Indian Journal of Gastroenterology September-October 2020
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EDITORIAL
Indian Journal of Gastroenterology September-October 2020 Jimmy K. Limdi 1,2,3
# Indian Society of Gastroenterology 2020
Clinical efficacy of infliximab level and anti-infliximab antibody measurement in patients with inflammatory bowel disease: An audit Anti-TNF therapies have transformed the care of patients with inflammatory bowel disease (IBD). Being immunogenic, these are associated with loss of response; up to 30% of patients have a primary non-response and up to 50% develop loss of response [1]. Treatment failure can be caused by low or undetectable drug concentrations due to immune (anti-drug antibodies) and nonimmune clearance [1]. Therapeutic drug monitoring (TDM) has been adopted for anti-TNF dose optimization. Dave et al. Mumbai, India present an experience infliximab (IFX) TDM monitoring in 50 IBD patients and its effect on management decisions [2]. IFX levels were sub-therapeutic in 40 and high antibody titers were present in 8 of 30 patients. IFX dose was altered in 35 patients (increased in 7, decrease in dosing interval in 17, increase in interval in 2 and stopped in 2 patients). Two patients had surgery and 5 had a change in biologic. TDM proved a powerful tool for effective treatment decisions.
Long-term outcomes in perianal fistulizing Crohn’s disease in a resource-limited setting: A cohort analysis The management of fistulising perianal Crohn’s disease (pCD) is challenging. The established treatment pathway is * Jimmy K. Limdi [email protected] 1
Section of Inflammatory Bowel Diseases, Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
2
Manchester Academic Health Sciences, University of Manchester, Manchester, UK
3
Manchester Metropolitan University, Manchester, UK
multidisciplinary involving management of proctitis and drainage of sepsis, prior to optimization of medical treatment, usually with a combination of thiopurine and antitumor necrosis factor (TNF) therapies [3]. Initial drainage of sepsis and placement of loose setons are the mainstay of surgical treatment, although surgery aimed at fistula closure may be offered in selected patients, and de-functioning stoma or proctectomy is sometimes required [3]. Data from resource limited settings are limited. Vuyyuru and colleagues report long-term outcomes of patients with pCD from All India Institute of Medical Sciences (AIIMS), New Delhi, India [4]. Among 65 patients (median follow-up 45 months), response rates to immunomodulators, biologicals, fistula surgery and defunctioning were 25%, 39.5%, 42.8% and 45.4%, respectively. Surgery was first-line therapy in 46.1% patients. Fistula surgery was associated with the highest risk of relapse. The authors report a potential role for immunomodulators in resource limited settings, acknowledging gold standard care when possible.
Self-expanding metal stent in esophageal perforations and anastomotic leaks Esophageal perforations and leaks can be life-threatening and are associated with high in-hospital mortality (25% and 30%, respectively) and sur
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