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Background and Aims Evidence on the safety of newer biologics during pregnancy is limited. We aimed to assess the safety of ustekinumab and vedolizumab treatment during gestation on pregnancy and infant outcome. Furthermore, we evaluated the placental transfer of these agents. Methods We performed a prospective, multicentre, observational study in consecutive women with inflammatory bowel disease exposed to ustekinumab or vedolizumab 2 months prior to conception or during pregnancy. Pregnancy, neonatal, and infant outcomes were evaluated and compared with the anti-tumour necrosis factor [TNF]-exposed control group. Drug levels were assessed in maternal and cord blood at delivery. Results We included 54 and 39 pregnancies exposed to ustekinumab and vedolizumab, respectively. In the ustekinumab group, 43 [79.9%] resulted in live births, and 11 [20.4%] led to spontaneous abortion. Thirty-five [89.7%] pregnancies on vedolizumab ended in a live birth, two [5.1%] in spontaneous, and two [5.1%] in therapeutic abortion. No significant difference in pregnancy outcome between either the vedolizumab or the ustekinumab group and controls was observed [p >0.05]. Similarly, there was no negative safety signal in the postnatal outcome of exposed children regarding growth, psychomotor development, and risk of allergy/atopy or infectious complications. The median infant-to-maternal ratio of ustekinumab levels was 1.67 and it was 0.59 in vedolizumab. Conclusions Use of ustekinumab and vedolizumab in pregnancy seems to be safe, with favuorable pregnancy and postnatal infant outcomes. Placental transfer differed between these two drugs, with ustekinumab having similar and vedolizumab having inverse infant-to-maternal ratio of drug levels compared with anti-TNF preparations.

Purpose We aimed to evaluate the diagnostic performance of computed tomography colonography (CTC) in the detection of internal hemorrhoids. Methods Three gastroenterologists systematically reported on the presence of internal hemorrhoids in patients with incomplete colonoscopy, for whom they considered a subsequent CTC. For 44 patients with internal hemorrhoids revealed by optical colonoscopy, an age- and gender-matched cohort of 66 patients with normal findings in the rectum was selected. Endoluminal and transaxial CTC views of the rectum were evaluated for the presence of internal hemorrhoids, the anal verge prominence, asymmetry, and cushion-like appearance on a Likert scale by two experienced radiologists and two gastroenterologists. Results The sensitivity, specificity, and AUC for identification of internal hemorrhoids were 0.61 (95% CI, 0.53-0.68), 0.69 (95% CI, 0.63-0.75) and 0.66 (95% CI, 0.62-0.70), respectively. The radiologists showed a better specificity, the gastroenterologists a slightly better sensitivity. When only the rating "very likely" was considered as positive, the specificity rose to 0.89 (95% CI, 0.81-0.94) with a sensitivity of 0.50 (95% CI, 0.38-0.62). The interobserver agreement was fair. The best predictor of the presence of hemorrhoids was a prominent anal verge in the supine position (OR=1.789, 95% CI, 1.267-2.525). The difference between supine and prone positions in the evaluated features in patients with internal hemorrhoids was not significant. Conclusion CTC has low sensitivity but high specificity in the detection of internal hemorrhoids, if the rater is confident in detecting them. Internal hemorrhoids do not substantially change their shape between prone and supine positions.

L’endoscopie par capsule (EC) utilisant le systeme Given Imaging, est disponible en Republique tcheque depuis fin 2002. Le but de cette etude retrospective a ete d’evaluer l’experience existante de la capsule endoscopique dans cinq centres de gastroenterologie de notre pays. Soixante dix-huit EC ont ete colligees (de novembre 2003 a avril 2004) concernant 38 hommes et 40 femmes (âge moyen: 54 ans). L’EC etait indiquee comme derniere etape dans l’algorithme diagnostique. La totalite de l’intestin grele a pu etre investiguee dans 54 cas sur 78 (69 %). Les angiodysplasies ont ete le plus frequemment retrouvees (16 patients), puis la maladie de Crohn (8 patients) et enfin, les tumeurs du grele (7). L’EC a ete suivie d’un geste chirurgical chez 15 patients, d’une enteroscopie per operatoire chez 9 patients et un traitement medical a ete initie ou modifie chez 26 patients. Une retention de la capsule a ete observee dans 5 cas (6 % et une impaction dans le grele dans 3 cas); un echec technique a ete rapporte dans 5 cas (6 %). L’EC est une methode complementaire qui n’entre pas en competition avec les autres outils diagnostiques d’investigation du grele. L’EC est particulierement precieuse en cas de saignement GI obscur. Cependant, notre experience reste jusqu’a present, assez limitee. Capsule endoscopy (CE), using a Given Imaging system, is available in the Czech Republic since late 2002. The aim of this retrospective study was to evaluate the existing experience with CE in five gastroenterology centers in the Czech Republic. Seventy-eight CE were reviewed (Nov 2002 – Apr 2004), 38 men, 40 women (mean age 54). CE was indicated as the last step in diagnostic algorithm. The entire small bowel was investigated in 54/78 cases (69 %). The most frequent findings were angiodysplasias (16 patients), Crohn’s disease (8) and small bowel tumours (7). CE was followed by surgery (15 pts), intraoperative enteroscopy (9 pts) and medical treatment was introduced or changed in 26 pts. Capsule retention was found in 5 cases (6 %; small bowel impaction in 3 cases), technical failure was noticed 5 times (6 %). CE is complementary, not competing with other diagnostic tools in the investigation of the small bowel. CE is helpful namely in obscure GI bleeding. However, the existing experience is limited so far.

To evaluate the frequency of the loss of the Adenomatous Polyposis Coli (APC) protein and to compare the APC status with the characteristics of colorectal adenomas.Immunohistochemical analysis of the APC protein was performed on 118 adenomas and the results were compared with parameters of malignant potential, location of adenomas, macroscopic appearance and age of the patients.A complete loss of the APC protein was found in 28 (24%) adenomas, while 90 (76%) were APC positive. The mean size of adenomas was 13.5 +/- 14.2 mm (95% CI 10.5-16.5) in APC-positive, and 13.8 +/- 15.5 mm (95% CI 7.8-19.8) in APC-negative adenomas (P = 0.364). Statistical analysis revealed no difference between APC-positive and negative adenomas as to the histological type (P = 0.327) and grade of dysplasia (P = 0.494). We found that even advanced adenomas did not differ in their APC status from the non-advanced tumors (P = 0.414). Finally, no difference was found when the location (P = 0.157), macroscopic appearance (P = 0.571) and age of patients (P = 0.438) were analysed and compared between both APC positive and negative adenomas.Most adenomas expressed full-length APC protein, suggesting that protein expression is not a reliable marker for assessment of APC gene mutation. Complete loss of APC protein did not influence morphology, location, or appearance of adenomas, nor was it affected by the patient's age.