IBD Watch®
Timely Information for Practicing Physicians
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JULY 2003 CROHN'S DISEASE (CD): GENETIC FACTORS CD patients’ relatives with subclinical intestinal inflammation. Bjarni Thjodleiffson and colleagues assessed the presence, prevalence, and inheritance pattern of subclinical intestinal inflammation in healthy relatives of CD patients in Iceland, a country with a well characterized, homogenous population. Fecal calprotectin concentration was used as a surrogate marker for intestinal inflammation. Fecal calprotectin concentrations in 49 patients with CD (47 mg/L) and their 151 first-degree relatives (11 mg/L) were higher than those of 163 healthy Icelandic volunteers (4 mg/L) and fecal calprotectin concentration was elevated in 49% of the relatives tested. There were 36 CD patients for whom the authors were able to study at least half of the first-degree relatives. The pattern of inheritance of elevated fecal calprotectin concentrations among the relatives of these 36 patients with CD was found to be most consistent with an additive model. These findings demonstrate a high prevalence of subclinical intestinal inflammation in first-degree relatives of CD patients. The genetic basis for the development of subclinical intestinal inflammation likely represents a risk factor for CD. (Thjodleifsson B, et al. Gastroenterology 2003;124:1728-1737) Swedish twin study. Jonas Halfvarson and associates in Orebo, Sweden updated their IBD twin study published in 1988. The Swedish population and cause of death registries were used to search for the twins and all living individuals were interviewed. The follow-up information revealed that 3 monozygotic twins who had been classified as healthy in 1988 had subsequently developed IBD. These data changed the pair concordance in monozygotic twins from 6.3% to 18.8% (3 of 16 pairs) in UC and from 44.4% to 50% (9 of 18 pairs) in CD. Seven of the 9 pairs of monozygotic twins with CD had ³3 identical disease characteristics according to the Vienna classification (disease location, behavior, progression, and age at diagnosis). These long-term follow-up data indicate a strong similarity of disease characteristics for concordant monozygotic twins with CD and suggest that genetic influences are greater in CD than UC. (Halfvarson J, et al. Gastroenterology 2003;124;1767-1773) CROHN'S DISEASE (CD) Long-term outcomes after colonoscopic balloon dilation of strictures. Siwan Thomas-Gibson et al retrospectively reviewed clinical data obtained from 59 patients who underwent 124 endoscopic balloon dilations of strictures due to CD. Strictures were anastomotic in 53 patients (111 dilations) and de novo in 6 patients (13 dilations). Long-term clinical benefit was achieved in 41% of patients following dilation (17% after a single dilation). Fifty-nine percent of patients required surgical treatment of their strictures after dilation. Two dilations were complicated by perforation. No deaths occurred. Thus, colonoscopic balloon dilation of strictures can result in long-term clinical benefit in a large percentage of CD patients and repeat dilations are justified for strictures that do not initially respond. However, longer term follow-up is needed to clarify the lower-than-expected incidence of complications. Editors’ note: Due to the unpredictable risk of perforation, these procedures should only be performed by experienced endoscopists with the presence of experienced surgical “back-up.” (Thomas-Gibson S, et al. Eur J Gastroenterol Hepatol 2003;15:485-488) ILEAL POUCH-ANAL ANASTOMOSIS Factors affecting cost and length of hospitalization. Brian Swenson and coworkers retrospectively evaluated hospital clinical charts and an accounting database associated with ileal pouch-anal anastomosis surgical procedures performed in 135 patients. Average cost and length of hospitalization increased from $12,738 and 13.5 days for a one-stage procedure to $32,758 and 23.9 days for a 3-stage procedure. Higher costs and longer hospitalizations continued to be associated with multiple-stage procedures after demographic and preoperative characteristics were factored into the analyses. Complications added an average of $9,304 to cost and 7.4 days to length of hospitalization. An urgent presentation of disease added an average of $5,258 to cost and 6.1 days to length of hospitalization. These data show that number of operative stages and post-operative complications are the greatest determinants of cost and length of hospitalization after the procedure. (Swenson BR, et al. Dis Colon Rectum 2003;46:754-761) ULCERATIVE COLITIS (UC) Randomized controlled study of infliximab. C. Probert et al conducted a multicenter study in which patients with glucocorticoid-resistant UC were randomized to receive either infliximab (5 mg/kg) (n = 23) or placebo (n = 20) therapy. Patients not in remission were offered open-label infliximab 10 mg/kg. Remission was defined as an ulcerative colitis symptom score (UCSS) of £2 and/or a Baron score of 0 at week 6. After 6 weeks of study therapy, the percentage of infliximab-treated patients with a UCSS £2 and a Baron score of 0 were 39% (n = 9) and 26% (n = 6), respectively, compared to 30% (n = 6) and 30% (n = 6), respectively, for patients in the placebo group (p = 0.76 and 0.82). Twenty patients received open-label infliximab (10 mg/kg) and remissions were achieved in 3 of 11 patients (27%) previously treated with infliximab (5 mg/kg) and 1 of 9 (11%) patients who previously were given placebo. The results of this small randomized placebo-controlled trial do not provide evidence that infliximab is more effective than placebo in the treatment of glucocorticoid-resistant UC. (Probert CSJ, et al. Gut 2003;52:998-1002) |
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