Background and aims: Several antibodies have been reported in the sera of patients with Crohn’s disease (CD) and ulcerative colitis (UC). The most commonly described are anti- Saccharomyces cerevisiae mannan antibodies (ASCA) in CD and perinuclear antineutrophil cytoplasm antibodies (pANCA) in UC. Familial clustering of these antibodies has been described, suggesting they might be genetic markers. Our aim was to investigate the presence of these antibodies before the emergence of overt clinical manifestations. Methods: Since 1980, the Israeli Defense Force (IDF) Medical Corps Serum Repository has stored serum samples obtained systematically from 5% of all recruits on enlistment, and from the same population on discharge from compulsory military service. We evaluated serum samples obtained from 32 subjects with CD and eight with UC before they were clinically diagnosed, along with samples from matched controls. Results: ASCA were present in 10/32 (31.3%) CD patients before clinical diagnosis compared with 0/95 (0%) controls (p<0.001). None of the eight patients with serum samples available before diagnosis of UC were ASCA positive. ASCA was positive in 54.5% of patients after diagnosis of CD. The mean interval between ASCA detection and diagnosis was 38 months. In 90% of patients, antibodies were detected in the first available serum sample; therefore, measurements of the average time from the presence of ASCA to diagnosis may be even longer. pANCA were present in 2/8 (25%) patients with available sera before the diagnosis of UC. None of their 24 matched controls were positive (p = 0.014). Conclusions: ASCA and pANCA may predict development of inflammatory bowel disease years before the disease is clinically diagnosed.

Appropriate and sufficient dietary intake is one of the main requirements for maintaining fitness and health. Inadequate energy intake may have a negative impact on physical performance which may result in injuries among physically active populations. The purpose of this research was to evaluate a possible relationship between dietary intake and stress fracture occurrence among combat recruits during basic training (BT).

Aliment Pharmacol Ther 31, 901–910Summary: Background  Coeliac disease is frequently diagnosed after a long delay resulting in increased morbidity and mortality.Aims  To define the parameters which have the highest impact on the cost‐effectiveness of mass screening for coeliac disease.Methods  A Markov model examined a coeliac disease screening programme of the healthy young‐adult general population compared with a no‐screening strategy. The main outcome measures were quality adjusted life‐years (QALYs) and incremental cost‐effectiveness ratio (ICER). Effects of variables were examined using sensitivity analyses.Results  The screening strategy resulted in a gain of 0.0027 QALYs. The ICER of screening vs. no‐screening strategy was US$48 960/QALYs. The variables with the largest impact on cost effectiveness were: the time delay from symptom onset to diagnosis, the utility of adherence to a gluten‐free diet (GFD) and the prevalence of coeliac disease. Screening would be cost‐effective if the time delay to diagnosis is longer than 6 years and utility of GFD adherence is greater than 0.978.Conclusions  Our model suggests that mass screening for coeliac disease of the young‐adult general population is associated with improved QALYs and is a cost effectiveness strategy. Shortening of the time‐delay to diagnosis by heightened awareness of health‐care professionals may be a valid alternative to screening.

Background Although exposure to diagnostic radiation may be associated with increased risk of malignancy, the use of abdominal CT (ACT) in the last decade has increased for patients in the emergency department (ED). Aim To examine the impact of ACT ordered in the ED on management of patients with inflammatory bowel diseases (IBD), as well as to quantify the cumulative effective dose (CED) of radiation received by these patients. Methods A total of 152 patients with Crohn's disease (CD) and 130 patients with ulcerative colitis (UC) that presented to the ED in a tertiary centre between 2009 and 2011 were identified. For patients that had an ACT, chart review assessed if the ACT findings changed clinical management. CED of diagnostic radiation (DR) was calculated for all imaging studies between 1 January 2006 and 30 August 2012. Results Abdominal CT use was 49% for CD and 19% for UC. ACTs with findings of penetrating/obstructive disease were 35% for CD. Urgent non-IBD-related diagnoses were found in 13% for CD and 28% for UC (P < 0.05). ACT caused a change in management in 81% of CD and 69% of UC patients. Mean CED from DR was 77.4 ± 63.0 mSv (median 53 mSv) for CD and 67.2 ± 51.0 mSv (median 56 mSv) for UC (P = 0.47). The CED for the 80-month period exceeded 75 mSv in 35% and 36% respectively (P = 0.99). Conclusions Although abdominal CT often changes management of IBD patients in the emergency department, this population carries a very high-risk of radiation exposure. Efforts should be made to decrease this risk by development of low-radiation protocols, and wider use of MRI/ultrasound.

Background/Aims: The role of cytomegalovirus (CMV) reactivation during exacerbations of ulcerative colitis (UC) is yet a matter of debate, and assessment of CMV infection in UC patients remains an ongoing challenge. We aimed to identify associated parameters and compare detection methods for CMV infection during UC exacerbation. Methods: Clinical, pathological and virological parameters were retrospectively analyzed in all patients hospitalized in our institution for UC exacerbation between January 2009 and April 2015, who underwent full evaluation for CMV infection in colonic tissue by histopathology, immunohistochemistry (IHC) and CMV-PCR. Results: Of 28 patients who underwent full examination for tissue CMV-infection, 13 (46.4%) were found to be positive for CMV. Tissue CMV-PCR was more sensitive for the detection of CMV infection than histopathology and IHC. CMV-positive patients had a statistically higher frequency of recent steroid treatment and fever, with higher mean partial Mayo scores and lower mean albumin levels. There were no significant differences between CMV-positive and CMV-negative patients in terms of age, severity of colitis and disease duration. In a multivariable model, only recent steroid treatment and fever were independently associated with colonic CMV infection. Conclusions: This study provides a clinical model to detect the presence of CMV infection in patients hospitalized with UC exacerbation, which could direct proper investigation and facilitate timely empirical therapy