Leukocytapheresis (LCAP), performed with a leukocyte removal filter, was administered five times, at 1-week intervals, for 5 weeks of intensive therapy and five times, at approximately 1-month intervals, for approximately 5 months of maintenance therapy, to 13 patients with inflammatory bowel disease (IBD) diagnosed as ulcerative colitis (UC) in 8 and Crohn's disease (CD) in 5. Clinical and blood examinations showed no side effects in any of the patients. During the intensive therapy, excellent or moderate clinical response was recognized in 11 of the 13 patients (84.6%), of whom 6 had a dramatic response; the excellent or moderate clinical response continued throughout the maintenance therapy in 8 of the patients (61.5%). Flow cytometry showed that the patients who had improved generally had high values for percentages of HLADR+, HLADR+CD3+, and HLADR+CD8+ cells before the first LCAP, and that these values and the C-reactive protein levels and erythrocyte sedimentation rates had decreased to the normal range by the end of both intensive and maintenance therapy. In the patients who showed poor response, in contrast, all the above values had been at or near normal before the initial LCAP administration. The clinical improvement in the absence of any additional medical treatment suggests that LCAP has the capacity to influence the causal mechanism(s) of IBD and that IBD is strongly associated with the cell-mediated immune response.

No abstract

Since specific treatment has not yet been decided on for Crohn's disease, the immediate target is the induction of remission and its maintenance. We examined the effects of an elemental diet (ED) in Crohn's disease with special reference to the maintenance of remission. Eighty-four patients received total enteral nutrition with the ED (35 to 40 kcal/kg ideal body weight/day) and/or conventional drug treatment for induction of remission. Sixty-one patients in remission were then followed-up with prolonged ED therapy (home elemental enteral hyperalimentation, HEEH) and/or drugs. During the follow-up periods the course of patients receiving HEEH was better than those of patients without HEEH, namely the cumulative continuous remission rates after one, 2 and 4 years were, 94%, 63% and 63% in the group receiving HEEH, 75%, 66% and 66% in the group receiving HEEH and drugs, 63%, 42% and 0% in the group receiving drugs, and 50%, 33% and 0% in the group receiving no maintenance therapy, respectively. In particular, when more than 30 kcal/kg ideal body weight/day of the ED was given, the maintenance of remission was successful in 95% of the patients. These results indicated that ED therapy was effective not only for the induction of remission but also for the maintenance of remission in Crohn's disease.

It is important to study the effect of Helicobacter pylori infection on the permeability of the intestine. Permeability was evaluated by oral sucrose tolerance test using sucrose 25 g in 200 ml of water. Existence of H. pylori itself was associated with increased permeability of sucrose. Also, the permeability of sucrose increased as polymorphonuclear and lymphocyte infiltration increased. The increase of mucosal permeability suggests that antigens like protein penetrate into the body and result in systemic reactions. Thus, it is important to study the implication of increased permeability in relation not only to gastric diseases but also certain systemic diseases.

Summary The effects of long-term supplementation with 1α-hydroxyvitamin D3 (1α (OH) D3) on serum pepsinogen (PG) I levels, and Helicobacter pylori (H. pylori) infection rate, were investigated in healthy elderly women, aged 70 to 99 years, in a nursing home. Of these 34 subjects, 15 have been administered one microgram of 1α (OH) D3 daily for twenty years, because of osteoporosis treatment, and 19 were free from the drug. Serum PG-I levels and H. pylori infection rate in subjects with 1α (OH) D3 were significantly lower than those without treatment (p<0.05). These results suggested the inhibitory effect of long-term administration of 1α (OH) D3 on H. pylori infection.