الملخص
Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Although there are several causes of anemia in IBD, the two most frequent etiologies are iron deficiency anemia and anemia of chronic disease. Despite the high prevalence of anemia in IBD and its significant impact on patient's quality of life, this complication is still underdiagnosed and undertreated by providers. Active screening for anemia, structured assessment, comprehensive management, and multidisciplinary collaboration are needed in IBD patients. The cornerstone of anemia management depends on the underlying etiology along with normalization of inflammatory activity. Although, oral iron is effective for the treatment of mild iron deficiency-related anemia, intravenous iron formulations have a good safety profile and can be used as first-line therapy in patients with active IBD, severe anemia and previous intolerance prior to oral iron. After proper treatment of anemia, careful monitoring is necessary to prevent its recurrence. Herein, we discuss the etiology, screening, diagnosis, therapy selection, and follow-up for anemia in IBD.
الموضوعات
Humans , Inflammatory Bowel Diseases/complications , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/etiology , Anemia/complications , Anemia/diagnosis , Quality of Life , Iron/therapeutic useالموضوعات
Humans , Inflammatory Bowel Diseases/therapy , Immunization , Quality of Health Care , Vaccinationالموضوعات
Humans , Female , Pregnancy , Inflammatory Bowel Diseases/drug therapy , Biological Therapyالملخص
DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe, rare and potentially lethal idiosyncratic condition associated with the use of some drugs. Given its broad spectrum of presentation, clinical suspicion is essential for management, since it requires the immediate withdrawal of the culprit drug, support measures and the use of corticosteroids as the first line of treatment. We report a 24-year-old woman with a diagnosis of ulcerative colitis with joint involvement despite the use of infliximab, who presented symptoms, signs and laboratory compatible with DRESS syndrome on the third week after indicating sulfasalazine for her baseline disease.
الموضوعات
Female , Humans , Young Adult , Sulfasalazine , Antirheumatic Agents , Eosinophilia , Drug Hypersensitivity Syndrome , Sulfasalazine/adverse effects , Adrenal Cortex Hormones , Antirheumatic Agents/adverse effects , Eosinophilia/chemically induced , Drug Hypersensitivity Syndrome/diagnosis , Drug Hypersensitivity Syndrome/etiology , Infliximabالملخص
Biological therapy dramatically changed the management of Ulcerative Colitis (UC). However, a significant number of these patients fail to respond or have secondary loss of response to this strategy. In this clinical situation, the options include intensification of anti-TNF therapy, the use of a second anti-TNF or being switched to another drug class. Among the later, tofacitinib, an oral small molecule directed against the JAK/STAT pathway, is safe and effective in inducing and maintaining remission in patients with moderate-severe UC. We report two patients with UC refractory to conventional treatment and biological therapy, who responded successfully to the use of tofacitinib.
الموضوعات
Humans , Male , Middle Aged , Piperidines/therapeutic use , Pyrimidines/therapeutic use , Colitis, Ulcerative/drug therapy , Protein Kinase Inhibitors/therapeutic use , Colitis, Ulcerative/diagnostic imaging , Colonoscopy , Treatment Outcomeالملخص
Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.
الموضوعات
Humans , Inflammatory Bowel Diseases/etiology , Environmental Exposure/adverse effects , Nicotiana/adverse effects , Inflammatory Bowel Diseases/epidemiology , Risk Factors , Probiotics , Diet/adverse effects , Protective Factors , Obesity/complicationsالملخص
Background: Primary non-response and secondary loss of response (LOR) are significant problems of biological therapy for inflammatory bowel disease (IBD). Therapeutic drug monitoring (TDM) in IBD patients receiving these drugs can improve outcomes. Aim: To measure serum infliximab levels and anti-infliximab antibodies (ATI) in patients with IBD post-induction phase and during maintenance therapy assessing the clinical course of IBD. Patients and Methods: Prospective study of IBD patients receiving infliximab between July 2016-May 2017. Group-A included patients who received induction therapy while Group-B included patients who were in maintenance therapy. TDM was performed in serum samples collected at weeks-14 and 30 in Group-A and before the infliximab maintenance dose in Group-B. Clinical scores, fecal calprotectin and endoscopic score were also evaluated. Results: Of 14 patients in Group-A, 57% achieved endoscopic response. Median serum infliximab concentrations at week-14 and 30 were 2.65 AU/mL (0.23-32.58) and 2.3 AU/mL (0.3-16.8), respectively. Patients with mucosal healing had non-significantly higher median infliximab concentrations at week- 14, as compared to week 30 (median 3.2 vs 2.2 AU/ml, respectively, p 0.6). ATI >10 ug/mL were found in one and seven patients at week-14 and 30, respectively. At 52 weeks of follow-up, four patients (31%) had LOR. Group-B included 36 patients, 33% had LOR. Median serum concentrations of infliximab were 1.4 AU/mL (0.27-7.03). No significant differences in serum infliximab concentration were observed between patients in remission and those with inflammatory activity. Seventeen patients had ATI >10 ug/mL. Conclusions: Clinical algorithms using TDM might help to optimize the pharmacological therapy of IBD.
الموضوعات
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , Gastrointestinal Agents/therapeutic use , Colitis, Ulcerative/drug therapy , Crohn Disease/drug therapy , Drug Monitoring/methods , Infliximab/therapeutic use , Reference Values , Severity of Illness Index , Gastrointestinal Agents/blood , Enzyme-Linked Immunosorbent Assay , Colitis, Ulcerative/diagnostic imaging , Crohn Disease/diagnostic imaging , Prospective Studies , Reproducibility of Results , Colonoscopy , Treatment Outcome , Statistics, Nonparametric , Infliximab/bloodالملخص
Primary colorectal lymphoma is a rare form of presentation of gastrointestinal tract lymphomas. Inflammatory bowel disease and its treatment are risk factors for its development. We report a 47-year-old male patient with Ulcerative Colitis of two years of evolution, treated initially with azathioprine and later on with infliximab. Due to a relapse in symptoms after the second dose of infliximab, a new coloncoscopy was performed showing a rectal ulcerative lesion, corresponding to a large cell Non-Hodgkin's Lymphoma. The patient was successfully treated with RCHOP chemotherapy (Rituximab cyclophosphamide doxorubicin vincristine prednisone). He is currently in disease remission.
الموضوعات
Humans , Male , Middle Aged , Rectal Neoplasms/etiology , Rectal Neoplasms/pathology , Colitis, Ulcerative/drug therapy , Lymphoma, Large B-Cell, Diffuse/etiology , Lymphoma, Large B-Cell, Diffuse/pathology , Immunosuppressive Agents/adverse effects , Rectal Neoplasms/diagnostic imaging , Azathioprine/adverse effects , Vincristine/administration & dosage , Biopsy , Gastrointestinal Agents/adverse effects , Prednisone/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Doxorubicin/administration & dosage , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Cyclophosphamide/administration & dosage , Rituximab/administration & dosage , Infliximab/adverse effects , Positron Emission Tomography Computed Tomographyالملخص
There are no evidence-based guidelines about prophylaxis against Pneumocystis jiroveci pneumonia in inflammatory bowel disease. We report a case of P. jiroveci pneumonia in patient with Crohn's disease receiving infliximab and methotrexate. This case emphasizes the importance of considering the possibility of this infection in inflammatory bowel disease patients treated on biological therapy.
الموضوعات
Humans , Female , Middle Aged , Pneumonia, Pneumocystis/chemically induced , Gastrointestinal Agents/adverse effects , Crohn Disease/drug therapy , Infliximab/adverse effects , Pneumonia, Pneumocystis/diagnostic imaging , Radiography , Tomography, X-Ray Computed , Risk Factors , Immunosuppressive Agents/adverse effectsالملخص
Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition that requires early recognition, hospitalization and adequate treatment. Currently, the use of infliximab in ulcerative colitis (UC) is recommended in the case of severe disease refractory to corticosteroids, once that superimposed bacterial or viral infections (such as cytomegalovirus or Clostridium difficile) have been excluded. However, conventional weight-based regimens of infliximab might be insufficient for patients with ASUC. Accelerated infliximab induction regimen may increase its serum concentration levels and efficacy by reducing early colectomy rates in these patients. We report a 34 year old female presenting with an ASUC. She was initially treated with hydrocortisone 300 mg/day and mesalazine enemas 4 g/day with an unfavorable clinical response. At the fifth day of therapy, an accelerated induction therapy with infliximab was started in doses of 10 mg/kg at weeks 0, 1 and 4. After the second dose, there was a favorable response with reduction of abdominal pain, stool frequency and hematochezia. She was discharged with prednisone and azathioprine. After a year of starting infliximab, the patient remains in clinical remission.
الموضوعات
Humans , Female , Adult , Gastrointestinal Agents/therapeutic use , Colitis, Ulcerative/drug therapy , Infliximab/therapeutic use , Biopsy , Colitis, Ulcerative/pathology , Colitis, Ulcerative/diagnostic imaging , Acute Disease , Colonoscopy , Treatment Outcome , Leukocyte L1 Antigen Complex/analysis , Fecesالملخص
Anti-tumor necrosis factor-α (TNF) agents have dramatically changed the management of Crohns Disease (CD). However, a significant number of these patients do not respond at all or cease to respond to antibodies against TNF. In this clinical situation, the options include intensification of anti-TNF therapy by either increasing the dose or by shortening the administration interval, the use of a second anti-TNF or medications with a different mechanism of action. Among the later, Natalizumab, a humanized IgG4 monoclonal antibody against α4β1 and α4β7 integrins, is safe and effective in inducing and maintaining remission in active CD patients refractory to anti-TNF. In spite of this, Natalizumab use has been limited because of an increased risk of progressive multifocal leukoencephalophaty which results from reactivation of the John Cunningham (JC) virus. However, the presence of antibodies against JC virus in serum can be used to reduce the risk for this complication. We report three patients with Crohns disease refractory to treatment with infliximab, who responded successfully to the use of Natalizumab.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Crohn Disease/drug therapy , Natalizumab/therapeutic use , Immunosuppressive Agents/therapeutic use , Treatment Outcome , Natalizumab/adverse effects , Immunosuppressive Agents/adverse effectsالملخص
The relationship between Microscopic Colitis and Inflammatory Bowel Disease is unclear. However, when both are diagnosed they seem to be part of a broader spectrum of the same disease, more than just a coincidence. We report a 55 years old woman with Ulcerative Colitis limited to the rectum with complete clinical and endoscopic response to standard treatment and adequate surveillance for 13 years, who abandoned treatment and control. After eight years, she consulted for mild-to-moderate non-bloody diarrhea lasting several months. Colonoscopy and basic laboratory did not show any alterations. Nevertheless, random biopsies had a characteristically pattern compatible with Lymphocytic Colitis. After the first week of treatment with budesonide the patient was asymptomatic and still in clinical remission, with negative fecal calprotectin at 6 months follow-up.