Jordan Morton

Curcumin and Inflammatory Bowel Disease: Biological Mechanisms and Clinical Implication

Increased recognition of the limits of conventional medicine has helped drive the growing interest in complementary and alternative medicine which is now being commonly used in patients with chronic diseases, including individuals with Crohn’s disease and ulcerative colitis. Recently, scientific interest has unraveled the beneficial pharmacological effects of curcumin. We present an updated concise review of currently available in vitro, animal and clinical studies demonstrating the therapeutic effect of herbal medication in inflammatory bowel disease.

Utilization of Preventive Measures for Glucocorticoid-Induced Osteoporosis among Veterans with Inflammatory Bowel Disease

Purpose. We examined current osteoporosis prevention practices in patients with inflammatory bowel disease (IBD) on chronic steroid using the 2003 American Gastroenterological Association guidelines as standard of care. Methods. We identified all IBD patients followed at the Oklahoma City VA Medical Center from January 2003 to December 2010, who had been on daily oral steroids (prednisone ≥5 mg or budesonide ≥6 mg) for ≥3 consecutive months. Associations of calcium and vitamin D (vitD) prescribing and bone mineral density (BMD) testing with patient characteristics were examined by logistic regression. Results. Sixty-three of 384 consecutive patients met inclusion criteria. Among 86 steroid courses, calcium and vitD were concurrently prescribed in 46%, and BMD was tested in 30%. There was no association of demographic and clinical characteristics with calcium/vitD prescribing and BMD testing. By multivariate analysis, steroid initiation after 2006, compared to before 2006, was associated with a significant increase in calcium (OR = 3.17 and P = 0.02) and vitD (OR = 2.96 and P = 0.02) prescribing and BMD testing (OR = 4.63 and P = 0.004). Conclusions. We observed a low, yet increasing, adherence to osteoporosis prevention guidelines in IBD since 2003, which highlights the need for continued physician education to enhance guideline awareness and implementation.

After the Party’s Over

While driving home from a party, a 35-year-old previously healthy woman had a sudden onset of chills, myalgias, nausea, and abdominal cramping. That night fever, explosive nonbloody diarrhea, frequent vomiting, and abdominal and low back pain developed.

Anti-GBM Disease in Pregnancy Acute Renal Failure Resolved After Plasma Exchange, Hemodialysis, and Steroids

Antiglomerular basement membrane (GBM) disease presenting during pregnancy is uncommon. We present a case of a pregnant female who presented with acute renal failure requiring dialysis due to anti-GBM disease. She responded well to plasma exchange, high-dose steroids, and hemodialysis. Cyclophosphamide was discussed but not given at the patient’s request due to concerns for the well-being of the fetus. Unfortunately, she suffered a spontaneous abortion in her eighth week of pregnancy. Subsequently, she had progressive improvement in her renal function and became hemodialysis independent at 2 weeks after diagnosis. Her renal function returned to baseline 3 months after diagnosis. We present this case in detail and review the literature regarding anti-GBM disease in pregnancy.

Anti-GBM of Pregnancy: Acute Renal Failure Resolved after Spontaneous Abortion, Plasma Exchange, Hemodialysis, and Steroids

Antiglomerular basement membrane disease presenting during pregnancy is very uncommon. We present a case of a pregnant female who presented with acute renal failure needing dialysis from Goodpastures disease. She responded very well to just plasma exchange, high dose steroids, and hemodialysis. Cyclophosphamide was never started on this patient. She had a spontaneous abortion in her 8th week of pregnancy and henceforth did very well to regain her renal function. Patient became hemodialysis independent at 2 months and returned to her baseline kidney function at 6 months. We present this remarkable case of recovery from acute renal failure in a patient with anti-GBM disease. We think the flare-up of renal failure was pregnancy related which resolved after spontaneous abortion.

Corrigendum to “Utilization of Preventive Measures for Glucocorticoid-Induced Osteoporosis among Veterans with Inflammatory Bowel Disease”

[This corrects the article DOI: 10.1155/2013/862312.].

Sa1231 Awareness Among Practitioners Regarding Efficacy of Oral Contraceptives With Concomitant use of Antibiotics in Inflammatory Bowel Disease (IBD) Patients

Background: Antibiotics such as metronidazole and ciprofloxacin are often prescribed to IBD patients. Common misperception is that use of antibiotics can decrease efficacy of oral contraceptives (OCPs) and result in contraception failure, refuted in a recently published guideline from the American College of Obstetrics and Gynecology. The purpose of this study was to assess the knowledge among practitioners regarding the lack of evidence to support decreased contraceptive efficacy with concomitant use of OCPs and antibiotics. Methods: We conducted a survey of 215 practitioners (GI-General n=36, IBD specialists n= 11, GI-Fellows n=39, Internal Medicine n=44, Family Medicine n=29, OB/Gyn n=19 and Pharmacists n=37). Practitioners were quizzed on two scenarios in which a 28-year-old female patient with fistulizing Crohns disease on an OCP was recently prescribed ciprofloxacin or metronidazole. The practitioners were asked whether they would: 1) ask the patient to use an alternativemethod of contraception, 2) ask the patient to use twomethods of contraception, or 3) inform the patient that there is no evidence to support decreased contraceptive efficacy with the concomitant use of OCPs and antibiotics. The percentage of practitioners among the different groups was compared using either χ2 or Fishers exact test as appropriate. Multiple, pair-wise comparisons were then performed if the overall χ2 test or Fishers exact test was statistically significant. The p-value was adjusted for multiple comparisons. Results: Compared to all other specialties combined, IBD specialists and OB/Gyns were more likely to accurately believe that there is no evidence to support a lack of contraceptive efficacy with concomitant use of ciprofloxacin (91% vs. 20% p <0.0005 and 90% vs.17% p <0.0005 respectively) and metronidazole (100% vs. 26% and 95% vs. 23% p <0.0005 respectively) (Figure 1). Knowledge among gastroenterologists (except for IBD specialists) for both questions was not statistically any different than internists (18% vs. 4%p=0.245), family physicians (18% vs. 0% p=0.11) or pharmacists (18% vs. 18% p=1.00). Ninety-eight percent of the practitioners who thought there was an interaction between antibiotics and OCPs answered that the information learned from this survey will change their practice. Conclusion: Excluding IBD specialists and OB/Gyns, most practitioners involved in the care of female patients with IBD believe there to be interaction between antibiotics and OCPs and would prescribe an alternative method of contraception or two different methods to such patients. It is thus important to appropriately educate those without the appropriate knowledge in order that patients are not falsely counseled to increase means of birth control.