Oral budesonide versus prednisolone in patients with extensive and left sided ulcerative colitis

BACKGROUND & AIMS: Systemic glucocorticosteroids (GCSs) have proven efficacy in active ulcerative colitis but cause undesired systemic side effects. Therefore, new GCSs with high topical activity and a high rate of metabolism may be of clinical value in this condition. The aim of this study was to explore the efficacy and safety of the topically acting GCS budesonide in an oral controlled-release formulation in extensive or left-sided, mild to moderately active ulcerative colitis. METHODS: A 9-week, randomized, double-blind, controlled trial was performed, and treatments with 10 mg budesonide or 40 mg prednisolone daily, both gradually tapered, were compared. Endoscopic improvement and effect on endogenous plasma cortisol were assessed. RESULTS: Thirty-four patients were administered budesonide, and 38 patients were administered prednisolone. Mean endoscopic scores improved significantly in both groups but without difference between the groups. Five patients in the budesonide group and 7 patients in the prednisolone group deteriorated and were withdrawn from the study. Morning plasma cortisol levels were suppressed in the prednisolone group (entry, 449 nmol/L; 2 weeks, 116 nmol/L; 4 weeks, 195 nmol/L) but were unchanged in the budesonide group. CONCLUSIONS: The GCS budesonide administered in an oral controlled-release formulation seems to give an overall treatment result in active ulcerative colitis approaching that of prednisolone but without suppression of plasma cortisol levels. This concept merits further evaluation

Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European society of gastrointestinal endoscopy position statement

To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE’s viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued: 1. Endoscopy reporting systems must be electronic. 2. Endoscopy reporting systems should be integrated into hospital patient record systems. 3. Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources. 4. Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry. 5. Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated. 6. Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically. 7. Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient’s satisfaction; adverse events; surveillance recommendations. 8. Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format