Sucrosomial Iron Supplementation for the Treatment of Iron Deficiency Anemia in Inflammatory Bowel Disease Patients Refractory to Oral Iron Treatment.

Iron deficiency anemia (IDA) is a common manifestation of Inflammatory Bowel Disease (IBD). Oral iron supplements are the treatment of choice, but are not always well tolerated. Sucrosomial® iron (SI) may represent an alternative. This prospective study assessed the tolerability and effectiveness of SI, and quality of life (QoL) of IDA-IBD patients who were intolerant to oral iron salts. The study included 52 individuals treated with 1 capsule/day for 12 weeks. Tolerability was assessed through a gastrointestinal symptom severity questionnaire. Hemoglobin (Hb) levels and clinical symptoms of IDA were analyzed. QoL was assessed using IBDQ-9 and EuroQoL questionnaires. The percentage of patients with excellent/good health increased from 42.9% to 94.3%. Mean Hb concentration significantly increased at all follow-up visits (p < 0.05). Almost all participants (96.9%) were adherent to the study medication. Patients' QoL improved (IBDQ-9: from 60.9 to 65.5). Patients also improved in mobility (71.8% to 78.1%), usual activities (51.3% to 68.7%), pain/discomfort (41.0% to 53.1%), and extreme depression/anxiety problems (7.7% to 3.2%); they worsened in self-care (100% to 90.6%), but perceived an enhancement in their global health [EQ-VAS score: 61.9 (±26.1) to 66.9 (±20.3)]. SI was well tolerated and improved IDA symptoms, IBD activity, and patients' QoL. In conclusion, SI should be considered in IDA-IBD patients.

Does smoking influence Crohn's disease in the biologic era? The TABACROHN study.

BACKGROUND: While most studies have found a negative effect of smoking on Crohn's disease (CD) phenotype, more recent data have failed to reproduce this association, which might be due to a current wider use of thiopurines and biologic therapy. The TABACROHN study aimed at defining the impact of smoking on CD in the largest published series. METHODS: This multicenter cross-sectional study included 1170 CD patients. Patients were classified as nonsmokers, current smokers, or former smokers according to their present smoking status. Clinical data regarding disease characteristics, treatment, and complications were collected. RESULTS: Smokers were more frequently under maintenance treatment when compared to nonsmokers. In addition, current smokers presented higher use of biologic drugs compared to nonsmokers. Tobacco exposure and a higher tobacco load were independent predictors of need for maintenance treatment and stenosing phenotype, respectively. CONCLUSIONS: In the era of early and widespread use of immunosuppressants and biologics, tobacco exposure is an independent predictor of need for maintenance treatment, specifically biologic therapy. The wider use of biologics and immunosuppressants could account for the existence of no major differences in disease behavior and complications between nonsmokers and current smokers.

Novedades en el tratamiento de la enfermedad de Crohn / Advances in the treatment of Crohn's disease

Durante el último congreso Digestive Disease Week (DDW) se presentaron numerosas comunicaciones en relación con la enfermedad de Crohn (EC). Varios estudios han explorado nuevas vías patogénicas. La inhibición de los linfocitos T producida por el abatacept no se mostró útil. Otros fármacos como la naltrexona (antagonista opiáceo) o el traficet- EN (antagonista de una molécula específica del tráfico de leucocitos) sí que se mostraron eficaces. Otra estrategia, modificar fármacos existentes como la mercaptpurina (DR6- MP), para disminuir su toxicidad podría ser útil en un futuro en pacientes con EC. En la prevención de la recurrencia se presentaron varios estudios: el VSL-3 no pudo demostrar su utilidad, pero tanto adalimumab como infliximab parece que son muy eficaces en esta circunstancia. Un objetivo terapéutico, la curación mucosa, fue motivo de varias comunicaciones. Este objetivo es más fácilmente alcanzable cuando se trata a los pacientes de forma continua con biológicos y tiene valor pronóstico de buena evolución. En los pacientes tratados con infliximab los valores valle se correlacionan con la curación mucosa. En caso de fracaso de un biológico se puede sustituir por infliximab, adalimumab, certolizumab o natalizumab. En caso de remisión con infliximab, el cambio por adalimumab no parece adecuado(AU)

Numerous communications were presented on Crohn's disease (CD) in Digestive Disease Week 2010. Several studies explored new pathogenic pathways. T lymphocyte inhibition by Abatacept was not demonstrated to be useful. Other drugs such as naltrexone (an opiate antagonist) and Traficet-EN (which targets the small-intestinal-specific chemokine receptor CCR9) have been shown to be effective. Another strategy, modifying already existing drugs such as mercaptopurine (DR6-MP), to reduce their toxicity could prove useful in future in patients with CD. Several studies on preventing recurrence were presented: VSL-3 failed to demonstrate efficacy but both adalimumab and infliximab seem to be highly effective in achieving this goal. One therapeutic objective —mucosal healing— was the subject of several communications. This aim is easier to achieve when patients are treated continuously with biological agents and has prognostic value in predicting favorable outcome. In infliximab-treated patients, trough levels correlate with mucosal healing. Patients unresponsive to biological agents can be switched to infliximab, adalimumab, certolizumab or natalizumab. In patients achieving remission with infliximab, substituting adalimumab does not seem appropriate(AU)

Coinfección oportunista durante el tratamiento con infliximab (antifactor de necrosis tumoral alfa) en un paciente con enfermedad de Crohn / Opportunistic co-infection in a patient with Crohn's disease during infliximab (anti-TNF-alpha) therapy

Objetivos Exponer y concienciar acerca del riesgo potencial de causar infecciones graves, oportunistas o no, inherentes al empleo de tratamientos biológicos y, en concreto, de fármacos bloqueadores del TNF-alfa, a partir de la descripción de un caso de infección fúngica invasiva. Métodos Revisión de la historia clínica a partir de la selección del caso obtenido en la base de datos de pacientes con enfermedades inflamatorias crónicas de base autoinmune, candidatos o a los que se les realizan nuevos tratamientos biológicos, y estudio de los aislamientos microbiológicos procedentes de las muestras clínicas significativas. Resultados Se comunica un caso de infección oportunista dual (nocardiosis y aspergilosis) de difícil diagnóstico y complejo tratamiento en un paciente afectado de enfermedad de Crohn e inmunodeprimido, que se desencadenó tras la administración de infliximab (anticuerpo monoclonal anti-TNF-alfa). Conclusiones Las infecciones fúngicas invasivas, bien con presentación clínica aislada o asociadas a otras infecciones oportunistas, están emergiendo en nuevos grupos de riesgo, como son los pacientes receptores de tratamientos biológicos anticitocinas reguladoras de la inflamación y de la inmunidad. Pueden ser potencialmente graves y se precisa un alto índice de sospecha para su diagnóstico precoz. En los pacientes con mayor riesgo de presentarlas deben investigarse las posibles medidas preventivas para evitar su aparición o minimizar su trascendencia(AU)

Background The biological therapies for chronic inflammatory diseases of autoimmune origin, particularly drugs inhibiting cytokines, such as the antagonists of the tumoral necrosis factor alpha (TNFalpha), are acceptably well tolerated in patients suffering rheumatologic, dermatologic and gastrointestinal pathologies. Nevertheless, pharmacologic vigilance studies have clarified several aspects of their security in daily clinical use. The adverse effects associated with inhibitors of TNFalpha can be related to the target (or class) and to the agent. The adverse effects related to the target include those potentially attributable to the inherent immunosuppressive state due to the blockade of the main cytokine, phenomenon that could increase the susceptibility to the infections and cancer. Aims To expound the potential risk of serious infections, opportunistic or not, inherent to the use of biological therapies and, specifically, antagonistic drugs of TNFalpha, from the description of a case of invasive fungal infection. Methods Revision of clinical records, obtained from the chronic inflammatory disease of autoimmune origin patient database, candidates or recipients of the new biological therapies, and study of the microbiological isolates. Conclusions Invasive fungal infections, with isolated or associated clinical presentation to other opportunistic infections, are emerging in new groups-at-risk as they are the recipients of anti-cytokine biological therapies, regulators of inflammation and immunity. They can be potentially serious in their evolution and a high index of suspicion is needed sometimes for their prompt diagnosis. Possible preventive measures in patients with a high risk of suffering them will have to be investigated(AU)