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Biomedical subjects

R Caprilli

Publications and source records attributed to R Caprilli.

At least 37 records · Page 2Linked to original sources
PubMed1999

"Crohn's disease activity index" is inaccurate to detect the post-operative recurrence in Crohn's disease. A GISC study. Gruppo Italiano per lo Studio del Colon e del Retto.

BACKGROUND: Even though endoscopy is considered to be the gold standard for the detection of post-operative recurrence in Crohn's disease, the Crohn's disease activity index continues to be used for this purpose. AIM: The aim of this study was, therefore, to assess the accuracy of Crohn's disease activity index to detect post-operative recurrence in Crohn's disease in comparison to endoscopy. PATIENTS AND METHODS: The study was performed in 110 patients submitted to intestinal resection for Crohn's disease of the terminal ileum. Crohn's disease activity index score was assessed at 6, 12, 24 and 36 months after surgery. At the same intervals colon-ileoscopy was performed in all patients. The Receiver Operating Characteristic analysis was used to assess the accuracy of the Crohn's disease activity index score. Some routine laboratory variables were also analyzed. RESULTS: Crohn's disease activity index was able to discriminate patients with and without recurrence in 65% of the cases. Considering 150 the standard cut-off value of Crohn's disease activity index, this figure corresponds to a specificity of 89% and a sensitivity of 30%. Out of the laboratory variables erythrocyte sedimentation rate, chloraemia and serum albumin, globally considered in a discriminant function, showed a predictive ability significantly better than Crohn's disease activity index (z = 1.97; two tailed p-value = 0.04). These variables were able to discriminate patients with and without recurrence in 88% of the cases, and at the same value of specificity for the Crohn's disease activity index reached double value of sensitivity (65%). Positive and negative predictive values of laboratory variables (80% and 78%, respectively) were better than the corresponding values of the Crohn's disease activity index score (71% and 56%, respectively). CONCLUSIONS: These results indicate that the Crohn's disease activity index alone is inadequate for detection of post-operative recurrence in Crohn's disease.

Blood Cell Count↗
PubMed1999

Evolving concepts on inflammatory bowel disease. Are we happy with the present nosology?

The term inflammatory bowel disease traditionally comprises ulcerative colitis, Crohn's disease and indeterminate colitis, an intermediate variant of the two major forms. The term is commonly used in the literature and in clinical practice even though it has never been revised in a Consensus Conference. The present nosology of inflammatory bowel disease seems not to be entirely satisfactory as it is limited to chronic diseases only and does not include several recently described idiopathic inflammatory bowel disorders. Although the aetiology of inflammatory bowel disease remains unknown, both ulcerative colitis and Crohn's disease are characterized by a similar pathogenesis which consists in a persistent intestinal inflammation resulting from disregulation of the gut mucosal immune system. The pathogenetic mechanisms could, therefore, provide a suitable criterion for the classification of idiopathic inflammatory bowel disease. A revised classification of inflammatory bowel disease is thus proposed. It seems reasonable to subclassify inflammatory bowel disease into acute and chronic forms. Acute forms should include the sudden attacks of ulcerative colitis and Crohn's disease with rapid and complete resolution and the so-called "acute self-limited colitis". The chronic forms should comprise, besides the classical forms of ulcerative colitis, Crohn's disease and indeterminate colitis, also other idiopathic inflammatory bowel conditions such as collagenous colitis, lymphocytic colitis and eosinophilic gastroenteritis.

Diagnosis, Differential↗
PubMed1998

Carbonic anhydrase I reduction in colonic mucosa of patients with active ulcerative colitis.

Ulcerative colitis (UC) is associated with low intracolonic pH and unbalanced transmucosal ionic exchanges. Along the gastrointestinal tract carbonic anhydrase isoenzyme I (CA-I) is specifically expressed in colon epithelium and is involved in mucosal control of ion, fluid, and acid-base balance. Since altered CA-I expression may play some role in UC, CA-I was measured at the mRNA and protein level and carbonic anhydrase (CA) enzyme activity was determined in colon biopsies of 14 UC patients (6 remission, 4 mild, 4 moderate UC) and of 12 healthy subjects. Patients with mild or moderate UC showed a significant reduction of CA-I mRNA and protein and of total CA activity in the inflamed mucosa compared to controls. Patients with UC in remission showed a pattern of CA-I expression and CA activity similar to controls. This is the first report showing a reduction in the expression of CA-I in active UC.

Acute Disease↗
PubMed1998

Serum levels of soluble CD30 are increased in ulcerative colitis (UC) but not in Crohn's disease (CD).

Imbalance in Th1 and Th2 subsets and their derived cytokines seems to be involved in the immune abnormalities underlying UC and CD. CD30 is a member of the tumour necrosis factor/nerve growth receptor superfamily expressed on T cells producing Th2 cytokines and released as a soluble form. In this study high levels of soluble CD30 were found in sera of UC patients independently of disease activity. Furthermore, increased titres of soluble CD30 molecule were shown, in the same patients, by mitogen-stimulated cultures of peripheral blood mononuclear cells. Our data seem to indicate that an activation of Th2 immune response is involved in the pathogenesis of UC, but not of CD. Furthermore, this finding indicates that serum soluble CD30 measurement may be helpful for differentiating these two forms of inflammatory bowel disease.

Adolescent↗
PubMed1998

Acute colitis following colonoscopy.

Colitis following colonoscopy is an acute, self-limited condition characterized by tenesmus and bloody diarrhea appearing within 48 hours of colonoscopy or sigmoidoscopy. Glutaraldehyde used for disinfection of the endoscopes is considered to be the main etiological agent. Three cases of severe acute self-limited colitis are described in this report. All three were observed within one week, and showed the typical anamnestic, clinical, endoscopic, histological, and radiological features of glutaraldehyde-induced colitis. The main characteristics in these cases were the time relationship with colonoscopy and the severity of the clinical presentation, with symptoms of systemic reaction and intense and diffuse edema of the colonic mucosa. The clinical and morphological features may mimic those of colonic ischemia. All three patients recovered completely within a few days, one spontaneously and two after treatment with steroids, antibiotics, and mesalazine. Acute colitis following colonoscopy should be regarded as one of the complications related to colonoscopy, and it should be taken into account in the differential diagnosis of acute colitis.

Acute Disease↗
PubMed1998

Hepatobiliary alterations in patients with inflammatory bowel disease: a multicenter study. Caprilli & Gruppo Italiano Studio Colon-Retto.

BACKGROUND AND METHODS: Four hundred and eighty-four patients with inflammatory bowel disease underwent clinical examination, ultrasonography, and biochemical liver function tests, to estimate the prevalence of hepatobiliary alterations. The patient group included patients without a history of liver disease. Controls were recruited from patients with functional symptoms. RESULTS: More patients with ulcerative colitis than controls had liver steatosis and increased alkaline phosphatase levels. Factors increasing the probability of liver damage were long-standing disease, the presence of moderate/severe disease activity, and treatment with steroids and mesalazine. A significant association was found between biliary disease and long-standing colitis and also therapy with steroids and mesalazine. Alkaline phosphatase and aminotransferase levels were significantly higher in Crohn's disease patients than in controls. Hepatic and biliary damage was found more commonly in the 1st year after diagnosis. CONCLUSIONS: The monitoring of hepatobiliary function is suggested for patients with inflammatory bowel disease, even in the absence of symptoms and history.

Adolescent↗
PubMed1998

Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC).

BACKGROUND: Using data from a case-control study carried out in Italy 1989-1992, we estimated the odds ratios (OR) and the population attributable risks (AR) for inflammatory bowel diseases (IBD) in relation to smoking, oral contraception and breastfeeding in infancy. METHODS: The study focused on 819 cases of IBD (594 ulcerative colitis: UC; 225 Crohn's disease: CD) originating from populations resident in 10 Italian areas, and age-sex matched paired controls. RESULTS: Compared with non-smokers, former smokers were at increased risk of UC (OR = 3.0; 95% confidence interval [CI]: 2.1-4.3), whereas current smokers were at increased risk of CD (OR = 1.7; 95% CI: 1.1-2.6). Females who reported use of oral contraceptives for at least one month before onset of symptoms had a higher risk of CD (OR = 3.4; 95% CI: 1.0-11.9), whereas no significant risk was observed for UC. Lack of breastfeeding was associated with an increased risk of UC (OR = 1.5; 95% CI: 1.1-2.1) and CD (OR = 1.9; 95% CI: 1.1-3.3). Being a 'former smoker' was the factor with the highest attributable risk of UC both in males (AR = 28%; 95% CI: 20-35 %) and in females (AR = 12%; 95% CI: 5-18%). Smoking was the factor with the highest attributable risk for CD in males (AR = 31%; 95% CI: 11-50%). Lack of breastfeeding accounted for the highest proportion of CD in females (AR = 11%; 95% CI: 1-22%). Oral contraceptive use accounted for 7% of cases of UC and for 11% of cases of CD. CONCLUSIONS: Taken together, the considered factors were responsible for a proportion of IBD ranging from 26% (CD females) to 36% (CD males). It is concluded that other environmental and genetic factors may be involved in the aetiology of IBD.

Adolescent↗
PubMed1998

In favour of prophylactic treatment for post-operative recurrence in Crohn's disease.

Endoscopic follow-up of patients resected for ileal Crohn's disease have shown that, in the absence of treatment, the post-operative recurrence rate is 70-90% within one year of the operation and 83-100% within 3 years. Post-operative recurrence requires further operation in approximately half the patients in a 10-year period of follow-up. Therapeutic strategies aimed to prevent recurrence are, therefore, needed. Evidence supporting the administration of drugs early after surgery are listed below. Evidence from morphological and immunological studies: minimal mucosal lesions have been found using scanning electron microscopy in unaffected specimens of ileum and colon from 2/3 of patients resected for Crohn's disease. An increased production of TNF alpha, IL-1 beta, IL-6 and phospholipase A2 has also been found in the unaffected mucosa of patients with Crohn's disease providing evidence for a sustained immune stimulation in Crohn's disease even in the absence of patent inflammation. These inflammatory mediators are inhibited "in vitro" by aminosalicylates and, therefore, their use early after surgery is justified. Evidence from randomised controlled trials: several randomised controlled clinical trials have shown that aminosalicylates are able to prevent post-operative recurrence. In particular, an Italian study demonstrated that the cumulative proportion of endoscopic recurrence at 36 months was significantly lower in patients treated with Asacol compared to controls (0.57 +/- 0.12 vs 0.83 +/- 0.07, p = 0.003). A less frequent occurrence of severe complications and reoperations was also observed in the Asacol group. A North American study confirmed these results at 3 years' follow-up using Salofalk. Additional evidence for effectiveness of aminosalicylates in the prevention of post-operative recurrence was provided by two more studies in which Pentasa was used. Further evidence in favour of 5-ASA treatment comes from a recent metanalysis which showed that 5-ASA is effective as maintenance treatment in Crohn's disease, in particular in patients with resection. Metronidazole and fish-oil have also been found to be useful in the prevention of post-operative recurrence in isolated reports but need further investigation. Finally, cigarette smoking and end-to-end anastomosis are considered to be associated with an increased risk of recurrence. Overall, these data suggest that to stop smoking, avoiding end-to-end anastomosis and early administration of admino-salicylates after surgery should be recommended for all patients resected for Crohn's disease.

Adrenal Cortex Hormones↗
PubMed1997

Appendectomy is an independent protective factor for ulcerative colitis: results of a multicentre case control study. The Italian Group for the Study of the Colon and Rectum (GISC)

BACKGROUND: Different exogenous factors are believed to play a role in the pathogenesis of ulcerative colitis. Smoking habits and other risk factors have received much attention. It has recently been reported that appendectomy decreases the risk of ulcerative colitis. AIM: Aim of the study was to further examine the role of appendectomy in ulcerative colitis. METHODS: A large multicentre case control study was performed. Cases were all patients with a recent new diagnosis of ulcerative colitis (from 1990 to 1994) at participating centres. One or two controls attending the orthopaedic and surgical units were considered and matched to cases for age (+/- 5 years), sex and year of diagnosis. A total of 536 cases and 755 controls were enrolled. Mean age of cases was 37.9 years (range 2-92). Assessment of exposure was done by examining the clinical records and by interview, if necessary. Smoking habits, alcohol consumption, use of oral contraceptives, type of occupation and area of residence were also recorded. Odds ratio and 95% confidence intervals were calculated by conditional logistic regression analysis. RESULTS: Forty-one out of the 536 cases (7.6%) and 150 out of the 755 controls (19.9%) had been submitted to appendectomy. A total of 110 out of 536 cases (20.5%) and 135 out of 753 (17.9%) controls had had tonsillectomy. Seven out of 41 cases and 15 out of 755 controls underwent appendectomy for recurrent pain. In all ulcerative colitis patients, appendectomy had been performed before the onset of disease. When data were adjusted for the confounding variables, ulcerative colitis patients were less likely to have had appendectomy compared with controls (odds ratio = 0.3, confidence interval = 0.19-0.48). There was no significant association of ulcerative colitis with tonsillectomy (odds ratio = 1.09, confidence interval = 0.76-1.58). The well recognized inverse association of ulcerative colitis with cigarette smoking was also shown in this study. CONCLUSIONS: The present data emerging from a large multicentre study, confirm that appendectomy has a protective role for the development of ulcerative colitis.

Adolescent↗
PubMed1996

Characterization of the mucins produced by normal human colonocytes in primary culture.

Mature goblet cells filled with mucin ready for secretion represent about one third of the cells in primary cultures of human colonocytes. In the present study characterization of the mucins produced by cultured human colonocytes was made by histochemical methods by lectin and monoclonal antibody binding. Two monoclonal antibodies and three lectins (Dolichos biflorus (DBA), Helix pomatia (HPA) and Arachis hypogea (PNA) recognizing epitopes or sugar haptens characteristic of different stages of mucin glycoprotein maturation, were employed. The reactivity to these probes was tested both on cultured colonocytes and on tissue sections of the normal colon mucosa. The results show that the mucins produced in culture are glycosylated to the mature form, as they show the same reactivity to lectins and antibodies of the mucins expressed in tissue sections of the normal colon mucosa. In addition, it is demonstrated that cultured human colonocytes do not express mucins reactive to PNA, which are characteristic of tumors. Since the cultured colonocytes maintain the expression of differentiated functions for at least three days, they may offer a useful model to study metabolism, function and regulation of colon mucins in health and disease.

Adult↗
PubMed1996

Prognostic factors for postoperative recurrence of Crohn's disease. Gruppo Italiano per lo Studio del Colon e del Retto (GISC)

UNLABELLED: Prognostic factors for postoperative recurrence of Crohn's disease (CD) have been widely investigated but not yet clearly identified. PURPOSE: Aim of this study was, therefore, to analyze the association between demographic, clinical, laboratory, and surgical characteristics of patients and the cumulative probability of endoscopic postoperative recurrence. METHODS: The study was performed in 110 patients who were enrolled in the Italian multicenter, randomized, controlled trial on the effectiveness of 5-aminosalicylic acid (5-ASA) in the prevention of postoperative recurrence in CD. Patients had undergone their first intestinal resection for CD of the terminal ileum with or without involvement of cecum ascending colon. Recurrence was defined on the basis of endoscopy. The following variables were evaluated as potential prognostic factors: gender, age, years since diagnosis, clinical course (perforative and non-perforative), Crohn's Disease Activity Index score, white blood count, erythrocyte sedimentation rate, C-reactive protein, and orosomucoids assessed before the operation. Timing of operation (elective or urgent), type of anastomosis (end-to-end, end-to-side, side-to-side), and prophylactic treatment were also evaluated. Colon ileoscopy was performed at 6, 12, 24, and 36 months after operation. The association between variables and the cumulative proportion of recurrence was analyzed both by univariate analysis (life table method, log-rank test) and multivariate regression analysis (Cox's model, stepwise procedure). RESULTS: Results of this study indicate that, of the features considered before surgery, only leukocytosis (white blood count, >9,000 ml) was significantly associated with an increased risk of recurrence (P < 0.05) at univariate analysis. This finding was not confirmed by multivariate analysis. A trend toward a higher risk of recurrence for patients who have had a resection with end-to-end anastomosis compared with those who have had a resection and other types of anastomosis was also observed. This trend reached significantly in the group of patients submitted to treatment with 5-ASA. The multivariate analysis showed that 5-ASA-treated patients with end-to-end had a risk of recurrence more than threefold higher than those with other types of anastomosis (relative risk, 3.40; 95 percent confidence interval, 1.00-11.96; P < 0.03). CONCLUSIONS: From a practical point of view, it has been estimated that the combination of intestinal resection plus side-to-side or end-to-side anastomosis with oral 5-ASA treatment reduces by 64 percent the postoperative recurrence rate in CD at three years follow-up.

Adult↗
PubMed1996

Incidence of inflammatory bowel disease in Italy: a nationwide population-based study. Gruppo Italiano per lo Studio del Colon e del Retto (GISC)

BACKGROUND: The epidemiology of inflammatory bowel disease (IBD) in Southern Europe is still unclear. Sporadic reports suggest a lower incidence of IBD in Italy than in other Western Countries and the USA. METHODS: A nationwide population-based study was carried out to estimate IBD incidence rates in eight Italian cities. All new cases of IBD diagnosed over 4 years in the target populations were collected from multiple information sources. RESULTS: From 1989 to 1992, 509 ulcerative colitis (UC), 222 Crohn's disease (CD) and 10 undefined IBD cases were collected, giving age-adjusted incidence rates (per 100,000 per year) of 5.2 for UC and 2.3 for CD. Using the capture-recapture method, an estimated completeness of 0.81 was obtained for case archives, without appreciable and significant differences between areas. The rates computed after correcting underestimation were 6.8 for UC and 2.8 for CD. The sex ratio M/F was 1.7 for UC and 1.0 for CD. The highest age-specific incidence rates were between 30 and 39 years for UC and between 20 and 29 years for CD. CONCLUSIONS: The incidence rate of CD in italy is homogeneous between the cities investigated and lower than those reported for other Mediterranean countries. In contrast, the UC incidence rate is within the range of those reported in European studies. A wide variability in the UC rates between the cities was also observed. These results could be related to different environmental factors or the genetic background of the populations, or both.

Adolescent↗
PubMed1995

Topical treatment of refractory distal ulcerative colitis with 5-ASA and sodium butyrate.

Nine patients with distal ulcerative colitis refractory to standard therapy were treated with intrarectal instillation of a sodium butyrate solution and 5-ASA. A marked clinical, endoscopical and, to a smaller extent, histological improvement was observed in seven of nine patients. The clinical improvement usually occurred within the second week of therapy, and thus earlier than in previous cases treated with butyrate alone. This preliminary experience suggests that the combined butyrate-5-ASA treatment may prove a useful therapeutic tool in refractory distal ulcerative colitis and possibly increase the effectiveness of the individual therapeutic regimens.

Administration, Topical↗
PubMed1995

Ulcerative colitis: rectal dilations in a patient with refractory diarrhea. Report of a case.

UNLABELLED: A 45-year-old man with an eight-year history of ulcerative colitis was evaluated for severe, nonbloody diarrhea. Symptoms, which began two years earlier, were characterized by 15 bowel movements per day, accompanied by urgency and incontinence. A reduced rectal compliance was measured at manometry. All conventional treatments were not able to modify the symptoms despite improvement of inflammatory colonic lesions. PURPOSE: The aim was to reduce bowel movements and incontinence by increasing rectal compliance. METHODS: Gradual pneumatic dilations of the rectum were performed three times per week for three weeks. RESULTS: The patient's diarrhea improved dramatically, decreasing in frequency from approximately 15 to only 3 bowel movements per day, while contemporaneously increasing rectal compliance. Such effect, still evident 15 months after discontinuation of dilation, was probably obtained by improvement of viscoelastic features of the intestinal wall. CONCLUSIONS: Rectal pneumatic dilation may be a successful attempt in some forms of intractable diarrhea in long-lasting ulcerative colitis.

Catheterization↗
PubMed1995

Short-chain fatty acid topical treatment in distal ulcerative colitis.

BACKGROUND: Some evidence indicates that short-chain fatty acid (SCFA) enemas are effective in the treatment of distal ulcerative colitis. METHODS: In a randomized, double-blind, placebo-controlled study, we tested the efficacy of a 6-week course of topical SCFA (100 mL, twice daily enemas of sodium acetate 80 mmol/L, sodium propionate 30 mmol/L and sodium butyrate 40 mmol/L) in 40 patients with mild to moderate distal colitis. Clinical, endoscopic and histological data were collected at the beginning and end of the study. RESULTS: Fourteen patients on SCFA improved (overall score 11.3 +/- 2.0 vs. 7.4 +/- 3.5) as compared to five in the placebo group (overall score 10.0 +/- 1.9 vs. 8.9 +/- 2.5). In the SCFA-treated group all parameters significantly improved except the number of bowel motions, whereas no significant changes were recorded in the control group. A statistically significant difference between the two treatment regimens, however, was observed only for intestinal bleeding (P < 0.05), urgency (P < 0.02) and the patient self-evaluation score (P < 0.05). This was probably due to the random inclusion of more patients with moderate disease into the SCFA-treated group, thus causing pretrial differences between the two groups. CONCLUSION: The present study confirms that irrigation with SCFA enemas is effective in distal colitis, and may represent an alternative therapeutic tool in the treatment of the disease.

Acetates↗
PubMed1995

Gastric and duodenal juxtamucosal pH and Helicobacter pylori.

One of the results of gastric cytoprotection is the generation of a juxtamucosal stable pH, maintained close to neutrality by several factors among which bicarbonate secretion and mucus layer. Since Helicobacter pylori (HP) induces structural and functional changes in the gastric mucus, this study was carried out to investigate the relationship between juxtamucosal pH and HP colonization. Thirty-one dyspeptic subjects who denied a past history of gastric or duodenal ulcer and free of endoscopic lesions were studied. Juxtamucosal pH of the gastric body, antrum and duodenum and gastric luminal fluid pH were measured during upper gastrointestinal endoscopy by a flexible glass electrode passed through the biopsy channel of a gastroscope. Multiple biopsies were subsequently taken for histological investigation, HP culture and a urea quick test. Twelve subjects (39%) were infected by HP (HP+). Juxtamucosal pH (mean +/- SE) was significantly lower (p = 0.0014) in the gastric body (5.67 +/- 0.16) in HP+ than in HP-negative (HP- 6.41 +/- 0.13 subjects, but not in the antrum (6.50 +/- 0.20 in HP+ vs. 6.52 +/- 0.09 in HP-) and in the duodenum (6.80 +/- 0.14 in HP+ vs. 6.94 +/- 0.08 in HP- subjects). No difference was found in gastric luminal fluid pH (1.71 +/- 0.23 in HP+ vs. 1.80 +/- 0.22 in HP- subjects). In conclusion, this study shows that dyspeptic HP+ patients have a reduced juxtamucosal pH in the gastric body but a pH in the antrum and duodenum similar to HP-subjects.

Adult↗
PubMed1995

[Use of isocolan in bowel preparation of patients with congestive heart failure].

The aim of this study was to verify the safety and effectiveness of a polyethylene-glycol electrolytes lavage solution (PEG-ELS) in patients with delicate fluid and electrolyte balance. Thirteen patients with chronic congestive heart failure (CHF) undergoing diagnostic colonoscopy, were asked to drink three liters of Isocolan (Bracco s.p.a.) at a rate of 500 ml/30 minutes, 8 hours before endoscopic examination. Plasma electrolytes (Na, K, C1), BUN, creatinine, glycemia, hematocrit, urine specific weight, arterial pressure, pulse rate, ECG and body weight were obtained before and after PEG-ELS supply. Colonic cleansing was judged by the same endoscopist as excellent, good or poor. Data, expressed as mean (SE), were analyzed by a two-tailed ranked test. PEG-ELS supply did not alter fluid and electrolyte balance, since no significant differences were found for all laboratory parameters studied. Out of the clinical features, diastolic arterial pressure significantly (p = 0.05) raised from 72.3 (3.0) to 78.8 (2.8) mmHg and body weight significantly (p = 0.007) increased from 70.7 (3.4) to 71.2 (3.4) kg. Colon cleansing resulted excellent in 8 patients and good in 5. This study shows that Isocolan proved to be safe in patients with CHF and that a slow drinking velocity do not impair adequate colon cleansing.

Aged↗