IBD Watch®
Timely Information for Practicing Physicians
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JANUARY 2006 ULCERATIVE COLITIS (UC) Randomized trial of nicotine enemas. Ingram and colleagues randomized 104 patients with active UC to receive 6 weeks of daily treatment with 6-mg nicotine enemas or placebo enemas in a double-blind study. Clinical remission was achieved in 27% of patients in the nicotine enema group and 33% of patients in the placebo group (P = 0.55). The UC disease activity index improved by 1.45 and 1.65 points in the nicotine enema and placebo groups, respectively (P = 0.88). Only 1 patient discontinued therapy because of an adverse event (abdominal pain). Thus, while the 6-mg nicotine enema was well tolerated, it was not found to be an effective therapy for active UC. (Ingram JR, et al. Clin. Gastroenterol. Hepatol. 2005;3:1107–1114) Editor’s note: This is another example of failed remissions with nicotine therapy, suggesting either a continued-dosing issue or overall lack of efficacy for this potential surrogate for cigarette smoking. Higher-dose mesalamine. Hanauer and colleagues conducted a double-blind, controlled trial (ASCEND II) in which 268 patients with moderately active UC were randomized to receive 4.8 g/day of mesalamine (Asacol®; dosed with investigational 800-mg tablets) or 2.4 g/day of mesalamine (dosed with 400-mg tablets). Treatment success was defined as either complete remission or a clinical response to therapy. At week 6, 72% and 59% of patients treated with mesalamine 4.8 and 2.4 g/day, respectively, achieved treatment success (P = 0.036). Both mesalamine regimens were tolerated well. These results indicate that, for patients with moderately active UC, a higher dose (4.8 g/day) of mesalamine is associated with enhanced effectiveness. (Hanauer SB, et al. Am. J. Gastroenterol. 2005;100:2478–2485) INFLAMMATORY BOWEL DISEASE (IBD) Iron therapy. The results of 2 studies investigating the efficacy and tolerability of iron therapy in patients with IBD have recently been reported. In the first study, de Silva and colleagues administered oral iron therapy to IBD and non-IBD patients with iron deficiency anemia. Both patient groups achieved increases in blood hemoglobin and serum ferritin levels. Iron intolerance developed in about one quarter of the patients in both treatment groups. Only 2 (6%) of 33 IBD patients experienced a relapse during oral iron treatment. In the second study, Schroder and coworkers randomized 46 IBD patients with iron deficiency anemia to receive intravenous (i.v.) iron sucrose or oral iron sulfate. The increase in blood hemoglobin concentration was comparable in the i.v. and oral iron treatment groups, but only patients receiving i.v. iron had an increase in serum ferritin levels. Adverse events caused 5 patients in the oral iron group and 1 patient in the i.v. iron group to discontinue treatment. These studies demonstrate that oral iron therapy is effective and well tolerated by most IBD patients. Iron sucrose administered intravenously may be tolerated more easily than oral iron sulfate in some IBD patients. (de Silva AD, et al. Aliment. Pharmacol. Ther. 2005;22:1097–1105; Schroder O, et al. Am. J. Gastroenterol. 2005;100:2503–2509) CROHN'S DISEASE (CD) Assessment of imaging techniques for small bowel disease. Albert et al investigated the diagnostic yield of capsule endoscopy, magnetic resonance imaging (MRI), and double contrast fluoroscopy in 52 consecutive patients with suspected small bowel CD. They found capsule endoscopy and MRI to be complementary methods for diagnosing and assessing this condition. Capsule endoscopy can detect limited mucosal lesions missed by MRI (awareness of bowel obstruction is mandatory), and MRI is helpful in identifying transmural disease, strictures, and extraluminal lesions. ¨ In another study of 30 IBD patients, Bernstein and associates compared the usefulness of MRI with that of barium sulfate oral contrast and small bowel follow-through (SBFT). Both MRI and SBFT studies were normal in 10 cases and showed similar extent of CD in 8 cases. SBFT yielded additional information in 4 cases; MRI provided more information concerning strictures and extraintestinal disease in 8 cases. These findings suggest that MRI is a useful imaging technique for the assessment of small bowel CD. (Albert JG, et al. Gut. 2005; 54:1721–1727; Bernstein CN, et al. Am. J. Gastroenterol. 2005;100:2493–2502)
Risk for intestinal
cancer. Jess and
coworkers performed a meta-analysis of population-based cohort studies to
determine the risk of intestinal cancer (colorectal cancer and small bowel
cancer) in patients with CD. They identified 6 papers in the literature that
reported standard incidence ratios (SIRs) of colorectal cancer in CD patients
ranging from 0.9 to 2.2 and
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