Health related quality of life (HRQL) in Puerto Ricans with inflammatory bowel disease (IBD)

Health related quality of life (HRQL) in Puerto Ricans with inflammatory bowel disease (IBD)


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SHORT TERM EFFECTS OF LACTULOSE IN PATIENTS WITH STABLE IBD: COLADAPT STUDY. Andrew Szilagyi, lulie Rivard, Alain Bitton, Albert Cohen, Seymour Mishkin, Ian Shrier, Garry Wild, 5MBD -lewish Gen Hosp, Montreal, PQ, Canada; Royal Victoria Hosp, Montreal, PQ, Canada; Montreal Gen Hosp, Montreal, PQ, Canada. A role for luminal bacteria in IBD has been described. A current focus of therapy is to manipulate colonic environment by the use of pro and prebiotics. In the IL-IO knockout mouse both lactobacilli and lactulose prevent enterocolitis. This study was undertaken to examine the feasibility of using lactulose as adjunctive therapy to maintenance of IBD. Tolerance and metabolic alteration in colonic flora (colonic adaptation) were specifically sought. Methods: After an overnight fast, a 30g lactulose dose was administered (T)to 16 stable patients [at least 4 weeks] and 9 healthy volunteers. Breath hydrogen (BH z) was measured Q )/z hour for 4 hours using a hand held Hz electrochemical sensor. A symptom score was recorded each liz hour. Lactulose crystals 10 g BID was then administered for 25.2 d ~ 1.09 SEM in patients and 21.4 ~ l.l SEM in controls. A second BH z (T z) was carried out at that time. Comparisons were made bedween 4 hours BHz (4HBH z) and T) and T z, peaks, and 4 hours symptom scores using Students paired T Test (P significant at < 0.05). Adaptation was defined as 25% reduction I 4 4HBH z (T) vs T z). Fecal samples were frozen for future analysis for {.:l-Galactosidase. Results: The age of patients was 42.8 ~ 4 and controls, 30 ~ 4 years. Eleven of the patients and 5 of the controls were male. Of the patients, 8 had Crohn' s colitis (CD) and 8 ulcerative colitis (UC). All patients were maintained on entry medication. Six of UC patients (75%), 3 of 8 CD patients (37.5%) and 5 of the controls (55.5%) adapted by BHz criteria (all NS). Neither I 4 hour BHz nor I 4 hour symptom score (4SS) reached statistical significance. If controls and patients are combined (N=25) statistical significance P = 0.049 is reached. As well, peak T) forN=25 was significantly higher than peak T2 (P = 0.032). Peak BH2 in UC was significantly higher with T) (101.6 ~ 16.7 Hz/time) than T z (54.4 ~ 24.1 Hz/time) (P = 0.031). In CD patients, mean peaks were almost equal (T) 95.1 ~ 17.3, T z 97.5 ~ 30.9). Patients and controls, both tolerated 3 weeks of daily lactulose quite well. Of the Crohn's patients, I had a mild flare requiring re-initiation of prednisone, I had onset of rectal bleed requiring medicated enemas HS. Of the UC patients, I had mild rectal bleed requiring hemorrhoidal therapy. Conclusion: Lactulose 109 BID was moderately well tolerated by patients. Based on BH z criteria alone, both controls and patients were equally but modestly adaptable. Randomized trials are needed to determine whether lactulose is beneficial in IBD.

MIGRATION OF PRECURSORS OF INTRAEPITHELIAL LYM. PHOCYTES (IELS) FROM HUMAN COLONIC LAMINA PRO· PRIA. Patrick 1. Tighe, Wael Ellabban, Brian e. McKaig, Herbert F. Sewell, Yashwant R. Mahida, Div of Immunology, Univ of Nottingham, Nottingham, United Kingdom; Div of Gastroenterology, Univ of Nottingham, Nottingham, United Kingdom. Together with epithelial cells, IELs represent the first cell lines of intestinal defence. IELs express the specific integrins aE{.:l7 and the majority of human IELs express af3 T-cell receptors (TCR) with a restricted repertoire. The epithelial basement membrane contains many discrete pores through which IEL precursors can migrate from the lamina propria into the epithelium. Using a recently described model (Clin Exp Immunol 1997;109: 377-386), we have investigated the migration of IEL precursors from the lamina propria. Methods. Fresh normal human colonic mucosal samples (n= 5) were denuded of the surface epithelium and placed in culture medium. T cells migrating out of the lamina propria (via basement membrane pores) were collected after I hand 16 h culture. Ratios of the expression of aE:TCRCa mRNA transcripts were determined by quantitative PCR. Expression of TCR f3-chain variable region (Vf3) was investigated by spectratyping using 24 family-specific PCRs. The number of peaks (reflecting the sizes of VDJ regions in the PCR products) for each member of TCRVf3 family was determined. Data are expressed as mean (~SEM). Results. The ratio of aE:TCR Ca mRNA transcripts in cells migrating out of the lamina propria over 0 - 1 h culture of denuded mucosal samples was significantly greater than in cells collected after the 1 - 16 h culture period [8.7(~2.2) vs 1.8(~0.5); p=0.024]. Compared to cells migrating over 1 - 16 h culture period, amplified TCRV{.:l transcripts of cells migrating over 0 - 1 h period showed fewer peaks [6.4( ~0.3) vs 3.1 (~ 0.3); p
6241 THE ROLE OF CHINESE HERBAL MEDICINES IN A RAT MODEL OF CHRONIC COLITIS. Xiaolan Tian, Marisabel Mourelle, Yuling Li, Francisco Guarner, Juan-R Malagelada, Dept of Digest Disease, Haikou City, P. R. China; Hosp Gen Vall d'Hebron, Barcelona, Spain; People's Hosp of Hainan Province, Haikou, P. R. China. Chronic inflammation of the colon is a common syndrome involving in human's health and the quality of life and medically incurable. Traditional Chinese herbal medicines (TCM) is China's precious ancient medical legacy, and was successively used to treat liver cirrhosis and decrese liver fibrosis. Aim: to investigate a mixture of TCM in the prevention of chronic colitis in rats.Methods: 60 rats were divided into 3 groups. Colitis was induced by trinitrobenzenesulfonic acid(TNB).On day 10, the mortality and colorectal obstruction rate were calculated, the colonic lesion score was assessed and collagenase activity and collagen concentration were measured. Results: 4 rats in INB group which died in the first two days of follow-up were out of statistical data. From day 5 after colitis, there were 10 more rats in this group died because of severe colorectal obstruction (n=6) or severe diarrhea and exhaustion(n=4). At the end of the trial, totally there were II rats survived, the survival rate was 53% (11121),but all these rats suffered severe obstruction, the abdomen was highly protuberant and few feces were found in the cages.The obstruction rate was 81%(17/21). While at the end of the trial in TCM group, only 5 rats died of either obstruction (n=4) or exhaustion (n= I), the survival rate was 80% (20/25). In these survivals, they all act quickly with normal diet and feces except two which had light abdominal protuberant. The obstruction rate was 24%(6/25). The survival rates and obstruction rates between TNB and TCM groups exist big differences (P<0.05 and P
6243 HEALTH RELATED QUALITY OF LIFE (HRQL) IN PUERTO RICANS WITH INFLAMMATORY BOWEL DISEASE (IBD). Esther A. Torres, Cynthia Perez, Betty Chinea, lavier Arroyo, Nestor Aponte, Aileen Guzman, Priscilla Magno, Dawn Provenzale, Univ of Puerto Rico, San Juan, PR; Duke Univ Med Ctr, Durham. NC. HRQL is an important aspect in the treatment of patients. The disease specific instrument Rating Form for Inflammatory Bowel Diseases Patients Concerns (RFIPC) has been used extensively to measure the HRQL in patients with IBD. No data exists for Hispanics with IBD. Aim: To describe the HRQL in Puerto Ricans with IBD, using the Spanish translation of the RFIPe. Methods:After obtaining informed consent, 87 consecutive patients from the IBD Clinics of the UPR self-administered the RFIPC under supervision. The RFIPC measures concerns in four areas using 25 questions on a visual analogue scale of 100. We calculated the median and interquartile ranges. Medians for ulcerative colitis (UC) and Crohn's disease (CD)were compared using the Wilcoxon rank-sum test. The protocol was approved by the IRB of the University of Puerto Rico. Results: 45 patients with DC (18M:21F, median age 34)and 42 with CD (21M:2IF, median age 38)were tested. Median scores for all IBD were 57.2 for impact of disease, 38.6 for sexual intimacy, 67.0 for complications and 68.5 for body stigma (higher scores reflect a worse quality of life). Median scores for CD and DC did not differ (p>O.05) for any subscale. Conclusions: The median RFIPC scores of Puerto Ricans were higher for all items than the means reported in a national survey by Drossman. Concerns for UC and CD were similar in our population. Although this may be the result of a referral bias in our population, it may also reflect different attitudes and concerns based on cultural differences. If confirmed, the management of Hispanics with IBD must address these issues.

6244 EVALUATION OF THE RATING FORM FOR INFLAMMATORY BOWEL DISEASES PATIENTS CONCERNS (RFIPC) SPANISH TRANSLATlON IN PUERTO RICANS WITH IBD. Esther A. Torres, Cynthia Perez, Betty Chinea, lavier Arroyo, Nestor Aponte, Aileen Guzman, Priscilla Magno, Dawn Provenzale, Univ of Puerto Rico, San luan, PR; Duke Univ Med Ctr, Durham, Ne. Health related quality of Life (HRQL) can be measured in patients with IBD using disease-specific instruments such as the RAPe. The RFlPC measures concerns over impact of disease, sexual intimacy, complications and body stigma, using 25 questions on a visual analogue scale of 100. There is no Spanish translation of the RFlPC for determining HRQL in Hispanics with IBD. A general instrument, the Short Form-36 (Medical Outcomes Trust), is available in Spanish. Aim:We evaluated the reliability and validity of a Spanish translation of the RFlPC using the SF-36 in Puerto Ricans with IBD. Methods: With permission from the author, the RFIPC was translated from English into Spanish using the back-translation method described by Sperber. The Spanish translation was done by two bilingual Puerto Rican physicians and translated back into English by two independent English-speaking bilingual scientists. The back-translations were compared to the original by a third English speaking physician. After informed consent, 30 consecutive patients from the UPR IBD clinics