A 7 6 6 AGA ABSTRACTS GASTROENTEROLOGY, Vol. 108, No. 4

EFFECT OF ORAL GLUTAMINE ON INTESTINAL PERMEABILITY AND NUTRITIONAL STATUS IN CROHN'S DISEASE . G. Zoli, M. Car6, F. Falco, C. Span6, R. Bernardi, G. Gesbarrini. I Patologia Medico, Centre Ricerche Nutrizione~Dip. Biochimica, University of Bologna; gicerca in Medicina, Bologna, H MediCma lnterna, Universit/t Cattolioa, Roma, Italy.

Malnutrition and inereesed intestinul permeability are well dooumented features of Crohnls disease (CD). Glutamine, a non essential aminoaeid, is the principal nutritional substrate used by the intestinal tract and it has been shown to prevent deterioration of gut permeability and: of mueosal structure. Eleven patients with inactive or moderate CD, but one with severe disease (9 males, median age 29, range 18-40 years), were studied before and after treaUnent with 3g of ghtamine bis h die, administered orally, in each patient disease activity was determined by the simple CD activity index (Harvey-Bradshaw); intestinal permeability was assessed by the permeability index (PI): lactulose/mannitol ratio; nu~tinnal status was assessed as percentage of ideal body weight (%IBW) and by raeasuremems of anthropometric parameters and of body bioetectrie impedance, from which body m a ~ index (BMI), fat body weight (FBW) (%, kg), fat free mass (FFM) (%, kg) and total body water (TBW) (%, 1) were calculated. Although the difference was not statistically sigtfifieant, CD actixaty index decreased in all subjects after treatment. PI was significantly decreased and weigh~, %IBW~ BMI, FBW (kg), FFM (kg) were significantly increased after treatment, compared to pre-treatment values:

PRE AFTER median range median range

PI 3.7 0-4.5 0.8 0-2.7 p<0.01 Weight (kg) 56.7 38-71.5 57.6 38.6-72 p<0.01 %IBW 87 64-102 91 64-102 p<0.02 BMI (kg/m 2) 20 15.4-23.7 21 16-21.1 p<0.01 FBW (kg) 9.5 5-13.2 9.8 5-13 p<0.05 FFM (kg) 46.6 33-62 47 34-62 p<0.05 No signigniflcant differences were found considering the other parameters. These pre'inninary data suggest that in CD patients oral ghtamine i) may decrease intestinal permeability and ii) improve nutritional status.

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@METABOLIC BONE ASSESSMENT IN PATIENTS WITH ILEAL POUCH- ANAL ANASTOMOSIS FOR INFLAMMATORY BOWEL DISEASE. ~'.A.bitbol, C.Roux, S.Chaussade, S.Guil lemant, P.Valleur, P.Hautefeuille, B.Amor, D.Couturier. Depts of gastroenterology and rheumatology, H6pitalCOCHIN, Paris- France.

Osteopenia has been reported in 31% to 59% of patients with I n f l ammato ry Bowel Disease (IBD) (Ab i tbo l and a l . , Gastroenterology, in press). Osteopenia results from low bone turnover due to cort icosteroids and in f lammatory process (cytokines). Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA) for Ulcerative Colitis (UC) removes risk factors of bone diseases as corticosteroids and inflammatory process. However, bacterial overgrowth in the pouch could induce malabsorption of vitamin D.

A!m¢ : 1 ) to study the preva lence and the mechanism of osteopenia in patients with IPAA for UC, 2) to assess their bone density variations (A BMD) during follow up.

Methods : 18 patients with IPAA for UC (9 women), aged 37 (25- 56) years, without current corticosteroids intake, hod a first measurement of lumbar spine and femoral neck bone density, by dual energy x-ray absorpt iometry, 26 (15-41) months after proctocolectomy. They had a second measurement of bone density 18 _+ 8 (4-31) months later. A BMD was expressed in %/year (mean+SD). Patients hod serum determinations of Calcium (Ca), Phosphate [P), parathyroid hormone (PTH 1-B4), osteocalcin (O), 25 hydroxy and 1-25 dihydroxy vitamin D.

Results : 1) At baseline, 4 (22%) patients had osteopenia < -2 SD compared age and matched controls, 2) 3 06%) had vertebral crush fractures on X rays, 3) Serum levels of vitamin D were normal, and no patient hod clinical or biological (Co, P, PTH, O) sign of osteomolacio. 4) Bone density increased with time elapsed since proctocolectomy (lumbar spine : r=0,67, p<0,004; femoral neck : r=0,52, p=0,03), 5) During follow up, A BMD was +1,96 +_ 3,96 and + 1,01+_ 6,51%/year at lumbar spine and femoral neck, respectively.

Conclusion : Our results suggest that : I ) patients with IPAA offer UC are at high risk of osteopenia and vertebral crush fractures; 2) os teopen ia af ter IPAA is not associated with vitamin D malabsorption in spite of bacterial overgrowth in the pouch; 3) the osteopenia of IBD is a slow reversible phenomena after removal of inflammatory process and corticosteroids.

@NUTRITIONAL FEATURES OF CHRONIC DIARRHEA IN HIV- INFECTED PATIENTS. IA Abonrached+ 1F Carbonnel, 1L Beangerie, i y Ng6, 2W Rozenbanm, 1jp Gendre, 1j Cosnes. Services de !Gastroent6mlogie et de 2Maladies infectienses. H6pital Rothschild, Paris.

The objective of this study was to assess the nutritional consequences of chronic diarrhea of various causes in HW-infected patients. Metlmds : 98 HW-infected consecutive patients (SF, 90M) with chronic diarrhea were prospectively studied using a predefmed protocol including upper gastrointestinal tract endoscopy and rectosigmoiduscopy with biopsies; dietary intake questionnaire; fecal weight, fat and nitrogen; search for stool parasites and bacterial pathogens and albumin serum levels.. Patients were classified in 3 categories : ¢a'yptosporidiosis, micmsporidiosis and idiopathic. Resells nean~SEM):

C'ryprosp Mierosp (n=28) (n=27)

i CD4 {/mm3) 4O-35 28±34 Duration diarrhea ~ 13±15 12~11

I (months) % loss of usual body ; 20±9 a wei~ht % ideal body weight Body Mass Index

htake ~ca~d) Fecal wei~hr (~/d) Fecal fat (%) Fat absorption (gZ4h) a significantly different f~om idiopathic ; ) significantly different from mic~osp; c : significantly different from idiopathic (Students' t tests). Conclusion : In HIV-infected patients, a) cryptosporidiosis appears as the most severe enteropathy and is correlated with the highest degree of malnutrition ; b) for most variables, mierosporidiosis does not differentiate from idiopathic diarrhea..

16±7

76±9 a,b 81±10 17.4-2 a~b 18.4:.~, 33a5 a 35±5 c 1556±586 1602~13 749.~629 a 639:s:521 C 32:e28 a' 20±l'S 36.5±21 a 43±16

Idiopathic P(anova) (n=43)

72=189 I NS 16=25 NS

15±8 0.05

84=9 0.03 19.3+9 0.002 38±5 0.01 1717±528 NS 409~282 0.02 19±14 NS 50-'~.0 0.04

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