Impact of budesonide on liver function tests and gut inflammation in patients with primary sclerosing cholangitis and ileal pouch anal anastomosis

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• 作者：Udayakumar Navaneethan^a ; ¹ ; ² ; Preethi G.K. Venkatesh^a ; ¹ ; ³ ; Ana E. Bennett^b ; ⁴ ; Viral Patel^a ; ⁵ ; Jeffrey Hammel^a ; ⁶ ; Ravi P. Kiran^a ; ⁴ ; Arthur J. McCullough^a ; ⁷ ; Bo Shen^a ; ⁷ ; ^{shenb@ccf.org}
• 关键词：CI ; confidence interval ; ERCP ; endoscopic retrograde pancreatocholangiography ; FAP ; familial adenomatous polyposis ; IBD ; inflammatory bowel disease ; IPAA ; ileal pouch-anal anastomosis ; LFT ; liver function tests ; OR ; odds ratio ; OLT ; orthotopic liver trans
• 刊名：Journal of Crohn's and Colitis
• 出版年：2012
• 期刊代码：pca215_18739946
• 类别：med
• 出版时间：June, 2012
• 卷：6
• 期：5
• 页码：536-542
• 文件大小：444 K

摘要

Background and aim

Budesonide has been studied in patients with primary sclerosing cholangitis (PSC). This study was designed to evaluate the efficacy of oral budesonide on liver function tests in patients with PSC and pouchitis associated with ileal pouch-anal anastomosis (IPAA).

Materials and methods

The study group consisted of 18 pouch patients with underlying ulcerative colitis (UC) and PSC who were treated with 9 mg daily of budesonide for their underlying pre-pouch ileitis and pouchitis for 1-3 months followed by 3-6 mg maintenance for another 9 months. Demographic and clinical variables were analyzed.

Results

The mean age was 39.4 卤 12.4 years (range, 21-59 years). There was no significant change in aspartate aminotransferase (AST) [median (interquartile range) (IQR) 32 (25, 43.8) vs. 35.5 (25.5, 53), p = 0.35], alanine aminotransferase (ALT) [37.5 (25.5, 49.5) vs. 40 (30, 84.3), p = 0.29], alkaline phosphatase [142.5 (98.5, 264.5) vs. 126 (94.3, 189.5), p = 0.35], serum bilirubin [0.7 (0.4, 1.3) vs., 0.6 (0.4, 1.6), p = 0.13] or albumin levels [4.3 (3.9, 4.4) vs. 4.2 (3.8, 4.4), p = 0.22] at the end of the treatment period (1 year). The revised Mayo Risk Score did not change significantly and three patients required evaluation for liver transplantation during treatment. There was a significant improvement in the endoscopy subscores in the afferent limb and pouch after a year of budesonide treatment (p = 0.001).

Conclusions

Oral budesonide appears to have no impact on liver function tests in pouch patients with PSC. However it significantly improved afferent limb and pouch inflammation in IPAA patients.