically significant during slow distention (P = 0.07). The frequency of rectal contractions and sensations, the majority of which were sensations of gas and a desire to defecate, were significantly greater in patients with IBS during both slow and fast distentions (both P < 0.025).nnnCONCLUSIONSnRecta of patients with IBS are hyperreactive to distention, and fast distention magnifies this abnormal motor response. A greater frequency of sensations during a fixed-time distention period may help to characterize the patients.

Anorectal dysfunction and delayed colonic transit in patients with progressive systemic sclerosis

We studied 14 unselected patients with progressive systemic sclerosis (PSS), six with constipation, and eight with normal bowel habits. A control group, matched for age and sex, comprised six patients with idiopathic constipation and seven healthy subjects. Anorectal manometry was performed with perfused catheters and segmental colonic transit was measured by a radiopaque marker technique. The resting pressure of the anal canal was significantly reduced in PSS with constipation (P<0.05). The rectoanal inhibitory reflex was detected in only one PSS patient with constipation, but was present in seven of eight PSS patients with normal bowel habits and in all controls (P<0.01). Total and right colonic transit times were significantly delayed in PSS with constipation and in patients with idiopathic constipation (P<0.05). In patients with PSS, colonic transit was delayed and anal sphincter function was impaired in constipated patients, suggesting involvement of both the colon and the anorectum by the disease.

Orocecal transit delay in obese patients

Orocecal transit time was assessed with lactulose hydrogen breath test in 12 obese patients during intravenous infusion of placebo or naloxone 40 μg/kg/hr given in randomized order and in double-blind conditions. Transit time was also evaluated in 22 healthy controls. Orocecal transit was significantly (P<0.01) longer in the obese patients during placebo treatment (median 130, range 100–200 min) than in the healthy controls (median 75, range 40–170 min). Compared with placebo, transit time in the obese subjects was delayed (P<0.05) during naloxone treatment (median 150, range 100–230 min).

The use of methotrexate for treatment of inflammatory bowel disease in clinical practice

BACKGROUNDnMethotrexate is considered a treatment for Crohns disease, whilst few data in ulcerative colitis are available.nnnAIMnTo evaluate frequency, indications, efficacy and safety of methotrexate in inflammatory bowel disease patients.nnnMETHODSn5420 case histories were reviewed.nnnRESULTSnMethotrexate was prescribed to 112 patients (2.1%; 89 Crohns disease, 23 ulcerative colitis). It was the first-line immunosuppressive option in 32 (28.6%), it was an alternative drug due to toxicity or failure of thiopurines in 80 (71.4%). Steroid-dependence represented the main indication both when it was used as first (13/32, 40.6%) and second option (41/80, 51.2%). Efficacy was considered optimal in 39/112 (34.8%), partial in 29/112 (25.9%), absent in 22/112 (19.6%), not assessable in 22/112 (19.6%). Side effects happened in 49 out of 112 patients (43.7%) (39 Crohns disease, 10 ulcerative colitis), leading to drug discontinuation in 38 (33.9%). The occurrence of side effects was approximately fivefold higher in patients who did not receive folic acid (14/19, 73.7%) than in those who did (35/93, 37.6%): odds ratio 4.64, 95% confidence interval 1.54-14.00; p=0.005.nnnCONCLUSIONSnThe use of methotrexate appears to be negligible in clinical practice. However, our results suggest that, if appropriately used, methotrexate could be more widely administered to inflammatory bowel disease patients with complicated disease.

Assessing the activity of perianal Crohn's disease: Comparison of clinical indices and computer-assisted anal ultrasound

Background: Assessing perianal disease activity is important for the treatment and prognosis of Crohns disease (CD) patients, but the diagnostic accuracy of the activity indices has not yet been established. The aim of this study was to determine the accuracy and agreement of the Fistula Drainage Assessment (FDA), Perianal Disease Activity Index (PDAI), and computer‐assisted anal ultrasound imaging (AUS). Methods: Sixty‐two consecutive patients with CD and perianal fistulae underwent clinical, FDA, PDAI, and AUS evaluation. Perianal disease was considered active in the presence of visible fistula drainage and/or signs of local inflammation (induration and pain at digital compression) upon clinical examination. The AUS images were analyzed by calculating the mean gray‐scale tone of the lesion. The PDAI and gray‐scale tone values discriminating active and inactive perianal disease were defined using receiver operating characteristics statistics. Results: Perianal disease was active in 46 patients. The accuracy of the FDA was 87% (confidence interval [CI]: 76%–94%). A PDAI of >4 and a mean gray‐scale tone value of 117 maximized sensitivity and specificity; their diagnostic accuracy was, respectively, 87% (CI: 76%–94%) and 81% (CI: 69%–90%). The agreement of the 3 evaluations was fair to moderate. The addition of AUS to the PDAI or FDA increased their diagnostic accuracy to respectively 95% and 98%. Conclusions: The diagnostic accuracy of the FDA, PDAI, and computer‐assisted AUS imaging was good in assessing perianal disease activity in patients with CD. The agreement between the techniques was fair to moderate. Overall accuracy can be increased by combining the FDA or PDAI with AUS.

Is the subjective perception of lactose intolerance influenced by the psychological profile

Symptoms of lactose intolerance are often attributed to lactose malabsorption but, as this relationship has not been demonstrated when a small dose of lactose similar to that contained in one cup of milk is ingested by intolerant patients, psychological factors may play a role in altered symptom perception.

Repeatability of lactulose hydrogen breath test in subjects with normal or prolonged orocecal transit.

The within-subject repeatability of orocecal transit assessed with lactulose hydrogen breath test was evaluated in 15 healthy volunteers and 16 constipated or obese patients. The test was repeated twice in each subject. Mean (sd) transit time was 105 (63) and 103 (60) min in the first and second series of tests, respectively, showing that the first measurement did not affect the second. The within-subject repeatability of the test was related to the length of transit, the scatter of the differences between the first and second test being greater with the increase of the mean gastrointestinal transit time. The 95% coefficient of repeatability was 84 min for all measurements and 30 and 118 min, respectively, for transit times under and over 100 min. The lowest reproducibility of the test was found in constipated patients with prolonged orocecal transit.

Perceptual sensitivity and response bias during rectal distension in patients with irritable bowel syndrome.

Abstractu2002 Patients with irritable bowel syndrome (IBS) report an increased frequency of sensations during rectal distension in comparison with healthy subjects. This alteration might be due to a psychological response bias leading patients to over report their sensations. The aim of this study was to measure perceptual sensitivity and response bias during rectal distension in healthy subjects and IBS patients using the sensory decision theory (SDT). Thirteen healthy subjects and 22 IBS patients underwent five rectal distensions up to 100u2003mL, five up to 200u2003mL and five sham distensions. They were asked to identify the distension by means of an electronic marker. Perceptual sensitivity and response bias were calculated according to the SDT. The patients identified a more 100u2003mL distensions than the healthy subjects (Pu2003=u20030.02), whereas there was no difference in the number of identified 200u2003mL and sham distensions between the two groups. The perceptual sensitivity of IBS patients was significantly greater during 100u2003mL (Pu2003=u20030.01), but not during 200u2003mL distensions. The response bias was not significantly different between the two groups. These data suggest that the increased frequency of sensations reported by IBS patients is not due to a psychological response bias.