BACKGROUND: New immunotherapy using immune checkpoint inhibitors plays a critical role in cancer treatment. Immune checkpoint inhibitor-related colitis (irAE-colitis) occurs in approximately 1–20% of cancer patients treated with immune checkpoint inhibitors. There are limited data on the outcomes of optimal treatment in patients with irAE-colitis. The aim of this report was to clarify treatment outcomes for patients with irAE-colitis in our facilities. METHODS: Of 676 patients who received immune checkpoint inhibitors at our hospital and related facilities, nine patients who developed irAE-colitis were included. We defined effectiveness as follows: a decrease of 3 points or more in a Mayo endoscopic sub-score, 0 or 1 points in a rectal bleeding score and 2 points or more in a Mayo clinical score. RESULTS: The male-to-female ratio was five to four. There were five cases of lung cancer, one case of renal cancer, one of head and neck cancer, one of melanoma, and one of gastric cancer. The immune checkpoint inhibitors pembrolizumab and nivolumab, which are anti-PD-1 antibodies, were used in six and three cases, respectively. The drugs used after onset are as follows. One case was mesalazine, six were steroids, one was infliximab, and one was cyclosporine. The effective rate of steroids was 84% (5/6 cases), of which two cases relapsed during steroid tapering. However, both cases improved with steroid re-administration. For one case where steroids were ineffective, we used infliximab. Although the patient’s condition improved temporarily, we encountered secondary failure and changed to cyclosporine, which was effective. One case died before treatment intervention due to severe diarrhea. Immune checkpoint inhibitors were discontinued in all cases. At the time of writing, six patients are still alive after improvement of abdominal symptoms. CONCLUSION(S): Steroid therapy was quite effective for the treatment of irAE-colitis, although early relapse occurred in some cases. Prospective studies are required to define the optimal management of irAE-colitis in order to maintain positive long-term outcomes.
Administering double doses of infliximab or shortening its dosing interval for patients with Crohn disease who experience a loss of response to treatment is an accepted treatment method; however, the effectiveness and appropriate timing of treatment intensification remain unclear. We examined the treatment outcomes of patients with Crohn disease receiving infliximab therapy intensification. Among 430 patients with Crohn disease who were seen at our related facilities from July 2002 to July 2018, 46 patients (30 men and 16 women) who were followed up for diminished infliximab effects for >1 year after therapy intensification were included in this study. The relationship between patient background and continuation of therapy intensification was retrospectively examined through a logistic regression analysis. Among the 46 patients, 67.4% (31 cases) continued therapy intensification for 12 months. The treatment discontinuation rate after 12 months (7.1% vs 43.8%, P = .015) and the C-reactive protein levels at the start of therapy intensification (P = .0050) were significantly lower in the group in which treatment was strengthened due to remaining endoscopic findings (n = 14) than that due to clinical symptoms (n = 32). There was no significant difference in the rates of treatment discontinuation after 12 months of treatment strengthening between patients receiving double doses (n = 34) and those with shortened dosing intervals (n = 12). Infliximab treatment discontinuation seems to be less likely to occur in patients with Crohn disease who are receiving infliximab treatment intensification based on endoscopic findings of exacerbations than in patients whose treatment is based on clinical symptoms.
Background Capsule endoscopy has been widely used to investigate obscure gastrointestinal bleeding (OGIB) in the small intestine since its approval in 2001. However, the clinical features of OGIB remain unclear. Aim We retrospectively examined the clinical features and risk factors of OGIB in patients who underwent capsule endoscopy in our hospital. Methods We included 420 of the 431 patients who underwent capsule endoscopy from June 2014 to May 2021, in whom the small intestine could be observed. We retrospectively compared the clinical features and treatment of OGIB cases, with or without active small bowel bleeding (n = 173), with other cases (n = 247). Patient sex, age, diabetes mellitus, and heart failure histories were matched for the analysis. Results The male/female ratio was 247/173 and the average age was 51.54 years. In multivariate analysis, the use of direct oral anticoagulants was significant (P = 0.016), and vascular lesions (P = 0.018) were observed in OGIB cases. When OGIB cases with and without active small bowel bleeding were compared, serum albumin level was lower in cases with active bleeding (P = 0.031). When treatment of OGIB cases were compared, those without vascular lesions could be treated conservatively (P = 0.0047). In the 1:1 propensity score matching analysis, serum creatinine level was elevated in cases of active bleeding (P = 0.029), and cases without vascular lesions were treated conservatively (P = 0.010). Conclusions Use of direct oral anticoagulants is frequently associated with OGIB. OGIB patients without vascular lesions may be treated conservatively.
BACKGROUND: Cronkhite-Canada syndrome (CCS) is a non-hereditary disease characterized by the presence of gastrointestinal polyposis and skin symptoms such as hair loss, nail plate atrophy, and skin pigmentation. Approximately 50% of cases of CCS also have small bowel lesions. However, there have been few image reports of the small intestine lesions. METHODS: We examined the findings of small intestine capsule endoscopy (CE) in 3 cases of CCS in our hospital. RESULTS: Case 1 was of a 64-year-old male whose chief complaint was diarrhea, abnormal taste, and weight loss. He had diarrhea for 2 months and aware of finger pigmentation and nail atrophy. Esophagogastroduodenoscopy (EGD) revealed a collection of reddish polyps that expanded in the stomach and duodenum, and colonoscopy (CS) revealed glossy reddish bumps in the colon. CE showed diffuse reddish, edematous mucosa and villi enlargement in the entire small bowel. From these characteristic endoscopic and skin findings, he was diagnosed with CCS and was started on prednisolone (PSL) treatment. The treatment response was good, and there was no relapse. Case 2 was of a 65-year old female whose chief complaint was skin pigmentation. She had been aware of pigmentation on her back, palms, and upper arms, and loss of fingernails for the last 6 years with repeated disappearances and exacerbations. Furthermore, erosive gastritis and gastric hyperplastic polyps had been detected 4 years ago, and she was followed-up for these symptoms. Gradually, she became aware of nausea and loose stools, which prompted her to visit our hospital. EGD and CS revealed multiple reddish polyps predominantly in the gastric antrum, villous atrophy and reddish polyps in the terminal ileum, and scattered reddish polyps in the entire colon. Mucosal biopsies revealed glandular dilation, mucosal edema, and inflammatory cell infiltration. CE showed diffuse mulberry ridges and villi atrophy throughout the small bowel. She was diagnosed with CCS based on characteristic clinical and endoscopic findings, and was started on steroid treatment. There was no relapse. Case 3 was of a 75-year old male whose chief complaint was diarrhea and hair loss. EGD and CS revealed multiple polyps in the stomach, duodenum, and colon. CE showed reddish edematous mucosa and villi mixed with atrophy and swelling in the small bowel. Of note were that these findings were found in the jejunum. He was diagnosed with CCS and started on PSL and immunomodulator. Four years later, the characteristic findings disappeared in the CE. CONCLUSION(S): All patients had lesions in the entire small bowel, but there they were not associated with clinical findings or steroid response. The mucosa of the small intestine were more likely to have various findings as the period from onset to diagnosis became longer.
Background Although biologics have improved the therapeutic goals for Crohn’s disease, the problem of diminishing efficacy exists. With recent advances, it is possible to administer double doses or shortening the dosing interval of infliximab (IFX); however, its effectiveness and right timing of strengthening remain unclear. In this study, we examined the treatment outcomes in patients with Crohn’s disease who received IFX-therapy intensification for the reduction of IFX effects at multiple centres. Methods Of the 243 patients with Crohn’s disease who were seen at our hospital and related facilities from July 2002 to July 2018, a total of 46 patients who could be observed for more than 1 year after IFX-therapy intensification for diminished effect of IFX were included in this study. The relationship between patient background and continuation of therapy intensification was retrospectively examined using logistic regression analysis. Furthermore, the relationship between therapy intensification and the treatment discontinuation rates for each of double doses and shortening the dosing interval was also evaluated. Results Of the 46 patients (30 men and 16 women), 67.4% (31 cases) were able to continue therapy intensification for 12 months. In univariate analysis of the relationship between patient background and continuation of therapy intensification, therapy intensification due to the remaining endoscopic findings contributed to the decrease in therapy intensification interruption rate. However, multivariate analysis did not reveal any significant contributing factors. Next, treatment discontinuation rates were compared between the group in which therapy intensification was performed due to the remaining endoscopic findings (n = 14) or clinical symptoms (abdominal pain, diarrhoea, and subjective general condition) (n = 32). The rate of treatment discontinuation 12 months after treatment strengthening was significantly lower in the therapy intensification group due to the remaining endoscopic findings than in that due to clinical symptoms (7.1% vs. 43.8%, p = 0.015). The rates of treatment discontinuation between the group of double doses (n = 34) and the group of shortening the dosing interval (n = 12) were also compared, but there was no significant difference after 6 or 12 months of treatment strengthening. Conclusion Treatment interruption would less likely occur among patients with Crohn’s disease receiving IFX if IFX-treatment intensification is triggered by the remaining endoscopic findings and not by clinical symptoms.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.