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PubMedDate not supplied

Is histology useful for the assessment of the efficacy of immunosuppressive agents in IBD and if so, how should it be applied ?

Crohn's disease and ulcerative colitis are two chronic relapsing inflammatory bowel diseases of unknown etiology. Both conditions are characterized by a considerable morbidity and have an impact upon the social and economic aspects of the patients life. At present, medical treatment is mainly aiming at the control of the inflammation. Drugs used for ulcerative colitis can induce microscopic healing of the mucosa. Similar results have been obtained recently with immunomodulatory drugs in Crohn's disease. The cost of these drugs is however high and the use of these drugs can be associated with side effects. Furthermore, many of the drugs need to be given for a long period. Therefore it is appropriate to assess the efficacy of the drugs before commercial use and even when used in routine practice. For both ulcerative colitis and Crohn's disease, clinical parameters combined in indices and endoscopy are commonly used together with some laboratory tests for the assessment of disease activity. In ulcerative colitis, histology has been used along with the other instruments for the measurement of disease activity because it was shown that the mucosal lesions could improve. More recently, histology has also been used for Crohn's disease. Routinely, disease activity when assessed with microscopy, should be divided into mild, moderate and severe. For drug trials and study purposes, more objective scoring systems should be used. Preferentially, a generally accepted score is used. This allows comparisons between different studies. Different scoring systems have been designed for ulcerative colitis and Crohn's disease. For the latter, multiple biopsies should be analysed. Most scoring systems still need validation.

Biopsy↗
PubMed2005

[Cytoapheresis for IBD].

Ulcerative colitis (UC) is associated with chronic relapsing inflammation of the colon. Cytoapheresis is a therapeutic strategy of extracorporeal immunomodulation that has been used in several immunological disorders. In Japan, several open trials of cytoapheresis for UC patients accumulated encouraging results in bringing steroid-resistant patients into remission. In this paper, three types of cytoapheresis [leukocytapheresis (LCAP), granulocytapheresis (GCAP), and centrifugal leukocyte apheresis] are reviewed.

CD4-Positive T-Lymphocytes↗
PubMed2005

[Evaluation and improvement of QOL among IBD patients].

This article provided a short review on the assessment of quality of life (QOL) among patients with ulcerative colitis. Quantitative approach with psychometric measures has empirically showed that psycho-social aspects of patient's QOL are often affected by her clinical, psychological, and social conditions. Although the control of disease activities plays a pivotal role for improving patient's QOL, more holistic approach such as psychoeducational intervention should also be considered to enhance patient's self-efficacy and sense of control. Besides, qualitative research suggests that helping patient's narrative reconstruction through enhanced communication with the physician may be the most powerful tool that the physician can provide for improving patient's QOL.

Colitis, Ulcerative↗
PubMed2001

Biological therapies in IBD: an international course.

Crohn's disease and ulcerative colitis, both chronic inflammatory bowel diseases, have become an important health problem in the US and in Northern Europe. Both diseases require significant medical therapy for treatment and prevention of relapses. Traditional treatment is based on aminosalicylates and steroids. Steroids are associated with major complications and many patients are either dependent upon or refractory to steroids. The development of new drugs is therefore very important. This is possible because of a better knowledge of the pathogenetic mechanisms of the diseases. Many of the new drugs belong to the family of biologic therapies. Because of the expense of production and the parenteral delivery systems needed for most of them, these therapies must prove to be significantly more effective than traditional drugs. Many biologic agents are still under investigation. Therapeutic strategies directed against tumor necrosis factor (TNF)-alpha, including monoclonal antibodies, such as infliximab and CDP-571 and the human recombinant TNF receptor fusion protein, etanercept, have already been proven to be beneficial, especially in treating Crohn's disease. Treatment with infliximab induces even endoscopic and histologic healing. The benefit of additional immunosuppressive therapy is under investigation. New treatment strategies that might change the natural course of the disease can be considered for Crohn's disease. The experience with biologic agents for ulcerative colitis is still limited. A preliminary study with antegren, a recombinant humanized antibody against integrins is promising. The initial safety experience with infliximab is favorable but, ultimately, evaluation of large populations of patients over many years is required to define the relative safety of biologic agents.

Journal Article↗
PubMed1999

Hepatitis, helicobacter, IBD and colon cancer.

As expected from a meeting the size of Digestive Disease Week (DDW), a large number of high quality papers covering all aspects of gastroenterological research was presented. Many themes emerged running through the symposia and poster sessions and this report is an attempt to bring together the thinking behind some of the more widely discussed themes.

Journal Article↗