Ultrasonographic Findings In Inflammatory Bowel Diseases: An Analysis Of Inter- And Intra-Observer Variation.

Background: Patients from inflammatory bowel disease (IBD) are at increased risk of systemic thromboembolic events.Two thirds of the episodes show up as deep vein thrombosis or pulmonary embolism (1).Activated protein C resistance (APC-R) due to factor V Leiden mutation is now recognized as the most common cause of deep venous thrombosis (DVT).Aim: To evaluate the prevalence of this mutation among patients with IBD.Patients and Methods: 82 patients with ulcerative colitis (UC) (M 54 F 28, mean age 43 yrs) and 68 with Crohn's disease (CD) (M 41 F 27, mean age 39 yrs) were evaluated.Two age and sex-matched healthy controls (300 blood donors) were enrolled for each patient.To exclude acquired APC-R, presence of Lupus anticoagulant, pregnancy, anticoagulants or heparin therapy, and oestroprogestinic treatment were not included.Protein C -protein S global system activity (pC-pS GT) (2) was performed in all cases and controls.In patients with a pC-pS GT below the normal range (60-140%), specific activity of protein C, protein S and APC-R were evaluated.APC-R was, therefore, confirmed by using a polymerase chain reaction with sequence specific primers to detect factor V Leiden mutation.Results: Heterozygosity for the factor V Leiden mutation was discovered in 4/150 (2.6%) IBD patients and in 6/300 (2%) healthy controls (p=0.44,OR 1.00, 95 % CI 0.267 to 3.74).In particular, 2/82 (2.5%) UC patients and 2/68 (2.9%) CD patients showed positive for factor V Leiden mutation (UC vs controls, p=0.54,OR 0.333, 95% CI 0.032 to 1.86; CD vs controls, p=0.45,OR 0.333, 95 % CI 0.032 to 1.86; UC vs CD p=0.61,OR 1,95% CI 0.725 13.8).No homozygosity was found either among the cases or controls.Conclusion: The prevalence of APC-R due to factor V Leiden mutation among IBD patients is low.This suggests that not only this inherited condition may be involved in the development of venous tromboembolism in IBD.