M. Vecchi

Bowel Sonoelastography in Patients with Crohn's Disease: A Systematic Review

Sonoelastography is an ultrasound-based method for evaluating the biological properties of a target tissue. It is commonly used in the diagnosis of liver and thyroid disease, but recently its use for monitoring the characteristics of bowel wall in patients affected by Crohns disease (CD) has been proposed. Our aim was a systematic review of the use of sonoelastography in patients with CD. An initial database search retrieved 32 possible articles. On initial screening, 7 articles, concerning a total of 129 patients and 154 lesions of the small and large bowel, were finally included in the review. The age range varied between 6 and 53 y, and disease duration ranged between 1 and 623u2009mo. We collected data on the examinations performed (type and time), bowel area considered and parameters evaluated. All authors found that elastography correlates well with the degree of fibrosis, as wall strain significantly decreases in segments affected by fibrotic stenosis. Even though the endpoints proposed in the various articles are relatively inhomogeneous and scarcely comparable, we found that sonoelastography is a promising tool in the evaluation of patients with CD as it can differentiate inflammatory and fibrotic strictures in small case series.

Ustekinumab in the management of Crohn’s disease: Expert opinion

This expert-opinion paper reviews available evidence for the use of ustekinumab, a human interleukin 12/23 monoclonal antibody, in the treatment of Crohns disease and discusses its potential role in the current treatment scenario for the condition. Ustekinumab appears to be associated with rapid and sustained clinical effect, as reported from the clinical research program, with additional support for potential mucosal healing. These characteristics are paralleled by a favorable safety profile, lack of immunogenicity and the presence of systemic anti-inflammatory activity. Importantly, ustekinumab requires only one single intravenous administration, while subsequent dosing is administered subcutaneously, with potential advantages for home-based therapy. Lastly, the dosage of ustekinumab is flexible. On the basis of the evidence, ustekinumab has a role in patients with primary failure or secondary loss of response to anti-tumor necrosis factor agents, as well as in those who have adverse events on front-line biologics or are reinitiating therapy after a treatment holiday. Current evidence suggests that ustekinumab may be particularly suitable in patients who present extra-intestinal manifestations of the disease or are at risk of infections. Ustekinumab may also be considered in the first-line setting, especially in frail patients, in young subjects or in those who have concomitant immune-mediated diseases.

OC.11.4 LONG TERM EFFICACY OF GRANULOCYTE-MONOCYTE-APHERESIS IN ULCERATIVE COLITIS. THE ITALIAN REGISTRY OF THERAPEUTIC APHERESIS

G A A b st ra ct s These cases were divided into two groups according to the period of availability of infliximab (IFX): pre-IFX (N=94, Jan. 1975 Jun. 2001) and post-IFX (N=88, Jul. 2001 Jun. 2009). Results: The perianal lesions were observed in 36.3% of CD patients, more common in male, and diagnosed at younger age than CD without perianal lesions. Fistula was the most prevalent lesion, followed by abscess, fissure, and stricture. Perianal lesions preceded abdominal symptoms such as pain and diarrhea in 25% of the cases. In post-IFX group, the remission rates with non-specific conservative management, specific medical treatment, surgical treatment, and combined surgical and medical treatment were 17%, 73%, 58%, and 72%, respectively. The remission rate of combined treatment in post-IFX group was significantly higher than that in pre-IFX group. Cumulative relapse rates in 1, 3, and 5 years were 9.4%, 31.3%, and 41.7%, respectively. Medical maintenance treatment was the only significant factor that lowers the relapse rates (p<0.01). Conclusions: These results suggest that initial medical treatment is effective and maintenance therapy lowers the recurrence rates in CD patients with perianal lesions.