Publications (10)43.89 Total impact
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Article: Post-Operative Recurrence f Crohn's Disease: Impact f Endoscopic Monitoring and Treatment Step-Up.
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ABSTRACT: Aim: Eighty percent of Crohn's disease patients require surgery, of whom 70 percent will require a further operation. Recurrence occurs at the anastomosis. Although often recommended, the impact of post-operative colonoscopy and treatment adjustment is unknown. Method: Patients with a bowel resection over a 10 year period were reviewed and comparison made between those who did and did not have a post-operative colonoscopy within one year of surgery, and those who did or did not have a step-up in drug therapy. Results: Of 222 operated patients 136 (65 male, mean age 33, mean disease duration 8 years, median follow-up 4 years) were studied. Of 70 patients with and 66 without post-operative colonoscopy, clinical recurrence occurred in 49% and 48% (p=NS) and further surgery in 9% and 5% (p=NS). Eighty-nine percent of colonoscoped patients had a decision based on the colonoscopic findings: Of these, 24% had a step-up of drug therapy [antibiotics (n=10), aminosalicylates (n=2), thiopurine (n=5), methotrexate (n=1),) and 76% had no step-up in drug therapy. In colonoscoped patients clinical recurrence occurred in 9 (60%) of 15 patients with, and 23 (49%) of 47 without step up and surgical recurrence in 2 (13%) of 15 and 4 (9%) of 47 (P=NS). Conclusion: Clinical recurrence occurs in a majority of patients soon after surgery. In this cohort, there was no clinical benefit from colonoscopy or increased drug therapy within one year post-operatively. However, the response to the endoscopic findings was not standardised and immunosuppressive therapy was uncommon. Standardising timing of colonoscopy and drug therapy, including more intense therapy may improve outcome, although this remains to be proven. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.Colorectal Disease 07/2012; · 2.93 Impact Factor -
Article: Recommendations for the treatment of ulcerative colitis with infliximab: a gastroenterology expert group consensus.
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ABSTRACT: Infliximab is currently the only biologic approved for treatment of adults with moderate to severe, active ulcerative colitis (UC) unresponsive to conventional therapies. It rapidly controls symptoms, induces and sustains steroid-free remission, stimulates mucosal healing, and reduces serious complications. Although infliximab tends to be reserved for patients with severe disease, it may be even more beneficial for moderate disease earlier in the disease course. Therefore, it is important to identify which patients are candidates for infliximab therapy. A collaborative Delphi survey was used to obtain consensus on use of biologic therapy in patients with UC from an expert panel of 12 gastroenterologists with substantial experience using infliximab in clinical practice and clinical trials. The panel also addressed issues that influence the use of infliximab in UC, including its potential as an alternative to surgery. The panel agreed that: (1) it is necessary to adopt additional treatment goals beyond symptom control, i.e., complete mucosal healing, steroid-free remission, improved QoL, and reduced long-term complications; (2) it may be possible to achieve these treatment goals with infliximab, especially if it is used earlier in the course of UC; and (3) infliximab should be offered as an alternative to surgery in patients being considered for colectomy. The panel also agreed on factors for identifying candidates for infliximab therapy (e.g., persistently active UC, steroid-dependent/refractory disease, and high C-reactive protein). This consensus statement provides useful and practical information on how to achieve evolving treatment goals with infliximab in moderate to severe UC.Journal of Crohn s and Colitis 03/2012; 6(2):248-58. · 2.57 Impact Factor -
Article: Recommendations for the treatment of Crohn's disease with tumor necrosis factor antagonists: an expert consensus report.
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ABSTRACT: Symptom relief is the traditional treatment goal in Crohn's disease (CD). New goals including mucosal healing and bowel preservation are now achievable with tumor necrosis factor (TNF) antagonists. Infliximab and adalimumab are approved as second-line treatments for severe, active CD. Certolizumab pegol is approved only in the U.S. and Switzerland as second-line treatment for moderate-to-severe, active CD. Data from trials of infliximab suggest that high-risk patients and patients with active inflammation (CRP elevation and/or ileocolonic ulcers) may benefit from earlier use of this drug. A Delphi survey was used to obtain consensus on issues surrounding bowel preservation and use of TNF antagonists. At the time of this survey, infliximab was the only TNF antagonist approved for the treatment of CD in Europe, Canada, and Australia. An expert panel of 12 gastroenterologists with substantial clinical experience using infliximab in clinical practice and trials in these areas participated. The experts agreed that bowel preservation and mucosal healing are relevant and achievable goals, and form a rationale for using TNF antagonists in CD patients. Control of inflammation and induction of mucosal healing were considered essential for bowel preservation. Consensus areas: 1) mucosal healing is predictive of improved long-term disease course and increases the likelihood of steroid-free remission; 2) infliximab induces sustained mucosal healing, promotes bowel preservation, and reduces hospitalizations and surgeries; 3) benefits of infliximab in relation to mucosal healing, bowel preservation, and clinical remission increase when therapy is initiated earlier. Treatment with TNF antagonists helps preserve the bowel in CD patients.Inflammatory Bowel Diseases 01/2012; 18(1):152-60. · 4.86 Impact Factor -
Article: High incidence of inflammatory bowel disease in Australia: a prospective population-based Australian incidence study.
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ABSTRACT: To date, there have been no population-based epidemiological studies published from Australia concerning the incidence of inflammatory bowel disease (IBD). Our hypothesis was that the incidence of IBD in Australia is at least as high as other industrialized countries, given similar genetic and environmental risk factors. A prospective, population-based IBD incidence study was conducted between April 2007 and March 2008 in Greater Geelong, Victoria, Australia. According to 2006 Australian Census data, this comprises an at-risk population of 259,015. Cases were ascertained from multiple overlapping sources. All local general practitioners, gastroenterologists, surgeons, and pediatricians were contacted every 2 months to identify new IBD cases. The Royal Children's Hospital in Melbourne, local endoscopy and pathology centers were also searched to ensure completeness of case capture. Standard IBD case definitions were used with clinical, endoscopic, and histological criteria. In all, 76 new cases of IBD were identified during the 1-year period. There were 45 cases of Crohn's disease, 29 of ulcerative colitis, and 2 of indeterminate colitis. The crude annual incidence rates for IBD overall, Crohn's disease, ulcerative colitis, and indeterminate colitis were 29.3 per 100,000 (95% confidence interval [CI] 23.5-36.7 per 100,000), 17.4 per 100,000, 11.2 per 100,000, and 0.8 per 100,000, respectively. When directly age-standardized to the World Health Organization standard population the overall IBD incidence rate was 29.6 per 100,000. This is the first prospective, Australian population-based IBD incidence study. The incidence rates are among the highest reported in the literature of IBD.Inflammatory Bowel Diseases 09/2010; 16(9):1550-6. · 4.86 Impact Factor -
Chapter: Cancer Surveillance in Inflammatory Bowel Disease
05/2010: pages 518 - 527; , ISBN: 9781444318418 -
Article: What is the optimal interval of surveillance colonoscopy in patients with long-standing ulcerative colitis?
Inflammatory Bowel Diseases 10/2008; 14 Suppl 2:S194-5. · 4.86 Impact Factor -
Article: Two-year combination antibiotic therapy with clarithromycin, rifabutin, and clofazimine for Crohn's disease.
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ABSTRACT: Mycobacterium avium subspecies paratuberculosis has been proposed as a cause of Crohn's disease. We report a prospective, parallel, placebo-controlled, double-blind, randomized trial of 2 years of clarithromycin, rifabutin, and clofazimine in active Crohn's disease, with a further year of follow-up. Two hundred thirteen patients were randomized to clarithromycin 750 mg/day, rifabutin 450 mg/day, clofazimine 50 mg/day or placebo, in addition to a 16-week tapering course of prednisolone. Those in remission (Crohn's Disease Activity Index <or=150) at week 16 continued their study medications in the maintenance phase of the trial. Primary end points were the proportion of patients experiencing at least 1 relapse at 12, 24, and 36 months. At week 16, there were significantly more subjects in remission in the antibiotic arm (66%) than the placebo arm (50%; P=.02). Of 122 subjects entering the maintenance phase, 39% taking antibiotics experienced at least 1 relapse between weeks 16 and 52, compared with 56% taking placebo (P=.054). At week 104, the figures were 26% and 43%, respectively (P=.14). During the following year, 59% of the antibiotic group and 50% of the placebo group relapsed (P=.54). Using combination antibiotic therapy with clarithromycin, rifabutin, and clofazimine for up to 2 years, we did not find evidence of a sustained benefit. This finding does not support a significant role for Mycobacterium avium subspecies paratuberculosis in the pathogenesis of Crohn's disease in the majority of patients. Short-term improvement was seen when this combination was added to corticosteroids, most likely because of nonspecific antibacterial effects.Gastroenterology 06/2007; 132(7):2313-9. · 11.68 Impact Factor -
Article: Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small-bowel Crohn's disease.
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ABSTRACT: The diagnosis of small-bowel Crohn's disease sometimes is difficult and may be missed by conventional imaging studies. Capsule endoscopy might identify small-bowel disease undetected by other investigations. Patients with or without known Crohn's disease who were suspected to have small-bowel Crohn's disease were prospectively evaluated with push enteroscopy, enteroclysis, and capsule endoscopy. Each examiner was blinded to results of other investigations. Referring doctors were required to complete questionnaires before and after the investigations. Twenty-two patients were known to have Crohn's disease (Group 1), and 21 were suspected to have small-bowel Crohn's disease (Group 2). In Group 1, capsule endoscopy detected more erosions than the other two investigations (p < 0.001). In Group 2, a new diagnosis of Crohn's disease was made in two patients, but there was no significant difference in yield compared with the other two investigations. Referring physicians rated the usefulness of capsule endoscopy as 4.4 on a scale of 5. Capsule endoscopy changed management for 30 patients (70%). Capsule endoscopy has a higher yield than push enteroscopy and enteroclysis in patients with known Crohn's disease when small-bowel mucosal disease is suspected, and this leads to a change in management in the majority of these patients.Gastrointestinal Endoscopy 03/2005; 61(2):255-61. · 4.88 Impact Factor -
Article: PRO: Endoscopic surveillance minimizes the risk of cancer.
The American Journal of Gastroenterology 10/2004; 99(9):1631-3. · 7.28 Impact Factor -
Article: Torsion bar spring for automobile suspension.
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ABSTRACT: Thesis (M.S. in M.E.)--University of Texas at Austin, 1947. Vita. Bibliography: ℓ. 26-28.
Top co-authors
Top Journals
Institutions
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2004–2010
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St. Vincent's Hospital Melbourne
- Department of Gastroenterology
Melbourne, Victoria, Australia
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2008
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Saint Vincent Hospital
Worcester, MA, USA
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