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Flare-up of ulcerative colitis after systemic corticosteroids: A strong case for Strongyloides

World Journal of Gastroenterology 2008年第27期14卷 4413-4415页

作者： Shomron Ben-Horin Iris Barshack yehuda chowers Meir Mouallem Department of Gastroenterology Sheba Medical Center and Sackler School of Medicine Tel-Aviv University Pathology Institute Sheba Medical Center and Sackler School of Medicine Tel-Aviv University Department of Medicine E Sheba Medical Center and Sackler School of Medicine Tel-Aviv University

Super-imposed infection with intestinal organisms can mimic a flare-up of underlying disease in patients with inflammatory bowel disease (IBD). We report a case of patient with long standing ulcerative colitis (UC), who presented with abdominal pain, diarrhea and low- grade fever after receiving systemic corticosteroids for an unrelated disorder. Despite a negative stool examination, a peripheral eosinophilia reappeared upon tapering down of a corticosteroid dose. Subsequently, duodenal biopsies showed evidence for Strongyloides, presumably acquired 20 years ago when the patient was residing in Brazil. The patient fully recovered following anti-helmintic therapy. This case underscores the importance of considering Strongyloides in the work-up of flaring-up IBD patients, even if a history of residing or traveling to endemic areas is in the distant past.

关键词： Ulcerative colitis Infection Parasites Eosinophilia Strongyloides

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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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Does capsule endoscopy have an added value in patients with perianal disease and a negative work up for Crohn's disease?

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World Journal of Gastrointestinal Endoscopy 2012年第5期4卷 185-188页

作者： Samuel N Adler Metzger Yoav Scapa Eitan chowers yehuda Rami Eliakim Departments of Gastroenterology Bikur Holim HospitalJerusalem91104(ASNMY)Asaf HarofehZrifin 70300(ES)and Rambam Health Care CampusHaifa 31096(CYER)Israel

AIM:To investigate the role of capsule endoscopy in patients with persistent perianal disease and negative conventional work up for Crohn's disease(CD).METHODS:Patients with perianal disease(abscesses,fistulas,recurrent fissures) were evaluated for underlying *** who had a negative work up,defined as a negative colonoscopy with a normal ileoscopy or a normal small bowel series or a normal CT/MR enterography,underwent a Pillcam study of the small bowel after signing informed *** using nonsteroidal anti-inflammatory drugs or who had a history of inflammatory bowel disease or rheumatic disease were ***:We recruited 26 patients aged 21-61 years(average 35.6 years),17 males and 9 *** case could not be evaluated since the capsule did not leave the *** 6 of 25(24%) patients with a negative standard work up for Crohn's disease,capsuleendoscopy(CE) findings were consistent with Crohn's disease of the small *** history of CD,white blood cell,hemoglobin,erythrocyte sedimentation rate or C-reactive protein did not predict a diagnosis of *** endoscopy findings led to a change in ***:In patients with perianal disease and a negative conventional work up to exclude CD,CE leads to incremental diagnostic yield of 24%.

关键词： Perianal abscess Perianal fistula Ileocolonoscopy Capsule endoscopy Crohn’s disease

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