Cyclosporine and Tacrolimus

Cyclosporine and tacrolimus are calcineurin phosphatase inhibitors used in a variety of GI disorders. It is used in patients with severe ulcerative colitis (UC) to prevent colectomy. It is also commonly used post-OLT. Cyclosporine and tacrolimus both cause osteopenia and osteoporosis by increasing bone turnover, which is reflected in high levels of osteocalcin (Epstein et al, 1995; Inoue et al, 2000). Renal transplantation patients given cyclosporine alone, however, did not have sig-

osteoclast precursor osteoclast precursor

FIGURE 55-3. Determinant of bone mineral density. IL = interleukin; TNF = tumor necrosis factor.

nificant bone loss at the end of 18 months whereas those treated with corticosteroids plus cyclosporine experienced the greatest losses suggesting corticosteroids are the worst offenders in this regard (Aroldi et al, 1997). Tacrolimus is associated with less bone loss, which is probably related to a decreased requirement for concurrent steroids (Monegal et al, 2001). Although not a justification for a colectomy, UC patients post-ileal pouch anal anastomosis have an improvement in BMD, again suggesting that correction of the underlying inflammatory problem as well as avoidance of glucocorticoids and cyclosporine results in improved BMD (Abitbol et al, 1997).

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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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