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Alexandre B, Vandermeeren Y, Dewit O, Moreels T, de Boer N, Dhar A, Ziady C, Shitrit ABG, Steinwurz F, Jojic N, Costantino G, Bihin B, Rahier JF, Katsanos KH. Optic Neuritis Associated or Not with TNF Antagonists in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:541-8. [PMID: 26759360 PMCID: PMC4957451 DOI: 10.1093/ecco-jcc/jjw003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Acute optic neuritis [ON] is an inflammatory condition affecting the optic nerve. Clinicians should suspect optic neuritis in cases of painful and rapidly progressive loss of central visual field. This condition may be associated with a multitude of diseases, and mostly with multiple sclerosis [MS] where it may present as an initial symptom. The literature reports that optic neuritis and MS occur in patients with inflammatory bowel disease [IBD] before and after the era of anti-tumour necrosis factor-α [TNFα] drugs. At the present moment, there is little consensus for managing this complication, currently treated with corticosteroids and discontinuation of the causative agents. METHODS We collected cases through a retrospective multicentre European Crohn's and Colitis Organisation CONFER [COllaborative Network For Exceptionally Rare case reports] project. We also performed a comprehensive retrospective search of the available literature on this topic. RESULTS We report herein 12 new cases of ON, including 10 under anti-TNF therapy, collected through the CONFER project. We also compare characteristics of ON associated or not with anti-TNFα agents. CONCLUSIONS The exceptional and current observation of distant family history of MS in 17% of our patients who developed ON, despite the small number and the lack of a control arm, might be an important signal that should be taken into account in our therapeutic strategies in the future.
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Affiliation(s)
- Benjamin Alexandre
- Department of Internal Medicine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, Gosselies, Belgium,*Corresponding author. Benjamin Alexandre, MD, Department of Internal Medecine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, 212 Chaussée de Nivelles, 6041 Gosselies, Belgium. Tel: +32 71 37 91 27;
| | - Yves Vandermeeren
- Department of Neurology, Université Catholique de Louvain, Yvoir, Belgium
| | - Olivier Dewit
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Tom Moreels
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Nanne de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anjan Dhar
- Darlington Memorial and Bishop Auckland Hospitals, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Chris Ziady
- Department of Gastroenterology, Kloof Hospital, Pretoria, South Africa
| | | | - Flavio Steinwurz
- Department of Gastroenterology, Hospital Israelita Albert Einstein, Sao Paolo, Brazil
| | - Njegica Jojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | - Giuseppe Costantino
- Department of Internal Medicine and Medical Therapy University of Messina, Messina, Italy
| | - Benoit Bihin
- Scientific Support Unit, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-François Rahier
- Department of Gastroenterology, Université Catholique de Louvain, Yvoir, Belgium
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Protic M, Seibold F, Schoepfer A, Radojicic Z, Juillerat P, Bojic D, Mwinyi J, Mottet C, Jojic N, Beglinger C, Vavricka S, Rogler G, Frei P. The effectiveness and safety of rescue treatments in 108 patients with steroid-refractory ulcerative colitis with sequential rescue therapies in a subgroup of patients. J Crohns Colitis 2014; 8:1427-37. [PMID: 24908178 DOI: 10.1016/j.crohns.2014.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/11/2014] [Accepted: 05/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Among patients with steroid-refractory ulcerative colitis (UC) in whom a first rescue therapy has failed, a second line salvage treatment can be considered to avoid colectomy. AIM To evaluate the efficacy and safety of second or third line rescue therapy over a one-year period. METHODS Response to single or sequential rescue treatments with infliximab (5mg/kg intravenously (iv) at week 0, 2, 6 and then every 8weeks), ciclosporin (iv 2mg/kg/daily and then oral 5mg/kg/daily) or tacrolimus (0.05mg/kg divided in 2 doses) in steroid-refractory moderate to severe UC patients from 7 Swiss and 1 Serbian tertiary IBD centers was retrospectively studied. The primary endpoint was the one year colectomy rate. RESULTS 60% of patients responded to the first rescue therapy, 10% went to colectomy and 30% non-responders were switched to a 2(nd) line rescue treatment. 66% of patients responded to the 2(nd) line treatment whereas 34% failed, of which 15% went to colectomy and 19% received a 3(rd) line rescue treatment. Among those, 50% patients went to colectomy. Overall colectomy rate of the whole cohort was 18%. Steroid-free remission rate was 39%. The adverse event rates were 33%, 37.5% and 30% for the first, second and third line treatment respectively. CONCLUSION Our data show that medical intervention even with 2(nd) and 3(rd) rescue treatments decreased colectomy frequency within one year of follow up. A longer follow-up will be necessary to investigate whether sequential therapy will only postpone colectomy and what percentage of patients will remain in long-term remission.
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Affiliation(s)
- Marijana Protic
- Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland.
| | - Frank Seibold
- Department of Gastroenterology, Spital Tiefenau, Tiefenaustrasse 112, 3004 Bern, Switzerland; Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland.
| | - Alain Schoepfer
- Department of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland.
| | - Zoran Radojicic
- Department of Statistics, Faculty of Organizational Sciences, Belgrade, Serbia.
| | - Pascal Juillerat
- Department of Gastroenterology, Inselspital, University Hospital Bern, Switzerland.
| | - Daniela Bojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia.
| | - Jessica Mwinyi
- Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland.
| | - Christian Mottet
- Department of Gastroenterology, Hospital Neuchâtel, Neuchâtel, Switzerland.
| | - Njegica Jojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia.
| | - Christoph Beglinger
- Department of Gastroenterology, University Hospital Basel, Basel, Switzerland.
| | - Stephan Vavricka
- Department of Gastroenterology and Hepatology, Stadtspital Triemli, Zürich, Switzerland.
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
| | - Pascal Frei
- Department of Gastroenterology, See Spital, Horgen, Switzerland.
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Protic M, Gligorijevic V, Bojic D, Popovic B, Damjanovic S, Jojic N. Autoimmune polyglandular syndrome type 2, alopecia universalis and Crohn's disease. J Crohns Colitis 2013; 7:318-21. [PMID: 22677116 DOI: 10.1016/j.crohns.2012.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 05/11/2012] [Accepted: 05/12/2012] [Indexed: 02/08/2023]
Abstract
Autoimmune polyglandular syndromes are defined as a spectrum of association between 2 or more organ specific endocrinopaties and non-endocrine autoimmune diseases. Autoimmune polyglandular syndromes type 2 is characterized by the coexistence of adrenal failure with autoimmune thyroid disease and diabetes mellitus type 1. Inflammatory bowel diseases are rarely associated with these autoimmune disorders. Here, we report about a case of 33 years old male with known history of Crohn's colitis diagnosed in childhood. In 2003 the patient experienced sudden loss of hair, eyebrows, eyelashes, beard and body hair - alopecia universalis was diagnosed. At the age of 28, the patient was hospitalized with severe dehydration and clinical signs of ketoacidosis. Increased blood glucose (40 mmol/L), ketonuria and metabolic acidosis indicated diabetes mellitus type 1. In 2005, he had severe relapse of Crohn's disease and was treated with systemic corticosteroid. Although patient responded well to the induction therapy, fatigue, hypotension, bradycardia called for further investigations: free thyroxine - 6.99 pmol/L, thyroid-stimulating hormone >75 U/ml, anti-thyroid peroxidase antibodies >1000 U/mL, so diagnosis of Haschimoto thyroiditis was confirmed. Persistent hypotension and fatigue, recurrent hypoglycemic crises indicated a possible presence of hypo-function of adrenal glands. After complete withdrawal of corticosteroid therapy, low cortisol levels (69.4 nmol/L) and positive tetracosactide stimulation test proved adrenal cortex failure. Regardless of the intensive treatment for diabetes, hypothyroidism, adrenal insufficiency and Crohn's disease, it was extremely difficult to achieve and maintain control of all four diseases.
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Affiliation(s)
- Marijana Protic
- Department of Gastroenterology and Hepatology, University Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, Serbia.
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Stankov K, Bogdanovic G, Kojic V, Stankov S, Jojic N, Popovic L, Popovic S. Expression analysis of genes involved in epigenetic regulation and apoptosis in human malignant haematopoietic cell lines treated with 5-azacytidine. J BUON 2011; 16:116-122. [PMID: 21674861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study was to investigate the modulation of the expression status of 10 different genes involved in epigenetic regulation and apoptosis by the DNA methyltransferase (DNMT) inhibitor 5-azacytidine (5-Aza), as markers of response to treatment, in two different human malignant haematopoietic cell lines. METHODS In our analysis we used the SybrGreen technology and gene-specific primers for the qRT-PCR analysis of 10 genes, in cDNA of PC-MDS and K562 cell lines, treated by 1 micromole of 5-Aza for 24h. RESULTS DNMT1 and DNMT3A showed statistically significant decrease of expression in 5-Aza-treated PC-MDS cells, whereas DNMT3B showed significantly decreased expression in 5-Aza-treated K562 cells. The members of the Bcl- 2 family of apoptosis-regulating genes Bcl-2 and Bax showed statistically significant differences in expression, in comparison with non-treated PC-MDS cells. Our most interesting result was the significant upregulation (re-expression) of p15, in 5-Aza-treated PC-MDS cells. CONCLUSION The re-expression of p15 in PC-MDS cell line evaluated by qRT-PCR makes this novel cell line a suitable model for the studies of pharmacologic demethylation as a plausible mechanism resulting in hematologic response in myelodysplastic syndrome (MDS).
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Affiliation(s)
- K Stankov
- Department of Biochemistry, Medical Faculty, Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia.
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Sandborn WJ, Regula J, Feagan BG, Belousova E, Jojic N, Lukas M, Yacyshyn B, Krzeski P, Yeh CH, Messer CA, Hanauer SB. Delayed-release oral mesalamine 4.8 g/day (800-mg tablet) is effective for patients with moderately active ulcerative colitis. Gastroenterology 2009; 137:1934-43.e1-3. [PMID: 19766640 DOI: 10.1053/j.gastro.2009.08.069] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 08/22/2009] [Accepted: 08/27/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS It is not clear what induction dose of mesalamine is optimal for treating patients with mildly and moderately active ulcerative colitis (UC). This study was conducted to determine the efficacy and safety of mesalamine 4.8 g/day compared with 2.4 g/day for the treatment of moderately active UC. METHODS A multicenter, randomized, double-blind, 6-week, active-control study (ASCEND III) was conducted to assess the noninferiority of delayed-release mesalamine 4.8 g/day (Asacol HD, 800-mg tablet; Procter & Gamble, Pharmaceuticals, Inc, Mason, Ohio) with 2.4 g/day (Asacol, 400-mg tablet; Procter & Gamble Pharmaceuticals, Inc) in 772 patients with moderately active UC. The primary endpoint was treatment success (overall improvement) at week 6, defined as improvement in the Physician's Global Assessment (based on clinical assessments of rectal bleeding, stool frequency, and sigmoidoscopy), with no worsening in any individual clinical assessment. RESULTS The primary objective of noninferiority was met. Seventy percent (273 of 389) of patients who received 4.8 g/day of mesalamine achieved treatment success at week 6, compared with 66% (251 of 383) of patients receiving 2.4 g/day (95% confidence interval for 2.4 g/day minus 4.8 g/day, -11.2 to 1.9). In addition, 43% of patients who received 4.8 g/day mesalamine achieved clinical remission at week 6 compared with 35% of patients who received 2.4 g/day (P = .04). A therapeutic advantage for the 4.8 g/day dose was observed among patients previously treated with corticosteroids, oral mesalamines, rectal therapies, or multiple UC medications. Both regimens were well-tolerated with similar adverse events. CONCLUSIONS Delayed-release mesalamine 4.8 g/day (800-mg tablet) is efficacious and well-tolerated in patients with moderately active UC.
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Affiliation(s)
- William J Sandborn
- Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
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Abstract
AIM: To search the pathophysiological mechanism of diarrhea based on daily stool weights, fecal electrolytes, osmotic gap and pH.
METHODS: Seventy-six patients were included: 51 with microscopic colitis (MC) [40 with lymphocytic colitis (LC); 11 with collagenous colitis (CC)]; 7 with MC without diarrhea and 18 as a control group (CG). They collected stool for 3 d. Sodium and potassium concentration were determined by flame photometry and chloride concentration by titration method of Schales. Fecal osmotic gap was calculated from the difference of osmolarity of fecal fluid and double sum of sodium and potassium concentration.
RESULTS: Fecal fluid sodium concentration was significantly increased in LC 58.11±5.38 mmol/L (P<0.01) and CC 54.14±8.42 mmol/L (P<0.05) than in CG 34.28±2.98 mmol/L. Potassium concentration in LC 74.65±5.29 mmol/L (P<0.01) and CC 75.53±8.78 mmol/L (P<0.05) was significantly less compared to CG 92.67±2.99 mmol/L. Chloride concentration in CC 36.07±7.29 mmol/L was significantly higher than in CG 24.11±2.05 mmol/L (P<0.05). Forty-four (86.7%) patients had a secretory diarrhea compared to fecal osmotic gap. Seven (13.3%) patients had osmotic diarrhea.
CONCLUSION: Diarrhea in MC mostly belongs to the secretory type. The major pathophysiological mechanism in LC could be explained by a decrease of active sodium absorption. In CC, decreased Cl/HCO3 exchange rate and increased chloride secretion are coexistent pathways.
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Affiliation(s)
- Marijana Protic
- Center for Gastroenterology and Hepatology, Zvezdara Clinical Center, Belgrade 11 000, Serbia and Montenegro.
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Svorcan P, Djordjevic J, Colic N, Jojic N, Vukcevic V, Bojovic S, Dapcevic B. Primary malignant mesothelioma of the peritoneum. Rom J Gastroenterol 2003; 12:135-7. [PMID: 12854001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Mesothelioma of the peritoneum represents an extremely rare malignancy of the abdominal cavity and forms about 10% of all mesotheliomas. The annual incidence of the tumor in the general population is 1-2 cases per million. The causative relationship between chronic exposure to asbestos and mesothelioma has been proved. Since the symptomatology of the tumor is usually not specific, the diagnosis is made in the advanced stages of the disease, which is the limiting factor for therapy. Most patients die within 2 years from the diagnosis. We report a case of a primary malignant mesothelioma of the peritoneum in a 60-year old male, who presented with three-month history of ascites, weakness and appetite loss. The patient gave the information that he had been living for 15 years in a loft which was insulated by material consisting of asbestos. After investigations, primary neoplasm of the peritoneum was suspected, which was confirmed by the biopsy and the morphopathological examination. Due to the advanced spread of the tumor and the poor general condition, the patient underwent palliative therapy. The patient died 3 months after the diagnosis. Epidemiological data for chronic exposure to asbestos have to be considered as the etiological factor of disease in this particular patient.
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Affiliation(s)
- Petar Svorcan
- Department of Gastroenterology, Zvezdara University Hospital, Beograd, Serbia and
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Popovic O, Jojic N, Milutinovic-Djuric S, Djurdjevic D, Milovic V. Propranolol for metronidazole-resistant giardiasis. Ital J Gastroenterol 1991; 23:359. [PMID: 1742528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- O Popovic
- Metabolic Department, Zvezdara University Hospital, Beograd, Yugoslavia
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