Infliximab therapy for moderately severe Crohn's disease and ulcerative colitis: a retrospective comparison over 6 years.

BACKGROUND: Infliximab has shown benefit in Crohn's disease (CD) and ulcerative colitis (UC). OBJECTIVE: Evaluation of long-term outcome of therapy for both diseases. METHODS: We analyzed retrospectively patients treated at infusion centers from one institution. Demographic, laboratory parameters leading up to biologic therapy and the subsequent pattern of outcomes in either disease were established as a database. Initial failure, subsequent need to change therapy, or need to adjust therapy were evaluated. Kruskal-Wallis (nonparametric) tests to compare two groups and Kaplan-Meier survival curve analysis were used to compare outcomes. RESULTS: Over approximately 6 years, 71 CD and 26 UC patients received 999 and 215 infusions, respectively, for a median of 62 months. Of these, 17% for CD and 19% for UC patients were primary failures. Following the start of infliximab, 18% of CD and 11% of UC patients required stoppage and switching to another type of therapy. In either CD or UC patients, 54% or 62%, respectively, continued therapy without the need to change to other treatments. Few serious side effects were noted. No important statistically significant differences in treatment patterns or outcome were observed between the groups. DISCUSSION: Long-term treatment of both inflammatory bowel diseases reflects outcomes of clinical trials. CONCLUSIONS: This study emphasizes similarities between CD and UC and reports therapeutic success for an extended time.

Fructose malabsorption may be gender dependent and fails to show compensation by colonic adaptation.

Fructose malabsorption is linked to gastrointestinal and other unusual symptoms. Polymers of fructose are also recognized prebiotics. While some prebiotics can self-adapt when consumed regularly (resulting in decreased breath hydrogen and symptoms), we wondered whether self-adaptation occurs with basic fructose. We evaluated 90 subjects (61 females). Each completed a diet questionnaire and underwent a fructose challenge. Breath hydrogen and quantified symptom scores were recorded. Group comparisons for sum of breath hydrogen and total symptom scores were evaluated with the Mann-Whitney U test. Spearman's correlation coefficient and chi(2) or Fisher's exact test were used as appropriate. Malabsorption occurred in 29 patients (32.2%) and low-grade symptoms without malabsorption in 30 (33%). Women complained of symptoms more frequently (p = 0.04) and exhibited more fructose malabsorption (p = 0.0527). Breath hydrogen correlated with symptoms (r = 0.516, p = 0.0037). Adaptation with increasing pretest fructose intake was absent. We conclude that gender may influence fructose malabsorption and there is no adaptation to regular consumption.

Comparison of a real-time polymerase chain reaction assay for lactase genetic polymorphism with standard indirect tests for lactose maldigestion.

BACKGROUND & AIMS: There is a discrepancy in outcome between the lactose tolerance and breath hydrogen tests for lactose maldigestion. The availability of a validated genetic test for lactase polymorphism allows a reevaluation of these tests. METHODS: Thirty healthy adults participated in a 50-g lactose challenge test at a university clinic. Blood was drawn for genetic and timed blood glucose testing (2 hours), and breath hydrogen was measured (4.5 hours). Lactase genetic polymorphism was assessed by a real-time polymerase chain reaction assay. Participants completed a diet questionnaire, and symptoms were recorded during the lactose challenge. Sensitivity and specificity were calculated for each indirect test. The 2-way kappa coefficient between these tests was evaluated. Student t test and Wilcoxon rank sum test were used to compare variables. RESULTS: The lactose tolerance test as a standard had an 87.5% sensitivity and 92.7% specificity for genetic status. Only a moderate agreement between lactose tolerance test and breath hydrogen test was observed (2-way kappa coefficient, .53; 95% confidence interval, .22-.83). When genetic status was used as standard, symptoms had a moderate sensitivity and specificity. Lactose tolerance test had very good sensitivity, and the breath test had excellent specificity. CONCLUSIONS: Both indirect tests independently have good to very good sensitivities and specificities for genetic lactase status. The noted disagreement likely reflects variables that affect the tests independently of intestinal lactase status. The value of these tests in the light of the availability of genetic testing is discussed.

Inverse dose effect of pretest dietary lactose intake on breath hydrogen results and symptoms in lactase nonpersistent subjects.

The aim of this study was to determine a relationship between pretest intake of lactose and outcome of lactose breath hydrogen test. Patients presented at a testing laboratory participated in the study. A 3-hour breath hydrogen, 50-g lactose challenge was carried out. Results were tabulated and patients completed a 3-day recall diet questionnaire. Daily lactose intake was independently calculated and was associated with breath hydrogen and total symptom score. Statistical analysis used Spearman's correlation, Mann-Whitney U-test and chi2 or Fisher exact test. Of 118 patients, 50% were lactose maldigesters. In these patients, measured breath hydrogen and symptom scores were significantly higher in the lowest intake group (< 5 g/d) than in the highest intake group (> 20 g/d) (P < .05). In the presumed lactose digesters, 59% experienced some symptoms during testing for unclear reasons. Pretest dietary intake of lactose inversely affects results of breath hydrogen.