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PubMed2004

[The conservative treatment of nonspecific inflammatory bowel diseases].

The treatment of inflammatory bowel diseases includes the nutritional management, the pharmacotherapy and the surgical treatment. The main aim of treatment is to achieve the remission, to prevent a relapse and to take a decision of surgical treatment. The treatment is introduced in the relevance to the intensification of disease. To assess properly the level of the intensification of disease there is a need of deep knowledge of clinical manifestations of the disease. In the treatment the corticosteroids, 5-aminosalicylic acid (5-ASA) or immunosuppressive treatment are used. Immunosuppressive treatment is now a widely accepted standard in Crohn's disease treatment. Some cases of Crohn's disease could be treated with anti-TNFalpha antibodies that successfully treat the relapses of disease. This treatment is especially well suited to cases that are not successfully treated with the standard pharmacological treatment. The nonsurgical treatment is successful in most cases. There are no standards of treatment of microscopic colitis. We usually start the treatment with 5-ASA and an antidiarrheal agent. In case of failure of this treatment we introduce corticosteroids. In this paper authors present basic information about the current state of knowledge about inflammatory bowel diseases treatment.

Anti-Inflammatory Agents↗
PubMed2002

Providing disease-related information worsens health-related quality of life in inflammatory bowel disease.

BACKGROUND: Patients with inflammatory bowel disease (IBD) have identified a need for more information about their disease. PURPOSE: To assess the effect of an educational intervention on health-related quality of life (HRQOL) in patients with IBD. METHODS: Consecutive ambulatory IBD patients were randomized to receive four IBD-specific educational booklets or usual care. Subjects completed two disease-specific HRQOL questionnaires-the Inflammatory Bowel Disease Questionnaire (IBDQ) (range 1-poor to 7-excellent) and the Quality Index in Crohn's and Colitis (QuICC) (range 1-excellent to 5-poor) at entry and after 2 weeks. The mean change in HRQOL scores at follow-up was compared between the education and control groups. RESULTS: 59 subjects participated, with a mean age of 40.0 +/- 11.9 years. 34 were given educational booklets and 25 received standard care. 6 patients (10%) did not complete the study. Mean IBDQ scores became significantly worse in the education group with a change of -0.17 +/- 0.49 compared with controls at +0.28 +/- 0.62 (p = 0.006). This could be explained by worsened disease activity in the education group. There was no significant change in the QuICC scores (p = 0.61). Education group patients who had not received prior educational material had improved mean IBDQ scores of +0.24 +/- 0.47 compared with education patients who had received educational material prior to this study, with a score change of -0.25 +/- 0.46 (p = 0.09). CONCLUSIONS: The addition of educational booklets to IBD patients in a tertiary center does not improve, and may worsen, short-term HRQOL. Education of newly diagnosed or less informed patients should be studied further.

Adult↗
PubMed2003

Previous experience and quiality of life in patients with inflammatory bowel disease during relapse.

BACKGROUND: inflammatory bowel disease (IBD) permanently impairs patients' perception of their health-related quality of life(HRQoL). A variable that may influence HRQoL perception is the capacity to cope with the disease, which may be influenced by previous experiences. In this respect, it is unknown whether past experience with previous relapses of IBD influences HRQoL perception. OBJECTIVE: the present study aims to determine whether HR-QoL at disease onset differs from that in repeated relapses of the disease. PATIENTS AND METHOD: 120 patients with clinically active IBD according to the Rachmilewitz index for the 57 patients with ulcerative colitis (UC) or the Harvey-Bradshaw index for the 63 with Crohn's Disease (CD). Patients were divided into two different groups depending on whether the outbreak was at onset of the disease (42 patients) or corresponded to the fourth or more relapses(78 patients). Each patient completed three HRQoL questionnaires: two generic (EuroQol and the Psychological General Well-Being Index -PGWBI-) and one specific (Inflammatory Bowel Disease Questionnaire -IBDQ-). RESULTS: patient characteristics (age, sex, smoking habit, activity index, hospital admission) were similar among the 4 groups of patients included. Time of evolution since diagnosis was significantly longer in the prolonged disease groups (median [percentiles 25-75]: (40 124-481 and 68 [36-120] for UC and CD, respectively) compared with the debut groups (1 [1-21 and 2 [1-2] for UC and CD, respectively) (p<0.001). IBDQ score did not differ between debut and prolonged disease groups either in UC or CD(4.0 vs 4.1 in CC and 4.3 us 4.3 in CD, p=ns). Absence of differences was also observed with the PGWBI (89 vs 78 in UC and 80.5 us 83 in CD, p=ns) and the EuroQol (tariff of 0.64 vs 0.57 in UC and 0.60 us 0.68 in CD, p=ns). CONCLUSIONS: accumulated previous experience with IBD relapses does not seem to significantly affect HRQoL perception during relapses of the disease.

Adult↗
PubMed2002

Self-reported awareness and use of the International Classification of Diseases coding of inflammatory bowel disease services by Ontario physicians.

RATIONALE: Population and health services research can be performed by linkage analysis of administrative data. However, the robustness of study results is determined by the accuracy of the diagnostic coding. OBJECTIVES: To estimate the awareness, use and accuracy of the International Classification of Diseases, Ninth Revision (ICD-9) coding by physicians providing services for patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS: All Ontario gastroenterologists and a 10% random sample of internists, pediatricians, pediatric or general surgeons, and family physicians were surveyed by postal questionnaire to estimate the frequency and 95% CI of using codes 555 or 556 when billing for CD- and UC-related services, respectively. c2 tests were used for between-group comparisons. RESULTS: Of the physicians who were surveyed, 67.7% (416 of 614) responded; 258 of 391 (66%) who were still practising in Ontario saw patients with inflammatory bowel disease (IBD), and 54% had more than 10 IBD patients; 86.5% (95% CI 82.4% to 90.6%) were familiar with ICD-9 codes, and 91.4% (95% CI 88.1% to 95.6%) used the codes 555 (CD) or 556 (UC) for billing. Rates of ICD-9 use did not differ by sex but were used more frequently by those graduating after 1981 (P<0.02). Gastroenterologists used ICD-9 IBD codes 555 or 556 significantly more often than all other physicians (P=0.001). Most (more than 75%) Ontario physicians used ICD-9 IBD codes always or frequently when billing for IBD-related services. Few (10%) used these codes to bill for non-IBD-related problems. CONCLUSIONS: These data suggest that there is acceptable use and accuracy of ICD-9 diagnostic coding for CD and UC services - comparable with results from studies of other diseases. Administrative data may thus be used to undertake epidemiological studies in IBD in Ontario.

Awareness↗
PubMed1993

Gut lavage fluid protein concentrations: objective measures of disease activity in inflammatory bowel disease.

BACKGROUND: Fluid obtained by whole gut lavage normally contains traces of immunoglobulin (Ig) G, albumin, and alpha-1-antitrypsin; higher concentrations have been found in patients with inflammatory bowel disease (IBD). METHODS: In a prospective study, 53 lavages were performed in 45 IBD patients (27 Crohn's disease, 18 ulcerative colitis), in whom disease activity was simultaneously assessed by Crohn's Disease Activity Index or Powell Tuck index. Concentration of IgG in lavage fluid was measured by enzyme-linked immunosorbent assay, and of albumin and alpha-1-antitrypsin by immunoturbidimetry. RESULTS: For IgG, concentrations in lavage fluid correlated closely with activity indices: in Crohn's disease, r = 0.723 (P < 0.0001), in ulcerative colitis, r = 0.714 (P < 0.0001). Results for albumin and alpha-1-antitrypsin concentrations were similar to those for IgG, but they were less sensitive in detecting active disease. However, this method cannot be used as a diagnostic test for IBD; normal results were obtained for IgG in 6 (all inactive) of 42 lavages in patients who had unequivocal radiological or endoscopic abnormalities. CONCLUSIONS: Assay of protein concentrations in gut lavage fluid is a simple, objective means of grading disease activity in patients with IBD; its potential uses are likely to be in the evaluation of complex cases and in clinical trials.

Adult↗
PubMed1995

Inflammatory Bowel Disease Questionnaire: cross-cultural adaptation and further validation.

OBJECTIVES: The Inflammatory Bowel Disease Questionnaire (IBDQ) is a disease-specific quality of life instrument. We translated and adapted the questionnaire and tested its reliability and (cross-cultural) validity. METHODS: We surveyed 271 patients with inflammatory bowel disease. The inflammatory Bowel Disease Questionnaire and its dimensional scores (bowel, systemic, social and emotional) were correlated with disease activity, health care use, medication and three other indices of quality of life. RESULTS: The reliability coefficient of the Inflammatory Bowel Disease Questionnaire was high (0.93). Patients with higher disease activity had significantly lower quality of life on all Inflammatory Bowel Disease Questionnaire dimensions (P < 0.001). Inflammatory Bowel Disease Questionnaire scores were significantly correlated with health care use (P < 0.01) but not with medication. Almost all Inflammatory Bowel Disease Questionnaire dimensions correlated highly (0.43-0.79, P < 0.001) with the corresponding scales of the standard quality of life indices, except for the bowel dimension. Modified Dutch Inflammatory Bowel Disease Questionnaire scores were consistent with Canadian Inflammatory Bowel Disease Questionnaire norms. CONCLUSIONS: These results support the Inflammatory Bowel Disease Questionnaire as a reliable and valid measure of the quality of life of inflammatory bowel disease patients in multicultural research settings.

Adaptation, Psychological↗
PubMed1995

The association of inflammatory bowel disease and leukemia--coincidence or not?

Inflammatory bowel diseases, (IBD) including Crohn's disease and ulcerative colitis, are chronic systemic disorders associated with intestinal and other systemic features. Common hematological manifestations of IBD include: anemia, hypercoagulable state, leukocytosis and thrombocytosis. Recently it has been recognized that lymphoma and leukemia can also be associated with both Crohn's disease and ulcerative colitis. Careful review of the literature reveals more than 30 cases of leukemia reported in patients with IBD. Epidemiological data show that this association is statistically significant (relative risk of 5.3; p < 0.01; 95% confidence interval). This review attempts to characterize the clinical features of this association. The etiology of leukemia in these cases seems to be multifactorial and may involve: genetic susceptibility, environmental factors, immune abnormalities, prior exposure to diagnostic radiation and a variety of therapeutic modalities. No definitive time interval, specific pattern or correlation between the extent of bowel involvement and type of leukemia was found. Treatment of leukemia might affect the activity and severity of the inflammatory bowel disease, but there is very little data relating to this issue. There is some evidence suggesting that bone marrow transplantation performed for leukemia may induce remission of both diseases. Further investigation is still required in the future in order to establish a definite relationship between these two disorders.

Adolescent↗
PubMed2003

Bone density improves with disease remission in patients with inflammatory bowel disease.

BACKGROUND AND AIMS: Patients with inflammatory bowel disease (IBD) are at risk of low bone mineral density (BMD). The aim of this cross-sectional study was to investigate (i) whether patients with IBD in long-term remission have greater bone density relative to patients with active disease, (ii) the effect of remission on BMD in ulcerative colitis and Crohn's disease, and (iii) the effect of azathioprine treatment, used to induce remission, on BMD. PATIENTS AND METHODS: BMD relative to the age-standardised mean (Z-score) was measured by dual-energy X-ray absorptiometry at the left femoral neck and lumbar spine in consecutive patients with IBD. Patients were divided into the following groups: (i) active disease, (ii) remission of less than one year, (iii) remission of one to three years, and (iv) remission of more than three years. Active disease was defined as three or more bowel motions per day, treatment with oral or rectal corticosteroids, and/or presence of a fistula. The subgroups with ulcerative colitis and Crohn's disease and the effect of taking azathioprine were compared. All results were controlled for confounding variables. RESULTS A total of 137 (64 ulcerative colitis, 73 Crohn's disease) patients were evaluated. Patients in remission for more than three years had a normal mean Z-score that was significantly higher than those with active disease at both the femoral neck and the lumbar spine for both ulcerative colitis and Crohn's disease. Patients taking azathioprine and in remission had significantly higher mean Z-scores at the lumbar spine than patients with active disease and who were not taking azathioprine. CONCLUSION: In patients with ulcerative colitis and Crohn's disease, age-matched BMD is higher with increasing duration of disease remission and induction of remission by azathioprine.

Adult↗
PubMed1999

Novel treatments in inflammatory bowel disease.

Recent advances in inflammatory bowel disease therapeutics have led to improved formulations of existing treatments and new indications for established drugs. Truly novel therapies based on recent understanding of pathogenesis are also being developed. These new treatments and their likely impact on the management of inflammatory bowel disease in the future are discussed.

Gastrointestinal Agents↗
PubMed1997

Significance of interleukin-1beta and interleukin-1 receptor antagonist genetic polymorphism in inflammatory bowel diseases.

OBJECTIVE: Genetic susceptibility to inflammatory bowel disease is well recognized. There is also increasing evidence for the activation of the mucosal immune system and the production of inflammatory cytokines, i.e., interleukin (IL)-1ra and IL-1beta in the inflammatory bowel disease. The aim of this study was to analyze the IL-1beta and IL-1ra gene polymorphism and linkage disequilibrium coefficient between the different alleles of these genes in patients with Crohn's disease (CD) or ulcerative colitis (UC), according to the severity of the disease. METHODS: Two hundred twenty-eight inflammatory bowel disease patients (87 UC and 141 CD) were included in this study and compared with 113 unrelated controls. The IL-1beta and IL-1ra gene polymorphism was studied after specific amplification of variable regions by PCR. A penta-allelic polymorphism, corresponding to a VNTR region located in intron 2 of the IL-1ra gene, was analyzed, whereas bi-allelic RFLPs displayed by two restriction enzymes (TaqI and AvaI) at position -511 of the IL-1beta gene were analyzed. RESULTS: There was no significant difference of genotype distribution between controls and CD or UC patients. However, surgically treated UC patients were characterized by a higher frequency of genotype IL-1ra 1-2 (39 vs 16%, pc < 0.01) compared with nonoperated UC patients. Moreover, nonoperated UC patients displayed a lower frequency of IL-1ra allele 2 than surgically treated UC patients (14 vs 34%, pc < 0.002) or controls (14 vs 30%, pc < 0.005). Furthermore, simultaneous analysis of the IL-1beta and IL-1ra genes that are located in the same region of chromosome 2 revealed that CD patients carrying the IL-1beta allele 2 were more often noncarriers of IL-1ra allele 2 (p < 0.005). Moreover, UC and CD patients were, characterized by a lower frequency of the association of IL-1ra allele 2 and IL-1beta allele 2 compared with controls (8.3 vs 20.3% and 10.6 vs 20.3%, p < 0.03). CONCLUSIONS: IL-1ra and IL-1beta gene polymorphism analysis from a clinical standpoint might help in defining UC prognosis. However, functional studies at both the circulating and mucosal level with stratification on allele associations, especially IL-1ra allele 2-IL-1beta allele 2 subgroups must be realized before therapeutic implications.

Adult↗
PubMed2005

The pathophysiologic rationale for biological therapies in inflammatory bowel disease.

PURPOSE OF REVIEW: Inflammatory bowel disease is driven by an excessive immune response in the gut wall. This review summarises important new developments in understanding this immune response and the downstream mechanisms of intestinal injury, alongside their potential role in opening up new avenues of treatment. RECENT FINDINGS: The evidence continues to accumulate that Crohn's disease is primarily due to a T helper cell-type 1 immune response in the gut wall. IL-12 and IL-18 appear to be the cytokines primarily responsible for Th1 polarisation, but IL-21 may also be important. The p40 chain of IL-12 also associates with a novel p19 chain to form IL-23 which is also a potent Th1-inducing cytokine but the expression of IL-23 in Crohn's disease has not been reported. Progress in understanding the immunology of ulcerative colitis remains slow, but IL-13 produced by natural killer T cells may be involved. T-cell resistance to apoptosis occurs in Crohn's disease, and human and mouse studies indicate that the signalling molecule STAT3, which transduces signals from IL-6 and IL-10, is involved in mucosal T cell homeostasis. Fibroblasts and metalloproteinases continue be implicated in ulceration, fibrosis, and fistula formation. SUMMARY: Understanding the immunology of inflammatory bowel disease continues to underpin the vast majority of new therapies and identifies new targets. Novel approaches, such as exploiting the antiinflammatory role of cannabinoid receptors, may also prove productive in the future.

Animals↗
PubMed1982

[Clinical features of inflammatory bowel disease (author's transl)].

Inflammatory bowel disease may be caused by virus, bacteria, fungus, parasites or mechanical conditions. Among the inflammatory bowel diseases caused by bacteria salmonellosis and cholera are most important. Their treatment has been revolutionized within the last decade. Instead of the administration of antibiotics the usage of fluids, glucose and electrolytes represents the method of choice. Using the so called "traveller's disease" as an example the pathophysiological aspects of the treatment may be best explained. Etiology and pathogenesis of Crohn's disease, the incidence of which seems to be increasing lately, are still unknown. Before onset of treatment it is essential to establish an exact diagnosis, further to determine distribution and inflammatory activity, as those control the therapy. Salazosulphapyridine and steroids have proved effective drugs. Azathioprine should only be used combined with steroids. Recent investigations suggest that certain formula diets, such as e. g. Survimed, may be useful in the management of the disease as well.

Azathioprine↗
PubMed2004

Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism?

BACKGROUND: Patients with inflammatory bowel disease (IBD) are thought to be at increased risk of venous thromboembolism (TE). However, the extent of this risk is not known. Furthermore, it is not known if this risk is specific for IBD or if it is shared by other chronic inflammatory diseases or other chronic bowel diseases. AIMS: To compare the risk of TE in patients with IBD, rheumatoid arthritis, and coeliac disease with matched control subjects. PATIENTS AND METHODS: Study subjects answered a questionnaire assessing the history of TE, any cases of which had to be confirmed radiologically. A total of 618 patients with IBD, 243 with rheumatoid arthritis, 207 with coeliac disease, and 707 control subjects were consecutively included. All three patient groups were compared with control subjects matched to the respective group by age and sex. RESULTS: Thirty eight IBD patients (6.2%) had suffered TE. This was significantly higher compared with the matched control population with only 10 cases reported (1.6%) (p<0.001; odds ratio (OR) 3.6 (95% confidence interval (CI) 1.7-7.8)). Five patients with rheumatoid arthritis (2.1%) had suffered TE compared with six subjects (2.5%) in the control population matched to patients with rheumatoid arthritis (NS; OR 0.7 (95% CI 0.2-2.9)). TE had occurred in two patients with coeliac disease (1%) compared with four subjects (1.9%) in the control population matched to the coeliac disease group (NS; OR 0.4 (95% CI 0.1-2.5)). In 60% of TE cases in the IBD group, at least one IBD specific factor (active disease, stenosis, fistula, abscess) was present at the time TE occurred. CONCLUSIONS: IBD is a risk factor for TE. It seems that TE is a specific feature of IBD as neither rheumatoid arthritis, another chronic inflammatory disease, nor coeliac disease, another chronic bowel disease, had an increased risk of TE.

Adult↗
PubMed1998

Genetics of inflammatory bowel disease.

1. The aetiology of the chronic inflammatory bowel diseases, Crohn's disease and ulcerative colitis, is uncertain. Studies of specific environmental factors and immune dysfunction have provided little insight into disease pathogenesis. 2. Concordance rates in twin pairs and siblings provide strong evidence that genetic factors are important in disease pathogenesis. In Oxford, information was obtained from 433 adult patients with Crohn's disease. Compared with the prevalence in the general population, the relative risks in siblings of patients with Crohn's disease calculated from these data were respectively 36.5 for Crohn's disease, 16.6 for ulcerative colitis and 24.7 for inflammatory bowel disease. 3. Clinical patterns of disease were compared in members of over 250 multiply affected families with inflammatory bowel disease. A high degree of concordance for many characteristics was noted (disease type, extent, extra-intestinal manifestations). However, in 77 affected parent-child pairs, the median age of onset in the parents was significantly higher than in offspring (P < 0.0001). These data reflect the results from other studies throughout the world, and are consistent with the phenomenon of genetic anticipation. 4. A detailed study investigating the contribution of the major histocompatibility complex was undertaken. Eighty-three affected sibling pairs were involved in a linkage analysis study; 348 patients with inflammatory bowel disease and 472 controls were involved in a detailed allelic association study. These data provide evidence that the major histocompatibility complex is an important determinant in ulcerative colitis, but not in Crohn's disease. 5. Cytokine genes are important candidate genes in inflammatory bowel disease. Allelic association study was performed to investigate the contribution of the gene encoding the interleukin-1 receptor antagonist and tumour necrosis factor-alpha. These data do not suggest that these genes encode important determinants of disease susceptibility in inflammatory bowel disease. 6. A two-stage genome-wide search for susceptibility loci in inflammatory bowel disease was performed involving 186 affected sibling pairs. The data provide strong evidence for the model of Crohn's disease and ulcerative colitis as related polygenic disorders. Loci on chromosomes 3, 7 and 12 were linked to inflammatory bowel disease overall, whereas loci on chromosomes 2 and 6 were linked only in ulcerative colitis. Linkage with chromosome 16 was noted in Crohn's disease only. Fine mapping of these susceptibility loci is in progress, and may lead to gene identification with attendant clinical benefits.

Age of Onset↗
PubMed2005

Efficacy and tolerability of oral iron therapy in inflammatory bowel disease: a prospective, comparative trial.

BACKGROUND: In patients with inflammatory bowel disease, oral iron is anecdotally reported to be less effective and less well tolerated than in those without inflammatory bowel disease, and to increase disease activity. AIM: To study prospectively the effects of oral iron in patients with and without inflammatory bowel disease. METHODS: Patients with ulcerative colitis, Crohn's disease and non-inflammatory bowel disease controls, all with iron deficiency anaemia, were assessed with symptom diaries, a quality of life questionnaire (Inflammatory Bowel Disease Questionnaire; inflammatory bowel disease patients only) and blood tests to measure iron repletion, disease activity and antioxidant capacity before and after starting 4 weeks of oral iron. In patients with ulcerative colitis, sigmoidoscopic scoring and rectal biopsies for reactive oxygen metabolite production were performed before and after iron therapy. RESULTS: All groups showed increases in haemoglobin and ferritin. Iron intolerance occurred in about a quarter of patients in each group. Two of 33 (6%) of inflammatory bowel disease patients had a relapse during treatment. Symptoms worsened in ulcerative colitis, but not in Crohn's disease or non-inflammatory bowel disease patients; Inflammatory Bowel Disease Questionnaire scores improved in ulcerative colitis. Laboratory markers of disease activity, sigmoidoscopic scores, histological scores, antioxidant capacity levels and reactive oxygen metabolite production did not change. CONCLUSIONS: Oral iron is equally efficacious and well tolerated in inflammatory bowel disease and non-inflammatory bowel disease patients. A tiny minority of inflammatory bowel disease patients relapse in association with use of oral iron therapy.

Administration, Oral↗
PubMed2004

Review article: antibiotics and probiotics in inflammatory bowel disease.

Treatment with antibiotics in inflammatory bowel disease has a long tradition and is widely used. The indications for antibiotic therapy are wide ranging, from specific situations such as abscesses or fistulae, to patients with severe disease (as an unspecific 'protective' measure), and to address the hypothesis that the enteric flora as a whole, or specific microorganisms such as mycobacteria, are involved in the pathogenesis of inflammatory bowel disease. The best-studied single antibiotic compound is metronidazole. However, overall, the scientific basis for the use of antibiotics is limited, which may reflect a lack of interest from sponsors within the pharmaceutical industry. Despite this weak evidence base, antibiotics are a globally established therapeutic tool in inflammatory bowel disease. Growing evidence from human and animal studies points towards a pivotal pathogenetic role of intestinal bacteria in inflammatory bowel disease. In view of these experimental findings, clinical trials have been undertaken to elucidate the therapeutic effects of probiotics in inflammatory bowel disease. Probiotics are viable nonpathogenic microorganisms which confer health benefits to the host by improving the microbial balance of the indigenous microflora. So far, of the many candidates, one specific strain (Escherichia coli Nissle 1917) and a mixture of eight different bacteria have demonstrated convincing therapeutic efficacy in controlled studies. Maintenance therapy in ulcerative colitis and prevention therapy, as well as the treatment of pouchitis, have emerged as areas in which probiotic therapy offers a valid therapeutic alternative to current treatments. Further investigations may detect additional clinically effective probiotics and other clinical indications.

Anti-Bacterial Agents↗
PubMed1984

Determining disease activity in inflammatory bowel disease.

To provide a stronger relationship between clinical assessment of disease activity and laboratory measurements, we studied hemoglobin concentrations, sedimentation rates, and the serum levels of albumin and of seromucoids in 86 patients; first when seriously ill with either ulcerative colitis or Crohn's disease, and then again when they were well. Only albumin and seromucoids were separated clearly in the two states: hemoglobin and sedimentation rates showed significant overlap. Paired correlation tests between 10 laboratory variables in 149 patients with Crohn's disease of varying severity revealed a highly significant correlation between seromucoids and albumin (r = 0.71). Both variables correlated with six others, but at lower levels. Processing the correlation matrix by factor analysis suggested that the serum levels of albumin and seromucoid are indicators of the same effect--disease activity. A simple index using only hemoglobin, albumin, and seromucoid values, was derived from this analysis, positive values indicating health and negative ill health. Serum levels of albumin and seromucoids provide the essential data to determine disease activity at routine follow-up of inflammatory bowel disease or to indicate the success or failure of therapeutic regimens, overriding any arbitrary clinical assessment.

Adult↗
PubMed2005

The use of medications for inflammatory bowel disease during pregnancy and nursing.

Inflammatory bowel disease includes two primary disorders, ulcerative colitis and Crohn's disease. These diseases mainly affect young adults, with a peak occurrence between 15 and 25 years of age. The causes of these diseases are largely unknown, with current treatments targeted against the heightened inflammatory response witnessed in the intestinal mucosa of both conditions. With the peak age ranges for pregnancy and inflammatory bowel disease overlapping, it is important to weigh the benefits of treating a mother during pregnancy against the potential risks to the fetus and the course of the pregnancy. This review examines the current safety data on medications used in women with inflammatory bowel disease during pregnancy.

Adolescent↗