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Role of colonoscopy in patients with persistent acute diverticulitis

World Journal of Gastroenterology 2008年第17期14卷 2763-2766页

作者： Adi Lahat henit yanai Emad Sakhnini Yoram Menachem Simon Bar-Meir Department of Gastroenterology ChaimSheba Medical Center and Sackler School of Medicine Tel AvivUniversity

AIM： To identify patients with persistent acute diverticulitis who might benefit from an early colonoscopy during their first hospitalization. METHODS： All patients hospitalized between July 2000 and December 2006 for acute diverticulitis who underwent colonoscopy were included in the study. Patients were followed during hospitalization and after discharge. Patients were considered to have a persistent course of acute diverticulitis if symptoms continued after 1 wk of conventional treatment with 1V antibiotics, or if symptoms recurred within 2 mo after discharge. Patients were considered to benefit from an early colonoscopy if the colonoscopy was therapeutic or if it changed a patient＇s outcome. RESULTS： Three hundred and six patients were hospitalized between July 2000 and December 2006 with the diagnosis of acute diverticulitis. Two hundred and twenty four of these were included in the study group. Twenty three patients （10.3%） fulfilled the criteria for a persistent course of acute diverticulitis. Of them, four patients （17.4%） clearly benefited from an early colonoscopy; these patients＇ clinical course is described. None of the patients with a regular non-persistent course demonstrated any benefit from colonoscopy. CONCLUSION： Early colonoscopy detected other significant pathology, which accounted for the clinical presentation in 17% of patients with persistent acute diverticulitis. Therefore, we believe an early colonoscopy should be considered in all patients with a persistent clinical course.

关键词： Persistent acute diverticulitis Early colonoscopy Clinical course

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Diverticulitis in the young patient-Is it different?

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World Journal of Gastroenterology 2006年第18期12卷 2932-2935页

作者： Adi Lahat Yoram Menachem Benjamin Avidan henit yanai Emad Sakhnini Eytan Bardan Simon Bar-Meir Department of Gastroenterology Chaim Sheba Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

AIM： To prospectively study the incidence and the natural history of acute diverticulitis in young patients. METHODS： A total of 207 patients hospitalized at our hospital between January 2000 to February 2005 with the diagnosis of acute diverticulitis were included. Their demographic characteristics, medical history, physical, radiographic and endoscopic findings as well as therapy were recorded. Patients were followed every 6 mo for the first year and later annually. RESULTS： The mean patients＇ age was 61 （range 27-92） years. Twenty- five patients （12%） were younger than 45 years. Acute diverticulitis was significantly more prevalent among male in the young age group as compared to the older age group （19/25, 76% vs 61/182, 33%, respectively, P = 0.0001）. Complications occurred more often in the young age group; 32% vs 13%, （P = 0.002）. During follow-up, 6 patients （28%） remained asymptomatic in the young age group as compared to 87 patients （55%） in the older age group （P = 0.024）. As a result, sigmoidectomies were performed twice as often in the young age group （38% vs 13%, P = 0.002）. CONCLUSION： Diverticulitis in young patients has a male predominance, a more aggressive course with a higher rate of complications and a higher recurrence rate. An earlier surgical approach might be considered in young patients with acute diverticulitis.

关键词： Diverticulitis Young patient Complications Sigmoidectomy

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Significance of low level infliximab in the absence of anti-infliximab antibodies

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World Journal of Gastroenterology 2015年第6期21卷 1907-1914页

作者： Bella Ungar Adi Anafy henit yanai Yulia Ron Miri Yavzori Orit Picard Ella Fudim Ronen Loebstein Uri Kopylov Yehuda Chowers Iris Dotan Rami Eliakim Shomron Ben-Horin Department of Gastroenterology Sheba Medical Center Tel Hashomer and Sack-ler School of Medicine Tel-Aviv University IBD Center Department of Gastroenterology Tel-Aviv Sourasky Medical Center and Sackler School of Medicine Tel-Aviv University Institute of Clinical Pharmacology Sheba Medical Center Tel Hashomer and Sackler School of Medicine Tel-Aviv University Rambam Health Care Campus and Bruce Rappaport School of Medicine Technion Institute of Technology

AIM:To evaluate the prevalence of double negative(DN)sera and the mechanisms responsible for DN ***:Sera of inflammatory bowel disease patients treated with infliximab(IFX)were tested for drug/antibodies to infliximab(ATI)trough levels and the proportion of DN results was compared between a commercially available double antigen ELISA(with labeled IFX as the detection antibody)and an antilambda ELISA(with anti-human lambda chain detection antibody).Repeat testing with lower than customary serum dilution(1:10)was *** with DN status were matched with IFX+/ATI-controls and were followed-up for subsequent development of nontransient ATI to investigate if DN status precedes ***:Of 67 sera obtained at time of loss of response,only 6/67(9%)were DN by anti-lambda ELISA compared to 27/67(40%)with double antigen ELISA(P<0.001,Fisher’s Exact test).Of the latter27 sera,22%were also DN by anti-lambda ELISA,whereas 44%were actually IFX positive(IFX+ATI-),30%were ATI positive(IFX-ATI+)and 4%were double positive(IFX+ATI+).Re-testing using a 1:10 dilution converted most DN results into IFX+and/or ATI+*** with DN status had shorter survival free of non-transient ATI compared with matched controls(log rank test,P<0.001).In 9/30(30%)of these patients,non transient ATI occurred before and after the event at which the DN serum was obtained,supporting the view that a DN result may represent aparticular time-point along the two curves of ATI titer rise and infliximab drug level ***:DN status may result from false negative detection of IFX or ATI by double antigen ELISA,suggesting a transitional state of low-level immunogenicity,rather than non-immunological clearance.

关键词： Inflammatory bowel disease Biological therapy Infl

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