genes in human CD.Conversely, given recent developments, the role of the human CD susceptibility gene Nod2 (Nature 2001;411:599-606) in SAMP1/Yit mice raises interesting questions.Furthermore, the adoptive transfer of ileitis by SAMP1/Yit T cells suggests that ileal antigens, possibly luminal microbial determinants, drive the inflammatory process.This model, therefore, provides an important opportunity to characterize regional immunologic and microbiologic differences that could explain the distribution of inflammation in CD.Furthermore, the natural history of fibrogenesis may be studied and potential therapeutic interventions aimed at inhibiting this process designed.Immunologic factors that determine transmural mucosal inflammatory changes may be characterized.Could the chronicity of transmural inflammation in these mice possibly lead to fistulization?Perhaps the natural history of surgical resection and postoperative recurrence could be investigated.In conclusion, the SAMP1/Yit mouse is a unique model for human CD and its further study should yield important information about the genetics, immunology, natural history, and therapy of CD.
Background and Study Aims: Many lesions found during push enteroscopy to evaluate obscure gastrointestinal bleeding are within the reach of standard endoscopes. The aim of this study was to determine whether the rate of proximal lesions varies in relation to the type of obscure bleeding that is present. Patients and Methods: A retrospective review of consecutive push enteroscopies carried out for obscure gastrointestinal bleeding between July 1996 and July 2000 was conducted. The patients were categorized into three groups: those with recurrent obscure/overt gastrointestinal bleeding; those with persistent obscure/overt gastrointestinal bleeding; and those with obscure/occult gastrointestinal bleeding. Results: A total of 63 patients (24 men, 39 women; mean age 69.8) were included. Push enteroscopy examinations were conducted for recurrent obscure/overt bleeding in 32 patients; for persistent obscure/overt bleeding in 12 patients; and for obscure/occult bleeding in 19 patients. The overall diagnostic yield of push enteroscopy was 47 % (15 of 32) in the group with recurrent obscure/overt bleeding; 66 % (eight of 12) in the group with persistent obscure/overt bleeding; and 63 % (12 of 19) in the group with obscure/occult bleeding. However, when lesions within the reach of standard esophagogastroduodenoscopy (EGD) were excluded, the yield of push enteroscopy was slightly higher in the group with recurrent obscure/overt bleeding (41 %) than in the groups with persistent obscure/overt bleeding (33 %) and obscure/occult bleeding (26 %). There were fewer lesions within the reach of EGD in the group with recurrent obscure/overt bleeding than in the groups with persistent obscure/overt bleeding (6 % vs. 33 %; P < 0.05) or obscure/occult bleeding (6 % vs. 37 %; P < 0.05). Conclusions: Patients undergoing push enteroscopy for recurrent obscure/overt bleeding were significantly less likely to have lesions within the reach of EGD than patients with persistent obscure/overt bleeding or obscure/occult bleeding. Patients in the latter two groups would be able to undergo a repeat EGD examination before more intense evaluation with push enteroscopy or capsule endoscopy.
There are few randomized, prospective trials evaluating the optimal diagnostic and therapeutic strategies in the management of lower gastrointestinal bleeding. However, recent data suggest that urgent colonoscopy represents a safe and effective initial diagnostic approach. The role of tagged erythrocyte scintigraphy is yet to be defined, but it may be of utility as a screening test for visceral angiography. Colonoscopy and angiography both offer substantial therapeutic options but remain of unproved benefit from a treatment standpoint; surgery continues to play an important role in the management of lower gastrointestinal bleeding. Obscure gastrointestinal bleeding, which often presents as lower gastrointestinal bleeding, continues to be one of the most challenging diagnostic and therapeutic problems in gastroenterology. Occult gastrointestinal bleeding, often arising from the lower gastrointestinal tract, usually mandates gastrointestinal evaluation.
The addition of somatostatin receptor scintigraphy and endoscopic ultrasound to the preoperative assessment of patients with Zollinger-Ellison syndrome has improved the ability to localize gastrinomas. We report a patient with Zollinger-Ellison syndrome with a gastrinoma localized preoperatively by endoscopic ultrasound only. We review the literature regarding the sensitivity of somatostatin receptor scintigraphy and endoscopic ultrasound and discuss the approach to imaging in Zollinger-Ellison syndrome.
Purpose: The FDA indicated dosages of Asacol® (mesalamine) delayed-release tablets are 2.4 g/day for the treatment of mild-moderately active ulcerative colitis (UC) and 1.6 g/day for maintenance of remission. There is anecdotal evidence that maintaining the induction dose may be better than dose-reduction to prevent relapse. This study used a naturalistic, retrospective design to compare the outcomes of UC patients maintained on the dose used to induce remission with those whose maintenance dose was reduced. Methods: The medical records from 411 UC patients from 39 geographically dispersed, community gastroenterology practices who had a disease flare between 1999 and 2003 successfully treated with Asacol without requiring steroids were reviewed. The review included the single flare of interest and the subsequent maintenance period. Outcome measures examined were maintenance of remission at 6 and 12 months post-induction, and% rated “normal” on the physician global assessment of symptom severity (PGA) at final data capture. The primary explanatory variable was the relation between maintenance (M) and induction (I) dose, coded as M = I vs. M < I. Other covariates examined were: Final induction dose: grouped on g/day, ≤2.4, 3.2–4.0, ≥4.8 Extent of disease: proctitis+proctosigmoiditis vs. left-sided vs. extensive Severity of disease: mild vs. moderate+severe Prior history: 1st flare vs. subsequent flare without immediately prior maintenance medication vs. subsequent flare while on maintenance medication. Results: In logistic regression analyses, no variables were significantly (p < .05) predictive of maintenance of remission at 6 or 12 months. When the initial PGA was forced into the logistic regression model first, to control for severity of attacks and to assess the impact of the other variables, the only significant predictor of final PGA was M = I vs. M < I (p < .01, OR = 2.21, 95% CI = 1.36–3.58). Results are shown in the table below.Table: No Caption available.Conclusions: Maintaining the same dose of Asacol used to induce remission significantly increased the likelihood of UC patients receiving a physician's global assessment of “normal” at one year post-induction. This finding was consistent across dosage levels and extent of disease.
