Volume 61 - 1998 - Fasc.3 - Original articles
A randomized prospective trial comparing 45 and 90-ml oral sodium phosphate with X-Prep in the preparation of patients for colonoscopy
Forty-six patients were randomized to receive either 45 or 90-ml oral sodium phosphate (NaP) (Fleet Phospho-Soda), or X-Prep (a Senna preparation) before elective colonoscopy to compare the quality of colon cleansing, ease of preparation, and gastrointestinal intolerance. Before colonoscopy, one of us administered a questionnaire to the patient to assess how well the preparation was tolerated (scale from 1 to 5 : 1 = easy, to 5 = unable to finish) and about the presence of four symptoms: abdominal pain, nausea, vomiting, and diziness. The quality of colon cleansing was graded by two gastroenterologists (1 = excellent, 2 = good, 3 = fair, 4 = poor), who were unaware of how the patient was prepared or tolerated the preparation. The overall quality of bowel preparation with 90-ml oral NaP was better than with X-Prep and 45-ml NaP (p < 0.01). Patients found preparation with NaP to be easier than X-Prep (p < 0.002). No difference was seen in the incidence of abdominal pain, nausea, vomiting or diziness. In the 90-ml NaP group, a significant rise in sodium and chloride occurred. However, increments were not greater than 5%. Hyperphosphatemia was noted with NaP, but was transient, and no concomitant decrease in calcium was seen. We conclude that, in the groups of patients studied, 90-ml NaP is a safe colonic cleansing agent that is better tolerated and more effective than others.
Nutritional value of an "anti-regurgitation" formula
Objective: Anti-regurgitation formulae are recommended in the therapeutic approach of regurgitation. However, their nutritional value needs to be evaluated. It is not known whether the addition of (fibers of) bean gum might influence the intestinal absorption of nutrients and minerals. Patients: Fourty healthy infants were included in an open randomised prospective trial, receiving either a regular adapted (casein/whey ratio 40/60) or an anti-regurgitation (casein/whey ratio 80/20) formula. Results: At the end of the study, at the age of 13 weeks, weight and length gain, and most serum parameters (iron, iron binding capacity, calcium, phophorus, protein, prealbumin, zinc) were comparable in the 20 infants in each group. The mean intake per day was higher in the anti-regurgitation formula group (755 ± 55 versus 680 ± 89 ml/day; p < 0.001), resulting in a higher protein intake (12.80 versus 9.52 g; p < 0.001), which might explain the increased plasma urea level in this group (23.1 versus 15.9 mg/dl ; p < 0.001). The albumine level, on the contrary, was smaller in the anti-regurgitation group (4.21 versus 4.85 g/dl ; p < 0.001). Conclusion : All nutrition parameters are within normal ranges, although there are some significant differences between both groups (for urea and albumin). However, the formula should also be evaluated in therapeutic conditions in regurgitating babies. Differences in intake might be related to the selection of the study population, which were asymptomatic babies.
Altered expression of aEss7 integrin on intra-epithelial and lamina propria lymphocytes in patients with Crohn's disease
Objective: To compare the expression of adhesion molecules on intestinal intra-epithelial (IEL) and lamina propria T cells (LPL) from ileum and colon, in patients with Crohn's disease (CD) versus healthy controls, with special reference for the aEss7 integrin. Methods: IEL and LPL were obtained from 18 CD patients and 20 controls by enzymatic extraction, and subsequently characterized by flow cytometry for CD3, CD4, CD8, CD25, LFA-1a (CD11a), CD44, a4 and aEss7 integrin. Resufts: In LPL of controls, a decreased CD4/CD8 ratio was noted in ileum compared to colon. This regional difference was accompanied by a higher expression of aEss7 integrin in ileum versus colon. In LPL from left hemicolon of CD patients, a decreased CD4/CD8 ratio was noted versus controls. aEss7 expression on T cells of LPL did not discriminate CD from controls. However, an overexpression of this ss7 integrin member was observed on CD25+ T cell subsets from lamina propria of left hemicolon, in CD versus controls. Moreover, in IEL, profound alterations in aEss7 integirin were observed in CD, compared to controls. A decreased expression of aEss7 was noted in IEL of ileum of CD patients. This was also apparent in non-inflamed mucosa. Conclusion : The observed changes of aEss7 integrin expression in CD patients versus controls are of pathogenic relevance, especially the decreased expression of aEss7 in IEL of non-inflamed CD mucosa. This may be one of the earliest events in the pathogenesis of this disease.
