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DIGESTIVE DISEASES UPDATE Gastric volume has more to do with gender than it does age or body mass, according to a study by researchers at the Mayo Clinic. It was just one of the 5,000 abstracts presented at Digestive Disease Week 2002 in San Francisco in May. Other presentations included a study by researchers at the University of Manitoba that calculated the financial costs of inflammatory bowel disease to society. New, effective drug therapies can be costly, but there's an even higher price to pay by not investing in them, both for patients and society, they say. Medical Post staff writer Lynn Haley was there, and files these reports. |
Warn NSAID patients of possible IBD relapse
More research needed before absolute association can be drawn
By Lynn Haley
SAN FRANCISCO – Use of NSAIDs, including ASA and selective COX-2
inhibitors, was associated with relapse in inflammatory bowel disease (IBD)
in a chart review of all patients who visited an IBD outpatient clinic in
Phoenix, Ariz. in an 18-month span.
Still, the researchers say a prospective cohort study is needed to
further evaluate this relationship.
The study, presented at Digestive Disease Week here recently, was
prompted because all NSAIDs have some effect on the inhibition of the
cyclo-oxygenase (COX) 1 and 2 isoenzymes. Their use in patients with Crohn's
disease, ulcerative colitis (UC) and indeterminate colitis is controversial.
The patients were selected from medical records in a database. Variables
identified from the patient's last visit included use of NSAIDs, maintenance
therapy, disease activity and smoking status. NSAID use was defined as at
least once-daily dosing of any COX inhibitor in the month prior to relapse.
Of the 60 patients studied, 22 were in the relapse group and 38 were in
the remission group. Nine in the relapse group used NSAIDs compared to 10 in
the remission group.
Maintenance therapy was used by 68% in the relapse group and 92% in the
remission group. Regression analysis adjusted for age, gender and
maintenance therapy. Smoking status was not included because it was
incomplete in 15% of the patients.
The adjusted odds ratio for IBD relapse in NSAID users was 6.31.
Gastroenterologist Dr. Jonathan Leighton, one of the authors of the
study, said despite the results, further research is needed before an
absolute association can be drawn.
"It's time to do a good prospective controlled trial," said Dr. Leighton.
"If you look at the data, it's still conflicting . . . what they (NSAIDs)
really do in inflammatory bowel disease. You can almost find as many
(studies) that say there's no effect as there are ones that suggest an
effect."
What the Phoenix group did differently in its study was to control for
maintenance therapy.
"That's important, because if you look at our trial, in the remission
group, 92% were on maintenance therapy, 68% in the relapse group," said Dr.
Leighton.
"So you can imagine that maintenance therapy could have its own effect on
relapse rates. We felt it was important to control for that. In doing that,
what we found was that 26% were using NSAIDs in the remission group, 41% in
the relapse group."
Because the controversy has not been cleared up, Dr. Leighton, said he is
advising caution. "But I think there's evidence that certain patients can
tolerate NSAIDs, and it's not an absolute that they'll have a remission."
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