Review article: the benefits of pharmacogenetics for improving thiopurine therapy in inflammatory bowel disease.

Background: Thiopurines represent an effective and widely prescribed therapy in inflammatory bowel disease (IBD). Concerns about toxicity, mainly resulting from a wide inter-individual variability in thiopurine metabolism, restrict their use. Optimal thiopurine dosing is challenging for preventing adverse drug reactions and improving clinical response.

Cytomegalovirus load in inflamed intestinal tissue is predictive of resistance to immunosuppressive therapy in ulcerative colitis.

Objectives: Previous studies have suggested an association between cytomegalovirus (CMV) infection and steroid-refractory inflammatory bowel disease. In this study, the use of CMV DNA load during acute flare-ups of ulcerative colitis (UC) to predict resistance to immunosuppressive therapy was evaluated in intestinal tissue.

Methods: Forty-two consecutive patients (sex ratio M/F: 0.

Use of thiopurine testing in the management of inflammatory bowel diseases in clinical practice: a worldwide survey of experts.

Background: We performed a worldwide survey to evaluate the extent to which gastroenterologists who are experts in the field of inflammatory bowel diseases (IBDs) are utilizing thiopurine metabolism in practice.

Methods: This was a Web-based cross-sectional survey consisting of 12 multiple-choice and open-ended questions.

Results: Between December 2009 and April 2010, 175 questionnaires were received.

The use of azathioprine in Crohn's disease during pregnancy and in the post-operative setting: a worldwide survey of experts.

Background: Although thiopurines are considered safe in humans, they are still pregnancy FDA category D drugs. Prevention of post-operative recurrence is a challenge in clinical practice in Crohn's disease. The European Crohn's and Colitis Organisation consensus states that thiopurines should be considered in high-risk patients.

Adherence to adalimumab therapy in Crohn's disease: a French multicenter experience.

Background: We evaluated adherence to adalimumab therapy in Crohn's disease (CD).

Methods: This was an observational multicenter study conducted in four French university hospitals between April 4, 2008 and January 1, 2010. Patients were systematically asked, at each clinical visit, whether or not they delayed or missed an injection of adalimumab over the past 3 months.

Therapy with anti-TNFα antibody enhances number and function of Foxp3(+) regulatory T cells in inflammatory bowel diseases.

Background: Inflammatory bowel diseases (IBDs) are associated with up-regulation of TNFα, hyperactivation of proinflammatory effector T cells (Teffs) and inefficient control by regulatory CD4(+) CD25(+) Foxp3(+) T cells (Tregs). The aim of this prospective study was to investigate the short-term impact of treatment of IBD patients with anti-TNFα antibodies (infliximab or adalimumab) on the frequency, phenotype, and suppressive function of Tregs.

Methods: Active IBD patients including 16 with Crohn's disease and 9 with ulcerative colitis were treated with anti-TNFα mAb.

A multicenter experience with infliximab for ulcerative colitis: outcomes and predictors of response, optimization, colectomy, and hospitalization.

Objectives: The objective of this study was to evaluate short- and long-term outcomes of infliximab in ulcerative colitis (UC), including infliximab optimization, colectomy, and hospitalization.

Methods: This was a retrospective multicenter study. All adult patients who received at least one infliximab infusion for UC were included.

Thiopurine metabolism monitoring: implications in inflammatory bowel diseases.

Background: Thiopurines (TP) are widely used in the management of inflammatory bowel diseases. Side effects and inefficacy are a major concern as they lead to withdrawal of the drug.

Materials And Methods: Tools investigating TP metabolism are useful to avoid inadequate cessation of TP therapy.

Infliximab for refractory ulcerative proctitis.

Background: Efficacy of infliximab in treating ulcerative proctitis remains unknown.

Aim: To evaluate the clinical, biological and endoscopic efficacy of infliximab therapy in refractory proctitis.

Methods: The charts of 420 patients treated with infliximab for ulcerative colitis were reviewed.

Tumour necrosis factor antagonists and inflammatory bowel diseases: a national practice survey.

Background: Although the use of tumour necrosis factor (TNF) antagonists is increasingly codified, several unresolved issues remain.

Aim: To conduct a French national survey on TNF antagonists use in inflammatory bowel disease (IBD).

Methods: A postal questionnaire was sent to all French gastroenterologists among whom 450 prescribe TNF antagonists for IBD.

A 6-thioguanine nucleotide threshold level of 400 pmol/8 x 10(8) erythrocytes predicts azathioprine refractoriness in patients with inflammatory bowel disease and normal TPMT activity.

Background And Aims: A therapeutic level of 6-thioguanine nucleotides (6-TGN) has been reported in inflammatory bowel disease (IBD) patients under azathioprine (AZA). We investigated the threshold value of 6-TGN that may be predictive of AZA refractoriness and its impact on safety profile.

Methods: Patients with normal thiopurine methyltransferase (TPMT) activity (7.

Interaction of ribavirin with azathioprine metabolism potentially induces myelosuppression.

Background: The interaction of ribavirin, an inosine monophosphate dehydrogenase inhibitor, with azathioprine metabolism, potentially leading to myelotoxicity, remains unexplored.

Aim: To underline the interaction of ribavirin, an inosine monophosphate dehydrogenase inhibitor, with azathioprine metabolism, potentially leading to myelotoxicity.

Methods: The medical records of eight patients who developed severe pancytopenia following concomitant use of azathioprine and ribavirin were retrospectively reviewed.

Long-term outcome of adalimumab therapy for ulcerative colitis with intolerance or lost response to infliximab: a single-centre experience.

Background: Adalimumab may be effective in inducing remission in patients with mild-to-moderate ulcerative colitis who had secondary failure to infliximab.

Aim: To evaluate long-term efficacy and safety of adalimumab in patients with ulcerative colitis who previously responded to infliximab, and then lost response or became intolerant.

Methods: We report our single-centre experience in 13 patients.

[An uncommon use of argon plasma coagulation: endoscopic transection of self-expanding metallic stents].

Migration, distal malposition or fracture of self-expanding metallic biliary or esophageal stents rarely occur but may lead to stent dysfunction, mucosal trauma secondary to impaction or friction on the digestive wall. We report our experience of using argon plasma to endoscopically cut three metallic biliary and esophageal self-expanding stents to restore permeability or to treat impaction of the stent after migration, malposition or fracture.

[External radiotherapy and photodynamic therapy for esophageal carcinoma: a dangerous association?].

A 60-year-old man presented an oesophageal transmural necrosis fistulised in the trachea following curative photodynamic therapy (PDT) for a superficial recurrence of an oesophageal carcinoma, initially treated by radiochemotherapy. Two stents, a tracheal and an oesophageal one, were placed. Eight months later the patient is in complete remission with only mild swallowing problems.