Treatment of refractory left sided ulcerative colitis : lessons from the sages IBD registry

Background: Left sided ulcerative colitis is often a severe disease which requires aggressive medical therapy. Rarely, it can result in colectomy. Moreover, it can progress and extent to involve the entire colon. Method: Retrospective analysis of patient data on the SAGES IBD database. Patient data with severe left sided ulcerative colitis requiring anti-TNF therapy for the period between September 2016 to August 2017. Patient consent was obtained. Results: A total of 149 requests for biologic therapy were received during this period of which 13 had left sided ulcerative colitis. Seven (53.4%) were male and the mean age at diagnosis 33.3 years. Mean age at commencement of biologic therapy was 40.9 years. There were no smokers. One (7.7%) had ulcerative proctitis, 7 (53.8%) had proctosigmoiditis and 5 (38.4%) had left sided colitis. No patient was receiving topical steroids and 2 (15.4%) patients had exposure to topical 5-aminosalicylic acid. All patients had exposure to oral 5-aminosalicylic acid and 9 (69.2%) were receiving ongoing treatment. Ten (76.9%) received azathioprine or 6-mercaptopurine and 5 (38.5%) received methotrexate. Of the 12 patients on immunomodulator therapy, 10 (76.9) were concurrently on 5-aminosalicylic acid. Seven (53.8%) patients received infliximab and 9 (69.2%) patients received adalimumab. No one received golimumab or vedolizumab. All patients received standard dose anti-TNF therapy except 1 (7.7%) patient who received double dose infliximab. Biologic therapy was well tolerated with good clinical outcome and no side-effects. Conclusion: The incidence of severe left sided ulcerative colitis was low in this cohort. Severe left sided disease is associated with a high medication burden and cost. Response to biologic therapy was excellent

Treatment of refractory left sided Ulcerative colitis: lessons from the Sages IBD registry

ABSTRACT Background: Left sided ulcerative colitis is often a severe disease which requires aggressive medical therapy. Rarely, it canresult in colectomy. Moreover, it can progress and extent to involve the entire colon. Method: Retrospective analysis of patient data on the SAGES IBD database. Patient data with severe left sided ulcerative colitis requiring anti-TNF therapy for the period between September 2016 to August 2017. Patient consent was obtained. Results: A total of 149 requests for biologic therapy were received during this period of which 13 had left sided ulcerative colitis. Seven (53.4%) were male and the mean age at diagnosis 33.3 years. Mean age at commencement of biologic therapy was 40.9 years. There were no smokers. One (7.7%) had ulcerative proctitis, 7 (53.8%) had proctosigmoiditis and 5 (38.4%) had left sided colitis. No patient was receiving topical steroids and 2 (15.4%) patients had exposure to topical 5-aminosalicylic acid. All patients had exposure to oral 5 aminosalicylic acid and 9 (69.2%) were receiving ongoing treatment. Ten (76.9%) received azathioprine or 6-mercaptopurine and 5 (38.5%) received methotrexate. Of the 12 patients on immunomodulator therapy, 10 (76.9) were concurrently on 5-aminosalicylic acid. Seven (53.8%) patients received infliximab and 9 (69.2%) patients received adalimumab. No one received golimumab or vedolizumab. All patients received standard dose anti-TNF therapy except 1 (7.7%) patient who received double dose infliximab. Biologic therapy was well tolerated with good clinical outcome and no side-effects. Conclusion: The incidence of severe left sided ulcerative colitis was low in this cohort. Severe left sided disease is associated with a high medication burden and cost. Response to biologic therapy was excellent

Childhood Inflammatory Bowel Disease in Libya: Epidemiological and Clinical Features

Background et Aims: Inflammatory bowel disease is thought to be rare in Libya. The aim is to determine the prevalence of juvenile onset inflammatory bowel disease in Libya. Setting: Al-Fateh childrens' hospital; Benghazi; Libya. Methods: This is a retrospective study of all cases diagnosed over 10 years (1997-2006) with either ulcerative colitis; Crohn's disease or indeterminate colitis. Inclusion criteria were age 15 years at time of presentation who were resident in the eastern part of the country and who diagnosed with inflammatory bowel disease. Clinical features were outlined using a proforma. Results: Sixteen cases were diagnosed with inflammatory bowel disease; of whom 11 were males (M:F ratio of 1.5:1). The prevalence and incidence rates in the year 2006 were 3.6 and 0.9 per 100;000 children; respectively. The incidence rate increased from 0.2 in 2002 to 0.9 in 2006 (Z score of 39.87; p); abdominal pain; anorexia and weight loss in 9 (56.2); anemia in 7 (43.75) and vomiting in 6 (37). Ileopancolitis was found in 3 patients whereas 6 patients had ileocecal disease. Conclusions: Childhood inflammatory bowel disease in this population is not so rare and it is increasing. The clinical pattern is similar to that reported by others

Place de l'amniocentèse dans le dépistage anténatal à Cotonou

L'amniocentese est la technique de reference pour les prelevements fotaux destines a la recherche des mutations de l'ADN de l'hemoglobine ou des anomalies chromosomiques. Nous avons mene une etude transversale analytique sur 20 mois chez 21 gestantes de 16 a 24 semaines d'amenorrhee (SA) porteuses (avec le conjoint) de mutation C ou S sur l'une ou les deux chaines de l'hemoglobine ; les prelevements de liquide amniotique etaient indiques dans 19 et 2 cas respectivement pour le risque d'enfants drepanocytaires et les signes d'appel echographiques de malformations congenitales. L'age moyen etait de 29;81 ans. L'extraction de l'ADN des amniocytes par PCR avait revele 5 cas de double mutation homozygote S; 2 doubles heterozygotes SC; 3 et 6 cas respectivement d'hemoglobine AS et AA ; le caryotype avait revele deux fotus trisomiques 13 et 18. L'issue de ces grossesses etait marquee par la naissance a terme de 15 nouveau- nes vivants et respectivement par 1 et 2 cas d'interruption de grossesse; volontaire (IVG) et medicale (IMG). Aucune complication imputable a la technique n'etait enregistree. L'innocuite de la methode est un point fort pour la conseiller dans le cadre du diagnostic antenatal de la drepanocytose a Cotonou