IBD Watch^®

^{Timely Information for Practicing Physicians}

 MAY 2006

Predictors of Crohn’s Disease (CD). Beaugerie and coworkers reviewed clinical data from patients with CD followed for at least 5 years to identify factors predictive of disabling disease. Among 1,123 evaluable patients identified between 1985 and 1998, 85.2% developed disabling disease within 5 years of diagnosis. Independent predictors were necessity for steroid treatment, age <40 years, and the presence of perianal disease at diagnosis. The positive predictive value of disabling disease in patients with two or three of these predictive factors was 0.91 and 0.93, respectively, when tested prospectively in 302 consecutive patients seen at the investigators’ center since 1998. These risk factors will help identify patients with CD who should be considered for early intensive therapy. (Beaugerie. L, et al. Gastroenterology. 2006;130:650–656.)  Editor’s note: While an important study, this is tautological, as the authors’ definition of disabling disease is the requisite for corticosteroids.

Antibiotic treatment. Prantera and others conducted a study in which 83 patients with mild to moderate CD were randomized to receive rifaximin, 800 mg orally once daily or twice daily, or placebo, for 12 weeks. Clinical remission was achieved in 32%, 52%, and 33% of patients in the three groups, respectively. Among patients with elevated C-reactive protein levels, remission rates in those receiving rifaximin twice daily were significantly higher than in those receiving placebo (P <0.05). These results indicate that rifaximin 800 mg twice daily for 12 weeks may provide clinical benefit to patients with mild to moderate CD. Further studies are needed to confirm these findings. (Prantera C, et al. Aliment Pharmacol Ther. 2006;23:1117–1125.)

Mortality 10 years after diagnosis. Wolters and colleagues assessed disease-related 10-year mortality in a cohort of 380 European patients in whom CD was diagnosed between 1991 and 1993. An increased mortality at 10 years after diagnosis was observed in this cohort (37 deaths compared with an expected 21.5 deaths; standardized mortality ratio, 1.85 [95% confidence interval (CI), 1.30–2.55]). The excess mortality was the result primarily of CD-related gastrointestinal causes. The mortality risk was significantly increased regardless of gender. In addition, colonic disease location, inflammatory disease at diagnosis, and age >40 years at diagnosis were associated with an increased risk of mortality. (Wolters FL, et al. Gut. 2006;55:510–518.)

Inflammatory bowel disease (IBD)-associated gastrointestinal cancer: Prognosis and risk. Delaunoit and associates retrospectively reviewed the medical records of 290 patients with IBD-associated colorectal cancer (CRC) and 290 patients with age- and gender-matched sporadic CRC who had been evaluated at the Mayo Clinic in Rochester, MN, between 1976 and 1996. The median age at the diagnosis of IBD-associated CRC was 48 years. A smaller percentage of IBD-associated tumors than of sporadic tumors was found to be distal to the splenic flexure (55% vs 78%). The 5-year survival rates were similar between patients who had IBD-associated tumors and sporadic tumors (54% and 53%, respectively). These data indicate that IBD-associated CRC occurs at a young age and is distributed more evenly throughout the colorectum than are sporadic tumors. Separately, Canavan and others performed a meta-analysis of relevant publications identified by a MEDLINE search to determine the relative risk of CRC and small bowel cancer in patients with CD. The relative risks of CRC in patients with colonic and ileal CD were 4.5 (95% CI, 1.3–14.9) and 1.1 (95% CI, 0.8–1.5), respectively. Patients with CD who lived in Scandinavia were found to have a significantly lower risk of CRC than were patients with CD who lived in the United Kingdom or North America. The cumulative risk of CRC at 10 years after the diagnosis of CD was 2.9%. The relative risk of small bowel cancer in patients with CD was 33.2 (95% CI, 15.9–60.9). These data show that the relative risks for both CRC and small bowel cancer are increased in patients with CD. (Delaunoit T, et al. Clin Gastroenterol Hepatol 2006;4:335–342; Canavan C, et al. Aliment Pharmacol Ther. 2006;23:1097–1104.)

Infliximab management of ulcerative colitis (UC) with pyoderma gangrenosum (PG). Brooklyn and colleagues conducted a double-blind study in which 30 patients who had UC with PG were randomized to receive infliximab, 5 mg/kg, or placebo. Patients were assessed 2 weeks later and nonresponders were offered open-label infliximab. At week 2, significantly more patients in the infliximab group than in the placebo group experienced clinical improvement (46% vs 6%; P = 0.025). Overall, 20 (69%) of 29 patients who were given infliximab, including those who received the drug during the open-label portion of the study, achieved a beneficial clinical response. At week 6 the remission rate was 21%. These results demonstrate that infliximab is a potentially effective therapy for patients who have UC with PG. (Brooklyn TN, et al. Gut. 2006;55:505–509.)

Review: A review of the management of pouchitis appears in the April 2006 issue of Alimentary Pharmacology & Therapeutics. Pardi and Sandborn discuss data on the epidemiology, clinical features, risk factors, diagnostic testing, differential diagnosis, and treatment of this inflammatory complication following an ileal pouch–anal anastomosis procedure in patients with UC. (Pardis DS, Sandborn WJ. Aliment Pharmacol Ther. 2006;23:1087–1096.)

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