une rch étendue - hepatowebhepatoweb.com/des/exposes/des12_2012_marteau/marteau_cc.pdf · une rch...
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Une RCH étendue
Département Médico-chirurgical de pathologie digestive - Hôpital Lariboisière - Philippe Marteau
Melle S… 26 ans
Rectorragies, glaires, 4 à 5/j, selles urgentes, depuis 4 semaines Température normale, abdomen souple, fréq. cardiaque 72/min Antécédent d’asthme, pas de voyage, pas de médicament RCH jusqu’à l’angle colique droit à limite supérieure nette Copro parasito négatives, éosinophiles 635/mm3, biopsies RCH
QUE FAITES VOUS ?
https://www.ecco-ibd.eu/publications/ecco-guidelines-publications.html
Active disease ECCO Statement: Extensive colitis
Extensive ulcerative colitis of mild-moderate severity should initially be treated with mesalazine >2g/day [EL1a, RG A], combined with topical mesalazine [EL1b, RG A]
Oral aminosalicylates alone induce remission only in a minority of patients [EL1a, RG A]….
Patients 116 patients
Mild to moderate exacerbation of extensive UC (UCDAI ≥3 and ≤8)
Exclusion criteria: ● maintenance treatment with aminosalicylates > 3 g/d ● corticosteroids ● immunosuppressive agents
Methods Double-blind, parallel-group, placebo-controlled RCT
For 8 weeks, each patient received 4 g/d 5-asa orally
During the initial 4 weeks, each patient additionally applied daily a 100 mL enema at bedtime, either containing 1 g 5-asa or placebo
Evaluation ● at inclusion, 4 weeks and 8 weeks ● UCDAI
Marteau et al. Gut 2005;54:960-5
0102030405060708090100
Rem. Imp. Rem. Imp.
week 4 week 8
%
P=0.308 P=0.030
P=0.026
Pentasa per os + lavement de pentasa
Pentasa per os + lavement placebo
Marteau et al. Gut 2005;54:960-5
* * *
Time to cessation of rectal bleeding Patients with frank bleeding at baseline
Systemic corticosteroids are appropriate if symptoms of active colitis do not respond rapidly to mesalazine [EL1b, RG C], or for patients who are already taking appropriate maintenance therapy
Active disease ECCO Statement: Extensive colitis
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