AIM:To assess the efficacy of intravenous cyclophos-phamide pulse therapy for refractory inflammatory boweldisease(IBD).METHODS:We included in our cohort eight patientswith(moderate/severe)steroid refractory IBD(4 wit...AIM:To assess the efficacy of intravenous cyclophos-phamide pulse therapy for refractory inflammatory boweldisease(IBD).METHODS:We included in our cohort eight patientswith(moderate/severe)steroid refractory IBD(4 withulcerative colitis and 4 with Crohn's disease).They allreceived 6 cycles of intravenous cyclophosphamide(800mg)per month.RESULTS:Patients entered into remission after the sec-ond/third cyclophosphamide pulse.Disease activity de-creased.There were no side effects and toxicity.All thepatients went into long lasting remission.All Crohn's diseasepatients and 3 of 4 ulcerative colitis patients achievedcomplete remission.One patient with ulcerative colitisshowed an impressive clinical response but did not enterinto remission.For the maintenance,patients with Crohn'sdisease were treated with methotrexate(15 mg/wk)andpatients with ulcerative colitis were treated with azathio-prine(2.5 mg/kg body weight/d).CONCLUSION:Remission was maintained in all pa-tients for 6 mo on the average.The drug was well toler-ated.These findings suggest that aggressive immuno-suppressive therapy may be useful in some refractorypatients and further controlled study should be consid-ered in order to fully evaluate this type of treatment as apotential therapy for IBD.展开更多
In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintesti...In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintestinal complication of IBD, squarely associated with the IBD activity. The application of antico-agulant and thrombolytic therapy in severe IBD is an unresolved issue. Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT). A 46-year-old male patient is reported who had Crohn's disease for 10 years. His right hand suddenly became cold and painful. Angiography proved acute occlusion of the brachial and radial artery. Vascular surgery intervention was not applicable. Endoscopy showed extended, severe inflammation of the colon. Despite the severe endoscopic findings, frequent bloody stools and moderate anaemia, CDT with recombinant tissue plasminogen activator was performed. The control angiography proved improvement, the radial artery pulse appeared. No bleeding complication was observed. This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.展开更多
AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METH...AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METHODS: A cohort of patients with independently confirmed typical histopathological changes was investigated. Fifty-three patients with histologically proved MC (46 with CC, 7 with LC) were included. The existence of diarrhea or constipation and the co-existence of autoimmune diseases were also investigated and all data were retrospectively analyzed.RESULTS: Twenty-three (43.39%) of MC patients had chronic constipation (20 in CC, 3 in LC patients). Twentyfour(45.28%) of MC patients had autoimmune disease and the diagnosis of autoimmune disease was always prior to MC. Sjogren's syndrome was associated only with the constipation subgroup.CONCLUSION: The Janus face of MC resembles the subgroups of irritable bowel syndrome. The co-existence of autoimmune diseases and MC is confirmed in both the constipation and diarrhea subgroups.展开更多
文摘AIM:To assess the efficacy of intravenous cyclophos-phamide pulse therapy for refractory inflammatory boweldisease(IBD).METHODS:We included in our cohort eight patientswith(moderate/severe)steroid refractory IBD(4 withulcerative colitis and 4 with Crohn's disease).They allreceived 6 cycles of intravenous cyclophosphamide(800mg)per month.RESULTS:Patients entered into remission after the sec-ond/third cyclophosphamide pulse.Disease activity de-creased.There were no side effects and toxicity.All thepatients went into long lasting remission.All Crohn's diseasepatients and 3 of 4 ulcerative colitis patients achievedcomplete remission.One patient with ulcerative colitisshowed an impressive clinical response but did not enterinto remission.For the maintenance,patients with Crohn'sdisease were treated with methotrexate(15 mg/wk)andpatients with ulcerative colitis were treated with azathio-prine(2.5 mg/kg body weight/d).CONCLUSION:Remission was maintained in all pa-tients for 6 mo on the average.The drug was well toler-ated.These findings suggest that aggressive immuno-suppressive therapy may be useful in some refractorypatients and further controlled study should be consid-ered in order to fully evaluate this type of treatment as apotential therapy for IBD.
文摘In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintestinal complication of IBD, squarely associated with the IBD activity. The application of antico-agulant and thrombolytic therapy in severe IBD is an unresolved issue. Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT). A 46-year-old male patient is reported who had Crohn's disease for 10 years. His right hand suddenly became cold and painful. Angiography proved acute occlusion of the brachial and radial artery. Vascular surgery intervention was not applicable. Endoscopy showed extended, severe inflammation of the colon. Despite the severe endoscopic findings, frequent bloody stools and moderate anaemia, CDT with recombinant tissue plasminogen activator was performed. The control angiography proved improvement, the radial artery pulse appeared. No bleeding complication was observed. This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.
文摘AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METHODS: A cohort of patients with independently confirmed typical histopathological changes was investigated. Fifty-three patients with histologically proved MC (46 with CC, 7 with LC) were included. The existence of diarrhea or constipation and the co-existence of autoimmune diseases were also investigated and all data were retrospectively analyzed.RESULTS: Twenty-three (43.39%) of MC patients had chronic constipation (20 in CC, 3 in LC patients). Twentyfour(45.28%) of MC patients had autoimmune disease and the diagnosis of autoimmune disease was always prior to MC. Sjogren's syndrome was associated only with the constipation subgroup.CONCLUSION: The Janus face of MC resembles the subgroups of irritable bowel syndrome. The co-existence of autoimmune diseases and MC is confirmed in both the constipation and diarrhea subgroups.