MRI is able to detect pathologic bowel segments in CD, as it allows the measurement of significant variations in wall thickness and contrast enhancement on changing from the active phase of the disease to remission.
Background: Colonoscopy is one of the methods of choice for screening relatives of patients with colorectal cancer. Objective: To evaluate the rate of adherence to colonoscopy in first-degree relatives of patients with colorectal cancer and describe the lesions found. Methods: A prospective, cross-sectional, multicentre, nationwide study was conducted. The study population was composed of first-degree relatives of patients with colorectal cancer selected randomly from the EPICOLON study. Seventy-four index patients were included. These had 342 living first-degree relatives (parents, siblings and children), of whom 281 were interviewed. Results: The adherence rate was 38% (107/281). Adherence was greater in families with a higher degree of familial aggregation for colorectal cancer (88.9% for Amsterdam vs 33.3% for Bethesda and sporadic cancer; p,0.05), an index patient aged under 65 years (60% for patients ,65 years vs 32.9% for patients >65 years; p,0.05) and an index patient who was female (46.2% for women vs 31% for men; p = 0.28). Adherence was also greater in relatives under 65 years (54% in patients ,65 years vs 18% in patients >65 years; p = 0.05), in female relatives (49% in female relatives vs 27.3% in male relatives; p,0.05) and in siblings and children (40% in siblings and children vs 13% in parents; p,0.05). Lesions were found in 26% (28/107) of the study population. Nine (8.4%) individuals had a total of 18 advanced lesions. Conclusions: These results indicate that adherence to colonoscopy in our population of first-degree relatives was low. The adherence was more frequently associated with a higher degree of familial aggregation, a relative age of under 65 years, a sibling or offspring relationship, and female sex.
Identifying risk factors of amyloidosis in IBD patients and screening for proteinuric renal dysfunction are useful to improve diagnostic accuracy. Referral of biopsies to a tertiary centre should also be considered, to improve diagnostic accuracy. Although there is no reliable evidence on the effectiveness of treatment, it seems reasonable to treat the underlying disease with potent immunosuppression to minimise inflammatory activity, thereby switching off amyloidogenesis.
Summary
Background
The long‐term outcome of patients after antitumour necrosis factor alpha (anti‐TNF) discontinuation is not well known.
Aims
To assess the risk of relapse in the long‐term after anti‐TNF discontinuation.
Methods
This was an extension of the evolution after anti‐TNF discontinuation in patients with inflammatory bowel disease (EVODIS) study (Crohn's disease or ulcerative colitis patients treated with anti‐TNFs in whom these drugs were withdrawn after achieving clinical remission) based in the same cohort of patients whose outcome was updated. Clinical remission was defined as a Harvey–Bradshaw index ≤4 points in Crohn's disease, a partial Mayo score ≤2 in ulcerative colitis and the absence of fistula drainage despite gentle finger compression in perianal disease.
Results
This was an observational, retrospective, multicenter study. A total of 1055 patients were included. The median follow‐up time was 34 months. The incidence rate of relapse was 12% per patient‐year (95% confidence interval [CI] = 11‐14). The cumulative incidence of relapse was 50% (95% CI = 47‐53): 19% at one year, 31% at 2 years, 38% at 3 years, 44% at 4 years and 48% at 5 years of follow‐up. Of the 60% patients retreated with the same anti‐TNF after relapse, 73% regained remission. Of the 75 patients who did not respond, 48% achieved remission with other therapies. Of the 190 patients who started other therapies after relapse, 62% achieved remission with the new treatment.
Conclusions
A significant proportion of patients who discontinued the anti‐TNF remained in remission. In case of relapse, retreatment with the same anti‐TNF was usually effective. Approximately half of the patients who did not respond after retreatment achieved remission with other therapies.
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