bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL COURSE and RELAPSE RATE IN INTESTINAL BEHCET'S DISEASE
Authors: Kim TI , Kim WH , Lee J‐H , Lee CR , Kang JK , Kim NK , Bang D 
Published: January 2004

Behçet's disease is a multisystemic recurrent inflammatory disease. Gastrointestinal tract involvement in Behçet's disease has been identified throughout the alimentary tract and causes diverse symptoms. Various treatment have been utilized to induce or maintain remission. However, little is known about clinical course and prognosis in Behçet's disease with intestinal involvement. The aims of this study were to evaluate the clinical course and relapse rate in intestinal Behçet's disease and to investigate factors that may affect relapse.Methods  Clinical course and characteristics, including demographic parameters, gastrointestinal symptoms as well as systemic manifestations, laboratory data, endoscopic findings, and treatment strategies for the induction of remission, of 97 patients (49 male, 48 female) with intestinal Behçet's disease were retrospectively reviewed. Cumulative relapse free rate and factors related with relapse were analysed by Kaplan–Meier method and log–rank test, respectively.Results  The median duration of the relapse free period was 7 months (ranges from 1 to 171 months). One, two, and five year relapse free rates were 41.2, 29.7 and 10.2%, respectively. Sex, clinical subtype of Behçet's disease, symptom and laboratory data at onset, colonoscopic findings, such as distribution of lesions as well as number, size, depth, and shape of ulcer, and initial treatment (medical vs. surgical) did not affect relapse rate. However, large ulcers (> 20 mm) and young age at onset (< 37 years old) were factors significantly related with higher relapse rate (P < 0.05, log–rank test).Conclusion  High relapse rate in intestinal Behçet's disease was identified. Age at onset and size of the ulcer are factors related with long‐term prognosis of intestinal Behçet's disease.
A PROSPECTIVE RANDOMISED TRIAL COMPARING ARGON PLASMA COAGULATION WITH TOPICAL FORMALIN APPLICATION IN THE TREATMENT OF RADIATION PROCTITIS
Authors: Tam William CE , Moore James WE , Conroy‐Hiller Tiffany A , Schoeman Mark N 
Published: January 2004

Argon plasma coagulation (APC) and topical formalin have both been shown to be effective in the treatment of radiation proctitis.Aim  To compare APC with topical formalin in the treatment of rectal bleeding due to radiation proctitis in a prospective randomised trial.Methods  Nineteen treatment‐naive patients (17 M) with proven radiation proctitis and troublesome rectal bleeding were randomised to receive day‐case APC or 4% topical formalin. A visual analogue scale (VAS) was used to assess rectal bleeding (0–10; 0 = no bleeding, 10 = severe bleeding) and well being (0–10; 0 = very unwell, 10 = very well). Anorectal function (urgency, incontinence) was assessed with the modified Wexner/Cleveland Continence Score (0–24; 0 = normal anorectal function, 24 = complete incontinence with severe urgency). Hemoglobin (Hb) and transfusion requirements were recorded. Treatment was given at 6‐weekly intervals until rectal bleeding had improved to VAS ≤ 2.5.Results  [Table, median (range)] The effects of APC and topical formalin were similar, with significant improvement in rectal bleeding after a median of 2 (1–3) treatment sessions. Haemoglobin increased in patients treated with APC. Four patients were transfusion‐dependent before treatment, all of whom did not require transfusions after treatment (three APC, one formalin). Patient well‐being and continence score did not change significantly after either treatment, although a trend was seen in well‐being score after APC. Two patients treated with APC developed minor rectal strictures, which were readily treated with dilatation.Conclusions  Argon plasma coagulation and topical formalin are equally effective in reducing rectal bleeding from radiation proctitis. Risk of rectal strictures may be higher after thermocoagulation with APC.

APC  Pre‐treatment
Post‐treatment
Formalin  Pre‐treatment
Post‐treatment

Well‐being score
6.8 (5–9.7)
7.5 (5–10)
5.9 (4.9–8.7)
6 (2.5–9.1)

Bleeding score
6 (4–7.6)
1.4 (0–2.5)*
5 (4.6–10)
1.5 (0–2.5)*

Continence score
7.5 (3–18)
7.5 (0–17)
6 (1–17)
6 (1–13)

Haemoglobin (g/L)
120.5 (71–159)
135.5 (82–164)*
143 (82–164)
144 (116–167)

Follow‐up (weeks)
45.5 (22–114)

27 (9–100)

P < 0.05.
CLINICAL COURSE IN KOREAN PATIENTS WITH ULCERATIVE COLITIS
Authors: Kim WH , Choi CH , Lee CR , Ahn SH , Kim TI , Park IS 
Published: January 2004

During recent several years, the incidence of ulcerative colitis is rapidly increasing in Korea. Both patients and physicians await good predictors of individual clinical course in terms of morbidity. We wanted to analyse not only clinical features in ulcerative colitis at the time of diagnosis, but also clinical courses during 5 years after diagnosis. Factors affecting clinical courses were also investigated.Methods  One hundred and seventy‐four patients with ulcerative colitis regularly followed at least 1 year, spanning from January 1988 to October 2000, were included. Morbidity was evaluated using annual disease burden index, defined as summation of monthly clinical severity (0 for remission, 1 for mild, 2 for moderate, and 3 for severe). Multiple variables such as, demographic parameters, social history, symptoms, duration before diagnosis, extent of disease, endoscopic as well as clinical severity, laboratory data including ANCA and treatment, were used to identify factors affecting clinical course.Results  Mean annual disease burden index at first, third and fifth year after diagnosis was 5.8 ± 4.4, 4.9 ± 5.3, and 3.8 ± 4.1, respectively. Mean annual symptomatic period also decreased from 4.0 ± 3.1 months at first year to 3.0 ± 3.4 months in fifth year. Presence of fever at the time of diagnosis was the only factor affecting annual disease burden index and symptomatic period at first year after diagnosis. Cumulative relapse free at 1, 2, and 5 years after diagnosis were 58.2, 68.2 and 86.8%, respectively. Young age at onset (< 30), short extent of disease (proctitis and left‐sided colitis vs. extensive colitis), and history of transfusion were factors significantly related with higher relapse rate (P < 0.05, log–rank test).Conclusion  Disease burden index and symptomatic period in each year tend to decrease with time during 5 years after diagnosis. Cumulative relapse rate in Korean patients with ulcerative colitis was comparable to that in Western countries and was affected by age at onset, extent of disease, and history of transfusion.
CLINICAL PRESENTATION OF CROHN'S DISEASE IN PAKISTAN
Authors: Khan Rustam , Abbas Zaigham , Memon Sadik , Hamid Saeed , Shah Hasnain , Jafri Wasim 
Published: January 2004

Introduction  Crohn's disease is uncommon in Pakistan and local demographic data is not available. Due to high prevalence of intestinal tuberculosis, it is often misdiagnosed and mismanaged. Aim of this study is to review the clinical presentation of Crohn's disease in our region.Methods  Medical records of 475 adult patients admitted during the last 13 years with label of Crohn's disease were reviewed for the presence of Crohn's disease. Symptoms and signs, activity of the disease, site of involvement and the management offered was recorded.Results  Diagnosis of Crohn's disease was made in 52 patients (29 females, 23 males). Mean age was 40.1 + 14.1 years. Disease was classified as inflammatory in 71%, obstructive in 15% and fistulizing in 14% cases. Disease activity was mild in 62%, moderate in 34% and severe in 4% cases. Pancolitis with skip lesions was the most common presentation present in 24 (46%) patients. Out of these 11 (21%) patients also had terminal ileum involvement. Ileocaecel disease was seen in only nine (17%) and isolated ileal disease in three (6%) patients. Another 11 (21%) patients showed one‐sided colitis. Predominant symptoms were diarrhea (88%), abdominal pain 83%, bleeding per‐rectum (52%), weight loss (48%), fever (37%), loss of appetite (27%), anal pain (10%) and jaundice (6%). Abdominal tenderness was present in 60%, pallor in 52% and abdominal mass in 15%. Anal signs were present in 25% of patients and included tags, fissures and abscesses. Extra intestinal manifestations were arthritis in seven (13%), sclerosing cholangitis in four (7.6%) and ankylosing spondylitis in two (3.8%). The patients were treated with steroids, 5‐aminosalisylic acid, azathiprine, metronidazole and antibiotics. Decision‐making was difficult in five patients who were initially treated with antituberculous drugs.Conclusion  Crohn's disease exists in Pakistan and should be considered in the differential diagnosis of inflammatory diseases of colon and intestine. It is important to rule out tuberculosis in these cases. The disease activity in our region is usually mild to moderate with predominant inflammatory pattern. Colon is most common site of involvement.
COBALAMIN DEFICIENCY and SMALL BOWEL BACTERIAL OVERGROWTH: A COMMON ASSOCIATION
Authors: Chitti L , Cummins AG 
Published: January 2004

Background  Bacterial overgrowth may cause cobalamin deficiency through competition for dietary cobalamin in the small intestine. The objective of this study was to prospectively determine the prevalence of small bowel bacterial overgrowth in patients with documented cobalamin deficiency in a tertiary referral centre.Methods  Patients identified with cobalamin deficiency underwent diagnostic investigations including: Endoscopy (with gastric antrum, gastric body and duodenal biopsies and duodenal aspirate), 14C‐D‐Xylose breath test, intrinsic factor antibody, anti‐endomysial antibody and red cell folate level. ‘Definite’ small bowel bacterial overgrowth was defined as either a positive 14C‐D‐Xylose breath test or > 100 000 CFU/mL of culture of duodenal aspirate. ‘Suspected’ small bowel bacterial overgrowth was defined as an elevated red cell folate in the absence of supplemental folate therapy.Results  Over a 2‐year period, 62 patients with cobalamin deficiency were identified, of whom, 26 (42%) had ‘definite’ small bowel bacterial overgrowth, whilst a further nine (15%) had ‘suspected’ small bowel bacterial overgrowth. Nineteen (31%) had pernicious anaemia, and no cause for cobalamin deficiency could be found in eight (13%) patients. The diagnosis found in the remaining patients included coeliac disease (4), Crohn's Disease (1), gastric resection (2), vegan (2), homozygotes of the MTHFR gene (C677T) mutation (2), and one had enteropathy associated with common variable immunodeficiency (CVID). ‘Definite’ small bowel bacterial overgrowth was found to coexist with nine of the 19 cases of pernicious anaemia, two coeliac subjects, one CVID enteropathy and one patient with the MTHFR gene mutation.Conclusion  Small bowel bacterial overgrowth is commonly associated with cobalamin deficiency.
COLONIC DYSPLASIAS IN IBD PATIENTS ARE LESS FREQUENT THAN EXPECTED
Authors: Ochsenkühn Thomas , Tillack Cornelia , Stepp Herbert , Ott Stephan J , Baumgartner Reinhold , Göke Burkhard , Sackmann Michael 
Published: January 2004

Objectives  Patients with long‐standing IBD have an increased risk to develop colonic dysplasias, however, by conventional colonoscopy dysplasias are likely to be missed. Endoscopic fluorescence imaging is a promising new technique to differentiate between normal colonic mucosa and dysplasia. We, therefore, used this technique to prospectivly evaluate the occurence of dysplasias in patients with longstanding IBD‐colitis.Methods  Twenty‐five consecutive patients with longstanding IBD‐colitis were screened for colonic dysplasias. To induce tumor‐selective intracellular synthesis of red‐fluorescent protoporphyrin IX, its precursor, 5‐aminolevulinic acid, was given orally at a dose of 1 g. Patients were examined by both conventional white light colonoscopy and by fluorescence imaging using a blue light source (400–410 nm) and a sensitive camera to detect fluorescence (D‐Light/Tricam SL, Storz, Germany). Biopsies were taken every 10 cm from normal appearing mucosa, from macroscopically suspicious areas, and from fluorescence‐positive areas.Results  The median duration of the IBD was 14 years. Fluorescence was negative in all but one patient. However, in this one patient, histology revealed no dysplastic tissue, thus the rate of false‐positive results was only 4%. In none of the biopsies dysplasias were detected histopathologically.Conclusions  Thorough endoscopic examination with a dense net of biopsies, in addition to fluorescence analysis, revealed no dysplasias in the colon of 25 patients with longstanding IBD‐colitis. These data show that the rate of colonic dysplasias in patients with long‐standing IBD‐colitis may be lower than previously reported.
COLONOSCOPIC SCREENING FOR FAMILY HISTORY OF COLORECTAL CANCER: ARE NHMRC GUIDELINES BEING FOLLOWED?
Authors: Yusoff Ian , Hoffman Neville , Ormonde Donald , Aitken James , Ee Hooi 
Published: January 2004

Aims  The NHMRC has published recommendations for screening of patients with a family history of colorectal cancer (CRC). We aimed to assess if referrals and follow‐up recommendations in an open access colonoscopy service concur with these guidelines.Methods  We prospectively interrogated patients referred for colonoscopy with a family history of CRC concerning the number, relationship and age of such relatives, to assess whether they satisfied NHMRC criteria for screening. Follow‐up recommendations were also assessed retrospectively.Results  From January 2000 to April 2001 2579 colonoscopies were performed. There were 340 cases with a family history of CRC and 202 of these were asymptomatic. Of these screening cases, mean age was 50 years (range 16–80 years). Referrals were from general practitioners in 92%, gastroenterologists in 5% and other specialists in 2% of cases.

NHMRC category
Number of patients in category
Satisfied all NHMRC criteria for  colonoscopic screening at referral

Unable to classify
3
0

1
84
0

2
107
87

3
8
8

Total
202
95

There were 87 patients who did not satisfy the criteria for colonoscopic screening (Unable to classify or Category 1). Of these, 25 (29%) were below the recommended age to commence any screening. There were 115 patients (57%) who satisfied the family history criteria for colonoscopic screening (NHMRC Category 2 or 3). Of these, 20 (17%) were below the recommended age to commence screening. Follow‐up recommendations were made in 108 patients (53%) and these concurred with NHMRC guidelines in 88 cases (81%). In 16 of the 20 cases where follow‐up recommendations did not occur with NHMRC guidelines, the interval to repeat colonoscopy was too short or colonoscopy was recommended rather than annual faecal occult blood testing.Conclusions  Less than half the patients being referred for screening colonoscopy for family history of CRC satisfy NHMRC criteria. In the majority of cases this is due to referral of Category 1 patients for screening. Follow‐up recommendations, when made, are usually in keeping with NHMRC guidelines.
COMBINATION ANTI‐PARATUBERCULOSIS THERAPY WITH CLARITHROMYCIN, RIFABUTIN and CLOFAZIMINE IN THE TREATMENT OF CROHN'S DISEASE. A PRELIMINARY REPORT ON THE AUSTRALIAN MULTICENTRE TRIAL
Authors: Selby W , Crotty B , Florin T , Pavli P , Morrow AW 
Published: January 2004

Mycobacterium paratuberculosis has been proposed as the cause of Crohn's disease, although this remains controversial. Observational studies of antibiotics with activity against this organism have led to the establishment of an Australian multicentre placebo‐controlled trial of clarithromycin, rifabutin and clofazimine in patients with active Crohn's disease. All subjects receive treatment with a tapering regimen of prednisolone for the initial 16 weeks, combined with either antibiotics or matching placebos. If remission is achieved at the end of this period and prednisolone has been ceased they continue the trial medications for 2 years. The primary outcomes – remission rates at 1, 2 and 3 years – aim to determine whether these antibiotics are of long‐term benefit in Crohn's disease. Secondary outcomes include rate of remission at 4 months, safety and quality of life.As of May 2001, 171 of the required 212 subjects have been enrolled. Eighty‐seven of 146 potential subjects have reached 16 weeks in remission (60%). Eighty of these are ongoing (92%). Only five withdrawals from the trial have occurred for adverse events thought probably related to trial medications – four subjects with raised LFTs and one who developed a rash. Other withdrawals have been mainly due to lack of response or worsening of Crohn's disease (37), hypomania from steroids (one patient) and pregnancy (one patient on placebo). There have been 11 withdrawals for protocol violations. An Independent Data Monitoring Committee has analysed progress of the trial and unanimously recommended that it continue.This study is the largest and longest suitably powered randomised controlled trial of antibiotics undertaken in Crohn's disease. It will determine whether this antibiotic combination alters the natural history of this disorder.This study is being supported by Pharmacia Australia Pty Limited.
COMPARATIVE ANALYSIS OF THE MUCOSAL ASSOCIATED MICROBIOTA (MMB) IN CROHN'S DISEASE (CD) and NON‐IBD CONTROL SUBJECTS
Authors: Wang Xin , Heazlewood Sharise , Florin Timothy 
Published: January 2004

The cause(s) of CD are not known, but its pathogenesis depends on the interaction of enteric bacteria and food antigen products with the mucosal immune system. Accumulated evidence clearly demonstrates that enteric microbiota influence the ontogeny and behavour of the innate and acquired mucosal immune system. Although there are significant enteric bacteria resident in the lumen of the human colon (up to 1013/g wet faeces), it is microbiota that associate with mucosa of intestinal epithelium (MMB) that are more likely to influence the mucosal immune system, to effect inflammation or tolerance.Aims  To analyse the MMB communities in CD vs. ulcerative colitis (UC) and non‐IBD subjects using molecular ecological approach.Methods  Total DNA are extracted from washed colonoscopic biopsy samples from macroscopically non‐involved CD (to date, n = 6 ileum and n = 1 colon), ulcerative colitis (n = 1 colon) and non‐IBD (n = 2 terminal ileum, n = 1 colon). Bacterial 16s‐rDNA are amplified by PCR with universal bacterial primers. After cloning, the diversity of bacterial communities are characterized by RFLP pattern analysis (ribotyping). Bacteria are then identified by phylogenetic analysis of DNA sequences of individual RFLP patterns.Results  There was significantly more bacterial DNA in CD than non‐IBD with mean total DNA (ng) in amplicons in ileal samples from CD subjects, 39.2, compared with non‐IBD, 4.25 and in CD colon, 24.6, compared with non‐IBD colon, 13.4 ng (Mann–Whitney, P = 0.014). Bacteroides sp. were numerically predominant both in four of seven CD and three of three non‐IBD biopsy samples. five of seven CD biopsies had a striking number of bacterial clones phylogenetically identified to belong to Clostridium cluster XIVa (13–36%) vs. 0–9% in non‐IBD controls and 11% in UC colon. The three CD with low bacteroides and lower Clostridium cluster XIVa (4–11%), had a high frequency of Pseudomonas spp. (19–40%), together with high occurrence of Klebsiella spp., as did one of three non‐IBD controls (36%) and the UC biopsy (11%).Conclusions  CD ileum may harbour an abnormal and more abundant resident MMB. Further study is required to describe the heterogeneous MMB in both normal and IBD ileum and colon. One of the XIVa species is extremely mucolytic. A Pseudomonas has recently been implicated in CD. The full 16s‐rDNA sequences of two XIVa species and the Pseudomonas spp. are being obtained, as well as specific PCR primers to screen a larger number of biopsies for the presence of these bacteria.
CORTICOTROPIN‐RELEASING HORMONE (CRH) MRNA EXPRESSION IN THE PARAVENTRICULAR NUCLEUS OF THE HYPOTHALAMUS (PVN) DURING EXPERIMENTAL COLITIS IN THE RAT
Authors: Kojima Kensaku , Wakabayashi Naoki , Mitsufuji Shoji , Ibata Yasuhiko , Tanaka Masaki 
Published: January 2004

Background  Neuroendocrine–immune interactions can influence processes arising from the brain, and there is evidence that the central nervous system may amplify or modulate aspects of intestinal inflammation through alterations of the autonomic nervous system activity and/or stimulation of the hypothalamic–pituitary–adrenal (HPA) axis (American Journal of Physiology 276: G1027, 1999). But the effect of the colitis itself on the HPA axis remains unclear.Aim  To investigate the effect of experimental colitis on the HPA‐axis, especially on CRH mRNA expression in the PVN, plasma adenocorticotropin (ACTH) and corticosterone (CORT) level.Methods  Under isoflurane anesthesia, male SD rats (250–300 g) were induced to colitis by intracolonic administration of 0.2 mL of 50% ethanol (v/v) containing 20 mg of 2,4,6‐trinitrobenzenesulfonic acid (TNBS). In the first experiment, rats were sacrificed before and on days 1, 3, 7 and 14 after induction of colitis, and CRH mRNA levels in the PVN were quantified by in situ hybridization, plasma ACTH and CORT levels were measured by radioimmunoassay, and the colonic damage was assessed by measurement of colonic myeloperoxidase (MPO) activity. In the second experiment, rats were adrenalectomized bilaterally and corticosterone pellet was implanted subcutaneously (ADX + CORT). On day 3 after ADX + CORT, rats were infused TNBS (TNBS group) or saline (saline group) rectally and CRH mRNA level, plasma ACTH and CORT levels were measured on day 7 after administration of TNBS or saline. In the third experiment, pair‐fed rats whose daily food intake was matched to that of their pair in the colitic group were used, and on day 7 after treatment, CRH mRNA level, plasma ACTH and CORT levels were measured.Results  In the first experiment, CRH mRNA levels in the PVN on days 3 and 7 after induction of colitis were significantly lower than those before induction of colitis (P < 0.05, P < 0.01, respectively). Plasma CORT levels during colitis were increased significantly (P < 0.001) from days 1 to 14, and plasma ACTH levels showed no significant change after day 3. In the second experiment, CRH mRNA level in the PVN in the TNBS group was significantly higher than those in the saline group (P < 0.01). In the third experiment, pair feeding resulted in no significant change in CRH mRNA, plasma ACTH and CORT levels.Conclusions  These findings indicated that CRH mRNA expression in the PVN was inhibited by glucocorticoid feedback during this experimental colitis, and the decrease in food intake during colitis was not simply responsible for the expression of CRH mRNA.