Vivek V. Gumaste

Erythrocyte sedimentation as a measure of Crohn's disease activity: opposite trends in ileitis versus colitis.

To test our hypothesis that the erythrocytic sedimentation rate (ESR) correlates well with clinical activity in inflammatory disease of the colon, but not of the small bowel, we stratified 49 Crohns disease patients according to their anatomic involvement and then measured the correlations between ESR and clinical activity within each of these anatomical subgroups. For 18 patients with Crohns disease involving primarily the colon, there was a trend toward a direct correlation between clinical score and ESR (p = 0.15). In the 14 patients with Crohns disease limited to the colon, this direct correlation was even more pronounced and statistically significant (p < 0.02). By contrast, an opposite trend was observed for patients with small bowel disease. For the 26 patients with disease involving predominantly the small bowel, as well as for the 22 with disease limited to small bowel, there were statistically significant inverse correlations between clinical score and ESR (p < 0.04). This difference between the directions of the correlations for Crohns colitis versus ileitis was statistically significant (p < 0.05). This study provides further evidence for the importance of analyzing putative indications of disease activity separately for each of the protean forms in which Crohns disease occurs.

Coombs-positive autoimmune hemolytic anemia in ulcerative colitis

SummaryCoombs-positive autoimmune hemolytic anemia is a rare complication of ulcerative colitis, occurring in fewer than 1% of cases. We have found eight patients with autoimmune hemolytic anemia in a series of 1150 hospitalized patients with ulcerative colitis (0.7%). There was a marked preponderance of female patients F∶M=7∶1, in accord with previous reports. The hemolytic anemia appeared at a mean of 10 years after the onset of colitis, apparently independent of the age of the patient. Although seven of the eight patients had active colitis at the time of diagnosis of anemia, there was no consistent relationship to the extent of the bowel disease.Seven of the eight patients survived. One patient showed a partial response to steroid therapy, two responded to splenectomy, but four required both colectomy and splenectomy. Steroids should be the first line of therapy followed by splenectomy, if necessary. For those patients who have severe colitis, which in itself would merit surgery, a total proctocolectomy combined with splenectomy seems advisable.

Colchicine therapy of the renal amyloidosis of ulcerative colitis.

Two patients with severe proteinuria, due to renal amyloidosis complicating chronic ulcerative colitis, improved remarkably with colchicine therapy. One patient with an initial daily urine protein excretion of 13.70 g had a reduction within 2 mo to 6.50 g and to 0.37 g after 9 yr. The other patients daily urine protein excretion was 9.00 g. This was reduced to 5.10 g/day within 3 mo and was 0.53 g/day by 8 mo. Renal function remained stable or improved during the period of therapy. Colchicine resulted in rapid and prolonged benefit for these patients, despite their amyloid-induced nephrotic syndrome.

Treatment of Gastroparesis: An Update

Gastroparesis is a chronic disorder of gastric motility that is characterized by delayed emptying of either solids or liquids from the stomach in the absence of any mechanical obstruction. Nausea, vomiting, early satiety and bloating are some of the manifestations of gastroparesis. Idiopathic, diabetes mellitus and postsurgical states account for the majority of cases. Gastroparesis is a difficult condition to treat. Prokinetic drugs like metoclopramide and erythromycin form the mainstay of therapy but are less than ideal. Some patients may benefit from endoscopic botolinium toxin injection. Gastric electrical stimulation, though promising, is not ready for prime time yet.

Pancreatic tuberculosis: a frequently fatal but potentially curable disease

A 40-year-old man with prolonged constitutional symptoms and clinical evidence of pancreatitis and biliary tract obstruction underwent exploratory laparotomy. Intraoperative liver and pancreatic biopsies revealed acid-fast bacilli. Mycobacterium tuberculosis subsequently grew from both sputum and urine cultures. The patient responded well to antituberculosis therapy, although 8 months later, he returned with acquired immunodeficiency syndrome (AIDS) and died of large cell lymphoma 1.5 years later. A review of the literature showed that most similar cases of pancreatic tuberculosis were diagnosed only at postmortem examination. A high index of suspicion and attention to special stains are warranted for diagnosis of this frequently fatal, but potentially curable, disease.

CT colonography can be an adjunct to optical colonoscopy in CRC screening.

CT colonography or virtual colonoscopy is a fairly new modality that has the potential to play a significant role in screening for colon cancer. CT colonography is an attractive option for two specific reasons. First, it is non-invasive and, second, it obviates the need for sedation. It thus overcomes the two major drawbacks of optical colonoscopy. CT colonography cannot be a stand-alone technique for colorectal cancer screening because, unlike conventional colonoscopy, it does not possess a therapeutic option or a definite diagnostic capability. However, CT colonography can be a cost-effective complement to traditional colonoscopy if it is reasonably priced and if appropriate cut-off levels (>6xa0mm polyp) are used to increase its sensitivity.

Contents Vol. 78, 2008

C. Beglinger, Basel (Switzerland) B. Göke, Munich (Germany) International Journal of Gastroenterology Founded as ‘Archiv für Verdauungskrankheiten’ 1895 by I. Boas Continued as ‘Gastroenterologia’ 1939–1967 Former Editors: P. Morawitz (1934–1936), R. Staehelin (1937–1943), A. Hurst (1940–1945), W. Löffl er (1943–1961), T.C. Hunt (1947–1967), N. Henning (1953–1962), B. Ihre (1953–1967), H. Bartelheimer (1963–1967), M. Demole (1963–1971), H. Kapp (1968–1970), R. Lambert (1972–1978), W. Creutzfeldt (1979–1992), R. Arnold (1993–2003)