[Show abstract][Hide abstract] ABSTRACT: Background and aims:
Azathioprine (AZA) is recommended for maintenance of steroid-free remission in IBD. The aim of this study has been to establish the incidence and severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors.
We studied 510 IBD patients (338 Crohn's disease, 157 ulcerative colitis, 15 indeterminate colitis) with initiation of AZA treatment in a prospective multicenter registry study. Acute pancreatitis was diagnosed in accordance with international guidelines.
AZA was continued by 324 (63.5%) and stopped by 186 (36.5%) patients. The most common cause of discontinuation was nausea (12.2%). AZA-induced pancreatitis occurred in 37 patients (7.3%). Of these, 43% were hospitalized with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections, 24% had to vomit and 14% had fever. No patient had to undergo nonsurgical or surgical interventions. Smoking was the strongest risk factor for AZA-induced acute pancreatitis (p<0.0002) in univariate and multivariate analyses CONCLUSIONS: AZA-induced acute pancreatitis is a common adverse event in IBD patients, but had a mild course in all patients. Smoking is the most important risk factor.
Full-text · Article · Oct 2015 · Journal of Crohn s and Colitis
[Show abstract][Hide abstract] ABSTRACT: Background:
The diagnosis of inflammatory bowel disease (IBD) is based on a combination of endoscopic, clinical and biochemical investigations as well as cross-sectional imaging. The applications of cross-sectional imaging in IBD are manifold. Ultrasonography has emerged as an important imaging modality in the diagnosis of Crohn's disease (CD) as well as for monitoring disease progression and in the therapeutic response to CD and ulcerative colitis (UC). Key Messages: Ultrasonography is non-invasive, radiation free, cheap, easy to use and well tolerated and accepted by patients. Bowel ultrasonography can be used for the primary diagnosis of CD as it has a similar sensitivity and specificity like that of MRI and CT, particularly in the case of CD. Ultrasonography can also be used to monitor treatment response to therapy and to detect disease recurrence of CD as well as UC. In CD, ultrasonography can also be used to detect complications such as strictures as well as extramural complications, including abscesses and fistulas. Contrast-enhanced ultrasonography is a useful tool that might be helpful to detect certain indications in CD, in particular the differentiation between abscesses and inflammation.
A variety of advantages of bowel ultrasonography over other imaging modalities suggest the more frequent use of this method to manage IBD patients in daily practice. Bowel ultrasonography should be a standard tool in IBD centers.
No preview · Article · Sep 2015 · Digestive Diseases
[Show abstract][Hide abstract] ABSTRACT: As the current treatment algorithms for patients with chronic inflammatory bowel disease have become more aggressive, often involving anti-TNF therapy, with the aim of reaching deep remission rather than just clinical improvement, the risk of relevant complications has increased. The aim of this review is to point out various potential areas of increased risk and to list necessary precautions to be taken before introducing anti-TNF therapy to keep the risk of complications as low as possible. The main focus is therefore on potential infectious complications, as these are the most frequent complications and as there are effective primary and secondary preventive strategies. Primary strategies include checking and, if necessary, updating the immunization record as well as providing specific advice on lifestyle. Secondary preventive strategies include the detection and treatment of acute or chronic infections, e.g. latent tuberculosis. In addition, special aspects to be considered in elderly patients with inflammatory bowel disease before treatment initiation are mentioned. By following these precautions, we are hopefully more effective in treating our patients, with an acceptable level of risk.
No preview · Article · Jan 2015 · Frontiers of gastrointestinal research
[Show abstract][Hide abstract] ABSTRACT: Intestinal ultrasound (IUS) is a cheap, non-invasive, risk-free procedure, which is significantly underutilized in the diagnosis and management of patients with inflammatory bowel disease (IBD) in the Asia-Pacific region. More cost-effective methods of monitoring disease activity are required in light of the increasing global burden of IBD (especially in Asia), the advent of personalized medicine and the rising cost of healthcare. IUS is a prime example of a technique that meets these needs. Its common clinical applications include assessing the activity and complications of IBD. In continental Europe, countries such as Germany and Italy use this imaging tool as the standard of care and have integrated it into management protocols. There are formal training programs in these countries to train gastroenterologists in IUS and it is used in an outpatient setting during patient consultations. Barriers to its use in the Asia-Pacific region include a lack of experience and research data, and there are few established centers with active training programs. These concerns can be addressed by investing more in IUS service provision, and by increasing allocation of resources towards local research and training. Increased uptake of IUS will ultimately benefit patients with IBD.
Full-text · Article · Dec 2014 · Journal of Gastroenterology and Hepatology
[Show abstract][Hide abstract] ABSTRACT: In the more recent years since the introduction of anti-TNF therapy, the treatment strategy in chronic inflammatory bowel disease has developed more towards an early intensive, often double immunosuppression. While this leads to an improved therapeutic success, this intensified therapy also increases the risk for side effects and especially for infectious complications. The early detection of this complication in the immunocompromised patient is often more difficult due to the potential broad spectrum of infectious agents, the often atypical presentation in conjunction with the immunosuppression as well as often similar symptoms regarding intestinal infectious complications common for a flare of the underlying disease. In the first part, this overview will discuss the broad spectrum of potential infectious complications, using pulmonary infections as an example and presenting an algorithm for detection and therapy. In the second part, common intestinal infectious complications will be discussed from diagnosis to therapy.
Preview · Article · Oct 2014 · Viszeralmedizin / Visceral Medicine