19,988,206 research outputs found
IBD: Sequential rescue therapy in steroid-refractory ulcerative colitis
No full textTreatment of patients with steroid-refractory ulcerative colitis is still a challenge for physicians. A recent study has evaluated the effectiveness and safety of sequential rescue therapies in this subgroup of patients
Rifaximin-Extended Intestinal Release Induces Remission in Patients With Moderately Active Crohn’s Disease
No full textBACKGROUND & AIMS: Bacteria might be involved in
the development and persistence of inflammation in patients
with Crohn’s disease (CD), and antibiotics could be
used in therapy. We performed a clinical phase 2 trial to
determine whether a gastroresistant formulation of rifaximin
(extended intestinal release [EIR]) induced remission in
patients with moderately active CD. METHODS: We performed
a multicenter, randomized, double-blind trial of the
efficacy and safety of 400, 800, and 1200 mg rifaximin-EIR,
given twice daily to 402 patients with moderately active CD
for 12 weeks. Data from patients given rifaximin-EIR were
compared with those from individuals given placebo, and
collected during a 12-week follow-up period. The primary
end point was remission (Crohn’s Disease Activity Index
150) at the end of the treatment period. RESULTS: At the
end of the 12-week treatment period, 62% of patients who
received the 800-mg dosage of rifaximin-EIR (61 of 98) were
in remission, compared with 43% of patients who received
placebo (43 of 101) (P .005). A difference was maintained
throughout the 12-week follow-up period (45% [40 of 89] vs
29% [28 of 98]; P .02). Remission was achieved by 54% (56
of 104) and 47% (47 of 99) of the patients given the 400-mg
and 1200-mg dosages of rifaximin-EIR, respectively; these
rates did not differ from those of placebo. Patients given the
400-mg and 800-mg dosages of rifaximin-EIR had low rates
of withdrawal from the study because of adverse events; rates
were significantly higher among patients given the 1200-mg
dosage (16% [16 of 99]). CONCLUSIONS: Administration
of 800 mg rifaximin-EIR twice daily for 12 weeks induced
remission with few adverse events in patients with moderately
active C
Problematic proctitis and distal colitis
No full textAbout two-thirds of patients with ulcerative colitis have an inflammatory involvement distal to the splenic flexure, and therefore may be effectively treated with topical treatment, allowing the delivery of the active drug directly to the site of inflammation and limiting systemic absorption and potential side-effects. Topical aminosalicylate therapy is the most effective approach, and most patients will benefit hugely, provided that the formulation reaches the upper extent of the disease. Therefore, the choice of topical preparation should be based on the proximal extent of the disease and on patient preference. Oral aminosalicylates are less effective than topical therapies; however, a combination of oral and topical aminosalicylates can be successful in refractory patients. Alternatives to aminosalicylates are the new glucocorticoids, budesonide and beclometasone dipropionate, either as enemas or oral formulations (only beclometasone dipropionate). A combination of oral or rectal new glucocorticoids with rectal aminosalicylates should be considered in patients refractory to either approach. When these measures fail, treatment with oral glucocorticoids is necessary. An intensive intravenous steroid regimen is also helpful for patients refractory to oral steroids. Alternative treatments include short-chain fatty acid enemas, nicotine enemas and patches, acetarsol suppositories, ciclosporin enemas and epidermal growth factor enemas. Several factors potentially having a negative impact on therapeutic response include concurrent enteric pathogens, coexistent irritable bowel syndrome, patient nonadherence to therapy, inadequate dosing and duration of therapy, and proximal progression of the disease. Surgical colectomy may be required in those rare patients refractory or intolerant to pharmacotherap
A current overview of corticosteroid use in active ulcerative colitis
No full textIntroduction: Ulcerative colitis (UC) is a chronic inflammatory condition that causes continuous mucosal inflammation of the colon. New biological drugs have been developed in order to avoid colectomy, but corticosteroids still play a crucial role in management of active UC. Areas covered: We reviewed the current literature about the importance of corticosteroid use in the treatment of ulcerative colitis. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence. Expert opinion: Corticosteroids represent the mainstay of treatment in patients with severe UC and are very effective in inducing remission in mild to moderate flares not responding to combined oral and topical mesalazine. A valid alternative to systemic corticosteroids is represented by poorly absorbed steroids, such as Beclomethasone dipropionate and Budesonide MMX. In mild-moderate distal disease topical administration of corticosteroids (both systemic and BDP) is an effective alternative to topical mesalazine. However, corticosteroids do not represent a therapeutic option as a maintenance treatment since they are associated with multiple adverse effects
A case of jejunal adenocarcinoma missed at cross-sectional techniques and diagnosed by capsule endoscopy
No full textPrimary tumors of the small bowel (SB) are rare, representing approximately 1% to 3% of all primary GI neoplasms. The overall incidence is increasing, probably owing to an improvement in diagnostic techniques. Small-bowel capsule endoscopy (SBCE) is a noninvasive and well tolerated procedure that allows direct visualization of the SB mucosa, with a detection rate for neoplasm ranging from 1.6% to 11.5% in procedures performed for any indication. The diagnostic yield of SBCE has previously been compared with that of CT, with either similar performance or favoring SBCE. In SBCE terminology, SB tumors are included in the protruding lesions. Typical endoscopic features include a well-defined lesion with distinctive color from the surrounding mucosa, and irregular mucosal pattern, bleeding stigmata, and ulceration. A delayed transit of the SBCE resulting in visualization of the lesion for several minutes is common. SBCE is helpful indiagnosing adenocarcinoma in the GI tract. By contrast, a submucosal tumor such as a GI stromal tumor could be mistaken as a nonspecific mucosal bulge on SBCE.
The most common adverse event of SBCE is capsule retention. This rare adverse event can be seen in 2% of all placed capsules and is mostly managed conservatively. This risk can be mitigated with the use of a patency test using either imaging or a patency capsule. In this patient, with a nondiagnostic CT scan, retention was the key to identifying the location
of the adenocarcinoma during surgery.
This case highlights the importance of having SBCE in our repertoire for early diagnosis of SB conditions
IBD: IBD and spondyloarthritis: Joint management
No full textSpondyloarthritis (SpA) is the most common extraintestinal manifestation of IBD. SpA symptoms are not always recognized in patients with IBD. Subsequently, patients with symptoms of SpA can be underdiagnosed with effective treatment delayed. Cooperation between gastroenterologists and rheumathologists is necessary and, ideally, an integrated management of these patients should be adopted
Pouchitis: Clinical features, diagnosis, and treatment
No full textProcto-colectomy with an ileal pouch anal anastomosis is the procedure of choice for ulcerative colitis patients that require colectomy. Pouchitis is a non-specific inflammation of the ileal reservoir, and the most common, inflammatory and long-term, complication after pouch surgery for ulcerative colitis. The aetiology is still unknown, but many risk factors have been individuated. Pouchitis can be classified based on aetiology, duration, clinical course, and response to antibiotic therapy. Accurate diagnosis and classification is the key factor for an adequate management, and exclusion of secondary causes of pouchitis is pivotal. Most of the patients consistently respond to antibiotic therapy, but management of the subgroup of patients with chronic-antibiotic-resistant-pouchitis is still challenging, being this entity one of the major causes of pouch failure
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