Original Article
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©2010 Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2010; 16(20): 2484-2495
Published online May 28, 2010. doi: 10.3748/wjg.v16.i20.2484
Table 1 Details of patients’ data
Case No. Sex Age (yr) Type of disease Anal lesion Disease duration Previous segmental resection Initial onset or relapse Hospitalization Fistula Tag On admission Main medication Duration of SVD (d) On discharge CDAI CRP (mg/dL) CDAI CRP (mg/dL) Morphology 1 F 52 C - - < 1 mo - I 161 0.6 Sulfasalazine 58 25 0.9 Active (CS) 2 M 22 C + + 4 yr and 3 mo + R 264 3.1 Infliximab 55 62 0 NT 3 F 21 EC + - 5 yr and 8 mo - R 133 6.3 Infliximab 48 38 0 NT 4 M 22 EC + - 5 yr and 3 mo - R 679 5.9 Infliximab 82 72 0.1 Remission (CS) 5 M 23 EC + - < 2 mo - I 235 1.5 Infliximab 55 98 0.1 Near remission (CS) 6 M 28 C - - 2 mo - I 88 2.5 Infliximab 68 59 0.5 Near remission (CS) 7 F 77 C - - 1 yr and 10 mo - R 233 13.8 Infliximab 49 39 0 Remission (CS and BE) 8 M 30 C + - 6 mo - I 281 4.6 Infliximab 50 39 0.1 Remission (CS) 9 M 55 C + + 8 mo - I 172 1.0 Infliximab 46 67 0.5 Remission (CS and BE) 10 M 19 EC + - 4 mo - I 147 0.8 Infliximab 43 40 0 Remission (CS and BE) 11 F 21 EC - + 3 mo - I 335 6.0 Infliximab 49 47 0.3 Improved still active (CS and BE) 12 F 50 E - - 1 mo - I 488 5.1 Infliximab 43 53 0 Remission (CS) 13 M 28 C - - 3 mo - I 52 0.6 Infliximab 50 2 0 Remission (CS) 14 M 19 EC + + 2 yr and 1 mo - I 193 0.8 Infliximab 43 35 0 Near remission (CS and BE) 15 M 29 C + - 1 yr and 4 mo - I 126 0.2 Infliximab 43 8 0 Improved still active (CS) 16 M 30 C + - 1 yr and 1 mo - I 211 11.8 Infliximab 47 28 0.8 Near remission (CS and BE) 17 F 21 EC - + 6 yr and 2 mo - R 544 3.7 Infliximab 46 64 0.3 Improved still active (BE) 18 F 45 EC - - 13 yr + R, PO 21st d 143 0.2 Metronidazole 19 105 0.1 NT 19 M 21 EC + + 2 yr - I, PO 13th d 217 1.1 Metronidazole 18 166 0.1 NT 20 M 34 EC - - 17 yr - R, PO 12th d 146 0 Metronidazole 24 108 0.1 NT 21 M 25 C - + 13 yr - R, PO 17th d 372 7.1 Metronidazole 21 149 0 NT 22 F 23 EC - - 8 yr - R, PO 25th d 151 8.0 Metronidazole 83 141 0.8 NT
Table 2 Nutritional data and hemoglobin during hospitalization
Case No. Dietary pattern before hospitalization Hospitalization On admission On discharge BMI (kg/m2 ) Albmin (g/dL) Chol (mg/dL) ChE (IU/mL) Hemoglobin (g/dL) BMI (kg/m2 ) Albmin (g/dL) Chol (mg/dL) ChE (IU/mL) Hemoglobin (g/dL) 1 Pro-Japanese 21.1 4.7 155 4929 14.8 20.5 4.1 145 4959 13.0 2 Standard 17.2 3.8 140 4059 14.0 17.1 4.5 145 4170 15.5 3 Japanese 17.2 3.7 102 2003 8.3 19.2 4.0 152 4117 11.1 4 Pro-Japanese 18.5 2.8 100 789 8.6 17.9 3.0 116 1876 12.7 5 Pro-western 17.7 4.8 132 5592 15.8 17.0 4.2 135 5057 14.4 6 Pro-western 21.3 3.0 122 2876 10.8 20.7 4.4 192 4321 10.8 7 Pro-Japanese 17.2 2.1 95 1549 7.5 16.8 3.2 177 2633 11.6 8 Pro-western 19.2 3.2 128 3441 12.6 18.3 4.2 114 4911 14.3 9 Japanese 19.7 3.9 190 5094 13.0 18.2 4.1 221 4602 14.1 10 Pro-western 17.6 4.0 147 4505 13.5 17.6 4.5 154 4725 13.7 11 Standard 19.8 3.7 147 4081 9.5 18.4 3.9 125 4837 10.3 12 Standard 24.1 4.4 149 5156 11.0 21.4 4.3 158 6626 10.7 13 Standard 24.4 4.6 151 4599 16.2 22.5 4.4 143 4376 15.1 14 Pro-western 19.0 4.7 167 5722 15.0 18.8 4.4 138 4861 16.0 15 Pro-western 24.1 4.6 188 5755 15.4 22.4 4.5 137 5643 15.8 16 Pro-western 22.5 3.7 138 3757 12.3 21.4 4.4 116 4304 14.3 17 Standard 18.8 3.8 187 2700 10.6 18.1 4.1 209 2798 11.8 18 Pro-Japanese 21.6 4.1 126 7943 10.7 21.9 3.9 129 9098 10.8 19 Pro-western 20.1 4.1 150 3320 11.0 20.1 4.2 152 3426 11.8 20 Polymeric diet 18.1 3.9 100 3512 11.0 17.9 4.1 130 3757 13.4 21 Standard 15.6 3.5 116 3387 10.2 15.6 4.0 138 3870 11.9 22 Pro-Japanese 16.5 3.2 58 2320 9.9 16.0 2.9 78 3355 9.8
Table 3 Lifestyle and dietary habits
Every day 3-5 times/wk 1-2 times/wk Rare None Smoking (No. of cigarettes/d) 20 ≤ 6-19 1-5 Rare P Regular exercise R R R P Alcohol P Eating between meals P R R Type of diet (D) Semi-vegetarian (R) Japanese Pro-Japanese Standard/mixed Pro-western (P) Food Rice P Miso soup P Pulses R P Vegetables R P Udon/soba (Japanese noodles) P Ramen (Chinese noodles) P R Bread (D) P R Tea, coffee Canned coffee (P) R (Sugar in tea or coffee) (D) Large amount (P) Average amount Small amount Rare None (R) Juice P R R Cola/soda P Beef P R Pork/chicken (D) P R Minced or processed meat P R Fish P Cheese/butter/margarine P R Sweets (D) P R R Ice cream/milk shake P Yoghurt (plain) R P Green tea (D) R P Potatoes/starches (D) R P Fruits (D) R P
Table 4 Content of semi-vegetarian diet (2000 kcal/d)
SVD DRI Energy Protein (%) 16.1 ± 0.5 < 20 Fat (%) 18.6 ± 1.4 20-30 Carbohydrate (%) 66.1 ± 1.6 50-70 Content Protein (g) 80.3 ± 3.0 M 60, F 50 Fat (g) 41.4 ± 3.6 Carbohydrate (g) 330.2 ± 11.4 Dietary fiber (g) 32.4 ± 2.1 M 20, F 17 Soluble dietary fiber (g) 6.8 ± 0.7 Insoluble dietary fiber (g) 23.3 ± 1.6 Calcium (mg) 873.7 ± 65.2 M 600-650, F 600 Phosphorus (mg) 1882.7 ± 101.8 M 1050, F 900 Iron (mg) 19.3 ± 1.3 M 7.5, F 10.5 Sodium (mg) 4492.9 ± 342.1 600 Kalium (mg) 4281.7 ± 250.6 M 2000, F 1600 Vitamin A (μgRE) 1416.6 ± 360.9 M 750, F 600 Vitamin B1 (mg) 2.0 ± 0.2 M 1.4, F 1.1 Vitamin B2 (mg) 1.3 ± 0.2 M 1.6, F 1.2 Niacin (mg) 26.6 ± 3.1 M 15, F 12 Vitamin C (mg) 133.1 ± 23.4 100 Vitamin D (μg) 3.2 ± 1.0 5 Vitamin E (mg) 12.3 ± 1.9 M 9, F 8 Cholesterol (mg) 285.9 ± 72.1 M < 700, F < 600 NaCl (g) 10.9 ± 0.8 M < 10, F < 8 Polyunsaturated fatty acid (g) 13.9 ± 1.9 Monounsaturated fatty acid (g) 9.3 ± 0.9 Saturated fatty acid (g) 7.1 ± 0.9 P:S ratio 2.0 ± 0.2
Table 5 Follow-up study
Case No. Main medication Dietary pattern Days of remission Reason for termination On final attendance Month 3 Year 1 Year 2 On relapse CDAI CRP (mg/dL) BMI (kg/m2 ) Alb (g/dL) Chol (mg/dL) ChE (IU/mL) Hemoglobin (g/dL) 1 SSZ for 1 yr SVD SVD SVD 730 Completion 0 0.1 23.1 4.5 235 5684 14.4 2 Mesalamine SVD Omni Omni 301 Relapse 193 8.2 17.5 3.8 151 3262 13.8 3 Mesalamine SVD Omni Omni 367 Relapse 167 11.3 21.1 3.5 133 3551 10.0 4 Mesalamine SVD SVD SVD 730 Completion 128 5.0 18.7 2.8 114 1113 9.3 5 SSZ for 1 yr SVD SVD 523 Moving 39 0 19.4 4.5 194 5509 15.0 6 Mesalamine Omni Omni 191 Relapse 192 5.7 21.7 3.9 134 3052 7.9 7 None SVD SVD 442 INFX for RA 61 2.0 19.6 4.0 158 5068 10.9 8 Mesalamine SVD SVD SVD 635 Relapse 174 7.6 19.1 3.1 88 2678 11.3 9 Mesalamine Omni Omni Omni 730 Completion 48 0.2 19.8 4.3 171 5461 15.2 10 Mesalamine SVD SVD SVD 730 Completion 18 0.1 18.2 5.1 181 4659 16.3 11 Mesalamine SVD SVD SVD 730 Completion 11 0 19.7 4.7 147 5215 13.9 12 Mesalamine SVD SVD SVD 730 Completion 45 0 20.2 4.7 163 6268 11.3 13 Mesalamine SVD SVD SVD 730 Completion 0 0 22.8 4.6 171 4770 15.6 14 Mesalamine SVD SVD 666 Ongoing 27 0.1 19.3 4.7 188 6084 15.1 15 Mesalamine SVD Omni 560 Ongoing 0 0 22.6 4.8 185 5671 16.8 16 Mesalamine SVD SVD 440 Ongoing 19 1.9 21.8 4.4 141 5146 14.2 17 Mesalamine SVD SVD 397 Ongoing 32 2.0 22.5 3.6 216 2683 11.1 18 Mesalamine SVD SVD SVD 730 Completion 25 0.4 22.6 3.7 151 10222 11.1 19 Mesalamine SVD SVD SVD 730 Completion 62 0 20.1 4.7 139 4391 13.3 20 None SVD SVD SVD 730 Completion 37 0.7 18.2 4.5 156 5655 13.2 21 SSZ SVD SVD SVD 730 Completion 16 0.1 19.0 4.9 205 6424 14.4 22 Mesalamine SVD Omni Omni 630 Relapse 118 5.1 22.1 3.5 84 3596 10.1
Table 6 Maintenance therapy in Crohn's disease following induction of remission or response
Induction therapy Maintenance therapy Subjects Regimen Regimen Duration 1 yr 2 yr Candy et al [55 ], 1995 CDAI > 200 PS (diminishing dose) + AZA 12 wk AZA 2.5 mg/kg Remission rate 42% (14/33) Placebo 7% (2/30) Hanauer et al [56 ], 2002 CDAI ≥ 220 Gr (1) and Gr (2) Gr (1) INFX 5 mg/kg every 8 wk Remission rate 25% (28/113) Responder to a single infusion of infliximab INFX 5 mg/kg at weeks 0, 2, 6 Gr (2) INFX 10 mg/kg every 8 wk 33% (37/112) Gr (3) INFX 5 mg/kg then placebo infusion at weeks 2, 6 Gr (3) placebo infusion every 8 wk 11% (12/110) Sandborn et al [58 ], 2005 Mild to moderate CD Budesonide 6 mg or 3 mg Budesonide 6 mg or 3 mg Relapse rate 60%-70% Placebo (In all 3 groups) Takagi et al [39 ], 2006 Active CD TPN (25 cases), TEN (22 cases), ED (half) + a free diet (half) Relapse rate 26.9% (7/26) PS (1 case), INFX (3 cases) A free diet 64.0% (16/25) Regueiro et al [59 ], 2009 CD patients who had surgery Ileocolonic resection INFX 5 mg/kg at weeks 0, 2, 6 Remission rate 80% (8/10) then every 8 wk Placebo 58% (7/13) Present study Active CD INFX 5 mg/kg at weeks 0, 2, 6 (16 cases), intestinal resection (5 cases), SSZ (1 case) Semi-vegetarian diet Remission rate 100% (16/16) 92% Omnivorous diet 67% (4/6) 25%
Table 7 Conventional and current diet in IBD at Nakadori General Hospital
Conventional Current Diet Low-residue diet Semi-lactoovovegetarian diet Menu Common for UC and CD SVD for UC (staple: white rice) SVD for RUC (staple: white rice 70%, brown rice 30%) SVD for CD (staple: brown rice) Refrainment Fiber-rich diet Minced or processed meat, bread, fast foods, sweets, cola/soda, juices Dairy products Refrainment Egg, milk: no refrainment Refrain from cheese/butter/margarine Calories 2000 kcal/d About 30 kcal/kg standard body weight/d Dietary analysis Absent Food-frequency questionnaire Dietary guidance Absent Guidance by doctor and registered dietitian