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Biomedical subjects

Edward V Loftus

Publications and source records attributed to Edward V Loftus.

At least 37 records · Page 2Linked to original sources
PubMed2006

A practical perspective on ulcerative colitis: patients' needs from aminosalicylate therapies.

A large, Internet-based survey of a random sample of members of the Crohn's and Colitis Foundation of America was undertaken to gain knowledge and understanding of patients' experiences with ulcerative colitis and first-line therapies. From 49,410 invitations to participate, 1,595 usable responses were received from patients with ulcerative colitis. Patients were prescribed a range of aminosalicylates for their ulcerative colitis. Treatments with the highest proportion of satisfied patients were associated with highest remission rates. Forty-three percent of patients considered their disease to be in remission; however, 74% reported disease relapse during the previous 12 months. Over 60% of patients reported that they were noncompliant with prescribed aminosalicylate dosing schedules, with reasons attributed to frequency of dosing, the number of pills, and the inconvenience of the medication. Many respondents reported that they had made significant lifestyle changes because of their ulcerative colitis, including spending more time at home (46%) and participating in fewer social activities (37%). When asked to describe their ideal treatment, patients considered high efficacy (97%), lack of side effects (74%), nonparenteral dosing (46%), nonrectal dosing (36%), low cost (23%), fewer pills (23%), and less frequent dosing (23%) as "very important." This study demonstrates that continuous symptomatic remission is central to patient satisfaction and that patients find currently available aminosalicylates to be inconvenient. Patients' ideal therapy would be an effective, oral formulation with fewer tablets, less frequent dosing, and minimal side effects. Development of such a therapy would, therefore, potentially improve both patient compliance and overall treatment success.

Adult↗
PubMed2006

A population-based study of the frequency of corticosteroid resistance and dependence in pediatric patients with Crohn's disease and ulcerative colitis.

BACKGROUND: The goal of this study was to examine the 1-year outcome after the first course of systemic corticosteroids in an inception cohort of pediatric patients with inflammatory bowel disease. METHODS: All Olmsted County (Minnesota) residents diagnosed with Crohn's disease (n = 50) or ulcerative colitis (n = 36) before 19 years of age from 1940 to 2001 were identified. Outcomes at 30 days and 1 year after the initial course of corticosteroids were recorded. RESULTS: Twenty-six patients with Crohn's disease (65%) and 14 with ulcerative colitis (44%) were treated with corticosteroids before age 19. Thirty-day outcomes for corticosteroid-treated Crohn's disease were complete remission in 16 (62%), partial remission in 7 (27%), and no response in 3 (12%), with 2 of these patients requiring surgery. Thirty-day outcomes for treated ulcerative colitis were complete remission in 7 (50%), partial remission in 4 (29%), and no response in 3 (21%). One-year outcomes for Crohn's disease were prolonged response in 11 (42%) and corticosteroid dependence in 8 (31%), whereas 7 (27%) were postsurgical. One-year outcomes for ulcerative colitis were prolonged response in 8 (57%) and corticosteroid dependence in 2 (14%), whereas 4 (29%) were postsurgical. CONCLUSIONS: Most pediatric patients with inflammatory bowel disease initially responded to corticosteroids. However, after 1 year, 58% of pediatric patients with Crohn's disease and 43% of pediatric patients with ulcerative colitis either were steroid dependent or required surgery. This finding emphasizes the need for early steroid-sparing medications in pediatric inflammatory bowel disease.

Adolescent↗
PubMed2006

True or false? The hygiene hypothesis for Crohn's disease.

The "hygiene hypothesis" for Crohn's disease postulates that multiple childhood exposures to enteric pathogens protect an individual from developing Crohn's disease later in life, while individuals raised in a more sanitary environment are more likely to develop Crohn's disease. In this issue of the American Journal of Gastroenterology, two Canadian case-control studies come to diametrically opposed conclusions regarding the hygiene hypothesis for Crohn's disease. This difference may be partially related to differences in study population (population based vs hospital based), age of onset, different genetic determinants, urban/rural residence (40% rural vs principally urban), or different exposures from the putative causative agent. As of now, the veracity of the hygiene hypothesis for Crohn's disease is not confirmed.

Crohn Disease↗
PubMed2006

Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography--correlation with endoscopic and histologic findings of inflammation.

PURPOSE: To determine retrospectively if quantitative measures of small-bowel mural attenuation and thickness at computed tomographic (CT) enterography correlate with endoscopic and histologic findings of small-bowel inflammation and to estimate the performance of these measures in predicting inflammatory Crohn disease. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant retrospective study, which was conducted with patient informed consent. CT enterography data in 96 patients (31 male patients and 65 female patients) who underwent ileoscopy with or without biopsy were examined for CT signs of active Crohn disease. The most highly enhancing segment of terminal ileum and a normal-appearing ileal loop were identified. After it was confirmed that semiautomated software could accurately measure mural attenuation and thickness, the selected terminal ileal and normal-appearing (control) ileal loops were examined (20 automated measurements at each location) to quantify mural attenuation and wall thickness. Results were compared with endoscopy and histology reports by using logistic regression analysis and receiver operating characteristic curves. RESULTS: Quantitative measures of terminal ileal mural attenuation and wall thickness correlated significantly with active Crohn disease (P < .001). Small-bowel wall thickness was not a significant factor after attenuation was taken into account. A threshold attenuation value with a sensitivity of 90% (18 of 20) for definite Crohn disease (compared with a sensitivity of 80% [16 of 20] for radiologist assessment) was selected. In patients who underwent ileal biopsy, threshold attenuation had a sensitivity identical to that of ileoscopy (81% [26 of 32]; 95% confidence interval: 64%, 93%) in predicting histologic inflammation. CONCLUSION: Quantitative measures of mural attenuation and wall thickness at CT enterography correlate highly with ileoscopic and histologic findings of inflammatory Crohn disease. Quantitative measures of mural attenuation are sensitive markers of small bowel inflammation.

Adolescent↗
PubMed2005

Evolving diagnostic modalities in inflammatory bowel disease.

Over the past several years, significant advances have been made in the diagnostic techniques used in the management of ulcerative colitis and Crohn's disease. These advances have occurred mainly in the area of gastrointestinal endoscopy and radiology. Capsule endoscopy and double-balloon endoscopy have permitted better visualization of the small bowel mucosa. Advanced imaging techniques, including chromoendoscopy, magnification endoscopy, confocal endomicroscopy, and spectroscopy, may aid in the diagnosis of colorectal neoplasia in patients with long-standing disease. Improved radiographic imaging techniques based on computed tomography and magnetic resonance imaging allow noninvasive means of evaluating the small bowel in patients with known or suspected Crohn's disease. Finally, positron emission tomography is an investigative tool for inflammatory bowel disease that may also aid in the detection of inflammation in these diseases.

Colonography, Computed Tomographic↗
PubMed2005

Medical Therapy of Crohn's Disease.

There is no medical or surgical treatment that provides a permanent cure for Crohn's disease (CD). However, an evolving understanding of the pathogenesis of CD has provided clinicians with a diversity of medical treatment options for the disease. The goal of therapy is to induce and maintain clinical remission. The efficacy of immune-modifying agents such as azathioprine/6-mercaptopurine and infliximab have supported a paradigm shift in CD treatment in which maintenance agents are introduced earlier in the disease course. At the same time, it is imperative to balance the efficacy, safety, and tolerability of medical therapy. Given the variable and relapsing clinical course of CD, the physician and patient should ideally develop an ongoing relationship that allows for individualization of treatment regimens, monitoring of response and side effects, and modification of the therapeutic strategy in the absence of improvement.

Journal Article↗
PubMed2005

Endoscopic factors in the diagnosis of colorectal dysplasia in chronic inflammatory bowel disease.

BACKGROUND: Surveillance colonoscopy in inflammatory bowel diseases (IBDs) is advocated for early diagnosis of neoplasia but is imperfect because some patients develop cancer despite surveillance. We sought to determine if any endoscopic factors during surveillance colonoscopy were associated with the diagnosis of colorectal dysplasia before the development of cancer. METHODS: We reviewed the Mayo Clinic endoscopic database and medical records of patients with IBD who underwent surveillance colonoscopy between January 2002 and November 2003. Associations were sought between endoscopic factors and the diagnosis of dysplasia. Among 635 IBD patients, 24 (3.8%) had flat dysplasia and 12 (1.9%) had IBD-related polypoid dysplasia. In 28 patients (4.4%), sporadic tubular adenoma was identified. Colonoscopies in which flat dysplasia was identified varied in duration from 7 to 81 minutes (median, 24.5 min) compared with 3 to 70 minutes (median, 22 min) for those in which dysplasia was not found. RESULTS: Using logistic regression analysis, we found that every additional minute in total colonoscopy time increased the flat dysplasia diagnosis rate by 3.5% (P = 0.0157). There was a significant correlation between median surveillance colonoscopy duration per endoscopist and flat dysplasia diagnosis rate (P = 0.0066). The number of biopsies taken during the procedures with flat dysplasia ranged from 6 to 36 (median, 28) compared with 2 to 54 (median, 25) in those without flat dysplasia. There was no significant effect of biopsy number of dysplasia diagnosis. CONCLUSIONS: Our results show that the practice of surveillance colonoscopy varies greatly among endoscopists, and longer procedure duration is significantly associated with the likelihood of dysplasia diagnosis.

Adult↗
PubMed2005

Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease.

INTRODUCTION: We sought to examine the relationship between C-reactive protein (CRP) and clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease (IBD). METHODS: All IBD patients at our institution between January 2002 and August 2003 who had a CRP, colonoscopy, and either small bowel follow-through (SBFT) or CT enterography (CTE) performed within 14 days were identified. Clinical activity was assessed retrospectively through review of the medical record. Logistic regression was used in Crohn's disease (CD) patients to estimate the odds ratio (OR) with 95% confidence intervals for an elevated CRP. Associations were assessed using Fisher exact test in ulcerative colitis (UC) patients due to small sample size. RESULTS: One-hundred four CD patients (46% males) and 43 UC and indeterminate colitis patients (44% males) were identified. In CD patients, moderate-severe clinical activity (OR, 4.5; 95% CI, 1.1-18.3), active disease at colonoscopy (OR, 3.5; 95% CI, 1.4-8.9), and histologically severe inflammation (OR, 10.6; 95% CI; 1.1-104) were all significantly associated with CRP elevation. Abnormal small bowel radiographic imaging was not significantly associated with CRP elevation. In UC patients, CRP elevation was significantly associated with severe clinical activity, elevation in sedimentation rate, anemia, hypoalbuminemia, and active disease at ileocolonoscopy, but not with histologic inflammation. CONCLUSIONS: CRP elevation in IBD patients is associated with clinical disease activity, endoscopic inflammation, severely active histologic inflammation (in CD patients), and several other biomarkers of inflammation, but not with radiographic activity.

Adolescent↗
PubMed2005

Acute pancreatitis in patients with Crohn's disease: clinical features and outcomes.

BACKGROUND: Acute pancreatitis has occasionally been associated with Crohn's disease (CD), but whether a causal association exists remains unclear. We sought to determine the frequency of etiologies in a consecutive series of patients with CD with acute pancreatitis. METHODS: A centralized diagnostic index was used to identify all patients with CD with acute pancreatitis that were evaluated at Mayo Clinic Rochester between 1976 and 2001. Both diagnoses were made or confirmed at our institution. Records were abstracted for demographics, presenting symptoms, diagnostic tests, risk factors of pancreatitis, treatment, and follow-up. RESULTS: Forty-eight patients with CD with pancreatitis were identified. The median age at diagnosis of acute pancreatitis was 47 years (range, 31-91 yr). Forty-six (96%) met biochemical criteria for acute pancreatitis. The most sensitive radiographic tests were abdominal computed tomography (70%) and abdominal ultrasound (46%). The etiology of pancreatitis was considered to be gallstones (21%), significant alcohol intake (15%), use of purine analogs (13%), duodenal Crohn's involvement (12%), postendoscopic retrograde cholangiopancreatography complications (10%), postoperative complications (12%), use of other medications (4%) and idiopathic (8%). The median length of hospitalization was 7 days (range, 0-40 d). Ten patients (21%) had recurrence of acute pancreatitis. Three patients (6%) were subsequently diagnosed with pancreatic cancer. CONCLUSIONS: A definite etiology could be identified in most patients with CD with acute pancreatitis. Gallstones and alcohol accounted for more than one third of cases, whereas CD, either because of duodenal involvement or medications used for its treatment, accounted for more than one quarter of the cases. A small proportion of patients remained idiopathic.

Acute Disease↗
PubMed2005

Avoiding the vicious cycle of prolonged opioid use in Crohn's disease.

The decision to use opioid analgesics in the management of chronic pain in patients with Crohn's disease is a complex one. Little is known about the effects of long-term high-dose opioids on cognitive function or risk of opioid addiction. At higher doses, opioids affect the gastrointestinal tract adversely and may result in perturbations of the endocrine and immune systems. Distinguishing functional gastrointestinal symptoms from inflammatory symptoms can further complicate this issue. Cross and colleagues have attempted in a retrospective cross-sectional study to identify factors which may predict narcotic use in patients with Crohn's disease. Increased disease activity, polypharmacy (particularly with neuropsychiatric drugs) and cigarette smoking were found to be independent predictors of chronic narcotic use in these patients. Future research in this area is greatly needed to improve patient care. In patients with Crohn's disease, caution should be exercised when it comes to the liberal use of narcotics.

Analgesics, Opioid↗
PubMed2005

Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology.

The discovery of a series of genetic and serological markers associated with disease susceptibility and phenotype in inflammatory bowel disease has led to the prospect of an integrated classification system involving clinical, serological and genetic parameters. The Working Party has reviewed current clinical classification systems in Crohn's disease, ulcerative colitis and indeterminate colitis, and provided recommendations for clinical classification in practice. Progress with respect to integrating serological and genetic markers has been examined in detail, and the implications are discussed. While an integrated system is not proposed for clinical use at present, the introduction of a widely acceptable clinical subclassification is strongly advocated, which would allow detailed correlations among serotype, genotype and clinical phenotype to be examined and confirmed in independent cohorts of patients and, thereby, provide a vital foundation for future work.

Biomarkers↗
PubMed2004

Management of extraintestinal manifestations and other complications of inflammatory bowel disease.

The past 18 months have seen many studies of the prevalence, pathogenesis, and treatment of the extraintestinal manifestations of inflammatory bowel disease (IBD). Inhibitors of tumor necrosis factor alpha have shown effectiveness in randomized trials for the treatment of spondyloarthropathies and ocular manifestations. Open-label studies suggest that these agents may be effective for pyoderma gangrenosum as well. The epidemiology of primary sclerosing cholangitis (PSC), and its relationship to IBD, is becoming clearer. Colorectal neoplasia in PSC remains an important clinical problem. Osteoporosis occurs more commonly in IBD, but the relative importance of corticosteroid use versus underlying chronic bowel inflammation as risk factors remains controversial. Chromoendoscopy may be an important means to improve detection of colorectal neoplasia in IBD. Observational studies suggest that prolonged use of aminosalicylates is associated with decreased risk of neoplasia, but data are conflicting. A randomized trial of ursodeoxycholic acid in PSC showed decreased risk of colorectal neoplasia in patients receiving the drug relative to those on placebo.

Arthritis↗
PubMed2004

Management of refractory inflammatory bowel disease.

One of the most challenging aspects of the management of inflammatory bowel disease is the high frequency of incomplete or absent response to medical therapy. Although many patients may be truly refractory to medical therapy, a lack of response may indicate several possibilities, including incorrect diagnosis, progression of disease extent, intestinal complication, superinfection, underdosing of therapy, monotherapy instead of combination therapy, or medication intolerance. This article provides a practical general approach to refractory inflammatory bowel disease patients encountered in clinical practice.

Humans↗