IBD Watch®
Timely Information for Practicing Physicians
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DECEMBER 2007 Crohn’s
Disease (CD) Long-term results of ileocecal resection. Cullen and colleagues
reviewed data from 139 patients with CD who underwent ileocecal resection
between 1980 and 2000 to assess clinical outcomes. While 72 patients (52%)
developed disease recurrence and 49 patients (35%) required repeat resection
surgery at a median of 7.2 years (range, 4.9 to 10.8 years), 67 patients (48%)
remained symptom-free. The presence of granulomas was associated with disease
recurrence (P = 0.03). These findings
demonstrate that the long-term results of ileocecal resection in patients with
CD are favorable and should be considered when evaluating patients for biologic
therapy. (Cullen G, et al. Inflamm Bowel
Dis 2007;13:1369–1373.) Race and health
insurance are predictors for bowel resection. Nguyen
and others analyzed 41,918 hospital discharge records of patients diagnosed with
CD between 1998 and 2003 obtained from the Nationwide Inpatient Sample database.
The data showed that, after adjusting for age, gender, health insurance,
comorbidity, median neighborhood income, and hospital characteristics, white
patients with CD underwent bowel resection more frequently than did their
non-white counterparts. The relative rate ratios of African American, Hispanic,
and Asian patients compared with white patients undergoing bowel resection were
0.68 (95% confidence interval [CI], 0.61 to 0.76), 0.70 (95% CI, 0.60 to 0.83),
and 0.31 (95% CI, 0.16 to 0.59), respectively. Furthermore, compared with
patients with CD who had private insurance, the relative risk of surgery for
patients with CD who had Medicare, Medicaid, or were self-payers was 0.48 (95%
CI, 0.44 to 0.54), 0.52 (95% CI, 0.46 to 0.59), and 0.67 (95% CI, 0.58 to 0.77),
respectively. These data demonstrate that bowel resection among hospitalized
patients with CD varies by race and type of health insurance. Further studies
are needed to evaluate these findings. (Nguyen GC, et al. Inflamm
Bowel Dis 2007;13:1408–1416.)
Adherence to thiopurines
and mesalamine in children. Oliva-Hemker
and associates performed a cross-sectional study of 51 pediatric patients with
CD who were receiving maintenance therapy with a thiopurine (6-mercaptopurine or
azathioprine) and/or mesalamine for 180 days. Pharmacy records were used to
evaluate adherence rates; nonadherence was defined as a refill rate of <80%
of the prescribed medication. Thiopurines were prescribed for 75% of the
patients and mesalamine for 86% of the patients. The prevalence of nonadherence
was 50% for the thiopurines and 66% for mesalamine. The mean number of health
care visits was greater in the adherent than in the nonadherent group (P
<0.001). These results show that nonadherence to thiopurines and mesalamine
therapy is common in pediatric patients with CD. (Oliva-Hemker MM, et al. J
Pediatr Gastroenterol Nutr 2007;44:180–184.) Ulcerative
Colitis (UC) Novel therapies. Predocol is a formulation of prednisolone
metasulfobenzoate that is absorbed sparingly. Rhodes and colleagues conducted a
double-blind study in which 181 patients with active UC were randomized to
receive Predocol 40 or 60 mg/day for 6 months or prednisolone 40 mg/day for 2
weeks, tapered to week 8 and followed by placebo until 6 months. Steroid-related
effects assessed by a visual analogue scale were significantly fewer in the
Predocol-treated patients (P = 0.01),
and remission rates were similar between the Predocol and prednisolone treatment
arms. In a second study, Stremmel and coworkers evaluated the use of phosphatidylcholine
for patients with steroid-refractory UC because an insufficient level of
phosphatidylcholine in colonic mucus has been identified as a possible risk
factor for UC. The results of a randomized, double-blind, placebo-controlled
study demonstrated that phosphatidylcholine reduced corticosteroid dependence
more than did placebo. Based on this finding, further study is warranted.
(Rhodes JM, et al. Aliment Pharmacol Ther
2007 Nov 6 [Epub ahead of print]; Stremmel W, et al. Ann Intern Med 2007;147:603–610.) Severe disease in
pediatric patients. Turner
and associates conducted a review of severe pediatric UC in a single-center
cohort with long-term follow-up (n = 99). Hospitalization for intravenous
corticosteroid therapy was required by 28% of patients and only 53% of these
patients achieved a response. Multivariable modeling identified C-reactive
protein and number of nocturnal stools to be significantly associated with
corticosteroid failure at both days 3 and 5. Cumulative colectomy rates in this
population were 42%, 58%, and 61% at the time of hospital discharge, 1 year
later, and 6 years later, respectively. These data may be used to identify
patients who are likely to fail corticosteroid therapy and for whom therapeutic
alternatives should be considered. (Turner D, et al. Gut 2007 Nov 2 [Epub ahead of print]) Inflammatory
Bowel Disease (IBD) Guideline reviews. Guidelines for establishing the diagnosis of IBD,
including the use of new endoscopic and noninvasive imaging techniques, are
reviewed in the November 2007 issue of Gastroenterology. Guidelines regarding the diagnosis and management
of anemia in patients with IBD are provided in the November 2007 issue of Inflammatory
Bowel Disease. (Nikolaus S, Schreiber S. Gastroenterology
2007;133:1670–1689; Gasche C, et al. Inflamm
Bowel Dis 2007;13:1545–1553.)
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