Elemental diets are considered an effective primary treatment for active Crohn's disease. This study examined the hypothesis that improvement occurs because of the presence of amino acids or the low fat content, or both.

No abstract

We conducted a randomized, placebo-controlled clinical study evaluating famciclovir (500 mg 3 times daily and 1.5 g once daily) for 1 year (6 months post-treatment follow-up) in patients with chronic hepatitis B e antigen (HBeAg)-positive hepatitis B virus (HBV) infection. The study was conducted in 80 centers in North America, Europe, and Australia/ New Zealand. A total of 417 patients with histologically documented chronic hepatitis B (histologic activity index [HAI] 9.5-11.0) received famciclovir (500 mg 3 times daily or 1.5 g once daily) or placebo. Famciclovir 500 mg 3 times daily significantly reduced HBV DNA and median HAI scores versus placebo. By week 8, median HBV DNA decreased from 1,645 to 283 MEq/mL (famciclovir 500 mg 3 times daily) and from 1,147 to 304 MEq/mL (famciclovir 1.5 g once daily), while increasing for placebo (1,617 to 1,685 MEq/mL). Median change in HBV DNA at the end of therapy was ؊76% (famciclovir 500 mg 3 times daily; P < .01) and ؊60% (famciclovir 1.5 g once daily; P ‫؍‬ .25) versus ؊37% for placebo. Median change in HAI was ؊1.5 points (famciclovir 500 mg 3 times daily; P ‫؍‬ .02) and ؊1.0 point (famciclovir 1.5 g once daily; P ‫؍‬ .35) and zero for placebo. Fifty percent of patients receiving famciclovir 500 mg 3 times daily (P ‫؍‬ .07) and 43% receiving 1.5 g once daily (P ‫؍‬ .41) experienced >2 points improvement in HAI versus 37% for placebo. Nine percent of patients treated with famciclovir 500 mg 3 times daily underwent anti-HBeAg seroconversion with undetectable HBV DNA at end of follow-up versus 3% in the placebo group (P ‫؍‬ .05). Famciclovir was well tolerated; the incidence of post-treatment alanine transaminase (ALT) elevations was comparable with placebo. In conclusion, famciclovir 500 mg 3 times daily gave modest suppression of viral replication, but translated into significant histologic improvement in median HAI score at 1 year. (HEPATOLOGY 2000;32:413-417.)Hepatitis B virus (HBV) infection is a major cause of chronic liver disease, with an estimated 350 million carriers worldwide. HBV induces a spectrum of clinical manifestations, ranging from mild, unapparent disease to fulminant hepatitis, severe chronic liver disease, and cirrhosis. The virus has also been clearly implicated in the development of primary hepatocellular carcinoma, causing one million deaths per year. [1][2][3] Interferon alfa is widely licensed for the treatment of chronic hepatitis B e antigen (HBeAg)-positive HBV infection. The drug is administered to patients with well-compensated liver disease who can tolerate the potential side effects, which may require dose reduction or discontinuation of treatment. In addition, interferon requires parenteral administration. Efficacy defined as HBe-seroconversion is limited to approximately 30% of treated patients. 4 Availability of nucleoside analogues with activity against HBV offers promise of improved efficacy, greater convenience (i.e., oral formulation) and applicability to patients with well and poorly compensated HBV infection. Lamivudine, the (...

general population due to relationship difficulties, body image problems, fear of pregnancy and inappropriate medical advice that pregnancy might be dangerous [1][2][3] . Pregnancy planning should be discussed with the patient and her partner early on prior to conception. Education and open communication are important as patients may be reluctant to broach this topic on their own. Patient concerns often relate to fertility, impact of IBD on pregnancy and fetal development, and drug effects pre-conception, during pregnancy and while breastfeeding. FERTILITYWomen with ulcerative colitis (UC) who have not undergone surgery or those with inactive Crohn's Disease (CD) have fertility rates comparable with the rest of the population. In comparison, women with UC who have had surgery [4] or those with active CD [5,6] have increased infertility. Fertility appears to revert to normal after induction of remission in women with CD. Women who have their first pregnancy after the onset of IBD have fewer pregnancies than population controls, whereas women who became pregnant prior to onset of IBD have similar reproductive history [5] . In addition, women with CD have a delayed age of first pregnancy after being diagnosed [7] and have been shown to have fewer children than might be expected after diagnosis with a higher rate of failure to conceive [8] . IMPACT OF IBD ON PREGNANCY AND FETAL DEVELOPMENTT he initial impression looking at multiple, small observational studies of pregnancy in women with IBD was that the outcome was normal [6,9] . Fetal mortality risk (spontaneous abortion, stillbirth or neonatal death) is not higher for IBD patients [3] , but there is an increased risk of preterm delivery (< 37 wk) and low birth weight (< 2.5 kg) in mothers with IBD [10][11][12][13][14] . Still, the majority of women with IBD will have a normal outcome of pregnancy. Disease activity is the main adverse factor predisposing to prematurity and low birth weight babies [15] . DISEASE ACTIVITYApproximately one-third of women with inactive IBD at conception will relapse during the pregnancy or puerperium. Management of inflammatory bowel disease in the pregnant patient AbstractInflammatory bowel disease (IBD) is a chronic disorder affecting young adults in their reproductive years. Many young women with IBD express concern about the effect their disease will have on fertility, pregnancy course and fetal development. This article presents an approach to management of IBD in the pregnant patient, including counseling and investigation, and summarizes existing data on the safety of medications used to treat IBD in pregnancy and breastfeeding.

No abstract

Inflammatory bowel disease (IBD) typically affects patients during their adolescent and young adult years. As these are the reproductive years, patients and physicians often have concerns regarding the interaction between IBD, medications and surgery used to treat IBD, and reproduction, pregnancy outcomes, and neonatal outcomes. Studies have shown a lack of knowledge among both patients and physicians regarding reproductive issues in IBD. As the literature is constantly expanding regarding these very issues, with this review, we provide a comprehensive, updated overview of the literature on the management of the IBD patient from conception to delivery, and provide action tips to help guide the clinician in the management of the IBD patient during pregnancy.

Ulcerative colitis (UC) is an idiopathic, chronic inflammation of the colon which may present with a range of mild to severe symptoms. The disease may be localized to the rectum or can be more extensive and involve the left side of the colon or the whole colon. Treatment in UC is directed towards inducing and maintaining remission of symptoms and mucosal inflammation. The key parameters to be assessed for the most appropriate treatment are the severity and extent of the inflammation. Meta-analyses of published trials have shown that topical treatment with 5-aminosalicylic acid (5-ASA) is the treatment of choice in active distal mild-to-moderate UC. Oral aminosalicylates are effective in both distal and extensive mild-to-moderate disease, but in distal disease, the rates of remission are lower than those obtained with topical 5-ASA. New steroids, such as budesonide and beclomethasone dipropionate (BDP), administered as enemas, constitute an alternative to 5-ASA therapy. In some studies, these have been shown to be as effective as conventional steroids but with significantly lower inhibition of plasma cortisol levels. Patients with unresponsive disease or those with more severe presentation will require oral corticosteroids and sometimes intravenous therapy. Approximately 10% of patients with unresponsive UC have severe attacks requiring hospitalization. Patients with severe disease should be managed jointly by a medical and surgical team, and intensive intravenous treatment should be started with high-dose steroids. Early recognition of failure of therapy will allow the introduction of immunosuppressive therapy with intravenous cyclosporine. Patients who respond are shifted to oral cyclosporine associated with azathioprine/6-mercaptopurine, whereas those who fail will require proctocolectomy. Oral aminosalicylates are the first-line therapy in maintenance of remission. Topical 5-ASA may play a role in distal disease. Patients who are steroid dependent can be started on azathioprine or 6-mercaptopurine although it may take up to 3 months for the treatment to become effective. They may have reversible immediate side effects, such as pancreatitis or bone marrow suppression, which disappear upon discontinuation of therapy. Close monitoring of these hematologic and biochemical parameters will improve safety. The use of biologic therapy with infliximab in more severe disease has not been established.

Inflammatory bowel disease (IBD) often affects women during their child-bearing years. Management of a pregnant IBD patient, or a patient contemplating pregnancy, poses unique challenges and can be quite daunting. Knowledge of the basic interplay among disease, normal host physiology and pregnancy is vital to managing these patients. One of the most important advances in the management of IBD over the past decade has been the finding that normal pregnancy outcomes can be achieved when a woman enters the pregnancy in remission. New insights into the safety of a wider spectrum of drugs in these patients has allowed for increased success in IBD management. The evidence supporting medical interventions including biological therapy such as antibodies to tumour necrosis factor agents is reviewed. Once the treating physician understands this complex relationship, management of the pregnant IBD patient can often become a rewarding experience.