14 research outputs found
M1085 Use of Infliximab and Adalimumab in Refractory Pouchitis
No full textINTRODUCTION: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. Anti-TNF agents are effective in both refractory ulcerative colitis and Crohn's disease.
AIMS & METHODS: This study aimed to evaluate the effectiveness of Infliximab (IFX) or Adalimumab (ADA) in inducing remission and improving quality-of-life (QOL) in such patients. From January 2007 to May 2009, 19 consecutive patients with refractory pouchitis were prospectively followed in a single tertiary center Patients with active pouchitis not responding after 1 month of antibiotic treatment (metronidazole 1g/day or ciprofloxacin 1g/
day) and 2 months of oral budesonide CIR at 9mg/day, were treated with IFX 5mg/kg at 0,2,6 weeks or ADA 160mg/80mg at weeks 0-2 and then 40 mg every-other-week. Shortterm efficacy was evaluated at week 10. Symptomatic, endoscopic and histological evaluations were done before and after treatment using the Pouchitis Disease Activity Index (PDAI) score. Remission was defined as a combination of a clinical PDAI score of 1. QOL was assessed using Inflammatory Bowel less or equal 2 and endoscopic PDAI score less or equal than Disease Questionnaire (IBDQ).
RESULTS: Twelve patients (7 males, 5 females, median age 32,6 years) received IFX, 7 (5 males, 2 females, median age 36,4 years) were treated with ADA; 2 of the patients treated with ADA were secondary failure to IFX. Nine of 12 (75 %) and 5 of 7 (71,4%) showed remission respectively in the IFX and ADA group. The median PDAI scores before and after therapy were 13 (range 8-18) and 2 (range 0-9) in IFX group(p<0.001), and 14 (range 9-18) and 2 (range 0-10) in the ADA group (p<0.001).
The median IBDQ score also significantly improved from 96 (range 74- 184) to 196 (range 92-230) in the IFX group (p<0.001), and from 105 (range 78-176) to 206 (range 94-226) in the ADA group (p<0.001).No serious side-effects were registered.
CONCLUSION: IFX and ADA were both effective in inducing remission and improving QOL in patients with refractory pouchitis, and were well tolerated
Adalimumab in the Treatment of Perianal Crohn's Disease: A Single Center in 64 Patients
No full textINTRODUCTION: Adalimumab is effective in inducing and maintaining remission in active steroid-dependent Crohn's disease (CD). A post hoc analysis has also shown its effectiveness in perianal CD. AIMS & METHODS: The aim of this study was to evaluate the effectiveness
of Adalimumab in the treatment of active perianal CD. Materials and methods: From January 2008 to May 2009, 64 consecutive patients, in a single tertiary center were prospectively followed (28f/36m, mean age 32 years, range 16-52, 8 smokers). The patients presented complex (trans or suprasphinteric, horse-shoes, multiple with or without rectal involvment) perianal fistulising disease, intolerant or resistant to immunosuppressive or secondary failure
to infliximab (IFX). Treatment: After a deep surgical perineum sanitization, all patients received 160/80mg as induction dose followed by 40mg eow if responders. In case of loss of response, a weekly treatment was performed. Immunosuppressive therapy was suspended at the start of treatment, steroid dose was reduced of 2.5 mg/week after the induction phase.Definitions: remission= complete closure of the fistula assessed with Evaluation Under
Anesthesia; Response= lack of drainage of purulent material at surgical evaluation. RESULTS: Results: Patients population: n = 64, 28 naive, 36 IFX failure, 42/64 colonic disease, 22/64
rectal involvement, 38/64 (59%) treated with azathioprine, 4/64 (6.2%) with methotrexate , 22/64 (34%) with steroids; media CDAI at baseline 310 (range 49-596), median IBDQat baseline 120 (range 58-208)]. At week 8, 8/64 patients (12,5%) were in remission and 20/64 (31%) responded; at week 24, 14/64 patients (22%) were in remission and 30/64 (47%) had a clinical response; at week 52, 32/52 patients (62%) were in remission and 38/52 (73%) had a clinical response; at week 76, 36/46 patients (78%) were in remission and 40/46 (87%) had a clinical response, assessed surgically. The effect was independent of the past use of IFX. Three patients loss response and moved to a temporary loop-ileostomy;
14/64 (22%) moved to a weekly treatment. No serious adverse events were registered. CONCLUSION: The data obtained in everyday clinical practice confirm the effectiveness of
adalimumab in the treatment of perianal CD and the safety and stability of efficacy over tim
Adult attachment and early parental experiences in patients with Crohn’s Disease
No full textCrohn’s Disease (CD) is a chronic, relapsing and remitting inflammatory bowel disease. The relationship of attachment to illness is considered bidirectional. 102 patients with CD and 306 healthy subjects filled out Attachment Style Questionnaire and Parental Bonding Instrument. The evaluation of attachment style and early parental experiences in patients with CD may shed a light on the bidirectional relationship between attachment and illness. Patients with CD exhibit a predominantly insecure attachment and perceived their parents’ behaviours characterised by lower maternal care and higher paternal overprotection. Those findings may confirm the bidirectional relationship between insecure attachment and chronic illness
Role of Biologics in refractory pouchitis
No full textIleal pouch-anal anastomosis (IPAA) is the surgical procedure of choice for patients with ulcerative colitis undergoing elective restorative proctolectomy. It preserves intestinal continuity and sphincter function and removes the entire colorectal mucosa. The most frequently observed long-term complication of IPAA is acute and/or chronic inflammation of the ileal reservoir, called pouchitis
Probiotics in IBD: A critical review
No full textThe rationale underlying probiotics use in the treatment of IBD is based on compelling evidence that intestinal bacteria have a role in disease pathogenesis. The distal ileum and the colon are the areas with the highest bacterial concentrations and are also the sites of inflammation in IBD. Similarly, pouchitis, the nonspecific inflammation of the ileal reservoir that can occur after ileo-anal anastomosis, appears to be associated with bacterial overgrowth and dysbiosis. Enteric bacteria and their products have also been found within the inflamed mucosa of patients with Crohn’s diseas
Ninety-six-hour wireless oesophageal pH monitoring following proton pump inhibitor administration in NERD patients.
No full textBACKGROUND: Comparative studies of proton pump inhibitors (PPIs) have revealed that acid reflux is influenced by PPI treatment, formulations and dosing regimens. Wireless pH capsules have circumvented some of the limitations of conventional catheter-based pH testing with the additional advantage of 96-h recording periods. AIM: To clarify the effectiveness of intra-oesophageal acid suppression by omeprazole, pantoprazole and lansoprazole in non-erosive reflux disease patients through a 4-day monitoring of oesophageal pH and related symptoms. METHODS: Twenty-four patients with typical symptoms of gastro-oesophageal reflux disease were enrolled and administered upper endoscopy and placement of a wireless pH capsule. Patients randomly received omeprazole, pantoprazole or lansoprazole for 3 days after the first 24 h. Symptom-reflux associations were expressed using the symptom index (SI). RESULTS: All patients completed the study. Significant decrease in acid exposure occurred on day 2 and in each successive day in all groups. Pantoprazole and omeprazole are more effective than lansoprazole at inducing a normalization of intra-oesophageal acid exposure at days 2 and 3. Significant reduction in SI at day 2 was observed. CONCLUSIONS: Four-day ambulatory oesophageal pH monitoring is feasible and safe. Omeprazole, pantoprazole and lansoprazole have an equivalent potency for normalizing intra-oesophageal acid exposure after 3 days of treatment in non-erosive reflux disease patients
Role of conventional therapies in the era of biological treatment in Crohn’s disease
No full textOutstanding progress regarding the pathophysiology of Crohn's disease (CD) has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD. This review concentrates on the results of randomized, placebo-controlled trials, and meta-analyses when available, that provide the highest degree of evidence. Current guidelines on the management of CD recommend a step-up approach to treatment involving the addition of more powerful therapies as the severity of disease and refractoriness to therapy increase. The advent of biological drugs has opened new therapeutic horizons for treating CD, modifying the treatment goals. However, the large majority of patients with CD will be managed through conventional therapy, even if they are a prelude to biological therapy
PROJETO DIÁLOGO COM O AUTOR: UMA PROPOSTA DE FORMAÇÃO CONTINUADA
No full textThis article presents the importance of continuing education, through the activities developed by the Research Group on Geography Teaching (GRUPEG/CNPq). This is the Dialogue with the Author project whose premise was the reading and debate of ideas contained in theoretical texts with the presence of the author himself. Among these dialogues, this article highlights the participation and discussions held by the authors: Lana Cavalcanti, Rafael Straforini and Carina Copatti. The texts selected by the teachers approach the theoretical and methodological bases that guide the teaching performance, the methodological proposals that can make it possible for the student to think geographically, through problematization, systematization and synthesis, teaching Geography as a spatial practice of discursive meaning and thinking pedagogical and geographic. The teachers presented, in a didactic and coherent way, some topics to motivate the dialogue. For this article, some of the most important aspects of the narratives and the relationship with theoretical texts were selected. The references used to theoretically support the article were essentially the texts suggested by the teachers. This continuing education activity contributed significantly to GRUPEG participants, as it mobilized reflection on their own practice.Este artículo presenta la importancia de la educación continua, através de las actividades desarrolladas en el Grupo de Investigación en Enseñanza de la Geografía (GRUPEG/CNPq). Se trata del proyecto dialogando con el autor, cuya premisa fue la lectura y debate de ideas contenidas en textos teóricos con la presencia del propio autor. Entre esos diálogos, este artículo destaca las participaciones y encuentros sostenidos por los autores: Lana Cavalcanti, Rafael Straforini y Carina Copatti. Los textos seleccionados por los docentes abordan las bases teórico metodológicas que orientan la actuación docente, como propuestas metodológicas que posibiliten que el estudiante piense geográficamente, através de la problematización, sistematización y síntesis, enseñando la Geografía como práctica espacial de sentido discursivo y lo pensamiento pedagógico y geográfico. Los docentes presentaron, de manera didáctica y coherente, algunos temas para motivar el diálogo. Para este artículo se seleccionaron algunos de los aspectos más importantes de las narraciones y la relación con los textos teóricos. Las referencias utilizadas para sustentar teóricamente el artículo fueron esencialmente los textos indicados por los professores. Esta actividad de formación continua contribuyó significativamente a los participantes de GRUPEG, ya que movilizó la reflexión sobre su propia práctica.Esse artigo apresenta a importância da formação continuada, por meio das atividades desenvolvidas no Grupo de Pesquisa no Ensino de Geografia (GRUPEG/CNPq)[1]. Trata-se do projeto Diálogo com o Autor que teve como premissa a leitura e debate de ideias contidas nos textos teóricos, com a presença do próprio autor. Dentre esses diálogos, esse artigo destaca as participações e discussões realizadas pelos autores: Lana Cavalcanti, Rafael Straforini e Carina Copatti. Os textos selecionados pelos professores abordam as bases teórico metodológicas que orientam a atuação docente, as propostas metodológicas que podem tornar viável ao aluno pensar geograficamente, por meio da problematização, sistematização e síntese, o ensinar Geografia como uma prática espacial de significação discursiva e o pensamento pedagógico e geográfico. Os professores apresentaram, de forma didática e coerente, alguns tópicos para motivar o diálogo. Para esse artigo, foram selecionados alguns aspectos mais importantes das narrativas e a relação com os textos teóricos. As referências utilizadas para embasar teoricamente o artigo foram, essencialmente, os próprios textos sugeridos pelos professores. Essa atividade de formação continuada contribuiu, de forma significativa, para os participantes do GRUPEG, visto que mobilizou a reflexão da própria prática.
