Mihai C

Bidirectional Relationship between Gastric Emptying and Plasma Glucose Control in Normoglycemic Individuals and Diabetic Patients

Gastric emptying and glycemic control pathways are closely interrelated processes. Gastric chyme is transferred into the duodenum with velocities depending on its solid or liquid state, as well as on its caloric and nutritional composition. Once nutrients enter the intestine, the secretion of incretins (hormonal products of intestinal cells) is stimulated. Among incretins, glucagon-like peptide-1 (GLP-1) has multiple glycemic-regulatory effects that include delayed gastric emptying, thus triggering a feedback loop lowering postprandial serum glucose levels. Glycemic values also influence gastric emptying; hyperglycemia slows it down, and hypoglycemia accelerates it, both limiting glycemic fluctuations. Disordered gastric emptying in diabetes mellitus is understood today as a complex pathophysiological condition, with both irreversible and reversible components and high intra- and interindividual variability of time span and clinical features. While limited delays may be useful for reducing postprandial hyperglycemias, severely hindered gastric emptying may be associated with higher glycemic variability and worsened long-term glycemic control. Therapeutic approaches for both gastric emptying and glycemic control include dietary modifications of meal structure or content and drugs acting as GLP-1 receptor agonists. In the foreseeable future, we will probably witness a wider range of dietary interventions and more incretin-based medications used for restoring both gastric emptying and glycemic levels to nearly physiological levels.

P144 Sarcopenia and osteopenia in patients with Crohn's disease

Background: Patients with Crohn’s disease (CD) are prone to sarcopenia and osteopenia. Sarcopenia represents the loss of muscle mass and strength, and is considered as well as osteopenia secondary to malnutrition. The aim of the study was to determine the prevalence of sarcopenia and osteopenia in CD patients and its relationship. Methods: We included 48 cases with CD (23 female/25 male; median age of 40 years ±15; body mass index (BMI) 20.36±3.6) and 20 healthy volunteers (10 female/10 male; median age 40 years ±15; BMI 23.2±2.7). Sarcopenia was assessed by grip strength (estimate muscle strength) and dual-energy x-ray absorptiometry (DXA) (estimate lean body mass) and defined as a skeletal muscle index (SMI) below 5.45 kg/m2 for women and 7.26 kg/m2 for men. Osteopenia was defined as a T-score for bone mineral density (BMD) below 1.0 measured by DXA. Results: We found sarcopenia in 56.2% of CD patients and osteopenia in 47.9% vs 15% and 5% of controls, respectively (P< 0.01). HGS, SMI as well as BMD was significantly lower in patients with CD than in controls (35 kg ±5 vs. 50 kg ±10; 5.9 kg/m2 ±1.2 vs. 6.4 kg/m2 ±1.5; 1.7 g/cm2 ±0.6 vs. 0.9 g/cm2 ±0.3; P< 0.01). Sarcopenic patients had significantly (P< 0.01) lower BMI (19.64 versus 21.9) than non-sarcopenic patients; 74% of sarcopenic patients were also osteopenic. Conclusions: The prevalence of sarcopenia and osteopenia is high in CD patients. These two phenomens may share similar mechanisms. Screening for sarcopenia and osteopenia may play an important role in the evaluation of CD patients.

PROTON PUMP INHIBITORS BETWEEN BENEFITS AND RISKS

PROTON PUMP INHIBITORS BETWEEN BENEFITS AND RISKS (Abstract): Proton pump inhibitors (PPI) have been widely used since 1989 because they are highly effective for acidrelated conditions. As a class, PPIs are among the safest of pharmacologic agents. In the last years concerns have risen regarding potential of adverse events due to PPI use. These include cancer risk (stomach and colorectal cancer), infection risk (pneumonia, Clostridium difficile associated diarrhea, small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, interstitial nephritis), metabolic effects on bone density with osteoporotic fractures, alteration of absorption of vitamins and minerals and the pharmacodynamic interaction with the metabolism of other medications by the hepatic cytochrome P450 enzyme systems (e.g., clopidogrel). Almost the entire evidence base regarding the safety of PPI therapy is composed of retrospective nonrandomized studies that demonstrate association but not causality and are limited by potential confounding factors. There is no evidence to support any benefit of changing existing clinical practice for preventing any of the potential adverse effects associated with PPI therapy. Therefore, in patients with appropriate indications for PPI, we should avoid continuous and high-dose therapy, considering on-demand therapy in suitable patients and step-down strategy.

NON-MALIGNANT PORTAL VEIN THROMBOSIS IN LIVER CIRRHOSIS: DIAGNOSIS AND ANTICOAGULANT TREATMENT

NON-MALIGNANT PORTAL VEIN THROMBOSIS IN LIVER CIRRHOSIS: DIAGNOSIS AND ANTICOAGULANT TREATMENT (Abstract): It has been accepted that patients with liver cirrhosis have a bleeding tendency related to the changes in the hemostatic system. However, it has now been established that patients with cirrhosis are at risk for both bleeding and thrombotic complications. These thrombotic complications include portal vein thrombosis, deep vein thrombosis, coronary or cerebrovascular infarctions and pulmonary embolism. Portal vein thrombosis (PVT) is frequently associated whith the advanced stages of liver cirrhosis. It has a wide ranging clinical spectrum from being an asymptomatic state to a potentially life-threatening situation. Development of PVT is often accompanied by complications, increased rate of morbidity and mortality and may affect patient candidacy for liver transplant. With advances in modern imaging techniques, PVT is being increasingly diagnosed. It is often difficult for the clinicians to decide whether it is acute or chronic. No definitive evidence exists regarding the treatment of acute portal vein thrombosis. Early anticoagulation with with low-molecular-weight heparin results in a higher rate of recanalisation. Although anticoagulants seem to be the most used treatment in the last few years, there is at present no consensus regarding the dose and duration of treatment.

P118 Vitamin D status and bone mineral density in patients recently diagnosed with ulcerative colitis

Background: Introduction: Inflammatory bowel diseases (IBD) are associated with an increased prevalence of decreased bone mineral density. One of the risk factors for the low bone mineral density is the inadequate level of 25 OH vitamin D. The aim of this study was to evaluate bone mineral density and level 25 OH vitamin D in patients recently diagnosed with UC. Methods: A prospective study was performed in The Center of Gastroenterology and Hepatology and included patients recently diagnosed with UC. We noted demographic and clinical data (age, sex, extent of lesions, the degree of disease activity and treatment). 25 OH vitamin D level was measured in all patients and dual-energy X-ray absorptiometry (DEXA) was performed at lumbar level and femoral neck. Results: 134 patients with UC were included; they had an average age of 46.21 years and were mostly men (59.7%) with an average evolution of the disease about 4 years (65% with an evolution <1.5 years or recently diagnosed). Most patients had extensive forms of the disease (56% left colitis, pancolitis 25.4%). In terms of disease activity: 29.9% had severe activity, 32.8% moderate, 23.9% mild and 13.4% were in clinical and biological remission. 29.1% of patients required treatment with oral or intravenous corticosteroids for about 4 months. Based on the lumbar and femoral neck osteodensitometry: 33.58% had normal BMD, 48.5% osteopenia and 17.91% osteoporosis. 25 OH vitamin D level was insufficient (<30 ng/ml) in 47% patients, normal in 31.34% patients, and 29 patients (21.64%) presented sever 25 OH vitamin D deficiency (<20 ng/ml). Conclusions: Decreased bone mineral density occurs early after the diagnosis of UC. Vitamin D deficiency is induced by extensive lesions and also by the inflammatory process. Vitamin D deficiency and the use of corticosteroids represent important risk factors in the development of bone demineralization in patients newly diagnosed with UC.

Do the needle type and the operator experience influence liver biopsy specimen quality

AimWe evaluated the influence of the type of needle and the operator’s experience on the quality of the specimen obtained at liver biopsy (LB).Material and methodWe performed a multicentre, prospective study in four university hospitals, including LBs performed using either “cutting” (TruCut) or “suction” (Menghini) needles. According to their experience, we considered the operators as “junior” (<100 LBs) or “senior” (>100 LBs).ResultsA total number of 745 LBs were evaluated, 413 performed with suction needles and 332 with cutting needles. Of all LBs, 473 where performed by “senior” and 272 by “junior” operators. The mean length of the fragment obtained was larger in LBs performed by senior (23.5±11.6 mm) vs. junior operators (15.9±9.8 mm, p<0.001) and also if modified Menghini needles were used (23.7±12.1 mm) vs. TruCut (13.0±5.2 mm, p<0.001). The number of portal tracts (PT) was higher in LBs performed by “senior” (14.3±8.8 PT) vs. “junior” operators (8.8±6.8 PT, p<0.001); and with Menghini needles (17.2±9.7 PT) vs. TruCut (8.6±5.0 PT, p<0.001).ConclusionOur study demonstrates that optimal biopsy samples are obtained by two intrahepatic passages with Menghini needles and that “senior” operators obtain better tissue samples than “junior” ones.