Initial response rates 70-90%
One Treatment = 50% relapse at 6m
Better outcomes with Vigorous (Type 3) Achalasia + Multiple Rx (esp if repeated at 1m) = 60-85% success at 2 year review

Faecal calprotectin is a neutophil degradation product which can be used as a non-invasive marker of inflammation. My own published research demonstrated a direct correlation between its presence and quantity with the endoscopic and histological assessments of inflammation within the bowel. A significant number of trials have been performed to demonstrate its usefulness in differentiating between organic (eg. IBD) and functional (eg. IBS) bowel disease with a high degree of sensitivity and specificity.

We aim to use it as a marker to monitor our stable IBD patients on patient self management programmes, and hope to publish data shortly on its effective use in reducing unnecessary colonoscopy.

P. Rutgeerts’ Leuven group have just released their outcome data from performing 237 stricture dilatations in 138 Crohn’s patients. This is the largest series to-date with the longest follow-up (5.8 years)

Immediate success was seen in 97%, with 46% requiring a repeat dilatation after a mean time of 12.5 months. In the long term surgery was still required in 24%, however, 76% avoided surgery and its associated morbidity and mortality rates. Serious adverse events did occur with thenedoscopic dilatation in 5.1% of cases (6/237 perforations, 5/237 GI bleeds and 1/237 acute abdominal pain requiring hospitalisation).

The procedures were performed with Boston Scientific water filled Rigiflex balloons (8cm long, 18mm diameter). A multistep inflation protocol was used (2 minutes at 15 – 16.5 – 18mm) and repeated if neccessary. Patients were observed for 1 hour after. In general this proved to be a very safe technique and the efficacy of endoscopic dilatation was felt to outweigh the complication risk.

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