IBD Watch®
Timely Information for Practicing Physicians
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NOVEMBER 2002COLLAGENOUS COLITIS Budesonide (Entocort; Astra Zeneca) treatment. Stephan Miehlke and colleagues conducted a multicenter, double-blind trial in which 51 patients with collagenous colitis were randomized to receive either oral budesonide (a locally acting anti-inflammatory steroid agent) 9 mg/day for 6 weeks or placebo. Clinical remission was achieved by a greater percentage of budesonide-treated patients than placebo patients (76.9% vs. 12.0%; p<0.001) and histological improvement occurred in 14 budesonide patients (60.9%) compared to only 1 placebo patients (4.5%) (p<0.001). Two patients in the budesonide group and 1 patient in the placebo group discontinued study treatment early due to adverse events. These results demonstrate that oral budesonide is well tolerated and is effective short-term therapy for patients with collagenous colitis. Long-term follow-up is needed. (Miehlke S, et al. Gastroenterology 2002;123:978-984) INFLIXIMAB THERAPY Improvement of pyoderma gangrenosum. Pyoderma gangrenosum that complicates inflammatory bowel disease (IBD) often fails to respond to systemic and/or surgical therapy. A prior retrospective analysis of 11 consecutive steroid-refractory IBD patients with pyoderma gangrenosum indicated that intravenous cyclosporine was an effective treatment in this clinical situation (Friedman S, et al. Inflamm Bowel Dis 2001; 7:1-7). T. Ljung and coworkers at the Karolinska Hospital (Sweden) now report the effects of tumor necrosis factor (TNF)-alpha blockade therapy with infliximab in 8 patients with Crohn's disease and pyoderma gangrenosum. Within 1 to 4 months of the initiation of infliximab treatment, the pyoderma gangrenosum completely healed in 3 patients, partially healed in 2 patients, and improved in 2 patients. These findings suggest that infliximab is another effective therapy for the skin manifestations of inflammatory bowel disease. (Ljung T, et al. Scand J Gastroenterol 2002;37:1108-1110)
CYCLOSPORIN THERAPY For severe ulcerative colitis (UC). G. McCormack et al. retrospectively studied 46 patients with high-dose corticosteroid-resistant UC who were treated with oral cyclosporin. Cyclosporin was tolerated well with only 2 patients reported to have developed serious infective complications. An initial response to cyclosporin treatment was achieved in 32 patients (69%) and 23 patients (50%) had a sustained response. With a mean follow-up of 22 months, 26% of patients remained in remission. These results are consistent with the previous findings of Cohen RD, et al. that cyclosporin therapy allowed steroid-resistant UC patients to retain their colons and indicate that oral cyclosporin is effective therapy for some patients with UC that has failed to respond to high-dose corticosteroid treatment. (McCormack G, et al. Dis Colon Rectum 2002;45:1200-1205) CHRONIC INFLAMMATORY BOWEL DISEASE (IBD) Screening for p53 and K-ras mutations. M. Heinzlmann and associates investigated the prevalence of p53 (by single-strand conformation polymorphism) and K-ras (oligomer-specific hybridization) mutations in colonic lavage fluid from 131 patients with IBD (Crohn's disease [CD] and UC) and 59 controls (49 non-tumor; 10 colorectal cancer). Mutations were frequently detected in the colon cancer patients (50%) and rarely found in the non-tumor controls (2.0%). These mutations were also detected in 15.4% of CD patients and 18.6% of patients with extensive UC. Furthermore, positive lavages were more commonly obtained in patients with longer disease durations (³ 11 years; p <0.05). This study showed that molecular screening is feasible in an IBD patient population. However, it is not known if the finding of these mutations in the colonic lavage fluid of IBD patients is predictive for the development of colorectal cancer. (Heinzlmann M, et al. Eur J Gastrenterol Hepatol 2002;14:1061-1066) CROHN'S DISEASE (CD) Osteoporotic vertebral fractures. J. Klaus and colleagues prospectively evaluated 293 patients with CD for complications due to osteoporosis. Among 156 patients found to have reduced bone mineral density, 34 patients (22%) had 63 vertebral fractures. Of the patients with vertebral fractures, 4 patients had severe back pain and one-third of the patients were less than 30 years of age. These data demonstrate that 1) bone mineral density is frequently decreased in CD patients and 2) patients with decreased bone mineral density are at high risk for the development of osteoporotic vertebral fractures. (Klaus J, et al. Gut 2002;51:654-658) |
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