Ulcerative Colitis: Kobayashi A

Tomomasa T, Kobayashi A, Ushijima K, Uchida K, Kagimoto S, Shimizu T, Tajiri H, Tahara T, Yoden A, Anonymous00348. · Department of Pediatrics, Gunma University Graduate School, Japan. · Pediatr Int. · Pubmed #15310325 No free full text.

Abstract: This paper introduces the guidelines for treatment of ulcerative colitis in children, created by the working group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro) and the Japanese Society for Pediatric Inflammatory Bowel Disease (IBD) (Chair: Akio Kobayashi). The ideas of the working group, with regard to the fundamental differences in medical treatment between children and adults, included: (1) for children, intensive medical treatment including appropriate systemic management is important during the acute phase of illness. (2) Treatment with steroids, which can cause growth disturbances, should not be continued for long periods of time. (3) Pulsed steroid therapy, selective removal of blood cells, and intravenous infusion of cyclosporin should be included in the therapeutic option for severe and fluminant cases.

Tajiri H, Tomomasa T, Yoden A, Konno M, Sasaki M, Maisawa S, Sumazaki R, Shimizu T, Toyoda S, Etani Y, Nakacho M, Ushijima K, Kobayashi A, Anonymous00112. · Department of Pediatrics, Osaka General Medical Center, Osaka, Japan. · Digestion. · Pubmed #18577852 No free full text.

Abstract: BACKGROUND AND AIMS: Azathioprine (AZA) and 6-mercaptopurine (6-MP) have recently been used in Japanese pediatric patients with ulcerative colitis. The aims of this study were to evaluate both the therapeutic efficacy and safety of AZA/6-MP in this group of patients. METHODS: Fourteen members of the Japanese Society for Pediatric Inflammatory Bowel Disease reported 35 retrospective cases that received AZA/6-MP and were evaluated for adverse drug effects. In those who tolerated AZA/6-MP, disease activity and corticosteroid doses before and during the first 6 months of therapy were assessed. RESULTS: AZA or 6-MP was safely used in 21 of 35 patients (60%) without adverse drug effects. The disease activity began to decrease from the first month of therapy and the maximum effect was achieved after 3 months. The mean daily prednisolone dose was decreased from 26.9 to 11.6 mg and dose reduction was achieved in 58% of patients after 6 months of therapy. Fourteen of the 35 patients (40%) experienced adverse drug effects, including leukopenia (n = 11), aplastic anemia (n = 1), pancreatitis (n = 1) and liver dysfunction (n = 1). CONCLUSIONS: The majority of Japanese children with ulcerative colitis tolerated AZA/6-MP and experienced favorable effects. However, 40% experienced adverse drug effects, mainly myelosuppression.

Tomomasa T, Kobayashi A, Kaneko H, Mika S, Maisawa S, Chino Y, Syou H, Yoden A, Fujino J, Tanikawa M, Yamashita T, Kimura S, Kanoh M, Sawada K, Morikawa A. · Department of Pediatrics, Gunma University Faculty of Medicine, Maebashi, Japan. · Dig Dis Sci. · Pubmed #12741466 No free full text.

Abstract: Granulocytapheresis (GCAP) has produced efficacy in adult patients with ulcerative colitis (UC) by adsorbing activated granulocytes and monocytes/macrophages. We retrospectively investigated efficacy and safety of GCAP in pediatric patients with active UC. Twelve steroid-refractory children (12.2 +/- 3.1 years old) were treated with GCAP, one session/week for 5-10 consecutive weeks. In 8 patients, clinical symptoms improved after two GCAP sessions. Normal body temperature, stool frequency, and disappearance of blood in stool were seen after 24.3 +/- 11.5 days. The endoscopic grade improved from 2.6 +/- 0.3 to 0.4 +/- 0.2. One patient who initially responded, developed bloody diarrhea later and 2 cases remained unchanged. The dose of steroid was tapered during GCAP therapy by 50%. No serious adverse effects were noted. Four of 8 cases relapsed 3.5 +/- 2.2 months after the last GCAP while on maintenance therapy, the other 4 were in remission up to 22.8 +/- 18.1 months. In conclusion, GCAP appears to be effective and well tolerated in children with steroid-refractory UC.

Nozue T, Kobayashi A, Takagi Y, Okabe H, Hasegawa M. · Department of Pediatrics, Showa University Toyosu Hospital, Tokyo, Japan. · Pediatr Int. · Pubmed #10881587 No free full text.

Abstract: BACKGROUND: We determined whether magnetic resonance imaging (MRI) could determine the activity and site of involvement in ulcerative colitis. METHODS: Colonoscopy, double-contrast barium enema and gadodiamide-enhanced MRI were performed prospectively in six patients with ulcerative colitis, including three females aged 10-22 years, both in the active and the remission stages. RESULTS: Characteristic findings of MRI in the active stage of ulcerative colitis were loss of haustral markings and thickening and contrast enhancement of the colonic wall. In five of six patients, the site of disease distribution determined by MRI was in accordance with that determined by colonoscopy. CONCLUSIONS: Gadodiamide-enhanced MRI is a safe and useful method of determining disease activity and extent in patients with ulcerative colitis.