IBD Watch®
Timely Information for Practicing Physicians
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JANUARY 2003 INFLAMMATORY BOWEL DISEASE (IBD) The risk for developing IBD is affected by having siblings. It has been hypothesized that siblings influence patterns of antigenic exposure in early life. S. Montgomery and colleagues at the Karolinska Institute (Stockholm, Sweden) compared 15,823 patients with ulcerative colitis (UC) and 12,668 patients with Crohn's Disease (CD) to 79,546 and 63,035 control subjects, respectively, in a case-control study to investigate the association of having siblings with the risk of developing IBD. Multiple logistic regression analysis identified having older siblings to be associated with an increased risk for UC (p <0.001) with an adjusted odds ratio of 1.15 (95% CI: 1.07 - 1.24) for having ³ 3 older siblings. In contrast, having younger siblings was associated with a decreased risk for CD (p <0.001) with an adjusted odds ratio of 0.83 (95% CI: 0.76 - 0.90) for having ³ 3 younger siblings. Older maternal age was independently associated with a decreased risk for CD while social class was not found to be a risk factor. These findings suggest that having siblings is associated with both the risk for having IBD and the type of IBD that one develops. (Montgomery SM, et al. Scand J Gastroenterol 2002;37:1301-1308) The impact of IBD on women. A. Trachter and coworkers present case studies that describe the difficulties women with IBD encounter in their partner relationships and sexual functioning after surgery. Gynecologic and pregnancy issues are also discussed. Further studies are needed to investigate modalities to improve the quality of life for women with IBD. (Trachter AB, et al. Inflamm Bowel Dis 2002;8:413-421) Impact on the labor force. A. Boonen and associates sent questionnaires by mail to 984 patients with IBD and 1,504 control subjects to assess the impact of IBD on social life. Results from 680 patients and 715 controls could be analyzed. Employment was found to be 6.5% lower (95% CI: 4.0 - 9.0) and chronic disability 17.1% higher (95% CI: 15.1 - 19.1) for IBD patients compared to controls. Sixty-two percent of employed IBD patients versus 53% of employed control subjects had experienced at least one episode of sick leave during the previous year (p = 0.002) resulting in more sick days per person per year for the patient group (p = 0.002). These data demonstrate that IBD has a significant impact on labor force participation. (Boonen A, et al. Inflamm Bowel Dis 2002;8:382-389) ULCERATIVE COLITIS (UC) Balsalazide therapy is associated with more rapid improvements. Ronald Pruitt et al. conducted a study in which 173 patients with UC were randomized in a double-blind fashion to receive either balsalazide, a novel azo-bonded 5-ASA analogue, 6.75 gm daily or mesalamine 2.4 gm daily (both treatments delivered 2.4 gm of 5-ASA per day). Overall, similar proportions of balsalazide- and mesalamine-treated patients achieved symptomatic remission (46% vs. 44%, respectively). However, the median time to symptomatic remission was shorter in the balsalazide group compared to the mesalamine group (25 vs. 37 days, respectively). Moreover, within 14 days a greater percentage of balsalazide-treated patients than mesalamine-treated patients had sigmoidoscopic (p = 0.002), stool frequency (p = 0.006), rectal bleeding (p = 0.006), and physician's global assessment score (p = 0.013) improvements. Similar proportions of patients (54% and 64%) in each treatment group reported adverse events (primarily gastrointestinal and nervous system events). This investigation demonstrated that balsalazide treatment was well tolerated and resulted in earlier symptomatic improvements in UC patients than mesalamine treatment. (Pruitt R, et al. Am J Gastroenterol 2002; 97:3078-3086) Note: see Dr. William Sandborn's editorial regarding the rational selection of 5-ASA products (below). Rational selection of oral 5-aminosalicylate (ASA) formulations. Multiple formulations and prodrugs have been designed to release 5-ASA directly into the distal ileum or colon for the topical treatment of UC. Within the colonic epithelium 5-ASA is either absorbed systemically or is metabolized to N-acetyl-5-ASA. William Sandborn reviews the safety, efficacy, and pharmacokinetic profiles of available formulations of oral 5-ASA to provide physicians with practical information for medication selection for the treatment of patients with UC. (Sandborn WJ. Am J Gastroenterol 2002;97:2939-2941) CROHN'S DISEASE (CD) A guide to infliximab treatment. William Sandborn and Stephen Hanauer have provided a guide for the use of infliximab therapy in CD. Currently infliximab therapy is indicated as induction treatment for patients with fistulizing CD and as induction treatment (and maintenance of remission) for patients with moderate to severely active inflammatory CD that has responded inadequately to conventional therapy. Emerging indications for infliximab therapy in CD patients include maintenance of fistula improvement, steroid sparing in steroid-treated patients, early use prior to failure of conventional therapy in patients hospitalized with severe disease, and in a variety of patients with unusual and/or extra-intestinal manifestations of the disease. Infliximab dosing regimens (induction; maintenance) as well as pretreatment and concomitant therapies are discussed. (Sandborn WJ and Hanauer SB. Am J Gastroenterol 2002;97:2962-2972) |
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