So should we abandon cyclosporine in favor of infliximab? The jury is out while we
wait the results of two prospective randomized, controlled trials, which VX-770 price are currently underway, that compare cyclosporine and infliximab for the treatment of steroid-refractory, severe UC. The Study Comparing Cyclosporine With Infliximab in Steroid-refractory Severe Attacks of Ulcerative Colitis is now complete, but is yet to be published in full.12 Preliminary reports suggest that cyclosporine and infliximab are equivalent at preventing colectomy at 90 days. Meanwhile, a British study comparison of infliximab and ciclosporin in steroid resistant ulcerative colitis: a trial continues to recruit patients.13 While rescue therapy remains important, and the results of the above studies are eagerly awaited, one should not forget the importance of performing the basics well when dealing with these very sick patients with UC. First of all, patients should be educated so as to know what to do when they are unwell in order that they seek medical attention early so that infections (e.g. cytomegalovirus and Clostridium
difficile) can be excluded, and a treatment plan established. Patient education, treatment plans, general practitioners, and IBD nurses can play an important role in expediting selleck inhibitor appropriate treatment. Second, patients requiring admission must be appropriately examined and investigated to diagnose severe disease (tachycardia, hypotension, peritonitis, raised C-reactive protein, low serum albumin), and imaged by plain abdominal radiology to exclude complications, such as toxic megacolon and perforation. Fluid resuscitation should be timely, and attention should be paid to the prevention of venous thromboembolism by using low molecular-weight heparin.14 Non-steroidalanti-inflammatory and opioid drugs should be avoided.
Finally, and most importantly, decisions regarding rescue therapy and surgery should be made in a timely fashion, and preferably within the first 3 days of intravenous steroid treatment by the patient, with guidance from both a gastroenterologist and colorectal surgeon, preferably conferring together. Patients with severe colitis who fail to respond to intravenous steroids in hospital continue to be a major clinical challenge. Attention must be paid to doing the basics well, but it is now pleasing to see that there are MCE公司 two rescue therapies available that might avert the need for colectomy. At this stage, it is not clear whether infliximab has usurped cyclosporine, but having a choice is likely to lead to improved outcomes for patients. “
“Although the incidence of bleeding from gastric varices is relatively low (10%–36%), the bleeding is massive once it has occurred and it increases the patient’s mortality. The management of esophageal variceal bleeding is highly differentiated with several effective treatments available. In contrast, bleeding from gastric varices continues to be a therapeutic challenge.