Browsing by Subject "gastroenterologi"

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  • Hwasser, Israel (s.l., s.a.)
  • Hwasser, Israel (Upsala, 1831)
  • Bochus, Henry L. (Philadelphia & London, 1963)
  • Le Clerc (Paris, 1695)
  • af Björkesten, Clas-Göran (Helsingin yliopisto, 2014)
    In Crohn s disease (CD), achievement of mucosal healing has been associated with good outcome. The role of clinical indices such as the Harvey-Bradshaw index (HBI) and surrogate inflammatory markers such as C-reactive protein (CRP) and faecal calprotectin to indicate mucosal healing is unsettled. Studies on predictive markers for endoscopic outcome in CD treated with anti-tumour necrosis factor-α antibodies (anti-TNF) are also limited. Retrospective data on 71 infliximab-treated patients (Study I) and prospective data on 42 either adalimumab- or infliximab-treated patients (Study II) underwent analysis to identify features predicting one-year endoscopic outcome. Study III analyzed retrospective data on 60 inflammatory bowel disease patients, including 34 with CD, to assess the predictive role of calprotectin measured after anti-TNF induction. Study IV included prospective data on 210 endoscopies to assess the power of surrogate markers and clinical indices to detect mucosal healing. Among patients receiving anti-TNF as maintenance therapy, 12-month mucosal healing was significantly more common in those patients who had presented 3-month mucosal healing, than in those with endoscopically active disease at 3 months. A normal calprotectin after anti-TNF induction was associated with, although without statistical significance, one-year endoscopic remission. Calprotectin was superior to CRP and clinical indices in detecting mucosal healing. However, although calprotectin alone identified endoscopic remission with 84% sensitivity and 74% specificity, it was beaten, but not statistically significantly, by a new combined index based on calprotectin and the HBI. In anti-TNF-treated active luminal CD, endoscopic remission at 3 months is a predictor for maintenance of the endoscopic response at one year. In patients on anti-TNF therapy, a normal faecal calprotectin after anti-TNF induction is a predictor of sustained clinical remission. A score based on a combination of calprotectin and the HBI may function as a new tool for identifying endoscopic remission. For optimisation of anti-TNF therapy in active luminal CD in clinical practice, these results suggest an objective inflammatory activity assessment such as ileocolonoscopy or determination of faecal calprotectin, performed as early as 3 months after initiation of therapy.
  • Ackermann, Johann Christian Gottlieb (Altdorf, 1800)