scholarly journals News and controversy in inflammatory bowel disease treatment

2013 ◽  
pp. 179-186
Author(s):  
Giulia Straforini ◽  
Ramona Brugnera ◽  
Rosy Tambasco ◽  
Fernando Rizzello ◽  
Paolo Gionchetti ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Topical Treatment ◽  
Preventive Treatment ◽  
High Dose ◽  
First Choice ◽  
Oral Steroids ◽  
Inflammatory Bowel

Background: The treatment of Inflammatory bowel disease comes from many years of esperience, clinical trials and mistakes. Discussion: In patients with active Crohn disease steroids are considerated the first choice, but recently, the introduction of anti-TNF alfa agents (infliximab and adalimumab) has changed the protocols. Anti-TNF are also used for closing fistula after surgical curettage. An efficently preventive treatment of Crohn disease still has not been found but hight dose of oral salicylates, azatioprine or 6-MP and antibiotics might be useful. In severe attacks of ulcerative colitis, high dose iv treatment of steroids are required for a few days. Later on, a further treatment with anti- TNF might delay the need of surgery. In patients with mild to moderate attacks of ulcerative colitis, topical treatment is preferred, it consists of enemas, suppositories or foams containing 5-aminosalycilic acid, traditional steroids, topical active steroids. Topical treatment can be associated with oral steroids or oral salicylates. Oral salicylates or azatioprine are used for prevention of relaps.

scholarly journals FREQUENCY OF OPHTHALMOLOGICAL POSTERIOR SEGMENT FINDINGS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

2018 ◽  
Vol 55 (2) ◽  
pp. 188-191 ◽  
Author(s):  
Luis Filipe NAKAYAMA ◽  
Vinicius Campos BERGAMO ◽  
Marina Lourenço de CONTI ◽  
Lívia BUENO ◽  
Nilva Simeren Bueno de MORAES ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Posterior Segment ◽  
Oct Angiography ◽  
Ophthalmological Examination ◽  
Study Objective ◽  
Systemic Inflammatory Disease ◽  
Inflammatory Bowel

ABSTRACT BACKGROUND: Inflammatory bowel disease is a systemic inflammatory disease classified as Crohn disease or ulcerative colitis. It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement. Among ophthalmological findings, posterior segment findings are present in less than 1% of patients with inflammatory bowel disease, however, these findings could bring definitive visual impairment. OBJECTIVE: Our study objective was to evaluate ocular posterior segment findings is patients with inflammatory bowel disease, through retinal mapping, color fundus retinography, optical coherence tomography (OCT) and OCT angiography, and compare our results to literature. METHODS: We evaluated eighty patients with inflammatory bowel disease through complete ophthalmological examination and posterior segment assessment. Color fundus retinography, OCT and OCT angiography was performed with Topcon Triton (Topcon ® , Tokyo, Japan). Macula and posterior pole were evaluated with binocular indirect ophthalmoscopy and fundus biomicroscopy. RESULTS: Participants mean age was 44.16 years (18.08-68.58), 28 (35%) male patients and 52 (65%) female patients. Thirty-five (44%) with diagnosis of Crohn disease, 41 (52%) patients with diagnosis of ulcerative colitis and 3 (4%) had non-conclusive Crohn disease or ulcerative colitis classification. We found abnormal exams in 21 (26.25%) patients. CONCLUSION: Our study found similar prevalence of ophthalmological posterior segment commitment compared to previous literature prevalence. The findings were predominantly unrelated to inflammatory bowel disease, rather than primarily related to it. The most prevalent, and non-previous reported, finding was increased arteriolar tortuosity, probably occurs due to systemic vascular impairment in inflammatory bowel disease.

Ulcerative Colitis and Crohn Disease in Children

1987 ◽  
Vol 9 (4) ◽  
pp. 109-120
Author(s):  
Kathleen J. Motil ◽  
Richard J. Grand
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Correct Diagnosis ◽  
Age Groups ◽  
Growth Failure ◽  
Clinical Findings ◽  
Chronic Inflammatory Bowel Disease ◽  
Inflammatory Bowel

Once considered rare in pediatric practice, chronic inflammatory bowel disease is now recognized with increasing frequency in children. Ulceractive colitis and Crohn disease constitute the two major entities, and it is still not clear whether these are two separate entities or different portions of the spectrum of one disease. Abdominal pain, diarrhea, rectal bleeding, weight loss, and anemia are prominent findings in both ulcerative colitis and Crohn disease; however, extraintestinal manifestations may dominate the clinical findings, masquerading as juvenile rheumatoid arthritis, idiopathic growth failure, or even anorexia nervosa. Often, it is not until intestinal manifestations are recognized that a correct diagnosis is made.1 EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE Since 1950, there has been an increase, in the incidence of Crohn disease, ranging from 100% to 400% in all age groups.2 In contrast, the incidence of ulcerative colitis has not changed significantly. Ulcerative colitis is diagnosed in 15% of patients before the age of 20 years, usually in adolescence. Although ulcerative colitis may occur in infancy, inflammatory disease of the colon during the first year of life is more often due to food allergy3 or infectious disease. Certain groups of children are at greater risk for the development of inflammatory bowel disease. Ulcerative colitis and Crohn disease occur more commonly among Northern European, Anglo-Saxon races, in urban rather than rural dwellers, and in Jewish individuals living in Europe and North America.

Monocytosis Is a Biomarker of Severity in Inflammatory Bowel Disease: Analysis of a 6-Year Prospective Natural History Registry

2021 ◽  
Author(s):  
Alyce Anderson ◽  
Cynthia Cherfane ◽  
Benjamin Click ◽  
Claudia Ramos-Rivers ◽  
Ioannis E Koutroubakis ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Natural History ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Disease Type ◽  
Care Utilization ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) is associated with alterations of the innate and adaptive immune systems. Monocytes respond to inflammation and infection, yet the relationship between monocytosis and IBD severity is not fully understood. We aimed to characterize the prevalence of monocytosis in IBD and the association between monocytosis and disease severity and IBD-related health care utilization. Methods We used a multiyear, prospectively collected natural history registry to compare patients with IBD with monocytosis to those without monocytosis, among all patients and by disease type. Results A total of 1290 patients with IBD (64.1% with Crohn disease; 35.9% with ulcerative colitis) were included (mean age 46.4 years; 52.6% female). Monocytosis was found in 399 (30.9%) of patients with IBD (29.3% with Crohn disease; 33.9% with ulcerative colitis). Monocytosis was significantly associated with abnormal C-reactive protein level and erythrocyte sedimentation rate, anemia, worse quality of life, active disease, and increased exposure to biologics (all P < 0.001). Compared with patients without monocytosis, patients with monocytosis had a 3-fold increase in annual financial health care charges (median: $127,013 vs. $32,925, P < 0.001) and an increased likelihood of hospitalization (adjusted odds ratio [AOR], 4.5; P < 0.001), IBD-related surgery (AOR, 1.9; P = 0.002), and emergency department (ED) use (AOR, 2.8; P < 0.001). Patients with monocytosis had a shorter time to surgery, hospitalization, and ED visit after stratifying by disease activity (all P < 0.05). Conclusions Patients with IBD with monocytosis, regardless of disease type, are at increased risk for worse clinical outcomes, hospitalization, surgery, and ED use. Peripheral monocytosis may represent a routinely available biomarker of a distinct subgroup with severe disease.

Colonic Disorders

2016 ◽  
pp. 217-228
Author(s):  
Conor G. Loftus
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Chronic Inflammation ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Key Factor ◽  
Inflammatory Bowel

Inflammatory bowel disease refers to 2 disorders of unknown cause: ulcerative colitis and Crohn disease. Other possible causes of inflammation, especially infection, should be excluded before making the diagnosis of inflammatory bowel disease. The presence of chronic inflammation on biopsy is the key factor for making a diagnosis of inflammatory bowel disease.

scholarly journals The Use of Thoracic Epidural for Rapid Opioid Taper

2021 ◽  
pp. 205-208
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Epidural Analgesia ◽  
Bowel Disease ◽  
High Dose ◽  
Fentanyl Patch ◽  
Transdermal Fentanyl ◽  
Thoracic Epidural ◽  
Inflammatory Bowel

BACKGROUND: Inflammatory Bowel Disease (IBD) is often associated with significant abdominal pain that can be challenging to control. Although controversial, opioids are often prescribed for the management of abdominal pain in patients with IBD. There have been several methods described for the rapid taper of patients on long-term, high-dose opioids. However, to date, there have been no reported cases using epidural analgesia for rapid opioid taper. CASE REPORT: We present a case of a 36-year-old man with ulcerative colitis and recurrent bowel obstructions on a high-dose transdermal fentanyl patch whose opioid consumption was rapidly tapered during inpatient hospitalization utilizing thoracic epidural analgesia. CONCLUSION: The potential role of epidural analgesia in rapid opioid taper has yet to be explored. In patients with chronic pain and inflammatory bowel disease or recurrent bowel obstructions, epidural analgesia may be particularly helpful to improve gastrointestinal motility while also being used to rapidly taper opioid dosage. KEY WORDS: Inflammatory bowel disease, ulcerative colitis, Crohn’s disease, epidural, opioids, rapid opioid taper, fentanyl patch

scholarly journals P404 Prolonged steroid exposure prior to admission is associated with increased likelihood of rescue therapy and colectomy in acute severe ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S373-S374
Author(s):  
A Barnes ◽  
P Spizzo
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Rescue Therapy ◽  
Electronic Record ◽  
High Dose ◽  
Retrospective Case ◽  
Severe Ulcerative Colitis ◽  
Inflammatory Bowel ◽  
One Year

Abstract Background Steroid exposure has been associated with poorer outcomes following colectomy in acute severe ulcerative colitis. Current treatment algorithms suggest three days of high dose intravenous steroid before the decision to commence rescue therapy. We aimed to look at medium-term outcomes in acute severe ulcerative colitis and their predictors including steroid exposure prior to admission. Methods A retrospective case note and electronic record review were conducted at a tertiary inflammatory bowel disease referral centre of admissions for acute severe ulcerative colitis meeting Truelove and Witts criteria from 2013 to 2019. Identified admissions were categorised as: not on steroid prior to admission or on steroid for less than one week prior to admission, on steroid for over one week prior to admission, and on steroid for over one month prior to admission. Data were analysed using Chi-squared test and Fisher’s exact test as appropriate. Results In total, 109 admissions were identified for acute severe ulcerative colitis meeting Truelove and Witts criteria over 2013 to 2019. Rescue therapy was significantly more likely in patients with over one week of steroid exposure prior to admission (76.0% vs. 28.5%, p = 0.0001). Prior steroid exposure was not associated with failure of medical rescue therapy (p = 0.42). Patients with steroid exposure for at least one week prior to admission trended towards increased likelihood to undergo colectomy during admission (32.0% vs. 16.6%, p = 0.0.09) and were significantly more likely to undergo colectomy within one year of admission (44.0% vs. 21.4%, p = 0.028). Excluding patients with a first presentation of inflammatory bowel disease showed that patients with steroid exposure for at least one week prior to admission trended towards significance to undergo colectomy during admission (32.0% vs. 13.2%, p = 0.05) and were significantly more likely to undergo colectomy within one year of admission (44.0% vs. 20.7%, p = 0.036). Readmissions within one year of acute severe ulcerative colitis admission were not significantly different (40.0% vs. 29.7%, p = 0.33). Conclusion Prolonged steroid exposure prior to admission was associated with an increased likelihood of rescue therapy but was not predictive of response to medical rescue therapy. Colectomy rates at one year were significantly higher with over one week of steroid exposure prior to admission. Consideration should be given to early commencement of rescue therapy in those with prolonged steroid exposure prior to admission.

An incidental enterocolic lymphocytic phlebitis pattern is seen commonly in the rectal stump of patients with diversion colitis superimposed on inflammatory bowel disease

2009 ◽  
Vol 62 (5) ◽  
pp. 464-467 ◽  
Author(s):  
R Chetty ◽  
S Hafezi ◽  
E Montgomery
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Diverticular Disease ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Rectal Stump ◽  
Colon Resection ◽  
Study Cohort ◽  
Diversion Colitis ◽  
Inflammatory Bowel

Aims:Enterocolic lymphocytic phlebitis (ELP) is an uncommon cause of bowel pathology and most frequently results in ischaemia. It is characterised by an artery-sparing, venulocentric lymphoid infiltrate that causes a phlebitis and vascular compromise. Rare cases of ELP have been encountered with lymphocytic colitis in the absence of ischaemic bowel change. The present study examined the occurrence of ELP in the setting of diversion colitis and inflammatory bowel disease, as well as in random colectomy specimens.Methods:The study cohort comprised the following: 26 completion proctectomy specimens for ulcerative colitis with superimposed diversion colitis in the rectal stump; 3 colectomy specimens for Crohn disease with diversion colitis; 6 colectomy specimens for adenocarcinoma and/or diverticular disease with diversion colitis; 34 resection specimens with ulcerative colitis only; 19 with Crohn disease only; and 100 random colon resection specimens for adenocarcinoma, adenoma, diverticular disease and ischaemia.Results:ELP was present in 18 of the 26 ulcerative colitis cases with diversion colitis, 3/3 Crohn disease cases with diversion colitis, 1/6 cases of diverticular disease with diversion colitis, 6/34 cases of ulcerative colitis without diversion, 2/19 Crohn disease cases without diversion colitis, and only 1 of 100 colectomy cases without inflammatory bowel disease or diversion colitis.Conclusion:ELP occurs most frequently in cases that have been diverted for inflammatory bowel disease. Fewer cases of ELP were noted in cases of inflammatory bowel disease in the absence of diversion colitis. It is postulated that altered bowel flora and immune dysregulation may be pivotal in the causation of this association.

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