IBD Watch®
Timely Information for Practicing Physicians
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FEBRUARY 2008 Incidence of arterial thromboembolic diseases. Bernstein
and others culled information from the University of Manitoba IBD Epidemiology
Database to determine if there was an increased risk for arterial thromboembolic
disease in patients with IBD. The database included information on 8,060
patients diagnosed with IBD between 1984 and 2003 and on a matched cohort of
80,489 patients without IBD. The risk for ischemic heart disease was increased
in all patients with IBD (incidence rate ratio [IRR], 1.26; 95% confidence
interval [CI], 1.11 to 1.44) and the risk for cerebrovascular disease was
increased in patients with Crohn’s disease (IRR, 1.32; 95% CI, 1.05 to 1.66),
while the risk for undifferentiated arterial thromboembolic disease was
increased only in female patients who had IBD, patients aged ≤39 years,
and patients aged 40 to 59 years. These data show that patients with IBD are
more likely to have arterial thromboembolic diseases than are patients without
IBD. Smoking, systemic inflammation, and genetic predisposition may contribute
to this risk. (Bernstein CN, et al. Clin
Gastroenterol Hepatol 2008;6:41–45.) Adverse events associated with cyclosporine. Cyclosporine
is effective for the management of IBD. Sternthal and associates conducted a
retrospective chart review of 111 consecutive patients with IBD who were treated
with intravenous cyclosporine 4 mg/kg per day, followed by oral cyclosporine 8
mg/kg per day. The mean treatment duration was 9.3 months (range, 1 week to 34
months). Major adverse events were reported in 17 patients (15.3%). Serious
infections occurred in seven patients (6.3%) and nephrotoxicity necessitating
cyclosporine discontinuation occurred in six patients (5.4%). In addition, four
cases of seizure, two deaths, and one case of anaphylaxis were reported. Minor
adverse events included paresthesias (51%), hypomagnesemia (42%), hypertension
(39%), hypertrichosis (27%), headache (23%), minor nephrotoxicity (19%),
abnormal liver function tests (19%), minor infections (15%), hyperkalemia (13%),
and gingival swelling (4%). These findings show that cyclosporine treatment is
frequently associated with adverse events, indicating that close monitoring is
required during therapy. ( Hormonal replacement therapy (HRT) may modify disease activity. Kane and Reddy performed a retrospective study to investigate the effect of menopause on IBD activity. Among 65 women with IBD, there was no relation between those who had a premenstrual flare of IBD and those who had a postmenstrual flare. However, postmenopausal HRT use was found to be associated with a significant protective effect on disease activity (hazard ratio, 0.18; 95% CI, 0.04 to 0.72). A dose-response effect was also noted. These data showed that the likelihood of having an IBD flare following menopause was not different from that of having a flare prior to menopause. However, HRT may protect against disease activity, possibly due to the anti-inflammatory effects of estrogen. (Kane SV, Reddy D. Am J Gastroenterol 2008 Jan 2 [Epub ahead of print].) Discriminating IBD from irritable bowel syndrome (IBS). Symptoms
of IBD and IBS can overlap. Schoepfer and colleagues sought to determine whether
markers of inflammation or IBD antibodies could discriminate IBD from IBS in a
study that included 64 patients with IBD, 30 patients with IBS, and 42 healthy
controls. The PhiCal™ test (Genova Diagnostics, Inc; Ashville, NC; fecal
calprotectin levels measured by enzyme-linked immunosorbent assay [ELISA]) and
the IBD-SCAN (fecal lactoferrin levels measured by ELISA) were highly accurate
for discriminating IBD from IBS. While the antibodies anti-Saccharomyces
cerevisiae [ASCA] and perinuclear antineutrophil cytoplasmic antibody [pANCA]
were highly specific for IBD, the use of these tests resulted in only marginal
additional diagnostic accuracy when combined with the PhiCal test and IBD-SCAN.
In a second study of 139 patients undergoing diagnostic ileocolonoscopy,
Langhorst and colleagues found the fecal markers calprotectin, lactoferrin, and
polymorphonuclear neutrophil elastase to be able to differentiate IBD from IBS
and active IBD from inactive IBD. All three fecal markers were superior to serum
C-reactive protein levels in diagnostic accuracy. (Schoepfer AM, et al. Inflamm
Bowel Dis 2008;14:32–39; Langhorst J, et al. Am
J Gastroenterol 2008;103:162–169.) Editor’s comment: Are
any of these expensive tests superior to examination for fecal leukocytes?—SH Relationship of IBS-like symptoms with quality of life. Ansari
and co-workers assessed the prevalence of IBS-like symptoms in 95 patients with
ulcerative colitis (UC; 45 patients with active disease and 50 patients in
remission for ≥12 months) and 100 controls without UC. The prevalence of
IBS-like symptoms was 46% in the patients with UC in remission and 13% in
controls (P <0.001). Health-related
quality of life (HRQOL) was significantly reduced in the patients who had UC in
remission and IBS-like symptoms compared with the patients who had UC in
remission but no IBS-like symptoms, and controls (P
<0.001). This study demonstrated that patients with UC in remission
frequently have IBS-like symptoms and that these patients have an impaired HRQOL.
(Ansari R, et al. Eur J Gastroenterol Hepatol 2008;20:46–50.) Editor’s comment: Another message is to make certain that
the symptoms are “inflammatory” rather than “irritable” when approaching
treatment.—SH |
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