Infliximab dependency is related to decreased surgical rates in adult Crohn's disease patients.

BACKGROUND: Infliximab dependency in children with Crohn's disease (CD) has recently been described and found to be associated with a decreased surgery rate. AIM: To assess infliximab dependency of adult CD patients, evaluate the impact on surgery, and search for possible clinical and genetic predictors. METHODS: Two hundred and forty-five CD patients treated with infliximab were included from Danish and Czech Crohn Colitis Database (1999-2006). Infliximab response was assessed as immediate outcome, 1 month after infliximab start: complete, partial, and no response. Three months outcome, after last intended infusion: prolonged response (maintenance of complete/partial response), infliximab dependency (relapse requiring repeated infusions to regain complete/partial response or need of infliximab >12 months to sustain response). RESULTS: Forty-seven percent obtained prolonged response, 29% were infliximab dependent and 24% nonresponders. The cumulative probability of surgery 40 months after infliximab start was 20% in prolonged responders, 23% in infliximab-dependent patients and 76% in nonresponders (P<0.001). The cumulative probability of surgery at 40 months in patients on maintenance versus on demand regime was 33 and 31%, respectively (P=0.63). No relevant clinical or genetic predictors were identified. CONCLUSION: The infliximab dependency response seems to be equivalent to the prolonged response in adult CD patients when comparing surgery rates.

[Diagnosing lactose intolerance in adults]. / Diagnosticering af laktoseintolerans hos voksne.

INTRODUCTION: Primary lactose malabsorption, adult type, is associated with the genotype CC in a lactase gene regulatory sequence (LCT-13910). In contrast, the genotype CT or TT in this position correlates with normal lactose absorption. Genotyping was implemented for routine testing of patients for primary lactose intolerance. We estimated the frequency of genotypes in a group of blood donors and compared it with the frequency among patients. MATERIALS AND METHODS: In total, 478 patients admitted to a hospital or to a specialist in gastroenterology and 100 blood donors were genotyped. DNA was obtained, and the relevant DNA sequence was amplified by real-time polymerase chain reaction (PCR) and analysed by the use of melting curve analysis. RESULTS: Among blood donors, the allelic distribution was 8% CC, 38% CT and 54% TT, whereas 14% CC, 37% CT, 48% TT was found in the patient group. CONCLUSION: Compared with the control group, the frequency of the CC genotype is almost doubled in the genotyped patients. Genotyping proved to be a convenient tool for routine clinical testing.