Enfermedad Inflamatoria Intestinal al Día最新文献

Pediatric Inflammatory Bowel Disease (P-IBD) has its own characteristics and early, intensive and sustained treatment is recommended. Immunomodulator treatment is indicated for maintenance of remission in P-CD (Pediatric Crohn's Disesase) treated with exclusive enteral nutrition (EEN) to induce remission and P-UC (Pediatric Ulcerative Colitis) that requires steroids to induce remission. Combo therapy is recommended for patients at high risk of complications; however, individualized treatment and the assessment of adverse events is mandatory. By now, the use of thiopurines is not justified for the prevention of loss of response to anti-TNF and antibody formation. Larger pediatric prospective studies are needed.

Objective

To reflect on aspects related to faecal incontinence, the way it modifies the lifestyle of patients with inflammatory bowel disease (IBD) and the nurse's role in this process.

Method

Literature review of faecal incontinence and the relationship between the specialist nurse.

Conclusions

It is essential that patients are rest assured that fighting against faecal incontinence is not only their responsibility, but also the nurse plays an active role.

Mesalazine is the drug of choice in patients with mild-moderate forms of ulcerative colitis, both for inducing clinical remission and for maintenance. In fact, half of patients will be controlled with mesalazine only during their progress. It is overall considered a safe drug, with few adverse effects. Still, some cases of hypersensitivity to aminosalicylates of idiosyncratic nature have been described, which could lead to the withdrawal of the drug. This could notably limit the chances of therapeutic management, especially in patients with a mild or moderate activity or in those with exclusively rectal involvement. We present 2 cases of ulcerative proctitis where an allergy to mesalazine was suspected, what led to an inadequate control of the disease. Upon completion of the immunoallergic study the sensitivity was ruled out, the drug was reintroduced and fast and prolonged clinical remission was achieved.

Aminosalicylates are the drugs of first-choice in the management of patients with mild to moderate ulcerative colitis. In general they are safe and well-tolerated drugs. Nevertheless, cases have been described where a pancreatitis has developed as a possible complication of the treatment with aminosalicylates. It has been suggested that the mechanism these drugs use to induce inflammation on a pancreatic level is idiosyncratic. Conversely, even if cases of mesalazine-induced pancreatitis are usually mild, their recurrence rate is high, even when administered rectally. Therefore, a close monitoring must be carried out in the event that a patient who already suffered mesalazine-induced pancreatitis needs to be provided with the treatment again. We present the case of a patient with ulcerative colitis who developed a pancreatitis secondary to oral treatment with mesalazine; both the rectally administered mesalazine as well as a different formulation or oral mesalazine developed the recurrence of episodes of pancreatitis.

Background

Maintenance treatment of Crohn's disease (CD) with adalimumab achieves sustained clinical remission and improves health-related quality of life (HRQOL) of patients. There is, however, no information about its long-term effect on normalization of patient's perceived health.

Objectives

To determine the long-term normal perception of health in CD patients in clinical remission with adalimumab.

Methods

Retrospective, observational study in CD patients in clinical remission for 36 months follow-up, treated with adalimumab 40 mg eow. Patients requiring a change of treatment or surgery were not included. HRQOL was assessed with the specific questionnaire IBDQ-36. The normalization of health was defined as an overall score ≥ 209.

Results

Twenty eight patients were included in sustained clinical remission for 36 months. Three patients required further escalation and de-escalation of the dose. The IBDQ-36 overall score remained unchanged in patients with inactive stable CD and even tended to increase with time (median overall score of 230 at 6 months and 238 at 3 years). The rate of normalization of health increased with time (68% to 78% at 6 and 36 months respectively).

Conclusions

Sustained clinical remission with effective maintenance treatment with adalimumab restores the perception of normal health of most of the patients with CD.