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B A Lashner

Publications and source records attributed to B A Lashner.

69 records · Page 4Linked to original sources
PubMed1989

Lack of association between oral contraceptive use and Crohn's disease: a community-based matched case-control study.

Previous epidemiologic studies have suggested a weak association between oral contraceptive use and Crohn's disease, specifically Crohn's colitis. To measure a possible etiologic association, 51 women with Crohn's disease who were 18-50 yr old were studied and compared with peer-nominated age- and sex-matched controls. There were no differences between cases and controls with respect to race, religion, marital status, and number of pregnancies. There was no association between oral contraceptive use and Crohn's disease incidence [current use: odds ratio (OR) 0.73, 95% confidence interval (CI) 0.34-1.59; former use: OR 1.80, CI 0.61-5.29; current or former use: OR 1.00, CI 0.46-2.16]. Stratifying by disease location also failed to identify an association. Cigarette smoking was significantly associated with Crohn's disease incidence. Controlling for possible confounding effects of cigarette smoking did not alter the lack of association between oral contraceptive use and Crohn's disease. Similarly, testing for interaction failed to demonstrate any effect modification. Analyzing for duration of current oral contraceptive use or time interval since last use failed to demonstrate a "dose-response" effect. The study was of sufficient size to detect statistical significance for oral contraceptive use for odds ratios of greater than or equal to 2.76. From this community-based matched case-control study, there was no association between oral contraceptive use and Crohn's disease, and women need not be advised to discontinue oral contraceptive use when a diagnosis of Crohn's disease is made.

Adult↗
PubMed1989

Sigmoid volvulus as a complication of ileal Crohn's disease.

Intestinal volvulus in patients with Crohn's disease is rare and we could find only one report of sigmoid volvulus with active Crohn's colitis. We have seen a 54-year-old woman with long-standing Crohn's disease who developed large-bowel obstruction. After eventual detorsion of the sigmoid volvulus, we found that her ileum was involved with active Crohn's disease and that her colonic mucosa was free of mucosal lesions. In this case, we suspect that the reactivation of the ileal Crohn's disease as well as other features commonly associated with Crohn's disease contributed to the development of sigmoid volvulus by causing fixation, torsion, and dilatation of distal bowel.

Crohn Disease↗
PubMed1989

Cigarette smoking in Crohn's disease.

Crohn's disease is a chronic disease of unknown etiology. Previous reports have suggested that cigarette smoking may be associated with the development of Crohn's disease. To examine this association, we conducted a case-control study of patients referred to a single practice over a 7-month period. The cigarette-smoking habits of 115 patients with Crohn's disease were compared with the cigarette-smoking exposure of 109 patients with the irritable bowel syndrome. Patients with Crohn's disease were more likely to smoke at the time of symptom onset than were irritable bowel syndrome controls (age and sex adjusted odds ratio 3.71, 95% confidence interval 1.93-7.13). After the diagnosis of Crohn's disease, patients were less likely to quit smoking (odds ratio 0.35, 95% confidence interval 0.18-0.69) than controls. This study demonstrates an association and a temporal relationship between cigarette smoking and Crohn's disease. For the exposure to be considered an etiologic factor for disease, biologic plausibility and pathophysiologic mechanisms require elucidation.

Adult↗
PubMed1988

Chronic hepatitis: disease factors at diagnosis predictive of mortality.

PURPOSE: Chronic hepatitis is known to be a disease with substantial mortality. The purpose of this study was to identify prognostic factors in a large group of patients with chronic hepatitis. We also wanted to determine whether the aminopyrine breath test (ABT) is of additional prognostic value in evaluation of this disease. PATIENTS AND METHODS: We studied 94 patients who had had a biopsy-proven diagnosis and an ABT between June 1, 1977, and June 30, 1981. Clinical features and biochemical test results at the time of diagnosis were retrieved from medical records, and histologic severity was assessed by reviewing all liver biopsy specimens under code. Survival was determined at a mean of 60 months. Data were studied with a Cox proportional hazards model to identify predictors of mortality and to control for confounding variables. RESULTS: Cumulative mortality as of December 31, 1985, was 5 percent in chronic persistent hepatitis, 6 percent in chronic active hepatitis, 29 percent in chronic active hepatitis with bridging necrosis, and 53 percent in chronic active hepatitis with cirrhosis. Histologic severity was a predictor of death (p less than 0.005). Other predictors of mortality were disease caused by hepatitis B virus (p less than 0.005), a high alkaline phosphatase level (p less than 0.025), a low alanine aminotransaminase level (p less than 0.001), and a depressed ABT result (p less than 0.005). CONCLUSION: The results suggest that patients with chronic hepatitis with one or more of these risk factors have an increased mortality and should be followed closely for liver failure, which may necessitate medical therapy or surgical intervention.

Adult↗
PubMed1988

Optimal timing of colonoscopy to screen for cancer in ulcerative colitis.

Patients with ulcerative colitis have a high risk of colon cancer that increases with duration of disease. Annual colonoscopy with biopsies for 99 patients with pancolitis and a mean duration of disease at entry of 17 years was evaluated. The outcomes of mucosal dysplasia or cancer were analyzed to determine the annual risk (hazard rate) of high-grade dysplasia or colon cancer. The hazard rates were used to recommend screening intervals. The delay in the diagnosis of cancer is minimized for any given number of tests when the time between tests is inversely proportional to the square root of the hazard rate. Since the hazard rate for cancer increases with duration of disease, intervals for screening tests should not be uniform. For a range of reasonable marginal benefits from additional testing, the number of tests recommended is less than the number of tests done in fixed-interval screening programs. Scheduling screening tests using patient-specific hazard rates to minimize the delay in the diagnosis of cancer reduces the number of colonoscopies, associated cost, and morbidity.

Adolescent↗
PubMed1988

Smoking and inflammatory bowel disease in families.

Smoking habits of inflammatory bowel disease (IBD) patients were compared with family members with IBD to determine the effects of cigarette smoking on the development of either ulcerative colitis or Crohn's disease. In a previous study of patients randomly selected from the University of Chicago IBD Registry, 40 patients with IBD were identified as having a confirmed IBD family history. Thirty-one of those probands and relatives were contacted and included in this study. Of the 36 patients in the study with Crohn's disease, 78% were former or current smokers, whereas only 27% of the 26 patients with ulcerative colitis were former or current smokers. Eighty-three percent of all those who had ever smoked, started before the onset of symptoms of their disease. There were high concordance rates for type of IBD (81%) and for smoking habits (65%, when a history of smoking was compared with a history of never having smoked) among the matched pairs. The concordance rates were not significantly different from each other, but the magnitude of concordance of each suggests that both smoking habits and consanguinity may be important factors in the pathogenesis of this disease.

Adult↗
PubMed1986

Prevalence and incidence of inflammatory bowel disease in family members.

To determine the risk of having or developing inflammatory bowel disease (IBD) in a family member of an IBD patient, a population of 245 IBD probands was randomly selected from the University of Chicago IBD Registry and their family history was elucidated by questionnaire and follow-up telephone call. One hundred seventy-nine (73%) probands responded to the questionnaire. There were no demographic distinctions between those eligible for the study, those who were complete responders, those who were nonresponders, and those with a positive family history of IBD. Fifty-four family members from 40 proband families (22%) had confirmed IBD. Prevalence of IBD in family members at the time of diagnosis of the proband was highest for parents (4.6%), siblings (2.6%), and children (1.9%). Grandparents, aunts and uncles, and first cousins had prevalence of IBD of less than 1%. Incident case frequency was determined by dividing the number of cases incident after the diagnosis of the proband by all those ever at risk. The incident case frequency was highest for siblings (1.9%), parents (1.0%), and children (1.0%). There was concordance noted for type of disease in the proband and the relative. No association could be discerned between the familial risk of IBD and gender, race, or religion of the proband. Despite a high occurrence rate of proband families with IBD, the specific risk to first, second, or third degree family members is low.

Adolescent↗
PubMed1986

Acute pancreatitis associated with high-concentration lipid emulsion during total parenteral nutrition therapy for Crohn's disease.

A 17-yr-old boy with Crohn's disease and growth retardation developed an acute abdominal crisis while receiving total parenteral nutritional support. Acute pancreatitis was confirmed surgically. After recovery, in an attempt to provide adequate calories and to elucidate the inciting agent, he was rechallenged with his original total parenteral nutritional solution which contained 500 ml/day of a 20% fat emulsion. Symptoms and signs of acute pancreatitis quickly returned. Total parenteral nutrition was continued without the fat emulsion and symptoms and signs disappeared. This case suggests that acute pancreatitis was due to intolerance of high-concentration lipid emulsion.

Acute Disease↗
PubMed1986

Clostridium difficile culture-positive toxin-negative diarrhea.

Antibiotic-associated colitis (AAC) is confirmed by the isolation of Clostridium difficile cytotoxin from stool in patients with diarrhea. Culture of the organism has not been required to confirm the diagnosis. A review of cases of C. difficile culture-positive patients was performed in an attempt to clarify the significance of culture-positive toxin-negative (CPTN) compared to culture-positive toxin-positive (CPTP) disease. During an 11-month period, 45 patients were identified who had stool cultures positive for C. difficile. Sixteen of the patients studied were CPTP and 29 were CPTN. There were no major differences between the two groups for underlying diseases, antibiotic exposure, or diagnostic testing. Of the CPTP patients, 10 were treated for AAC and all responded. Two untreated patients resolved spontaneously. Of the CPTN patients, none was given specific antibiotic therapy, symptoms spontaneously resolved in 17, and symptoms were unresolved in five (colectomy or expired before resolution). A prospective analysis was performed of all C. difficile isolated from stool samples by the microbiology laboratory. Isolates were incubated in vitro and cytotoxin production was measured. Of isolates from CPTP patients 97% produced cytotoxin compared to 67% of isolates from CPTN patients (p less than 0.005). The results suggest that C. difficile, despite the absence of cytotoxin, may be an etiological factor in certain diarrheal syndromes. Until a randomized therapeutic trial for CPTN patients is conclusive, a positive culture should be considered evidence for treatment of patients with persistent diarrhea.

Anti-Bacterial Agents↗
PubMedDate not supplied

Bioavailability of magnesium diglycinate vs magnesium oxide in patients with ileal resection.

BACKGROUND: Patients who have undergone ileal resection are at risk for developing magnesium depletion/deficiency because of poor absorption and decreased intake as well as increased endogenous losses. Magnesium repletion is difficult to accomplish because of the cathartic action of most oral magnesium supplements at therapeutic doses. The results of in vitro and in situ studies show that magnesium diglycinate (chelate) represents a highly available form of magnesium that is absorbed in part as an intact dipeptide in the proximal small intestine. METHODS: We conducted a double-blind, randomized crossover trial with 12 patients who had ileal resections in order to compare the bioavailability of a 100-mg dose of 26Mg-labeled chelate with MgO in this patient population. RESULTS: For the patient group as a whole, 26Mg absorption was low but was not different for the two supplements (23.5% vs 22.8% for magnesium chelate and MgO, respectively). However, 26Mg absorption was substantially greater from the chelate (23.5% vs 11.8%; p < .05) in the four patients who showed the greatest impairment of magnesium absorption with MgO and was better tolerated by all patients. Peak isotope enrichment also occurred significantly earlier after 26Mg chelate than after 26MgO ingestion (mean difference 3.2 +/- 1.3 hours; p < .05), and the area under the enrichment vs time curve was greater after chelate ingestion (p < .05). CONCLUSIONS: Data from this study support the suggestion that some portion of magnesium diglycinate is absorbed intact, probably via a dipeptide transport pathway. Magnesium diglycinate may be a good alternative to commonly used magnesium supplements in patients with intestinal resection.

Administration, Oral↗
PubMedDate not supplied

Colorectal cancer in ulcerative colitis patients: survival curves and surveillance.

BACKGROUND: Survival curves can provide useful information for designing cancer surveillance programs. OBJECTIVE: To outline how to derive the density and hazard functions from the survival curve and to use this information to make recommendations regarding cancer surveillance in patients with ulcerative colitis. DISCUSSION: The hazard of cancer or dysplasia remains low during the first decade of ulcerative colitis but rises exponentially thereafter. After 40 years, approximately 20% of patients with ulcerative colitis acquire cancer or dysplasia per year. CONCLUSION: A reasonable recommendation for cancer surveillance based on information from survival curves would be a colonoscopy with biopsy approximately 10 years after the onset of ulcerative colitis, and repeated every 3 years for the next decade, every 2 years for the subsequent decade, and every year thereafter. Prophylactic proctocolectomy is an option after 40 years of disease due to the extremely high cancer risk, but data supporting this option are sparse.

Adolescent↗
PubMedDate not supplied

Use of old and new oral 5-aminosalicylic acid formulations in inflammatory bowel disease.

Although sulfasalazine, a 5-aminosalicylic acid (5-ASA) agent, is still the anti-inflammatory agent of choice for ulcerative colitis and Crohn's disease, newer formulations, which release drug to specific regions of the colon for maximal efficacy, also can be appropriate first-line agents. This article reviews recent clinical studies of therapy with older and newer 5-ASA formulations.

Administration, Oral↗