Ulcerative Colitis: Lichtenstein GR

Su C, Lichtenstein GR. · No affiliation provided · Am J Gastroenterol. · Pubmed #11151860 No free full text.

This publication has no abstract.

Osterman MT, Lichtenstein GR. · Division of Gastroenterology, Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4283, USA. · Methods Find Exp Clin Pharmacol. · Pubmed #19357797 No free full text.

Abstract: Ulcerative colitis is an idiopathic chronic inflammatory disease of the colon characterized by symptoms of bloody diarrhea and abdominal pain. Although conventional aminosalicylates have been the foundation of treatment of mild to moderate ulcerative colitis for both the induction and maintenance of remission, they are limited in a number of ways, such as which formulation and what dose are optimal, as well as the high pill burden, which often leads to low compliance with these medications. Multi-Matrix System (MMX) mesalamine (SPD476) is a promising new aminosalicylate formulation; it seems to have solved some of the problems of conventional aminosalicylates, as it is effective as a once-daily treatment in high doses and induces both clinical remission and endoscopic mucosal healing. This review article summarizes the data on the use of both conventional aminosalicylates and MMX mesalamine in the treatment of ulcerative colitis.

Schreiber S, Kamm MA, Lichtenstein GR. · Medicine & Gastroenterology, Institute for Clinical Molecular Biology, Center for Conservative Medicine, Schittenhelmstr. 12, 24105, Kiel, Germany. · Expert Rev Gastroenterol Hepatol. · Pubmed #19072380 No free full text.

Abstract: Mesalamine with MMX Multi Matrix System technology (hereafter referred to as MMX mesalamine) is an oral, high-strength (1.2 g/tablet), once-daily formulation of 5-aminosalicylic acid used for the treatment of ulcerative colitis. This new formulation has been designed to provide delayed and prolonged 5-aminosalicylic acid release throughout the colon. In recent clinical studies, MMX mesalamine (taken as a once-daily dose of 2.4 or 4.8 g) effectively induced clinical remission and mucosal healing versus placebo in patients with active, mild-to-moderate ulcerative colitis. Once remission was achieved, MMX mesalamine effectively maintained disease remission in the majority of patients for at least 12 months. In this paper, we comprehensively review the results of studies exploring the clinical pharmacology, efficacy and safety of MMX mesalamine in patients with ulcerative colitis, and examine the implications of these findings on clinical practice.

Lichtenstein GR, Kamm MA. · Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Aliment Pharmacol Ther. · Pubmed #18532992 No free full text.

Abstract: BACKGROUND: Many oral 5-aminosalicylic acid (5-ASA) formulations are designed to maximize 5-ASA release in the colon where it acts topically on the colonic mucosa. Delayed-release formulations and azo-prodrugs minimize 5-ASA absorption in the upper gastrointestinal (GI) tract. AIMS: To review methods for assessing 5-ASA release and colonic distribution from oral formulations, and the potential use of this information for guiding clinical decisions. METHODS: PubMed and recent conference abstracts were searched for articles describing techniques used to assess 5-ASA release from ulcerative colitis (UC) therapies. RESULTS: In-vitro GI models, although unable to simulate more complex aspects of GI physiology, can provide useful data on 5-ASA release kinetics and bioaccessibility. Gamma-scintigraphy is useful for investigating GI disintegration of different formulations, but may not accurately reflect 5-ASA distribution. Plasma pharmacokinetic studies provide data on systemic exposure, but not on colonic distribution or mucosal uptake. Mucosal biopsies provide direct evidence of colonic distribution and may predict clinical efficacy, but must be interpreted cautiously because of considerable inter-subject variability and other confounding factors. CONCLUSION: While assessment of 5-ASA release is important, limitations of individual measurement techniques mean that randomized clinical studies in UC patients remain the best guide for dosing and treatment regimen decisions.

Lichtenstein GR, Rubin DT, Sabesin SM, Velayos FS, Vitat P. · Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Rev Gastroenterol Disord. · Pubmed #18477967 No free full text.

Abstract: Recent evidence suggests that there is a link between increased colonic inflammation and risk of colorectal cancer, stressing the importance of preventing relapse. The risk of relapse is associated with several factors, of which the foremost is patient nonadherence to prescribed medical therapy. Nonadherence may be affected by such factors as complicated dosing regimens, forgetfulness, male sex, and treatment delivery methods. Mesalamine is the standard, first-line therapy and the treatment of choice for inducing and maintaining clinical and endoscopic remission of inflammation in patients with mild-to-moderate ulcerative colitis. Novel formulations of mesalamine and newly devised, high-dose regimens offer additional therapeutic options and may lead to improved treatment adherence, longer-lasting periods of remission, and enhanced patient well-being.

Blonski W, Lichtenstein GR. · Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland. · Inflamm Bowel Dis. · Pubmed #17304581 links to  free full text

Abstract: Several biologic agents have been assessed in patients with inflammatory bowel disease (IBD; Crohn's disease [CD] and ulcerative colitis [UC]). Until recently, only infliximab (humanized monoclonal anti-TNF-alpha antibody) had been approved by the Food and Drug Administration (FDA) to induce and maintain remission in patients with active mild to moderate and/or fistulizing Crohn's disease who are refractory to conventional therapy. Two recent trials, ACT 1 and ACT2, observed high efficacy of infliximab in inducing and maintaining clinical remission, mucosal healing, and corticosteroid-sparing effects in patients with moderate to severe UC. This agent also was recently approved by the FDA for the treatment of ulcerative colitis to reduce signs and symptoms, to induce clinical remission and healing of the intestinal mucosa, and to eliminate the use of corticosteroids in patients with moderately to severely active UC who have had an inadequate response to conventional therapy. There have been many randomized, double-blind, controlled and open-label uncontrolled studies of large and small numbers of patients assessing the efficacy and safety of various biologic agents considered potentially useful in the treatment of IBD. Among all the biologic agents, infliximab has the most robust data on safety. This is because it has been evaluated in many more trials than has any other biologic agent. In addition, postmarketing experience provides very valuable information about adverse events occurring during treatment with this agent.

Su C, Lewis JD, Goldberg B, Brensinger C, Lichtenstein GR. · Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania and University of Pennsylvania Presbyterian Medical Center, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. · Gastroenterology. · Pubmed #17258720 No free full text.

Abstract: BACKGROUND & AIMS: Knowledge of the placebo outcomes and understanding specific study features that influence these outcomes is important for designing future clinical trials evaluating therapy of ulcerative colitis (UC). The aims of this study were to estimate the placebo rates of remission and response in placebo-controlled, randomized clinical trials for active UC and to identify factors influencing these rates. METHODS: We performed a systematic review and meta-analysis of placebo-controlled, randomized clinical trials evaluating therapies for active UC identified from MEDLINE from 1966 through 2005. RESULTS: Forty studies met the inclusion criteria. The pooled estimates of the placebo rates of remission and response were 13% (95% confidence interval, 9%-18%; range, 0%-40%; median, 12%) and 28% (95% confidence interval, 23%-33%; range, 0%-67%; median, 30%), respectively, both with significant heterogeneity. Studies that used more stringent definitions of outcomes had lower placebo rates of remission and response. Study duration, number of study visits, disease duration, baseline composite and rectal bleeding scores of the disease activity index, and inclusion of endoscopic mucosal healing as the remission definition all were associated with the placebo remission rate. CONCLUSIONS: Rates of remission in the placebo arm of UC clinical trials ranges from 0% to 40%. The placebo remission rates are influenced by the trial length, number of study visits, use of stricter remission definitions, and design features that enroll patients with more active disease. These factors should be considered when designing future placebo-controlled clinical trials in patients with active UC.

Aberra FN, Lichtenstein GR. · Division of Gastroenterology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. · Gastroenterol Clin North Am. · Pubmed #17129815 No free full text.

Abstract: Infliximab is effective for treatment of moderate-to-severe UC and is recommended for patients who have had an inadequate response to medical therapy or who are intolerant of or do not desire to take the potential risk of using specific agents including immunomodulators (cyclosporine A, azathioprine, or 6-mercaptopurine), corticosteroids, and, potentially, mesalamine. Future trials are needed to assess the efficacy of infliximab with immunomodulators to see if additional benefit is achieved so that the risk-benefit ratio is positive. Based on the favorable efficacy of infliximab for UC therapy, the ground work has been established for evaluating infliximab and addressing some of the many unanswered questions and also for assessing other anti-TNF agents and streamlining the anti-TNG antibody to improve efficacy, reduce side effects, and ease administration.

Lichtenstein GR, Cohen R, Yamashita B, Diamond RH. · Center for Inflammatory Bowel Disease, University of Pennsylvania Health System, Philadelphia, PA, USA. · J Clin Gastroenterol. · Pubmed #16940876 No free full text.

Abstract: Ulcerative colitis, a chronic inflammatory disease of the rectal and colonic mucosa, affects approximately 250,000 to 500,000 people in the United States, with 30% to 40% of patients requiring some form of surgical intervention during the course of their disease. The predominant reason for total proctocolectomy is for symptoms refractory to currently available medical therapy. Less common reasons are dysplasia or cancer. The goal of colectomy is to prevent recurrence of systemic inflammatory disease. Consequently, surgery with total proctocolectomy and creation of an ileal J-pouch-anal anastomosis has become the procedure of choice for many patients without other therapeutic options. Health-related quality of life (QOL) in patients with severe ulcerative colitis is so poor that, after ileal J-pouch-anal anastomosis, QOL is considered to improve in most clinical studies (8 studies, improved QOL; 1 study, no change; 1 study, QOL worse than general population). However, QOL and bowel function after such surgery cannot be considered "normal" in all patients, because a substantial number still have problems with urgency, leakage, nocturnal soiling, sexual dysfunction, and pouchitis, and some require conversion to a permanent ileostomy after ileal J-pouch-anal anastomosis failure. Thus, despite the availability of ileal J-pouch-anal anastomosis, surgery does not always restore all aspects of QOL to normal.

Chang JT, Lichtenstein GR. · Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. · Nat Clin Pract Gastroenterol Hepatol. · Pubmed #16582964 No free full text.

Abstract: In the past decade, advances in the understanding of the pathogenesis of inflammatory bowel disease have permitted the development of agents directed against rational therapeutic targets. In particular, various antagonists of tumor-necrosis factor-alpha have been developed. These include infliximab, adalimumab, certolizumab (CDP870), CDP571, etanercept, and onercept. Clinical trials of these agents have demonstrated varying degrees of clinical efficacy. The use of these agents can be limited by infection, immunogenicity, acute infusion reactions, delayed hypersensitivity reactions, and autoimmune phenomena. This review provides insights into the use of antagonists of tumor-necrosis factor-alpha for the treatment of inflammatory bowel disease.

Blonski W, Lichtenstein GR. · Division of Gastroenterology, Department of Medicine, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Curr Opin Gastroenterol. · Pubmed #16319674 No free full text.

Abstract: PURPOSE OF REVIEW: The purpose of this review is to analyze the complications associated with treatment of inflammatory bowel disease with biologic agents. RECENT FINDINGS: There have been various biologic agents evaluated in patients with inflammatory bowel disease; that is, Crohn's disease and ulcerative colitis. Thus far only infliximab has been approved by the US Food and Drug Administration as induction and maintenance treatment in patients with active Crohn's disease (moderate-to-severe and/or fistulizing) who are refractory to conventional therapy. Recent data from two large multicenter, multicountry, randomized controlled clinical trials have demonstrated that infliximab is efficacious also for the treatment of ulcerative colitis. Other biologics considered potentially efficacious are still undergoing evaluation in various clinical trials. SUMMARY: The data concerning biologics' associated toxicity in patients with inflammatory bowel disease are the most robust in the case of infliximab. These data are derived from both prospective, randomized clinical trials and from post-marketing experience. In the case of the remaining agents the data concerning safety in inflammatory bowel disease are limited, as these agents were not evaluated in as many trials as infliximab; indeed, some of them included only several patients.

Cuffari C, Present DH, Bayless TM, Lichtenstein GR. · Johns Hopkins Hospital Division of Gastroenterology and Hepatology Baltimore, Maryland 21287, USA. · Inflamm Bowel Dis. · Pubmed #16189424 No free full text.

Abstract: Pancolitis affects approximately 20% to 40% of the total ulcerative colitis population and remains a therapeutic challenge for clinicians. Practitioners must focus on pancolitis when evaluating a patient for ulcerative colitis, because pancolitis is associated with more severe and fulminant disease and a higher rate of colorectal cancer and colectomy. It is imperative for clinicians to be knowledgeable in the clinical course, medications, and appropriate manner to induce and maintain clinical remission to prevent serious sequelae of the disease. The purpose of this article is to provide a review of the treatment of pancolitis for general gastroenterologists, because medical management decisions have life-long effects for this subgroup of patients.

Aberra FN, Lichtenstein GR. · Department of Medicine, Center for Inflammatory Bowel Disease, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 3400 Spruce Street, 3rd floor Ravdin Building, Philadelphia, PA 19104-4283, USA. · Aliment Pharmacol Ther. · Pubmed #15709982 links to  free full text

Abstract: The armamentarium of medications for the treatment of inflammatory bowel disease is growing and becoming more complicated to use. Immunomodulators are a class of medications that have found a niche for the treatment of Crohn's disease and ulcerative colitis. Because of the mounting supporting evidence for efficacy, the most commonly-used immunomodulators are azathioprine, mercaptopurine, methotrexate and ciclosporin. These medications are being used more often due to their steroid-sparing and potentially surgery-sparing effects. Immunomodulators are also known for a significant side-effect profile and require careful monitoring. This review provides the latest information for clinicians on efficacy, side-effects, dosing and monitoring of these medications for treatment of inflammatory bowel disease.

Lichtenstein GR. · Center for Inflammatory Bowel Diseases, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. · Am J Gastroenterol. · Pubmed #14697915 No free full text.

Abstract: Crohn's disease and ulcerative colitis constitute a group of disorders collectively known as inflammatory bowel disease. Men and women are equally affected, and no socioeconomic classes are spared. The age of disease onset is relatively young, frequently in the second and third decade of life. The constellation of nonspecific symptoms that constitute the prototypic symptoms of patients afflicted with inflammatory bowel disease are often overlooked and not attributed to their correct origin. These multisystem disorders commonly involve the musculoskeletal system. The skeletal system can be involved by the disease itself or by the medications used in the treatment of the disease. The finding of abnormal bone mineral density in patients with either ulcerative colitis or Crohn's disease is a relatively commonplace finding. This review discusses the pathophysiology involved in the formation of abnormal bone mineral density and the treatment of this condition in patients with inflammatory bowel disease.

Su C, Lichtenstein GR. · Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Third Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA. · Med Clin North Am. · Pubmed #12510462 No free full text.

Abstract: The evolving medical armamentarium holds promise for more precise and effective therapies for IBD. The experience with anti-TNF therapy, particularly infliximab, illustrates the potential efficacy of therapies targeted at specific mediators or pathways involved in the pathogenesis. Advances in molecular technology have enabled the development of novel and potentially effective targeted therapies. Equally important is the increasing scientific understanding of the pathogenesis of IBD, which will likely improve the ability to stratify disease and to select therapies based on genotypic, immunologic, and phenotypic profiles in the future.

Chawla A, Judge TA, Lichtenstein GR. · Center for Inflammatory Bowel Disease, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Department of Medicine, Division of Gastroenterology, 3400 Spruce Street, Ravdin Building, Philadelphia, PA 19104-4283, USA. · Gastrointest Endosc Clin N Am. · Pubmed #12486942 No free full text.

Abstract: This article discusses patients with inflammatory bowel disease (IBD), a group which is at increased risk for colorectal carcinoma based on extent and duration of their disease. Patients with chronic IBD (at least 8-10 years duration) should be screened with colonoscopy every 1 to 2 years with multiple jumbo biopsies every 10 cm through the entire colon. Patients with sporadic adenomas can be followed after complete polypectomy, whereas patients with adenoma-like dysplasia-associated lesion or mass (DALMs) need increased surveillance. Patients with flat dysplasia or non adenoma-like DALMs are at high risk for progression and should undergo colectomy. The patients who have indeterminate lesions can be differentiated based on the endoscopic, histologic, and molecular features of the lesion. Long-term follow-up is necessary to determine the natural history of these lesions.

Judge TA, Lewis JD, Lichtenstein GR. · Division of Gastroenterology, Department of Medicine, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3rd Floor Ravdin Building, Philadelphia, PA 19104-4283, USA. · Gastrointest Endosc Clin N Am. · Pubmed #12486941 No free full text.

Abstract: Extracolonic malignancies are a relatively rare complication of inflammatory bowel disease. In contrast, colorectal cancer remains a major concern for patients with long-standing UC. The best available evidence suggests that patients with long-standing Crohn's colitis are at similar risk for colorectal cancer as those patients with long-standing UC. In patients with UC, the magnitude of this increased risk appears to be greater in patients with more extensive colonic involvement. It appears that the magnitude of this risk increases with increasing duration of disease, at least in UC. Whether this reflects the increased risk of cancer that occurs with the aging process or a separate phenomena distinct to UC is unclear. To date, the methods available to reduce the risk of cancer are less than optimal. Although surgical procedures eliminate the risk, the mental and physical sequelae of these procedures can be substantial. Surveillance with colonoscopic biopsies is likely effective in reducing although not eliminating the risk of colorectal cancer. Efforts to develop chemopreventative agents and improved surveillance methods remain areas of active investigation.

Lichtenstein GR. · Division of Gastroenterology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. · Rev Gastroenterol Disord. · Pubmed #12478240 No free full text.

Abstract: Patients with inflammatory bowel disease (IBD)-either Crohn's disease (CD) or ulcerative colitis (UC)-are at increased risk for developing cancers of the gastrointestinal tract, particularly colorectal cancer (CRC). Because of the relative rarity of IBD in the general population, it has been difficult to quantify this risk; nonetheless, within particular subsets of IBD patients, the cumulative risk of developing dysplasia and CRC may be substantial. Efforts to reduce this risk have included both prophylactic surgery and endoscopic screening programs. Despite the impact this disease has on quality of life and life expectancy, an optimal strategy for reducing the risk has yet to be defined. This article reviews the current literature relating to the risk of cancer for patients with IBD and methods available to help reduce this risk.

Blam ME, Stein RB, Lichtenstein GR. · Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA. · Am J Gastroenterol. · Pubmed #11467623 No free full text.

Abstract: Crohn's disease and ulcerative colitis are two idiopathic inflammatory disorders of the GI tract. Manifestations of disease can be severe and lead to long term therapy with a variety of medications and/or surgery. Standard medical therapy consists of agents that either treat suppurative complications or modulate the inflammatory cascade in a nonspecific manner. Many specific chemokine and cytokine effectors that promote intestinal inflammation have been identified. Such work has led to experimental clinical trials with a variety of cytokine antagonists. Compounds directed against one such cytokine, tumor necrosis factor alpha (TNF), have demonstrated the greatest clinical efficacy to date. This is consistent with scientific observations that suggest a central role for TNF in the inflammatory cascade. Infliximab is a chimeric monoclonal antibody against TNF that has been demonstrated to be effective for the treatment of Crohn's disease. Infliximab is Food and Drug Administration approved for the treatment of Crohn's disease. There exist several other TNF antagonists in various phases of investigation, including the monoclonal antibody CDP 571, the fusion peptide etanercept, the phosphodiesterase inhibitor oxpentifylline, and thalidomide. The clinical efficacy of these agents and the role of TNF in the pathogenesis of inflammatory bowel disease is reviewed.

Su CG, Stein RB, Lewis JD, Lichtenstein GR. · Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA. · Dig Liver Dis. · Pubmed #11057928 No free full text.

Abstract: The treatment of Crohn's disease and ulcerative colitis has evolved and has improved the quality of life of patients afflicted with these disorders. Immune modulators such as azathioprine and 6-mercaptopurine are an important class of medications used for the treatment of patients with inflammatory bowel disease. Controlled studies have demonstrated their efficacy in both induction and maintenance of remission in Crohn's disease, and similarly, for the induction and maintenance of remission in patients with ulcerative colitis. These agents have had an increasing importance in the management of steroid-resistant, steroid-dependent diseases, and fistulizing Crohn's disease. The primary limitations to these agents have been their slow onset of action and their side effect profile. Despite these limitations, these agents have demonstrated efficacy and have become paramount to the management of patients with these incurable potentially disabling disorders. The precise role of azathioprine/6-mercaptopurine, their limitations and their safety are reviewed in this paper.

Stein RB, Lichtenstein GR. · Hospital of the University of Pennsylvania and Presbyterian Medical Center, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. · Semin Gastrointest Dis. · Pubmed #10706224 No free full text.

Abstract: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is currently the procedure of choice for ulcerative colitis patients who require colectomy. Despite its wide acceptance, a variety of long-term complications of the procedure exist that can be severe and even lead to pouch excision. Pouchitis occurs in up to one half of patients after IPAA, but is usually well controlled with medical therapy. A small percentage of patients develop chronic persistent pouchitis, which often requires long-term medical therapy and may result in pouch failure. Fistulas and strictures can also complicate the pouch procedure. In general, patients with Crohn's disease are not usually offered IPAA, because recurrence of disease, fistulas, abscesses, and strictures may lead to a higher incidence of pouch failure. Some ulcerative colitis patients develop complications after IPAA and are subsequently diagnosed with Crohn's disease. These patients may develop refractory fistulas, strictures, and extraintestinal manifestations of inflammatory bowel disease. Neoplastic transformation of the pelvic pouch has also been reported, particularly in patients with chronic pouchitis. Thorough follow-up and endoscopic surveillance with biopsies of the ileal pouch are therefore recommended.

Stein RB, Lichtenstein GR, Rombeau JL. · University of Pennsylvania School of Medicine, Presbyterian Medical Center, Philadelphia 19104, USA. · Curr Opin Clin Nutr Metab Care. · Pubmed #10589377 No free full text.

Abstract: Clinical and basic research continues to expand our understanding of the complex pathogenesis of inflammatory bowel diseases. The potential roles played by fatty acid intake, serum leptin, and nitric oxide in the promotion of intestinal inflammation in Crohn's disease and ulcerative colitis will be reviewed. In addition, important advances in the areas of bone disease, vitamin deficiency, growth failure, and home parenteral nutrition will be discussed.

Lewis JD, Deren JJ, Lichtenstein GR. · Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, USA. · Gastroenterol Clin North Am. · Pubmed #10372277 No free full text.

Abstract: Patients with inflammatory bowel disease (IBD) are at increased risk for developing cancer of the gastrointestinal tract, particularly colorectal cancer. Because of the relative rarity of IBD in the general population, it has been difficult to quantify this risk. Efforts to reduce the risk have included both prophylactic surgery and endoscopic screening programs. Because of the potential impact on quality of life and life expectancy, the optimal strategy for reducing this risk has not been defined. This article reviews the current literature relating to the risk of cancer for patients with IBD and methods to reduce this risk.

Han PD, Burke A, Baldassano RN, Rombeau JL, Lichtenstein GR. · University of Pennsylvania School of Medicine, Philadelphia, USA. · Gastroenterol Clin North Am. · Pubmed #10372275 No free full text.

Abstract: This article reviews the nutritional aspects of inflammatory bowel disease (IBD) including the mechanisms and manifestations of malnutrition and the efficacy of nutritional therapies. Nutrient deficiencies in patients with IBD occur via several mechanisms and may complicate the course of the disease. Nutritional status is assessed by clinical examination and the use of nutritional indices such as the Subjective Global Assessment of nutritional status. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need parenteral nutrition.

Kamm MA, Lichtenstein GR, Sandborn WJ, Schreiber S, Lees K, Barrett K, Joseph R. · St Vincent's Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia. · Inflamm Bowel Dis. · Pubmed #18671232 No free full text.

Abstract: BACKGROUND: Many patients with ulcerative colitis (UC) respond to mesalamine therapy within 8 weeks. Those not achieving remission after 8 weeks are often treated with steroids or other immunosuppressive therapies. This study aimed to determine the effect of 8 weeks' high-dose MMX mesalamine extension therapy in patients with active, mild-to-moderate UC who had previously failed to achieve complete remission in 2 phase III, double-blind, placebo-controlled studies of MMX mesalamine (SPD476-301 and -302). METHODS: Patients with active, mild-to-moderate UC who did not achieve clinical and endoscopic remission after <or=8 weeks' treatment with MMX mesalamine (2.4 or 4.8 g/day), ASACOL (mesalamine) delayed-release tablets 2.4 g/day, or placebo in the phase III studies received MMX mesalamine 4.8 g/day for 8 weeks. The aim was to assess remission at week 8, defined as a total modified UC Disease Activity Index score of <or=1, calculated as: scores of 0 for rectal bleeding and stool frequency, a combined Physician's Global Assessment score and sigmoidoscopy score of <or=1, no mucosal friability, and a >or=1 point reduction from baseline in sigmoidoscopy score.Results: Overall, 304 patients who entered this acute extension study were evaluated; 59.5% achieved remission at week 8. Remission rates were similar irrespective of prior treatment in the initial acute phase III studies. CONCLUSIONS: Most patients with mild-to-moderate UC who fail to achieve remission with up to 8 weeks' initial mesalamine therapy can achieve clinical and endoscopic remission following a further 8 weeks' treatment with high-dose MMX mesalamine therapy, thereby avoiding step-up therapy.