RESUMEN
BACKGROUND: The extent of bone density reduction in patients with Crohn disease is still being debated. The aim of this study was to examine bone mineral density (BMD) and factors associated with reduced BMD in a representative population of patients with Crohn disease aged between 20 and 70 years. METHODS: BMD (using dual energy X-ray absorptiometry) was measured in spine and hip in 55 patients with Crohn disease recruited from the entire Crohn population (n = 96) in a defined area of southern Norway. Demographic and clinical data were also collected. The patients were compared with 52 age- and gender-matched healthy controls. Potential demographic and disease-related factors associated with BMD reduction were statistically tested with bi- and multivariate analyses. RESULTS: The BMD reduction in patients with Crohn disease was 7.1% (P = 0.02) in spine L1-4, 6.1% (P = 0.08) in femoral neck and 8.4% (P = 0.02) in total hip as compared with the controls. In total hip and femoral neck, age, body weight and gender were independently associated with reduced BMD, but in the spine only body weight. Among the disease-related variables, only ever use of prednisolone was independently associated with reduction in BMD but this only in the femoral neck. CONCLUSIONS: The spine and hip BMD reduction of 6%-8% is similar to that found in a comparable population-based study performed in another area in Norway. Among the disease-related variables tested for, only the use of prednisolone was independently associated with BMD reduction. However, the BMD reduction measured in this study indicates that disease-related mechanisms are involved.
Asunto(s)
Desmineralización Ósea Patológica/etiología , Desmineralización Ósea Patológica/patología , Densidad Ósea , Enfermedad de Crohn/complicaciones , Absorciometría de Fotón , Adulto , Distribución por Edad , Factores de Edad , Anciano , Antiinflamatorios/efectos adversos , Peso Corporal , Desmineralización Ósea Patológica/diagnóstico por imagen , Desmineralización Ósea Patológica/epidemiología , Estudios de Casos y Controles , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/inmunología , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Noruega/epidemiología , Vigilancia de la Población , Prednisolona/efectos adversos , Cintigrafía , Sistema de Registros , Factores de Riesgo , Distribución por SexoRESUMEN
BACKGROUND: Early detection of cobalamin deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. However, serum cobalamin and other commonly used tests have limited ability to diagnose a deficiency state. METHODS: We investigated the ability of hematological variables, serum cobalamin, plasma total homocysteine (tHcy), serum and erythrocyte folate, gastroscopy, age, and gender to predict cobalamin deficiency. Patients (n = 196; age range, 17-87 years) who had been referred from general practice for determination of serum cobalamin were studied. Cobalamin deficiency was defined as serum methylmalonic acid (MMA) >0.26 micromol/L with at least 50% reduction after cobalamin supplementation. ROC and logistic regression analyses were used. RESULTS: Serum cobalamin and tHcy were the best predictors, with areas under the ROC curve (SE) of 0. 810 (0.034) and 0.768 (0.037), respectively, but age, intrinsic factor antibodies, and gastroscopy gave additional information. CONCLUSIONS: When cobalamin deficiency is suspected in general practice, serum cobalamin should be the first diagnostic test, and the result should be interpreted in relation to the age of the patient. When a definite diagnosis cannot be reached, MMA and tHcy determination will provide additional discriminative information, but MMA, being more specific, is preferable for assessment of cobalamin status.
Asunto(s)
Ácido Metilmalónico/sangre , Deficiencia de Vitamina B 12/diagnóstico , Vitamina B 12/sangre , Adolescente , Anciano , Anciano de 80 o más Años , Femenino , Ácido Fólico/sangre , Gastroscopía , Homocisteína/sangre , Humanos , Masculino , Persona de Mediana Edad , Oxidación-Reducción , Curva ROC , Análisis de Regresión , Factores SexualesRESUMEN
Between 1985 and 1987, 25 patients had abdominal operations for hiatal hernia and/or gastroesophageal reflux disease. Eight of them had complicated reflux esophagitis. One patient had a Belsey Mark IV repair, the others had a Nissen fundoplication. There was no mortality. After a median follow-up of 16 months (range 3-38) six patients had symptoms of "gas-bloat". The esophagitis was healed in ten patients. 22 patients were completely or fairly satisfied with the results of the surgery. Two patients were not satisfied. Both had complicated reflux esophagitis before they were operated on. Patients with esophagitis should be evaluated for surgery before stricture or Barrett's ulcer develop.
Asunto(s)
Esofagitis Péptica/complicaciones , Hernia Diafragmática/complicaciones , Hernia Hiatal/complicaciones , Adulto , Anciano , Esofagitis Péptica/cirugía , Femenino , Estudios de Seguimiento , Hernia Hiatal/cirugía , Humanos , Masculino , Persona de Mediana Edad , PronósticoAsunto(s)
Duodeno/diagnóstico por imagen , Enfermedades Gastrointestinales/diagnóstico , Estómago/diagnóstico por imagen , Adolescente , Adulto , Anciano , Sulfato de Bario , Ensayos Clínicos como Asunto , Duodenoscopía , Gastroscopía , Humanos , Persona de Mediana Edad , Estudios Prospectivos , RadiografíaRESUMEN
In 1976 endoscopy with at least 20 biopsies and cytology were performed in 108 patients 20-25 years after partial gastrectomy (Billroth II). In one patient advanced carcinoma and in three cases severe dysplasia or carcinoma in situ, were found. At the follow-study in 1979, 7 patients had died of causes other than gastric carcinoma. A re-examination with endoscopy, biopsies and cytology were performed in fifty-eight patients. The present study did not show a progress of dysplasia in the gastric remnant during the three years of follow-up. The observations may suggest that re-examinations with gastroscopy and multiple biopsies every 3-5 years may be satisfactory in detecting carcinoma of the gastric remnant.