Lior H. Katz

Doubling the infliximab dose versus halving the infusion intervals in Crohn's disease patients with loss of response

Background: Intensifying infliximab therapy is often practiced in Crohns disease (CD) patients losing response to the drug but there are no data if halving the interval is superior to doubling the dose. We aimed to assess the efficacy of infliximab dose intensification by interval‐halving compared with dose‐doubling. Methods: A multicenter retrospective study of CD patients losing response to infliximab was undertaken. The clinical outcome of patients whose infusion intervals were halved (5 mg/kg/4 weeks) was compared with patients treated by dose‐doubling (10 mg/kg/8 weeks). Results: In all, 168 patients were included from 18 centers in Europe, USA, and Israel. Of these, 112 were intensified by dose‐doubling and 56 received interval‐halving strategy. Early response to dose‐escalation was experienced by 86/112 (77%) patients in the dose‐doubling group compared with 37/56 patients (66%) in the interval‐halving group (odds ratio [OR] 1.7, 95% confidence interval [CI] 0.8–3.4, P = 0.14). Sustained clinical response at 12 months postescalation was maintained in 50% of patients in the dose‐doubling group compared with 39% in the interval‐halving group (OR 1.5, 95% CI 0.8–2.9, P = 0.2). On multivariate analysis, predictors of long‐term response to escalation were a nonsmoking status, CD diagnosis between 16–40 years of age, and normal C‐reactive protein (CRP). Conclusions: Dose intensification leads to a sustained regained response in 47% of CD patients who lost response to standard infliximab dose, but halving the infusion intervals is probably not superior to dose‐doubling. Given the costs and patient inconvenience incurred by an additional infusion visit, the dose‐doubling strategy may be preferable to the interval‐halving strategy. (Inflamm Bowel Dis 2012;)

Large population study shows that adolescents with celiac disease have an increased risk of multiple autoimmune and nonautoimmune comorbidities

Celiac disease (CD) is a systemic disorder that is associated with various autoimmune disorders and a higher prevalence of other diagnoses and complications. This large, cross‐sectional, population‐based study investigated the associations between CD and various medical conditions during late adolescence.

Efficacy of urine alkalinization by oral administration of sodium bicarbonate: a prospective open-label trial

BACKGROUNDnUrine alkalinization is indicated for various medical conditions. Alkalinization is usually achieved by intravenous administration of alkali substances titrated by repeated urinalyses. Some situations such as mass casualty events might require urine alkalinization by the oral route. We evaluated the efficacy of oral sodium bicarbonate administration for urine alkalinization.nnnMETHODSnIn a prospective open-label trial, 4 g of sodium bicarbonate was administered orally 3 times daily to 9 healthy volunteers for 24 hours. Serial blood and urine samples were collected, and urine pH was evaluated. Plasma electrolytes and pH were also measured for safety purposes.nnnRESULTSnAll participants had a urine pH of at least 7 after 10 hours. At 20 hours, all participants had a urine pH of at least 8. No adverse effects or abnormal blood results were documented during the 24-hour follow-up.nnnCONCLUSIONSnOral administration of a standard dose of sodium bicarbonate tablets resulted in effective urine alkalinization. Further research is needed to investigate the natural course of urine pH after cessation of our protocol and the efficacy of longer periods of treatment.

Adolescent body mass index and risk of colon and rectal cancer in a cohort of 1.79 million Israeli men and women: A population‐based study

This study examined the association between the body mass index (BMI) in late adolescence and the risk of colon and rectal cancer.

Chromoendoscopy, Narrow-Band Imaging or White Light Endoscopy for Neoplasia Detection in Inflammatory Bowel Diseases

BackgroundStudies have confirmed an increased risk of colorectal cancer in patients with ulcerative colitis; hence, surveillance is recommended. Optional modalities include white light endoscopy (WLE) or dye-spray chromoendoscopy. However, narrow-band imaging (NBI) is still not considered comparable to chromoendoscopy.AimThe aim of this study was to compare the diagnostic yield (DY) of WLE, chromoendoscopy, NBI for detection of neoplasia in patients with inflammatory bowel disease (IBD) by performing a meta-analysis of the existing literature.MethodsWe searched databases for prospective studies. For each modality, we performed comparative per-lesion analysis (any neoplasia detection) and per-patient analysis (patient with neoplastic lesions). Meta-analysis was performed using fixed-effect model unless heterogeneity was high. Odds ratios (ORs) with 95% CIs were calculated and pooled.ResultsFive studies compared chromoendoscopy to WLE. Chromoendoscopy (nxa0=xa0361) was superior to WLE (nxa0=xa0358) with per-patient analysis OR 2.05 (95% CI 1.26, 3.35) and per-lesion analysis OR 2.79 (95% CI 2.08, 3.73). High-definition (HD) chromoendoscopy was superior to HD-WLE with per-lesion analysis OR 2.48 (95% CI 1.55, 3.97). In four studies comparing NBI to WLE (nxa0=xa0305), no difference was found in per-patient analysis OR 0.97 (95% CI 0.62, 1.53) and per-lesion analysis OR 0.94 (95% CI 0.63, 1.4). In two studies comparing CE to NBI (nxa0=xa0104), no difference was found in per-patient analysis OR 1.0 (95% CI 0.51, 1.95) and per-lesion analysis OR 1.29 (95% CI 0.69, 2.41).ConclusionChromoendoscopy is superior to WLE for detection of dysplasia in IBD, even with HD endoscopy. No difference in DY could be demonstrated for NBI in comparison with other modalities.

Cardiovascular Risk Factors in Adolescents With Celiac Disease: A Cross-sectional Population-Based Study

Background: Recent data have shown that adults with celiac disease (CD) may have a higher prevalence of risk factors for cardiovascular disease (CVD) compared with the general population. Thus, we aimed to investigate the association of CD with CVD risk factors at late adolescence in a cross-sectional population-based study. Methods: A total of 2,001,353 Jewish Israeli adolescents who underwent a general health examination at median age of 17.1 years from 1988 to 2015 were included. Covariate data included demographic measures, blood pressure (BP), resting heart rate, and risk factors associated with CVD. Results: Overall, 10,566 cases of CD were identified (0.53%). Multivariate analysis showed that mean diastolic BP was significantly lower in subjects with CD (men: 72.0±8.7 vs 70.4u200a±u200a8.5, Pu200a<u200a0.0001; women: 70.0u200a±u200a8.3 vs 69.0u200a±u200a8.2, Pu200a<u200a0.0001), whereas systolic BP did not differ between groups. Resting heart rate was higher in CD cases (an absolute difference of 0.4 beats per minute, Pu200a<u200a0.0001). The proportions of overweight and obese subjects were significantly lower in CD cases. Noninsulin-dependent diabetes mellitus (relative risk [RR], 4.1; 95% confidence interval [CI] 2.8–5.7), hypercoagulability (RR, 2.6; 95% CI 1.5–4.5), and hyperlipidemia (RR, 1.9; 95% CI 1.2–3) were significantly more common in subjects with CD. Conclusions: At the age of 17 years, the prevalence of risk factors for CVD is higher in subjects with CD compared with the general population. There is, however, neither increase in BP nor increase in overweight and obesity rates.

Anthropometric measures and prevalence trends in adolescents with coeliac disease: a population based study

Objectives To investigate the impact of coeliac disease (CD) diagnosis on anthropometric measures at late adolescence and to assess trends in the prevalence of diagnosed CD over time. Design A population based study. Patients Prior to enlistment, at the age of 17u2005years, most of the Israeli Jewish population undergoes a general health examination. Subjects medical diagnoses are entered into a structured database. Interventions The enlistment database was thoroughly searched for CD cases between the years 1988 and 2015. Medical records of 2u2005001u2005353 subjects were reviewed. Main outcome measures Anthropometric measures at the age of 17u2005years. Results Overall, 10u2005566 CD cases (0.53%) were identified and analysed. Median age at data ascertainment was 17.1u2005years (IQR, 16.9–17.4). Multivariable analysis demonstrated that boys with CD were leaner (Body Mass Index 21.2±3.7 vs 21.7±3.8, p=0.02) while girls with CD were shorter (161.5±6u2005cm vs 162.1±6u2005cm, p=0.017) than the general population. The prevalence of diagnosed CD increased from 0.5% to 1.1% in the last 20u2005years with a female predominance (0.64% vs 0.46%). CD prevalence was significantly lower in subjects of lower socioeconomic status and those of African, Asian and former Soviet Union origin. Conclusions Adolescent boys with CD were leaner and girls with CD were shorter compared with the general population. However, the clinical relevance of the small differences suggests that when CD is diagnosed during childhood, final weight and height are not severely impaired. Our cohort reinforces the observed increase in diagnosed CD.

Body mass index at adolescence and risk of noncardia gastric cancer in a cohort of 1.79 million men and women

This study assessed adolescent predictors of noncardia gastric cancer (NCGC) with a focus on the body mass index (BMI) in late adolescence.

Anthropometric Measures in Adolescents With Inflammatory Bowel Disease: A Population-Based Study

BACKGROUNDnGrowth impairment is common in pediatric inflammatory bowel disease (IBD) patients. Nevertheless, a controversy exists regarding disease impact on anthropometric measures in the long term. Thus, we aimed to investigate the impact of IBD on anthropometric measures, including weight, height, and body mass index (BMI), during late adolescence in a cross-sectional, population-based study.nnnMETHODSnA total of 1,144,213 Jewish Israeli adolescents who underwent a general health examination from 2002 to 2016 at a median age (interquartile range) of 17.1 (16.9-17.3) years were included. Inflammatory bowel disease cases were stratified into Crohns disease (CD) and ulcerative colitis (UC). Patients were also subgrouped based on age at IBD diagnosis.nnnRESULTSnOverall, 2372 cases of IBD were identified out of 1,144,213 persons examined (0.2%). Crohns disease accounted for 68% of IBD cases. Males and females with CD (but not with UC) had significantly lower weight and BMI compared with controls. Differences in height at late adolescence were not statistically significant for either disease compared with controls (females: 162 cm vs 161.7 cm vs 161.5 cm; males: 174 cm vs 173.7 cm vs 173.6 cm for controls, UC, and CD, respectively). In a subgroup analysis, patients with CD diagnosed at age <14 years were significantly shorter than controls (males: 172.7 cm vs 174 cm; P = 0.001; females: 160.6 cm vs 162; P = 0.008). This pattern was not noted in UC patients.nnnCONCLUSIONSnAdolescents with CD were leaner compared with the general population. No overall difference was noted in height at late adolescence. Younger age at diagnosis was associated with reduced height in CD patients.

Gastric cancer in a teenager: a case report

Abstract Background Gastric cancer occurs mainly in older patients, with a peak incidence over 60 years of age. It is relatively rare among younger individuals. However, the frequency of gastric cancer in young patients appears to be on the rise worldwide. Case presentation We report the case of a 19-year-old female soldier who, after a considerable diagnostic delay, was diagnosed with gastric adenocarcinoma. She is one of the youngest gastric adenocarcinoma patients ever reported in Israel. Conclusion This case should serve as a reminder that gastric carcinoma is a possible diagnosis even in young patients. It also highlights the critical importance of obtaining a thorough medical history in the process of clinical decision making.