European guideline on IgG4-related digestive disease – UEG and SGF evidence-based recommendations

The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs, including IgG4-related cholangitis. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6–0.8 mg/kg body weight/day orally (typical starting dose 30-40 mg/day prednisone equivalent) for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2–4 with clinical, biochemical and morphological markers. Maintenance treatment with glucocorticoids should be considered in multi-organ disease or history of relapse. If there is no change in disease activity and burden within 3 months, the diagnosis should be reconsidered. If the disease relapsed during the 3 months of treatment, immunosuppressive drugs should be added

Papers on education and methodology

Available from Latvian Academic Library / LAL - Latvian Academic LibrarySIGLELVLatvi

Clinical trial: five or ten cycles of granulocyte-monocyte apheresis show equivalent efficacy and safety in ulcerative colitis.

APPENDIX: INVESTIGATORS BY PARTICIPATING SITE: A Dignass: Markus-Krankenhaus, Frankfurt, Germany; H Lochs: Campus Charité Mitte Berlin, Germany; H Porst: Städtisches Klinikum Dresden, Germany; G von Boyen: Universitäts-klinikum Ulm, Ulm, Germany; A Raedler: Asklepios Westklinikum, Hamburg, Germany; M Reinshagen: Städtisches Klinikum, Braunschweig, Germany; B Bonaz: Albert Michallon Hospital, Grenoble, France; W Vogel: LKH Univ.-Klinik, Innsbruck, Austria; S Vavricka: Universita¨tsspital Zürich, Switzerland; C Felley: CHUV Lausanne, Switzerland; F Seibold: Inselspital, Bern, Switzerland; C Ciacci: Università Federico II, Napoli, Italy; M Vecchi: Policlinico S. Donato Milanese, Italy; R Sablich: Ospedale S. Maria degli Angeli, Pordenone, Italy; A Malesci: Clinico Humanitas Rozzano, Milano, Italy; M Cottone: Ospedale Cervello Palermo, Italy; G Riegler: Policlinico II, Università di Napoli, Napoli, Italy; G Minoli: Ospedale Valduce, Como, Italy; A Lanzini: Spedali Civili 1, Brescia, Italy; X Hébuterne: Hôpital de l'Archet 2, Nice, France; P Premchand: Queen's Hospital, Romford, United Kingdom; K Douglas: West of Scotland Cancer Centre, Glasgow, United Kingdom; J Rhodes: Royal Liverpool Hospital, Liverpool, United Kingdom; L Castro-Larsa: Hospital Virgen Macarena, Seville, Spain; A Rodriguez- Pérez: Hospital Universitario de Salamanca, Salamanca, Spain; A Pukitis: Paul Stradins Clinical University Hospital, Riga, Latvia; A Kilander: Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden; A Lapidus: Ersta Sjukhus, Stockholm, Sweden; A Makin: Manchester Royal Infirmary, Manchester, United Kingdom; M H Vatn: Rikshospitalet, Oslo, Norway; R Løfberg: Sophia Hemmet Hospital, Stockholm, Sweden; Y Bouhnik: Hopital Beaujon, Clichy, France; B Flourié: Centre Hospitalier Lyon Sud, Pierre-Bénite, France; W Kruis: Ev. Krankenhaus, Köln-Kalk, Germany; G Bommelaer: CHU HOTEL-Dieu, Clermont-Ferrand, France; A Thillainayagam: Charing Cross Hospital, London, United Kingdom; A Sturm and DC Baumgart: Charité Campus Virchov-Klinikum, Berlin, Germany; V Annese: CSS-IRCCS Hospital, San Giovanni Rotondo, Italy; A Indriolo: Ospedali Reuniti, Bergamo, Italy; A Eriksson: Sahlgrenska University Hospital ⁄ East Hospital, Gothenberg, Sweden; S Vavricka: Universitätsspital, Basel, Switzerland; J Emmrich: Universität Rostock, Rostock, Germany.International audienceBACKGROUND: Ulcerative colitis is characterized by leucocyte infiltration into the colonic mucosa. Granulocyte-monocyte apheresis depletes these cells. AIM: To assess the non-inferiority of 5-10 apheresis treatments in patients with steroid-dependent or steroid-refractory ulcerative colitis. METHODS: A total of 196 adults with moderate-severe ulcerative colitis were randomized 1:1 to 5 (n = 96) or 10 (n = 90) open label apheresis treatments. The primary endpoint was non-inferiority of clinical activity index score after 12 weeks. RESULTS: The intent-to-treat population comprised 82 and 80 patients for the 5- and 10-treatment groups, respectively. The difference between the two groups in mean clinical activity index was 0.24 with an upper 95% confidence interval of 1.17, which was below a predefined non-inferiority threshold of 1.33. Clinical activity index score improved from baseline in both groups (from 8.7 to 5.6 with 5 treatments, and from 8.8 to 5.4 with 10), with no significant difference between the groups (P = 0.200). Outcomes for the 5- and 10-treatment groups were similar--clinical remission: 44% and 40%, respectively (P = 0.636); clinical response: 56% and 59%, respectively (P = 0.753). The treatment was well tolerated in both groups. CONCLUSIONS: This prospective study comparing apheresis regimens in ulcerative colitis demonstrates that 5 treatments were not inferior to 10 treatments in steroid-refractory or -dependent ulcerative colitis

adenocarcinoma: A systematic review

Background/objectives: Cachexia affects similar to 80% of pancreatic cancer patients. An international consensus defines cachexia as an ongoing loss of skeletal muscle mass (sarcopenia) with or without loss of fat, which impairs body functioning and cannot be reversed by conventional nutritional measures. Weight loss percentage and elevated inflammation markers have been employed to define this condition earlier. This review aimed to assess the prevalence and consequences of cachexia and sarcopenia on survival in patients with pancreatic ductal adenocarcinoma.Methods: The systematic review was performed by searching the articles with preset terms published in PubMed and Cochrane Database until December 2013. After identifying relevant titles, abstracts were read and eligible articles data retrieved on preformatted sheets. The prevalence and impact of sarcopenia/cachexia on survival was evaluated.Results: In total 1145 articles were retrieved, only 10 were eligible. Definitions of cachexia and sarcopenia were heterogeneous. In patients with normal weight (BMI 18.5-24.9 kg/m(2)) the prevalence of sarcopenia ranged from 29.7 to 65%. In overweight or obese patients (BMI >25 kg/m(2)) were 16.2%-67%. Sarcopenia alone was not demonstrated to be an independent factor of decreased survival, although obese sarcopenic patients were shown to have significantly worse survival in two studies.Conclusions: Impact of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma is currently understudied in the available literature. Definitive association between cachexia and survival cannot be drawn from available studies, although weight loss and sarcopenic obesity might be considered as poor prognostic factors. Further prospective trials utilizing the consensus definition of cachexia and including other confounding factors are needed to investigate the impact of cachexia and sarcopenia on survival in pancreatic adenocarcinoma. Copyright (C) 2014, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved

Influence of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma: a systematic review.

BACKGROUND/OBJECTIVES: Cachexia affects ∼ 80% of pancreatic cancer patients. An international consensus defines cachexia as an ongoing loss of skeletal muscle mass (sarcopenia) with or without loss of fat, which impairs body functioning and cannot be reversed by conventional nutritional measures. Weight loss percentage and elevated inflammation markers have been employed to define this condition earlier. This review aimed to assess the prevalence and consequences of cachexia and sarcopenia on survival in patients with pancreatic ductal adenocarcinoma. METHODS: The systematic review was performed by searching the articles with preset terms published in PubMed and Cochrane Database until December 2013. After identifying relevant titles, abstracts were read and eligible articles data retrieved on preformatted sheets. The prevalence and impact of sarcopenia/cachexia on survival was evaluated. RESULTS: In total 1145 articles were retrieved, only 10 were eligible. Definitions of cachexia and sarcopenia were heterogeneous. In patients with normal weight (BMI 18.5-24.9 kg/m(2)) the prevalence of sarcopenia ranged from 29.7 to 65%. In overweight or obese patients (BMI >25 kg/m(2)) were 16.2%-67%. Sarcopenia alone was not demonstrated to be an independent factor of decreased survival, although obese sarcopenic patients were shown to have significantly worse survival in two studies. CONCLUSIONS: Impact of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma is currently understudied in the available literature. Definitive association between cachexia and survival cannot be drawn from available studies, although weight loss and sarcopenic obesity might be considered as poor prognostic factors. Further prospective trials utilizing the consensus definition of cachexia and including other confounding factors are needed to investigate the impact of cachexia and sarcopenia on survival in pancreatic adenocarcinoma