Choon Jin Ooi 1, Kwong Ming Fock, Govind K Makharia, Khean Lee Goh, Khoon Lin Ling, Ida Hilmi, Wee Chian Lim, Thia Kelvin, Peter R Gibson, Richard B Gearry, Qin Ouyang, Jose Sollano, Sathaporn Manatsathit, Rungsun Rerknimitr, Shu-Chen Wei, Wai Keung Leung, H Janaka de Silva, Rupert Wl Leong, Asia Pacific Association of Gastroenterology Working Group on Inflammatory Bowel Disease
Tag: ulcerative colitis
Scientific corner
The Asia-Pacific consensus on ulcerative colitis
Inflammatory bowel disease (IBD) is increasing in many parts of the Asia-Pacific region. There is a need to improve the awareness of IBD and develop diagnostic and management recommendations relevant to the region. This evidence-based consensus focuses on the definition, epidemiology and management of ulcerative colitis (UC) in Asia. A multi-disciplinary group developed the consensus statements, reviewed the relevant literature, and voted on them anonymously using the Delphi method. The finalized statements were reviewed to determine the level of consensus, evidence quality and strength of recommendation. Infectious colitis must be excluded prior to diagnosing UC. Typical histology and macroscopic extent of the disease seen in the West is found in the Asia-Pacific region. Ulcerative colitis is increasing in many parts of Asia with gender distribution and age of diagnosis similar to the West. Extra-intestinal manifestations including primary sclerosing cholangitis are rarer than in the West. Clinical stratification of disease severity guides management. In Japan, leukocytapheresis is a treatment option. Access to biologic agents remains limited due to high cost and concern over opportunistic infections. The high endemic rates of hepatitis B virus infection require stringent screening before initiating immune-suppressive agents. Vaccination and prophylactic therapies should be initiated on a case-by-case basis and in accordance with local practice. Colorectal cancer complicates chronic colitis. A recent increase in UC is reported in the Asia-Pacific region. These consensus statements aim to improve the recognition of UC and assist clinicians in its management with particular relevance to the region.
asia / consensus / efficacy / gma / GUIDELINES / Leukocytapheresis / procedure / severe / steroid-dependent / steroid-naive / Steroid-refractory / ulcerative colitis /
Scientific corner
13 Apheresis therapy showed its high safety and adequate efficacy for the treatment of patients with ulcerative colitis – the postmarketing surveillance of more than 600 ulcerative colitis patients in Japan
Scientific corner
Leukocytapheresis in pediatric patients with ulcerative colitis
Takeshi Tomomasa 1, Hitoshi Tajiri, Seiichi Kagimoto, Toshiaki Shimizu, Atsushi Yoden, Kosuke Ushijima, Keiichi Uchida, Hiroaki Kaneko, Daiki Abukawa, Mutsuko Konno, Shun-ichi Maisawa, Takao Kohsaka, Akio Kobayashi, Japanese Study Group for Pediatric Ulcerative Colitis J Pediatr Gastroenterol Nutr. 2011 Jul;53(1):34-9. doi: 10.1097/MPG.0b013e31821058bc.
Objective: Leukocytapheresis (LCAP) is a nonpharmacologic therapy that has recently been used to treat ulcerative colitis (UC). This multicenter open-label study prospectively assessed the efficacy and safety of LCAP in pediatric patients with UC. Patients and methods: Twenty-three patients ages 8 to 16 years with moderate (n = 19) to severe (n = 4) steroid-resistant UC were enrolled. One of 2 LCAP columns with different volumes (model EX and the half-volume model EI) was selected, according to body weight. LCAP was performed once per week for 5 consecutive weeks. Clinical and laboratory data were collected at predetermined time points. The primary endpoint was decreased stool frequency/hematochezia score, and secondary endpoints were clinical, laboratory, and endoscopic improvements. Results: The stool frequency/hematochezia score decreased significantly from 4.5 ± 1.2 before treatment to 1.6 ± 1.9 after the fifth treatment. Clinical parameters, including stool frequency, presence of visible blood, abdominal pain, and body temperature, were significantly improved. Fecal calprotectin decreased significantly. Endoscopic findings evaluated using Matts score also improved (P < 0.01). The steroid dose decreased from 1.1 ± 0.4 mg/kg before treatment to 0.8 ± 0.5 mg/kg after treatment. There were no significant differences in changes between the EX and EI columns. The incidence of adverse effects was 61%, although none was serious. The most common adverse effects were decreased hematocrit and hemoglobin concentration. Conclusions: The present study showed that LCAP was well tolerated in children with UC, mostly moderate, and was as effective as in adults. The types of pediatric patients best suited to LCAP remain to be determined.
Scientific corner
Leukocytapheresis in the treatment of inflammatory bowel disease: Current position and perspectives.
Piero Vernia 1, Valeria D’Ovidio, Donatella Meo, Transfus Apher Sci. 2010 Oct;43(2):227-9.
Therapeutic apheresis, a novel approach for immunodisorders, has been used in the last decade for the treatment of ulcerative colitis with promising result, and represents an alternative to conventional pharmacological therapy. Selective apheresis is aimed at reducing the number of circulating lymphocytes, interfering with recruitment and activation of mucosal granulocytes and macrophages, reducing cytokine and chemokine production which are thought to contribute to induction and perpetuation of inflammation. The article briefly reports indications, treatment schedule and clinical results of leukocytapheresis in ulcerative colitis. Available data for the two selective adsorption devices so far approved for clinical use (granulocyte-monocyte apheresis- Adacolumn- and leukocytapheresis-Cellsorba) are partially conflicting, and the number of controlled studies too small to draw definitive conclusions. Nonetheless apheresis definitely appears to be an effective non-conventional tool for the treatment of steroid refractory and steroid dependent UC patients with moderately active disease. The excellent safety profile of the procedure makes this approach attractive, both in adult and in pediatric patients, more so in those refractory to conventional drug therapy, who are presently treated with immunosuppressive and biological therapies.
Scientific corner
Mucosal healing in patients with ulcerative colitis during a course of selective leukocytapheresis therapy: A prospective cohort study
Takayuki Yamamoto 1, Satoru Umegae, Koichi Matsumoto, Inflamm Bowel Dis. 2010 Nov;16(11):1905-11.
MH is achieved more frequently in patients with moderate than with severe endoscopic severity at entry. Further, patients with MH have a reduced risk of future clinical relapse as compared with patients who achieve remission without MH.
Scientific corner
Efficacy of Granulocytapheresis for the Treatment of Active Ulcerative Colitis and Avoidance of Systemic Corticosteroid Administration
Chikako Tokoro, Masahiko Inamori, Takasi Uchiyama, Hiroshi Iida, Hiroki Endo, Kunihiro Hosono, Yasunari Sakamoto, Hirokazu Takahashi, Tomoko Koide, Ayumu Goto, Hiroaki Yasuzaki, Yasunobu Abe, Reikei Matsuda, Daisuke Takahashi, Ichiro Kawana, Shinichiro Suzuki, Atsushi Nakajima, Digestion. 2010;82(1):37-8.
Scientific corner
Sustained remission after steroids and leukocytapheresis induced response in steroid-dependent ulcerative colitis: results at 1 year
Jose L Cabriada 1, Nora Ibargoyen, Anaiansi Hernández, Antonio Bernal, Agustín Castiella, Dig Liver Dis. 2010 Jun;42(6):432-5.
Initial remission can be maintained at 1 year in half of the patients without the need for additional steroids. Complete remission and endoscopic mucosal healing is proposed as an objective for achieving a lasting response.
Scientific corner
Tumor necrosis factor-α-secreting CD16+ antigen presenting cells are effectively removed by granulocytapheresis in ulcerative colitis patients
Joaquin Sanchez-Garcia 1, Juana Serrano-López, Valle García-Sanchez, Miguel A Alvarez-Rivas, Rosario Jimenez-Moreno, Carlos Pérez-Seoane, Concepcion Herrera-Arroyo, Josefina Serrano, Juan F de Dios, Antonio Torres-Gomez, J Gastroenterol Hepatol. 2010 Dec;25(12):1869-75
The effect of GCAP in peripheral blood APC consisted mainly on a significant depletion of tumor necrosis factor-α secreting CD16-mDC. This finding could suggest a potential mechanism of GCAP beneficial effect that must be confirmed in larger series.
Scientific corner
Clinical and endoscopic features of responders and non-responders to adsorptive leucocytapheresis: A report based on 120 patients with active ulcerative colitis.
Tomotaka Tanaka 1, Hideharu Okanobu, Yoshio Kuga, Yoshikazu Yoshifuku, Hatsue Fujino, Tomohiro Miwata, Takashi Moriya, Toshihiro Nishida, Toshihide Oya, Gastroenterol Clin Biol. 2010 Dec;34(12):687-95.
Steroid naïve patients with short duration of UC were the best responders, while patients with deep colonic lesions and extensive loss of the mucosal tissue were non-responders.
Scientific corner
Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease.
Annelie Lindberg 1, Michael Eberhardson, Mats Karlsson, Per Karlén, BMC Gastroenterol. 2010 Jul 6;10:73.
Background: Patients with IBD and chronic inflammation refractory to conventional therapy often demonstrate higher risk of serious complications. Combinations of immunosuppression and biological treatment as well as surgical intervention are often used in this patient group. Hence, there is need for additional treatment options. In this observational study, focused on re-treatment and long-term results, Granulocyte/Monocyte Adsorption (GMA, Adacolumn) treatment has been investigated to study efficacy, safety and quality of life in IBD-patients with chronic activity.
Methods: 15 patients with ulcerative colitis and 25 patients with Crohn’s disease, both groups with chronically active inflammation refractory to conventional medication were included in this observational study. The patients received 5-10 GMA sessions, and the clinical activity was assessed at baseline, after each completed course, and at week 10 and 20 by disease activity index, endoscopy and quality of life evaluation. Relapsed patients were re-treated by GMA in this follow-up study up to 58 months.
Results: Clinical response was seen in 85% and complete remission in 65% of the patients. 10 patients in the UC-group (66%) and 16 patients in the CD-group (64%) maintained clinical and endoscopic remission for an average of 14 months.14 patients who relapsed after showing initial remission were re-treated with GMA and 13 (93%) went into a second remission. Following further relapses, all of 7 patients were successfully re-treated for the third time, all of3 patients for the fourth time and 1 for a fifth time.
Conclusions: IBD-patients with chronic inflammation despite conventional therapy seem to benefit from GMA. Re-treatment of relapsing remission patients seems to be effective.
Contact UsFor more information
Contact Us