RESUMEN
BACKGROUND: Infliximab is used for treatment of Crohn's disease and, following the Active Ulcerative Colitis Trials (ACT) 1 and 2, it has been used as rescue and maintenance therapy in moderate and severe ulcerative colitis (UC). AIM: To report on English experience with maintenance infliximab in terms of response and colectomy rates and side-effect profile in UC. METHODS: A retrospective audit conducted by using a web-based questionnaire filled in by 12 gastroenterologists from six English centres. RESULTS: Of the 38 patients receiving induction with infliximab, 28 (73.6%) maintained an ongoing response (8-weekly infusions 5 mg/kg) for a mean duration of 16.8 months (range 4-59), with 21 (55.3%) being in remission. Three of 38 patients (7.9%) who also responded had a secondary loss of response after an average of 10 months (range 8-13); seven of 38 patients (18.4%) showed no response. The colectomy rate was seven of 38 (18.4%, five non-responders and two with secondary loss of response). Adverse effects occurred in five patients (13.2%). Two discontinued infliximab (alopecia, invasive breast cancer). The three less-severe adverse effects were acute and delayed-type hypersensitivity reactions and one persistent otitis media. CONCLUSION: Our experience suggests acceptable response rates, colectomy rates and side-effect profile of maintenance therapy with infliximab in moderate and severe UC.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Colectomía/estadística & datos numéricos , Colitis Ulcerosa/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Colitis Ulcerosa/cirugía , Femenino , Fármacos Gastrointestinales/efectos adversos , Humanos , Infliximab , Masculino , Persona de Mediana Edad , Inducción de Remisión/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Interferón gamma/antagonistas & inhibidores , Anticuerpos Monoclonales Humanizados , Linfocitos T CD4-Positivos/inmunología , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/inmunología , Humanos , Enfermedades Inflamatorias del Intestino/inmunología , Interferón gamma/inmunologíaAsunto(s)
Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Mercaptopurina/uso terapéutico , Azatioprina/uso terapéutico , Medicina Basada en la Evidencia , Fármacos Gastrointestinales/uso terapéutico , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The extrinsic compression of the hepatocholedochus by a cavernomatosis of the portal vein, is an unusual pathology. The present case begun clinically as an obstructive jaundice, assuming that the vascular origin of the compression increased the litiasic biliary disease. The percutaneous transhepatic cholangiography was the diagnostic method that suggested a double illness of the biliary system. The surgery and the pathology certificated the diagnosis. The correct treatment once confirmed the obstructive trial, must be: the extraction of the biliary gallstones and the bile-digestive derivation (preferently the hepatic-jejunum anastomosis in Y of Roux).
Asunto(s)
Enfermedades del Conducto Colédoco/etiología , Cálculos Biliares/etiología , Hemangioma Cavernoso/complicaciones , Vena Porta , Colangiografía , Colestasis/etiología , Enfermedades del Conducto Colédoco/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana EdadRESUMEN
La compresion extrinseca del hepatocoledoco por una cavernomatosis de la vena porta es una inusual patologia. El presente caso debuto clinicamente como un sindrome coledociano, dado que la estenosis de origen vascular incremento la enfermedad biliar litiasica. La colangiografia transparietohepatica fue el metodo diagnostico que oriento hacia una doble patologia de la via biliar. El acto quirurgico y la anatomia patologica certificaron el diagnostico. El tratamiento correcto al comprobar el proceso obstructivo biliar, debe ser: la extracion de los calculos y una anastomosis biliodigestiva (preferentemente la hepatico-yeyuno anastomosis en Y de Roux)