Aim. To define the frequency of adverse events and loss of the response in patients with ulcerative colitis (UC) and Crohns disease (CD), treated with original medicine infliximab (IFX) Remicaide and its biosimilars. Materials and methods. We included 154 patients with IBD: 78 UC patients (50.6%) и 76 CD patients (49.4%), treated with original medicine IFX Remicade and its biosimilars. In our study we did not include patients, who previously underwent induction treatment with IFX and its biosimilar. Results. Among 78 UC patients, IFX was cancelled in 25 (32.0%) patients and they were switched to the other anti-TNF inhibitor or medicine with the another mechanism of action; in patients group, treated with biosimilar 16 (20.5%) and 9 (11.5%) patients, who were interchanged biosimilar and/or original IFX. Among 76 CD patients IFX was cancelled in 20 (26.3%) patients: 11 (14.5%) patients in group, treated with similar trade name biosimilar, 8 (10.5%) patients, who were interchanged biosimilar and/or original IFX and 1 patient (1,3%), receiving original IFX. We found no difference in the secondary loss of response and adverse events in patients with CD and UC, switched from original IFX to biosimilar (p=0.6257 and p=0.6635, correspondingly). The frequency of the secondary loss of response or adverse events in patients with UC and CD, switched from original IFX to IFX biosimilar, was similar (p0.05). Conclusion. Approximately 30% of IBD patients, receiving IFX biosimilar, will be switched to the other anti-TNF therapy or medicine with the another mechanism of action because of secondary loss of response or adverse events.
Background Zonulin is a protein, reversibly increasing the permeability of the intestinal wall by changing the structure of tight junctions of the lateral surfaces of intestinal epithelial cells. Fecal zonulin is used for noninvasive assessment of increased intestinal permeability. Normal values of zonulin in stool (≤ 110 ng/ml) indicate the absence of damage of the intestinal villous mucosal surface and normal density of intercellular contacts. The aim of the study was to determine the level of fecal zonulin (FZ) in the feces of ulcerative colitis (UC) patients with exacerbation of the disease and the presence of COVID-19 in the acute period and without COVID-19 to assess the degree of intestinal permeability. Methods 46 patients with IBD without COVID-19 (Me age — 36 years) and 31 patients with UC with the presence of COVID-19 infection in the acute period (Me age — 42 years) were examined. Untreated stool samples of patients were frozen and stored at a temperature of 80 °C. FZ was measured by ELISA (IDK ® Zonulin ELISA Kit, Immunodiagnostik AG, Germany) in ng/ml. Reference values: < 83.15 ng/ml - a variant of the norm, 83.15-110 ng/ml - an elevated level, 110 ng/ml - a high level Results In the stool samples of patients with UC exacerbation without COVID-19 FZ was detected from 172.6 to 460.8 ng/ml (Me - 316), the average value was 322.4±14.6 ng/ml. In the stool samples of patients with UC exacerbation and COVID-19 infection, FZ was detected from 354.8 to 628.3 ng/ml (Me – 489.9), the average value was 472.9±18.4 ng/ml (p=0.000001). Conclusion FZ concentration in the feces of UC patients is significantly higher in UC patients with the presence of COVID-19 infection in the acute period, which indicates a higher permeability of the intestinal wall.
Background: Previous research has shown smoking to have a deleterious effect on Crohn's Disease (CD) development, with smoking being identified as both a risk factor for CD and associated with poorer outcomes. Previous studies have shown smoking cessation interventions are associated with decreased rates of CD flares and lower rates of disease progression. While previous guidelines have called for increased focus on counseling for smoking cessation amongst CD patients, little research to date has demonstrated to what extent this counseling is routinely provided in an outpatient setting. Methods: We examined the rates of education for tobacco cessation among current and former smokers during visits for CD captured within the National Ambulatory Medical Care Survey (2002-2018) (NAMCS) and The National Hospital Ambulatory Medical Care Survey (2002-2011) (NHAMCS) database, a nationally representative dataset of outpatient visits. Patients with CD were identified using the International Classification of Diseases (ICD)-9-Clinical Modification codes 555.x as well as ICD-10-Clinical Modification codes K50. We analyzed rates of tobacco cessation counseling among all CD visits as well as CD visits for current/former tobacco users. In addition, a multivariable logistic regression model was performed to determine factors associated with rates of tobacco cessation counseling, including age, race, gender, geographic area and insurance type.Results: Among all visits for CD, the overall rate of counseling for tobacco cessation was 2.0% (95% CI: 1.1-3.5). The rate of counseling amongst former or current smokers with CD was slightly higher at 5.4% (95% CI: 2.9-10.0). In addition, rates of smoking cessation counseling were not significantly different between smokers with and without CD (P 5 0.26). In a multivariable logistic regression model, tobacco cessation counseling was less likely at visits with Hispanic patients compared to White, non-Hispanic patients with an aOR (adjusted odds ratio) of 0.06 (95% CI 0.01-0.30). Conclusion(s): Overall, rates of counseling and education for smoking cessation in outpatient CD visits were infrequent. Furthermore, lower rates of smoking cessation were noted in Hispanic patients compared to non-Hispanic patients, a finding documented in several previous studies. Though smoking has an important role in disease course and development, these findings indicate that education on smoking cessation does not frequently occur in the outpatient setting for CD patients. Overall, this highlights the need for increased focus by providers on screening and counseling for tobacco cessation in CD patients.
Case: Hepatic abscesses are a rare extraintestinal manifestation of inflammatory bowel disease (IBD) with only 60 cases reported in the literature, the majority of which being in Crohn's disease (CD) patients. In ulcerative colitis (UC) patients, Streptococcus is the most common pathogen identified in hepatic abscesses followed by Escherichia coli, and Staphylococcus aureus is the most common cultured hepatic abscess aspirate from Crohn's disease patients. In extremely rare cases, however, no pathogen is isolated, and these so-called visceral aseptic hepatic abscesses represent part of the spectrum of neutrophilic disease and an extremely rare manifestation of IBD. Our case illustrates a middle-aged female with Crohn's disease on adalimumab presenting with an aseptic hepatic abscess. A 49-year-old female with a history of longstanding Crohn's disease on adalimumab status-post partial ileal resection, atrial fibrillation on apixaban, chronic obstructive pulmonary disease, lupus, and hypothyroidism presented for 2 days of cramping right hemi-abdominal pain, fever, and vomiting. Her vitals were within normal limits. Labs showed a mild leukocytosis of 11.1 with neutrophilic predominance, an erythrocyte sedimentation rate of 67, and a C-reactive protein of 20.64. The rest of her labs were unremarkable. Computed tomography (CT) of the abdomen/pelvis showed a subcapsular 2.4 x 2.3 x 1.7 cm rim-enhancing abscess within segment 5 of the liver with central and peripheral hypodensity. There was also a short segment of proximal ascending colon wall thickening most consistent with an inflammatory colitis. She was given ceftriaxone and metronidazole in the emergency department. Repeat CT the following day showed an increase in abscess size, now measuring 3.4 x 3.3 x 3.1 cm. The patient was switched to piperacillin-tazobactam per Infectious Disease recommendations due to concerns for hepatic inoculation from Crohn's colitis and underwent an ultrasound-guided placement of a percutaneous drainage catheter into the abscess by Interventional Radiology 2 days later. Fluid cultures were remarkably negative for any organisms. Post-procedure, with continued catheter drainage, the patient reported significant improvement of symptoms. She was discharged along with removal of her catheter on hospital day 14 with instructions to hold her adalimumab until follow-up in clinic. There are only 7 other reports of aseptic abscesses in the literature as the presenting manifestation of Crohn's disease. Multiple theories have been purported regarding the development of hepatic abscesses in IBD patients. One proposes that ulceration and loss of mucosal barrier integrity leads to microbial invasion of the portal venous system with parenchymal seeding. Another suggests that the increased incidence of cholelithiasis and primary sclerosing cholangitis in IBD patients leads to ascending cholangitis and dissemination of bacteria up the biliary tree to seed the liver. Biologics and other immunosuppressives have also been suggested to reactivate chronic inf...
Background: Alpha-1-antitrypsin (AAT) is a protein that is the main inhibitor of neutrophil elastase and is released during inflammatory processes to reduce the activity of proteolytic enzymes in areas of inflammation. An indicator in the diagnosis of diseases of the small and large intestine. AAT plays an important role in the pathogenesis and regulation of the inflammatory process in inflammatory bowel diseases, can be used as diagnostic and prognostic markers in patients with intestinal lesions. The aim of the study was to determine the level of a-1-antitrypsin in the blood serum and in the feces in patients of UC with and without COVID-19 to assess the degree of inflammation activity and permeability in the intestine. Methods: Forty-two patients of UC with exacerbation of the disease without COVID-19 (Me age-32 years) with different disease activity according to the Meio activity index (group 1) and 23 UC patients with COVID-19 in the acute period (group 2) were examined. -a1-antitrypsin (AAT) (a1-Antitrypsin Clearance ELISA Immundiagnostik, Germany) was determined in blood serum and in feces. Statistical processing was carried out using the Statistica 6.0 program. Results: In the blood serum of UC patients with exacerbation of the disease without COVID-19, AAT fluctuations from 355 to 3056 mcg/l (norm 900-1800 mcg/l) were detected, the average value was 847.9616.5 mcg/l. In UC patients with exacerbation of the disease and the presence of COVID-19 in the acute period, AAT fluctuations from 645 to 4896 mcg/l (norm 900-1800 mcg/l), the average value is 2286.3 6181.4 mcg/l (P 5 0.000000). The range of AAT concentration in feces ranged from 55 to 625 ml/g of feces (norm 25-35 mg/g of feces), on average 364.9 6 11.4 ml/g of feces. The range of AAT concentration in feces ranged from 112 to 898 ml/g feces) (norm 25-35 mg/g feces), on average 539.6618.4 ml/g feces (P 5 0.000000). Conclusion(s):The increase in AAT in the blood serum and in the feces of patients with exacerbation of UC with the presence of COVID-19 infection in the acute period is significantly higher in patients with UC without COVID-19, which indicates a higher permeability of the intestinal wall.
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