Cytokine Levels After Consumption of a Medicinal Agaricus blazei Murill-Based Mushroom Extract, AndoSan™ , in Patients with Crohn's Disease and Ulcerative Colitis in a Randomized Single-Blinded Placebo-Controlled Study

Ingestion of the Agaricus blazei Murill-based mushroom extract AndoSan^™ has been shown in randomized placebo-controlled studies to improve symptoms in Crohn's disease (CD) and ulcerative colitis (UC) and also fatigue and quality of life in the latter patients. The aim was to examine whether this clinical impact of AndoSan^™ intake could be explained by influence on foremost pro-inflammatory cytokines in the patients. Fifty patients with symptomatic UC and CD were randomized and blinded for oral daily intake of AndoSan^™ or placebo. Blood samples taken before (visit 1) and after 21 days' (visit 3) consumption were analysed for cytokines IL-1ß, IL-2, IL-4-8, IL-10, IL-12-13, IL-17, G-CSF, GM-CSF, IFN-γ, MCP-1, MIP-1ß and TNF-α. Baseline cytokine levels were similar in CD and UC. In CD, cytokine levels at visit 1 versus visit 3 were unaltered within the AndoSan^™ and the placebo groups. Only IL-2 was significantly reduced at visit 3 in the Andosan^™ compared with the placebo group. However, when combining IL-1ß, IL-6 and G-CSF in the patients with CD, the cytokine levels were significantly lower in the AndoSan^TM - versus the placebo group, visit 3. In UC, levels of IL-2, IL-5 and MIP-1ß were reduced within the AndoSan^™ group. IL-5 was also reduced at visit 3 compared with placebo. Generally, the effect on reduction in systemic cytokine levels by consumption of AndoSan^™ was limited and supported only marginally anti-inflammatory effects in these patients. Therefore, other explanations behind the clinical anti-inflammatory effects than the contribution of cytokines seem more pertinent, including anti-allergic and antioxidant activities.

Effect of an extract based on the medicinal mushroom Agaricus blazei Murill on expression of cytokines and calprotectin in patients with ulcerative colitis and Crohn's disease

An immunomodulatory extract (AndoSan™) based on the medicinal mushroom Agaricus blazei Murill (AbM) has shown to reduce blood cytokine levels in healthy volunteers after 12 days' ingestion, pointing to an anti-inflammatory effect. The aim was to study whether AndoSan™ had similar effects on cytokines in patients with ulcerative colitis (UC) and Crohn's disease (CD). Calprotectin, a marker for inflammatory bowel disease (IBD), was also measured. Patients with CD (n = 11) and with UC (n = 10) consumed 60 ml/day of AndoSan™. Patient blood plasma was harvested before and after 6 h LPS (1 ng/ml) stimulation ex vivo. Plasma and faecal calprotectin levels were analysed using ELISA and 17 cytokines [IL-2, IFN-γ, IL-12 (Th1), IL-4, IL-5, IL-13 (Th2), IL-7, IL-17, IL-1β, IL-6, TNF-α, IL-8, MIP-1β, MCP-1, G-CSF, GM-CSF and IL-10] by multiplex assay. After 12 days' ingestion of AndoSan™, baseline plasma cytokine levels in UC was reduced for MCP-1 (40%) and in LPS-stimulated blood for MIP-1β (78%), IL-6 (44%), IL-1β (41%), IL-8 (30%), G-CSF (29%), MCP-1 (18%) and GM-CSF (17%). There were corresponding reductions in CD: IL-2 (100%), IL-17 (55%) and IL-8 (29%) and for IL-1β (35%), MIP-1β (30%), MCP-1 (22%), IL-8 (18%), IL-17 (17%) and G-CSF (14%), respectively. Baseline concentrations for the 17 cytokines in the UC and CD patient groups were largely similar. Faecal calprotectin was reduced in the UC group. Ingestion of an AbM-based medicinal mushroom by patients with IBD resulted in interesting anti-inflammatory effects as demonstrated by declined levels of pathogenic cytokines in blood and calprotectin in faeces.

C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study

BACKGROUND AND AIMS

C-reactive protein (CRP) levels are often used in the follow-up of patients with inflammatory bowel disease (IBD). The aims of this study were to establish the relationship of CRP levels to disease extent in patients with ulcerative colitis and to phenotype in patients with Crohn's disease, and to investigate the predictive value of CRP levels for disease outcome.

METHODS

CRP was measured at diagnosis and after 1 and 5 years in patients diagnosed with IBD in south-eastern Norway. After 5 years, 454 patients with ulcerative colitis and 200 with Crohn's disease were alive and provided sufficient data for analysis.

RESULTS

Patients with Crohn's disease had a stronger CRP response than did those with ulcerative colitis. In patients with ulcerative colitis, CRP levels at diagnosis increased with increasing extent of disease. No differences in CRP levels at diagnosis were found between subgroups of patients with Crohn's disease as defined according to the Vienna classification. In patients with ulcerative colitis with extensive colitis, CRP levels above 23 mg/l at diagnosis predicted an increased risk of surgery (odds ratio (OR) 4.8, 95% confidence interval (CI) 1.5 to 15.1, p = 0.02). In patients with ulcerative colitis, CRP levels above 10 mg/l after 1 year predicted an increased risk of surgery during the subsequent 4 years (OR 3.0, 95% CI 1.1 to 7.8, p = 0.02). A significant association between CRP levels at diagnosis and risk of surgery was found in patients with Crohn's disease and terminal ileitis (L1), and the risk increased when CRP levels were above 53 mg/l in this subgroup (OR 6.0, 95% CI 1.1 to 31.9, p = 0.03).

CONCLUSIONS

CRP levels at diagnosis were related to the extent of disease in patients with ulcerative colitis. Phenotype had no influence on CRP levels in patients with Crohn's disease. CRP is a predictor of surgery in subgroups of patients with either ulcerative colitis or Crohn's disease.

Increased skewing of X chromosome inactivation with age in both blood and buccal cells

The X chromosome inactivation pattern in peripheral blood cells becomes more skewed after age 55, and a genetic effect on this age-related skewing has been reported. We investigated the effect of age on X inactivation phenotype in blood, buccal cells and tissue from duodenal biopsies in 80 females aged 19-90 years. The X inactivation pattern correlated positively with age in blood (r = 0.238, P = 0.034) and buccal cells (r = 0.260, P = 0.02). The mean degree of skewing was higher in the elderly (>/=55 years) than in the young (<55 years) in blood (70.1 and 63.5%, respectively, P = 0.013) and in buccal cells (64.7 and 59.0%, respectively, P = 0.004). Correlation of X inactivation between the different tissues was high in all tissues with a tendency to increase with age for blood and buccal cells (P = 0.082). None of the duodenal biopsies had a skewed X inactivation, and the mean degree of skewing was similar in the two age groups. The tendency for the same X chromosome to be the preferentially active X in both blood and buccal cells with advancing age is in agreement with a genetic effect on age-related skewing and indicates that genes other than those involved in hematopoiesis should be investigated in the search for genes contributing to age related skewing.

Health-related quality of life in patients with inflammatory bowel disease five years after the initial diagnosis

BACKGROUND

Health-related quality of life (HRQOL) has become an important tool in evaluating patient satisfaction in inflammatory bowel disease (IBD). So far, few prospective follow-up studies have been done to identify variables that influence HRQOL. We aimed to identify demographic and clinical variables that influence HRQOL 5 years after diagnosis in patients with ulcerative colitis (UC) or Crohn disease (CD) included in a prospective follow-up study from 1990 to 1994 (the IBSEN study).

METHODS

All patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease-specific quality-of-life questionnaire translated into Norwegian and validated. We present data from 497 patients (328 UC patients and 169 CD patients, mean age 43.3 years, 48% female). The impact of age, gender, smoking, symptom severity, disease distribution, rheumatic symptoms and surgery on IBD patients' HRQOL was analysed.

RESULTS

Women had a reduction in IBDQ total score of 10 points compared to men, CD patients had a reduction of 7.5 compared to UC patients. The patients with moderate/severe symptoms had a 50 points lower score than the patients without symptoms. The patients with rheumatic symptoms had a 10 points lower total score than the patients without these symptoms. All differences were statistically significant. The multiple regression analysis showed that symptom severity, rheumatic symptoms and female gender were the strongest predictors of reduction in HRQOL for both diagnosis groups.

CONCLUSION

IBD symptoms, rheumatic symptoms and female gender have a significant influence on patients' HRQOL as measured by IBDQ. This was confirmed by the regression analysis.

Bowel MR imaging with oral Gastrografin: an experimental study with healthy volunteers

Our objective was to evaluate Gastrografin for MR bowel imaging. Twenty-three healthy volunteers in two randomised groups received 300 or 400 ml 50% Gastrografin, drunk continuously during 2 and 3 h, respectively. Images were applied during breath-hold in three orthogonal orientations. The balanced fast-field echo (BFFE) and balanced turbo field-echo (BTFE) sequences, with acquisition times from 13 to 25 s, were used before gadolinium (Gd) DTPA implying 1- to 2-mm-thick slices locally or 6-mm-thick slices through the entire gastrointestinal tract. The Gd-enhanced images were performed using a 3D T1-weighted FFE sequence with water selective excitation (Proset). Image quality, including bowel distention, homogeneity of opacification and wall conspicuity, were evaluated by two experienced reviewers, and the adverse reactions were recorded. Very good or excellent distention, homogeneity and wall conspicuity were achieved in the central segments from the ileum to the left colon flexure in 83-96% of cases, due to the adequate contrast media supply in these regions. Distention, homogeneity and delineation were good in the central segments of the remaining bowels. Diarrhoea was a major problem affecting all participants, followed by nausea. Provided that there is modern fast sequential technology, excellent MR imaging of the bowel can be achieved by the oral administration 50% diluted Gastrografin. Further studies are needed to refine the technique and optimise the quantity and concentration of Gastrografin in order to avoid or reduce adverse reactions.

Octreotide in patients with active ulcerative colitis treated with high dose corticosteroids (OPUS 1)

BACKGROUND

In ulcerative colitis the intestinal somatostatin content is reduced. Somatostatin has several immune-inhibitory effects. In vitro it diminishes activity of intestinal lymphocytes and peripheral blood monocytes. Its long-acting analogue octreotide has beneficial effects on mucosal damage in acute experimental acetic acid colitis in rats.

AIMS

To determine the potential benefits of octreotide as a treatment for patients with severe ulcerative colitis treated with high dose corticosteroids.

PATIENTS

Forty-two patients with severe ulcerative colitis (more than 10 points on the Powell-Tuck scoring system and mucosal disease Heatly grade III or IV).

METHODS

In a multi-centre, double blind, placebo-controlled trial all patients were treated with oral 5-ASA (1.6-2.4 g daily) and high dose corticosteroids (tapering off from 60 to 80 mg daily). They were randomly assigned to receive subcutaneous placebo (n = 22) or octreotide 500 microg (n = 20) thrice daily during 21 days. Clinical and endoscopic disease activity, histology and laboratory parameters were obtained during the study period.

RESULTS

Clinical disease activity for both octreotide and placebo were not significantly different at baseline and after 21 days of treatment. Endoscopic disease activities (mean +/- SD) changed from 12.5 +/- 4.7 to 7.2 +/- 5.3 for octreotide, and from 11.5 +/- 5.0 to 5.0 +/- 3.4 for placebo (NS). Seven patients from both groups received additional treatment (colectomy (n = 6), cyclosporin (n = 1)). Adverse events occurred equally in both groups.

CONCLUSIONS

Subcutaneous administration of octreotide 500 microg thrice daily is not of additional benefit as adjuvant therapy to high dose corticosteroids in severe ulcerative colitis.

Removal of IgG from normal plasma and plasma from untreated patients with active Crohn's disease--effect on levels of contact factors

Protein G columns were used to remove IgG from human plasma, and the effect on levels of factor XII, factor XI and prekallikrein was studied in functional tests. IgG was detected in PAGE immunoblot experiments with Fc-specific antibodies. Removal of the bulk of IgG in a procedure based on a low plasma dilution (1+2.5) allowed the passage of an IgG fraction along with the contact factors. This fraction was found to be present in higher amounts in plasma from patients with Crohn's disease (n=5) than in control plasma (n=12). In a previous study, PAGE immunoblot experiments showed that part of the prekallikrein was removed along with IgG when a higher plasma dilution (1+10.8) was used (Scand J Clin Lab Invest 1999; 59: 55-64). This observation was supported by results in the present work based on parallel assays with the peptide substrates S-2302 and Bz-Pro-Phe-Arg-pNA. The prekallikrein fraction removed was present in a functional state differing from the main part of prekallikrein by yielding kallikrein with a significantly increased activity against the substrate S-2366. This prekallikrein fraction was present in higher amounts in patient plasma than in control plasma. Part of the corresponding amidase activity was blocked by lima bean trypsin inhibitor, suggesting its presence in association with factor XI. The results also indicated that prekallikrein activator activity was connected with this fraction. With the high dilution procedure an extensive removal of IgG from the patient plasma was obtained compared to the control plasma.

[Treatment of Helicobacter pylori infection]

The article presents information gained from a survey among Norwegian hospitals in March 1997 concerning their treatment of infections with Helicobacter pylori. Altogether 52 hospitals answered the questionnaire. A combination of proton pump inhibitors, metronidazole and clarithromycin was used by 59% as first choice and urea quick test (94%) and urea breath test (42%) as the primary diagnostic procedures, whereas serology was in little use (17%). Besides ordinary ulcer disease, indications for treatment were: ulcer induced by non-steroid anti-inflammatory drugs (79%), gastrooesophageal reflux (37%), non-ulcer dyspepsia (14%) and cancer prophylaxis (14%). The gastro group at the Department of Pharmacotherapeutics at the University of Oslo invited specialists from all health regions to discuss indications for treatment of H pylori, the diagnosis and the role of general practitioners. The extensive use of clarithromycin might be doubtful due to development of resistance. Indications for treatment of H pylori other than ulcer disease and mucosa associated lymphoid tissue lymphoma are still uncertain. Uncritical use of serological tests in primary care should be discouraged. At present there is no uniform strategy for the diagnosis and treatment of H pylori infection, and a coordinated strategy between general practitioners and specialists is needed.

Intestinal IgA- and IgM-producing cells are not decreased in marathon runners

Alterations in duodenal immunoglobulin (Ig-)producing cells after excessive physical stress (marathon running) were studied by immunohistochemistry in 11 well-trained male adults, both shortly after running (race time, approximately 3.00 h) and later on after a "resting period" of 8-12 weeks with normal training (7-20 h/week). The ratios of IgA-, IgM- and IgG-producing cells were similar in the two biopsy specimens and virtually identical to those in eight normal duodenal controls (medians 77.6% IgA, 18.6% IgM, and 2.5% IgG). However, in the first sample the total number of positive cells per intestinal length unit was increased in five for IgA and in seven for IgM, while it was decreased in eight for IgG compared with the second biopsy. Also, the IgA cell number tended to be slightly increased immediately after the race (median 128 cells/unit) compared with that in normal controls (median 111 cells/unit); the same tendency was found for all Ig classes considered together. This apparent change was not explained by a thickening of the mucosa. Our study showed that marathon runners seem to maintain or even enhance their intestinal IgA and IgM-production, in contrast to the IgA decrease reported for other compartments such as salivary secretions and peripheral blood. The tendency to slightly increased intestinal IgA and IgM immunocyte populations in some runners might reflect a stress-induced hormonal influence on the homing of primed B cells to the mucosa, or perhaps an immune response to elevated influx of stimulatory luminal antigens.

Clinical course during the 1st year after diagnosis in ulcerative colitis and Crohn's disease. Results of a large, prospective population-based study in southeastern Norway, 1990-93

BACKGROUND

The clinical course and prognosis in ulcerative colitis (UC) and Crohn's disease (CD) have been described in many studies, mostly retrospective. Such studies are hampered by problems such as inclusion over a long time period, proper definitions, incomplete case records, and outdated methods of diagnosis. In a prospective study we identified 846 patients with inflammatory bowel disease (IBD) over a 4-year period from 1990 to 1993. Uniform diagnostic and therapeutic strategies were used as a basis for later assessment of the short-term clinical course in different subgroups of UC and CD and analysis of potential risk factors for relapse or surgery.

METHODS

At the time of follow-up, a mean of 16.2 months after diagnosis, 496 UC patients and 232 CD patients, altogether 98%, were available for evaluation. A colonoscopy was performed in 88% (410 of 465) of the UC patients attending a clinical examination and in 76% (164 of 216) of the CD patients.

RESULTS

Eleven patients with UC and five patients with CD died during follow-up, four of complications related to IBD. The cumulative 1-year relapse rate in the remaining patients was 50% for UC and 47% for CD. Of the patients with relapses 11 % of the UC patients and 10% of the CD patients had a chronic relapsing course without any difference with regard to the various disease categories in UC or CD. An increased risk of relapse was found in patients less than 50 years old only in UC. In UC a higher risk for surgery was found in patients with extensive colitis compared with left-sided colitis (P = 0.011), and CD patients with small-bowel involvement had a higher risk of surgery than patients with disease confined to the colon (P = 0.021). There was no excess risk of relapse or surgery in smokers as compared with non-smokers or former smokers, nor did the risk of relapse vary with the level of cigarette consumption in either UC or CD patients.

CONCLUSION

The high relapse rate of around 50% for both UC and CD calls for a review of the existing treatment. Further follow-up will be necessary to improve our ability to make clinical decisions relating to medical and surgical treatment options.

Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway

BACKGROUND

The incidence figures for ulcerative colitis (UC) and Crohn's disease (CD) have been difficult to interpret, and geographical variations may be due to differences in classification criteria and study design. Few studies have based the incidence on prospective systematic follow up to confirm the initial diagnosis.

METHODS

Between 1990 and 1993, in a prospective incidence study of inflammatory bowel disease (IBD) in south eastern Norway, 527 cases of UC, 228 cases of CD, 36 cases of indeterminate colitis (IND), and 55 cases of possible IBD were identified, yielding an annual incidence of 13.6, 5.9, 0.9, and 1.4 per 10(5) respectively. The diagnosis and all clinical data were reviewed by two gastroenterologists independently of each other. One to two years after diagnosis, all patients were offered a clinical follow up in which the initial diagnosis was assessed.

RESULTS

Between the time of diagnosis and the follow up, 16 patients had died, four of complications related to IBD. Of the remaining 830 patients, 98% (814/830) were available for follow up, 93% (772/830) attended a clinical examination which included a colonoscopy in 77% (637/830), and the remainder had had a telephone interview, or reassessment based on hospital records, or both. Twenty seven patients were reclassified as not having IBD (3%), and 65 patients were characterised as possible IBD (8%). Of the patients initially classified as UC, 88% had their diagnosis confirmed, compared with 91% with an initial diagnosis of CD. In patients with indeterminate colitis, 33% were classified as definite UC and 17% as CD. This reclassification of patients yielded a corrected annual incidence of 12.8 for UC and 6.0 for CD.

CONCLUSION

At follow up one to two years after the diagnosis of IBD, the initial incidence was only marginally altered. This is probably due to uniform inclusion criteria and careful diagnostic methods. The study also illustrates the importance of the re-evaluation of the initial diagnosis as close to 10%, both among patients with UC and CD, were reclassified at follow up.

Development and evaluation of written patient information for endoscopic procedures

BACKGROUND AND STUDY AIMS

In the process of revising our written patient information, we wanted to incorporate some patient feedback into the text, and to compare the new brochures with the old one in terms of procedure-related anxiety and general patient satisfaction.

PATIENTS AND METHODS

A total of 136 patients were asked about their present sources of information and issues they would like more information on. New brochures were developed for upper endoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP), and 235 consecutive patients were then randomized to receive either the new brochures or the old one. Before the endoscopy procedure, the patients' sources of information, level of anxiety (on a five-point Likert scale) and general satisfaction with the written information was assessed. In addition, 89 patients completed a similar questionnaire after completing the endoscopic procedure, recording their degree of anxiety and discomfort during the procedure, and the appropriateness of the written information they had received.

RESULTS

The written brochure was regarded as providing important information by 79% of the patients, while only 31% felt they had received important information from their referring doctor. The general level of anxiety was 2.0 (slightly anxious) with both brochures, with a mean score of 2.1 and 1.9 for the old brochure and the new one, respectively (P = 0.04). Previous endoscopy, male sex and high age were associated with a lower anxiety score. The post-endoscopy response indicated that the patients had received a realistic description of the procedure. The new brochures were rated as "excellent" or "very good" by 87% of the respondents.

CONCLUSIONS

We have developed a new set of information brochures which appear to serve the purpose of providing adequate information, without causing patients undue anxiety.

Incidence of Crohn's disease in four counties in southeastern Norway, 1990-93. A prospective population-based study. The Inflammatory Bowel South-Eastern Norway (IBSEN) Study Group of Gastroenterologists

BACKGROUND

Standardized criteria for Crohn's disease (CD) have only recently been developed, and prospective community-based incidence studies have been performed only during the past 3 decades. Geographic variations in incidence may therefore be due to differences in study design.

METHODS

From 1 January 1990 to 31 December 1993 all new cases of CD in four counties in southeastern Norway were prospectively registered.

RESULTS

A total of 225 new cases yielded an annual incidence of 5.8/10(5), with the highest incidence in mixed rural-urban areas. A peak of 11.2/10(5) in the annual incidence was found for the age group 15 to 24 years, with no significant differences in the overall annual incidence by gender. An average duration of 6 months of disease before diagnosis was unchanged during the 4 years. About half of the patients had isolated colonic disease, and one-quarter had isolated small-bowel disease.

CONCLUSIONS

This study confirms the high incidence figures for Scandinavia, with a particularly high incidence in mixed rural-urban areas. Ileocolonoscopy improves the accuracy of the diagnosis and of the determination of disease extent, which may have therapeutic implications for the treatment and follow-up of patients.

Incidence of ulcerative colitis and indeterminate colitis in four counties of southeastern Norway, 1990-93. A prospective population-based study. The Inflammatory Bowel South-Eastern Norway (IBSEN) Study Group of Gastroenterologists

BACKGROUND

The incidence of ulcerative colitis (UC) has been difficult to interpret because prospective studies have only been performed during the past 3 decades. Geographic variations may therefore be due to differences in study design.

METHOD

From 1 January 1990 to 31 December 1993 all new cases of UC in four counties in southeastern Norway were prospectively registered. Cases diagnosed as indeterminate colitis (IND) when endoscopy and histopathology were inconclusive or diverged with regard to diagnosis of UC or Crohn's disease (CD) were also included in the study.

RESULTS

A total of 525 cases of UC and 93 cases of IND yielded an mean annual incidence of 13.6/10(5) and 2.4/10(5), respectively. There were differences in incidence between counties, and a peak of 21.5/10(5) in the annual incidence was found for the age group 25 to 34 years in UC. The distribution was about equal for each of the groups proctitis and left-sided and extensive colitis. The time interval from onset of symptoms to diagnosis was 4 months.

CONCLUSION

In this study one of the highest incidences of UC in the world has been found. The classification 'indeterminate colitis' seems reasonable to use in some of the cases to prevent misclassification at the initial stage of diagnosis.

Incidence of inflammatory bowel disease in southeastern Norway: evaluation of methods after 1 year of registration. Southeastern Norway IBD Study Group of Gastroenterologists

To assess the feasibility of a prospective incidence study of inflammatory bowel disease (IBD), the registration methods and incidence figures during 1990 were evaluated. The study was a collaboration between 14 hospitals in an area of close to one million inhabitants. Common diagnostic criteria for ulcerative colitis (UC), Crohn's disease (CD) and indeterminate colitis (IND) were established prior to the start of the study. There was an overall incidence rate for IBD of 19.3 per 10(5) inhabitants, with 10.6 for UC, 5.1 for CD and 3.6 for IND. The age-specific incidence rates showed a peak between 25 and 34 years for UC and between 15 and 25 for CD. There was a male predominance for UC and a female preponderance for CD. These results are comparable with the previous registrations in western and northern areas of Norway.

[Follow-up of chronic inflammatory bowel disease. A 10-year material]

During a ten year period, all patients (N = 641) with chronic inflammatory bowel disease were systematically followed, clinically and endoscopically by means of mucosal biopsies. The complexity of these disorders was obvious, and in 103 patients it was impossible to establish a diagnosis of either ulcerative colitis or Crohn's disease. Fulminant colitis occurred in 9.8% of the ulcerative colitis patients and only four of these had to have surgery. Total colectomy was necessary in only 58 patients. Twenty-one patients died, four from causes related to the inflammatory bowel disease. Six patients with ulcerative colitis were treated for adenocarcinoma of the colon. No malignancies were found in the patients with Crohn's disease. The biopsies showed only two patients with high grade dysplasia.

Gastrointestinal bleeding: dyspeptic symptoms and clinical course in relation to use of non-steroidal antiinflammatory drugs

To study the symptoms of NSAID-associated gastroduodenal bleeding, 94 patients (median age 71 years, range 19-90), were included in a prospective, clinical trial where hematemesis or melena from gastroduodenal ulceration or haemorrhagic/erosive gastritis were the inclusion criteria. NSAID use within one month was studied in relation to subjective symptoms prior to admission and to clinical course of the episode. Significantly fewer of the NSAID users (n = 54) than the non-users (n = 40) had experienced prior peptic ulceration or dyspeptic symptoms. Otherwise, no differences were seen between users and non-users, as regards pre-admission epigastric pain, heartburn or nausea. Also, the clinical course was similar in the two groups. We also found sporadic and regular NSAID use to be similar in this respect. These data do not support the alleged masking of ulcer symptoms by NSAIDs in bleeding ulcers.

[Endoscopic retrograde cholangio-pancreatography in suspected acute gallstone pancreatitis]

During the 5-year-period from July 1983 to July 1988, ERCP was performed within 48 hours after onset of clinical symptoms in 63 patients with suspected gallstone pancreatitis. In 53 patients this etiology was confirmed, and acute endoscopic papillotomy was done in 30 of these patients. ERCP seems to be a safe diagnostic procedure in acute gallstone pancreatitis, and papillotomy gives effective drainage and relief of the acute symptoms.

Secretin infusion in acute ischemic left ventricular failure: effects on myocardial performance and metabolism in a closed-chest dog model

Acute ischemic left ventricular (LV) failure in eight closed-chest, anesthetized dogs was induced by embolization of the left coronary artery with 50 micron polystyrene microspheres until LV end-diastolic pressure reached 25.2 +/- 1.4 mm Hg. Cardiac output was reduced by 33%, LVdP/dt by 32% and mean arterial pressure fell substantially. Plasma secretin increased significantly during the induction of failure. Infusion of secretin, 16 clinical units X kg-1 X hr-1 caused a persistent increment in LV performance, due to arteriolar dilation as well as a modest inotropic effect. Heart rate was elevated slightly and LV end-diastolic pressure unchanged. Mean arterial pressure was unchanged initially, but decreased slightly at the end of the infusion period. Myocardial oxygen consumption was unaltered. It is concluded that secretin may be well suited for the treatment of acute LV failure.

Gastrointestinal peptides in serum and synovial fluid from patients with inflammatory joint disease

The concentrations of immunoreactive vasoactive intestinal polypeptide (ir-VIP), immunoreactive pancreatic polypeptide (ir-PP), ir-somatostatin, and ir-secretin were measured in serum and synovial fluid from patients suffering from various inflammatory joint diseases. One group of patients were not taking any medication, while another group received anti-inflammatory treatment at the time of sampling. High levels of ir-VIP in the synovial fluid were observed in the untreated group of patients, and the concentration of ir-VIP in the synovial fluid was significantly higher than in parallel serum samples. On the other hand, no significant differences in the concentrations of the other peptides were observed either between serum and synovial fluid or between the two groups of patients. It is suggested that VIP is released locally at the inflammatory site and that VIP may be of significance in inflammatory disorders.

Release of gastrointestinal hormones in cardiodepressive shock

In previous studies increased plasma levels of vasoactive intestinal polypeptide (VIP), somatostatin and pancreatic polypeptide (PP) were demonstrated in a porcine endotoxin shock model. Unchanged levels of gastric inhibitory polypeptide (GIP) and secretin point to a specific shock reaction of peptide release and not to a diffuse mucosal leakage. A porcine model of cardiodepressive shock was developed to enable discrimination to be made between a general low-flow state and endotoxin reaction. Infusion of the tricyclic antidepressive agent nortriptyline 15 mg/kg bodyweight resulted in a grave shock state. Increased plasma levels of somatostatin, PP and insulin were found. No increase in VIP levels could be demonstrated. Endotoxin given after nortriptyline administration resulted in the increase of VIP levels regularly seen during endotoxinaemia. VIP release during endotoxin shock is related to endotoxin and not to a general low flow state.

The origin and fall of plasma motilin during Escherichia coli endotoxin shock in pigs

Plasma motilin decreased significantly during a 120 min intravenous Escherichia coli endotoxin infusion which induced deep shock in six anaesthetized pigs. Plasma motilin was significantly higher in the portal vein and significantly lower in the internal jugular vein than in the aorta and the superior caval vein. Following gastrointestinal resection with blood sampling from the portal vein, the aorta and the superior caval vein in another six pigs, motilin almost disappeared in non-portal plasma, while it decreased significantly in portal plasma in which it also fell further during E. coli endotoxin infusion. The results support the opinion that the gastrointestinal tract is the main source of plasma motilin.

Increased plasma levels of vasoactive intestinal polypeptide in pigs during endotoxinaemia

Vasoactive intestinal polypeptide (VIP) is a highly potent vasodilatator. Cardiovascular changes and plasma VIP levels were studied during endotoxinaemia (Escherichia coli endotoxin 1 mg/kg) in a carefully monitored porcine model. Endotoxin infusion resulted in a profound but reversible shock and a substantial rise in plasma VIP levels. Increased levels of VIP could be demonstrated already after 30 min of endotoxin infusion and increased further during the infusion. Animals followed for a period of 60 h demonstrated slowly declining levels of VIP after endotoxin infusion but significantly elevated levels were usually found 24 h after infusion. Control animals did not show any changes in VIP during a similar procedure. Release of gastrointestinal peptides may be of importance during septic shock.

Lower plasma levels of some gastrointestinal peptides in Raynaud's disease. Influence of transcutaneous nerve stimulation

In a previous study it was shown that Raynaud patients during ischemic attacks displayed significantly lower levels of vasoactive intestinal polypeptides (VIP) in cubital vein plasma than did normal subjects in the same relatively cold environments. Low-frequency transcutaneous nerve stimulation (TNS), producing widespread cutaneous vasodilatation, was associated with a 30-35% increase in plasma VIP in both groups. In the present study parallel observations were made in some of the same subjects under the same experimental conditions with regard to six other gastrointestinal peptides: somatostatin, motilin, pancreatic polypeptide (PP), secretin, gastric inhibitory polypeptide (GIP), and cholecystokinin (CCK), determined radioimmunochemically. Except for CCK, the mean plasma levels of all these gut peptides were similarly lower in the Raynaud patients than in the normal subjects in cold environments. However, TNS did not induce significant increases in the plasma levels of any of these 6 peptides. These findings appear to place VIP in a different functional category than the other gut peptides.

Portal and systemic plasma VIP and secretin during intravenous infusion of Escherichia coli endotoxin in pigs

Plasma vasoactive intestinal polypeptide (VIP) increased significantly in the portal vein, the superior caval vein, the internal jugular vein, and the aorta during an intravenous infusion of E. coli endotoxin in six anesthetized pigs, which all developed a deep shock, with fall in aortic blood pressure and urinary output. Plasma VIP peaked simultaneously with the most pronounced shock symptoms, and the level in the portal vein was significantly higher than in blood from the other sampling sites. In contrast, no significant change in plasma secretin was noted. It is suggested that the gastrointestinal tract is the main source of the high plasma VIP levels seen during endotoxinemia and that VIP may play a significant role in endotoxin shock.

Radioimmunoassayable plasma motilin in man. Secretagogues, insulin-induced suppression, renal removal, and plasma components

In normal humans, significant motilin increases were found after meal ingestion, intraduodenal infusion of fat, and intraduodenal infusion of physiological HCl doses. Only a non-significant plasma motilin increase was found in response to intraduodenal infusion of cattle bile. Plasma motilin decreased significantly after an intravenous insulin injection. During routine cardiac catheterization in a group of 10 patients plasma motilin was significantly lower in the renal vein than in the femoral vein, femoral artery, right atrium, and hepatic vein, suggesting that the kidneys participate in the removal of motilin from the circulation. Fasting and oral fat-stimulated plasma motilin immunoreactivity eluted in two peaks on a Sephadex G-50 Fine column. The two peaks behaved identically with porcine motilin in dilution series.

Somatostatin release and plasma molecular somatostatin components in man

The present paper describes a sensitive, precise and specific radioimmunoassay method for measurements of plasma somatostatin; significant rises in plasma somatostatin following a test meal, intraduodenal infusion of fat and HCl, and intravenous injection of insulin; and separation of immunoreactive plasma somatostatin into two components probably representing bound and free molecular forms of somatostatin both in fasting and postprandial human plasmas.

Vasoactive intestinal polypeptide and somatostatin in leucocytes

Vasoactive intestinal polypeptide (VIP) was measured in extracts from polymorphonuclear (PMN) and mononuclear (MN) leucocytes from 14 healthy persons and 12 pigs. In addition, extracts from PMN and MN cells from eight pigs were studied for possible contents of somatostatin. Immunoreactive VIP was present in the PMN and MN leucocytes from man and pigs with a significantly higher level in the MN cells. Similarly, immunoreactive somatostatin was found in both cell lines from pigs with a significant higher amount in the MN leucocytes. Furthermore, extracts from pure populations of human PMN and MN leucocytes were separately applied on a Sephadex G-50 Fine column, and VIP, somatostatin, secretin, GIP and motilin were measured in the eluted fractions. Only VIP and somatostatin were found to be present in detectable amounts. Immunoreactive VIP eluted corresponding to the elution volume for pure porcine VIP in extracts from both PMN and MN cells, while immunoreactive somatostatin eluted corresponding to the elution volume for the synthetic tetradecapeptide somatostatin in extracts from MN cells only. Possible physiological implications of these findings are briefly discussed.

Plasma cholecystokinin (CCK) before and after a jejunoileal bypass operation in obese patients with reference to appetite regulation

Plasma cholecystokinin (CCK) rose significantly after a 15-min liquid test meal in six normal controls and six obese patients, both before and after a jejunoileal bypass operation. Post-prandial rises in the obese patients were virtually unaffected by the operation, and tended to be higher in the obese patients than in the normal controls. It is therefore concluded that hormonal CCK is unlikely to be a mediator of satiety signals from the digestive tract in obese persons.

Diurnal profile of plasma somatostatin in man

Plasma somatostatin was followed for 24 h in 6 healthy young males having 4 regular meals with water allowed freely, and performing their normal daily activities. Plasma somatostatin rose significantly after each meal, it returned towards the basal level before the next meal, and it rose higher and stayed significantly elevated longer after the evening meal than after any of the other meals. A possible physiological circadian rhythm of plasma somatostatin is discussed.

Mezlocillin treatment of septicemia in general hospitals

Gramnegative septicemia in 23 patients from different Norwegian departments of general medicine or surgery was treated with mezlocillin. Most of the patients were old, and 14 patients were considered compromised due to underlying disease. In the majority of cases the septicemia originated from urinary tract infections. Uneventful recovery was accomplished in 16 patients (70%) and another 5 cases improved. In 2 patients no clinical effects were observed within 3 days of treatment. Apart from diarrhoea in 5 of the cases, no side-effects occurred. Mezlocillin proved to be a safe and efficient drug for the treatment of gramnegative septicemias of the type that is most commonly encountered in Norwegian general hospitals.

The effect of insulin-induced hypoglycemia with and without atropine on plasma vasoactive intestinal polypeptide in man

Plasma vasoactive intestinal polypeptide (VIP) was measured in six healthy male students on 2 separate days after insulin-induced hypoglycemia with and without atropine and on a 3rd day in five of the students after atropine alone. A significant increase in peripheral plasma VIP was observed when atropine was given together with insulin, whereas insulin or atropine alone had no effect on plasma VIP. It is suggested that cholinergic nicotinic receptors may be involved in the increase of VIP after insulin-induced hypoglycemia and that the lack of VIP increase seen after insulin alone may be caused by an inhibitory effect of other gastrointestinal hormones.

Secretin exerts inhibition of the 8BrcAMP-stimulated 86Rb influx into avian red blood cells

Avian erythrocytes possess a Na+ and K+ cotransport system which can be inhibited by loop diuretics. The newly discovered diuretic effect of secretin in man led us to study the effect of this hormone on the cotransport system. Secretin caused a 50% inhibition of the 8BrcAMP-stimulated 86Rb influx into red blood cells from goose at a concentration of 8.5 X 10(-6) M, while furosemide and bumetanide caused a 50% inhibition at concentrations of 7 X 10(-6) M and 9 X 10(-8) M, respectively. It is suggested that the diuretic effect of secretin is mediated through an inhibitory or blocking effect on the Na+ and K+ cotransport system.

The effect of atropine on plasma vasoactive intestinal polypeptide after intraduodenal infusion of fat in man

Plasma vasoactive intestinal polypeptide (VIP) was measured in six healthy young men after intraduodenal infusion of 100 ml Lipomul (66 g triglycerides) on 2 separate days. On one of the days 0.5 mg atropine sulphate was injected intravenously at the start of the fat infusion, immediately followed by 0.75 mg atropine sulphate infused intravenously during the first hour. Plasma VIP rose significantly (p less than 0.05) and stayed significantly elevated for at least 120 min after intraduodenal infusion of fat alone. This effect was abolished by atropine, suggesting that the VIP release seen after intraduodenal fat may be dependent on a certain tone of muscarinic receptors influencing the VIPergic neurons. However, we cannot exclude the possibility that the blocking effect of atropine in part reflects a delayed transit time of fat in the intestine.

Iodination with Iodo-gen and radioimmunoassay of cholecystokinin (CCK) in acidified plasma, CCK release, and molecular CCK components in man

The preparation of a stable fully immunoreactive 125I-labeled CCK39 using a modified Iodo-gen method with high specific radioactivity; the production of an avid and specific cholecystokinin (CCK) antiserum, and a sensitive, precise and specific radioimmunoassay method allowing measurements of fasting plasma CCK in the low picomole per liter range together with the significant rises in plasma CCK following a test meal and duodenal infusion of fat are described. Apparent immunoreactive fasting plasma CCK was eluted from a Sephadex G-50 Fine column in one peak probably representing plasma CCK bound to plasma proteins and nonspecific plasma effects. Apparent immunoreactive postprandial plasma CCK was eluted from a Sephadex G-50 Fine column in four peaks. The first peak probably represents plasma CCK bound to plasma proteins and nonspecific plasma effects; the second peak probably represents component I with a molecular weight between some 5,000 and 30,000; the third peak probably represents component II or CCK33, and the fourth peak probably represents component IV or CCK8.

The effect of a 34-h fast on the meal-induced rises in plasma GIP, serum insulin, and blood glucose in man

The meal-induced rises in plasma GIP, serum insulin, and blood glucose were studied after an overnight fast and after a 34-h fast in six healthy men. After the 34-h fast, the postprandial mean plasma GIP level at 120 min and the mean serum insulin and blood glucose levels at 60 and 90 min were significantly higher than those seen after the overnight fast.

The effect of somatostatin on fasting and postprandial plasma GIP, serum insulin, and blood glucose in man

Six healthy men were given a standard breakfast, one day with and another day without a 2-h 100 micrograms/h somatostatin infusion. During the somatostatin infusion the meal-induced responses of plasma GIP and serum insulin were completely blocked, whereas the rise in blood glucose was significantly augmented. After termination of the somatostatin infusion the mean plasma GIP increased gradually to a peak after 2 h, whereas mean serum insulin showed a marked rebound phenomenon and peaked after 30 min, on the one hand, and mean blood glucose fell to an apparent nadir after another 30 min, on the other. The effect of somatostatin on basal plasma GIP, serum insulin, blood glucose, and gastric H+ secretion was studied in another group of six healthy men. Mean plasma GIP tended to fall during the initial 1-h saline infusion, fell further during the first part of the 2-h 100 micrograms/h somatostatin infusion, and started to rise first 85 min after termination of the somatostatin infusion. Similarly, mean serum insulin, mean blood glucose, and mean gastric H+ secretion decreased during the somatostatin infusion, and thereafter returned to their basal levels.

The effect of duodenal infusion of bile on plasma VIP, GIP, and secretin and on duodenal bicarbonate secretion

Nine healthy young male students were studied before, during, and after a 10-min period of duodenal infusion of 6 g dried cattle bile dissolved in 75 ml distilled water to iso-osmolarity and pH adjusted to pH 7.0. Plasma vasoactive intestinal polypeptide (VIP), gastric inhibitory polypeptide (GIP), and duodenal bicarbonate secretion increased significantly, whereas plasma secretin showed a late but not significant tendency to rise after the bile infusion.

Diurnal variation of plasma gastric inhibitory polypeptide in man

Plasma gastric inhibitory polypeptide (GIP) was studied for 24 h in six healthy, young men who ate four meals and performed their usual physical activities. Plasma GIP peaked after each meal and stayed significantly elevated from the peak after breakfast till late evening.

The effect of a test meal on plasma vasoactive intestinal polypeptide (VIP), gastric inhibitory polypeptide (GIP), and secretin in man

In six fasting healthy young male students a 15-min test meal consisting of 160 ml milk, 200 ml coffee, 70 g bread, 3.5 g butter, 35 g cheese, and 30 g ham (45 g carbohydrates, 30 g proteins, and 25 g fat) caused a late but significant elevation in plasma vasoactive intestinal polypeptide (VIP), an early and sustained significant rise in plasma gastric inhibitory polypeptide (GIP), but no significant change in plasma secretin.

Radioimmunoassay of vasoactive intestinal polypeptide in plasma

A sensitive, precise, and specific radioimmunoassay for vasoactive intestinal polypeptide (VIP) is described, with a detection limit of 0.8 pmol/l, within assay precision of 7.8%, and between assay precision of 13.1%. The final dilution of the antiserum to bind 50% of 0.9 fmol 125I-labeled VIP was 1:250000. The antiserum showed an effective equilibrium constant (Keff) according to Scatchard of 7.4 x 1011 l/mol, an average equilibrium constant (Ko) according to Sips of 7.3 x 1011 l/mol, an index of heterogeneity (alpha) according to Sips of 0.99, and a negligible cross-reactivity with secretin. 125I-labeled VIP was prepared by a modified Chloramine-T method, and the label purified on a Sephadex G-15 column followed by a SP Sephadex C-25 column had a specific radioactivity of 1700 muCi/nmol. The present assay allows measurements of fasting plasma VIP in the very low pmol/l range and the increase and gradual fall in plasma VIP subsequent to a brief period of duodenal acidification.