Erik J. Schoon

Bone mineral density in relation to efficacy and side effects of budesonide and prednisolone in Crohn’s disease

BACKGROUND & AIMSnOsteoporosis frequently occurs in Crohns disease, often because of corticosteroids. Budesonide as controlled release capsules is a locally acting corticosteroid with low systemic bioavailability. We investigated its effects on bone compared with prednisolone.nnnMETHODSnIn 34 international centers, 272 patients with Crohns disease involving ileum and/or colon ascendens were randomized to once daily treatment with budesonide or prednisolone for 2 years at doses adapted to disease activity. One hundred eighty-one corticosteroid-free patients had active disease (98 had never received corticosteroids, corticosteroid naive; 83 had received corticosteroids previously, corticosteroid exposed), and 90 had quiescent disease, receiving long-term low doses of corticosteroids, corticosteroid-dependent; in 1 patient, no efficacy data were obtained. Bone mineral density and fractures were assessed in a double-blinded fashion; disease activity, side effects, and quality of life were monitored.nnnRESULTSnNeither the corticosteroid-free nor the corticosteroid-dependent patients treated with budesonide differed significantly in bone mineral density from those receiving prednisolone. However, corticosteroid-naive patients receiving budesonide had smaller reductions in bone mineral density than those on prednisolone (mean, -1.04% vs -3.84%; P = .0084). Treatment-emergent corticosteroid side effects were less frequent with budesonide. Efficacy was similar in both groups.nnnCONCLUSIONSnTreatment with budesonide is associated with better preserved bone mass compared with prednisolone in only the corticosteroid-naive patients with active ileocecal Crohns disease. In both the corticosteroid-free and corticosteroid-dependent groups, budesonide and prednisolone were equally effective for up to 2 years, but budesonide caused fewer corticosteroid side effects.

Discordance between the degree of osteopenia and the prevalence of spontaneous vertebral fractures in Crohn's disease.

Background : A high prevalence of osteoporosis has been noted in Crohns disease, but data about fractures are scarce.

Effect of antitumour necrosis factor-alpha therapy on bone turnover in patients with active Crohn's disease: a prospective study

Background and aims:u2002 Patients with Crohns disease are at increased risk of osteoporosis. Disease activity and circulating proinflammatory cytokines are thought to play a role in this process. Infliximab, a chimaeric antitumour necrosis factor‐α antibody is effective in the treatment of Crohns disease. The aim of this study was to investigate the impact of treatment with infliximab on bone turnover in Crohns disease patients.

Gas within the wall of the stomach due to emphysematous gastritis: case report and review.

Emphysematous gastritis is a rare variant of phlegmonous gastritis due to invasion of the stomach wall by gas-forming bacteria. We present a case of emphysematous gastritis in a 66-year-old woman admitted with Staphylococcus aureus septicaemia, and a review of gas in the wall of the stomach is given with focus on emphysematous gastritis.

Abnormal bone turnover in long-standing Crohn's disease in remission.

A high prevalence of osteoporosis is found in patients with Crohn’s disease. The pathogenesis of this condition seems to be multifactorial and its pathophysiology is still not completely understood.

High prevalence of morphometric vertebral deformities in patients with inflammatory bowel disease

Background Earlier studies have documented that the prevalence of decreased bone mineral density (BMD) is elevated in patients with inflammatory bowel disease. The objective of this study was to investigate the prevalence of vertebral deformities in inflammatory bowel disease patients and their relation with BMD and bone turnover. Methods One hundred and nine patients with Crohns disease (CD) and 72 with ulcerative colitis (UC) (age 44.5±14.2 years) were studied. BMD of the hip (by dual X-ray absorptiometry) was measured and a lateral single energy densitometry of the spine for assessment of vertebral deformities was performed. Serum markers of bone resorption (carboxy-terminal cross-linked telopeptide of type I collagen) and formation (procollagen type I amino-terminal propeptide) were measured, and determinants of prevalent vertebral deformities were assessed using logistic regression analysis. Results Vertebral deformities were found in 25% of both CD and UC patients. Comparing patients with and without vertebral deformities, no significant difference was found between Z-scores and T-scores of BMD, or levels of serum carboxy-terminal cross-linked telopeptide of type I collagen and serum procollagen type I amino-terminal propeptide. Using logistic regression analysis the only determinant of any morphometric vertebral deformity was sex. The presence of multiple vertebral deformities was associated with older age and glucocorticoid use. Conclusion The prevalence of morphometric vertebral deformities is high in CD and UC. Male sex, but neither disease activity, bone turnover markers, clinical risk factors, nor BMD predicted their presence. The determinants for having more than one vertebral deformity were age and glucocorticoid use. This implies that in addition to screening for low BMD, morphometric assessment of vertebral deformities is warranted in CD and UC.

2-Year maintenance treatment of ileocecal Crohn's disease with budesonide capsules or prednisolone: which patients are eligible?

2-Year maintenance treatment of ileocecal Crohns disease with budesonide capsules or prednisolone: which patients are eligible?