IBD Watch®
Timely Information for Practicing Physicians
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October 2003INFLAMMATORY BOWEL DISEASE (IBD)Infliximab treatment of pyoderma gangrenosum. Pyoderma gangrenosum is a rare immune-mediated complication of IBD characterized by ulcerative skin lesions often refractory to standard therapies (wound care, antibiotics, corticosteroids, and immunomodulators). M. Regueiro et al at the University of Pittsburgh Medical Center conducted a retrospective study of 13 IBD patients with moderate to severe pyoderma gangrenosum treated with infliximab. The skin lesions completely healed in all 13 patients, and complete responses were achieved in 3 patients with induction infliximab treatment while the remaining 10 patients maintained healing with infusions of infliximab every 4-12 weeks. All patients were able to discontinue corticosteroids following the initiation of infliximab therapy. The only infliximab-related adverse events noted were sunburn in one patient and an infusion reaction in another. This study shows that infliximab is well-tolerated and effective treatment for IBD-associated pyoderma gangrenosum. (Reguiero M, et al. Am J Gastroenterol 2003;98:1821-1826)Nonsteroidal anti-inflammatory drugs (NSAIDs) and colonic ulcers. A minority of patients with collagenous colitis also have colonic mucosal ulceration. S. Kakar and associates at the Mayo Clinic recently reviewed clinical and histological data from 9 patients with collagenous colitis and mucosal ulceration and 18 unselected collagenous colitis patients without mucosal ulceration. Seven patients (77.8%) with mucosal ulceration compared to only 2 patients (20.2%) without mucosal ulceration had a history of NSAID ingestion (p = 0.006). Halting NSAID use resulted in the resolution of diarrhea in 4 mucosal-ulceration patients and improvement in diarrhea in one other patient. Among the 2 mucosal-ulceration patients who were not taking NSAIDs, diarrhea resolved in one patient after stopping lisinopril (an ACE inhibitor) and the colonic ulcerations were thought to be ischemic in origin in the second patient. These findings demonstrate that the treatment of collagenous colitis patients with colonic mucosal ulceration should include an assessment of medications and the cessation of NSAIDs. (Kakar S, et al. Am J Gastroenterol 2003;98:1834-1837)Corticosteroid use and bone fracture. C. Bernstein and others from the University of Manitoba utilized a population-based IBD epidemiology database to identify 13 patients with Crohn's disease (CD) and 28 patients with ulcerative colitis (UC) who had a new diagnosis of fracture between the years 1997 and 2000. Although an association between the administration of corticosteroids and the development of fracture was not seen in UC patients, they found that 7 (54%) of the CD patients with fracture compared to 21 (22%) of 103 CD patients without fracture had a history of prior corticosteroid use (p = 0.035). No correlations between fractures and the daily dose or the duration of administration of corticosteroids were observed. These data suggest that CD patients receiving corticosteroid therapy are at increased risk for fracture and that further studies are needed to identify a dose/duration of corticosteroid therapy that is predictive of fracture. (Bernstein CN, et al. Am J Gastroenterol 2003;98: 1797-1801)Aminosalicylates and colorectal cancer in IBD: a review. IBD is associated with an increased risk of developing intestinal cancer at sites of chronic inflammation. In the August issue of the American Journal of Gastroenterology, B.M. Ryan and associates review evidence from epidemiological, in vivo and in vitro studies on the possible chemopreventive value of aminosalicylates against the development of colorectal cancer among individuals with and without IBD. The body of literature to date suggests that aminosalicylates confer some protection against the development of colonic neoplasia in a variety of models including the noninflamed gut, thus implying that aminosalicylates may be of chemopreventive value in normal individuals as well as IBD sufferers. (Ryan BM, et al. Am J Gastroenterol 2003;98:1682-1687)CROHN'S DISEASE (CD)Conventional vs. laparoscopic ileocolic resection. R. Bergamaschi and others at the Angers University Hospital (Angers, France) compared the outcomes of 39 patients with refractory CD who underwent laparoscopic ileocolic resection to those of 53 patients who had undergone open ileocolic resection at their institution. Disease was confined to the terminal ileum and cecum in these patients. Operating time was longer (p<0.001), but hospital stay was shorter (p<0.001) for laparoscopic resection patients. The 5-year small bowel obstruction rate was lower in the laparoscopic-resected compared to the open-resected patients (11.1% vs. 35.4%; p = 0.02). Five-year recurrence rates were similar in the two treatment groups. These findings indicate that laparoscopic ileocolic resection results in lower 5-year small-bowel obstruction rates than open ileocolic resection in selected CD patients. (Bergamaschi R, et al. Dis Colon Rectum 2003;46:1129-1133) |
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