Oral mesalamine (Asacol) for mildly to moderately active ulcerative colitis. A multicenter study.

OBJECTIVE: To evaluate the efficacy and safety of a pH-sensitive, polymer-coated oral preparation of mesalamine in patients with mildly to moderately active ulcerative colitis. DESIGN: A multicenter, double-blind, placebo-controlled randomized trial. SETTING: Five university-based medical centers, one inflammatory bowel disease center, and three private practice sites. PATIENTS: A total of 158 patients with newly or previously diagnosed active ulcerative colitis. INTERVENTION: A pH-sensitive, polymer-coated oral preparation of mesalamine (5-aminosalicylic acid) was used at 1.6 and 2.4 g/d for 6 weeks. MEASUREMENTS: Efficacy was measured by scores for stool frequency, rectal bleeding, patient's functional assessment, sigmoidoscopic findings, and physician's global assessment. Stringent criteria for disease activity were established prospectively. RESULTS: The analysis of protocol-compliant patients showed a significant improvement at 3 weeks in patients taking 2.4 g/d of mesalamine compared with patients taking placebo (32% versus 9%; P = 0.003). At 6 weeks, both the 1.6 g/d (43%) and 2.4 g/d (49%) doses were significantly superior to placebo (23%) (P = 0.03 and P = 0.003, respectively). In addition, more patients worsened in the placebo group compared with the 2.4 g/d group (50% versus 19%; P = 0.003); however, there was no statistically significant difference in worsening between the 1.6 g/d mesalamine group and the placebo group. The oral mesalamine tablet was well tolerated, and no clinically significant changes were observed in hematologic, hepatic, or renal laboratory profiles. CONCLUSION: Colon-targeted oral mesalamine at 2.4 g/d is effective therapy for mildly to moderately active ulcerative colitis. It is well tolerated and should provide a viable therapeutic alternative to sulfasalazine.

Statement on outpatient percutaneous liver biopsy.

This document represents a consensus statement dealing with optimum patient care in a significant clinical area. The statement has been prepared by the Patient Care Committee of the American Gastroenterological Association with the advice of other experts and with peer review. As with all such guidelines, this should be interpreted in a nondogmatic manner, so as not to exclude other therapies or opinions in any particular situation. Based on present knowledge, limited at times, future modifications or other changes in this statement may be necessary.

A new technique for the management of vesicorectal fistulas.

We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy. The fistula was patched with a rectal prosthesis similar to that used to patch esophageal-tracheal and esophageal-bronchial fistulas.

Endoscopic Yag laser therapy in a community hospital.

Our early experience would indicate that in a community hospital the presence of a Yag laser in the hands of an experienced endoscopist can contribute: to alleviate symptoms of esophageal carcinoma, to control bleeding and obstructive manifestations of colorectal neoplasms, and perhaps to remove entirely certain villous adenomas of the colon.

Cystic fibrosis. As they grow older.

Twenty-eight patients with cystic fibrosis, who survived to over 18 years of age are reported. The ages at the time of diagnosis ranged from and two and half months to over 21 years. Manifestations of cystic fibrosis in adults and youngsters are compared and contrasted. A review of the patients surviving shows that steatorrhea is under control. There is no evidence of biliary cirrhosis in any of these patients. Rectal prolapse has not been an important factor. Pseudomonas and Staphylococci were the major infecting organisms causing lung disease. Two-thirds of the patients do not use prophylactic antibiotics and one-third do not practice regular pulmonary care. Two female patients died; one of Pseudomonas lung infection and respiratory failure, after a pregnancy that was carried to term (live baby); one, of respiratory failure, also with severe Pseudomonas respiratory tract infection, two years after a pregnancy that was terminated in the first trimester.

Endoscopic electrosurgical polypectomies of the upper gastrointestinal tract.

The electrosurgical removal of polypoid lesions from the upper gastrointestinal tract with the esophagogastro-duodenoscope has proven to be a safe, effective, and relatively inexpensive procedure. Twenty-six polypectomies performed on 24 different patients are presented. Polyps were removed from the distal esophagus, stomach, duodenum, and jejunum. There were no significant complications.

Endoscopic electrosurgical polypectomies of the upper gastrointestinal tract.

The electrosurgical removal of polypoid lesions from the upper gastrointestinal tract with the esophagogastroduodenoscope has proven to be safe, effective and relatively inexpensive procedure. Thirty polypectomies performed on 26 different patients are presented. Polyps were removed from the distal esophagus, stomach, duodenum and jejunum. There were no significant complications.

The removal of an esophageal papilloma by endoscopic means. A case report and brief review of the literature.

The case of a 77-year old white male on anticoagulant therapy who developed sudden onset of gastrointestinal bleeding is presented. A benign esophageal papilloma was a fortuitous finding. The papilloma was removed in toto by fiberoptic endoscopic polypectomy. A brief review of this rare lesion is presented and the importance of a careful endoscopic examination as well as the therapeutic/curative potentialities of the procedure are stressed.