National Cooperative Crohn's Disease Study: Results of drug treatment

Summers, Robert W.; Switz, Donald M.; Sessions, John T.; Becktel, Jack M.; Best, William R.; Kern, Fred; Singleton, John W.

doi:10.1016/0016-5085(79)90385-8

Cited by 1,136 publications

(499 citation statements)

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“…Compared to the evidence base for ulcerative colitis, the efficacy of sulfasalazine in Crohn's disease is less definitive and more dependent on location of disease activity [357,362,380,406]. The necessity for colonic bacterial azo-reductase activity to liberate 5-ASA implies that sulfasalazine is unlikely to benefit proximal (small intestinal) Crohn's disease and, in two early clinical trials evaluating more than 500 patients with active Crohn's disease sulfasalazine at dosages of 3-5 g/day were superior to placebo only for patients with ileocolonic or colonic disease but not for patients with disease confined to the small intestine [407,408]. Although sulfasalazine has been commonly used to prevent relapse for patients with quiescent Crohn's disease, neither the National Cooperative Crohn's Disease Study nor the European Cooperative Crohn's Disease Study demonstrated maintenance benefits at (low) dosages of 1-3 g/day.…”

Section: Aminosalicylates In Crohn's Disease Mild To Moderate Active mentioning

confidence: 99%

“…57.34). Dosed within a range of 0.25-0.75 mg/kg with subsequent taper after remission induction, prednisone or prednisolone were shown to be superior to placebo in both the National Cooperative Crohn's Disease Study [480] and the European Cooperative Crohn's Disease Study [408]. Studies of higher doses (1 mg/kg of prednisolone) showed superior remission rates, from roughly 60% to over 90% [241].…”

Section: Corticosteroids In Crohn's Disease Oral Corticosteroidsmentioning

confidence: 99%

“…In one study, 6-month outcomes were similar with a 4-week vs. 12-week taper of methylprednisolone from an initial dose of 40 mg daily [481]. Clinical trial outcomes in Crohn's disease are superior to sulfasalazine [407,408] and to elemental diets (with and without antibiotics) [482,483]. Remission rates with oral corticosteroids were better than for combination therapy with metronidazole and ciprofloxacin [442].…”

Section: Corticosteroids In Crohn's Disease Oral Corticosteroidsmentioning

confidence: 99%

“…There have been multiple placebo-controlled trials of the purine analogues in patients with Crohn's disease [221,480,[552][553][554][555][556] most of which support the use of these agents in the induction or maintenance of remission, and in the closure of Crohn's fistulae. A metaanalysis calculated an odds ratio for response (vs. placebo) of 3.09 for patients with active disease, 2.27 for quiescent disease, and 4.44 for fistulous disease [540].…”

Section: Azathioprine and 6-mercaptopurine In Crohn's Diseasementioning

confidence: 99%

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Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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In the US, H. pylori vacA shows allelic variation in the signal sequence (which may be type sla, slb or s2) and the mid-region (type ml or m2). Previous PCR-based vacA mid-region typing classified most, but not all, Asian and South American strains tested as ml or m2. We now sought to investigate vacA mid-region diversity further.MotlmodL We studied 13 Japanese, 6 Chinese, 9 Thai, and 8 Peruvian H. pylori isolates. cagA was identified by colony hybridisation (CH), vacA signal sequence was typed by PCR, and vacA mid-region was typed proximally by CH and distally by PCR. Sections of the vacA mid-region from 8 strains were PCR-amplified, sequenced, and compared with known sequences from 8 other strains.Rcuts Of the 36 Asian and South American strains studied, 35 were cagA+ (the cagA-was Peruvian) and 35 were vacA sla (1 cagA + Peruvian was slb). vacA mid-regions from the 13 Japanese strains were not PCR-amplified by ml or m2-specific primers, but hybridised weakly with an ml probe. Sequence analysis of vacA from 1 Japanese strain revealed 91% nucleotide identity with the ml probe but only 71% identity with the m2 probe. The previously equivocal Thai and Peruvian strains also had ml-like mid-region sequences. A Chinese strain was ml in the proximal mid-region and m2 distally, showing a clear crossover site. Final mid-region types were: Japanese, all 13 ml; Chinese, 1 ml, 1 ml/m2, 4 m2; Thai, 3 ml, 6 m2; Peruvian 4 ml, 4 m2. Distal mid-region sequences of 16 strains, compared over 294 bp, clustered into 2 groups, ml and m2. Nucleotide identity between ml and m2 strains ranged from 73-78%. Within groups, m2 strains were less diverse than ml strains (m2 range 94-99.7%, ml 88-99.3%, p<0.001). Sequence analysis of 7 ml and 3 m2 strains over 1.1kb proximally showed maintenance of clustering outside the 294bp region C duions These Asian and South American strains are similar in terms of cagA status and vacA sla genotype, but fall into 2 vacA midregion groups. ml sequences are more diverse than m2, and thus may be phylogenetically older. The vacA sequence of 1 Chinese strain suggests recombination in vivo between ml and m2 alleles. Introduction: H.pylori antimicrobial susceptibility is an important determinant ofthe efficacy of eradication therapies'. The prevalence of antimicrobial resistance varies within the UK and may increase given the increased use of eradication therapy. This multicentre study assesses the prevalence and possible associations ofH.pylon antimicrobial resistance. Methods: H.pylon was isolated from antral biopsies of patients undergoing routine endoscopy and cultured according to standard microbiological methods. Antimicrobial resistance was determined using "E-tests" or disc tests (tinidazole only) with breakpoints defined by previous studies. Results: H.pyloni was isolated from 32% (1222/3823) of patients and antimicrobial susceptibility determined in 90% (1077/1222) Previous case-control studies of IBD have used hospital or community derived controls. There are obvious inherent biases in both metho...

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Section: Aminosalicylates In Crohn's Disease Mild To Moderate Active mentioning

confidence: 99%

Section: Corticosteroids In Crohn's Disease Oral Corticosteroidsmentioning

confidence: 99%

Section: Corticosteroids In Crohn's Disease Oral Corticosteroidsmentioning

confidence: 99%

Section: Azathioprine and 6-mercaptopurine In Crohn's Diseasementioning

confidence: 99%

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Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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“…Im Gesamtfiberblick liegt die Rate der erreichten Remissionen mit EN zwischen 50 und 70% und damit nicht wesentlich unter den M6glichkeiten der Kortikosteroidtherapie (bei Diinndarmbefall) aber auch nur etwas fiber der Gr613enordnung der spontanen Remissionen, die in multizentrischen Therapiestudien mit 40-60% angegeben wird [49,78,81].…”

Section: Enterale Erniihrungsmethodenunclassified

Welche Rolle spielt die Ern�hrung beim Morbus Crohn? Ein Beitrag zur Bedeutung der di�tetischen Therapie der Enteritis regionalis

Nagel

Canzler

Pichlmayr³

1991

Langenbecks Arch Chir

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The clinical appearance of Crohn's disease (CD) is especially marked by nutritional deficits and insufficiencies. For a long time the goal of nutritional care was reduced to the readjustment of the nutritional status. The development and clinical use of controlled parenteral nutrition (TPN) and enteral nutritive solutions (EN) did not only emphasize this therapeutical issue, but furthermore showed positive effects on the conservative as well as on the surgical treatment concepts. Therefore today artificial nutritional support is a firm part of therapy in acute, active phases or in the contact of surgical management of CD. This is especially valid in children, where complications in general and growth failure in particular can be reduced. EN is the preferred feeding method in most of the cases, due to a lower complication rate and reduced cost when compared to TPN. The question regarding the importance of nutritional support as primary therapy has also been investigated. The results differ extensively, but point towards the conclusion that patients with solitary small bowel disease do profit from this therapeutical concept. Nevertheless it is unclear, how TPN or EN interfere in the pathophysiology or -biochemistry in this process. A question about reduction e.g. of allergic components of daily diet did stimulate new theories regarding the hypothesis of a possible causal relationship between diet and the pathogenesis of CD. Investigations on dietary habits and daily dietary therapy did not reveal an overall accepted dietary guideline. Nevertheless it seems obvious that dietary counselling has a positive effect on the disease process. It does appear, that today in the acute, active phase as well as in the long term management of Crohn's disease nutritional-care is an important therapeutical method.

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