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Inflammatory bowel disease serology in Asia and the West

World Journal of Gastroenterology 2013年第37期19卷 6207-6213页

作者： Lani Prideaux Michael A Kamm Peter De Cruz Daniel R van Langenberg Siew C Ng Iris Dotan Department of Gastroenterology St Vincent’s HospitalFitzroy 3065MelbourneAustralia Department of Medicine University of Melbourne Department of Medicine Imperial College Department of Gastroenterology Box Hill Hospital Department of Medicine and Therapeutics Chinese University of Hong Kong Inflammatory Bowel Disease Center Department of GastroenterologySourasky Medical Center

AIM:To study serological antibodies in Caucasians and Asians,in health and inflammatory bowel disease(IBD),in Australia and Hong Kong(HK).METHODS:Anti-glycan antibodies[anti-chitobioside(ACCA),anti-laminaribioside(ALCA)],and anti-mannobioside(AMCA),anti-Saccharomyces cervisiae(gASCA);and atypical perinuclear anti-neutrophil cytoplasmic antibody(pANCA)were tested in IBD patients,their unaffected relatives,and healthy controls in Australia and HK(China).Antibody status(positive or negative)and titre was compared between subjects of different geography,ethnicity and disease state.RESULTS:Ninety subjects were evaluated:21 Crohn’s disease(CD),32 ulcerative colitis(UC),29 healthy controls,and 8 IBD patient relatives.Forty eight subjects were Australian(29 Caucasian and 19 ethnic Han Chinese)and 42 were from HK(all Han Chinese).Caucasian CD patients had a significantly higher antibody prevalence of gASCA(67%vs 3%,P<0.001),ALCA(44%vs 6%,P=0.005),and AMCA(67%vs 15%,P=0.002),whereas HK CD patients had a higher prevalence of only AMCA(58%vs 25%,P=0.035),when compared with UC and healthy subjects in both countries.Caucasian CD had significantly higher gASCA prevalence(67%vs 0%,P<0.001)and titre(median59 vs 9,P=0.002)than HK CD patients.Prevalence and titres of ALCA,ACCA and AMCA did not differ between CD in the two countries.Presence of at least one antibody was higher in Caucasian than HK CD patients(100%vs 58%,P=0.045).pANCA did not differ between countries or ethnicity.CONCLUSION:Serologic CD responses differ between HK Asian and Australian Caucasian patients.Different genetic,environmental or disease pathogenic factors may account for these differences.

关键词： Crohn’s disease Ulcerative colitis Serological antibodies Asia Ethnic Anti-Saccharomyces cervisiae antibodies Anti-chitobioside antibodies Antilaminaribioside antibodies Anti-mannobioside antibodies Atypical perinuclear anti-neutrophil cytoplasmic antibodies

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大便失禁对这一尴尬问题现有许多治疗措施

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英国医学杂志中文版 2004年第6期7卷 331-332页

作者： Michael A Kamm 周正飞 St Mark's Hospital Watford Road Harrow HA1 3UJ

对于大便失禁这一在医学界不引人注意的问题，过去10年无论在认识上还是治疗上都有了显著的变化，如今病人和医生都已直言不讳。借助于医学影像学的进展，对其病理生理学有了较为深入的了解。由于废除了早期的侵袭性括约肌手术，转而采... 详细信息

对于大便失禁这一在医学界不引人注意的问题，过去10年无论在认识上还是治疗上都有了显著的变化，如今病人和医生都已直言不讳。借助于医学影像学的进展，对其病理生理学有了较为深入的了解。由于废除了早期的侵袭性括约肌手术，转而采用简单药物治疗、行为训练技术、注射生物材料以及必要时采用微侵袭手术，治疗正在不断得到改善。

关键词：大便失禁治疗病理生理学微侵袭手术

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Cost-effectiveness of Crohn's disease post-operative care

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World Journal of Gastroenterology 2016年第14期22卷 3860-3868页

作者： Emily K Wright Michael A Kamm Peter Dr Cruz Amy L Hamilton Kathryn J Ritchie Sally J Bell Steven J Brown William R Connell Paul V Desmond Danny Liew Department of Gastroenterology St Vincent's Hospital University of Melbourne Fitzroy VIC 3065 Melbourne Australia Imperial College London SW7 2AZ United Kingdom Melbourne EpiCentre University of Melbourne and Melbourne Health Parkville VIC 3010 Melbourne Australia

AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn's disease following intestinal resection.METHODS: In the "POCER" study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care(6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin(FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients(active care n = 43, standardcare n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those inremission [ $ 26347( IQR 25045-27485) vs $2729(IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented. CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.

关键词： Crohn’s disease Post-operative Health economics Health care cost Biologics

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Gastroenterologist perceptions of faecal microbiota transplantation

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World Journal of Gastroenterology 2015年第38期21卷 10907-10914页

作者： Sudarshan Paramsothy Alissa J Walsh Thomas Borody Douglas Samuel Johan van den Bogaerde Rupert WL Leong Susan Connor Watson Ng Hazel M Mitchell Nadeem O Kaakoush Michael A Kamm Gastroenterology and Hepatology Department St Vincent’s Hospital Centre for Digestive Diseases Gastroenterology and Hepatology Department Bankstown-Lidcombe Hospital Gastroenterology and Hepatology Department Nambour General Hospital Gastroenterology and Hepatology Department Liverpool Hospital University of New South Wales School of Biotechnology and Biomolecular Sciences Departments of Gastroenterology and Medicine St Vincent's Hospital and University of Melbourne

AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT,8% more than once. Ninety percent would refer patients with Clostridium difficile infection(CDI) for FMT if easily available,37% for ulcerative colitis,13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication,including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic,17% nasoduodenal,13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence,12% infection risk,10% non infectious adverse effects/lack of safety data,10% aesthetic,10% lack of efficacy,4% disease exacerbation,and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.CONCLUSION: Despite general enthusiasm,most gastroenterologists have limited experience with,or access to,FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.

关键词： Perceptions Gastroenterologist Clostridium diffici

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Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials

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Open Journal of Gastroenterology 2017年第1期7卷 32-43页

作者： Stefan Müller-Lissner Erika Richter Marion Eberlin Harald Weigmann Tobias Mück michael A. kamm Department of Internal Medicine Park-Klinik Weissensee Berlin Germany Sanofi-Aventis GmbH Frankfurt-Hoechst Germany St Vincent’s Hospital University of Melbourne Melbourne Australia

Background: Quality of life (QoL) is impaired in chronic constipation. Among nonprescription laxatives QoL data out of randomized controlled trials are available only for bisacodyl and sodium picosulfate (SPS). Methods: In two randomized, double-blind, placebo-controlled, parallel-group trials, the efficacy and safety of treatment with either bisacodyl or SPS, respectively, were assessed. After a 2-week baseline period patients with functional constipation were randomized to a 4-week treatment with either bisacodyl (2 tablets = 10 mg), SPS (18 drops = 10 mg), or matching placebo in a ratio of active drug to placebo of 2:1. Dose reduction as well as resuming the original dose was permitted. Patients who did not experience a bowel movement for more than 72 h were allowed to use a bisacodyl suppository. The primary endpoint was the mean number of Complete Spontaneous Bowel Movements (CSBMs) per week during the trial. QoL was assessed using the Patient Assessment of Constipation (PAC)-QoL questionnaire. Results: Active treatment led to a greater improvement of PAC-QoL scores for every domain. Active treatment was also superior to placebo for all individual questions of the questionnaire. Of note, SPS or bisacodyl not only improved satisfaction with stool patterns (“quite a bit/extremely satisfied” in 12.8% of patients on placebo and 50.3% on active treatment) but bloating was also considerably ameliorated (“not at all feeling bloated” in 24.5% on placebo and 41.4% on active treatment). Conclusion: Bisacodyl and SPS not only improve stool variables but also quality of life in patients with chronic functional constipation. (EudraCT Nos. 2007-001991-34 and 2007-002087-10).

关键词： Constipation Laxative Bisacodyl Sodium Picosulfate Quality of Life

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