RESUMO
INTRODUCTION: The response of Crohn's disease (CD) to infliximab is initially good, although a loss of efficacy is observed over time. Dose escalation has been recommended in such cases. AIMS: To study the response to an intensified infliximab regimen in patients with CD; and to evaluate the adverse effects associated with intensification of therapy and identify predictors of loss of response. METHODS: We performed a retrospective multicenter survey of all patients with CD who had been treated with at least the 3 induction doses of standard infliximab therapy, and for whom treatment had to be intensified due to loss of response. We analyzed the efficacy of the intensified regimen. RESULTS: Thirty-three patients were included. After the first intensification dose, 79% of patients had a clinical response (33.5% complete response, 45.5% partial response). In the long term, 83%, 69%, 47%, and 29% of patients who had an initial response to the intensification maintained the response at 6, 12, 18, and 36 months, respectively. The loss of efficacy after escalation was 43% per patient-year of follow-up. One patient had an infusion reaction after 36 doses. One patient developed a herpes zoster infection. CONCLUSIONS: A high proportion of patients whose dose of infliximab is increased due to loss of efficacy respond initially. However, nearly half lose the response after one year. The safety profile of an intensified infliximab regimen is good.
Assuntos
Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Doença de Crohn/tratamento farmacológico , Adulto , Idoso , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Feminino , Seguimentos , Humanos , Infliximab , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The long-term efficacy of adalimumab in patients with ulcerative colitis is not well known. AIM: To evaluate the short- and long-term outcomes of adalimumab in ulcerative colitis patients previously treated with infliximab. METHODS: Patients with active ulcerative colitis were treated with adalimumab after failure of other therapies including infliximab. Short-term clinical response and remission were assessed at weeks 4 and 12. The proportion of patients who continued on adalimumab and the proportion of patients who remained colectomy free were assessed over the long term. RESULTS: Clinical response at weeks 4 and 12 was achieved in 16 (53%) and 18 (60%) patients, respectively, and clinical remission was obtained in 3 (10%) and 8 (27%) patients, respectively. After a mean 48 weeks' follow-up, 15 patients (50%) continued on adalimumab. Six patients (20%) required colectomy. All patients who achieved clinical response at week 12 were colectomy free at long term. CONCLUSIONS: Adalimumab was well tolerated and induced durable clinical response in many patients with otherwise medically refractory ulcerative colitis. Patients achieving clinical response at week 12 avoided colectomy over the long term.
Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Adalimumab , Adulto , Anticorpos Monoclonais Humanizados , Colectomia , Colite Ulcerativa/cirurgia , Feminino , Humanos , Infliximab , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Retratamento , Fatores de Tempo , Resultado do TratamentoAssuntos
Humanos , Masculino , Adulto , Doença de Crohn/complicações , Pioderma Gangrenoso/diagnóstico , Corticosteroides/administração & dosagem , Pioderma Gangrenoso/tratamento farmacológico , Administração Oral , Corticosteroides/uso terapêutico , Biópsia , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Diagnóstico Diferencial , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Pioderma Gangrenoso/patologia , Pele/patologiaRESUMO
No disponible
Assuntos
Humanos , Remoção de Componentes Sanguíneos/métodos , Granulócitos , Doenças Inflamatórias Intestinais/imunologia , Colite Ulcerativa/imunologia , Doença de Crohn/imunologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doença de Crohn/complicações , Fístula Intestinal/complicações , Fístula Cutânea/etiologia , Recusa do Paciente ao TratamentoRESUMO
Inflammatory bowel disease commonly affects women with child-bearing potential, and clinical activity extent is most relevant at the time of conception. Below, we report on the case of a 19-year-old woman who was admitted for first-trimester metrorrhagia and fever, with various extraintestinal manifestations, mainly including erythema nodosum and episcleritis during the course of disease. The differential diagnosis of these manifestations led to the diagnosis of Crohn's disease, which involved the whole colon.
Assuntos
Doença de Crohn/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Doença de Crohn/complicações , Feminino , Febre/etiologia , Humanos , Metrorragia/etiologia , Gravidez , Primeiro Trimestre da GravidezRESUMO
La enfermedad inflamatoria intestinal afecta frecuentemente a mujeres en edad fértil, siendo fundamental el grado de actividad clínica en el momento de la concepción. A continuación se presenta el caso de una mujer de 19 años que ingresa por metrorragia del primer trimestre y fiebre; destacando durante su evolución la aparición de diferentes manifestaciones extraintestinales, fundamentalmente eritema nodoso y epiescleritis. A través del diagnóstico diferencial de estas manifestaciones se llegó al diagnóstico de una enfermedad de Crohn que afectaba a todo el colon
Assuntos
Feminino , Gravidez , Adulto , Humanos , Doença de Crohn/diagnóstico , Complicações na Gravidez/diagnóstico , Doença de Crohn/complicações , Metrorragia/etiologia , Primeiro Trimestre da GravidezRESUMO
No disponible
Assuntos
Feminino , Idoso , Idoso de 80 Anos ou mais , Humanos , Melanoma/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Fígado/patologiaRESUMO
A case of gangliocytic paraganglioma of the papilla of Vater in a 76-year-old man with a history of recurrent obstructive jaundice is presented. This is the first case of gangliocytic paraganglioma of the major papilla successfully resected by endoscopic ampullectomy.
Assuntos
Neoplasias do Ducto Colédoco/cirurgia , Paraganglioma/cirurgia , Idoso , Ampola Hepatopancreática/patologia , Biópsia , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias do Ducto Colédoco/patologia , Humanos , Masculino , Paraganglioma/patologia , Segurança , Resultado do TratamentoRESUMO
BACKGROUND: Alpha and beta interferon (IFN-alpha and beta) treatment is associated with the synthesis of thyroid autoantibodies and the development of autoimmune thyroid diseases. METHODS AND RESULTS: We have retrospectively evaluated their effect in patients with chronic viral hepatitis (CH) (n = 118) and multiple esclerosis (ME) (n = 10). Thyroid dysfunction has been detected in 7.4% of patients, and seroconversion in 4.7%. CONCLUSIONS: Pre-treatment antithyroid antibodies do not predispose to altered thyroid function, after IFN therapy; their presence should not contraindicate IFN treatment.
Assuntos
Antivirais/efeitos adversos , Hepatite Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Tireoidite Autoimune/induzido quimicamente , Tireoidite Autoimune/imunologia , Doença Aguda , Adulto , Anticorpos Anti-Idiotípicos/biossíntese , Anticorpos Anti-Idiotípicos/imunologia , Feminino , Hepatite Crônica/virologia , Humanos , Iodeto Peroxidase/imunologia , Masculino , Estudos Retrospectivos , Testes de Função Tireóidea/métodos , Tireoidite Autoimune/diagnósticoRESUMO
A 65-year-old man was admitted to our hospital with gastrointestinal bleeding. Seventeen years previously, he had a Billroth II procedure for a bleeding duodenal ulcer. A gastroscopy performed on admission showed a stomal ulcer with signs of recent haemorrhage. In the proximal end of the afferent loop, we saw retained gastric mucosa. Histological evaluation confirmed the existence of antrum gastric mucosa. Other diagnostic test for retained gastric antrum were normal. The different approaches in the diagnosis of retained gastric antrum, the importance of our findings and the clinic implications are discussed. We conclude that endoscopic management may be the first diagnostic method in the assessment of retained gastric antrum, and it's possible to find gastric mucosa in the proximal end of the afferent loop (antrum retained), without clinic manifestations.