Scandinavian journal of gastroenterology. Supplement
-
Patients with Crohn's disease are at increased risk of developing disturbances in bone and mineral metabolism because of several factors, including the cytokine-mediated nature of the inflammatory bowel disease, the intestinal malabsorption resulting from disease activity or from extensive intestinal resection and the use of glucucorticoids to control disease activity. Inability to achieve peak bone mass when the disease starts in childhood, malnutrition, immobilization, low BMI, smoking and hypogonadism may also play a contributing role in the pathogenesis of bone loss. The relationship between long-term use of glucocorticoids for any disease indication and increased risk for osteoporosis and fractures is well established. ⋯ The issue of the magnitude of the problem of osteoporosis has become particularly relevant in Crohn's disease, since the ability of therapeutic interventions to beneficially influence skeletal morbidity has been clearly established in patients with osteoporosis, whether post-menopausal women, men or glucocorticoid users. The main question that arises is whether all patients with Crohn's disease should be treated with bone protective agents on the assumption that they all have the potential to develop osteoporosis or whether the use of these agents should be restricted to patients clearly at risk of osteoporosis and fractures, providing these can be identified. We recommend, based on the available literature and our own experience, that all patients with Crohn's disease should be screened for osteoporosis by means of a bone mineral density measurement in addition to full correction of any potential calcium and vitamin D deficiency, to allow timely therapeutic intervention of the patient at risk while sparing the vast majority unnecessary medical treatment.
-
Scand. J. Gastroenterol. Suppl. · Jan 2004
ReviewChildren with constipation: what happens to them when they grow up?
Constipation and soiling are common complaints in childhood and often cause distress to the children and their parents. The treatment for these symptoms is oral and sometimes rectal laxatives or behavioural therapy. ⋯ A recent long-term follow-up study in The Netherlands showed that 30% of the children followed beyond puberty continued to have severe complaints of constipation such as a low defecation frequency and soiling. Long-lasting support and the development of improved therapeutic regimens are necessary to treat these difficult patients more effectively.
-
Scand. J. Gastroenterol. Suppl. · Jan 2003
ReviewPathophysiological characteristics of long- and short-segment Barrett's oesophagus.
Depending on the length of the segment of columnar epithelium in the distal oesophagus, Barrett's oesophagus can be divided into long-segment and short-segment Barrett's oesophagus. This article describes the pathophysiological characteristics of both forms of Barrett's oesophagus. ⋯ Pathophysiological abnormalities appear to be more prominent in long-segment Barrett's oesophagus than in short-segment Barrett's oesophagus.
-
Scand. J. Gastroenterol. Suppl. · Jan 2003
ReviewNew developments in systemic chemotherapy in advanced colorectal cancer.
The majority of patients with newly diagnosed colorectal cancer who present with concurrent metastases are considered to be incurable from the disease. For their treatment, these patients depend on systemic anticancer therapy and supportive care. ⋯ The current debate is no longer whether to use palliative chemotherapy in metastatic colorectal, but which patient will benefit from which combination and in what sequence.
-
Unlike other types of cancer, there are several options for screening for colorectal cancer (CRC). The most extensively examined method, faecal occult blood testing (FOBT), has been shown, in three large randomized trials, to reduce mortality from CRC by up to 20% if offered biennally and possibly more if offered every year. Recently published data from the US trial suggest that CRC incidence rates are also reduced by up to 20%, but only after 18 years. ⋯ Sensitivity for small adenomas is low, but perhaps it is less essential to find such lesions. Some groups have suggested that virtual colonoscopy might be a useful option for investigating patients who test positive with stool-based screening tests. Whichever CRC screening method is finally chosen (and there is no reason why several methods should not ultimately be available), high quality endoscopy resources will always be required to investigate and treat neoplastic lesions detected.