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Frankfurt am Main, Germany

Chiappetta S.,Center for Minimal Invasive Surgery | Squillante S.,Justus Liebig University | Stein J.,Crohn Colitis Center Rhein Main
Drugs of the Future

A high proportion of patients with ulcerative colitis (UC) do not achieve clinical remission with current therapies, including mesalazine, immunosuppressors and anti-TNF agents. The latest pathophysiological findings have led to a range of new and different target therapies in UC. The purpose of this report is to provide clinicians with an overview of emerging options for the treatment of UC. The scientific literature was reviewed to evaluate data on the use of immunosuppressors, anti-TNF agents, leukocyte trafficking inhibitors, inhibitors of Janus kinase, drugs to protect the mucosal barrier, anti-IP-10 antibodies and Toll-like receptor 9 agonists in UC. The blockade of the α4β7/MAdCAM-1 interaction, particularly vedo lizumab, is an effective and safe gut-specific treatment. Tofacitinib, which blocks the JAK/STAT pathway, is showing impressive results, with the highest rate of clinical response and clinical remission. Also, treatment with LT-02, a mucoprotective substance and the first substance interacting with the mucosa, shows good results. Agents targeted against multiple targets in the pathophysiology of UC have shown positive results in phase I-III trials and hold great promise for the future. Overall, more clinical research is needed to optimize the future role of these agents. Copyright © 2014 Prous Science, S.A.U. or its licensors. All rights reserved. Source

Tannich E.,Bernhard Nocht Institute for Tropical Medicine | Hartmann F.,Crohn Colitis Center Rhein Main
BMJ Case Reports

The treatment of ulcerative colitis is based on systemic corticosteroids, immunomodulators such as cyclosporine and azathioprine and TNF-α antagonists. Patients undergoing such immunosuppressive treatment are more susceptible for infectious pathogens. Here, we report the case of a patient with a 13-year history of ulcerative colitis, treated initially with systemic corticosteroids in combination with immunomodulators, and subsequently with infliximab. The patient presented with severe watery diarrhoea, abdominal cramps, weight loss and low-grade fever. Stool examinations for cytomegalovirus, bacteria and parasites were negative. Following detection of numerous oocytes of Isospora belli (IB) in direct smear preparations of the diarrhoeic stool samples, the patient was successfully treated with trimethoprim-sulfamethoxazole (co-trimoxazole). Copyright 2013 BMJ Publishing Group. All rights reserved. Source

Blumenstein I.,Frankfurt University Hospital | Dignass A.,Crohn Colitis Center Rhein Main | Vollmer S.,Gastroenterological Practice | Klemm W.,Gastroenterological Practice | And 2 more authors.
Journal of Crohn's and Colitis

Background/aim: Anaemia is a common complication in inflammatory bowel disease (IBD), frequently resulting from iron deficiency. IBD guidelines advocate intravenous iron administration although some patients respond to oral supplementation. This non-interventional study investigates the current status of anaemia management in German IBD patients. Methods: Baseline data on pre-study treatment for anaemia were retrospectively analysed in IBD patients with anaemia participating in a prospective trial of the efficacy and safety of ferric carboxymaltose. Data were collected from 55 German gastroenterological centres up to August 2010. Subjects had received care at their centre for at least 12. months prior to baseline. Results: 193 cases of IBD-associated anaemia (115 Crohn's disease, 77 ulcerative colitis) were analysed (mean age: 39. years (18-83), 79 (41%) males). Anaemia and iron status were usually assessed by haemoglobin (100%), serum ferritin (97%), and transferrin saturation (82%). In the previous 6. months, only 84 patients (43.5%) had been treated for anaemia: 47 (56%) with oral iron, 13 (15%) parenteral iron, 16 (19%) oral plus parenteral iron and 8 (10%) transfusions. No patients received erythropoietin stimulating agents. Conclusion: Although intravenous iron supplementation is recommended in IBD patients, current German practice still relies on oral therapy, even in severe anaemia. The high incidence of severe anaemia in this cohort reflects inadequate iron replacement and status monitoring. While the proportion of IBD patients with inadequately treated anaemia/iron deficiency is unknown, greater awareness of existing guidelines for iron deficiency management in IBD patients appears necessary. © 2014 European Crohn's and Colitis Organisation. Source

Stein J.,Abteilung Gastroenterologie Ernahrungsmedizin | Stein J.,Crohn Colitis Center Rhein Main | Schulzke J.-D.,Charite - Medical University of Berlin

The structure of the small bowel reflects its numerous and diverse physiological functions. In addition to its function as a diffusional boundary for the digestion and resorption of nutritional matter, the epithelium of the small bowel plays an important role as an immunological barrier. The small bowel is also responsible for the forward movement of chyme. Furthermore, it is an active endocrine organ. The small bowel is therefore a multifunctional organ, within which the individual anatomic structures have accordingly been described as functional compartments. The small bowel owes its functional diversity to an anatomical basis comprised of specific epithelial and subepithelial structures. © 2014. Source

Loitsch S.M.,Goethe University Frankfurt | Reuter K.C.,Goethe University Frankfurt | Oremek G.M.,Central University of Costa Rica | Wetzstein R.,Charite - Medical University of Berlin | And 6 more authors.
Clinical Laboratory

Background: A high-performance liquid chromatographic (HPLC) assay for vitamin B6 in human serum was compared with a novel microbiological assay (ID-Vit®) that uses microtitre plates precoated with a specific microorganism, thus avoiding numerous problems associated with the use of stock cultures utilized by common other microbial assay mit B6. Methods: Data obtained using HPLC were compared with ID-Vit® results in 170 healthy individuals and in 68 patients with coronary artery disease (CAD, 37 with acute coronary syndrome [ACS], 31 with stable CAD). Regression and Bland-Altman analysis were performed. Homocysteine in CAD patients was measured by HPLC. Results: The ID-Vit® assay correlated well with the HPLC assay (Pearson's r = 0.89 [p < 0.0001] in healthy and 0.82 [p < 0.001] in CAD individuals). Bland-Altman analyses revealed good agreement between the results of both methods in both cohorts, with ≥ 95% of all values grouping within the lines of agreement. In CAD patients, mean homocysteine values did not differ between stable CAD and ACS and were normal. Thirty-seven percent of CAD patients had estimated glomerular filtration rates (GFR) below 60 mL/min/1.73m2. GFR correlated inversely with homocysteine levels (r = -0.80, p < 0.001) whereas neither HPLC nor ID-Vit® values for B6 did. Conclusions: ID-Vit® assay and the HPLC standard are in very good agreement. The new assay can easily be automated and is less laborious than common microbiological assays. The lack of correlation between B6 vitamin and homocysteine can be accounted for by the fact that mean vitamin B6 in our CAD patients was in the normal range and that a relevant percentage of patients had chronic renal disease. Source

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