Alan Shand

A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis

Background  Forty per cent of patients with acute severe ulcerative colitis will not respond to intravenous corticosteroids and require second‐line medical therapy or colectomy. A recent controlled trial has suggested that infliximab may be effective as rescue therapy.

The safety profile of anti-tumour necrosis factor therapy in inflammatory bowel disease in clinical practice: analysis of 620 patient-years follow-up.

Background  Anti‐TNF agents are now widely used in Crohn’s disease (CD), and in ulcerative colitis (UC).

Adenocarcinoma arising in columnar lined oesophagus following treatment with argon plasma coagulation

Editor,—Following the recent report by Van Laethem et al ( (2000) Gut 46:574–7. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] ) of adenocarcinoma developing in a patient whose columnar lined oesophagus had been treated by argon plasma coagulation, we wish to highlight a second case. A 67 year old man presented with epigastric discomfort but no “alarm” symptoms of dysphagia or weight loss. Endoscopy revealed a 5 cm length of columnar lined oesophagus with no evidence of ulceration or stricture. Histology showed intestinal metaplasia with low grade dysplasia. He consented to enter a study of argon plasma coagulation treatment in Barretts oesophagus. One half of the affected oesophagus was treated with argon plasma coagulation (Erbe APC 300, Erbe Elektromedizin GmbH, Germany). He was commenced on omeprazole 40 mg. Repeat endoscopy at two months showed macroscopic regrowth of the squamous epithelium in the area treated by argon plasma coagulation. This was confirmed histologically and the previously noted dysplasia had disappeared. He … [1]: {openurl}?query=rft.jtitle%253DGastrointestinal%2Bendoscopy%26rft.stitle%253DGastrointest%2BEndosc%26rft.aulast%253DLaine%26rft.auinit1%253DL.%26rft.volume%253D44%26rft.issue%253D5%26rft.spage%253D523%26rft.epage%253D526%26rft.atitle%253DProspective%2Bcomparison%2Bof%2Bcommercially%2Bavailable%2Brapid%2Burease%2Btests%2Bfor%2Bthe%2Bdiagnosis%2Bof%2BHelicobacter%2Bpylori.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0016-5107%252896%252970002-0%26rft_id%253Dinfo%253Apmid%252F8934155%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0016-5107(96)70002-0&link_type=DOI [3]: /lookup/external-ref?access_num=8934155&link_type=MED&atom=%2Fgutjnl%2F48%2F4%2F580.3.atom [4]: /lookup/external-ref?access_num=A1996VT20700002&link_type=ISI

Lack of association between cervical dysplasia and IBD: a large case-control study.

Background: It has been variously reported that women with inflammatory bowel disease (IBD) have an increased risk of cervical dysplasia. We aimed to assess in a large, accurately phenotyped, case‐controlled population whether women with IBD had increased rates of abnormal cervical smears and if this was affected by immunosuppressant therapy or disease phenotype. Methods: Women with IBD diagnosed prior to the age of 60 were studied at a single tertiary referral center in Scotland. Full cervical smear histories were available on 411 women (204 Crohns disease, 207 ulcerative colitis, median age at diagnosis 28.4 years, median current age 44.1 years). All the cases were matched 1:4 to healthy controls (n = 1644) from the same geographical location. Results: There was no difference in rates of abnormal smears between patients with IBD (80.5% negative, 10.5% low‐grade, and 9.0% high‐grade dysplasia) and controls (85.4%, 7.7%, and 6.9%, P = 0.37). The use of immunosuppressant therapy had no impact on rates of cervical dysplasia or neoplasia. Furthermore, there was no effect of disease location, behavior, or oral contraceptive use. However, there were significantly more abnormal cervical smears in IBD patients who were current smokers compared with exsmokers and those who had never smoked (27.4% versus 11.4%, P = 0.001, odds ratio = 2.95, 95% confidence interval = 1.55–5.50). Conclusions: Women with IBD are not at increased risk of abnormal cervical smears unless they smoke. These data suggest that young women with IBD should be managed as per the background population; attending for regular smear testing, and undergoing vaccination against cervical cancer when available. (Inflamm Bowel Dis 2009)

The use of adalimumab in the management of refractory Crohn’s disease

Background Adalimumab is a humanized monoclonal antibody targeting tumour necrosis factor‐α. Recent clinical trials have demonstrated its efficacy in Crohn’s disease; however, experience in clinical practice remains limited.

Regular review: Ulcerative colitis

Ulcerative colitis is a relapsing and remitting disease characterised by acute non-infectious inflammation of the colorectal mucosa. In the United Kingdom the annual incidence is around 7 cases per 100 000 population.1 The rectal mucosa is invariably affected. Confluent inflammation and shallow ulceration extend proximally from the anal margin. A patient may have proctitis, left sided colitis (the proximal limit being below the splenic flexure), extensive colitis (involving the transverse colon), or pan colitis. At any point in time, 50% of patients are asymptomatic, 30% have mild symptoms, and 20% have moderate to severe symptoms.2 Many patients have long periods of complete remission, but the cumulative probability of remaining free from relapse at two years is only 20%, decreasing to less than 5% at 10 years.3 Later relapses generally affect the same region of the colon as previous episodes. Several of the current clinical and therapeutic issues in ulcerative colitis include: (a) medical treatment options for relapse and for maintenance of remission; (b) management of the minority of patients who develop a severe life threatening relapse or chronic unremitting disease; (c) surgical treatment of ulcerative colitis; and (d) long term complications in patients with extensive disease—namely, colonic and biliary cancers and sclerosing cholangitis. Summary points Ulcerative colitis may present at any age, but the anatomical distribution of involvement at presentation is different between children and adults All patients with bloody diarrhoea need to have infection excluded Outpatient rigid sigmoidoscopy is the best method of diagnosing the nature of inflammation The extent of inflammation may be established by total colonoscopy (or a double contrast barium enema) The mainstays of treatment are rectal and systemic 5-aminosalicylic acid derivatives and corticosteroids, with azathioprine in steroid dependent or resistant cases Restorative proctocolectomy with ileal pouch-anal anastomosis should be considered in every patient in whom colectomy is contemplated

Efficacy and complications of adalimumab treatment for medically-refractory Crohn's disease : analysis of nationwide experience in Scotland (2004-2008)

Background  Adalimumab is a second generation humanized anti‐tumour necrosis factor (TNF) monoclonal antibody with established efficacy in Crohn’s disease (CD).

A trial of mercaptopurine is a safe strategy in patients with inflammatory bowel disease intolerant to azathioprine: an observational study, systematic review and meta-analysis

Thiopurines maintain remission and modify disease course in inflammatory bowel disease. Use is limited by intolerance and subsequent drug withdrawal in approximately 17% of patients treated with azathioprine. Previous case series have addressed the success rates of re‐treatment with mercaptopurine in these individuals.

Endoscopic fibrin sealant injection : a novel method of closing a refractory gastrocutaneous fistula

Tytgat GNJ. Self-expanding metal stents for palliation of esophagocardial malignancies. Gastrointest Endosc 1995;41: 58-63. 25. Simon M, Kaplow R, Salzman E, Freiman DA. A vena cava filter using thermal shape memory alloy. Radiology 1977;125: 89-94. 26. Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakit AN. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993;329:1302-7. 27. Neuhaus H. Therapeutic endoscopy in the esophagus. Curr Opinion Gastroentrol 1993;9:677-84.

Gastric fundic gland polyps in south-east Scotland: Absence of adenomatous polyposis coli gene mutations and a strikingly low prevalence of Helicobacter pylori infection

Background and Aim: Fundic gland polyps (FGP) were originally described in association with familial polyposis syndromes, but it is now accepted that the majority of FGP are picked up incidentally in up to 1.9% of routine endoscopies in dyspeptic patients. The familial adenomatous polyposis phenotype arises from germline mutations of the adenomatous polyposis coli (APC) gene. We aimed to see if there was any association between the presence of FGP, Helicobacter pylori, and two common APC gene mutations.