Ileocolonoscopy and microscopic examination of ileum biopsies were performed on 35 patients with reactive arthritis, with asymmetrical pauciarticular arthritis and enthesopathies. Ileocolonoscopy was also performed on 26 patients with ankylosing spondylitis (AS) and on 19 control patients with rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus and psoriatic arthritis. In the reactive group, ileocolonoscopy showed macroscopic inflammation in 16 cases and abnormal microscopic examination in all but 2 cases, even in patients without gastrointestinal disorders. In the 2 patients with sexually acquired disease, the gut was normal. In the AS group, inflammation was observed in the B27 negative and positive patients with peripheral joint involvement. Occasionally, ileal signs were seen in the HLA-B27 positive patients without peripheral joint involvement. None of the controls showed signs of gut inflammation. Ilecolonoscopy may be of value in detecting subclinical forms of bowel inflammation.

BACKGROUND Activated lymphocytes are considered to play a pathogenic role in Crohn's disease (CD) and ulcerative colitis (UC), although only a limited fraction of the gut-residing lymphocytes in these diseases may be pathogenetically involved, due to active recruitment from the peripheral circulation. Our aim was to characterize in situ preactivated lymphocytes in inflammatory bowel disease mucosa by expansion with interleukin-2. METHODS Flow cytometry was performed on T cells expanded from the colon of patients with CD (7), UC (16), and controls (20), with special reference to T-cell activation markers and adhesion molecules. RESULTS In CD a decrease in alpha4beta7 integrin expression was associated with an increase in alphaEbeta7. In UC a similar increase in alphaEbeta7 was observed. Moreover, L-selectin and CD30 were overexpressed on T helper cells in UC versus CD. CONCLUSION These findings indicate different immunopathogenic pathways for CD and UC.

Ileocolonoscopy was performed on 357 patients meeting the European Spondylarthropathy Study Group criteria for spondyloarthropathy. HLA loci A, B and C were determined in all patients; HLA-B27 was detected in 196 and was absent in the 161 remaining patients. A number of clinical, laboratory and radiological variables were determined before ileocolonoscopy and compared between the HLA-B27+ and HLA-B27- patients. The HLA-B27+ patients were mainly men, with significantly more family members with spondyloarthropathies. Clinical evidence of tendinitis and uveitis was more frequently found in these patients. Like several authors, we found that these patients were more severely affected since they presented more severe radiological involvement of the sacroiliac joints. Syndesmophytes, bamboo spine and erosive joint lesions were more frequent in this group, the hip involvement being of the concentric type. In HLA-B27+ patients ankylosing spondylitis was more prevalent, while in the B27- patients enterogenic, urogenital or undifferentiated spondyloarthropathy was diagnosed. The HLA-B27- patients experienced more episodes of diarrhea, and Crohn-like inflammatory gut lesions were more frequently seen on ileocolonoscopy. In this group a number of patients probably had a form of subclinical Crohn's disease of which the locomotor symptoms were the only clinical expression.

We present two cases of small-bowel adenocarcinoma and dysplasia in patients with longstanding Crohn's disease. In one case, the dysplasia and cancer were exclusively located in the terminal ileum, whereas in the other case, several cancers were found from the ileum toward the transverse colon. In both cases, we found a clinically unsuspected Dukes C1 mucinous adenocarcinoma together with large foci of polypoid villous dysplasia or with multifocal high-grade dysplasia and intramucosal carcinoma. Immunohistochemical staining for carcinoembryonic antigen (CEA) revealed a different staining pattern in various diseased areas. The intensity of CEA staining paralleled the histologic degrees of dysplasia and neoplasia. Cytokeratin expression was disturbed in inflamed mucosa, and it was more pronounced in high-grade dysplasia and invasive carcinoma. We conclude that the presence of dysplasia in an intestinal biopsy of a patient with Crohn's disease should arouse the pathologist's suspicion of carcinoma and force him or her to take multiple sections from strictures and polypoid lesions, especially since the clinical symptoms of a carcinoma may be obscured by the symptoms of inflammatory bowel disease. Immunohistochemical staining with CEA and cytokeratin are useful in the objectivation of dysplasia.

We describe an 84-yr-old woman in whom a straight Amsterdam-type biliary endoprosthesis was inserted because of endoscopically unremovable large common duct stones. After 18 months, the prosthesis migrated through the duodenum and the intrapancreatic portion of the bile duct, with its distal tip close to the vena cava and the aorta. In view of this high-risk complication, the authors avoid placing straight biliary endoprotheses for common bile duct stones in patients who might be lost to follow-up.

Journal Article lleocolonoscopy and Spondarthritis Get access H. MIELANTS, H. MIELANTS 1Departments of Rheumatology, University of GhentBelgium. Search for other works by this author on: Oxford Academic PubMed Google Scholar E. M. VEYS, E. M. VEYS 1Departments of Rheumatology, University of GhentBelgium. Search for other works by this author on: Oxford Academic PubMed Google Scholar C. CUVELIER, C. CUVELIER 2Pathology , University of GhentBelgium. Search for other works by this author on: Oxford Academic PubMed Google Scholar M. DEVOS M. DEVOS 3Gastroenterology, University of GhentBelgium. Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume 27, Issue 2, April 1988, Pages 163–164, https://doi.org/10.1093/rheumatology/27.2.163-b Published: 01 April 1988 Article history Received: 23 December 1987 Published: 01 April 1988

The prevalence of HLA-A, B, C and DR antigens was determined and compared in 94 patients with reactive arthritis, 54 patients with ankylosing spondylitis (AS), 37 patients with inflammatory bowel disease (IBD) and in 1,010 apparently normal blood donors. The 185 patients all underwent ileocolonoscopy with biopsy of ileum, ileocecal valve and cecum. HLA-B27 was found elevated in the groups with reactive arthritis (48%, chi 2 = 82, p less than 0.0005) and the AS groups (78%, chi 2 = 157, p less than 0.0005), compared to healthy controls. HLA-Bw62 was significantly raised in the patients with reactive arthritis (34%, chi 2 = 73, p less than 0.0005) (particularly the HLA-B27 negatives (48%, chi 2 = 90, p less than 0.0005) and in the HLA-B27 negative patients with AS (25%, chi 2 = 5.5, p less than 0.02). This did not apply to the other patients with AS (4.7% NS). HLA-Bw62 could be associated with a specific clinical picture of asymmetrical pauciarticular arthritis, accompanied by enthesopathies and sacroiliitis classified as idiopathic reactive arthritis, especially when the disease is of enterogenic origin. The frequency of HLA-Bw62 was very high in patients with reactive arthritis and in patients with AS with active chronic (n = 39, 23%, chi 2 = 13, p less than 0.0005) and Crohn-like lesions (n = 14, 50%, chi 2 = 35, p less than 0.0005) on gut biopsy, normal in patients with acute lesions (n = 35, 11%, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

SummaryPlatelet counts, coagulation and fibrinolysis tests were done before, 10 min. 1, 3 and 24 hr after the performance of 24 sessions of injection Serotherapy with Polidocanol 1 % of oesophageal varices in 16 patients with liver cirrhosis. Thrombocytopenia was often present no significant changes occurred after sclerotherapy. The APTT and PT values did not change. The levels of F II. F V. F VII-X, F VIII F IX. and F X remained in the same range. Also the fibrinogen and plasminogen values did not change after the selerotherapy session. A rise in the scrum fibrin/fibrinogen degradation Products was not found, levels of antithrombin protein C, x antiplasmin and t-PA antigen femaincd stable. The absence of any change in the clotting parameters measured is in accordance with the clinical safety of the injection sclerotherapy of aesophageal varices in patients with liver cirrhosis.