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Background The impact of early treatment with immunomodulators ( IM) and/or TNF antagonists on bowel damage in Crohn's disease ( CD) patients is unknown. Aim To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis. Methods Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications. Results The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio ( HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery ( HR 0.322, P = 0.005), and perianal surgery ( HR 0.361, P = 0.042), as well as developing any complication ( HR 0.567, P = 0.006). Conclusions Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication. [ABSTRACT FROM AUTHOR]

Background/Aims: Herbal agents are popular and perceived as safe because they are supposedly ‘natural’. We report 10 cases of toxic hepatitis implicating Herbalife® products. Methods: To determine the prevalence and outcome of hepatotoxicity due to Herbalife® products. A questionnaire was sent to all public Swiss hospitals. Reported cases were subjected to causality assessment using the CIOMS criteria. Results: Twelve cases of toxic hepatitis implicating Herbalife® preparations (1998–2004) were retrieved, 10 sufficiently documented to permit causality analysis. Median age of patients was 51 years (range 30–69) and latency to onset was 5 months (0.5–144). Liver biopsy (7/10) showed hepatic necrosis, marked lymphocytic/eosinophilic infiltration and cholestasis in five patients. One patient with fulminant liver failure was successfully transplanted; the explant showed giant cell hepatitis. Sinusoidal obstruction syndrome was observed in one case. Three patients without liver biopsy presented with hepatocellular (2) or mixed (1) liver injury. Causality assessment of adverse drug reaction was classified as certain in two, probable in seven and possible in one case(s), respectively. Conclusions: We present a case series of toxic hepatitis implicating Herbalife® products. Liver toxicity may be severe. A more detailed declaration of components and pro-active role of regulatory agencies would be desirable. [Copyright &y& Elsevier]