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
Downloads:
Views:
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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,
Pia Oksanen
