Ramona Brugnera

Ninety-six-hour wireless oesophageal pH monitoring following proton pump inhibitor administration in NERD patients

Background  Comparative studies of proton pump inhibitors (PPIs) have revealed that acid reflux is influenced by PPI treatment, formulations and dosing regimens. Wireless pH capsules have circumvented some of the limitations of conventional catheter‐based pH testing with the additional advantage of 96‐h recording periods.

Role of conventional therapies in the era of biological treatment in Crohn’s disease

Outstanding progress regarding the pathophysiology of Crohns disease (CD) has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD. This review concentrates on the results of randomized, placebo-controlled trials, and meta-analyses when available, that provide the highest degree of evidence. Current guidelines on the management of CD recommend a step-up approach to treatment involving the addition of more powerful therapies as the severity of disease and refractoriness to therapy increase. The advent of biological drugs has opened new therapeutic horizons for treating CD, modifying the treatment goals. However, the large majority of patients with CD will be managed through conventional therapy, even if they are a prelude to biological therapy.

Which therapies are advisable in pouchitis

Antibiotics Antibiotics are the mainstay of treatment. Usually ciprofloxacin and metronidazole represent the most common first therapeutic approach, and most patients with acute pouchitis respond quickly to administration of 1 g/day. In a small randomized clinical trial, ciprofloxacin 1 g/day and metronidazole 20 mg/kg/day were given for 2 weeks. Both drugs significantly reduced the total Pouchitis Disease Activity Index (PDAI) scores; however, ciprofloxacin led to a greater degree of reduction in total PDAI score, to a greater improvement in symptoms and endoscopic scores, and furthermore, was better tolerated (33% of metronidazole-treated patients reported adverse effects such as nausea, vomiting, abdominal discomfort, headache, skin rash, dysgeusia, and peripheral neuropathy, compared with none of ciprofloxacin-treated patients).1 Therefore, ciprofloxacin should be considered the first-line therapy for acute pouchitis.

News and controversy in inflammatory bowel disease treatment

Background: The treatment of Inflammatory bowel disease comes from many years of esperience, clinical trials and mistakes. Discussion: In patients with active Crohn disease steroids are considerated the first choice, but recently, the introduction of anti-TNF alfa agents (infliximab and adalimumab) has changed the protocols. Anti-TNF are also used for closing fistula after surgical curettage. An efficently preventive treatment of Crohn disease still has not been found but hight dose of oral salicylates, azatioprine or 6-MP and antibiotics might be useful. In severe attacks of ulcerative colitis, high dose iv treatment of steroids are required for a few days. Later on, a further treatment with anti- TNF might delay the need of surgery. In patients with mild to moderate attacks of ulcerative colitis, topical treatment is preferred, it consists of enemas, suppositories or foams containing 5-aminosalycilic acid, traditional steroids, topical active steroids. Topical treatment can be associated with oral steroids or oral salicylates. Oral salicylates or azatioprine are used for prevention of relaps.

Medical treatment and management of severe ulcerative colitis.

Severe colitis is a life-threatening complication of ulcerative colitis. Early recognition of the severity of the colitis and intensive treatment and monitoring have all contributed to improved outcome. Since their introduction in the 1950s, corticosteroids are the first line therapy for severe active ulcerative colitis (UC). Several prognostic parameters (such as stools movement per day, C-reactive protein, increased amount of intestinal gas or small bowel dilation, hypoalbuminemia, fever, etc.) help the physician to quickly introduce infliximab or cyclosporine or to refer the patient to the surgeon. This decision requires a careful evaluation of the patient and a medical/surgical team.