Is rifaximin effective in maintaining remission in Crohn's disease?

BACKGROUND

Recent studies indicate that persistent intestinal inflammation in patients with Crohn's disease (CD) might be caused by abnormal intestinal microbiota. This hypothesis may suggest a beneficial effect of antibiotics in CD therapy. So far, guidelines do not recommend antibiotics except in the treatment of complicated CD, and there are few studies on the effects of rifaximin in these patients.

METHODS

Between December 2011 and December 2012, we performed a blinded randomized trial in 168 patients with a previous history of moderately active CD concerning the efficacy of rifaximin. All the patients had previously achieved remission with standard therapy (prednisone/budesonide). Data from patients receiving 800 mg of rifaximin (83 patients) twice a day for 12 weeks were compared with those from patients who received placebo (83 patients). The primary endpoint was maintaining remission during the follow-up.

RESULTS

All the patients (100%; 83/83) on 800 mg of rifaximin were in remission after 12 weeks of treatment in comparison with 84% (70/83) of the placebo group. This significant difference was also persistent at the 24-week follow-up [78% (65/83) vs. 41% (34/83), respectively]. The last evaluation performed at 48 weeks revealed disease activity in 45% (38/83) of the patients of the rifaximin group, i.e. a significant decrease compared with the placebo group [75% (63 of 83)].

CONCLUSIONS

Remission previously obtained with standard treatment can be sustained in patients with moderately active CD after the administration of 800 mg of rifaximin.

Nutrition in inflammatory bowel diseases

The relationship between nutrition and inflammatory bowel disease (IBD) is a complex one, the evaluation and correction of nutritional deficits being integral part of therapy in these patients. The diet that consists in excessive consumption of meat, sugar, fats (with a higher 0 6 /o) 3 polyunsaturated fatty acids ratio) are factors involved in the epidemiology and pathogenesis of IBD. Malnutrition is present among most IBD patients, being the result of multiple mechanisms from digestive symptoms to inflammatory process, intestinal resection and administration of medications. Oral diet is high-calorie, high protein at correcting the vitamin and mineral deficiencies. Enteral diet has both an adjuvant role and that of inducing and maintaining remission as single treatment, particularly in children. Parenteral nutrition is reserved for patients with obstruction, fistula, toxic megacolon, short bowel syndrome, severe malabsorption, and other conditions that make enteral nutrition impossible or inefficient.

The prevalence of anaemia in patients with inflammatory bowel diseases in North-Eastern Romania

Anemia is a frequent complication of inflammatory bowel diseases (IBD). The main incriminated mechanisms are the iron deficiency and the chronic inflammation. The aim of this study was to determine the prevalence of anemia in IBD patients and to identify the main causes.

MATERIAL AND METHODS

A prospective study was carried out between April 1st 2011 and April 30th 2012 on a batch of 144 IBD patients diagnosed in the Gastroenterology and Hepatology Center of lasi. The IBD diagnosis was based on clinical, biological, endoscopic and histological criteria. The anemia diagnosis was based on the World Health Organization criteria.

RESULTS

Anemia was present in 40.27 % of IBD patients. The main cause identified was mixed type anemia, followed by iron deficiency and inflammation. Iron deficiency anemia was present especially in patients with ulcerative colitis with long evolution, frequent activity spurts and extended forms of diseases; an inflammatory anemia emerged mainly in patients with exterided and moderate-severe forms of the diseases.

CONCLUSIONS

Anemia remains a frequently associated pathology to the inflammatory bowel disease that requires specific management.

Quality of life in patients with ulcerative colitis

Patients with inflammatory bowel disease (IBD) have to live with the perspective of a potential disability, which may lead in time to impaired quality of life (QoL). In order to fully understand the impact of IBD on patients and their careers we need to quantify the QoL.

AIM

To evaluate HRQol in ulcerative colitis patients as opposed to the general population and to identify the significant changes of HRQoL in accordance with the specific progression of UC.

METHODS

The prospective study (January 2010 - December 2012), included 105 patients with ulcerative colitis (UC). Disease activity was quantified by means of the Truelove and Witts score (mild, moderate and severe). All patients were administered a self-completed IBD questionnaire (IBDQ). Lower scores were related to a worse QoL. Statistical analysis was performed and di fferences were considered significant when p < or = 0.05.

RESULTS

Ninety-one percent (91%) were admitted with a flare, while they were asked to fill in the IBDQ. Proctitis was met in 2.94% of the cases, left-sided colitis in 71.1% and pancolitis in 26%. There were 32 patients with mild activity, 62 with moderate activity and only 3 with severe activity. The range score for QoL was 90-180. In proctitis: 80-190, in left-side colitis: 120-200, in pancolitis: 70-160 (p>0.05). The patients with severe form had a lower score (50-140) than patients in remission (130-180) (p<0.01).

CONCLUSION

Patients with UC have significantly influenced the QoL as compared to the general population. We found no significant differences regarding the extension of the lesions. The severity of the flare had a significant impact on the QoL.