Seasonal patterns of hospital treatment for inflammatory bowel disease in Italy

AIM

It is still debated whether clinical flare-ups of chronic inflammatory bowel disease follow a seasonal pattern, and the various reports are based on general practitioners' records or hospital discharge charts. There are, however, no specific figures for treatment in hospital gastroenterology units, which serve as a reference point for these disorders. This study was therefore designed to investigate whether there is a seasonal pattern in admissions for inflammatory intestinal disease in Italy, differing from what is generally known about gastrointestinal pathologies, since there are no nation-wide figures on the subject.

METHODS

The RING (Ricerca Informatizzata in Gastroenterologia) project is an observational study collecting hospital discharge forms from 22 centers in Italy.

RESULTS

From winter 2000 to autumn 2003, the 22 gastroenterology units participating in the RING project discharged 32,357 patients following ordinary hospital admissions. Of these, 2,856 (8.8%) had a main diagnosis of inflammatory bowel disease: 1,541 Crohn's disease, and 1,315 ulcerative colitis. No seasonal patterns were detected for either category, or when the analysis was done by age, sex and site of disease.

CONCLUSIONS

The most serious flare-ups of inflammatory bowel disease, i.e. those requiring routine hospital treatment, do not appear to follow any seasonal pattern, regardless of the site of the disease or the patient's age or sex.

Effect of somatostatin on mesenteric vascular resistance in normal and portal hypertensive rats

Vasoactive effects of natural somatostatin (SRIF-14) and its analogue octreotide were studied in in vitro perfused superior mesenteric arterial beds of normal (Sham) and portal hypertensive (PVL) rats. Tested concentrations covered the whole range used in clinical settings (10(-10) to 10(-5) M for SRIF-14 and 10(-11) to 10(-6) M for octreotide, respectively). Vessel resistances only minimally changed to infusions of SRIF-14 (from 3.5 +/- 0.4 to 3.7 +/- 0.5 mmHg.ml-1.min and 3.8 +/- 0.3 to 3.9 +/- 0.4 mmHg.ml-1.min for PVL and Sham) and octreotide (from 3.3 +/- 0.2 to 3.4 +/- 0.4 mmHg.ml-1.min and 3.8 +/- 0.4 to 4.0 42- 0.4 mmHg.ml-1.min for PVL and Sham). The same was true for bolus injections. In contrast, norepinephrine induced significant increases in vessel resistance (up to 110.6 +/- 20.1 mmHg.ml-1.min). In conclusion, SRIF-14 and octreotide exert no direct effect on vascular smooth muscle tone in splanchnic resistance vessels of Sham and PVL rats. The vasoconstriction reported in vivo seems therefore probably mediated by the ability of these peptides to inhibit the secretion of vasodilatatory substances.

Propranolol ameliorates the development of portal-systemic shunting in a chronic murine schistosomiasis model of portal hypertension

We investigated the role of early portal hypotensive pharmacotherapy in preventing the development of portal-systemic shunting in a portal hypertensive model of chronic murine schistosomiasis induced by infecting C3H mice with 60 cercariae of Schistosoma mansoni. Propranolol was administered in drinking water to 20 animals for a period of 6 wk at a dose of 10 mg.kg-1d-1, starting at 5 wk of schistosomal infection. 32 age-matched mice with chronic schistosomal infection served as controls. All animals were studied 11 wk after the infection. Compared with controls the portal pressure (10.8 +/- 0.40 mmHg) was significantly lower (P less than 0.001) in the propranolol-treated animals (7.9 +/- 0.80 mmHg). Portal-systemic shunting was decreased by 79%, from 12.2 +/- 3.34% in controls to 2.5 +/- 0.99% in the propranolol group (P less than 0.05). Portal venous inflow was reduced by 38% in the propranolol treated animals (2.50 +/- 0.73 ml/min; n = 6) compared with controls (4.00 +/- 0.34 ml/min; n = 8; P less than 0.05). The worm burden, the granulomatous reaction, the collagen content of the liver, and the serum bile acid levels were not significantly different between the two groups of animals. These results demonstrate that in chronic liver disease induced by schistosomiasis, the development of portal-systemic shunting can be decreased or prevented by the reduction of flow and pressure in the portal system.

The human liver in extrahepatic cholestasis: ultrastructural morphometric data

The present study reports the data obtained through a quantitative analysis performed on needle liver biopsies of five jaundiced patients with extrahepatic cholestasis. Whatever the duration of jaundice, the surface density of the smooth endoplasmic reticulum remained in the normal range in all subjects. The surface density of the rough endoplasmic reticulum was variable, showing elevated values in three of the five patients. The surface density of peroxisomes was unchanged with respect to controls. All the subjects exhibited an increase of the surface density of mitochondrial cristae without changes of the outer membrane. These data fail to show evidence of hypertrophy of the smooth endoplasmic reticulum in hepatocytes of human liver during extrahepatic cholestasis. Instead, the increased surface density of the mitochondrial cristae, which has also been previously reported in patients with uncomplicated cholelithiasis, appears as an early and constant phenomenon associated with conformational changes of this mitochondrial component. Such a structural modification might represent an elementary response of the liver cells to alterations in the pathways of synthesis and/or excretion of biliary components.