IBD Watch^®

^{Timely Information for Practicing Physicians}

 MARCH 2005

ULCERATIVE COLITIS (UC)

Risk factors for acute and chronic pouchitis.  Jean-Paul Achkar and others performed a case-control study in which 40 patients with acute pouchitis and 40 patients with chronic pouchitis were matched with 40 UC patients who never had pouchitis (control group). Multivariate logistic regression identified extensive colonic disease and extraintestinal manifestations to be associated with the development of both acute and chronic pouchitis.  Additionally, both a history of fulminant colitis and the postoperative use of NSAIDs were found to be risk factors for chronic pouchitis.  (Achkar J-P, et al. Clin Gastroenterol Hepatol 2005;3:60–66)

Is endoscopy necessary?  Peter Higgins and coworkers evaluated 66 consecutive UC patients with invasive and noninvasive indices to investigate whether endoscopy is necessary for the assessment of disease activity. Linear regression modeling revealed that the noninvasive indices (Simple Clinical Colitis Activity Index and Seo Index) correlated well with the invasive St. Mark's Index. In addition, after adjustment for the 3 noninvasive Ulcerative Colitis Disease Activity Index items, the endoscopy item predicted only 0.04% of the variance in the St. Mark's Index.  These data indicate that the treatment of UC patients based on reported symptoms is appropriate. (Higgins PDR, et al. Am J Gastroenterol 2005;100:355–361)

Long-term risk of colorectal cancer.  Karen Winther and colleagues followed a population-based cohort of 1160 UC patients, diagnosed in Copenhagen County (Denmark) between 1962 and 1987, for a median of 19 years.  The observed number of colorectal cancers (13) was equal to the expected number (12.42).  The cumulative probability of colorectal cancer was 0.4% by 10 years, 1.1% by 20 years, and 2.1% by 30 years.  No hepatobiliary cancers and no increased risk for lymphoma or leukemia were observed.  An increased risk for malignancy was not demonstrated by this population-based cohort study of UC patients with long-term follow-up.  (Winther KV, et al. Clin Gastroenterol Hepatol 2004;2:1088–1095)  Editor’s note:  There are several possible explanations for the low risk of malignancy in this study.  One is that the malignancy risk is lower in Denmark than in North America, and another is that the colectomy rate is higher. 

CROHN'S DISEASE (CD)

Impact of immunosuppressant therapies.  Jacques Cosnes and coworkers reviewed the medical records of 565 newly diagnosed CD patients, seen from 1978 to 2002, to determine whether the use of immunosuppressants (azathioprine or methotrexate) over the past 25 years has affected the need for surgery.  The patients were divided into 5 consecutive 5-year cohorts.  Their analyses revealed that, while the probability of a CD patient receiving an immunosuppressant agent increased significantly since 1978 (P < 0.001), the cumulative risk of intestinal resection remained unchanged. Also unchanged was the risk of developing a stricture or a penetrating intestinal complication. These findings indicate that the more frequent use of immunosuppressant medications has not altered the need for surgery in patients with CD.  (Cosnes J, et al. Gut 2005;54:237–241)

INFLAMMATORY BOWEL DISEASE (IBD)

IBD summer camp and improvement in health-related quality of life (HRQOL).  Melissa Shepanski and colleagues evaluated HRQOL and State-Trait Anxiety Inventory questionnaires completed by children and adolescents with IBD before and after a 1-week camp sponsored by the Crohn's and Colitis Foundation of America.  No significant difference was found between anxiety scores before and after camp, although HRQOL improved.  These early data suggest that the HRQOL improvements may have been due to an increase in social functioning, an acceptance of IBD symptoms, and less distress regarding treatment interventions.  Future studies utilizing this multimodal measurement approach are warranted.  (Shepanski MA, et al. Inflamm Bowel Dis 2005;11:164–170)

IBD-related osteonecrosis.  Osteonecrosis is a complication of IBD that is associated with steroid use.  G Klingenstein and others reviewed the records of 23 IBD patients whose clinical courses were complicated by osteonecrosis. Their study showed that multiple joints are usually involved in patients who develop osteonecrosis.  The prednisone dosing data were not sufficient to determine a threshold dose, but the findings indicate that long-term steroid use and short-term, high-dose steroid treatment increase the risk of osteonecrosis. (Klingenstein G, et al. Aliment Pharmacol Ther 2005;21:243–249)

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