Renato Dani

Isolation of Helicobacter pylori from the Intestinal Mucosa of Patients with Crohn's Disease

Background:  Helicobacter species are associated with inflammatory bowel disease in rodents and in nonhuman primates. Therefore, we prospectively investigated the presence of Helicobacter species in the intestinal mucosa of patients with and without Crohns disease by culture and polymerase chain reaction (PCR) assays.

Immune Response and Gene Polymorphism Profiles in Crohn's Disease and Ulcerative Colitis

Background: Polymorphisms in genes linked to the innate and adaptive immune response may be involved in inflammatory bowel disease pathogenesis. Our aim was to investigate associations among IL1B‐511, IL1B‐31, IL1RN, TNFA‐307, TLR‐2, TLR‐4, IL2‐330, NOD2 G908R, NOD2 L1007fsinsC polymorphisms and both Crohns disease (CD) and ulcerative colitis (UC) in a Brazilian population. Methods: We studied 43 patients with CD, 42 with UC, and 541 blood donors. Polymorphisms were evaluated by PCR, PCR‐CTPP, or PCR‐RFLP. Data were analyzed in multivariate models adjusting for confounding factors. Results: IL1RN VNTR (P = 0.00, odds ratio [OR] = 2.43, 95% confidence interval [CI] = 1.50–3.90), as well as TNFA‐307 polymorphic allele (P = 0.05, OR = 1.70, 95% CI = 1.00–2.94) were associated with UC. Both NOD2 mutations (G908R, P = 0.02, OR = 6.83, 95% CI = 1.62–25.45, and L1007fsinsC, P = 0.00, OR = 20.00, 95% CI = 3.21–124.69) were associated with CD. Conclusions: Our analyses showed positive associations between proinflammatory polymorphisms at IL1RN and TNFA‐307 loci and UC, as well as polymorphisms in the NOD2 gene and CD. These results highlight the importance of different genetic profiles associated with CD and UC.

Helicobacter Species in the Intestinal Mucosa of Patients with Ulcerative Colitis

ABSTRACT In a search for Helicobacter species in the intestinal mucosae of 42 patients with ulcerative colitis (UC) and 74 without UC, only H. pylori was found. Although the bacterium was detected in UC patients by culture (7.1%) and nested PCR (19.0%), its presence was not associated with the disease (P = 0.13).

Etiology of chronic calcifying pancreatitis in Brazil: a report of 329 consecutive cases.

SummaryThe authors observed 329 consecutive cases of chronic calcifying pancreatitis (CCP) from January 1963 to January 1986. Alcoholism was the etiological agent in 282 cases (86%). In 34 patients (10%) no cause was detectable (idiopathic). Malnutrition was responsible for 10 cases (3%) and chronic familial pancreatitis was diagnosed in 3 cases (0.9%). The mean age at the apparent onset of symptoms was 36.5 ± 10.5 for the alcoholics, 22.6 ± 15.4 in the idiopathic cases and 7.3 ± 3.0 for the nutritional etiology patients. Mean age differences are statistically significant for the 3 groups. Pancreatic calcifications were found in 224 alcohol-induced cases (79%), in 32 idiopathic cases (94%), in 8 patients with malnutrition (80%) and in one patient with familial pancreatitis (33%). All cases of nutritional etiology presented severe protein-caloric deficiences with edema, and none complained of pain, but 9 had pancreatic insufficiency. Mean daily ethanol intake for the alcohol-addicted patients was 396.6 ± 286 g (range 80–1664 g) with the onset of alcoholism at 19.1 ± 6.8 yr old and 20.8 ± 8.3 (4–44) yr of alcohol indulgence. Pancreatic carcinoma developed in 7 cases. Six cases of chronic pancreatitis were seen among relatives in the group with CCP of alcoholic etiology.

The presence of Helicobacter pylori in the liver depends on the Th1, Th17 and Treg cytokine profile of the patient

The hypothesis that Helicobactermight be a risk factor for human liver diseases has arisen after the detection of Helicobacter DNA in hepatic tissue of patients with hepatobiliary diseases. Nevertheless, no explanation that justifies the presence of the bacterium in the human liver has been proposed. We evaluated the presence of Helicobacterin the liver of patients with hepatic diseases of different aetiologies. We prospectively evaluated 147 patients (106 with primary hepatic diseases and 41 with hepatic metastatic tumours) and 20 liver donors as controls. Helicobacter species were investigated in the liver by culture and specific 16S rDNA nested-polymerase chain reaction followed by sequencing. Serum and hepatic levels of representative cytokines of T regulatory cell, T helper (Th)1 and Th17 cell lineages were determined using enzyme linked immunosorbent assay. The data were evaluated using logistic models. Detection of Helicobacter pylori DNA in the liver was independently associated with hepatitis B virus/hepatitis C virus, pancreatic carcinoma and a cytokine pattern characterised by high interleukin (IL)-10, low/absent interferon-γ and decreased IL-17A concentrations (p < 10(-3)). The bacterial DNA was never detected in the liver of patients with alcoholic cirrhosis and autoimmune hepatitis that are associated with Th1/Th17 polarisation. H. pylori may be observed in the liver of patients with certain hepatic and pancreatic diseases, but this might depend on the patient cytokine profile.

Immunological Participation in Chronic Calcifying Pancreatitis

Immunological studies performed in 12 patients with chronic calcifying pancreatitis show significant increase in serum concentrations of IgA and IgM. Presence of autoantibodies to smooth muscle, mitochondria, antinuclear, gastric parietal cells and IgG was not frequent. Immune complexes were detected in the sera of 11 patients. Normal numbers of B lymphocytes and a significant decrease in T-active and total T lymphocytes were observed in peripheral blood. These results suggest an immunologic participation in chronic calcifying pancreatitis and may explain the persistence and progressive nature of the disease.

Magnetic resonance cholangiopancreatography in cystic lesions of the pancreas

There are few reports about magnetic resonance cholangiopancreatography (MRCP) in cystic lesions of the pancreas (KLP). For this reason, we have undertaken a prospective study evaluating the diagnostic efficiency of MRCP as compared with ultrasonography. Twenty-four patients with KLP were examined with magnetic resonance imaging (MRI), and standard and cholangiopancreatography. There were seven cases of cysts associated with acute pancreatitis, 11 patients with KLP and chronic calcifying pancreatitis, five cases of cystic neoplasms of the pancreas, and one polycystic disease of the gland. All cases were first submitted to ultrasonography, which failed to diagnose only a case of cyst associated with chronic pancreatitis depicted by MRCP. We used a GE Signa Horizon 1.5-T system (20 examinations) and a Siemens Magneton Plus 1.5-T machine (four examinations). Eleven patients were operated on. In all cases, it was possible to identify the cysts, the main pancreatic duct and the biliary tree, and verify the relationship of the cyst with neighboring organs. Communication of the cyst with the main pancreatic duct was described in five instances, but we cannot be sure that MRCP would have depicted all cyst–duct communications. The MRI and MRCP images were confirmed by surgery in the 11 operated-on cases. The diagnosis of duct alterations and small pancreatic stones in initial cases of chronic calcifying pancreatitis may be problematic. Clinical findings are very important data to be considered in the differential diagnosis of KLP. Together with the clinical data, MRCP is a very important technique in the diagnostic and therapeutic decision making of KLP. Standard magnetic resonance is advisable as part of the examination in all cases. MRCP is not invasive, is reliable if one knows its limitations, and the patient can return at once to his activities. It allows the analysis of many variables in one examination, contributing to better therapy.

The Presence of Helicobacter pylori in the Intestinal Mucosa is Closely Associated with Ulcerative Colitis Like Crohn's Disease (UCLCD) Phenotype

The Presence of Helicobacter pylori in the Intestinal Mucosa is Closely Associated with Ulcerative Colitis Like Crohn’s Disease (UCLCD) Phenotype Dulciene M.M. Queiroz, Adriana G. Oliveira, Maria das Gracas P. Sanna, Andreia M.C. Rocha, Gifone A. Rocha Sr., Silvia B. Moura, Renato Dani, Maria de Lourdes A. Ferrari, Frederico P. Marinho, Liano S. Moreira, Lucia P.F. Castro Crohn’’s disease (CD) is a heterogeneous disorder with diverse clinical manifestations. Recently, fibrostenosing CD was associated with a serologic response to gut microbiota such as Pseudomonas fluorescens, ASCA and mutated allele of NOD2. We investigated whether the presence of Helicobacter in the intestinal mucosa was associated with specific disease phenotypes. We studied 117 patients: 74 controls and 43 with CD (22 with fibrostenosing, 16 with perforating and 12 UCLD). Fragments from the ileum and 6 different colon regions were obtained at colonoscopy. Helicobacter was investigated by culture, Helicobacter 16S rRNA, ureAnested PCR and characterized by 16S rRNA sequencing. Gastric HP infection was diagnosed by C-UBT and serology. Seven HP strains were isolated from the intestinal mucosa of 1 (2.2%) control and 6 (14.0%) CD patients (1with perforating and 5withUCLD) (p=0.02). SpecificHPDNAwas detected in the intestinal biopsies of 7 (9.5%) controls and 17 (39.5%) CD patients (p=0.0003).No otherHelicobacter species was identified.HPwasmore frequently isolated (47.1%v3.2%, p=0.004) or detected by PCR (58.3%v 22.6%, p=0.03) in the intestinal mucosa of patients with UCLD. If we considered only the group of gastric HP-positive patients, PCR was positive in 18.4% of the controls and in 100% of UCLD CD patients (p=0.00007). The positive results of culture (0.0% v 28.6%, p=0.009) and PCR (18.2% v 47.6%, p=0.04) were negatively associated with fibrostenosing disease. Positive culture was also inversely associated with ileal localization of CD (p=0.006). No association was seen between fistulating disease and positive culture (6.3% v 18.5%, p=0.4) and PCR (25.0%v 37.0%, p=0.4). Positive culture and PCRdid not associate with diarrhea **468 The Prevalence of Erosive Esophagitis in Children: A Populationbased Study Mark A. Gilger, Hashem B. El-Serag, Craig L. Dietrich Symptoms of gastroesophageal reflux disease (GERD) occur in 2-7% of children. The manifestations of GERD can be limited to symptoms (e.g. heartburn, regurgitation) or can be more complicated, such as erosive esophagitis (EE), esophageal strictures or Barrett’s esophagus. The prevalence of such GERD complications in children is unknown. PURPOSE: To determine the prevalence of endoscopic findings of EE in children.METHODS: All children aged 0 to 18 years who underwent EGD that was recorded in the Pediatric Endoscopic Database System Clinical Outcomes Research Initiative (PEDS-CORI) between 1999 and 2002 were included. Endoscopic reports that were incomplete, missing demographic features, indications for endoscopy or endoscopic findings were excluded. EE was defined either descriptively (erythema, erosion, ulcer) or by Los Angeles classification. Esophageal biopsy was not evaluated. RESULTS: 8038 children who underwent EGD fulfilled the inclusion and exclusion criteria. Of those, 1070 (13.3%) had EE. The mean age of children with children with EE was 12.6 (+/ 5.6) yrs vs. 10.0 (+/ 6.0) yrs in those without EE (p=<0.0001). There were 575 (53.7%) males with EE as compared with 3315 (46.7%) in those without EE (p=.0002). EE was found in 106 (9.9%) children aged 0-2 years, 73 (6.8%) children aged 3-5 years, 277 (25.9%) children aged 6-12 years, and 432 (40.4%) children aged 13-17 years. Hiatal hernia was found in 108 (10.1%) of children with EE, compared to 228 (3.2%) in those without EE (p=<0.0001). Mucosal abnormalities were identified in 390 (36.4%) of children with EE vs. 1327 (19.0%) of those without EE (p=<0.0001). The prevalence of Barrett’s esophagus, esophageal stricture, ulcer, prior surgery, nodules, foreign body/retained food and anatomical abnormalities were not significantly different between children with EE and those without. CONCLUSIONS: The prevalence of erosive esophagitis is slightly higher inmales and increases with age. In contrast to erosive esophagitis in adults, there were no significant variations according to race or ethnicity. Hiatal hernia is the only clinical observation that predicts the presence of EE.