Background and aims: There are conflicting reports on the role of azathioprine (AZA) thioguanine nucleotide (TGN) metabolites in optimising therapy for inflammatory bowel disease(IBD). The aim of this study was to inv...Background and aims: There are conflicting reports on the role of azathioprine (AZA) thioguanine nucleotide (TGN) metabolites in optimising therapy for inflammatory bowel disease(IBD). The aim of this study was to investigate TGN intrapatient variation, and the relationship between TGN concentrations and disease activity in IBD patients taking long term constant dose AZA. Methods: TGN and methylmercaptopurine nucleotide(MeMPN) concentrations were measured at intervals over a two year period. Disease activity was assessed at each clinic visit using the Crohn s disease activity index or Walmsley simple index for ulcerative colitis. Results: Serial TGNs were measured in 159 patients (3-14 TGN assays, median 6). Intrapatient variation in TGN concentrations was 1-5 fold (median 1.6); the incidence of non-compliance was 13% . At the end of two years,131 patients were evaluable at TGN steady state. Of this group,patients who remained in remission had significantly higher mean TGN concentrations than those patients who developed active disease (median TGNs 236 v 175, respectively; median difference 44 pmol (95% confidence interval 1-92); p=0.04).MeMPN concentrations were not related to AZA efficacy or toxicity. Conclusions: This study has shown that lower TGN concentrations were linked to the development of active dis ease,and that TGNs may act as useful markers of compliance. However,it is clear that repeat TGN measurements are required for an unambiguous index of active metabolite exposure. In view of the high intrapatient variability in TGN production over time,TGN measurements may not be currently advocated for routine clinical use.展开更多
Background and Study Aims:Optical colonoscopy is considered the gold standard for colorectal examination and has the advantage of allowing biopsies and polypectomy.However,the data on its safety and effectiveness in t...Background and Study Aims:Optical colonoscopy is considered the gold standard for colorectal examination and has the advantage of allowing biopsies and polypectomy.However,the data on its safety and effectiveness in the elderly population are limited and somewhat conflicting.We prospectively assessed whether there are differences in completion rates,diagnostic yield,complication rates and 30-day mortality between patients aged ≥65 years and patients aged < 65 undergoing colonoscopy at our centre.Patients and Methods:Data were collected prospectively on 2000 colonoscopies performed over a 2-year period(January 2002 to January 2004).We compared 1000 consecutive colonoscopies in patients aged≥65 with 1000 consecutive colonoscopies in patients aged < 65(control group).Data were collected on sedation;on completion rates,both crude and adjusted to discount failures due to obstructive disease;on diagnostic yield;complications,and on 30-day mortality.Results:The median age was 75 years(51%women)for the elderly group and 54 years(59%women)for controls.The proportion of patients who received sedation was similar for both groups(59%vs.62%,P=0.97)but the mean dose of midazolam was lower in the elderly group(3.8 mg vs.4.5 mg,P < 0.0001).The crude completion rate was lower for the elderly group(81.8%vs.86.5%,P=0.004),but the adjusted rate was similar for both groups(88.1%elderly vs.87.6%control,P=0.18).The overall diagnostic yield was higher in the elderly group(65%vs.45%,P < 0.0001)with higher rates of carcinoma detected(7.1%vs.1.3%,P< 0.0001).The complication rate was low(0.2%per group).Conclusions:Colonoscopy in the elderly is safe and effective with a high diagnostic yield.Colonoscopy may now be the imaging modality of choice in the elderly population.展开更多
文摘Background and aims: There are conflicting reports on the role of azathioprine (AZA) thioguanine nucleotide (TGN) metabolites in optimising therapy for inflammatory bowel disease(IBD). The aim of this study was to investigate TGN intrapatient variation, and the relationship between TGN concentrations and disease activity in IBD patients taking long term constant dose AZA. Methods: TGN and methylmercaptopurine nucleotide(MeMPN) concentrations were measured at intervals over a two year period. Disease activity was assessed at each clinic visit using the Crohn s disease activity index or Walmsley simple index for ulcerative colitis. Results: Serial TGNs were measured in 159 patients (3-14 TGN assays, median 6). Intrapatient variation in TGN concentrations was 1-5 fold (median 1.6); the incidence of non-compliance was 13% . At the end of two years,131 patients were evaluable at TGN steady state. Of this group,patients who remained in remission had significantly higher mean TGN concentrations than those patients who developed active disease (median TGNs 236 v 175, respectively; median difference 44 pmol (95% confidence interval 1-92); p=0.04).MeMPN concentrations were not related to AZA efficacy or toxicity. Conclusions: This study has shown that lower TGN concentrations were linked to the development of active dis ease,and that TGNs may act as useful markers of compliance. However,it is clear that repeat TGN measurements are required for an unambiguous index of active metabolite exposure. In view of the high intrapatient variability in TGN production over time,TGN measurements may not be currently advocated for routine clinical use.
文摘Background and Study Aims:Optical colonoscopy is considered the gold standard for colorectal examination and has the advantage of allowing biopsies and polypectomy.However,the data on its safety and effectiveness in the elderly population are limited and somewhat conflicting.We prospectively assessed whether there are differences in completion rates,diagnostic yield,complication rates and 30-day mortality between patients aged ≥65 years and patients aged < 65 undergoing colonoscopy at our centre.Patients and Methods:Data were collected prospectively on 2000 colonoscopies performed over a 2-year period(January 2002 to January 2004).We compared 1000 consecutive colonoscopies in patients aged≥65 with 1000 consecutive colonoscopies in patients aged < 65(control group).Data were collected on sedation;on completion rates,both crude and adjusted to discount failures due to obstructive disease;on diagnostic yield;complications,and on 30-day mortality.Results:The median age was 75 years(51%women)for the elderly group and 54 years(59%women)for controls.The proportion of patients who received sedation was similar for both groups(59%vs.62%,P=0.97)but the mean dose of midazolam was lower in the elderly group(3.8 mg vs.4.5 mg,P < 0.0001).The crude completion rate was lower for the elderly group(81.8%vs.86.5%,P=0.004),but the adjusted rate was similar for both groups(88.1%elderly vs.87.6%control,P=0.18).The overall diagnostic yield was higher in the elderly group(65%vs.45%,P < 0.0001)with higher rates of carcinoma detected(7.1%vs.1.3%,P< 0.0001).The complication rate was low(0.2%per group).Conclusions:Colonoscopy in the elderly is safe and effective with a high diagnostic yield.Colonoscopy may now be the imaging modality of choice in the elderly population.
