ABSTRACT
BACKGROUND: Endoscopic and clinical recurrence of Crohn's disease (CD) appears in up to 80 and 30 % of patients, respectively, 1 year after surgery. Both infliximab (IFX) and adalimumab (ADA) have been demonstrated to be effective in reducing the possibility of recurrence after surgery, but head-to-head studies have not been performed so far. The aim of this open-label prospective study was to compare endoscopic, histological and clinical recurrence after 1 year of treatment with IFX or ADA as postoperative prophylaxis in CD patients with a high risk of recurrence. METHODS: Consecutive CD patients who underwent curative ileocolonic resection were randomized to receive IFX or ADA for 1 year. Co-primary endpoints were endoscopic, histological and clinical recurrence after 12 months of therapy. RESULTS: Twenty consecutive CD patients (9 males and 11 females; median age 32.5 years, range 20-39 years) were enrolled after undergoing curative ileocolonic resection. Among the 10 patients treated with IFX, 2 (20 %) had endoscopic recurrence compared to 1 (10 %) in the group of 10 ADA patients (p = 1.0). Three out of 10 (30 %) IFX patients and 2 out of 10 (20 %) ADA patients had histological recurrence (p = 1.0). No significant clinical differences were found between the two groups. CONCLUSIONS: IFX and ADA were similar in preventing histological, endoscopic and clinical recurrence after curative ileocolonic resection in high risk CD patients.
Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Antibodies, Monoclonal/administration & dosage , Crohn Disease/drug therapy , Digestive System Surgical Procedures , Adalimumab , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Biopsy , Crohn Disease/diagnosis , Crohn Disease/surgery , Dose-Response Relationship, Drug , Endoscopy, Digestive System , Female , Follow-Up Studies , Humans , Infliximab , Injections, Subcutaneous , Male , Pilot Projects , Postoperative Period , Prospective Studies , Recurrence , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Young AdultABSTRACT
BACKGROUND: Clarithromycin resistance has decreased the eradication rates of Helicobacter pylori. AIMS: To determine whether a 10-day course of sequential therapy (ST) is more effective at eradicating H pylori infection than triple therapy (TT) in the first or second line, and to assess side effects and compliance with therapy. METHODS: One hundred sixty treatment-naive and 40 non-treatment-naive patients who were positive for H pylori infection by ¹³C-urea breath test or endoscopy were enrolled. Eighty of 160 patients underwent TT, while 80 of 160 underwent ST with omeprazole (20 mg) plus amoxicillin (1 g) twice/day for five days, followed by omeprazole (20 mg) with tinidazole (500 mg) twice/day and clarithromycin (500 mg) twice/day for five consecutive days. H pylori eradication was evaluated by ¹³C-urea breath test no sooner than four weeks after the end of treatment. RESULTS: Eradication was achieved in 59 of 80 treatment-naive patients treated with TT (74%), in 74 of 80 patients treated with ST (93%), and in 38 of 40 non-treatment-naive patients (95%). Eradication rates in treatment-naive patients with ST were statistically significantly higher than TT (92.5% versus 73.7%; P=0.0015; OR 4.39 [95% CI 1.66 to 11.58]). Mild adverse effects were reported for both regimens. CONCLUSIONS: ST appears to be a well-tolerated, promising therapy; however, randomized controlled trials with larger and more diverse sample populations are needed before it can be recommended as a first-line treatment.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Helicobacter Infections , Helicobacter pylori , Omeprazole/administration & dosage , Peptic Ulcer/etiology , Anti-Bacterial Agents/adverse effects , Anti-Ulcer Agents/administration & dosage , Anti-Ulcer Agents/adverse effects , Breath Tests , Drug Administration Schedule , Drug Resistance, Bacterial , Drug Therapy, Combination/standards , Endoscopy, Gastrointestinal , Female , Helicobacter Infections/complications , Helicobacter Infections/diagnosis , Helicobacter Infections/drug therapy , Helicobacter Infections/microbiology , Helicobacter pylori/drug effects , Helicobacter pylori/metabolism , Humans , Male , Medication Adherence , Middle Aged , Omeprazole/adverse effects , Peptic Ulcer/microbiology , Quality Improvement , Treatment OutcomeABSTRACT
BACKGROUND: Inflammatory bowel disease (IBD) is an idiopathic condition of gastrointestinal tract whose pathogenesis results from the complex interaction of genetic susceptibility and environmental influences. Is well known how IBD patients have an increased risk of thrombosis. OBJECTIVES: To assess the frequency and characteristics of thromboembolic events (TEE) in IBD and the role of certain etiopathological factors in such thrombotic patients. MATERIAL AND METHODS: We report the case of a young woman affected by protein C deficiency, who during a clinical recurrence of ulcerative colitis (UC), developed a spontaneous right ventricular thrombus and pulmonary embolism. Then, we made a review of literature that documented thromboembolic events in IBD patients. RESULTS: A search using the PubMed database identified 65 case reports documenting thromboembolic events in patients with known UC and 7 documenting thromboembolic events in known Crohn's disease. DISCUSSION: The data of the literature confirm that IBD patients have an approximately three fold greater risk for developing a TEE compared with the general population. The risk for thrombosis correlates well with disease activity in Crohn's disease, and to lesser extent in ulcerative colitis.
