Medicine Gastroenterology News Archive Featured in the Media JeffNEWS

The following summaries are based on presentations by Thomas Jefferson University Researchers at Digestive Disease Week 2007 in Washington, D.C.

Prevalence and clinical significance of autoantibodies in autoimmune hepatitis. Embargoed for release on Sunday, May 20  (#S1796).

Researchers at Jefferson Medical College have shown that the traditional markers for Autoimmune Hepatitis (AIH)--antinuclear antibodies (ANA) and anti smooth muscle antibodies (ASMA)--are not always present in patients who have the disease. They recommend that patients with clinical features consistent with AIH should be aggressively treated.

Autoimmune hepatitis is a rare but potentially serious disorder in which the body's immune system attacks liver cells.

Seventy two patients—53 women and 19 men with a mean age of 53 years— diagnosed with AIH from 1999 to 2004, were studied. Evidence of ANA was found in 49 patients (68 percent). Evidence of ASMA was found in 42 patients (58 percent) and 34 patients (47 percent) were both ANA/ASMA positive.

The patients with autoantibodies were similar to the patients without antibodies with respect to age, gender and treatment regimen. All patients had a biopsy consistent with AIH and had been treated with corticosteroid therapy.

Lead researcher Pradnya Mitroo, M.D., will present the results at Digestive Disease Week 2007 in Washington, D.C., on Sunday, May 20 (#S1796).

The researchers conclude that autoantibodies should not be used to predict autoimmune hepatitis activity or outcome. Patients with clinical features consistent with AIH should be treated regardless of their serologic status.

Members of the team who conducted this study at Thomas Jefferson University in Philadelphia, Pa., are:  Pradnya Mitroo, M.D., Simona Rossi, M.D., Victor J. Navarro, M.D., and Steven K. Herrine, M.D.

_ _ _ _ _ _ _ _

 

Post-sphincterotomy transampullary balloon dilation is not associated with an increased incidence of post-ERCP pancreatitis on Monday, May 21  (#M1298).

Researchers at Jefferson Medical College have shown that an alternative technique to facilitate the success of endoscopic retrograde cholangiopancreatogram (ERCP)—a procedure performed to diagnose and manage problems in the tubes that drain the liver, gall bladder and pancreas—is safe and effective.

Lead researcher Rahul Nathwanti, M.D., will present the results at Digestive Disease Week 2007 in Washington, D.C., on Monday, May 21 (#S1796).

 Pancreatitis is an inflammation of the pancreas gland which produces the enzymes that digest food. Pancreatitis is a major complication of ERCP.

“The ERCP procedure is often performed to manage obstruction of the ducts that drain the liver and pancreas,” says Thomas Kowalski, M.D., director of Gastrointestinal Endoscopy in the division of Gastroenterology and Hepatology at Jefferson Medical College of Thomas Jefferson University.  Stones and cancers are the most common causes of these blockages. “There are times when stretching with a balloon device, known as dilation, can be helpful to complete the procedure.

“In the past, physicians have been reluctant to perform balloon dilation because of fear that the stretching can cause pancreatitis,” he explains.

“Through our experience at Thomas Jefferson University, we found that injury to the pancreas can be reduced if an incision of the ampulla (the area at the end of the bile duct where it joins the pancreas duct and the intestine) is performed prior to stretching the duct with a balloon,” explains David Loren, M.D., director of Endoscopic Research in the division of Gastroenterology and Hepatology at Jefferson Medical College.

To determine the incidence of post-ERCP pancreatitis when performing balloon dilation following endoscopic sphincterotomy, researchers at Jefferson Medical College examined the records of patients who underwent ampullary balloon dilation at Thomas Jefferson University Hospital from 2000 to 2006.

The researchers conducted a retrospective study of 30 patients with varying diagnoses-- including gallstones (choledocholithiasis), inflammation and restrictions of the bile duct, and cancers--who were treated with endoscopic sphincterotomy followed by ampullary balloon dilation using varying sizes of balloon. 

“We conclude that ampullary balloon dilation following endoscopic sphincterotomy is  safe and is not associated with an increased incidence of post-ERCP pancreatitits,” Dr. Loren says.

The researchers recommend that additional studies be carried out regarding the technique although “endoscopists may be reassured when performing post sphincterotomy transampullary balloon dilation in order to accomplish therapeutic goals,” he adds.

Members of the team who conducted this study at Thomas Jefferson University in Philadelphia, Pa., are:  Rahul A. Nathwani, M.D., Kuldip S. Banwait, M.D., Leonardo Salese, M.D., David Assis, M.D., David Loren, M.D., and Thomas Kowalski, M.D.