12 research outputs found
Intramural gastric pseudocyst: A case report and a comprehensive literature review
Rationale: Intramural pseudocyst, although first reported several decades ago, is a rare entity. Scientific knowledge regarding its clinical management is sparse. Patient concerns: We present three cases to show the diverse clinical patterns of patients diagnosed with an intramural gastric pseudocyst. Diagnosis: A final diagnosis should rest on proper evaluation by cross sectional imaging, including computer tomography and magnetic resonance imaging. Endoscopic ultrasound adds to the work-up. Interventions: Previously, identified âlesions of the gastric wallâ were not well recognized as an intramural pseudocyst, and treatments including resectional surgery were employed. Contemporary proper diagnostics should provide support to a less aggressive treatment approach. Outcomes: While an indolent natural history without any clinical symptoms or discomfort could be expected in most cases, individual clinical evaluation should be applied. Lessons: A heterogeneous information pattern from the limited number of cases in the literature makes it difficult to draw any firm conclusions. Attention to this rare condition should be increased to help clinicians arrive at a correct diagnosis and possibly prevent some patients from being over treated or from the use of unnecessary surgery.publishedVersio
Diagnostikk og behandling av autoimmun hepatitt
Autoimmun hepatitt er en kronisk leversykdom som ubehandlet kan føre til levercirrhose og leversvikt. Majoriteten av pasientene responderer godt pü standard immunsuppressiv behandling, men noen opplever bivirkninger eller manglende behandlingseffekt. Diagnostikk, evaluering av behandlingsrespons og valg av annenlinjebehandling kan vÌre utfordrende. Vi sammenfatter her oppdatert kunnskap om diagnostikk og behandling av pasienter med komplisert autoimmun hepatitt.publishedVersio
Intramural gastric pseudocyst: A case report and a comprehensive literature review
Rationale: Intramural pseudocyst, although first reported several decades ago, is a rare entity. Scientific knowledge regarding its clinical management is sparse. Patient concerns: We present three cases to show the diverse clinical patterns of patients diagnosed with an intramural gastric pseudocyst. Diagnosis: A final diagnosis should rest on proper evaluation by cross sectional imaging, including computer tomography and magnetic resonance imaging. Endoscopic ultrasound adds to the work-up. Interventions: Previously, identified âlesions of the gastric wallâ were not well recognized as an intramural pseudocyst, and treatments including resectional surgery were employed. Contemporary proper diagnostics should provide support to a less aggressive treatment approach. Outcomes: While an indolent natural history without any clinical symptoms or discomfort could be expected in most cases, individual clinical evaluation should be applied. Lessons: A heterogeneous information pattern from the limited number of cases in the literature makes it difficult to draw any firm conclusions. Attention to this rare condition should be increased to help clinicians arrive at a correct diagnosis and possibly prevent some patients from being over treated or from the use of unnecessary surgery
Determination of lower cut-off levels of adalimumab associated with biochemical remission in Crohn's disease
Background and Aim: Adalimumab is administered and dosed using a standardized treatment regimen. Although therapeutic drug monitoring (TDM) may help optimize treatment efďŹcacy, the lower cut-off concentration of adalimumab needed to retain disease remission has not been established. This cross-sectional study of patients with Crohnâs disease on stable medication aimed to determine a lower therapeutic drug concentration threshold of adalimumab associated with biochemical disease remission.
Methods: C-reactive protein (CRP) and fecal calprotectin were used as established markers and albumin as an explorative marker of disease activity. Time since introduction, treatment interval, drug dosage, serum drug concentration and antidrug antibodies, disease duration, age, and sex were recorded.
Results: The study included 101 patients who were divided into âactive diseaseâ and âremissionâ groups for inďŹammatory markers based on cut-off levels of 5 mg/L for CRP and 50 mg/kg for fecal calprotectin. Cut-off levels for albumin of 36.5 and 41.5 g/L were also added as further indicatives of remission. Receiver operating characteristic analysis found optimal thresholds for adalimumab associated with remission at 6.8â7.0 mg/L for the combination of CRP and fecal calprotectin and when combining CRP, fecal calprotectin, and albumin.
Conclusions: In patients with Crohnâs disease, serum adalimumab of at least 6.8 mg/L was associated with biochemical disease remission based on CRP and fecal calprotectin, supporting the use of TDM to ensure disease control. Albumin should be further tested in this setting.publishedVersio
Diagnostikk og behandling av autoimmun hepatitt
Autoimmun hepatitt er en kronisk leversykdom som ubehandlet kan føre til levercirrhose og leversvikt. Majoriteten av pasientene responderer godt pü standard immunsuppressiv behandling, men noen opplever bivirkninger eller manglende behandlingseffekt. Diagnostikk, evaluering av behandlingsrespons og valg av annenlinjebehandling kan vÌre utfordrende. Vi sammenfatter her oppdatert kunnskap om diagnostikk og behandling av pasienter med komplisert autoimmun hepatitt
Histologic healing and factors associated with complete remission following conventional treatment in ulcerative colitis
Background:
Endoscopic and histological activity scores in ulcerative colitis (UC) are associated with clinical outcomes and have become important targets of clinical trials. However, these endpoints have been scarcely investigated in patients receiving only conventional treatment.
Objective:
We aimed to assess the deep and complete remission rates after 3âmonths of conventional treatment in patients with newly diagnosed UC with moderate to severe endoscopic activity. We also aimed to investigate whether selected clinical and biochemical variables at baseline were associated with complete remission status after 3âmonths.
Design:
This was a prospective cohort study.
Methods:
Newly diagnosed patients with active UC commencing 5-aminosalicylate, corticosteroid, and/or azathioprine treatment were consecutively included. Clinical, biochemical, endoscopic, and histological data were collected at baseline and after 3âmonths. Rates of clinical remission (Partial Mayo Scoreâ⊽â2), mucosal healing (Mayo Endoscopic Scoreâ⊽â1), and histologic healing (Nancy Indexâ⊽â1) were determined. Deep remission was assessed as clinical remission plus mucosal healing and complete remission as deep remission plus histologic healing. Predictors of complete remission were identified by logistic regression.
Results:
A total of 180 patients were included in the study. Deep remission and complete remission occurred in 62.8% and 42.2% of patients, respectively. Thus, of patients in deep remission one-third had persistent histologic activity. Histologic activity in mucosally healed patients was associated with higher symptom scores and faecal calprotectin levels. Of baseline variables, less endoscopic distribution and disease activity showed strongest association with achieving complete remission, and limited distribution in combination with moderate activity gave highest odds for complete remission (odds ratio: 4.1, 95% confidence interval: 7.69â2.18).
Conclusion:
In patients with mucosal healing, persistent histologic activity was a common finding and was associated with increased disease activity. Pancolitis and severe inflammatory activity at baseline were associated with lower complete remission rates.publishedVersio
Subtherapeutic concentrations of infliximab and adalimumab are associated with increased disease activity in Crohnâs disease
Background: Low anti-tumor necrosis factor Îą (TNFÎą) serum concentrations may result in lack of treatment response in patients with inflammatory bowel disease. We determined the anti-TNFÎą drug concentrations in patients with inflammatory bowel disease and investigated whether or not subtherapeutic drug concentrations were associated with increased levels of disease activity. Methods: In a single-center cross-sectional study, we included patients with ulcerative colitis or Crohnâs disease who were receiving infliximab or adalimumab maintenance therapy. Demographic data, disease activity symptom scores (Partial Mayo Score, Harvey Bradshaw Index), inflammatory markers [C-reactive protein (CRP), fecal calprotectin], antidrug antibodies and serum drug concentrations were recorded. Therapeutic drug concentrations were defined as 3â8 mg/liter for infliximab and 5â12 mg/liter for adalimumab. Results: Of 210 patients included, 137 (65.2%) had Crohnâs disease. In the adalimumab group, subtherapeutic drug concentrations were measured in 16.7% of patients with ulcerative colitis and in 27.7% of patients with Crohnâs disease. In the infliximab group, subtherapeutic drug concentrations were found in 23% (ulcerative colitis) and 30.3% (Crohnâs disease) of patients. In Crohnâs disease, subtherapeutic adalimumab concentrations were associated with higher fecal calprotectin and CRP concentrations compared with therapeutic concentrations. Subtherapeutic infliximab concentrations in patients with Crohnâs disease were also associated with higher CRP concentrations compared with therapeutic concentrations. Conclusions: The prevalence of subtherapeutic drug levels ranged from 17% to 30%. In patients with Crohnâs disease, subtherapeutic serum drug concentrations were associated with significantly higher disease activity with both anti-TNFÎą agents. These findings were not observed in patients with ulcerative colitis. Clinicaltrials.gov identifier [NCT02134054
sj-docx-1-tag-10.1177_17562848221140659 â Supplemental material for Histologic healing and factors associated with complete remission following conventional treatment in ulcerative colitis
Supplemental material, sj-docx-1-tag-10.1177_17562848221140659 for Histologic healing and factors associated with complete remission following conventional treatment in ulcerative colitis by Ăyvind Steinsbø, Arne Carlsen, Ole Gunnar Aasprong, Lars Aabakken, Espen Tvedt-Gundersen, Steinar Bjørkhaug, Rune Gjerde, Lars Normann Karlsen and Tore Grimstad in Therapeutic Advances in Gastroenterology</p