Volume 72 - 2009 - Fasc.3 - Original articles
Octreotide in chemotherapy induced diarrhoea in colorectal cancer : a review article
Background : Chemotherapy-induced diarrhoea (CID) is well known in cancer management. The risk is greater when the pri- mary cancer is colorectal. This article aims towards assessing the role of octreotide in CID through an extensive literature search.
Methods : After searching through PUBMED, MEDLINE and the Cochrane library, only those studies which were published over the last 20 years in English and where at least the majority of the cohort were colorectal patients, were included. Two randomized trials, four non-randomized studies and two case-series publica- tions were thus considered.
Results: It was seen in both the randomized studies, that octreotide had much better outcome as compared to loperamide in treating severe CID. Among 88 patients from the non-randomized studies with severe CID, the primary cancer was colorectal in 79 patients. 61 patients had drug-resistant CID. Within a maximum of 96 hours, octreotide reduced CID by = 2 grades in 91% of 88 patients and in 88.52% patients with drug-resistant CID.
Conclusion : Octreotide is effective in treating severe CID, resist- ant to other modes of treatment. It is associated with a few minor adverse effects. Though expensive, octreotide could be considered as first line medication in CID of grades 3 or above. Its use in lower grades of CID would not be cost effective. (Acta gastroenterol. belg., 2009, 72, 289-295).
High fat consumption in children with celiac disease
Aim : The purpose of this study was to estimate the caloric intake and fat consumption in children with celiac disease (CD) following a gluten-free diet (GFD).
Patients and methods : This study enrolled 100 subjects, includ- ing 50 children with CD on a gluten-free diet and a control group of 50 healthy children. Statistical analysis to compare groups was performed using one-way ANOVA.
Results : A significant increase in fat consumption was observed in children with CD as compared to healthy children. The daily fat intake was 72.5 ± 37.2 g per 100 g of food in the CD group and 52.9 ± 35.4 g per 100 g of food in the control group (p < 0.008). A significant difference in fat intake was found between celiac and healthy females (10.21 ± 3.15 g/100 g in the celiac group vs 7.46 ± 2.91 g/100 g in the control group), p = 0.004.
Conclusions : This study describes a significantly higher fat consumption in patients with CD on GFD as compared to controls. This increase was more pronounced in females and during the puberal age. Based on these interesting preliminary results we estimate that further investigations are necessary, such as a randomized multicentre study on the long-term effects of GFD with particular attention to the imbalance in daily fat intake. (Acta gastroenterol. belg., 2009, 72, 296-300).
Diagnostic value of antineutrophil cytoplasmic antibodies and anti- Saccharomyces cerevisiae antibody in Iranian patients with inflammatory bowel disease
Background and study aims : Perinuclear antineutrophil cyto- plasmic autoantibodies (pANCA) and anti-Saccharomyces Cerevisiae antibody (ASCA) are potential markers for diagnosis of inflammatory bowel disease (IBD). The aim of the present study was to evaluate the diagnostic value of pANCA and ASCA in Iranian patients with IBD.
Patients and Methods: Serum samples were collected from 144patients with IBD (113 ulcerative colitis and 31 Crohn's disease) and patients with non-IBD problems were assayed for ASCA by Enzyme-Linked Immunosorbent Assay (ELISA) and for pANCA by indirect immunofluorescence assay.
Results : Sensitivity and specificity of pANCA in UC were 39.8% and 82.1%, respectively. For CD, pASCA test provided the sensitivity of 58% and specificity of 70%. A combination of pANCA+/ASCA- for diagnosis of UC showed a sensitivity of 31.9% and specificity of 89.1%. In addition the combination of pANCA-/ASCA+ showed a sensitivity of 35.5% and specificity of 79.8% for diagnosis of CD.
Conclusion : Due to low sensitivity of pANCA and ASCA alone or in combination, they are not valuable serological markers for diagnosis of UC or CD. (Acta gastroenterol. belg., 2009, 72, 301-305).
An anti-preS2 antibody protects human hepatocytes from hepatitis B virus infection
Background : Hepatitis B virus infection is a major problem in liver transplantation. In this study, we examined the potential efficay of a recombinant adenovirus expressing an antibody against the HBV preS2 antigen (Ab-H-HBV-S2) in preventing HBV recurrent infection after liver transplantation.
Methods : A gene for humanized antibody against the HBV preS2 antigen was cloned into pDC315, a type 5 adenoviral shuttle plasmid. Recombinant virus was obtained by homologous recom- bination in the 293 packaging cells. The virus containing the Ab-H- HBV-S2 gene was transduced into the rat liver graft during cold preservation. The recombinant virus produced antibody and showed protective effects on human hepatocytes from hepatitis B virus infection in vitro.
Results : The recombinant virus titer determined by TCID50 analysis was 5.1×1010 PFU/mL. The concentration of preS2 anti- body in BALB/C nude mice was 16.7 ± 10.5 µg/mL on day 3, 30.9 ± 13.6 µg/mL on day 7, and lasted for 5 weeks after the injection. At a concentration of 0.5 µg/mL or above, the preS2 antibody protect- ed cultured human hepatocytes from hepatitis B virus.
Conclusions : Adenovirus-mediated gene transduction of anti- preS2 antibody in the transplanted liver may be a useful approach to prevent hepatitis B infection after liver transplantation. (Acta gastroenterol. belg., 2009, 72, 306-311).
Physiologic variables for videofluoromanometric assessment of dysphagia : an exploratory study
Study Aim : To assess the physiological variables among Upper Esophageal Sphincter Nadir (UESN), Hypopharyngeal Peak Pressure (HPP) and Pharyngo-Esophageal Pressure Gradient (PEPG) for Videofluoromanometry (VFM).
Patients & Method : Exploratory non-randomised prospective study comparing UESN, HPP and PEPG of three cohorts of individuals presumably presenting very distinctive "manometric signatures" based on McConnel's Piston Model of swallowing : 11 non-dysphagic volunteers called the Control Group (CG), 10 dysphagic patients presenting a Myotonic Dystrophy (MD), at various stages of evolution, and 10 patients presenting a Crico- Pharyngeal Barr (CPB), with no post-swallow pharyngeal residue at a previous Modified Barium Swallow (MBS).
VFM tests are performed using solid-state three unidirectional transducers produced by Gaeltec Inc. The simultaneous display storage of the standard fluoroscopic swallow of 10 ml liquid bari- um with UESN and HPP measurements, continuously recorded on a 3-channel polygraph, is performed using a Kay-Pentax Swallowing Work Station. PEPG calculations are subsequently made.
Results: Significant different HPP and PEPG values were observed between the three cohorts. MD patients presented HPP and PEPG below 100 mmHg while CPB patients presented HPP and PEPG above 200 mmHg. The CG presented HPP and PEPG between 100 and 200 mmHg.
UESN values revealed no significant difference between the three cohorts.
A reading scale is proposed. The aim of the scale is to make a link between HPP or PEPG values and physiopathological (not diagnostic) conditions. Patients presenting an HPP or PEPG below 100 mmHg indicate a High probability of Pharyngeal Propulsion Impairment while patients presenting an HPP or PEPG above 200 mmHg are more likely to have an Increased Flow Resistance with appropriate Propulsion Response.
Pros and cons for calculation of the PEPG, representing a possi- bly unnecessary step, are discussed.
Conclusions : In our study, the use of HPP or PEPG as physio- logical variables provides quantitative data that allow VFM to dis- criminate three very distinctive swallowing conditions. Further studies are needed to assess the HPP and PEPG obtained with other manometic devices within the same specific populations for them to be considered as universal physiological variables. Eventually, further investigations should answer the question as to whether the calculation of the PEPG represents any value in com- parison with HPP measurement alone. (Acta gastroenterol. belg., 2009, 72, 312-320).
