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Crohn's disease is associated with involuntary weight loss in up to 75% of patients, due to diminished oral intake,malabsorbtion, and an increased total energy expenditure(1). This loss of mass is associated with an initial decrease in fat stores and later in lean body mass(2). Coticosteroid therapy produces further malnutrition and catabolism of protein resulting in markedly diminished fat and protein stores. Nutritional supplementation in these individuals has been limited to oral,enteral and parenteral support,which mainly serve to replenish fat stores while minimally affecting lean body mass.
We report the case of an individual treated with oxandrolone,an anabolic steroid effective in inducing protein synthesis,for cachexia in the context of Crohn's disease.
The patient is a 29-yr-old woman with Crohn's disease diagnosed at age 20,who presented on 2/12/96 with severe wasting and a history of prednisone use since her initial diagnoses.
Physical examination revealed a cachetic, 160-cm tall,35.7-kg woman(60% of ideal body weight), with complaint of upper abdominal pain and oral thrush. Bioelectric impedence analysis(BIA) on 2/20/96 showed a fat mass(FM) of 0.6kg, a fat-free(FFM) of 35.0 kg, with a body cell mass(BCM) of 13.9 kg and a phase angle of 3.9 degrees. The patient was started on a daily oxandrolone at 7.5mg b.i.d. a typiacal regimen for a patient with HIV-associated wasting. Her other medications included prednisone 60mg q.d. pentasa 1g q.i.d. and ferrous sulfate supplementation.
The patient continued oxandrolone, which was later increased to 10mg b.i.d. on 3/26/96, and showedmarked improvement in all aspects of her BIA. In addition, the oral thrush noted on initial presentation was absent on further examinations, and the patient subjectively reported that she felt more energetic than she had in years. On day 98 of treatment(5/28/96), oxandrolone was discontinued due to an increase in facial hair noted by the patient. BIA on 7/16/96 revealed a total body weight of 48.2kg, FM of 10.7 kg, FFM of 37.5 kg, with a BCM of 16.3 kg and a phase angle of 4.7 degrees.
Oxandrolone therapy is currently used in patients with weight loss after surgery or severe trauma, with chronic infections, with prolonged corticosteroid use, and for some patients without known reason who fail to gain weight.(3). Recently, HIV-associated wasting has also been treated with this medication due to the very low risk:benefit ratio. Multiple studies have demonstrated the efficacy and safety of oxandrolone(4,5). In addition nutrition in HIV, specifically the phase angle, has been shown to be an even stronger predictor of survival than CD4 count(6).
We decided to initiate therapy in our patient to promote weight gain and to counteract the the protein catabolism caused by high-dose prednisone use. Much of the weight loss that occurs in Crohn's disease is secondary to lipid oxidation(2). However once a patient is depleted of fat stores, protein, including body cell mass is catabolized. Our patient also had oral thrush, a sign of immuno-suppresion. While thrush may have been a consequence of corticosteroid treatment, once the patient started to gain weight, it resolved despite the continued use of prednisone.
Although the most significant improvement in BIA occurred in the fat compartment(+10.1kg), this patient also showed substantial increase in BCM (+2.4 kg), as well as phase angle (5.0 angle on 5/28/96).
Follow-up with this patient over 1 yr after treatment discontinuation showed maintenance of body weight (56.8 kg on 7/21/96) and well-being
Nutritional supplementation with TPN in Crohn's disease has been shown to substantially replace fat losses and water, but has little effect on lean mass(1). Enteral feeding aids in protein as well as fat and water repletion, though it requires feeding through a nasogastric or nasoduodenal tube(7). Oxandrone therapy allows for protein repletion via a non-invasive and safe oral medication.Based on these results, we will expand the use of oxandrolone in our practice to include severe weight loss in Crohn's disease.
REFERENCES
1. Fleming CR. Nutrition in patients with Crohn's disease: Another piece of the puzzle. J Parenter Enteral Nutr 1995; 19:93-4.
2. Mingrone G Greco AV, Benedetti G, et al. Increased resting lipid oxidation in Crohn's disease. Dig Dis Sci 1996;41: 72-6
3. Ferraresi RW. Clinical profile of Oxandrin. BTG Pharmaceuticals 1996; 1-7.
4. Berger JR, Pall L. Hall CD, et al. Oxandrolone in AIDS-wasting myopathy. AIDS 1996;10: 1657-62
5. Poles MA, Meller JA, Lin A et al. Oxandrolone as a treatment for AIDS-related weight loss and wasting. Presented at the Infectious Disease Society of America Conference, New Orleans, LA, September 19, 1996
6. Ott M, Fischer H, Polat H, et al. Bioelectrical impedence analysis as a predictor of survival in patients with human immunodificiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 9: 20-5.
7. Royall D, Greenburg GR, Allard JP, et al. Total enteral nutrition support improves body composition of patients with active Crohn's disease. J Parenter Enteral Nutr 1995; 19: 95-9.
This amount of typing suckks! I'm buying a scanner tomorrow!
Peace.....B32
We report the case of an individual treated with oxandrolone,an anabolic steroid effective in inducing protein synthesis,for cachexia in the context of Crohn's disease.
The patient is a 29-yr-old woman with Crohn's disease diagnosed at age 20,who presented on 2/12/96 with severe wasting and a history of prednisone use since her initial diagnoses.
Physical examination revealed a cachetic, 160-cm tall,35.7-kg woman(60% of ideal body weight), with complaint of upper abdominal pain and oral thrush. Bioelectric impedence analysis(BIA) on 2/20/96 showed a fat mass(FM) of 0.6kg, a fat-free(FFM) of 35.0 kg, with a body cell mass(BCM) of 13.9 kg and a phase angle of 3.9 degrees. The patient was started on a daily oxandrolone at 7.5mg b.i.d. a typiacal regimen for a patient with HIV-associated wasting. Her other medications included prednisone 60mg q.d. pentasa 1g q.i.d. and ferrous sulfate supplementation.
The patient continued oxandrolone, which was later increased to 10mg b.i.d. on 3/26/96, and showedmarked improvement in all aspects of her BIA. In addition, the oral thrush noted on initial presentation was absent on further examinations, and the patient subjectively reported that she felt more energetic than she had in years. On day 98 of treatment(5/28/96), oxandrolone was discontinued due to an increase in facial hair noted by the patient. BIA on 7/16/96 revealed a total body weight of 48.2kg, FM of 10.7 kg, FFM of 37.5 kg, with a BCM of 16.3 kg and a phase angle of 4.7 degrees.
Oxandrolone therapy is currently used in patients with weight loss after surgery or severe trauma, with chronic infections, with prolonged corticosteroid use, and for some patients without known reason who fail to gain weight.(3). Recently, HIV-associated wasting has also been treated with this medication due to the very low risk:benefit ratio. Multiple studies have demonstrated the efficacy and safety of oxandrolone(4,5). In addition nutrition in HIV, specifically the phase angle, has been shown to be an even stronger predictor of survival than CD4 count(6).
We decided to initiate therapy in our patient to promote weight gain and to counteract the the protein catabolism caused by high-dose prednisone use. Much of the weight loss that occurs in Crohn's disease is secondary to lipid oxidation(2). However once a patient is depleted of fat stores, protein, including body cell mass is catabolized. Our patient also had oral thrush, a sign of immuno-suppresion. While thrush may have been a consequence of corticosteroid treatment, once the patient started to gain weight, it resolved despite the continued use of prednisone.
Although the most significant improvement in BIA occurred in the fat compartment(+10.1kg), this patient also showed substantial increase in BCM (+2.4 kg), as well as phase angle (5.0 angle on 5/28/96).
Follow-up with this patient over 1 yr after treatment discontinuation showed maintenance of body weight (56.8 kg on 7/21/96) and well-being
Nutritional supplementation with TPN in Crohn's disease has been shown to substantially replace fat losses and water, but has little effect on lean mass(1). Enteral feeding aids in protein as well as fat and water repletion, though it requires feeding through a nasogastric or nasoduodenal tube(7). Oxandrone therapy allows for protein repletion via a non-invasive and safe oral medication.Based on these results, we will expand the use of oxandrolone in our practice to include severe weight loss in Crohn's disease.
REFERENCES
1. Fleming CR. Nutrition in patients with Crohn's disease: Another piece of the puzzle. J Parenter Enteral Nutr 1995; 19:93-4.
2. Mingrone G Greco AV, Benedetti G, et al. Increased resting lipid oxidation in Crohn's disease. Dig Dis Sci 1996;41: 72-6
3. Ferraresi RW. Clinical profile of Oxandrin. BTG Pharmaceuticals 1996; 1-7.
4. Berger JR, Pall L. Hall CD, et al. Oxandrolone in AIDS-wasting myopathy. AIDS 1996;10: 1657-62
5. Poles MA, Meller JA, Lin A et al. Oxandrolone as a treatment for AIDS-related weight loss and wasting. Presented at the Infectious Disease Society of America Conference, New Orleans, LA, September 19, 1996
6. Ott M, Fischer H, Polat H, et al. Bioelectrical impedence analysis as a predictor of survival in patients with human immunodificiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 9: 20-5.
7. Royall D, Greenburg GR, Allard JP, et al. Total enteral nutrition support improves body composition of patients with active Crohn's disease. J Parenter Enteral Nutr 1995; 19: 95-9.
This amount of typing suckks! I'm buying a scanner tomorrow!
Peace.....B32
