Ulcerative Colitis: López San Román A

Obrador A, López San Román A, Muñoz P, Fortún J, Gassull MA, Anonymous00002. · Servicio de Digestivo. Hospital Son Dureta. Palma de Mallorca. España. · Gastroenterol Hepatol. · Pubmed #12525326 No free full text.

This publication has no abstract.

Mañosa M, López San Román A, Garcia-Planella E, Bastida G, Hinojosa J, Gonzalez-Lama Y, Masnou H, Domènech E. · Hospital Universitari Germans Trias i Pujol, Universitat Autònoma Barcelona, Badalona, Spain. · Digestion. · Pubmed #19439969 No free full text.

Abstract: BACKGROUND: Cyclosporin (CsA) and infliximab (IFX) have proven efficacy in avoiding colectomy in patients with steroid-refractory ulcerative colitis (UC). AIM: To assess the clinical outcome of patients treated with IFX after CsA failure for acute steroid-refractory flares of UC. Methods: Medical records of patients with a steroid-refractory UC flare who did not respond to CsA or relapsed soon after hospital discharge, and who followed rescue therapy with IFX, were reviewed retrospectively. RESULTS: Sixteen patients were included, 69% with extensive UC. Thirteen patients had moderate-to-severe disease activity at the time IFX was started. Median time between CsA discontinuation and the first IFX infusion was 19 days. Thirteen patients completed an induction regimen, and 6 of them followed scheduled maintenance treatment with IFX. After a median time of follow-up from the first IFX infusion of 195 days, 6 patients (37.5%) required colectomy. Median time for colectomy was 47 days. There were no deaths or malignancies, and only one septic complication was recorded. CONCLUSIONS: IFX rescue therapy might avoid short-term colectomy in a proportion of steroid-refractory UC patients who do not respond to CsA, but systematic use of sequential rescue therapy is not recommended until more data about its safety profile is available.

Bermejo F, López San Román A, Algaba A, van Domselaar M, Carneros JA, Rivero M, Piqueras B, Valer MP. · Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Madrid, Spain. · Gastroenterol Hepatol. · Pubmed #19174078 No free full text.

Abstract: AIM: Infliximab can provoke acute or delayed infusion reactions (IR) leading to treatment withdrawal. Our aim was to determine the frequency of IR in patients with inflammatory bowel disease receiving intravenous infliximab and premedicated with steroids and antihistaminics. METHODS: We prospectively studied 100 consecutive patients (74 with Crohn's disease, 26 with ulcerative colitis) treated with infliximab induction therapy (3 doses: weeks 0-2-6), followed or not by maintenance every 8 weeks. All patients were premedicated with 100 mg i.v. hydrocortisone and 5 mg i.v. dexchlorpheniramine 30 min before each infusion. RESULTS: The mean age was 40.9+/-13 years (51% females, and 38% smokers). Ninety-two percent of the patients were under immunomodulator therapy (azathioprine/ mercaptopurine 85% or methotrexate 7%). A total of 560 infusions were administered, with a mean of 5.6 per patient (range, 1-21). Fifty-six percent of the patients received maintenance therapy. The mean length of follow-up was 17+/-16 months. IR occurred in 6 patients (6%) and in 1.4% of all infusions (8/560). All reactions were mild or moderate. Five IR were immediate, occurring in the second infusion. One IR was delayed (exanthema 5 days after the second infusion). Infliximab therapy was discontinued in only 3 patients (in the patient with the delayed IR and in 2 patients with immediate IR that reappeared during the third infusion). CONCLUSION: In patients with inflammatory bowel disease treated with infliximab and under immunomodulator therapy, premedication with steroids and antihistaminics was associated with a low prevalence of IR. Moreover, after close follow-up, infliximab had to be discontinued in only 3% of the patients.

López San Román A, Rivero Fernández M. · Servicio de Gastroenterología, Hospital Ramón y Cajal, Madrid, España. · Rev Clin Esp. · Pubmed #17568519 No free full text.

Abstract: Treatment of inflammatory bowel disease should take some general considerations into account, standing out among them the importance of nutrition, antithrombotic prophylaxis in certain situations, prevention of osteoporosis and prevention of colorectal cancer by endoscopic screening in extensive ulcerous colitis or Crohn's colitis. Ulcerous colitis is still effectively treated with salicylates and steroids in its mild and moderate forms. Severe forms require parenteral steroids, cyclosporine or infliximab, and these are successfully used with immunosuppressants (azathioprine or mercaptopurine) in steroid dependence. Maintenance with salicylates, that should be adequately complied with, is an important point. Crohn's disease is treated with steroids in its mild and moderate forms, and again in corticodependent ones with immunosuppressants, which we are using increasingly sooner. Refractory forms or fistulous forms benefit from the use of biological treatments (infliximab) generally accompanied by immunosuppressants.

Pastor Rojo O, López San Román A, Albéniz Arbizu E, de la Hera Martínez A, Ripoll Sevillano E, Albillos Martínez A. · Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain. · Inflamm Bowel Dis. · Pubmed #17206721 links to  free full text

Abstract: BACKGROUND: In inflammatory bowel disease (IBD), enhanced inflammatory activity in the gut is thought to increase the risk of bacterial translocation and endotoxemia. By searching for signs of endotoxin-signaling cascade activation, including augmented levels of endotoxin, lipopolysaccharide-binding protein (LBP), and soluble CD14 receptor (sCD14), this prospective study sought to establish whether endotoxemia could contribute to greater clinical activity of disease. METHODS: Concentrations of plasma endotoxin, LBP, sCD14, several cytokines, acute phase proteins and clinical activity indices were determined in 104 patients with Crohn's disease (CD) and 52 patients with ulcerative colitis (UC). RESULTS: Endotoxemia was present in 48% of the patients with CD and in 28% of the patients with UC. The mean LBP was higher in patients with active CD (23.1 +/- 13.7 microg/mL) and UC (21.4 +/- 10.9 microg/mL) than in healthy controls (7.2 +/- 1.8 microg/mL; P < 0.01). Elevated serum concentrations of endotoxin and LBP were even detected in patients with inactive CD. Among the patients with active IBD, those with higher endotoxin levels had the worst clinical activity scores and the highest LBP levels. Treatment normalized LBP concentrations, from 29.1 +/- 13.0 to 15.2 +/- 7.3 microg/mL; (P < 0.05) in active CD and from 21.7 +/- 9.8 to 13.6 +/- 5.7 microg/mL; (P < 0.01) in active UC, along with normalizing endotoxin and sCD14 plasma concentrations. CONCLUSIONS: Patients with IBD show increased serum levels of endotoxin, LBP and sCD14. This alteration correlates with disease activity, with normal levels recovered after treatment, although less completely in Crohn's disease, and parallels a rise in proinflammatory cytokines, suggesting a contribution of bacterial products to the inflammatory cascade in these patients.

López San Román A, Bermejo F, Carrera E, Pérez-Abad M, Boixeda D. · Service of Digestive Diseases, Hospital Ramón y Cajal, Madrid, Spain. · Rev Esp Enferm Dig. · Pubmed #15982180 links to  free full text

Abstract: AIM: Adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease. PATIENTS AND METHODS: We explored adherence to treatment and its modifiers in 40 patients with inflammatory bowel disease using a battery of tests. RESULTS: A 67% of patients (95% CI: 51-81%) acknowledged a certain degree of involuntary nonadherence, and 35% (95% CI: 20-51%) of voluntary nonadherence. Overall, 72% (95% CI: 56-85%) of patients had some form of nonadherence. An objective correlation of these self-reported data was assessed by the determination of urine salicylate levels in the subset of patients treated with mesalazine or its derivatives (15 cases). Two of them (13%) had no detectable urinary drug levels, indicating complete nonadherence. Voluntary nonadherence was higher in patients with lower scores in the intestinal (p = 0.02) and social areas (p = 0.015) of IBDQ-32, as well as in those with less active Crohn s disease (p < 0.005), patients with high depression scores and high patient-physician discordance (p = 0.01), patients with long-standing disease (p = 0.057), patients who considered themselves not to be well informed about the treatment they were getting (p = 0.04) or who trusted their attending physicians less (p = 0.03). CONCLUSIONS: Intentional nonadherence to therapy is prevalent among patients with inflammatory bowel disease. A correction of factors associated to poor adherence could lead to higher therapeutic success.

López San Román A, Bermejo F, Aldanondo I, Carrera E, Boixeda D, Muñoz Zato E. · Services of Gastroenterology, University Hospital Ramón y Cajal, Madrid, Spain. · Rev Esp Enferm Dig. · Pubmed #15230672 No free full text.

Abstract: Pyoderma gangrenosum is an extraintestinal manifestation of inflammatory bowel disease that can be therapeutically troublesome. We comment on the case of a patient with clinically inactive ulcerative colitis who progressively developed necrotic lesions on both tibial aspects of his legs, which corresponded both clinically and histologically to pyoderma gangrenosum. Treatment with steroids and azathioprine could not control this complication. A single dose of infliximab 5 mg/kg was given, achieving an impressive response of the skin lesions followed by complete healing 3 months later. Infliximab can be useful in the management of refractory extraintestinal manifestations of inflammatory bowel disease.