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ABSTRACT: : Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. This study explores factors that affect adherence to surveillance colonoscopy.
: Three hundred and seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and at least one-third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics.
: Two hundred and eight patients were female and 189 had ulcerative colitis. The mean age was 49.9 years and mean disease duration 22.9 years. The total number of surveillance colonoscopies performed was 1529, and the mean number per patient was 4.01. The mean interval between surveillance colonoscopies was 2.71 years; 282 patients had a mean interval of <3 years. Self-reported adherence was consistently higher than chart-documented adherence. Significant categories of reasons for nonadherence were logistics (P = 0.012), health perceptions (P = 0.0001); stress regarding procedure, job, or personal life (P = 0.0002); and procedure problems (P = 0.001). The most frequently cited most important reason was difficulty with the bowel preparation (18 patients; 4.8%). Of the 26 patients with inflammatory bowel disease-related dysplasia, 3 had cancer, 4 high-grade dysplasia, 15 low-grade dysplasia, and 4 indefinite dysplasia. Detection of dysplasia was not related to adherence or to lack of adherence.
: In this study, 25.5% of our patients underwent surveillance colonoscopies at >3-year intervals on average. Significant categories of reasons for nonadherence included logistics, health perceptions, stress, and procedure problems.
Inflammatory Bowel Diseases 03/2013; 19(3):534-9. · 4.86 Impact Factor
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ABSTRACT: Patients with extensive ulcerative (UC) or Crohn's (CD) colitis have an increased risk of colon cancer and require colonoscopic surveillance. This study explores patient attitudes and behavior regarding inflammatory bowel disease (IBD), colonoscopies, and colon cancer risk.
In all, 514 patients with UC or CD colitis for at least 7 years and at least one-third of the colon involved participated in this cross-sectional questionnaire study performed at three tertiary referral IBD clinics.
In all, 288 patients were female, 262 had UC, and 252 had CD. The mean age was 48 (range, 20-88) and mean number of years with symptoms was 20 (range, 7-51); 70.8% reported "my doctor" as an extensive information source. The mean perceived lifetime risk of developing colon cancer without having routine colonoscopies was 56% (SD 24.193). We developed and validated a scale of 10 important messages that IBD patients remember doctors discussing with them ("Doctor Told Scale"). Higher scores correlated with better quality of life (P < 0.001) and positive descriptors of colonoscopies and IBD (P < 0.001). Patients with higher scores perceived a higher chance of getting colon cancer without having surveillance colonoscopies (P < 0.001) and were more likely to report that the correct surveillance interval is every 2 years (P < 0.01).
Patients who remember their doctor's messages are more likely to have a positive outlook about colonoscopies and IBD, have a better quality of life, undergo surveillance colonoscopies at the correct interval, and perceive cancer risk more realistically.
Inflammatory Bowel Diseases 09/2011; 18(8):1531-9. · 4.86 Impact Factor
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ABSTRACT: Erlotinib is a tyrosine kinase inhibitor recently approved by the Food and Drug Administration for the treatment of non-small-cell lung cancer and pancreatic cancer. We report a case of a patient with stage IV non-small-cell lung cancer who died of fulminant hepatic failure as a result of treatment with erlotinib.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 09/2007; 5(8):917-20. · 5.64 Impact Factor
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ABSTRACT: IBD is now best considered as a group of genetic disorders of immune dysregulation with failure of downregulation of the intestinal mucosa's normal immune response to its intraluminal commensal bacterial milieu combined with inappropriate migration of antigenic material triggered by multiple host (appendectomy, pregnancy, breast feeding, age) and environmental factors (tobacco smoking, birth control pill, NSAIDS). The result is the predominance of an effector or pro-inflammatory cytokine response due to clonal expansion of T1 and T2 helper lymphocytes (Th1 and Th2 response) combined with an inadequate regulatory cytokine response by T3 helper (Th 3) and T1 regulatory (Tr1) lymphocytes. The persistence of this imbalance in the inflammatory response then leads to tissue damage resulting in both local and systemic illness. In human IBD, a distinction can now be drawn between Crohn's disease with its Th1 effector response characterized by high levels of the cytokines interleukin-12 (IL-12), interferon gamma (IFN) and tumor necrosis factor (TNF) leading to transmural inflammation with granulomas, and ulcerative colitis with a Th2 effector response, high levels of interleukin-4 (IL-4), interleukin-5 (IL-5), interleukin-6 (IL-6), and interleukin-13 (IL-13) characterized by strictly mucosal inflammation. The difficulty with adherence to current maintenance therapy for the inflammatory bowel diseases as well as the toxicity and relative ineffectiveness of induction therapy has provided the impetus for the development of new biologic and novel therapies which will be reviewed in this article. Biologic therapy has been divided into five areas of study: 1) native biologic preparations and isolates such as vaccines, hormone fragments and blood products, 2) recombinant peptides or proteins, including granulocyte macrophage colony stimulating factor, 3) monoclonal antibody-based therapies, 4) anti-sense nucleotides to nucleic acids, and 5) cell and gene therapies. Since the early 1990's, investigation in all five of these areas has yielded numerous potential agents for use in treating IBD more effectively and safely. While only one, infliximab (Remicade), is FDA-approved, several additional agents should be available for clinical use in the near future with the promise of more to follow. Our discussion of biologic and novel therapies represents a review of the most promising treatments and a status report of on-going clinical trials. Peripheral leukocyte apheresis and stem cell transplants, while suggesting an exciting new pathway for investigation, will not be reviewed. Our discussion is organized by each agent's hypothesized mode of intervention in altering the pathogenesis of IBD.
Current Medicinal Chemistry - Anti-Inflammatory & Anti-Allergy Agents 05/2005; 4(3):319-331.
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ABSTRACT: Persistent duodenal stenosis has been noted as a complication of chronic pancreatitis, but its clinical importance and histologic basis have not been defined. We report three patients with chronic alcoholic pancreatitis who developed duodenal stenosis and intractable abdominal pain. In two patients, the stenosis was caused by severe inflammation of pancreatic tissue within the wall of the duodenum. Pancreaticoduodenectomy resulted in prompt and sustained clinical improvement in both patients. In the third patient, who had mural inflammation in the distal stomach and presumably in the duodenum as well, vagotomy and gastrojejunostomy relieved severe duodenal obstruction but not pain. This study supports the view that duodenal stenosis is caused by severe intramural duodenal inflammation and suggests that a pancreaticoduodenectomy may be required for relief of pain.
Digestive Diseases and Sciences 05/1982; 27(6):525-532. · 2.12 Impact Factor
