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1.
Opinion statement Infliximab is arguably the first major advance in therapy for inflammatory bowel disease in more than a quarter of a century.
Although it is important to distinguish efficacy from effectiveness, the data from clinical practice mirror those from randomized
controlled trials. Infliximab has proven efficacious for luminal manifestations of Crohn’s disease (CD) regardless of location.
It also has proven efficacy in the subset of penetrating disease to the skin and perianal area, and it increases rates of
steroid-free remission. These benefits are reflected in improved quality of life, with limited data showing that infliximab
can decrease rates of hospitalization and CD-related surgery. Infliximab also has proven to be efficacious in patients with
ulcerative colitis (UC) and has increased rates of steroid-free remission. Whether infliximab will have an impact on the risk
of colorectal cancer in UC and Crohn’s colitis has yet to be determined. The combination of strong evidence from large randomized
controlled trials with substantial examination of use in the practice setting has moved biologic therapy with infliximab from
novel to mainstream. In this review, the data for the efficacy of infliximab in controlled trials will be discussed in the
context of real world effectiveness. 相似文献
2.
Opinion statement Recent controlled and uncontrolled trial data in inflammatory bowel disease have suggested several new avenues of possible
therapies and refined our understanding of the uses and selectiveness of anti-tumor necrosis factor (TNF)-based therapies.
Infliximab remains the only proven effective anti-TNF therapy, whereas others have proven ineffective (etanercept, CDP-571)
or of limited utility (thalidomide, CDP-870). A Crohn’s disease Clinical trial Evaluating infliximab in a New long-term Treatment
regimen (ACCENT I) and ACCENT II trials supported the strategy of using 5 to 10 mg/kg of infliximab on an every 8-week basis
for maintenance of remission, although in clinical practice many physicians take variable approaches to maintenance of remission
dosing schedules. On the other hand, no controlled trial data to date have supported the use of infliximab in ulcerative colitis.
Therapies utilizing novel mechanistic approaches, such as hematopoietic growth factors, mitogen-activated protein (MAP)-kinase
inhibition, and peroxisome proliferator activated receptor gamma ligand receptor binding have shown promise in small uncontrolled
trials and await confirmation of their utility in randomized, placebo-controlled trials. Newer biologic (natalizumab) or cytokine-based
therapies (monoclonal antibody to interleukin-6) have shown preliminary evidence of efficacy in controlled trials, but neither
have yet been approved by the US Food and Drug Administration and, therefore, have not been commercialized. However, tacrolimus,
a potent calcineurin inhibitor and inhibitor of interleukin-2 expression, has shown efficacy in Crohn’s disease, albeit at
the cost of substantial potential toxicity. 相似文献
3.
Pediatric inflammatory bowel disease encompasses a spectrum of disease phenotype, severity, and responsiveness to treatment.
Intestinal healing rather than merely symptom control is an especially important therapeutic goal in young patients, given
the potential for growth impairment as a direct effect of persistent chronic inflammation and the long life ahead, during
which other disease complications may occur. Corticosteroids achieve rapid symptom control, but alternate steroid-sparing
strategies with greater potential to heal the intestine must be rapidly adopted. Exclusive enteral nutrition is an alternate
short-term treatment in pediatric Crohn’s disease. The results of multi-center pediatric clinical trials of both infliximab
and adalimumab in Crohn’s disease and of infliximab in ulcerative colitis (all in children with unsatisfactory responses to
other therapies) have now been reported and guide treatment regimens in clinical practice. Optimal patient selection and timing
of anti-TNF therapy requires clinical judgment. Attention must be paid to sustaining responsiveness safely. 相似文献
4.
Opinion statement Various biologic agents have been evaluated in patients with inflammatory bowel disease (eg, Crohn’s disease [CD]) and ulcerative
colitis (UC). At present, only one, infliximab (humanized monoclonal anti-tumor necrosis factor-á antibody), is approved by
the US Food and Drug Administration for induction and maintenance treatment in patients with active moderate to severe and/or
fistulizing CD who are refractory to conventional therapy. Two recent trials, Active Ulcerative Colitis Trial (ACT) 1 and
ACT 2, observed high efficacy of infliximab in inducting and maintaining clinical remission, mucosal healing, and corticosteroid-sparing
effects in patients with moderate to severe UC. A plethora of randomized, double-blind, controlled and open-label, uncontrolled
studies on large and small numbers of patients has assessed efficacy and safety of various biologic agents of potential use
in treatment of inflammatory bowel disease. With respect to safety of biologic agents used for treatment, the most accurate
data are available only in the case of infliximab. This is due to the fact that infliximab was evaluated in many more trials
than any other biologic agent. Moreover, postmarketing experience also provides very valuable information about any side effects
occurring during treatment with this agent. 相似文献
5.
Laura Núñez-Gómez Francisco Mesonero-Gismero Agustín Albillos-Martínez Antonio López-Sanromán 《Gastroenterologia y hepatologia》2018,41(9):576-582
Anti-tumor necrosis factor agents (anti-TNF) drugs are commonly used in patients with inflammatory bowel disease (IBD) and have proven effective in both induction and maintenance therapy in luminal Crohn's disease and ulcerative colitis. Their efficacy has also been proven in fistulising perianal Crohn's disease. However, the evidence in other scenarios, such as stricturing, penetrating and non-fistulising perianal Crohn's disease, extraintestinal IBD manifestations and ileoanal reservoir complications, is not as robust. The aim of this review was to perform an analysis of the available literature and to determine the role of anti-TNF drugs in common clinical practice in patients affected by these complications. 相似文献
6.
Tremaine WJ 《Current gastroenterology reports》2012,14(2):162-165
About 10% of patients with colitis due to inflammatory bowel disease have indeterminate colitis. Despite newer diagnostic
tools, the frequency has not diminished over the past 33 years. The current preferred term among academicians is colonic inflammatory
bowel disease unclassified (IBDU), although indeterminate colitis is the term endorsed for inclusion in the ICD-10 coding
system. Indeterminate colitis is more frequent among children. The anti-Saccharomyces cerevisiae (ASCA) and perinuclear anti-cytoplasmic
antibody (pANCA) are useful in distinguishing IBDU from ulcerative colitis and Crohn’s disease. However, current serologic
and genetic studies, as well as endoscopic and imaging studies lack sufficient positive predictive values to make a definite
diagnosis of Crohn’s colitis or ulcerative colitis. Patients with IBDU who undergo proctocolectomy with ileal pouch-anal anastomosis
have more complications than patients with ulcerative colitis. Although some patients with indeterminate colitis eventually
develop characteristic ulcerative colitis or Crohn’s disease, a subgroup are durably indeterminate. 相似文献
7.
Therapeutic management of inflammatory bowel disease remains beyond the limits of conventional therapy in many cases. Novel
therapies used include tacrolimus, a new powerful immunosuppressive drug, employed in some case reports and a few studies
that have tried to evaluate its effectiveness in Crohn’s disease and ulcerative colitis with promising results, but its role
in the management of inflammatory bowel disease remains controversial. We performed a systematic review that analyzed a total
of 23 reported experiences in 286 patients with inflammatory bowel disease treated with tacrolimus. Although most of the published
studies are uncontrolled, short, and heterogeneous, promising results have been obtained in fistulizing disease, unresponsive
cases of both ulcerative colitis and Crohn’s disease, and even extraintestinal manifestations. The overall outcome was good
enough to consider tacrolimus as a rationale therapeutic option. However, comparative studies with standard therapeutic options
like infliximab are needed to assess the correct role that tacrolimus may play in these patients. 相似文献
8.
The definition of remission in Crohn’s disease and ulcerative colitis has evolved to include mucosal healing as a measure
of treatment efficacy. Randomized, controlled trials have demonstrated mucosal healing is attainable with the current arsenal
of therapies available to treat inflammatory bowel disease. Mucosal healing has been shown to reduce the likelihood of clinical
relapse, reduce the risk of future surgeries, and reduce hospitalizations. This review focuses on the latest studies addressing
clinical outcomes of mucosal healing in the clinical trial and practice setting. 相似文献
9.
Opinion statement Therapeutic options for refractory colonic inflammation in patients with ulcerative colitis or Crohn’s disease have recently
been augmented by the introduction of biologic therapies. Intravenous corticosteroids and cyclosporin A remain the standard
therapies for severe ulcerative colitis. Monoclonal antibodies directed at tumor necrosis factor alfa (TNF-α) have proven
to be most efficacious in patients with severe or refractory Crohn’s disease. Immunomodulatory therapy with azathioprine,
6-mercaptopurine, or methotrexate has demonstrated efficacy for maintenance of remission in patients with refractory ulcerative
colitis or Crohn’s disease. The use of experimental biologic agents may be considered for those patients who fail to respond
to or remain dependent on corticosteroids. Surgical intervention is indicated for patients with severe colitis who fail to
respond to medical therapy or develop life-threatening complications such as perforation or toxic megacolon. 相似文献
10.
Opinion statement Therapeutic options for refractory colonic inflammation in patients with ulcerative colitis or Crohn’s disease have recently
been expanded with the introduction of biologic therapies. Intravenous corticosteroids and cyclosporine A remain the standard
therapies for severe ulcerative colitis. Monoclonal antibodies directed at tumor necrosis factor-α have proven to be exceptionally
efficacious in patients with severe or refractory Crohn’s disease. Immunomodulatory therapy with azathioprine, 6-mercaptopurine,
or methotrexate has demonstrated efficacy for maintenance of remission in patients with refractory ulcerative colitis or Crohn’s
disease. The use of experimental biologic agents may be considered for those patients who fail to respond to or remain dependent
on corticosteroids. Surgical intervention still remains for patients with severe colitis who fail to respond to medical therapy
or develop life-threatening complications such as perforation or toxic megacolon. 相似文献
11.
Recently, conventional therapies for inflammatory bowel disease (IBD) have not received the same amount of attention as biologic
therapies, yet they remain the backbone of therapy for IBD because of their efficacy, safety, and relatively low cost. Advances
in efficacy and safety continue because of modifications in drug dosing and monitoring. Higher doses of mesalamine per pill,
together with once-daily dosing, may help to optimize drug delivery and patient compliance. Budesonide, an effective agent
for both induction and short-term remission maintenance in Crohn’s disease, is devoid of many of the toxicities common to
corticosteroids. Assessments of thiopurine methyltransferase and metabolite levels are helping to fine-tune dose optimization
for the thiopurines azathioprine and 6-mercaptopurine. The oral calcineurin inhibitors tacrolimus and cyclosporine have been
shown to have expanded roles in IBD, and methotrexate may be useful in some patients with refractory ulcerative colitis. Probiotics
are showing promise for maintenance of remission in Crohn’s disease, ulcerative colitis, and pouchitis. 相似文献
12.
Purpose Alimentary factors, especially those modifying the intestinal flora, may influence the course of inflammatory bowel disease.
It is known that T and B cells of patients with Crohn’s disease can be stimulated with the yeast antigen, mannan. We evaluated
the impact of eating habits with special respect to food containing yeast on the course of inflammatory bowel disease.
Methods Questionnaires were sent to 180 German-speaking patients of the Inflammatory Bowel Disease Outpatient Clinic at the University
Hospital Bern, Switzerland. The following information was obtained by the questionnaires: (1) course of disease, (2) eating
habits, (3) environmental data, and (4) inflammatory bowel disease questionnaire. The survey was anonymous.
Results A total of 145 patients (80.5 percent 95 with Crohn’s disease, and 50 with ulcerative colitis) responded. Food items containing
yeast were better tolerated by patients with ulcerative colitis than by patients with Crohn’s disease. A significant difference
between the two groups was observed concerning food containing raw yeast (dough, P = 0.04; and pastry, P = 0.001).
Conclusions Food items containing raw yeast led to more frequent problems for patients with Crohn’s disease than for patients with ulcerative
colitis. This observation supports our previous data, which showed the stimulatory effect of the yeast antigen, mannan, on
B and T cells of patients with Crohn’s disease but not of controls.
Poster presentation at Digestive Disease Week (DDW), organized by the American Gastrointestinal Association, Chicago, Illinois,
May 14 to 19, 2005. 相似文献
13.
Oxidative Stress and Pathogenesis of Inflammatory Bowel Disease: An Epiphenomenon or the Cause? 总被引:6,自引:0,他引:6
Crohn’s disease (CD) and ulcerative colitis (UC), known as inflammatory bowel disease (IBD), are fairly common chronic inflammatory
conditions of the gastrointestinal tract. Although the exact etiology of IBD remains uncertain, dysfunctional immunoregulation
of the gut is believed to be the main culprit. Amongst the immunoregulatory factors, reactive oxygen species are produced
in abnormally high levels in IBD. Their destructive effects may contribute to the initiation and/or propagation of the disease.
We provided an extensive overview on the evidences from animal and human literature linking oxidative stress to IBD and its
activity. Moreover, the effects of antioxidant therapy on IBD patients in randomized, controlled trials were reviewed and
the need for further studies elaborated. We also summarized the evidence in support for causality of oxidative stress in IBD. 相似文献
14.
15.
Introduction CARD15 gene mutations may present different frequencies in populations and sometimes surgical interventions may become a
necessary therapy for inflammatory bowel disease patients. Mutations of 1007fs, G908R, R702W and polymorphisms of P268S, IVS8+158 of the CARD15 gene and their relation with disease-related surgery were investigated in Turkish inflammatory bowel disease
patients in this study. Material and Method 1007fs, G908R, R702W mutations and P268S, IVS8+158 polymorphisms of CARD15 gene were analyzed in 130 inflammatory bowel disease patients (67 Crohn’s disease, 63 ulcerative
colitis) and 87 healthy controls. After obtaining DNA samples, genotyping was performed by polymerase chain reaction - restriction
fragment length polymorphism (PCR-RFLP) analysis. Results were evaluated by statistical analysis and accepted as significant
if P < 0.05. Results R702W gene mutation was significantly lower in the inflammatory bowel disease group (1.5%) than the controls (4.8%) (P < 0.05). The overall allele frequency of mutations in the inflammatory bowel disease group (2.7%) was lower than in controls
(6.6%) (P < 0.05). Disease-related surgery history was present in 20 Crohn’s and 25 ulcerative colitis patients; familial history was
present in four Crohn’s and five ulcerative colitis patients. Statistically, no relationship was detected between disease-related
surgeries and the investigated genetic tests. Conclusion In Turkish patients, no important relationship was detected between the investigated allele frequencies of the CARD15 gene
and inflammatory bowel disease nor between disease-related surgeries and inflammatory bowel disease.
Dedicated to the memory of the Turkish scientist Turgut Tukel MD. Thanks for his contributions and supports. 相似文献
16.
Kelly DG 《Current gastroenterology reports》1999,1(4):324-330
The nutritional impact of inflammatory bowel disease is notable, both in Crohn’s disease and ulcerative colitis. The causes
of malnutrition include decreased intake, maldigestion, malabsorption, accelerated nutrient losses, increased requirements,
and drug-nutrient interactions. Inflammatory bowel disease causes alterations in body composition and, because of these changes,
affects energy expenditure. Various approaches have been most effective in correcting malnutrition, supporting growth, and
managing short-bowel syndrome, but the success of primary therapy has been limited. 相似文献
17.
Surgical intervention is often required for patients with inflammatory bowel disease. Total proctocolectomy with ileal pouch-anal
anastomosis is the surgical treatment of choice for patients with ulcerative colitis. The main long-term complication of this
surgery is pouchitis, with 10-year cumulative incidence rates between 24% and 46%. For patients with Crohn’s disease, postoperative
recurrence is a significant problem, with clinical recurrence rates as high as 55% at 5 years and 76% at 15 years. Increasing
evidence suggests that postoperative medical therapy has the potential to decrease the risk of postoperative Crohn’s disease
recurrence. 相似文献
18.
Evolving diagnostic modalities in inflammatory bowel disease 总被引:1,自引:0,他引:1
Over the past several years, significant advances have been made in the diagnostic techniques used in the management of ulcerative
colitis and Crohn’s disease. These advances have occurred mainly in the area of gastrointestinal endoscopy and radiology.
Capsule endoscopy and double-balloon endoscopy have permitted better visualization of the small bowel mucosa. Advanced imaging
techniques, including chromoendoscopy, magnification endoscopy, confocal endomicroscopy, and spectroscopy, may aid in the
diagnosis of colorectal neoplasia in patients with long-standing disease. Improved radiographic imaging techniques based on
computed tomography and magnetic resonance imaging allow noninvasive means of evaluating the small bowel in patients with
known or suspected Crohn’s disease. Finally, positron emission tomography is an investigative tool for inflammatory bowel
disease that may also aid in the detection of inflammation in these diseases. 相似文献
19.
Surgical Management of Inflammatory Bowel Disease 总被引:1,自引:0,他引:1
Opinion statement Surgery continues to be a central component in the treatment of patients with inflammatory bowel disease (IBD). The most important
aspect of caring for patients with IBD is a close and ongoing interaction between the surgeon and gastroenterologist both
before and after surgery. Surgery in patients with chronic ulcerative colitis (CUC) is curative. In the appropriate patient,
we recommend proctocolectomy with ileal pouch anal anastomosis (IPAA). In contrast, patients with Crohn’s disease cannot be
cured with surgery. Instead, surgery is used in conjunction with maximal medical therapy to treat symptoms of the disease
and improve the patient’s quality of life. Surgical interventions should be limited in scope. Small bowel disease should be
treated with either limited resection or strictureplasty, if possible, to conserve bowel length. For limited involvement of
the colon, segmental resection yields good results. Minimal surgical intervention, drainage of abscesses, placing draining
setons, and aggressive medical therapy is recommended as treatment of perianal Crohn’s disease. 相似文献
20.
Traditional medications for inflammatory bowel disease are small molecule drugs, most of which were developed for use in other
diseases before being found to be efficacious for the treatment of ulcerative colitis or Crohn’s disease. Recently, several
exciting alternative approaches to the medical treatment of inflammatory bowel disease have been developed. These include
biologic, probiotic, and apheresis therapies that offer certain advantages over traditional drug therapy for inflammatory
bowel disease. The purpose of this review is to assess the current state of knowledge about novel biologic, probiotic, and
apheresis therapies and to analyze how best to incorporate these therapies into evolving management paradigms of inflammatory
bowel disease. 相似文献