Intensification of infliximab therapy in Crohn's disease: efficacy and safety.

INTRODUCTION: The response of Crohn's disease (CD) to infliximab is initially good, although a loss of efficacy is observed over time. Dose escalation has been recommended in such cases. AIMS: To study the response to an intensified infliximab regimen in patients with CD; and to evaluate the adverse effects associated with intensification of therapy and identify predictors of loss of response. METHODS: We performed a retrospective multicenter survey of all patients with CD who had been treated with at least the 3 induction doses of standard infliximab therapy, and for whom treatment had to be intensified due to loss of response. We analyzed the efficacy of the intensified regimen. RESULTS: Thirty-three patients were included. After the first intensification dose, 79% of patients had a clinical response (33.5% complete response, 45.5% partial response). In the long term, 83%, 69%, 47%, and 29% of patients who had an initial response to the intensification maintained the response at 6, 12, 18, and 36 months, respectively. The loss of efficacy after escalation was 43% per patient-year of follow-up. One patient had an infusion reaction after 36 doses. One patient developed a herpes zoster infection. CONCLUSIONS: A high proportion of patients whose dose of infliximab is increased due to loss of efficacy respond initially. However, nearly half lose the response after one year. The safety profile of an intensified infliximab regimen is good.

A young woman with first-trimester metrorrhagia, fever and skin lesions.

Inflammatory bowel disease commonly affects women with child-bearing potential, and clinical activity extent is most relevant at the time of conception. Below, we report on the case of a 19-year-old woman who was admitted for first-trimester metrorrhagia and fever, with various extraintestinal manifestations, mainly including erythema nodosum and episcleritis during the course of disease. The differential diagnosis of these manifestations led to the diagnosis of Crohn's disease, which involved the whole colon.

Safe endoscopic resection of gangliocytic paraganglioma of the major duodenal papilla.

A case of gangliocytic paraganglioma of the papilla of Vater in a 76-year-old man with a history of recurrent obstructive jaundice is presented. This is the first case of gangliocytic paraganglioma of the major papilla successfully resected by endoscopic ampullectomy.

[Thyroid disorders associated with interferon treatment in patients with chronic viral hepatitis or multiple sclerosis]. / Alteraciones tiroideas asociadas al tratamiento con interferón en pacientes con hepatitis crónica viral o esclerosis múltiple.

BACKGROUND: Alpha and beta interferon (IFN-alpha and beta) treatment is associated with the synthesis of thyroid autoantibodies and the development of autoimmune thyroid diseases. METHODS AND RESULTS: We have retrospectively evaluated their effect in patients with chronic viral hepatitis (CH) (n = 118) and multiple esclerosis (ME) (n = 10). Thyroid dysfunction has been detected in 7.4% of patients, and seroconversion in 4.7%. CONCLUSIONS: Pre-treatment antithyroid antibodies do not predispose to altered thyroid function, after IFN therapy; their presence should not contraindicate IFN treatment.

[The retained antrum, its endoscopic diagnosis and clinical significance]. / Antro retenido, diagnóstico endoscópico y significación clínica.

A 65-year-old man was admitted to our hospital with gastrointestinal bleeding. Seventeen years previously, he had a Billroth II procedure for a bleeding duodenal ulcer. A gastroscopy performed on admission showed a stomal ulcer with signs of recent haemorrhage. In the proximal end of the afferent loop, we saw retained gastric mucosa. Histological evaluation confirmed the existence of antrum gastric mucosa. Other diagnostic test for retained gastric antrum were normal. The different approaches in the diagnosis of retained gastric antrum, the importance of our findings and the clinic implications are discussed. We conclude that endoscopic management may be the first diagnostic method in the assessment of retained gastric antrum, and it's possible to find gastric mucosa in the proximal end of the afferent loop (antrum retained), without clinic manifestations.