Distal esophageal involvement in Crohn disease: short treatment with adalimumab

Musto, Dario; Martorelli, L.; Cirillo, A.; Selvaggi, Francesco; Esposito, Pasquale; Russo, Michele; Riegler, G.

doi:10.1055/s-0030-1255788

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…ECCO guidelines recommend a lower threshold for starting TNF-α inhibitors for esophageal involvement than for disease elsewhere owing to the poor prognosis associated with this site [ 11 ]. Use of infliximab, adalimumab, and ustekinumab has been associated with rapid improvement on repeat endoscopy [ 2 , 6 , 12 , 13 ]. These findings imply that repeat endoscopy should be performed in patients with persistent symptoms to rule out other causes or to confirm persistent disease activity.…”

Section: Discussionmentioning

confidence: 99%

Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn’s disease: a case report

et al. 2016

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BackgroundEsophageal Crohn’s disease is reported as a rare manifestation, although its prevalence may be underestimated because upper endoscopies are not routinely performed in asymptomatic adults. Tofacitinib, an oral janus kinase inhibitor, is a new biologic that has shown promise in the treatment of ulcerative colitis and may be effective in the treatment of Crohn’s disease according to phase 2 trials. We report the first case of esophageal Crohn’s disease successfully treated with tofacitinib in a patient with worsening symptoms despite maintenance therapy with a tumor necrosis factor-α inhibitor.Case presentationA 67-year-old Caucasian woman presented with new dysphagia and had findings of esophageal Crohn’s disease on endoscopy. The dosage of her current biologic therapy—adalimumab—was increased in frequency, without improvement. Our patient was started on tofacitinib and demonstrated an improvement in symptoms, with a repeat endoscopy showing resolution of the previous lesions.ConclusionEsophageal Crohn’s disease is likely underdiagnosed but is an important consideration in a patient with new symptoms of dysphagia and known Crohn’s disease. Tofacitinib, while a novel agent, could have a role in the treatment of esophageal Crohn’s disease that does not improve with intensification of the current biologic therapy. It provides a different mechanism in patients who become refractory to maintenance therapy.

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Section: Discussionmentioning

confidence: 99%

Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn’s disease: a case report

et al. 2016

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“…CD and UC are the two principal IBD, which can affect people at any age and are characterised by a remitting-relapsing course [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [25] , [26] , [27] , often requiring medical, surgical, or combined approaches [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] . Etiopathogenesis of IBD relies on complex interactions between autoimmune mechanisms and environmental factors, which have not been fully understood [1] , [25] , [26] .…”

Section: Discussionmentioning

confidence: 99%

“…These patients have been reported to have a protean genetic and bimolecular landscape that differs from that of general population in many aspects [1] , [25] , [26] . It is true that IBD patients often need surgery, and may have inflammation-driven systemic complications, but it also true that disease remission, either obtained with surgery or achieved with medications, is not able to control all of them [1] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] . Hence, compound pathways could produce this effect, not dissimilarly from those observed with EIMs.…”

Section: Discussionmentioning

confidence: 99%

“…However, we used a prospective database and excluded patients operated on and those with active disease (confounders for VTE [54] ), significantly reducing the number of patients suitable for inclusion observed at an ambulatory of Colorectal Surgery. Surgery plays a relevant role in IBD patients, and complex or repeated procedures can be needed [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] . This could have weakened the results, but at the same time is offering a snapshot on outpatient IBD subjects, and is providing IBD physicians with a practical, clinical insight on how to manage IBD patients willing to use oral contraceptives.…”

Section: Discussionmentioning

confidence: 99%

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Hormonal contraceptives and venous thromboembolism: Are inflammatory bowel disease patients at increased risk? A retrospective study on a prospective database

Pellino

Sciaudone

Caprio

et al. 2015

Annals of Medicine &Amp; Surgery

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Recent studies showed an increased risk of venous thromboembolism (VTE) in patients receiving oral hormonal contraceptives. Inflammatory bowel diseases (IBD) often affect young patients and represent a pro-coagulant condition. This could result from active inflammation, but a potential role for genetic and molecular factors has been suggested. Hormonal contraceptives have also been associated with increased risk of VTE and the risk may be greater in IBD patients that already are in a pro-coagulant status, but no definitive data are available in this population. The purpose of our study was to seek for differences of the risk of VTE in IBD patients receiving hormonal contraceptives compared with controls.This is a retrospective study. We interrogated a prospectively maintained database of IBD patients observed at our outpatient clinic between 2000 and 2014. All female patients managed conservatively, with no active disease, who were taking oral hormone contraceptives in the study period, were included. Patients observed for other-than-IBD conditions at our Unit and at the Unit of Gynaecology and Obstetrics, receiving contraceptives, served as controls (ratio 1:2). Patients with cancer, those receiving hormonal therapy, and those with known genetic predisposition to VTE were excluded.We included 146 six IBD patients and 290 controls. One patient in each group developed VTE. Overall, the incidence of VTE associated with oral contraceptives was 0.5%. IBD was associated with increased risk of VTE (OR 1.9, 95% CI 0.12–32.12, p > 0.99). Active smokers since 10 years (17.2%) had higher risks of VTE (OR 8.6, 95% CI 1.16–19.25, p = 0.03).Our data show that patients with IBD in remission are not at higher risk of VTE due to oral oestrogen-containing contraceptives compared with non-IBD controls. Smokers are at increased risk, irrespective of the baseline disease.

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Preventive NPWT over closed incisions in general surgery: Does age matter?

Pellino

Sciaudone

Candilio

et al. 2014

International Journal of Surgery

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Surgical site events (SSE), including surgical wound complications and surgical site infections, are a major concern in patients undergoing general surgery operations. These increase the costs of care, and can lead to prolonged hospital stay and need for further treatments, ultimately resulting in poor quality of life. Negative pressure wound therapy (NPWT) has been recently reported as a preventive strategy to avoid SSE, but little is known on the topic, and particularly in geriatric population. Our primary aim was to assess the efficacy of NPWT by means of a pocket device (PICO, Smith & Nephew, London, UK) in preventing SSE compared with conventional dressings in patients undergoing surgery with primary wound closure for breast and for colorectal diseases in our Unit. Our secondary aims were to assess the efficacy and safety of PICO in elderly patients, and to seek for differences between breast and abdominal results. All consecutive patients undergoing breast and colorectal surgery in our Unit between September 2012 and May 2014 were prospectively enrolled in this open label controlled study. Breast patients receiving NPWT were assigned to group B1, those receiving conventional dressings were assigned to group B2. Colorectal patients were assigned to group C1 (NPWT) and C2 (conventional dressings) in similar fashion. Each group included 25 patients, and at least 10 (40%) patients aged over 65 years to allow sub-analyses. NPWT significantly reduced SSE in both breast and colorectal patients compared with controls. No significant differences were observed according to age. Similar benefits were observed in breast and colorectal patients. Our results suggest that PICO is an effective tool to prevent SSE in patients undergoing general surgery, irrespective of age. Its use is recommended in frail, elderly patients at risk of SSE.

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Distal esophageal involvement in Crohn disease: short treatment with adalimumab

Cited by 5 publications

References 3 publications

Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn’s disease: a case report

Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn’s disease: a case report

Hormonal contraceptives and venous thromboembolism: Are inflammatory bowel disease patients at increased risk? A retrospective study on a prospective database

Preventive NPWT over closed incisions in general surgery: Does age matter?

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