Crohn’s Disease Activity

Finally, Shafran et al. [52] presented recently an open-label study on the efficacy and safety of rifaximin 600 mg/ day for 16 weeks in the treatment of mildly to moderately active CD. At the end of the study, 59% of patients were in remission (as defined by a Crohn s Disease Activity Index, CDAI, <150) with a significant reduction of the... 

E. Therapeutic response The safety and efficacy of a single intravenous dose of Remicade were assessed in a randomized, double-blind, placebo-controlled study of patients with moderate to severe active Crohn s disease who had failed standard therapy. The primary end point was the proportion of patients who experienced a clinical response, defined as a minimum decrease in the Crohn s Disease Activity Index from baseline at the 4-week evaluation and without an increase in Crohn s... 

In a randomized, multicenter study in 94 patients, mesalazine 4 g/day for 12 weeks in a microgranular formulation was as effective as a standard dose of a glucocorticoid (6-methylpredisolone 40 mg/day) in mild to moderate Crohn s ileitis (Crohn s Disease Activity Index 180-350) (9). The group treated with methylpredisolone had a higher number of adverse events than those given mesalazine. The only adverse effect related to mesalazine was acute pancreatitis, which resolved on withdrawal. 

Best WR, Becktel JM, Singleton JW. Development of a Crohn s disease activity index. Gastroenterology 1976 70 439M4. 

The severity of ulcerative colitis may be assessed by factors such as stool frequency, presence of blood in stool, fever, pulse, hemoglobin, erythrocyte sedimentation rate, C-reactive protein, abdominal tenderness, and radiologic or endoscopic findings. The severity of Crohn s disease can be assessed by the Crohn s disease activity index, which includes stool frequency, presence of blood in stool, endoscopic appearance, and physician s global assessment. 

The clinical significance of the degree of bowel wall thickening in known CD patients is controversial. Several studies attempted to establish a relationship between maximum bowel wall thickness and clinical (Crohn s disease activity index, CDAI) and biochemical (erythrocyte sedimentation rate, C reactive protein) parameters of CD activity. However, almost all the results of these studies produced weak corre-... 

Haber HP, Busch A, Ziebach R, Stern M (2000) Bowel wall thickness measured by ultrasound as a marker of Crohn s disease activity in children. Lancet 355 1239-1240 Haber HP, Busch A, Ziebach R et al (2002) US findings correspond to clinical, endoscopic, and histologic findings in infiammatory bowel disease and other enterocolitides. J Ultrasound Med 21 375-382... 

Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Papamastorakis G, Prassopoulos P, Roussomoustakaki M (2004) Assessment of Crohn s disease activity in the small bowel with MR and conventional enteroclysis preliminary results. Eur Radiol 14 1017-1024... 

Hematologic diseases autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, pernicous anemia Kidney disease Goodpasture syndrom, lipoid nephroses, minimal change glomerulonephritis Diseases of the gastrointestinal tract autoimmune chronic active hepatitis, autoimmune atrophic gastritis, Crohn s disease, ulcerative colitis... 

ALT, alanine aminotransferase ASC, apoptosis-associated speck-like protei containing a CARD AST, aspartate aminotransferase CARD, caspase activation and recruitment domains CD, Crohn s disease COP, CARD-only protein DD, death domain DED, death effector domains DIABLO, direct LAP-binding protein with low pi... 

Recombinant soluble TNF-RI-IgGl fusion protein Etanercept, Enbrel is a chimeric molecule consisting of the extracellular domain of the TNF receptor I (TNF-RI) and the Fc portion of human IgGl. Two Fc domains are bound to each other via disulfide bonds, thereby yielding dimers with two binding sites for the TNF trimer. Etanercept binds with high affinity to extracellular TNF and reduces TNF activity. Etanercept is not effective in Crohn s disease, possibly because it does not lead to destiuction of membrane TNF-a expressing cells. Indications and side effects are similar to those of Infliximab and Adalimumab. 

Human tumor necrosis factor (TNF) (Fig. 1) is a hormone-like proinflammatory peptide belonging to the group of cytokines. It is mainly produced by cells of the immune system in response to infection, inflammation, or cell damage. Disregulated TNF is an important factor in many pathological situations, like sqDsis, rheumatoid arthritis, inflammatory bowel disease (Crohn s disease), and Cachexia. The cytotoxic activity of TNF is of interest in development of new antitumoral strategies. 

Crohn s disease, rheumatoid arthritis Treatment of active to moderate ulcerative colitis, proctosigmoiditis, or proctitis... 

ROM production by peripheral blood monocytes Production of ROM by peripheral blood monocytes in response to a variety of stimuli is increased in patients with active IBD (Table 10.2), su esting that such cells may respond to local stimulants within the gut more readily than in normal subjects or those with quiescent disease, and so may play a role in perpetuating the inflammatory response, cent studies have su ested that peripheral blood monocytes in Crohn s disease may be primed by the baaerial cell wall products LPS and peptidoglycanpolysaccharide (Muraki et al., 1992). 

Baldassano, R.N., Schreiber, S., Johnston, R.B. and MacDermott, KP. (1991). Increased respiratory burst activity from Crohn s disease peripheral blood mononuclear ph o-cytes. Gastroenterology 100, A559. 

Burdelski, M., Oellericch, M., Pippenger, C.E., Meng, X., Rodeck, B., Latta, A. and Kucher, K. (1990). Free radical scavenging enzyme activities in erythrocytes of paediatric patients with Crohn s disease. In Trends in Inflammatory Bowel Disease Therapy (ed. C. J. Williams), pp. 453-454. Kluwer Academic Publishers, Lancaster. 

Munck, A., Therond, P., Cezard, J.P., Demelier, J.P. and Navarro, J. (1991). Oxidative metabolism in children with active or quiescent Crohn s disease. Gastroenterology 100, A234. 

Treatment of active mild to moderate Crohn s disease involves use of oral or topical aminosalicylate derivatives, whereas moderate to severe disease may require systemic corticosteroid therapy. 

Knutson, L., Ahrenstedt, O., Odlind, B., Hallgren, R., The jejunal secretion of histamine is increased in active Crohn s disease. Gastroenterology 1990, 98, 849-854. 

An increasing number of both clinical and laboratory-derived observations support the importance of luminal components in driving the inflammatory response in ulcerative colitis and Crohn s disease. Although its role is unclear, antibiotic therapy is commonly used in clinical practice for the treatment of moderately to severely active ulcerative colitis. Metronidazole and/or ciprofloxacin are currently employed in active Crohn s disease, particularly in patients with colonic involvement and with perianal disease. Rifaximin, a rifamycin-derived antibiotic, is characterized by a wide range of antibacterial activity and a very low systemic absorption. Some preliminary data show its efficacy in severe active ulcerative colitis, pouchitis and prevention of postoperative recurrence in Crohn s disease. 

Ursing B, Aim T, Barany F, Bergelin I, Ganrot-Norlin K, Hoevels J, Huitfeldt B, Jarnerot G, Krause U, Krook A, Lindstrom B, Nordle O, Rosen A A comparative study of metronidazole and sulfasalazine for active Crohn s disease The cooperative Crohn s disease study in Sweden. II. Result. Gastroenterology I982 83 550-562. 

Prantera C, Zannoni F, Scribano ML, Berto E, Andreoli A, Kohn A, Luzzi C An antibiotic regimen for the treatment of active Crohn s disease A randomized controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol 1996,91 328-332. 

Colombel JF, Lemann M, Cassagnou M, Bouh-nik Y, Duclols B, Dupas JL, Notteghem B, Mary JY A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn s disease. Am J Gastroenterol 1999 94 674-678. 

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