European journal of gastroenterology & hepatology
-
Eur J Gastroenterol Hepatol · Dec 2016
The role of capsule endoscopy in the diagnosis and treatment of obscure gastrointestinal bleeding in older individuals.
Capsule endoscopy (CE) is currently recommended as the first-line diagnostic modality for the investigation of obscure gastrointestinal bleeding (OGIB). This study aimed to evaluate the diagnostic efficacy of CE and to determine the subsequent impacts on the treatment of the OGIB episode in older individuals. ⋯ Our study confirmed the important role of CE in the diagnosis of OGIB and its huge impact on decision making in the management plan for older patients.
-
Eur J Gastroenterol Hepatol · Nov 2016
Inflammatory bowel disease: adherence to immunomodulators in a biological therapy era.
Combination therapy, with anti-tumor necrosis factor-α agents and immunomodulators, is the most effective option to induce and maintain remission in inflammatory bowel disease (IBD). Infliximab, with its administration features, determines particular conditions of adherence; the same is not possible with thiopurines. Nevertheless, research on adherence to these treatments is scarce. Nonadherence worsens the prognosis of IBD. ⋯ Nonadherence to thiopurines plays a significant role in IBD. Nonetheless, it does not increase with association with biological agents. Involuntary nonadherence is higher. Male sex, younger age, nonsmoker, and presence of depression were independent predictors of nonadherence to immunomodulators. More than one-third of IBD patients had concerns about drugs. Optimizing the discussion on patients' concerns to overcome perceptual barriers related to drugs may obviate the negative course of IBD related to nonadherence.
-
Eur J Gastroenterol Hepatol · Oct 2016
Improving testing for hepatitis B before treatment with rituximab.
Individuals with current or previous infection with the hepatitis B virus (HBV) can experience viral reactivation when treated with immunosuppression. Rituximab, an anti-CD20 antibody used to treat many diseases, has potent immunosuppressant effects with a high risk of causing HBV reactivation. Reactivation can range from elevated liver enzymes to acute severe hepatitis with liver failure and a significant mortality risk. HBV screening and appropriate use of prophylactic antiviral therapy can prevent reactivation. This work describes the introduction of a local policy for HBV testing in patients before rituximab treatment and assesses its impact. ⋯ This work clearly indicates that simple strategies can markedly improve appropriate HBV screening. In our cohort, 6% (of whom only 43% had recognized HBV risk factors) required antiviral prophylaxis, which emphasizes the importance of universal screening before rituximab. Reinforcement of the guidelines and ongoing education is needed to further increase testing rates.
-
Eur J Gastroenterol Hepatol · Aug 2016
Sarcopenia and two types of presarcopenia in Japanese patients with chronic liver disease.
The frequency of sarcopenia, defined as loss of both muscle volume and strength, was analyzed in chronic liver disease (CLD). ⋯ Evaluation of handgrip strength and psoas index is an easy and effective method for the detection of sarcopenia and presarcopenia.