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e116
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
San Matteo, Università di Pavia; Italia., Pavia, Italy,
3
3Laboratorio
di Citometria Clinica, Ematologia; Fondazione IRCCS Policlinico San
Matteo, Università di Pavia; Italia., Pavia, Italy,
4
4Dipartimento
Medicina Diagnostica; Fondazione IRCCS Policlinico San Matteo,
Università di Pavia; Italia., Pavia, Italy
Background and aim:
Mesenchymal stem cells (MSC) are an
attractive therapeutic tool thanks to their multilineage differ
entiation, powerful action on all immune cells, homing to
inflamed sites, and immune-privileged status which allows their
transplantation across HLA barriers. RCD represents a clinical
challenge since no standardized therapy is available and the
prognosis is dismal. This is due to a progressive accumulation of
aberrant intra-epithelial lymphocytes (IELs) triggered and sustained
by overexpression of interleukin (IL)-15.
We investigated the feasibility, safety and efficacy of serial infusions
of autologous bone marrow-derived MSC in a 51-year-old woman
suffering from severe malabsorption syndrome due to type II RCD,
as diagnosed following widely accepted criteria.
Material and methods:
After systemic steroid therapy was
undertaken with no improvement of her clinical condition and
continuous need of parenteral nutrition and electrolyte correction,
serial intravenous infusions of MSC scheduled every 4 months were
proposed as rescue therapy. Monitoring of malabsorption indexes,
mucosal architecture, rate of aberrant IELs and circulating FoxP3+
T-cells during the 12 months treatment period and the following
6 months was performed. The levels of IL-15 and its receptor on
mucosal samples were also evaluated by means of Western blotting.
Results:
A total of 3.9x10^8 MSC were obtained and the patient
underwent 4 intravenous infusions of 2x10^6 MSC/kg. At baseline
she had severe malnutrition (BMI 14.9kg/m^2, albumin 1.9g/
dL, potassium 1.99mEq/L, xylose 2.2mg/dL), Marsh 3 lesions at
histology with monoclonal rearrangement of TCR
g
-chain, 94% of
aberrant IELs, and 0% of FoxP3+T-cells. During the treatment, there
was a gradual improvement with normalization of all parameters
after 12 months (BMI 19 kg/m^2, albumin 3.9g/dL, potassium
3.5mEq/L, xylose 58.6mg/dL). Moreover, a complete recovery of
both mucosal architecture and FoxP3+ T-cell percentage (45%) was
observed, although the persistence of monoclonal rearrangement
and aberrant IELs. The high levels of both IL-15 and IL-15R
a
found
at baseline almost completely disappeared at the end of treatment.
Conclusions:
MSC serial infusions in RCD appears feasible, safe and
effective in terms of clinical and mucosal recovery. The inhibitory
effects on IL-15 pathway and the recovery of normal values of
regulatory FoxP3+ T cells may play a role in silencing the specific
pathogenic mechanism leading to tissue injury.
OC.12.4
TEMPOROMANDIBULAR DISORDERS (TMD) IN PATIENTS WITH
IRRITABLE BOWEL SYNDROME (IBS)
Gallotta S.*
1
, Bruno V.
2
, Mobilio N.
2
, Catapano S.
2
, Ciacci C.
1
, Iovino P.
1
1
University of Salerno, Salerno, Italy,
2
University of Ferrara, Ferrara,
Italy
Background and aim:
Patients with IBS often have at least
one co-morbid somatic complaint and many IBS patients meet
diagnostic criteria for other functional disorders. Studies on the
association between IBS and Temporomandibular disorders (TMD),
that encompass a group of musculoskeletal and neuromuscular
conditions that involve the temporomandibular joints (TMJs), the
masticatory muscles, and all associated tissues, are scanty. Moreover,
it is not known whether the association of IBS and TMD depends on
the level of severity or the predominant symptom of the intestinal
disorder. The aim of this study was to evaluate the prevalence of
TMD in patients with IBS and the association of TMD with patterns
and severity of the intestinal disorder.
Material and methods:
Seventy-seven consecutive patients
diagnosed as having IBS, according to Rome III Diagnostic Criteria
and 48 healthy controls, negative for IBS, were included in the study.
IBS patients were classified into three different patterns according
to the predominant bowel symptom and into three levels of severity
using the irritable bowel severity scoring system (IBS-SSS) by
Francis et al. In all partecipants, evaluation of TMD was carried out
according to Axis I and Axis II of the Research Diagnostic Criteria for
TMD (RDC/TMD).
Results:
The prevalence of facial pain in the last month and jaw
click were significantly increased in patients with IBS compared
with controls (39% vs 20.8%, p = 0.03 and 42.9% vs. 20.8%, p = 0.01,
respectively). The prevalence of depressive symptoms and non-
specific physical symptoms (included and excluded the painful
symptoms) were significantly higher in patients with IBS than
controls (71.4% vs 52.1% p = 0.028, 85.7% vs 60.4% p = 0.001 and 83.1%
and 47.9% p = 0.000, respectively). The severity of chronic facial
pain was significantly correlated to the severity of IBS (p = 0.029),
while no significant correlation was found between the severity of
chronic facial pain and the patterns of IBS. Moreover, a significant
correlation was found between the facial pain score (0-10 VAS) and
the abdominal pain on a 100-point VAS (p= 0.009).
Conclusions:
TMD occur frequently with irritable bowel syndrome.
The severity of TMD and IBS are positively correlated. Further
studies on somatic and visceral sensitivity in patients affected by
different degrees of severity of IBS and TMD are clearly needed for
a better pathophysiological understatement and management of
these syndromes.
OC.12.5
ESOPHAGEAL SHORTENING IS ASSOCIATED TO SWALLOW-
INDUCED LES RELAXATION AND INCOMPLETE TLES RELAXATIONS
IN NERD PATIENTS AND HEALTHY CONTROLS
Ribolsi M.*, Balestrieri P., Biasutto D., Cicala M.
Campus Bio Medico, Roma, Italy
Background and aim:
Background: Transient lower esophageal
sphincter relaxations (TLESRs) contribute to episodes of reflux.
It has been demonstrated that longitudinal muscle contraction
occurs during swallows and may play a role in eliciting TLESRs.
LES lift, evaluated by means of high-resolution manometry (HRM),
is a possible marker of the longitudinal muscle contraction of the
esophagus.
Aim:
To assess the length of esophago-gastric junction (EGJ) lift
during liquid swallows and incomplete TLESRs in non-erosive reflux
disease patients and healthy volunteers (HVs).
Material and methods:
15 NERD patients with typical symptoms,
without hiatal hernia, and 15 HVs, underwent HRM combined with
impedance (HRM-MI), before and 60 min. after a standardized solid/
liquid meal, in a sitting position. Before meal, a total of 10 liquid
(5ml) swallows, at 30-sec intervals, were performed. A catheter
with 36 solid-state pressure sensors and 9 impedance segments
was used. Color HRM plots were analyzed to determine the lower
edge of the LES lift during swallow-induced LES relaxation as well
as during incomplete TLESRs. Incomplete TLESRs were recognized
when the end-expiratory LES pressure during relaxation was more
than 5mmHg. Average intra-esophageal pressures were measured
before and during incomplete TLESRs.
Results:
In the post-prandial period, a total of 68 and 59 incomplete
TLESRs were recorded in NERD and HVs, respectively. The frequency
of complete TLESRs did not differ between NERD patients and HVs.
TLESRs in patients were more often associated with reflux episodes
than in HV [129 (79% of TLESRs) vs 94 (66% of TLESRs), p<0.05]. Mean