ABSTRACT
Inflammatory bowel disease (IBD) is related to different liver extraintestinal manifestations and occurs with or without a link to disease activity. Primary sclerosing cholangitis (PSC) is the most common hepatobiliary manifestation. Other autoimmune hepatopathies may develop during the evolution of the latter, which is known as overlap syndrome. Sequential overlap syndrome occurs when these conditions appear in subsequent stages, and it is less frequently associated with IBD. We report three cases of sequential overlap syndrome with autoimmune hepatitis as the first manifestation, followed by PSC after 7-19 years and subsequently IBD. Liver extraintestinal manifestations may precede IBD by several years. Therefore, it is crucial to keep this association in mind, thereby reducing the diagnostic delay.
Subject(s)
Cholangitis, Sclerosing , Hepatitis, Autoimmune , Inflammatory Bowel Diseases , Liver Diseases , Cholangitis, Sclerosing/complications , Cholangitis, Sclerosing/diagnosis , Delayed Diagnosis , Hepatitis, Autoimmune/complications , Hepatitis, Autoimmune/diagnosis , Humans , Inflammatory Bowel Diseases/complicationsABSTRACT
Los objetivos actuales del tratamiento en la enfermedad inflamatoria intestinal (EII), tanto en enfermedad de Crohn como en colitis ulcerosa, son alcanzar la remisión clínica, endoscópica e idealmente histológica, mejorando de esta manera la calidad de vida de estos pacientes. Las terapias actuales son efectivas en lograr estos objetivos, pero no existen guías claras respecto de la duración óptima del tratamiento de mantención. Esta revisión tiene por objetivo evaluar la evidencia actual respecto del retiro de la terapia con 5-aminosalicilatos, tiopurínicos y metotrexato. A su vez, buscamos determinar grupos específicos de pacientes que, encontrándose en remisión y en ausencia de factores de riesgo, pudieran suspender la terapia con el menor riesgo de recaída posible
The current goals of treatment in inflammatory bowel disease, both Crohn's disease and ulcerative colitis, are to achieve clinical, endoscopic and ideally histological remission and improve the quality of life of these patients. Current therapies are effective in achieving remission in most cases, but there is a lack of clear guidelines on their optimal duration. This review aims to evaluate the current evidence on the withdrawal of therapy with 5-aminosalicylates, thiopurines and methotrexate. We also aim to identify which specific group of patients, while in remission and in the absence of risk factors, may be able to discontinue therapy without a significant risk of relapse
Subject(s)
Humans , Pelvic Inflammatory Disease/drug therapy , Quality of Life , Methotrexate/administration & dosage , Azathioprine/administration & dosage , Withholding Treatment , Risk Factors , Biological TherapyABSTRACT
The current goals of treatment in inflammatory bowel disease, both Crohn's disease and ulcerative colitis, are to achieve clinical, endoscopic and ideally histological remission and improve the quality of life of these patients. Current therapies are effective in achieving remission in most cases, but there is a lack of clear guidelines on their optimal duration. This review aims to evaluate the current evidence on the withdrawal of therapy with 5-aminosalicylates, thiopurines and methotrexate. We also aim to identify which specific group of patients, while in remission and in the absence of risk factors, may be able to discontinue therapy without a significant risk of relapse.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Azathioprine/therapeutic use , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Mercaptopurine/therapeutic use , Mesalamine/therapeutic use , Methotrexate/therapeutic use , Humans , Remission Induction , Withholding TreatmentABSTRACT
La efectividad de la terapia con fármacos antifactor de necrosis tumoral alpha en la enfermedad inflamatoria intestinal ha sido probada en la práctica clínica. Tras más de una década de uso de este tipo de fármacos, surge la interrogante acerca de si existe un momento apropiado para suspender estas terapias, y de qué manera esta debiera realizarse. Esta revisión tiene por objetivo evaluar la evidencia actual acerca del retiro de la terapia con antifactor de necrosis tumoral alpha y, eventualmente, identificar las condiciones o los subgrupos de pacientes potencialmente candidatos a la suspensión o el retiro de esta
Anti-tumour necrosis factor alpha therapy in inflammatory bowel disease has been shown to be effective in clinical practice. After more than a decade using these therapies the question arises about whether there is an appropriate time to suspend these therapies, and how this should be done. This review aims to evaluate the current evidence on these topics concerning anti-tumour necrosis factor alpha therapies, and eventually identify conditions and subgroups of patients that could potentially be candidates for withdrawal
Subject(s)
Humans , Inflammatory Bowel Diseases/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Withholding TreatmentABSTRACT
Anti-tumour necrosis factor α therapy in inflammatory bowel disease has been shown to be effective in clinical practice. After more than a decade using these therapies the question arises about whether there is an appropriate time to suspend these therapies, and how this should be done. This review aims to evaluate the current evidence on these topics concerning anti-tumour necrosis factor α therapies, and eventually identify conditions and subgroups of patients that could potentially be candidates for withdrawal.
