Enfermedad Inflamatoria Intestinal al Día最新文献

Up to 30% of patients with Crohn's disease are refractory to corticoesteroids. Currently, these patients are treated with inmunosupressive or biologic therapies or surgery. A proper differential diagnosis must be established knowing that many infections can mimic inflamatory bowel disease, and the diagnosis is not always easy. A case of an ileocolonic Crohn's disease refractory to corticosteroid because an Entamoeba histolytica infection in a patient without epidemiologic risk factors is presented.

Objectives

To compare effectiveness, efficiency and safety of two parenteral iron formulations in patients with inflammatory bowel disease: ferric-carboximaltose vs ferric-sacarose.

Methods

Retrospective analysis of 72 patients undergoing intravenous iron treatment. Indications of treatment: hemoglobin < 10 g/dL and or ferritininemia < 100 μg/L. The need of transfusion of red blood cells pools was registered, meaning the immediate closure of the follow-up of the patient. Iron protocol administration: ferric-carboximaltose (40 patients): maximum dose 1000 mg in 15 minutes perfusion; ferric-sacarose (32 patients): maximum dose 200 mg in 1 hour perfusion.

Results

There were no significant differences in average levels of haemoglobin (Ferric-carboxymaltose 10.78 ± 2.06 mg/dL vs. Ferric-sucrose 10.14 ± 2.33 mg/dL), haematocrit (ferric-carboxymaltose 32.15 ± 3.24% vs. ferric-sucrose 30.47 ± 4.53%), MCV (ferric-carboxymaltose 72.40 ± 7.72 fL vs. ferric-sucrose 69.54 ± 8.46 fL) and MCH (ferric-carboxymaltose 25.43 ± 6.22 pg/dL vs. ferric-sucrose 23.75 ± 5.93 pg/dL). Average ferritin levels were higher in ferric-carboxymaltose group (246.74 ± 17.83 μg/L vs. 179.52 ± 21.36 μg/L; P=.023).

Adverse events registered in the administration of ferric-carboxymaltose were lower (2 urticarial reactions) vs. al ferric-sucrose (13 stomachache and headache cases); p < 0.001. 2 patients with ferric-carboxymaltose required blood transfusion vs. 6 patients with Ferric-sucrose group; p = 0.062. The number of administered dosages was significantly higher in ferric-sucrose group in a ratio ferric-sucrose/ferric-carboxymaltose of 3.39 dosages/patient. Ferric-carboxymaltose application reduced treatment cost in €948.46/patient.

Conclusions

Treatment with intravenous ferric-carboxymaltose shows an effectiveness profile not inferior to ferric-sucrose. Higher repletion of systemic stock and a better security profile. Related to posology, treatment shows to improve efficiency, reducing dosages, blood transfusion and cost per patient.

Extra-intestinal manifestations are frequent in Crohn's disease (CD). Adult onset Still's disease is a rare disease presenting with arthritis and arthralgia, high ( > 39 °C) and persistent fever, rash, sore throat, lymphadenopathies and hepatosplenomegaly. There are only 3 cases in literature of adult onset Still's disease presenting in CD patients. We describe a new case of adult onset Still's disease associated to connective tissue disease. Although infrequent, it is important to become aware of this disease for the differential diagnosis of arthralgia and high fever in CD patients.

Microscopic colitis (MC) comprises 2 fundamental entities (lymphocytic colitis and collagenous colitis) defined by chronic or recurrent watery diarrhea, normal colonoscopy and characteristic histopathological features. The exposure of the colonic mucosa at different luminal antigens, including different drugs, has been involved in the still poor understood pathophysiology of MC. Thus, the relationship between the development of MC after drug exposure has been the subject of research for more than 2 decades, mainly based on observational studies, including case reports and case series, case-control studies, and data on drug prescriptions. Among others, proton-pump inhibitors, nonsteroidal antiinflammatory drugs, selective inhibitors of serotonin reuptake, beta-blockers and statins, have been linked to the onset of MC, but all these drugs are also recognized as a frequent cause of drug-associated diarrhea.

At present we have no universally accepted criteria for establishing cause-effect relationships in adverse drug reactions, although several methods have provide us with different levels of likelihood. Thus, the existence of a high probability of MC occurrence as an adverse effect to a specific drug has been shown only in individual cases by using chronological (exposure, effect of withdrawal and relapse with re-exposure) and semiological criteria. Although case-control studies have repeatedly shown significant associations between drug exposure and MC, variability in their designs, including reference populations used and the criteria considered in defining drug exposure, requires a detailed analysis. This article critically examines the complex relationship between drugs, diarrhea and MC, to conclude that a likely cause-effect relationship has only been described for few drugs and in individual cases of MC.