Updates in therapeutic drug monitoring in inflammatory bowel disease.

Biologics and immunomodulators (IMM) are generally considered the most effective therapies for the treatment of ulcerative colitis and Crohn's disease. However, despite the efficacy of these therapies, many patients either have a primary lack of response or a secondary loss of response to these medications. Therapeutic drug monitoring (TDM) is a systematic approach to managing such patients.

Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment.

Endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel disease (IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care of patients with IBD. As endoscopic technologies have progressed, tools such as endoscopic ultrasound, capsule endoscopy, and balloon-assisted enteroscopy have expanded the role of endoscopy in IBD.

Histoplasma meets Crohn's disease: a rare case of new-onset ascites.

A 53-year-old man with Crohn's disease treated with adalimumab was hospitalised with abdominal pain, fatigue, fever and chills. CT scan of the abdomen showed chronic thickening of the terminal ileum and cecum and new-onset ascites. Further studies revealed weakly positive urine and serum histoplasma antigen.

Medical Therapy for Inflammatory Bowel Disease.

Surgeons often care for patients with inflammatory bowel disease (IBD) who are receiving therapies that can include 5-ASA compounds, steroids, immunomodulators, and biologics. The goal of these agents is to suppress intestinal inflammation, ultimately improving the quality of life in patients afflicted with IBD. Traditionally, an acceptable therapeutic endpoint was the resolution of symptoms, defined as clinical remission.

Predisposing factors for positive D-Xylose breath test for evaluation of small intestinal bacterial overgrowth: a retrospective study of 932 patients.

Aim: To investigate, in the largest cohort to date, patient characteristics and associated risk factors for developing small intestinal bacterial overgrowth (SIBO) using the D-Xylose breath test (XBT).

Methods: We performed a retrospective cross-sectional study to analyze patient characteristics who underwent the XBT for evaluation of SIBO. Diagnostic testing with the XBT was performed based on a clinical suspicion for SIBO in patients with symptoms of bloating, abdominal pain, abdominal distension, weight loss, diarrhea, and/or constipation.

Advanced therapy for inflammatory bowel disease: a guide for the primary care physician.

Primary care physicians care for patients with inflammatory bowel disease (IBD) who are receiving advanced therapies that include immunomodulator drugs (eg, azathioprine and methotrexate) and biologic therapy. These agents have significantly improved remission rates and the quality of life for patients suffering from IBD. However, patients taking these drugs need special care and counseling with regard to adverse effects, infection risk, cancer risk, and pregnancy.

The appropriate use of vaccines in patients with inflammatory bowel disease.

An increasing majority of patients with inflammatory bowel disease (IBD) will be placed on immunosuppressive medications, thus increasing their susceptibility to infections. Although many of these infections are preventable through the use of vaccinations, vaccines seem to be underutilized in IBD patients. This article reviews current immunization guidelines and makes evidence-based recommendations regarding the appropriate use of vaccinations for patients with IBD.

Hepatic portal venous gas due to cryptosporidiosis in a patient with acquired immunodeficiency syndrome.

Although the presence of hepatic portal venous gas (HPVG) on computed tomography (CT) is typically an ominous finding, HPVG may sometimes be less catastrophic. The clinical significance of HPVG is variable, and it depends primarily on the underlying pathology. We report a case of a patient with acquired immunodeficiency syndrome (AIDS) who was found to have HPVG on CT as a presumed result of gastrointestinal cryptosporidiosis, an association that, to our knowledge, has not been reported.

Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis.

Aim: To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to identify risk factors for the development of CIN.

Methods: We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography (CT) with intravenous contrast at the University of Rochester between the years 2000-2005. We retrospectively examined factors associated with a high risk for CIN, defined as a decrease in creatinine clearance of 25% or greater within one week after receiving contrast.

Utilizing intraluminal pressure gradients to predict esophageal clearance: a validation study.

Background: Esophageal bolus clearance requires a preferential esophagogastric pressure gradient sustained for a sufficient period. We aimed to validate a high-resolution manometry (HRM) paradigm for predicting bolus clearance.

Methods: Twenty volunteers and 30 patients were studied with HRM during barium swallows with concurrent fluoroscopy.

Utilizing intraluminal pressure differences to predict esophageal bolus flow dynamics.

Successful esophageal emptying depends on the generation of a sustained intrabolus pressure (IBP) sufficient to overcome esophagogastric junction (EGJ) obstruction. Our aim was to develop a manometric analysis paradigm that describes the bolus driving pressure difference and the flow permissive time for esophageal bolus transit. Twenty normal subjects were studied with a 36-channel manometry assembly (1-cm spacing) during two 5- and one 10-ml barium swallows and concurrent fluoroscopy.