Notes: To investigate serum levels of transforming growth factor-β1 and interferon-γ in active ulcerative colitis and to assess changes during treatment.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:We prospectively evaluated serum from 25 patients with untreated active ulcerative colitis and 19 healthy controls. Disease activity score (DAI), serum transforming growth factor-β1 and interferon-γ levels were measured at baseline and after 7 days of conventional treatment. Disease activity score and transforming growth factor-β1 were also assessed at 42 days.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Baseline transforming growth factor-β1 levels were significantly higher in patients than in controls (P 〈 0.02). On the 7th day, transforming growth factor-β1 levels increased only in patients who responded (P 〈 0.01); variations in transforming growth factor-β1 levels and disease activity score were inversely correlated (r=– 0.72, P 〈 0.001). At day 42, serum transforming growth factor-β1 decreased significantly compared with the 7th day (P 〈 0.05). While in controls, interferon-γ was undetectable; untreated patients had higher, widely variable, levels. At day 7, responders had higher interferon-γ values than unresponsive cases. Variations in interferon-γ correlated moderately with changes in transforming growth factor-β1 (r=0.53, P 〈 0.05). Cytokine response did not depend upon the type of treatment.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusions:Both transforming growth factor-β1 and interferon-γ may play a role in the injury–repair process in active ulcerative colitis. Variations in circulating transforming growth factor-β1 levels in the first week of treatment seem to be related to the therapeutic response.

Notes: Pouchitis has been suggested to be a recurrence of ulcerative colitis in a colon-like mucosa. Topical steroids are a valid therapeutic alternative for distal forms of ulcerative colitis.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To investigate the efficacy and tolerability of budesonide enema in the treatment of pouchitis compared with oral metronidazole.〈section xml:id="abs1-3"〉〈title type="main"〉Materials and methods:Twenty-six patients with an active episode of pouchitis (defined as a pouchitis disease activity index score ≥ 7) and no treatment during the previous month were randomized to receive either budesonide enema (2 mg/100 mL at bedtime) plus placebo tablets or oral metronidazole (0.5 g b.d.) plus placebo enema in a prospective, double-blind, double-dummy, 6-week, controlled trial.〈section xml:id="abs1-4"〉〈title type="main"〉Results:Based on the intention-to-treat principle, we detected a significant improvement in disease activity at the end of the first week with both drugs (P 〈 0.01). After that, improvement was moderated until stabilization at 4 weeks in both treatments. The per protocol analysis showed that both drugs had similar efficacy in terms of disease activity, clinical and endoscopic findings. Fifty-eight per cent and 50% of patients improved (decrease in pouchitis disease activity index ≥ 3) with budesonide enema and metronidazole, respectively (odds ratio, 1.4; confidence interval, 0.2–8.9). Adverse effects were observed in 57% of patients given metronidazole and in 25% of patients given budesonide.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Budesonide enemas are an alternative treatment for active pouchitis, with similar efficacy but better tolerability than oral metronidazole.

Notes: Aim: To assess the long-term effect of a gluten-free diet on bone mineral density of adults with untreated coeliac disease. Methods: Bone mineral density was assessed at baseline and after a mean duration of 37 months of treatment in 25 unselected newly diagnosed coeliac patients. Results: At baseline, osteopenia (〉−1 s.d. below normal) was evident in the lumbar spine and total skeleton in 18 (72%) and 21 (84%) patients, respectively. At the end of the study, bone density had increased (mean bone mass Z-score increase: Z-score +1.0 for the lumbar spine and +1.1 for total skeleton) in 22 and 23 patients, respectively. Patients who adhered to strict gluten restriction (n=15) demonstrated a similar bone remineralization in the spine than those patients with partial compliance (n=10) (mean Z-score increase: +1.0, in both areas). A greater mean annual change in Z-score in the total skeleton was noted in patients who followed strict gluten restriction (0.4±0.1) respect to those with partial compliance (0.3±0.1); however, this difference was not statistically significant. Pre-menopausal women had significantly greater remineralization that post-menopausals (P〉0.05). Remineralization showed an inverse correlation with the degree of basal osteopenia (r=−0.525; P〈0.002). Conclusions: Long-term treatment with gluten-free diet produces a significant improvement in bone density in coeliac patients. Remineralization was more pronounced in patients who better comply with gluten-free diet, in pre-menopausal women and in patients with the lowest baseline bone mineral density.

Notes: Background: The screening and diagnosis of coeliac disease have been simplified by the advent of new serological tools.Aim: To assess the clinical utility of a newly developed kit for antibodies to human recombinant tissue transglutaminase (hu-anti-tTG) in a large population of patients undergoing intestinal biopsy for suspected intestinal disorders.Methods: We evaluated 426 serum samples from consecutive adult patients (250 from untreated coeliac disease patients and 176 from individuals in whom a diagnosis of coeliac disease had been excluded), obtained at the time of intestinal biopsy. Samples were tested for immunoglobulin A (IgA) hu-anti-tTG by enzyme-linked immunoabsorbent assay, IgA endomysial antibodies (EmA) by indirect immunofluorescence and IgA and IgG antigliadin antibodies by enzyme-linked immunoabsorbent assay. A sub-group of samples was also assessed for a guinea-pig-based anti-tissue transglutaminase.Results: According to the cut-off for hu-anti-tTG, the sensitivity, specificity and positive and negative predictive values were 91%, 96%, 97% and 87%, respectively. Simultaneous determination of EmA showed values of 86%, 100%, 100% and 83% for the same parameters. Although 19 coeliac disease patients (7.6%) were negative for EmA and hu-anti-tTG, both tests rendered superior statistical values to antigliadin antibody tests. At diagnosis, IgA deficiency was detected in 11 patients, but both assays were able to detect samples with mild to moderate deficiency. The comparison of hu-anti-tTG with EmA showed excellent concordance between the tests (κ statistic, 0.85). Discordance was observed in 20 samples from coeliac disease patients (8%) and in nine samples from controls (5%). Fifteen samples had an EmA-negative but hu-anti-tTG-positive serology, and five showed the converse pattern. Comparison of human recombinant and guinea-pig tests showed concordant results in 96% of cases.Conclusions: The quantitative determination of hu-anti-tTG type IgA using a commercial enzyme-linked immunoabsorbent assay kit was highly sensitive and specific for the detection of coeliac disease. Our results in a large population of patients with a clinical condition suggestive of the disorder demonstrated that the test can be used to detect a substantial number of patients otherwise unrecognized by IgA EmA.