ABSTRACT
BACKGROUND: TNFalpha-antibodies have been used increasingly in treatment of inflammatory bowel disease (IBD) during the last years. This article provides an overview of indications, contraindications, efficacy, and side effects of this so-called biological treatment of IBD. MATERIAL AND METHODS: Based on the clinical experience of the authors, literature was selected through a non-systematic search in PubMed. RESULTS: TNFalpha-antibodies have a documented initial effect in 60-70 % of patients with moderate to severe luminal and/or fistulising IBD. Approximately 30 % of patients achieve remission after a relatively short treatment period. However, the effect seems to decrease during long-term treatment. It is still unsettled whether these drugs prevent colectomy in ulcerative colitis. The treatment seems to increase the risk of serious infections and there are also some indications of an increased risk of malignancy. Combination therapy with azathioprin is common and probably increases both the effect and the risk of side effects. INTERPRETATION: TNFalpha-antibodies have become an important part of the treatment for moderate to severe IBD, but the effect decreases during long-term treatment and has to be evaluated in light of potential side effects. Further long-term studies are necessary.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Colitis, Ulcerative/drug therapy , Crohn Disease/drug therapy , Adalimumab , Adult , Anti-Inflammatory Agents/adverse effects , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Contraindications , Drug Therapy, Combination , Evidence-Based Medicine , Female , Humans , Infliximab , Male , Treatment OutcomeABSTRACT
BACKGROUND: The importance of biopsies of the endoscopically normal colonic mucosa is controversial. MATERIAL AND METHODS: All patients who underwent total colonoscopy at St. Olav"s Hospital in 2004 were considered for inclusion if their colonoscopy was normal. Patients who were already enrolled in follow-up protocols were excluded. Biopsy practice and histological findings were recorded. RESULTS: Biopsies were taken in 266 of 738 normal colonoscopies (36%) The number of biopsies per colonoscopy varied from 1 to 16 (median 6). Biopsies from 8 of the 266 patients (3.0%) showed histological abnormalities of certain clinical significance. Seven of the 8 patients were investigated because of diarrhoea. In addition, histological abnormalities of limited clinical significance were found in biopsies from 13 of the patients (4.9%). INTERPRETATION: Use of biopsy in the endoscopically normal colon varied considerably. Taking biopsies in patients without diarrhoea was of minor clinical importance. Guidelines for taking biopsies of the endoscopically normal colon are desirable.
