Crohn Disease: Gomollón F

Domènech E, Esteve M, Gomollón F, Hinojosa J, Panés J, Obrador A, Gassull MA, Anonymous00132. · Servicio de Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain. · Gastroenterol Hepatol. · Pubmed #15771858 No free full text.

This publication has no abstract.

Domènech E, Esteve-Comas M, Gomollón F, Hinojosa J, Obrador A, Panés J, Gassull MA, Anonymous00043. · Hospital Universitari Germans Trías i Pujol, Badalona, Barcelona, Spain. · Gastroenterol Hepatol. · Pubmed #11864540 No free full text.

This publication has no abstract.

Gomollón F, López SG. · Servicio de Aparato Digestivo, Hospital Universitario Lozano Blesa, Facultad de Medicina, Zaragoza, España. · Acta Gastroenterol Latinoam. · Pubmed #18697408 No free full text.

Abstract: Crohn's disease (CD) is often very difficult to treat. Almost ten years ago "biologic" agents were introduced in the armamentarium to control CD. Although there are many new drugs in the pipeline, only two antiTNF agents have been released to the market (infliximab and, recently, adalimumab) and probably in 2008 certolizumab will be approved. A review of available evidence suggests that the three antibodies are effective in the induction and maintenance of response, and (to a lesser extent) remission. Infliximab has been very useful in fistulizing disease, and preliminary data do suggest that adalimumab and certolizumab will be also. Cost and long-term safety limit the use of these agents in daily practice. To maximize benefits and minimize risks, good patient selection and strict adherence to Clinical Guidelines seem the key points. It has been suggested that these drugs should be used in early disease to avoid progression, but current data are very scarce to generalize this recommendation. In anycase, we think that the use of "biologics" will provoke a dramatic change in CD treatment in the next 10 years.

Gisbert JP, Gomollón F. · Gastroenterology Unit, Hospital Universitario de la Princesa, Madrid, and "Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas" (CIBEREHD), Spain. · Am J Gastroenterol. · Pubmed #18477354 No free full text.

Abstract: Anemia is the most common systemic complication of inflammatory bowel disease (IBD); so common that it is almost invariably not investigated and rarely treated. Several misconceptions are the reason for these clinical errors, and our goal will be to review them. The most common misconceptions are: anemia is uncommon in IBD; iron deficiency is also uncommon; just by treating the intestinal disease, anemia will be corrected; iron deficiency is the only cause for anemia in IBD; ferritin is an accurate parameter for the diagnosis of iron deficiency in IBD; the impact of anemia on the quality of life of IBD patients is limited; iron supplementation is rarely needed in IBD; high-dose oral iron solves the problem of iron malabsorption in IBD; intravenous (IV) iron is dangerous and of no proven benefit in IBD; IV iron is useful only for severe anemia; and erythropoietin has no role in the treatment of IBD anemia. These misconceptions are not evidence-based. On the contrary, there is enough evidence to support the following statements: (a) anemia is very common in IBD, (b) anemia should be investigated with care because many factors can be responsible, (c) treatment of anemia results in clear improvement in the objective parameters of well-being, especially in the quality of life, (d) IV iron is safe and effective in the treatment of iron deficiency anemia in IBD patients, and (e) erythropoietin is useful in a subset of patients with refractory anemia. Anemia diagnosis and treatment must not be neglected in IBD patients, and several misconceptions should be promptly abandoned.

Panés J, Gomollón F, Taxonera C, Hinojosa J, Clofent J, Nos P. · Department of Gastroenterology, Hospital Clinic, Barcelona, Spain. · Drugs. · Pubmed #18034589 No free full text.

Abstract: Crohn's disease is a debilitating and expensive disease that is growing in incidence in both developing and developed countries. While conventional therapies, such as corticosteroids and immunosuppressants, continue to play a vital role in treating this condition, it is evident that many affected individuals do not respond to therapy or develop intolerable adverse effects. The addition of modern biological therapies to the Crohn's disease armamentarium is providing a change in expectations for disease outcome. Infliximab and adalimumab are currently the only biological agents approved for induction and maintenance treatment in adults (infliximab and adalimumab) and children (infliximab) with Crohn's disease. Furthermore, infliximab has a beneficial effect on perianal fistulas. Other tumour necrosis factor (TNF)-alpha inhibitors, such as certolizumab pegol, also demonstrate promising results in adults with moderate to severe active disease. In addition, adalimumab and certolizumab pegol have shown clinical efficacy in patients who are intolerant to or lose response to infliximab, suggesting that switching between agents may allow response to be maintained over time. The primary safety concerns with TNFalpha inhibitors include increased risk of serious infection (including reactivation of tuberculosis), malignancy (particularly lymphoma) and demyelinating disease. Other agents in development include recombinant human anti-inflammatory cytokines, agents that target pro-inflammatory cytokines and granulocyte-macrophage colony-stimulating factors. Further prospective studies will provide interesting insight into different mechanisms by which factors involved in the pathophysiology of Crohn's disease can be modulated.

Gisbert JP, Gomollón F, Maté J, Pajares JM. · Servicio de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid. Spain. · Gastroenterol Hepatol. · Pubmed #12732107 No free full text.

This publication has no abstract.

Gisbert JP, Gomollón F, Maté J, Figueroa JM, Alós R, Pajares JM. · Servicio de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid. Spain. · Gastroenterol Hepatol. · Pubmed #12435308 No free full text.

This publication has no abstract.

Gisbert JP, Gomollón F, Maté J, Pajares JM. · Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Madrid, Spain. · Gastroenterol Hepatol. · Pubmed #12069704 No free full text.

This publication has no abstract.

Gisbert JP, Gomollón F, Maté J, María Pajares J. · Servicios de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid. · Med Clin (Barc). · Pubmed #11412666 No free full text.

This publication has no abstract.

Gomollón F, Hinojosa J, Nos P. · Servicio de Aparato Digestivo, Hospital Miguel Servet, Zaragoza. · Gastroenterol Hepatol. · Pubmed #10650668 No free full text.

This publication has no abstract.

Hinojosa J, Gomollón F, García S, Bastida G, Cabriada JL, Saro C, Ceballos D, Peñate M, Gassull MA, Anonymous00211. · Hospital de Sagunto, Valencia, Spain. · Aliment Pharmacol Ther. · Pubmed #17269996 No free full text.

Abstract: BACKGROUND: The use of tumour necrosis factor antagonists has changed the therapeutic approach to Crohn's disease. AIM: To determine response and remission rates associated with the 4-week induction phase of adalimumab treatment in patients with luminal and/or fistulizing Crohn's disease, who have lost response to or become intolerant of infliximab. METHODS: In this multicentre, prospective, open-label, observational, 52-week study, 50 adults received an induction dose of adalimumab (160 mg at baseline followed by 80 mg at week 2). RESULTS: Of the 36 patients with luminal Crohn's disease, 83% achieved clinical response [> or =70-point reduction in the Crohn's Disease Activity Index (CDAI) score] and 42% achieved clinical remission (CDAI score <150) at week 4. Of the 22 patients with fistulizing disease, five (23%) experienced fistula remission (complete closure of all fistulas that were draining at baseline), and nine (41%) experienced fistula improvement (> or =50% decrease in the number of fistulas that were draining at baseline) at week 4. Of the 19 adverse events, most [13 (68%)] were mild, and no serious or infectious adverse events occurred. CONCLUSIONS: Adalimumab may be an effective alternative in patients with luminal and/or fistulizing Crohn's disease who have lost response to or become intolerant of infliximab.

Cabriada JL, García Sánchez V, Gomollón F, Hinojosa J, López San Román A, Mendoza JL, Mínguez M, Ricart E, Saro C. · Hospital de Galdakao, Galdakao, Vizcaya, Spain. · Gastroenterol Hepatol. · Pubmed #19174086 No free full text.

This publication has no abstract.

Sicilia B, Vicente R, Arroyo MT, Arribas F, Gomollón F. · Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza, Spain. · Gastroenterol Hepatol. · Pubmed #15771854 No free full text.

Abstract: INTRODUCTION: Few population-based studies have been published on predictive factors in the clinical course of Crohn's disease (CD). The only constant risk factor for postsurgical recurrence is smoking. The aim of this study is to describe surgical need, etiology and characteristics, and the distinct clinical variables that act as risk or protective factors for the indication of surgery in an incidence cohort of patients with a diagnosis of CD in Aragon. MATERIAL AND METHODS: Based on the results of a population-based, prospective study reporting the incidence of inflammatory bowel disease in Aragon, 88 patients with a diagnosis of CD were included in the present study. The patients medical records were reviewed and data on the following clinical variables from diagnosis (1992-1995) to February 2001 were gathered: surgery, type of surgery and etiology, anatomic distribution, number of relapses, remission, clinical course, death, smoking, oral contraceptive intake, and hospitalization. Descriptive and bivariate analyses were performed to investigate the association between these variables and surgery during follow-up. RESULTS: Eighty-eight patients with at least 6 months of follow-up were included (88/103; 85%), with a mean follow-up of 77 months (range, 6-110 months). Some kind of surgery during follow-up was required by 20.5% of our patients; in nearly 50% of these, surgery was indicated for intestinal obstruction. A second surgical intervention was required in 10.2% due to fistula and/or abscess or ileostomy for subsequent reconstruction of intestinal transit. Although ileal localization was more frequently associated with surgery, this association was not statistically significant. No association was found between surgery during follow-up and sex, age at diagnosis or oral contraceptive intake. Factors positively associated with surgery were a chronic clinical course and a greater number of hospitalizations. We found no positive or negative association with smoking, non-smoking or time free of smoking, but the total time of smoking was positively associated with surgery. CONCLUSIONS: Risk factors for surgery in patients with CD were a chronic clinical course, the number of hospitalizations and total time of smoking. Ileal localization was more frequently associated with surgery but this association was not statistically significant.

Domènech E, Hinojosa J, Esteve-Comas M, Gomollón F, Herrera JM, Bastida G, Obrador A, Ruiz R, Saro C, Gassull MA, Anonymous00177. · Hospital Universitari Germans Trias i Pujol, Badalona, Spain. · Aliment Pharmacol Ther. · Pubmed #15606397 links to  free full text

Abstract: BACKGROUND: Uncontrolled studies suggest that granulocyteaphaeresis might be useful in the management of active ulcerative colitis. AIM: To assess the efficacy of granulocyteaphaeresis treatment in active steroid-dependent inflammatory bowel disease. METHODS: We conducted a multicentre, prospective, open, pilot study in patients with steroid-dependent inflammatory bowel disease. All patients were started on 60 mg/day of prednisone; after 1 week, a five-session programme of granulocyteaphaeresis (once per week) was started. The steroid dose was tapered weekly if there was clinical improvement. Remission was defined as an inactive clinical activity index together with complete withdrawal of steroids at week 6. The patients were followed up for at least 6 months or until disease relapse. RESULTS: Twenty-six patients (14 ulcerative colitis, 12 Crohn's disease) were included. More than a half had been previously treated with immunomodulators. Remission was achieved in 62 and 70% of ulcerative colitis and Crohn's disease, respectively. During a median follow-up of 12.6 months, six of eight ulcerative colitis patients maintained their clinical remission; however, only one Crohn's disease patient remained in remission after the first 6 months of follow-up. CONCLUSIONS: Granulocyteaphaeresis is a safe treatment option in inflammatory bowel disease. A five-session programme of granulocyteaphaeresis seems to be efficient in the treatment of steroid-dependent ulcerative colitis, but not in Crohn's disease.

Gisbert JP, Gomollón F, Maté J, Pajares JM. · Department of Gastroenterology, University Hospital of La Princesa, Madrid, Spain. · Dig Dis Sci. · Pubmed #11911332 No free full text.

This publication has no abstract.

Sicilia B, López Miguel C, Arribas F, López Zaborras J, Sierra E, Gomollón F. · Digestive Disease Unit, Miguel Servet University Hospital, Zaragoza, Spain. · Dig Liver Dis. · Pubmed #11838611 No free full text.

Abstract: BACKGROUND: The pathogenesis of inflammatory bowel disease probably involves an interaction between genetic and environmental factors: cigarette smoking, appendectomy and oral contraceptives have been the factors most frequently linked to its aetiology AIM: To analyse the association between known environmental risk factors and development of Crohn's disease in the community of Aragón, Spain. PATIENTS AND METHODS: A case-control, population-based study has been carried out. All patients diagnosed with Crohn's disease in the community of Aragón from 1st February 1992 to 31st January 1995 were prospectively included. The Lennard Jones criteria were used to define the cases and selected controls among the healthy population matched with patients for age, sex and rural/urban habitat. Statistical analysis included multivariate analysis using conditional logistic regression, testing 38 different models. RESULTS: A total of 103 patients were diagnosed with Crohn's disease in Aragón from 1st February, 1992 to 31st January, 1995. Of these 62 patients (60.2%) with Crohn's disease were smokers, compared with 42 (40.8%) controls (p<0.001). Cigarette smoking is considered a risk factor for Crohn's disease with an odds ratio of 3.09 (95% confidence interval, 1.58-6.05). After multivariate analysis, the positive association is maintained. A dose-dependent relation could not be demonstrated. No statistical differences (p=0.50) were detected in the analysis of previous appendectomy. Use of oral contraceptive acts as a risk factor with a p=0.048; odds ratio 2, 8, 95% confidence interval: 1.009-7.774; but this association disappears in the multivariate analysis. Eight patients had a family history (3 first degree and 5 second degree relatives) versus none of the controls (p=0.002). Of the variables studied for childhood hygiene none appeared significant. CONCLUSION: Smoking, family history, and oral contraceptive use, appear as risk factors for developing Crohn's disease in univariate analysis, but only smoking remains significant in all models of multivariate analysis.