Showing papers by "William J. Tremaine published in 2000"
TL;DR: The overall incidence rate of ulcerative colitis in Olmsted County increased until the 1970s, and remained stable thereafter, and was similar to that of the general population.
Abstract: BACKGROUND There is significant geographic variation in the reported incidence of ulcerative colitis. AIMS To update the incidence and prevalence of ulcerative colitis in Olmsted County, Minnesota, examine temporal trends, and determine overall survival. PATIENTS All Olmsted County residents diagnosed with ulcerative colitis between 1940 and 1993 (incidence cases), and all residents with ulcerative colitis alive on 1 January 1991 (prevalence cases). METHODS Incidence and prevalence rates were adjusted using 1990 US census figures for whites. The effects of age, sex, and calendar year on incidence rates were evaluated using Poisson regression. Survival from diagnosis was compared with that expected for US north-central whites. RESULTS Between 1940 and 1993, 278 incidence cases were identified, for an adjusted incidence rate of 7.6 cases per 100 000 person years (95% confidence interval (CI), 6.7 to 8.5). On 1 January 1991, there were 218 residents with definite or probable ulcerative colitis, for an adjusted prevalence rate of 229 cases per 100 000 (95% CI, 198 to 260). Increased incidence rates were associated with later calendar years (p 0.2). CONCLUSIONS The overall incidence rate of ulcerative colitis in Olmsted County increased until the 1970s, and remained stable thereafter. Incidence rates among men and urban residents were significantly higher. The prevalence rate in Rochester in 1991 was 19% higher than that in 1980. Overall survival was similar to that of the general population.
482 citations
TL;DR: It is demonstrated that the absolute risk of non-Hodgkin’s lymphoma remains quite small (0.01% per person-year) and may not exceed that in the general population.
153 citations
TL;DR: Infliximab for Crohn's disease in clinical practice at the Mayo Clinic: the first 100 patients as mentioned in this paper, who were treated by the same team of researchers. But they did not report any side effects.
73 citations
TL;DR: The most recently recognized and least understood forms of inflammatory bowel disease are two types of idiopathic microscopic colitis-collagenous colitis and lymphocytic colitis.
Abstract: The most recently recognized and least understood forms of inflammatory bowel disease are two types of idiopathic microscopic colitis-collagenous colitis and lymphocytic colitis. These disorders share many clinical and histologic features, but they have a few notable differences. Whether these are two distinct entities or different presentations of the same disease remains controversial. Bismuth subsalicylate is effective in some patients and treatment is symptomatic and empirical in others. Unlike ulcerative colitis and Crohn's disease, these forms of inflammatory bowel disease rarely require surgery. Ileostomy with or without colectomy is curative for the rare patient with severe symptoms that are refractory to medical measures. Collagenous and lymphocytic colitis are not associated with an increased risk of malignancy.
59 citations
TL;DR: Histologic lesions of pouchitis are associated with a mucosal imbalance between EL-8 and IL-10, and EL-10 could be proposed as a new treatment for pouchitis.
Abstract: Background: Mucosal lesions of pouchitis are characterized by a neutrophil infiltrate. Interleukin (IL)-8 is the main mediator involved in neutrophil recruitment and is downregulated by IL-10. Aim: To look for an imbalance between IL-8 and IL-10 in patients with pouchitis. Patients/Methods: 18 patients having an ileoanal pouch for ulcerative colitis were studied. Eleven had pouchitis defined by the pouchitis disease activity index of ⩾7 points and 7 had no history of pouchitis. Biopsies taken at the site of inflammation or in the normal mucosa were scored for the histologic lesions, the intensity of neutrophil infiltration, and the presence of crypt abscesses. Mucosal IL-8 and IL-10 mRNA were quantified by competitive polymerase chain reaction. Results: IL-8, IL-10, and IL-10/IL-8 mRNA were similar in patients with or without pouchitis. IL-8 mRNA levels were significantly higher in patients with a histologic score >2 (p = 0.01) and in patients with crypt abscesses (p = 0.01). IL-10/IL-8 mRNA was significantly lower in patients having a histologic score >2 (p = 0.019), a neutrophil infiltration ⩾10% (p = 0.013), and crypt abscesses (p = 0.01). Conclusion: Histologic lesions of pouchitis are associated with a mucosal imbalance between EL-8 and IL-10. EL-10 could be proposed as a new treatment for pouchitis.
50 citations
01 May 2000
TL;DR: Observations suggest that in patients with both IBD and chronic obstructive pulmonary disease, α 1 AD testing should be considered, and may point to a unique phenotypic subgroup of patients with α 1AD and severe UC.
Abstract: Objective To evaluate a possible etiologic role of a α -antitrypsin deficiency (α 1 AD), most frequently caused by a Z allele mutation, in ulcerative colitis (UC) and Crohn disease (CD). Patients and Methods This retrospective study included 10 patients diagnosed with and/or treated for inflammatory bowel disease (IBD) between 1976 and 1997 and identified from the Mayo Clinic Medical Index System. All 10 patients had either α 1 AD and CD or α 1 AD and UC. The α 1 -antitrypsin (α 1 AT)types and levels were determined with isoelectric focusing testing. The allele types, representing genotypes, were designated PiZZ (or ZZ ) for homozygotes and PiMZ (or MZ ) for heterozygotes. Results Seven patients had UC: 4 were genotype ZZ and 3 MZ . Four of these 7 patients had emphysema, 2 had asthma, and 1 had chronic bronchitis. Five were cigarette smokers, but only 1 had smoked coincident with activity of her UC. Two of the UC patients never smoked, and 1 of these 2 had asthma. Three of the 10 patients had CD, 2 genotype ZZ and 1 MZ . Two of the 3 patients were longterm cigarette smokers, and both had emphysema. Nine of the 10 patients with UC and α 1 AD required surgery. Conclusions The need for surgery in patients with UC and α 1 -AD may point to a unique phenotypic subgroup of patients with α 1 AD and severe UC. Further studies are required to substantiate the etiologic role of α 1 AD in IBD. Our observations, if confirmed by future studies, suggest that in patients with both IBD and chronic obstructive pulmonary disease, α 1 AD testing should be considered.
39 citations
TL;DR: Early measles infection is associated with an increased risk of developing Crohn's disease and ulcerative colitis, and the risk may be higher with earlier infection.
36 citations
TL;DR: Intravenous azathioprine appears to be safe and of clinical benefit in inducing response and avoiding colectomy in severe steroid refractory ulcerative colitis and data from an i.v. azathyprine trial in Crohn’s disease suggests oral dosing alone may obtain the same results.
29 citations
TL;DR: Combination therapy with methotrexate and low‐dose oral cyclosporine did not alter methot Rexate pharmacokinetics and resulted in high rates of cyclosporaine‐associated toxicity.
Abstract: Introduction: This study reports the clinical outcome, toxicity, and methotrexate pharmacokinetics after the addition of low-dose cyclosporine to methotrexate in patients with ulcerative colitis or Crohn's disease. Methods: Three patients with steroid-refractory ulcerative colitis and two patients with steroid refractory Crohn's disease who failed monotherapy with subcutaneous methotrexate 25 mg/week for 16 weeks were treated with the combination of methotrexate and low-dose oral cyclosporine (3 mg/kg/day) for an additional 16 weeks. Clinical response was measured with the Inflammatory Bowel Disease Questionnaire (IBDQ) score. Concentrations of erythrocyte methotrexate, plasma methotrexate, and plasma 7-hydroxymethotrexate were also determined. Results: Both patients with Crohn's disease withdrew from the study for toxicity (headaches, seizure). The three patients with ulcerative colitis experienced clinical improvement with a mean increase in the IBDQ score from 164 to 190 points, p = 0.01. The mean serum creatinine in the three patients who completed the study increased from 0.9 mg/dL at baseline to 1.2 mg/dL at week 16, p = 0.04. One patient developed hypertension. There was no significant change from baseline in the concentrations of erythrocyte methotrexate, plasma methotrexate, and plasma 7-hydroxymethotrexate. Conclusions: Combination therapy with methotrexate and low-dose oral cyclosporine did not alter methotrexate pharmacokinetics and resulted in high rates of cyclosporine-associated toxicity.
16 citations
13 citations