Research Article
The Long-term Outcomes of Patients with Ulcerative Colitis Treated with First Trial of Biological
Issue:
Volume 9, Issue 1, June 2025
Pages:
1-8
Received:
29 November 2024
Accepted:
17 December 2024
Published:
7 January 2025
DOI:
10.11648/j.ijg.20250901.11
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Abstract: Introduction: The advent of biologicals and small molecules have changed treatment strategies in ulcerative colitis (UC) as therapies now aim for complete mucosal healing. Real-world data on the outcome of UC patients after first trial of biologics is still lacking and is investigated here. Materials and Methods: UC patients treated with at least one biological at Tampere University Hospital between January 2009 and January 2020 were identified and reviewed from patient records. Results: A total of 192 patients were included. The median follow-up was 3.8 years (range 0-11 years). Seventy-four (40%) of the 185 patients treated with tumour necrosis factor α (TNFα) inhibitors (anti-TNF) and four out of the seven treated with vedolizumab continued treatment after follow-up with no need for treatment enhancement or colectomy. Seventy (36%) of all patients needed at least one consecutive treatment and 58 (30%) required surgery with median time of 1 year (range 0-5 years) from initiation of first biological to colectomy. Of the operated patients 34% had at least two different treatment trials with biologicals or janus kinase inhibitors (JAKs) prior to surgery. There was no significant difference in the persistence of different treatments nor between treatment with infliximab alone or in combination with immunomodulator. When analysing predictive factors for colectomy females and patients treated prior the year 2015 had slightly higher colectomy rates. Conclusion: Two fifth of the patients benefitted from the first trial of biological. However, in third subsequent treatment trials merely postponed colectomy while patients suffered from prolonged symptoms. Means are needed to identify patients benefitting from surgery early on.
Abstract: Introduction: The advent of biologicals and small molecules have changed treatment strategies in ulcerative colitis (UC) as therapies now aim for complete mucosal healing. Real-world data on the outcome of UC patients after first trial of biologics is still lacking and is investigated here. Materials and Methods: UC patients treated with at least o...
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Case Report
Case Report: Atypical Surgical Technique for Crohn's Disease of the Duodenum
Issue:
Volume 9, Issue 1, June 2025
Pages:
9-14
Received:
7 December 2024
Accepted:
31 December 2024
Published:
17 January 2025
DOI:
10.11648/j.ijg.20250901.12
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Abstract: Crohn’s disease (CD) is an idiopathic chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract (GIT), though it most commonly involves the terminal ileum and colon. Duodenal involvement is rare, accounting for only 0.5%–4% of cases, and isolated duodenal CD is even less common, occurring in fewer than 0.07% of patients. This report describes a 37-year-old female with a long history of CD presenting with progressive duodenal stenosis and associated symptoms such as epigastric pain, weight loss, and vomiting. Despite medical therapy with biologics, including adalimumab and ustekinumab, the disease progressed, leading to the need for surgical intervention. The patient underwent an innovative surgical procedure involving antrectomy, resection of the first, second, and third portions of the duodenum, Roux-en-Y gastrojejunostomy, cholecystectomy, and total pancreas preservation. Histopathological analysis confirmed the diagnosis of CD with chronic transmural inflammation, non-caseating granulomas, and lymphoid follicle formation. Postoperatively, the patient experienced significant clinical improvement, with good nutritional recovery and no recurrence of symptoms during follow-up. This case highlights the challenges in managing rare and severe manifestations of CD, particularly when medical therapy is insufficient. Surgical intervention is often reserved for complications such as obstruction, perforation, or intractable symptoms. The described surgical approach deviated from traditional methods like Whipple’s procedure, focusing instead on preserving the pancreas and minimizing GIT disruption. This innovative technique proved effective, underscoring the importance of tailoring surgical strategies to individual patient needs.Given the rarity of duodenal CD and the paucity of literature on its management, this report adds valuable insights into the potential for conservative surgical approaches to improve outcomes while reducing morbidity. Further studies are warranted to explore optimal strategies for treating this uncommon presentation of CD.
Abstract: Crohn’s disease (CD) is an idiopathic chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract (GIT), though it most commonly involves the terminal ileum and colon. Duodenal involvement is rare, accounting for only 0.5%–4% of cases, and isolated duodenal CD is even less common, occurring in fewer than 0.07% of patie...
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Research Article
Clinical Profile of Filipino Elderly Patients with Upper Gastrointestinal Bleeding Admitted in a Tertiary Hospital: A Retrospective Cohort Study
Issue:
Volume 9, Issue 1, June 2025
Pages:
15-24
Received:
26 March 2025
Accepted:
2 April 2025
Published:
28 April 2025
DOI:
10.11648/j.ijg.20250901.13
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Abstract: Background of the Study: Upper Gastrointestinal bleeding (UGIB) remains to be a significant clinical concern for geriatric patients due to their prolonged hospital stay and higher mortality and morbidity rates. The clinical profile of the geriatric patients are important aspects to consider, given that there is limited data in elderly population. Objective: The study is aimed to determine the clinical profile of elderly patients with UGIB admitted in a Tertiary Hospital from January 2024 to June 2024. Methods: This is a retrospective cohort study among elderly Filipino patients aged 60 years and above; admitted as UGIB and underwent esophagogastroduodenoscopy (EGD). Baseline Demographic, clinical presentation, laboratory results, endoscopic findings, prognosis and predictors of mortality were evaluated. Statistical analysis involved the application of Pearson’s chi-square, Fisher’s exact test, T-test and univariate and multivariate logistic regression analysis. Results: Among 102 admitted elderly patients with UGIB, 67 of them underwent EGD, thus were included in the study; 43 (64.18%) were male and 24 (35.82%) were female with the median age of 69.66 (±7.40) years. The prevalence rate of UGIB among elderly Filipino is 8.90%. 50 of those patients (74.63%) had comorbidities, the most common were: hypertension 38 (56.72%), diabetes mellitus 19 (28.36%) and chronic kidney diseases (13.43%). Patients presented mostly with melena (67.16%), generalized body weakness (53.73%) and 19.40% had abdominal pain. During endoscopy, (47.76%) was due to gastritis and gastric ulcer (19.40%). Mortality rate was higher in patients admitted at the ICU. No association was noted between the patients’ mortality and their sex, age, comorbidities, medications used, clinical findings, INR, BUN, hemoglobin, blood transfusion, and endoscopic findings. Conclusion: The present study reported that elderly patients with UGIB were male, with hypertension as the most common comorbidity. EGD findings showed gastritis as the most common cause of UGIB. Mortality rate is higher in patients admitted at the ICU. None of the variables showed significant differences in terms of predictors of mortality.
Abstract: Background of the Study: Upper Gastrointestinal bleeding (UGIB) remains to be a significant clinical concern for geriatric patients due to their prolonged hospital stay and higher mortality and morbidity rates. The clinical profile of the geriatric patients are important aspects to consider, given that there is limited data in elderly population. O...
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,
Pia Oksanen
