Treatment of active steroid-refractory inflammatory bowel diseases with granulocytapheresis: Our experience with a prospective study

AIM： To report our experience with the use of granulocytapheresis （GCAP） in 14 patients with active steroid-refractory inflammatory bowel disease （IBD） in order to evaluate its efficacy in achieving remission and maintaining a long lasting symptom-free period. METHODS： The activity of the disease was evaluated by clinical activity index （CAI） and endoscopic index （EI） in ulcerative colitis （UC）, while by Crohn＇s disease activity index （CDAI） in Crohn＇s disease （CD）. The patients were treated using the AdacolumnTM system, an adsorption column which selectively binds to granulocytes and monocytes. One session/week of GCAP was performed for 5 wk. Steroids were stopped during apheresis. RESULTS： All the patients completed the five-week course showing no complications. At the end of the last session, 93% of patients showed a clinical remission of the disease that persisted for 6 too. Nine months after the end of the treatment, 60% of the cases maintained remission, while 23% of the patients were still in clinical remission after 12 too. CONCLUSION： Even if the number of our patients with steroid-refractory IBDs was not big, we can assert that GCAP is well tolerated and effective, especially in the first six months after the treatment, in a significant percentage of cases. The rate of sustained response drops slightly after 6 mo and significantly after 12 too, however the absence of severe side effects can be a stimulus for further evaluating new schedules of treatment.

Recent and currently emerging medical treatment options for the treatment of alcoholic hepatitis

Patients with severe alcoholic hepatitis (AH) need to be treated with specific treatment for better outcome.Currently available specific treatment modalities are use of corticosteroids or pentoxifylline.However,the response rate to these drugs is only about 50%-60%.Hence,there is an urgent need for better and more effective treatment options.Tumor necrosis factor plays an important role in the pathogenesis of AH.However,agents blocking the action of tumor necrosis factor have not been found to be effective.Rather the randomized studies evaluating these agents showed an adverse effect and more infections in treated patients.Critical role of tumor necrosis factor in hepatic regen-eration explaining this contrast is discussed.Oxidative stress and inflammation derived from gut bacteria ate two main components in the pathogenesis of AH laying foundation for the role of antioxidants,probiotics,and antibiotics in the management of AH.This article reviews the current data and status of these newer agents for the treatment of AH.Of the various options available,Vitamin E and N-acetylcysteine (NAC) have shown great promise for clinical use as adjunct to corticosteroids.With these encouraging data,future well designed studies are suggested to assess Vitamin E and NAC before their routine use in clinical practice in the management of AH.

Cytapheresis for pyoderma gangrenosum associated with inflammatory bowel disease:A review of current status

Pyoderma gangrenosum(PG)is a neutrophilic dermatosis clinically characterized by the presence of painful skin ulcerations with erythematous.As it is frequently associated with inflammatory bowel diseases,including ulcerative colitis,gastroenterologists should be familiar with the disease including therapeutic options.Therefore,we have conducted a review focusing on the cytapheresis for PG in cases of inflammatory bowel diseases.A literature search was conducted to extract studies published in the last 20 years,with information on demographics,clinical symptoms,treatment,and the clinical course from a total of 22 cases reported and our recent case.In most patients,cytapheresis was associated with improvement or resolution of PG after failure of conventional therapeutic options such as corticosteroids,antibiotics,immunosuppressive agents and immunoglobulin.Based on the information summarized,cytapheresis is helpful in the majority of patients with PG refractory to medical treatment associated with inflammatory bowel diseases and could be further studied in a multicenter,randomized trial.