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CMV disease in UC only affects seropositive, steroid-refractory UC patients. Steroid/cyclosporine treatment together with disease activity may predispose to latent colonic CMV reactivation. The impact of antiviral therapy on the clinical outcome of these patients remains to be elucidated.

Steroids are recommended in severe alcohol-induced hepatitis, but some data suggest that artificial nutrition could also be effective. We conducted a randomized trial comparing the short-and long-term effects of total enteral nutrition or steroids in these patients. A total of 71 patients (80% cirrhotic) were randomized to receive 40 mg/d prednisolone (n ‫؍‬ 36) or enteral tube feeding (2,000 kcal/d) for 28 days (n ‫؍‬ 35), and were followed for 1 year or until death. Side effects of treatment occurred in 5 patients on steroids and 10 on enteral nutrition (not significant). Eight enterally fed patients were prematurely withdrawn from the trial. Mortality during treatment was similar in both groups (9 of 36 vs. 11 of 35, intention-to-treat) but occurred earlier with enteral feeding (median 7 vs. 23 days; P ‫؍‬ .025). Mortality during follow-up was higher with steroids (10 of 27 vs. 2 of 24 intention-to-treat; P ‫؍‬ .04). Seven steroid patients died within the first 1.5 months of follow-up. In contrast to total enteral nutrition (TEN), infections accounted for 9 of 10 follow-up deaths in the steroid group. In conclusion, enteral feeding does not seem to be worse than steroids in the short-term treatment of severe alcoholinduced hepatitis, although death occurs earlier with enteral nutrition. However, steroid therapy is associated with a higher mortality rate in the immediate weeks after treatment, mainly because of infections. A possible synergistic effect of both treatments should be investigated. (HEPA-TOLOGY 2000;32:36-42.)The outcome of alcohol-induced hepatitis (AH) varies with its severity. Whereas patients with mild cases easily recover by stopping alcohol intake, the course of patients with severe disease is much poorer despite becoming abstinent, with a short-term mortality rate higher than 40%. 1-3 Moreover, dietary intake in patients with mild AH is usually adequate, whereas severe patients remain anorectic for several weeks.A number of pharmacologic approaches to the treatment of severe AH have been attempted in the last 3 decades, most of them with disappointing results. Corticosteroids have been extensively evaluated in this setting. Two of the 3 published meta-analyses of the placebo-controlled randomized trials showed a beneficial effect of steroids, 4,5 whereas the third found no differences. 6 Nevertheless, rather than rejecting a therapeutic effect of steroids, this latter meta-analysis emphasizes

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Sexuality is often disturbed in IBD patients, particularly among women. Many factors seem to contribute to worsened intimacy. Sexuality should be considered when QoL is assessed in these patients.

As many as 1 of 4 patients on thiopurine therapy had adverse events during follow-up. A relatively high proportion of patients (17%) had to discontinue the treatment with thiopurines due to adverse events. However, more than half of patients that restarted thiopurine treatment after its discontinuation due to adverse events tolerated it. Several predictive factors for some adverse events have been identified.

Data available to date show that steroids are better than enteral nutrition to induce remission in active Crohn's disease. These results are more evident when peptide-based diets are administered, but they are not conclusive when either elemental or whole protein-based diets are used.