1
|
Mishra J, Stubbs M, Kuang L, Vara N, Kumar P, Kumar N. Inflammatory Bowel Disease Therapeutics: A Focus on Probiotic Engineering. Mediators Inflamm 2022; 2022:9621668. [PMID: 35082553 PMCID: PMC8786545 DOI: 10.1155/2022/9621668] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of gastrointestinal (GI) tract with dysregulated mucosal immune functions and disturbed commensal ecosystem of the intestinal lumen. IBD is categorized into two major subsets: Crohn's disease (CD) and ulcerative colitis (UC). Though advent of biologics has shifted the treatment with relatively longer remission compared to small molecule pharmaceuticals, patients still suffer from long-term complications. Since gut-microbiome is now accepted as another human organ holding potential for long-lasting human health, probiotics, and its engineering hold great promises to treat several previously untreatable chronic inflammatory conditions including IBD. Several emerging biological engineering tools have unlimited potential to manipulate probiotic bacterial system. These can produce useful therapeutic biologics with a goal to either ameliorate and/or treat previously untreatable chronic inflammatory conditions. As gut-microbiome is diverse and vary in different ethnic, geographic, and cultural human population, it will be important to develop vision for personalized probiotic treatment and develop the technology thereof to make personalized probiotic options a reality. The aim of this review paper is to present an overview of the current knowledge on both pharmacological and nonpharmacological IBD treatment modalities with a special emphasis on probiotic strains that are developed through the probiotic engineering. These engineered probiotics contain the most anti-inflammatory cytokines found within the human immune response and are currently being used to treat the intestinal inflammation in IBD for the IBD treatment.
Collapse
Affiliation(s)
- Jayshree Mishra
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Madyson Stubbs
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Longxiang Kuang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Nitza Vara
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Priyam Kumar
- Santa Gertrudis Academy High School, Kingsville, Texas, USA
| | - Narendra Kumar
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| |
Collapse
|
2
|
Burke J, Toomey D, Reilly F, Cahill R. Single access laparoscopic total colectomy for severe refractory ulcerative colitis. World J Gastroenterol 2020; 26:6015-6026. [PMID: 33132651 PMCID: PMC7584061 DOI: 10.3748/wjg.v26.i39.6015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site incision. While intuitively appealing, there is sparse evidence for its use beyond feasibility.
AIM To examine the usefulness of single access laparoscopy (SAL) in a general series experience of patients sick with ulcerative colitis.
METHODS All patients presenting electively, urgently or emergently over a three-year period under a colorectal specialist team were studied. SAL was performed via the stoma site on a near-consecutive basis by one surgical team using a “surgical glove port” allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport surgery. Standard, straight rigid laparoscopic instrumentation were used without additional resource.
RESULTS Of 46 consecutive patients requiring surgery, 39 (85%) had their procedure begun laparoscopically. 27 (69%) of these were commenced by single port access with an 89% completion rate thereafter (three were concluded by multi-trocar laparoscopy). SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs (> 100€case) and postoperative hospital stay (median 5 d vs 7.5 d, P = 0.045) without increasing operative time. It proved especially efficient in those with preoperative albumin > 30 g/dL (n = 20). Its comparative advantages were further confirmed in ten pairs case-matched for gender, body mass index and preoperative albumin. SAL outcomes proved durable in the intermediate term (median follow-up = 20 mo).
CONCLUSION Single port total colectomy proved useful in planned and acute settings for patients with medically refractory colitis. Assumptions regarding duration and cost should not be barriers to its implementation.
Collapse
Affiliation(s)
- John Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin D09, Ireland
| | - Des Toomey
- Department of Colorectal Surgery, Beaumont Hospital, Dublin D09, Ireland
| | - Frank Reilly
- Department of Colorectal Surgery, Beaumont Hospital, Dublin D09, Ireland
| | - Ronan Cahill
- Department of Surgery, Mater Misericordiae University Hospital, Dublin D07, Ireland
| |
Collapse
|
3
|
Massuger W, Moore GTC, Andrews JM, Kilkenny MF, Reyneke M, Knowles S, Purcell L, Alex G, Buckton S, Page AT, Stocks N, Cameron D, Manglaviti F, Pavli P. Crohn's & Colitis Australia inflammatory bowel disease audit: measuring the quality of care in Australia. Intern Med J 2019; 49:859-866. [DOI: 10.1111/imj.14187] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/06/2018] [Accepted: 11/27/2018] [Indexed: 01/14/2023]
Affiliation(s)
| | - Gregory T. C. Moore
- Crohn's & Colitis AustraliaMelbourneVictoriaAustralia
- Gastroenterology and Hepatology UnitMonash HealthMelbourneVictoriaAustralia
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - Jane M. Andrews
- IBD Service, Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Faculty of Health SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Monique F. Kilkenny
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
- Stroke DivisionThe Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
| | - Megan Reyneke
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - Simon Knowles
- Department of Psychological SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Liz Purcell
- Dietetic DepartmentMetro South Health Logan HospitalLogan CityQueenslandAustralia
| | - George Alex
- Department of Gastroenterology and Clinical NutritionRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Stephanie Buckton
- Department of GastroenterologySunshine Coast University HospitalQueenslandAustralia
| | - Amy T. Page
- School of Medicine and PharmacologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Nigel Stocks
- Discipline of General PracticeUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Don Cameron
- Department of Gastroenterology and Clinical NutritionRoyal Children's HospitalMelbourneVictoriaAustralia
| | | | - Paul Pavli
- Gastroenterology and Hepatology UnitThe Canberra HospitalCanberraAustralian Capital TerritoryAustralia
- Medical SchoolAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| |
Collapse
|
4
|
Zhang R, Ray JW, Jain MK, Han S. Ileectomy-induced Bile Overaccumulation in Mouse Intestine. J Vis Exp 2017. [PMID: 28872123 DOI: 10.3791/55728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer that often results in severe short bowel syndrome-like adverse effects including bile acid diarrhea, dehydration, electrolyte disturbances, and nutrient malabsorption. Here we introduce a murine ileal resection model, termed ileectomy, to evaluate tissue communication and the maintenance of systemic homeostasis. After ileal resection, circulating blood is permanently devoid of the ileum-specific endocrine hormone fibroblast growth factor 15 (FGF15), which releases its endocrinal inhibition of bile acid synthesis in the liver. In combination with the increased production and abolished reabsorption of bile acids after removing the ileum, mice that underwent surgery suffer from bile salt overaccumulation in the intestine and associated diarrhea, morbidity, and mortality. Novel usage of the surgery model introduced in this study may provide mechanistic and functional insights into ileal control of systemic metabolic regulation in physiology and disease.
Collapse
Affiliation(s)
- Rongli Zhang
- Department of Medicine, Case Cardiovascular Research Institute, Case Western Reserve University; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Institute for Transformative Molecular Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center
| | - Jonathan W Ray
- Department of Medicine, Case Cardiovascular Research Institute, Case Western Reserve University; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center
| | - Mukesh K Jain
- Department of Medicine, Case Cardiovascular Research Institute, Case Western Reserve University; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center;
| | - Shuxin Han
- Department of Medicine, Case Cardiovascular Research Institute, Case Western Reserve University; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center;
| |
Collapse
|
5
|
Rieder F, Latella G, Magro F, Yuksel ES, Higgins PDR, Di Sabatino A, de Bruyn JR, Rimola J, Brito J, Bettenworth D, van Assche G, Bemelman W, d'Hoore A, Pellino G, Dignass AU. European Crohn's and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn's Disease. J Crohns Colitis 2016; 10:873-85. [PMID: 26928961 DOI: 10.1093/ecco-jcc/jjw055] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/16/2016] [Indexed: 01/24/2023]
Abstract
This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practice.
Collapse
Affiliation(s)
- Florian Rieder
- Department of Pathobiology, Lerner Research Institute, Cleveland, OH, USA Department of Gastroenterology, Hepatology & Nutrition, Lerner Research Institute, Cleveland, OH, USA
| | - Giovanni Latella
- Department of Life, Health and Environmental Sciences, Gastroenterology Unit, University of L'Aquila, L'Aquila, Italy
| | - Fernando Magro
- Department of Pharmacology & Therapeutics, Department of Gastroenterology, Faculty of Medicine University of Porto, Porto, Portugal
| | - Elif S Yuksel
- Department of Gastroenterology, Izmir Ataturk Teaching and Research Hospital-Katip Celebi University, Izmir, Turkey
| | - Peter D R Higgins
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Antonio Di Sabatino
- First Department of Internal Medicine, St Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Jessica R de Bruyn
- Academic Medical Center Amsterdam, Tytgat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands
| | - Jordi Rimola
- Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jorge Brito
- Department of Radiology, Centro Hospitalar do Algarve, Lagos, Portugal
| | | | - Gert van Assche
- Division of Gastroenterology, University of Leuven, Leuven, Belgium
| | - Willem Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Andre d'Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Gianluca Pellino
- Department of Medicine 1, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Axel U Dignass
- Department of Pathobiology, Lerner Research Institute, Cleveland, OH, USA
| |
Collapse
|
6
|
Abstract
PURPOSE Single-incision laparoscopic surgery (SILS) has been described in adults with Crohn's disease, but its use in pediatric Crohn's patients has been limited. The purpose of this study was to review our experience with SILS in pediatric patients with Crohn's disease. METHODS A retrospective review was performed for patients diagnosed with Crohn's disease who underwent small bowel resection or ileocecectomy at a freestanding children's hospital from 2006 to 2014. Data collected included demographic data, interval from diagnosis to surgery, operative time, length of stay, and postoperative outcomes. RESULTS Analysis identified 19 patients who underwent open surgery (OS) and 41 patients who underwent SILS. One patient (2.4 %) within the SILS group required conversion to OS. Demographic characteristics were similar between the 2 cohorts. The most common indication for surgery was stricture/obstruction (SILS 70.7 % vs. OS 68.4 %, p = 0.86), and ileocecectomy was the most common primary procedure performed (SILS 90.2 % vs. OS 100 % OS). Operative times were longer for SILS (135 ± 50 vs. 105 ± 37 min, p = 0.02). However, when the last 20 SILS cases were compared to all OS cases, the difference was no longer statistically significant (SILS 123.3 ± 34.2 vs. OS 105 ± 36.5, p = 0.12). No difference was noted in postoperative length of stay (SILS 6.5 ± 2.2 days vs. OS 7.4 ± 2.2 days, p = 0.16) or overall complication rate (SILS 24.4 % vs. OS 26.3 %, p = 0.16). CONCLUSION SILS ileocecectomy is feasible in pediatric patients with Crohn's disease, achieving outcomes similar to OS. As experience increased, operative times also became comparable.
Collapse
|
7
|
Getting personal: a review of sexual functioning, body image, and their impact on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis 2015; 21:923-38. [PMID: 25789923 PMCID: PMC4369789 DOI: 10.1097/mib.0000000000000257] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic relapsing disorder associated with distressing physical and psychological symptoms. Many patients with IBD have impaired quality of life. Sexual functioning and body image are rated high among concerns of patients with IBD and may impact quality of life. A better understanding of the roles of sexual functioning and body image in quality of life for patients with IBD is needed because improvement in quality of life is a primary therapeutic goal. The aim of this review was to summarize the current literature on sexual functioning and body image in patients with IBD, emphasizing their impact on quality of life. METHODS An electronic search of the literature was conducted using the PubMed, PsycINFO, and Cochrane databases. Key phrases included: "Ulcerative Colitis/Crohn's disease/Inflammatory Bowel Disease and sexual function," and "Ulcerative Colitis/Crohn's disease/Inflammatory Bowel Disease and body image." The search produced 1284 citations. We identified 56 studies, which were conducted from 1990 through April 2014, written in English, and included at least 10 adults with IBD. CONCLUSIONS Few studies have tested directly the association between quality of life and sexual functioning and body image among patients with IBD. Results preliminarily suggest a positive relationship between quality of life and sexual functioning and body image postoperatively among patients with IBD. Future studies comprised of patients who have not had surgery are necessary to better understand the relationship between sexual functioning, body image, and quality of life in patients with active and inactive IBD.
Collapse
|
8
|
Moftah M, Nazour F, Cunningham M, Cahill RA. Single port laparoscopic surgery for patients with complex and recurrent Crohn's disease. J Crohns Colitis 2014; 8:1055-61. [PMID: 24589026 DOI: 10.1016/j.crohns.2014.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 01/14/2014] [Accepted: 02/06/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Single port laparoscopic surgery (SPLS) is a modified access technique allowing grouping of instruments at a single parietal site. It is intuitively appealing specifically for patients with Crohn's disease (CD) as its minimal invasiveness favors cosmesis and facilitates any future (re)operation. METHODS Consecutive patients presenting either electively or urgently for resectional surgery for CD over a 36 month period were considered for SPLS using, by preference, a transumbilical 'Surgical Glove Port'. Standard, straight laparoscopic instrumentation was used without additional resources. RESULTS Of 33 consecutive, unselected patients, 28 (92%) had their procedure initiated by SPLS including those needing urgent intervention (n=15) and those with prior abdominal operation (n=8), obstruction (n=7), mass (n=6), fistula (n=6) and/or abscess (n=4). The median (range) age and BMI of the patients were 31 (17-69) years and 21.3 (18.6-28) kg/m2 respectively. 31 had ileocolonic resection (6 with recurrent disease) while two underwent segmental colectomy. No-one suffered intraoperative or anastomotic complication. Both conversion (15%) and postoperative complication (13 Clavian-Dindo complications - I: 8; II: 2; IIIa: 3) rates were predominantly reflective of patient and disease complexity. Median (range) postoperative day of discharge was 6 (3-33) overall and 5 (3-18) in those completed by SPLS. There was one early readmission (for infectiouscolitis) and median follow-up is now 21 months. CONCLUSIONS Complex and recurrent Crohn's resections can be performed by SPLS in the majority of patients presenting elective or urgently for surgery. The Surgical Glove Port performs capably and, by minimizing cost, can facilitate broad embrace of this approach.
Collapse
Affiliation(s)
- Mohamed Moftah
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Fady Nazour
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Ronan A Cahill
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.
| |
Collapse
|
9
|
Salehimarzijarani B, Jalaly NY, Dadvar Z, Hemmasi G, Ashrafi M, Zali M. Long-term quality of life after ileal pouch anal restorative proctocolectomy for ulcerative colitis. Indian J Gastroenterol 2013; 32:49-53. [PMID: 23238689 DOI: 10.1007/s12664-012-0284-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 11/13/2012] [Indexed: 02/04/2023]
Abstract
Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) has evolved as the surgical procedure of choice for ulcerative colitis (UC). The aim of our study was to evaluate the quality of life (QOL) of UC patients who underwent this procedure over 5 years ago. Thirty-nine UC patients who underwent restorative proctocolectomy with IPAA were interviewed by the validated inflammatory bowel disease questionnaire (IBDQ). Each patient was assigned a score, ranging from 32 to 224, in which the highest score indicates the best QOL. QOL for postoperative patients was good in 15 (38.5 %), regular in 23 (59 %), and bad in 1 (2.6 %) patient. QOL was not significantly influenced by age or gender of the patient. The emotional aspect received the highest score in the IBDQ and for each question that was analyzed separately; most of the patients were pleased and thankful with their lives and this question received the highest score. Long-term QOL was good in UC patients who underwent IPAA. This operation should be considered as the first choice since the patients were stable after long-term follow up.
Collapse
Affiliation(s)
- Babak Salehimarzijarani
- Research Center for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | | | | | | | | |
Collapse
|
10
|
Gardenbroek TJ, Tanis PJ, Buskens CJ, Bemelman WA. Surgery for Crohn's disease: new developments. Dig Surg 2012; 29:275-80. [PMID: 22922840 DOI: 10.1159/000341567] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/29/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Crohn's disease is a chronic relapsing inflammatory bowel disease requiring surgery in a large number of patients. This review describes new developments in surgical techniques for treating Crohn's disease. RESULTS Single-incision laparoscopic surgery decreases abdominal wall trauma by reducing the number of abdominal incisions, possibly improving postoperative results in terms of pain and cosmetics. The resected specimen can be extracted through the single-incision site or the future stoma site. Another option is to use natural orifices for extraction (i.e. transcolonic/transanal), but actual benefits of these procedures have not yet been determined. In patients with extensive perianal disease or rectal involvement, transperineal completion proctectomy is often feasible, thereby avoiding relaparotomy. By using a close rectal intersphincteric resection, damage to the pelvic autonomic nerves is avoided. In addition, the risk of presacral abscess formation is reduced by leaving the mesorectal tissue behind. CONCLUSION Minimally invasive surgery and associated techniques have become standard clinical practice in surgical treatment of patients with Crohn's disease. New developments aim at further reducing the hospital stay and morbidity, and improving the cosmetic outcomes.
Collapse
Affiliation(s)
- T J Gardenbroek
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
11
|
Cucchiara S, Romeo E, Viola F, Cottone M, Fontana M, Lombardi G, Rutigliano V, de'Angelis GL, Federici T. Infliximab for pediatric ulcerative colitis: a retrospective Italian multicenter study. Dig Liver Dis 2008; 40 Suppl 2:S260-4. [PMID: 18598998 DOI: 10.1016/s1590-8658(08)60535-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infliximab (IFX), the chimeric anti TNFalpha antibody, an established treatment for Crohn's disease in adults and in children, is used less frequently in ulcerative colitis (UC). AIM OF THE STUDY To report the clinical course of pediatric patients with active UC receiving IFX. PATIENTS AND METHODS Charts of 22 patients were reviewed (13 male, 9 female): 4 with a severe UC attack refractory to systemic corticosteroids (CS); 18 with a protracted course, of which 16 CS-dependent and 2 CS-resistant. The baseline therapeutic program consisted of 3 consecutive intravenous infusions (0, 2, 6 weeks) of IFX (5 mg/kg), followed by a retreatment schedule (infusion every 8 weeks); azathioprine (AZA) was administered chronically in all. Clinical evaluation was done with the Lichtiger Colitis Activity Index (LCAI). Follow-up was performed until week 54. LCAI >/= 9 was considered treatment failure; a LCAI </= 2 was consistent with remission. RESULTS All 22 patients began the study with a LCAI > 9: 12 had a full response and were on remission at week 54 and did not receive CS (8 on IFX re-treatment and AZA, 4 on AZA alone); 6 had a partial response; 4 were non responders. Colectomy was performed in 7 patients, beyond the period of the acute attack in all but one. CONCLUSIONS In children with severe ulcerative colitis IFX is a valuable treatment for inducing remission, avoiding emergency colectomy; retreatment may be offered to maintain remission.
Collapse
Affiliation(s)
- S Cucchiara
- Division Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University of Rome "La Sapienza", Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
|