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Nakahigashi M.,Aichi Medical University | Nakahigashi M.,Suzuka University of Medical Science | Yamamoto T.,Inflammatory Bowel Disease Center | Sacco R.,University of Pisa | And 2 more authors.
International Journal of Colorectal Disease | Year: 2016

Purpose: The value of enteral nutrition (EN) as maintenance therapy in patients with quiescent Crohn’s disease (CD) has not been fully evaluated. The purpose of this study was to review the efficacy of EN for the maintenance of remission in patients with quiescent CD. Methods: Seven prospective cohort studies evaluating the efficacy of EN for the maintenance of remission in quiescent CD were included. Three of the seven studies were randomized-controlled trials (RCTs). In all studies, patients used EN as a supplement or as a nocturnal tube feeding in addition to their normal food. Results: One study compared the efficacy of elemental diet and polymeric diet. Elemental and polymeric diets were equally effective for the maintenance of clinical remission and for allowing tapering and cessation of steroid therapy. The other six studies compared the outcomes between patients treated with and without EN. The maintained clinical remission rate at 1 year was significantly higher in patients treated with EN in four of the six studies. Quantitative pooling of the studies was not feasible due to a small number of RCTs and a narrative account of the study characteristics. Conclusions: Our review suggests that EN is useful for the maintenance of remission in patients with quiescent CD. However, there are several limitations in the reviewed studies. There are few RCTs. Further, the sample size is small, and the duration of intervention and follow-up is short. Large and well-designed RCTs should be conducted to rigorously evaluate the efficacy of EN for maintaining remission. © 2015, Springer-Verlag Berlin Heidelberg. Source


Hanai H.,Center for Gastroenterology and Inflammatory Bowel Disease Research | Takeda Y.,Hyogo College of Medicine | Eberhardson M.,Karolinska Institutet | Gruber R.,OPEL | And 3 more authors.
Clinical and Experimental Immunology | Year: 2011

Patients with active inflammatory bowel disease (IBD) have elevated and activated myeloid leucocytes which infiltrate the colonic mucosa in vast numbers. Myeloid leucocytes such as the CD14+CD16+ monocytes are major sources of tumour necrosis factor (TNF)-α, and therefore selective granulocyte/monocyte (GM) adsorption (GMA) should promote remission or enhance efficacy of pharmacological therapy. However, studies in IBD have reported both impressive as well as disappointing efficacy outcomes, indicating that patients' demographic factors might determine responders or non-responders to GMA. Nonetheless, this non-drug intervention has an excellent safety profile, and therapeutic GMA is expected to expand. In this review, attempts have been made to compile an update on the mode of actions (MoA) of the Adacolumn GMA. The MoA of GMA appears to be more than adsorption of excess neutrophils and TNF-producing CD14+CD16+ monocytes per se. Adsorbed GMs release interleukin (IL)-1 receptor antagonist, hepatocyte growth factor and soluble TNF receptors, which are anti-inflammatory. Additionally, a sustained increase in lymphocytes including the regulatory CD4+CD25+ T cells (lymphocyte sparing) is seen post-GMA. The impact of GMA on the immune system is potentially very interesting in the context of treating immune-related diseases. Future studies are expected to add intriguing insights to the MoA of GMA. © 2010 The Authors. Clinical and Experimental Immunology © 2010 British Society for Immunology. Source


Yoshimura N.,Tokyo Yamate Medical Center | Yokoyama Y.,Hyogo College of Medicine | Matsuoka K.,Tokyo Medical and Dental University | Takahashi H.,Sendai Medical Center | And 23 more authors.
BMC Gastroenterology | Year: 2015

Background: Granulocyte and monocyte adsorptive apheresis (GMA) has shown efficacy in patients with active Crohn's disease (CD). However, with routine weekly therapy, it may take several weeks to achieve remission. This study was performed to assess clinical efficacy and safety of intensive GMA in patients with active CD. Methods: In an open-label, prospective, randomized multicentre setting, 104 patients with CD activity index (CDAI) of 200 to 450 received intensive GMA, at two sessions per week (n = 55) or one session per week (n = 49). Clinical remission was defined as a CDAI score <150. Patients in each arm could receive up to 10 GMA sessions. However, GMA treatment could be discontinued when CDAI decreased to <150 (clinical remission level). Results: Of the 104 patients, 99 were available for efficacy evaluation as per protocol, 45 in the weekly GMA group, and 54 in the intensive GMA group. Remission was achieved in 16 of 45 patients (35.6 %) in the weekly GMA and in 19 of 54 (35.2 %) in the intensive GMA (NS). Further, the mean time to remission was 35.4 ± 5.3 days in the weekly GMA and 21.7 ± 2.7 days in the intensive GMA (P = 0.0373). Elevated leucocytes and erythrocyte sedimentation rate were significantly improved by intensive GMA, from 8005/μL to 6950/μL (P = 0.0461) and from 54.5 mm/hr to 30.0 mm/hr (P = 0.0059), respectively. In both arms, GMA was well tolerated and was without safety concern. Conclusions: In this study, with respect to remission rate, intensive GMA was not superior to weekly GMA, but the time to remission was significantly shorter in the former without increasing the incidence of side effects. UMIN registration 000003666. © 2015 Yoshimura et al. Source


Hanai H.,Center for Gastroenterology and Inflammatory Bowel Disease Research | Iida T.,Center for Gastroenterology and Inflammatory Bowel Disease Research | Takeuchi K.,Center for Gastroenterology and Inflammatory Bowel Disease Research | Arai H.,Center for Gastroenterology and Inflammatory Bowel Disease Research | And 9 more authors.
Digestive and Liver Disease | Year: 2012

Background: 6-Mercaptopurine is often used as maintenance therapy in patients with Crohn's disease. However, toxicities like myelosuppression limit its clinical benefit. Aims: To evaluate the efficacy of elemental diet versus 6-mercaptopurine as maintenance therapy in Crohn's disease. Methods: Ninety-five eligible patients with Crohn's disease activity index ≤150 were randomly assigned to: 6-mercaptopurine (0.5-1.5. mg/kg/day, n= 30); Elental as an elemental diet (≥900. kcal/day, n= 32); none (control, n= 33). In the three groups, patients were and remained on 5-aminosalicylic acid (2250-3000. mg/day). Patients were observed for 2 years and the rate of relapse (Crohn's disease activity index ≥200) was monitored. Results: At 24 months, the fractions of patients who had maintained remission were 60%, 46.9% and 27.2% for 6-mercaptopurine, Elental and the control groups, respectively. Log-rank test showed better efficacy for 6-mercaptopurine (P= 0.0041) and Elental (P= 0.0348) versus control. No significant difference was found between 6-mercaptopurine and Elental. Further, in the 6-mercaptopurine group, 2 patients experienced liver injury and one developed alopecia. Conclusions: This 24 months comparison study showed that Elental as maintenance therapy in Crohn's disease patients was as effective as 6-mercaptopurine. Elental should be useful for long-term maintenance therapy in Crohn's disease. This is the first comparison study evaluating nutritional therapy versus 6-mercaptopurine. © 2012 Editrice Gastroenterologica Italiana S.r.l. Source


Ikeya K.,Center for Gastroenterology and Inflammatory Bowel Disease Research | Sugimoto K.,Hamamatsu University School of Medicine | Kawasaki S.,Center for Gastroenterology and Inflammatory Bowel Disease Research | Iida T.,Center for Gastroenterology and Inflammatory Bowel Disease Research | And 3 more authors.
Digestive and Liver Disease | Year: 2015

Background: Tacrolimus has shown efficacy in patients with ulcerative colitis. Aims: To evaluate the efficacy of tacrolimus as remission induction therapy and assess medium to long-term outcomes in patients who achieve remission. Methods: Forty-four ulcerative colitis patients who were treated with tacrolimus in three institutes during 2009-2013 were retrospectively reviewed. Short-term efficacy was based on the clinical activity index and the Mayo endoscopic subscores. Clinical activity index. ≤. 4 meant clinical remission, while Mayo endoscopic subscore 0 or 1 meant mucosal healing. Medium to long-term prognosis was based on relapse free survival in relation to the Mayo endoscopic subscore and duration of tacrolimus therapy in patients who achieved remission. Results: At 12 weeks, clinical remission was achieved in 29 of 44 patients (65.9%). Thirty-two patients received endoscopic evaluations, and mucosal healing rate was 43.8%. Among patients with clinical remission, mucosal healing rate was 60.9%. Relapse-free survival at 6, 12, and 24 months were 66%, 56%, and 50%, respectively, and was higher in patients on long-term tacrolimus (over 4 months, P= 0.03), and patients with better endoscopic subscore (P= 0.009). Conclusions: Mucosal healing observed within 12 weeks or after a longer duration of tacrolimus therapy was associated with significantly better remission maintenance time. © 2015 Editrice Gastroenterologica Italiana S.r.l. Source

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