Nontoxic Gluten for Celiac Patients
A Dutch study of different wheat varieties has shown that sufficient genetic variation exists to justify continuing the search for wheat with low amounts of the T-cell-stimulatory epitopes that trigger celiac disease, the most common food intolerance in the Western Hemisphere.
Liesbeth Spaenij-Dekking of Leiden (the Netherlands) University Medical Center and her colleagues prepared gluten samples from selected wheat varieties and then tested the gluten for the presence of T-cell-stimulatory epitopes. They used T-cell clones that were generated from small intestine biopsy specimens of celiac disease (CD) patients (Gastroenterology 2005;129:797–806).
The research team found “striking differences” in the clones' responses to individual wheat preparations, independent of the genome background of the accessions. They concluded that “this is promising for future breeding programs aimed at generating new varieties that will be acceptable for the manufacturing of food products for CD patients.”
In an accompanying editorial, Marco Londei of University College, London, and his associates point out that the current CD therapy of a gluten-free diet is neither easy to follow nor foolproof, as gluten can contaminate many foods during processing and preparation (Gastroenterology 2005;129:1111–3).
Reflux-Related Sleep Disorders
Acid suppression therapy significantly reduced the loss of workplace productivity in patients with gastroesophageal reflux disease-related sleep disorder, according to the first large, randomized controlled trial conducted on such therapy.
David A. Johnson, M.D., of Eastern Virginia School of Medicine, Norfolk, and his colleagues concluded that esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances, improving work productivity and sleep quality as measured by the Pittsburgh Sleep Quality Index questionnaire (Am. J. Gastroenterol. 2005;100:1914–22).
The 675 eligible patients were randomized to three treatment groups: esomeprazole 40 mg, esomeprazole 20 mg, and placebo; 650 of the patients were included in the efficacy analyses. Moderate to severe nighttime heartburn was relieved in 53.1% (111/209), 50.5% (111/220), and 12.7% (28/221) of patients receiving esomeprazole 40 mg, esomeprazole 20 mg, and placebo, respectively.
Certolizumab for Crohn's Disease
Certolizumab pegol (CDP870), a polyethylene glycolated Fab' fragment of a humanized anti-tumor necrosis factor-á monoclonal antibody, may be effective at a 400-mg subcutaneous dose and is well tolerated in patients with moderate to severe Crohn's disease, a placebo-controlled, phase II study showed.
Stefan Schreiber of the Hospital for General Internal Medicine and the Institute for Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany, and his colleagues conducted an international study of 292 patients at 58 centers in 10 countries. The researchers concluded that, while ongoing phase III studies are necessary to confirm their finding of clinical efficacy, the treatment had no untoward effects according to serial hematologic and biochemical measurements (Gastroenterology 2005;129:807–18).
However, the results were somewhat compromised by high placebo response rates in a patient subgroup with low C-reactive protein (CRP) levels. In a related editorial, the role of CRP levels was emphasized as potentially helping physicians to improve treatment of patients in routine clinical care. “With increasing development of expensive, and potentially toxic, therapies, we need to optimize the benefit-to-risk profile of our therapies,” noted James D. Lewis of the University of Pennsylvania, Philadelphia (Gastroenterology 2005;129:1114–6).
Treating Bleeding Peptic Ulcer
According to a metaanalysis of randomized controlled trials comparing endoscopic and medical interventions for bleeding peptic ulcer with adherent clot, the two are comparable in terms of need for surgical intervention, length of hospital stay, transfusion requirement, and mortality, but endoscopic therapy is superior for preventing recurrent hemorrhage.
Charles J. Kahi of Indiana University Medical Center, and Roudebush Veterans Affairs Medical Center, Indianapolis, and his colleagues identified six studies including 240 patients, of whom 61 underwent endoscopic clot removal and treatment with thermal energy, electrocoagulation, and/or injection of sclerosants. Another 85 patients received medical therapy including transfusions as needed, monitoring in the intensive care unit if indicated, and acid suppression with intravenous H2 blockers and a proton pump inhibitor (Gastroenterology 2005;129:855–62).
The metaanalysis showed that rebleeding occurred in 5 of the 61 endoscopic therapy patients (8.2%) versus 21 of the 85 (24.7%) medical therapy patients.