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Han B, Tang D, Lv X, Fan J, Li S, Zhu H, Zhang J, Xu S, Xu X, Huang Z, Huang Z, Lin G, Zhan L, Lv X. Integrated multi-omics reveal gut microbiota-mediated bile acid metabolism alteration regulating immunotherapy responses to anti-α4β7-integrin in Crohn's disease. Gut Microbes 2024; 16:2310894. [PMID: 38312103 PMCID: PMC10854365 DOI: 10.1080/19490976.2024.2310894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024] Open
Abstract
Gut microbiota and related metabolites are both crucial factors that significantly influence how individuals with Crohn's disease respond to immunotherapy. However, little is known about the interplay among gut microbiota, metabolites, Crohn's disease, and the response to anti-α4β7-integrin in current studies. Our research utilized 2,4,6-trinitrobenzene sulfonic acid to induce colitis based on the humanized immune system mouse model and employed a combination of whole-genome shotgun metagenomics and non-targeted metabolomics to investigate immunotherapy responses. Additionally, clinical cases with Crohn's disease initiating anti-α4β7-integrin therapy were evaluated comprehensively. Particularly, 16S-rDNA gene high-throughput sequencing and targeted bile acid metabolomics were conducted at weeks 0, 14, and 54. We found that anti-α4β7-integrin therapy has shown significant potential for mitigating disease phenotypes in remission-achieving colitis mice. Microbial profiles demonstrated that not only microbial composition but also microbially encoded metabolic pathways could predict immunotherapy responses. Metabonomic signatures revealed that bile acid metabolism alteration, especially elevated secondary bile acids, was a determinant of immunotherapy responses. Especially, the remission mice significantly enriched the proportion of the beneficial Lactobacillus and Clostridium genera, which were correlated with increased gastrointestinal levels of BAs involving lithocholic acid and deoxycholic acid. Moreover, most of the omics features observed in colitis mice were replicated in clinical cases. Notably, anti-α4β7 integrin provided sustained therapeutic benefits in clinical remitters during follow-up, and long-lasting remission was linked to persistent changes in the microbial-related bile acids. In conclusion, gut microbiota-mediated bile acid metabolism alteration could play a crucial role in regulating immunotherapy responses to anti-α4β7-integrin in Crohn's disease. Therefore, the identification of prognostic microbial signals facilitates the advancement of targeted probiotics that activate anti-inflammatory bile acid metabolic pathways, thereby improving immunotherapy responses. The integrated multi-omics established in our research provide valuable insights into potential mechanisms that impact treatment responses in complex diseases.
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Affiliation(s)
- Bing Han
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Daiyuan Tang
- Postgraduate College, Kunming Medical University, Kunming, China
| | - Xiaodan Lv
- Department of Clinical Experimental Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junhua Fan
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shiquan Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui Zhu
- Department of Microbiology, Guangxi Medical University, Nanning, China
| | - Jiatong Zhang
- Postgraduate College, Guangxi Medical University, Nanning, China
| | - Shang Xu
- Postgraduate College, Guangxi Medical University, Nanning, China
| | - Xiaofang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ziqian Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhixi Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guangfu Lin
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lingling Zhan
- Department of Clinical Experimental Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoping Lv
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Duan S, Cao Y, Chen P, Yang Y, Zhang Y. Circulating and intestinal regulatory T cells in inflammatory bowel disease: A systemic review and meta-analysis. Int Rev Immunol 2023; 43:83-94. [PMID: 37615427 DOI: 10.1080/08830185.2023.2249525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023]
Abstract
Regulatory T cells (Tregs) play an important immunosuppressive role in inflammatory bowel disease (IBD). However, findings on the quantitative and functional changes of intestinal and circulating Tregs in patients with IBD are rather contradictory. We therefore conducted a meta-analysis on this issue. The pooled effect was assessed using the standardized mean difference (SMD) with a 95% confidence interval (CI), and subgroup analyses were performed to investigate heterogeneity. This analysis included 764 IBD (402 UC and 362 CD) patients and 341 healthy controls (HCs) pooled from 17 eligible studies. The percentage of circulating Tregs was significantly decreased in active IBD patients compared to HCs (SMD = -0.95, p < 0.001) and inactive IBD patients (SMD = -0.80, p < 0.001). There was no difference in the percentage of circulating Tregs between inactive IBD patients and HCs. The suppressive function of circulating Tregs was impaired in active IBD patients according to limited data (SMD = -0.75, p = 0.02). Besides, the percentage of intestinal Tregs was significantly higher in inflamed regions than in non-inflamed regions (SMD = 0.85, p < 0.001). Our study quantitatively summarized the quantitative and functional changes of Tregs and supported the therapeutic potential of Tregs in IBD. Moreover, additional research into the functions and characteristics of intestinal Tregs in IBD is needed.
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Affiliation(s)
- Shihao Duan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Yubin Cao
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Pingrun Chen
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
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3
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Kamp K, Clark-Snustad K, Yoo L, Winders S, Cain K, Levy RL, Dey N, Lee S, Keefer L, Heitkemper M. A Comprehensive Self-Management Intervention for Inflammatory Bowel Disease (CSM-IBD): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46307. [PMID: 37285195 DOI: 10.2196/46307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) experience a variety of symptoms, including abdominal pain, fatigue, anxiety, and depression. Few nonmedical self-management interventions are available for people with IBD. A validated comprehensive self-management (CSM) intervention is effective for patients with irritable bowel syndrome who can have symptoms similar to those of individuals with IBD. We created a modified CSM intervention tailored to individuals with IBD (CSM-IBD). The CSM-IBD is an 8-session program delivered over 8-12 weeks with check-ins with a registered nurse. OBJECTIVE The primary objective of this pilot study is to determine the feasibility and acceptability of study procedures and the CSM-IBD intervention and to evaluate preliminary efficacy on quality of life and daily symptoms for a future randomized controlled trial. Additionally, we will examine the association of socioecological, clinical, and biological factors with symptoms at baseline and response to intervention. METHODS We are conducting a pilot randomized controlled trial of the CSM-IBD intervention. Participants aged 18-75 years who are experiencing at least 2 symptoms are eligible for inclusion. We plan to enroll 54 participants who will be randomized (2:1) into the CSM-IBD program or usual care. Patients in the CSM-IBD program will have 8 intervention sessions. Primary study outcomes include the feasibility of recruitment, randomization, and data or sample collection, as well as the acceptability of study procedures and interventions. Preliminary efficacy outcome variables include quality of life and symptoms. Outcomes data will be assessed at baseline, immediately post intervention, and 3 months post intervention. Participants in the usual care group will have access to the intervention after study participation. RESULTS This project is funded by the National Institutes of Nursing Research and reviewed by the University of Washington's institutional review board. Recruitment began in February 2023. As of April 2023, we have enrolled 4 participants. We expect the study to be completed by March 2025. CONCLUSIONS This pilot study will evaluate the feasibility and efficacy of a self-management intervention (a web-based program with weekly check-ins with a registered nurse) that aims to improve symptom management in individuals with IBD. In the long term, we aim to validate a self-management intervention to improve patient quality of life, reduce direct and indirect costs related to IBD, and be culturally appropriate and accessible, particularly in rural and underserved communities. TRIAL REGISTRATION ClinicalTrials.gov NCT05651542; https://clinicaltrials.gov/ct2/show/NCT05651542. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46307.
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Affiliation(s)
- Kendra Kamp
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Kindra Clark-Snustad
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, WA, United States
| | - Linda Yoo
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Samantha Winders
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Kevin Cain
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, United States
| | - Neelendu Dey
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Scott Lee
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, WA, United States
| | | | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
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Pavia G, Spagnuolo R, Quirino A, Marascio N, Giancotti A, Simeone S, Cosco C, Tino E, Carrabetta F, Di Gennaro G, Nobile C, Bianco A, Matera G, Doldo P. COVID-19 Vaccine Booster Shot Preserves T Cells Immune Response Based on Interferon-Gamma Release Assay in Inflammatory Bowel Disease (IBD) Patients on Anti-TNFα Treatment. Vaccines (Basel) 2023; 11:vaccines11030591. [PMID: 36992175 DOI: 10.3390/vaccines11030591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Immune-modifying treatment in inflammatory bowel disease (IBD) impairs the humoral response. The role of T lymphocytes in this setting is still unclear. This study aims to assess if a booster shot (third dose) of BNT162b2 mRNA COVID-19 vaccine enhanced the humoral response and elicited cellular immunity in IBD patients on different immuno-therapy regimens compared to healthy controls (HCs). Five months after a booster dose, serological and T-cell responses were assessed. The measurements were described using geometric means with 95% confidence intervals. The differences between study groups were assessed by Mann–Whitney tests. Seventy-seven subjects (n = 53 IBD patients and n = 24 HCs), who were fully vaccinated and not previously SARS-CoV-2 infected, were recruited. Regarding the IBD patients, 19 were affected by Crohn’s disease and 34 by ulcerative colitis. During the vaccination cycle, half of the patients (53%) were on stable treatment with aminosalicylates, and 32% were on biological therapy. No differences in antibody concentrations between IBD patients and HCs, nor T-cell responses, were found. Stratifying IBD patients based on the type of treatment (anti-TNFα agents vs. other treatment regimens), a decrease only in antibody titer (p = 0.008), but not in cellular response, was observed. Even after the COVID-19 vaccine booster dose, the TNFα inhibitors selectively decreased the humoral immune response compared to patients on other treatment regimens. The T-cell response was preserved in all study groups. These findings highlight the importance of evaluating T-cell immune responses following COVID-19 vaccination in a routine diagnostic setting, particularly for immunocompromised cohorts.
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Affiliation(s)
- Grazia Pavia
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Rocco Spagnuolo
- Unit of Gastroenterology, Department of Clinical and Experimental Medicine, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Angela Quirino
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Nadia Marascio
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Aida Giancotti
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Silvio Simeone
- Unit of Gastroenterology, Department of Clinical and Experimental Medicine, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Cristina Cosco
- Unit of Gastroenterology, Department of Clinical and Experimental Medicine, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Elena Tino
- Unit of Gastroenterology, Department of Clinical and Experimental Medicine, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Federico Carrabetta
- Unit of Gastroenterology, Department of Clinical and Experimental Medicine, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, School of Medicine, "Magna Græcia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Carmelo Nobile
- Department of Health Sciences, School of Medicine, "Magna Græcia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Aida Bianco
- Department of Health Sciences, School of Medicine, "Magna Græcia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Giovanni Matera
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
| | - Patrizia Doldo
- Unit of Gastroenterology, Department of Clinical and Experimental Medicine, "Magna Græcia" University of Catanzaro-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy
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5
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Weintraub Y, Cohen S, Anafy A, Chapnik N, Tsameret S, Ben-Tov A, Yerushalmy-Feler A, Dotan I, Tauman R, Froy O. Inverse Relationship Between Clock Gene Expression and Inflammatory Markers in Ulcerative Colitis Patients Undergoing Remission. Dig Dis Sci 2023; 68:2454-2462. [PMID: 36745299 DOI: 10.1007/s10620-023-07847-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Changes in the expression of clock genes have been reported in inflammatory bowel disease (IBD) patients. AIMS We aimed to investigate whether reduced inflammation restores clock gene expression to levels of healthy controls. METHODS This was a prospective study. Participants completed questionnaires providing data on demographics, sleeping habits, and disease activity. Anthropometric parameters, C-reactive protein (CRP), and fecal calprotectin (Fcal) levels were collected. Peripheral blood samples were analyzed for clock gene (CLOCK, BMAL1, CRY1, CRY2, PER1, PER2) expression. Patients with IBD were separated by diagnosis into ulcerative colitis (UC) and Crohn's disease (CD). Each diagnosis was further divided into active disease and disease under remission. RESULTS Forty-nine patients with IBD and 19 healthy controls completed the study. BMAL1 and PER2 were significantly reduced in active patients with UC compared to patients with UC in remission. BMAL1, PER1, and PER2 were significantly reduced in patients with UC with CRP > 5 mg/dl. PER2, CRY1, and CRY2 were significantly reduced in patients with UC with Fcal > 250 mg/kg. Clock gene expression of patients with UC in remission was comparable to healthy controls. When all patients with IBD were analyzed, an overshoot in CRY1 expression was observed in patients in remission, patients with CRP < 5 mg/dl, and patients with Fcal < 250 mg/kg. CONCLUSION CRP and Fcal are inversely related to clock gene levels in patients with UC. CRY1 may play a role in counteracting the anti-inflammatory processes when remission is induced in patients with IBD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03662646.
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Affiliation(s)
- Y Weintraub
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel
| | - A Anafy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel
| | - N Chapnik
- Institute of Biochemistry, Food Science and Nutrition, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel
| | - S Tsameret
- Institute of Biochemistry, Food Science and Nutrition, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel
| | - A Ben-Tov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel
| | - A Yerushalmy-Feler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel
| | - I Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - R Tauman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sleep Disorders Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - O Froy
- Institute of Biochemistry, Food Science and Nutrition, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel.
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Cao J, Yu Q, Sun M, He M, Liu R, Liu W, Wang F, Li T. Acupuncture for Crohn's disease: protocol for a systematic review and meta-analysis of randomized clinical trials. Medicine (Baltimore) 2022; 101:e32163. [PMID: 36482527 PMCID: PMC9726384 DOI: 10.1097/md.0000000000032163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic recurrent gastrointestinal disorder with a high incidence of inflammation due to intestinal inflammation. Acupuncture is commonly used as an alternative therapy for patients with CD. The aim of this study was to design a systematic review and meta-analysis protocol, to provide guidance for the establishment of systematic evaluation and meta-analysis on the efficacy and safety of acupuncture on CD. METHODS We will search PubMed, the Cochrane Library, Embase, Web of Science, and 4 Chinese databases: China National Knowledge Infrastructure (CNKI), Wanfang database, VIP database, and Chinese Biomedical Database to obtain randomized controlled trials of CD treated with acupuncture from inception to November 5, 2022. Primary outcome include CD symptoms severity and clinical efficacy, secondary outcome indicators include laboratory indicators or inflammatory markers, severity of endoscopic lesions, quality of life, and safety outcomes. We will analyze the data using RevMan V.5.4 software. Two reviewers will assess the risk of bias and study quality by the Cochrane Collaboration Risk of Bias Tool and GRADE methods, respectively. RESULTS This systematic review and meta-analysis protocol will analyze the efficacy, symptom improvement, quality of life, and safety of acupuncture therapy for CD. CONCLUSION This protocol outlines the planned scope and methodology of a forthcoming systematic review and meta-analysis to provide guidelines for a rigorous assessment of the efficacy and safety of acupuncture for the treatment of CD.
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Affiliation(s)
- Jiazhen Cao
- Acupuncture and Moxibustion Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Qianhui Yu
- Acupuncture and Moxibustion Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Mengmeng Sun
- Northeast Asian Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Min He
- Northeast Asian Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Renming Liu
- Acupuncture and Moxibustion Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Wu Liu
- Acupuncture and Moxibustion Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Fuchun Wang
- Department of Acupuncture, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Tie Li
- Acupuncture and Moxibustion Academy, Changchun University of Chinese Medicine, Changchun, China
- * Correspondence: Tie Li, Acupuncture and Moxibustion Academy, Changchun University of Chinese Medicine, Changchun 130117, China (e-mail: )
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7
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Natural History of Perianal Crohn's Disease: Long-term Follow-up of a Population-Based Cohort. Clin Gastroenterol Hepatol 2022; 20:e102-e110. [PMID: 33359730 DOI: 10.1016/j.cgh.2020.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The natural history of perianal Crohn's disease (PCD) remains poorly described and is mainly based on retrospective studies from referral centers. The aim of this study was to assess the incidence, outcomes and predictors of the onset of PCD. METHODS All incident cases of patients diagnosed with possible CD were prospectively registered from 1994 to 1997 in Brittany, a limited area in France. At diagnosis, the clinical features of perianal disease were recorded. All patient charts were reviewed from the diagnosis to the last clinic visit in 2015. RESULTS Among the 272 out of 331 incident CD patients followed up, 51 (18.7%) patients had PCD at diagnosis. After a mean follow-up of 12.8 years, 93 (34%) patients developed PCD. The cumulative probabilities of perianal CD occurrence were 22%, 29%, and 32% after 1 year, 5 years, and 10 years, respectively. The cumulative probabilities of anal ulceration were 14%, and 19% after 1 year and 10 years, respectively. Extraintestinal manifestations were associated with the occurrence of anal ulceration. The cumulative probabilities of fistulizing PCD were 11%, 16%, and 19% after 1 year, 5 years, and 10 years, respectively. Extraintestinal manifestations, rectal involvement and anal ulceration were predictors of fistulizing PCD. The cumulative probability of developing anal stricture was 4% after 10 years. CONCLUSIONS PCD is frequently observed during CD, in approximately one-third of patients. These data underline the need for targeted therapeutic research on primary perianal lesions (proctitis, anal ulceration) to avoid the onset of fistulizing perianal disease.
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Kamp KJ, Clark-Snustad K, Barahimi M, Lee S. Relationship Between Endoscopic and Clinical Disease Activity With Fatigue in Inflammatory Bowel Disease. Gastroenterol Nurs 2022; 45:21-28. [PMID: 35020629 PMCID: PMC8820259 DOI: 10.1097/sga.0000000000000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/01/2021] [Indexed: 01/03/2023] Open
Abstract
Fatigue is a prevalent symptom among individuals with inflammatory bowel disease. Yet, few studies have examined the relationship between fatigue and endoscopic disease activity. A retrospective chart review was conducted to determine the prevalence of fatigue based on endoscopic inflammation and clinical disease activity and describe the factors associated with fatigue among adults with inflammatory bowel disease. One hundred sixty patients were included. The majority had Crohn disease (72.5%), with an average age of 40.5 years. Sixty-one percent reported fatigue. Both endoscopic (p = .03) and clinical disease activities (p = .001) were significantly associated with fatigue. Among participants reporting fatigue, 52% had inactive disease and 48% had active disease based on endoscopy whereas 63% reported clinically active disease and 37% reported clinically inactive disease. In the multivariate regression model, clinical disease activity (odds ratio [OR] = 8.5; 95% CI [3.9, 18.6]) and anxiety (OR = 2.8; 95% CI [1.0, 7.6]) were significantly associated with fatigue. The prevalence of fatigue is high among individuals with active and inactive disease. Clinical disease activity and anxiety, but not endoscopic disease activity, were associated with fatigue.
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Affiliation(s)
- Kendra J Kamp
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Kindra Clark-Snustad
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Mitra Barahimi
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Scott Lee
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
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Zittan E, Steinhart AH, Goldstein P, Milgrom R, Gralnek IM, Silverberg MS. Post-Induction High Adalimumab Drug Levels Predict Biological Remission at Week 24 in Patients With Crohn's Disease. Clin Transl Gastroenterol 2021; 12:e00401. [PMID: 34613952 PMCID: PMC8500561 DOI: 10.14309/ctg.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We investigated whether early adalimumab drug levels (ADL) at week 4 predicted biological remission at week 24. METHODS In a prospective study, we assessed clinical and biological remission at weeks 0, 4, 12, and 24 after induction of adalimumab in 33 patients with Crohn's disease. Disease activity was determined by the Harvey-Bradshaw Index, ileocolonoscopy reports, cross-sectional imaging, C-reactive protein (CRP), and fecal calprotectin (FC) levels. Clinical remission was defined as Harvey-Bradshaw Index <5. Biological remission was defined as a combination of FC < 200 μg/g and CRP <5 μg/mL. ADL trough levels were tested using a liquid phase, mobility shift assay. RESULTS At 24 weeks, 18/33 (55%) of the patients were with biological remission. Ten (30%) patients required dose escalation or withdrawal from adalimumab by week 24 because of lack of response and exhibited significantly higher FC (P = 0.003) and CRP (P = 0.002). ADL levels at week 4 (19.8 μg/mL vs 10.2 μg/mL, P = 0.001) were significantly higher in patients with biological remission vs nonresponders at week 24. ADL levels at week 4 were a good predictor of biological remission at week 24, with area under the curve 0.86, 95% confidence interval (1.1; 1.67) and for combined biological and clinical remission, with area under the curve 0.8. The best ADL cutoff at week 4 that predicted biological remission at week 24 was 13.9 μg/mL (sensitivity 94.4% and specificity 73.3%). DISCUSSION In individuals with Crohn's disease, higher adalimumab drug levels at week 4 (>13.9 μg/mL) were significantly associated with biological remission at week 24.
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Affiliation(s)
- Eran Zittan
- The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - A. Hillary Steinhart
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Raquel Milgrom
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Ian M. Gralnek
- The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mark S. Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
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Chen H, Chen L, Wang X, Ge X, Sun L, Wang Z, Xu X, Song Y, Chen J, Deng Q, Xie H, Chen T, Chen Y, Ding K, Wu J, Wang J. Transgenic overexpression of ITGB6 in intestinal epithelial cells exacerbates dextran sulfate sodium-induced colitis in mice. J Cell Mol Med 2021; 25:2679-2690. [PMID: 33491282 PMCID: PMC7933932 DOI: 10.1111/jcmm.16297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/13/2020] [Accepted: 01/09/2021] [Indexed: 12/16/2022] Open
Abstract
Integrins, as a large family of cell adhesion molecules, play a crucial role in maintaining intestinal homeostasis. In inflammatory bowel disease (IBD), homeostasis is disrupted. Integrin αvβ6, which is mainly regulated by the integrin β6 subunit gene (ITGB6), is a cell adhesion molecule that mediates cell-cell and cell-matrix interactions. However, the role of ITGB6 in the pathogenesis of IBD remains elusive. In this study, we found that ITGB6 was markedly upregulated in inflamed intestinal tissues from patients with IBD. Then, we generated an intestinal epithelial cell-specific ITGB6 transgenic mouse model. Conditional ITGB6 transgene expression exacerbated experimental colitis in mouse models of acute and chronic dextran sulphate sodium (DSS)-induced colitis. Survival analyses revealed that ITGB6 transgene expression correlated with poor prognosis in DSS-induced colitis. Furthermore, our data indicated that ITGB6 transgene expression increased macrophages infiltration, pro-inflammatory cytokines secretion, integrin ligands expression and Stat1 signalling pathway activation. Collectively, our findings revealed a previously unknown role of ITGB6 in IBD and highlighted the possibility of ITGB6 as a diagnostic marker and therapeutic target for IBD.
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Affiliation(s)
- Haiyan Chen
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Department of Radiation OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Liubo Chen
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xin Wang
- Department of Pathology & Pathophysiology, and Department of Colorectal Surgery of the Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaoxu Ge
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Lifeng Sun
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhanhuai Wang
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaoming Xu
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Department of PathologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yongmao Song
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jing Chen
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Qun Deng
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Haiting Xie
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Ting Chen
- Key Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalCancer InstituteZhejiang University School of MedicineHangzhouChina
| | - Yan Chen
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Kefeng Ding
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jingjing Wu
- Department of Pathology & Pathophysiology, and Department of Colorectal Surgery of the Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jian Wang
- Department of Colorectal Surgery and OncologyKey Laboratory of Cancer Prevention and InterventionMinistry of EducationThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Center for Inflammatory Bowel DiseasesThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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Lucca FDA, Malaguti C, Chebli LA, Reboredo MM, Pinheiro BV, Ribeiro TCDR, Azevedo FMD, Corrêa JODA, Gaburri PD, Chebli JMF. Infliximab-induced remission improves physical activity in patients with active Crohn's disease. Rev Assoc Med Bras (1992) 2020; 66:1566-1572. [PMID: 33295411 DOI: 10.1590/1806-9282.66.11.1566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/11/2020] [Indexed: 01/04/2023] Open
Abstract
AIM To compare the level of physical activity (PA), exercise capacity, and body composition before and after infliximab-induced clinical remission in patients with Crohn's disease (CD). METHODS This prospective longitudinal study evaluated 44 adult outpatients with active CD before infliximab administration and 24 weeks after infliximab therapy. The patients were evaluated for PA in daily life, exercise capacity, muscle strength, and body composition. RESULTS 38 (86.4%) patients achieved infliximab-induced remission at 24 weeks and presented an increment in the number of steps taken of 1092 (7440±2980 vs. 6348±3177, respectively; p=0.006). The inactive time was reduced when compared to the baseline value (454.2±106.3 vs. 427.9±97.8, respectively; p=0.033). There was no difference in the distance walked before and after infliximab therapy, while there was an increase in the fat mass index in responders to infliximab compared to the baseline (19.1±7.6 vs. 14.9±5.8; p=0.001). CONCLUSIONS Infliximab-induced remission was shown to be effective for increasing physical activity by improving the number of steps and reducing inactive time. The maintenance of clinical remission associated with incentives to regular PA may contribute to making these patients reach an ideal level of PA.
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Affiliation(s)
- Fernando de Azevedo Lucca
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Carla Malaguti
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Liliana Andrade Chebli
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Maycon Moura Reboredo
- Laboratório de Investigação Pulmonar, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Bruno Valle Pinheiro
- Laboratório de Investigação Pulmonar, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Tarsila Campanha da Rocha Ribeiro
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Felipe Meirelles de Azevedo
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - José Otávio do Amaral Corrêa
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Pedro Duarte Gaburri
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Julio Maria Fonseca Chebli
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
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12
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LAGE AC, OLIVEIRA CC, BATALHA APDB, ARAÚJO AF, CZUBER-DOCHAN W, CHEBLI JMF, CABRAL LA, MALAGUTI C. THE INFLAMMATORY BOWEL DISEASE-FATIGUE PATIENT SELF-ASSESSMENT SCALE: TRANSLATION, CROSS-CULTURAL ADAPTATION AND PSYCHOMETRIC PROPERTIES OF THE BRAZILIAN VERSION (IBD-F BRAZIL). ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:50-63. [PMID: 32294736 DOI: 10.1590/s0004-2803.202000000-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
Abstract
ABSTRACT BACKGROUND: Fatigue is a common symptom in patients with inflammatory bowel diseases (IBD). A translated and culturally adapted, instrument with robust psychometric for measuring fatigue in Brazilian patients with IBD is needed. OBJECTIVE: To translate and cross-culturally adapt the inflammatory Bowel Disease Fatigue Scale (IBD-F) into Brazilian-Portuguese and to test its measurement properties in Brazilian patients with IBD. METHODS: Data from 123 patients with IBD were collected. In addition to IBD-F, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) was used. The measurement properties tested were: internal consistency, reproducibility (reliability and agreement), construct validity, internal and external responsiveness, and ceiling and floor effects. RESULTS: The Brazilian-Portuguese version of the IBD-F showed excellent internal consistency (Cronbach’s alpha of 0.95), excellent reproducibility (ICC=0.97) and a minimal detectable change of 6.0 points. The construct validity was demonstrated with a good correlation between the IBD-F and FACIT-F (r=- 0.46). Effect sizes used for measuring internal responsiveness were moderate among those with Crohn’s (0.66) disease and low in patients with ulcerative colitis (0.24). The Brazilian-Portuguese version of the IBD-F presented with high external responsiveness for Crohn’s disease (0.84) and with low external responsiveness for ulcerative colitis (0.33). The area under the curve considered for responsiveness was 0.84. Twenty-five percent of floor effects and no ceiling effect were recorded. CONCLUSION: The Brazilian-Portuguese version of IBD-F has adequate measurement properties and its use can be recommended in clinical practice and research.
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Cabalzar AL, Azevedo FMD, Lucca FDA, Reboredo MDM, Malaguti C, Chebli JMF. PHYSICAL ACTIVITY IN DAILY LIFE, EXERCISE CAPACITY AND QUALITY OF LIFE IN PATIENTS WITH CROHN'S DISEASE ON INFLIXIMAB-INDUCED REMISSION: A PRELIMINARY STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 56:351-356. [PMID: 31618395 DOI: 10.1590/s0004-2803.201900000-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Physical activity in daily life and exercise capacity have not been assessed in patients with Crohn's disease to date. OBJECTIVE To evaluate the physical activity in daily life, exercise capacity, quality of life, and prevalence of mood disorders in patients with moderate-to-severe Crohn's disease on infliximab-induced remission and the possible associations among variables. METHODS A cross-sectional preliminary study was conducted. Twenty-six patients with Crohn's disease and 20 controls were selected. Participants underwent evaluation of physical activity in daily life (triaxial accelerometer), exercise capacity (shuttle walk test), handgrip strength, quality of life, and presence of mood disorders. RESULTS The number of steps taken (7446±3081 vs 7898±2487), active time (80.6±42 vs 89.7±24.3min), shuttle walk test distance [665 (405) vs 710 (409) m] and handgrip strength [31 (15) vs 29 (20) kgf did not show any difference between the patients with Crohn's disease and the controls. The time spent lying down [95.8 (68.8) vs 60.9 (74.7) min] was greater and some domains of the quality of life were superior in the patients with Crohn's disease. No correlation was observed between the physical activity in daily life and quality of life or presence of mood disorders in patients with Crohn's disease. CONCLUSION Patients with Crohn's disease on infliximab-induced remission, despite to more time spent lying down, they have the same level of physical activity in daily life and exercise capacity min compared with the controls.
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Affiliation(s)
- Andrea Lemos Cabalzar
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Felipe Meirelles de Azevedo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Fernando de Azevedo Lucca
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Maycon de Moura Reboredo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Carla Malaguti
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Júlio Maria Fonseca Chebli
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
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Weintraub Y, Cohen S, Chapnik N, Ben-Tov A, Yerushalmy-Feler A, Dotan I, Tauman R, Froy O. Clock Gene Disruption Is an Initial Manifestation of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:115-122.e1. [PMID: 30981000 DOI: 10.1016/j.cgh.2019.04.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Sleep disruption modifies the immune system and can trigger flares of inflammatory bowel diseases (IBD). Changes in expression of clock genes have been reported in patients with IBD. We investigated whether a change in the circadian clock is an early event in development of IBD. METHODS We performed a prospective study of patients younger than 21 years old who underwent diagnostic endoscopies at the pediatric and adult gastroenterology units at the Tel Aviv Sourasky Medical Center from August 2016 through August 2017. Questionnaires were completed by 32 patients with IBD (8-21 years old) and 18 healthy individuals (controls) that provided data on demographics, sleep, disease activity scores. We also obtained data on endoscopic scores, anthropometric parameters, blood level of C-reactive protein (CRP), and fecal level of calprotectin. Peripheral blood and intestinal mucosa samples were analyzed for expression levels of clock gene (CLOCK, BMAL1, CRY1, CRY2, PER1, and PER2). RESULTS Levels of CRP and fecal calprotectin were significantly higher in patients with IBD compared with controls (P<.05). Expression levels of clock genes (CLOCK, CRY1, CRY2, PER1, and PER2) were significantly lower in inflamed intestinal mucosa from patients compared with intestinal mucosa from controls (P<.05). Expression levels of all clock genes except for PER2, were also significantly lower in non-inflamed intestinal mucosal tissues from patients compared with controls (P<.05). Expression levels of clock genes (CLOCK, BMAL1, CRY1, CRY2, PER1 and PER2) were lower in white blood cells from patients with IBD compared with controls. This reduction was greater in white blood cells from patients with ulcerative colitis than in patients with Crohn's disease. CONCLUSION Young, newly diagnosed, untreated patients with IBD have reduced expression of clock genes in inflamed and non-inflamed intestinal mucosal samples, and also in blood cells, compared with healthy individuals. Alterations in expression of clock genes might be an early event in IBD pathogenesis. ClinicalTrials.gov Identifier: NCT03662646.
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Affiliation(s)
- Yael Weintraub
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nava Chapnik
- Institute of Biochemistry, Food Science and Nutrition, the Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel
| | - Amir Ben-Tov
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Riva Tauman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sleep Disorders Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Oren Froy
- Institute of Biochemistry, Food Science and Nutrition, the Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel.
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Correlation between Serological Biomarkers and Disease Activity in Patients with Inflammatory Bowel Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6517549. [PMID: 31950048 PMCID: PMC6944953 DOI: 10.1155/2019/6517549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
Abstract
Background Current biomarkers have been routinely used noninvasive methods for assessing disease activity of inflammatory bowel disease (IBD), but none of them are specific. This study was aimed to determine the performance of the serological biomarkers for detecting disease activity in patients with IBD. Methods A prospective study that included 73 ulcerative disease (UC) subjects, 141 Crohn's disease (CD) subjects, and 30 of them complicated with C. difficile infection (CDI) were diagnosed at a single-institution IBD center. Disease activity was assessed using by Truelove and Witts criteria for UC and Harvey Bradshaw Simple Index for CD. Serological inflammatory biomarkers were compared in different severity groups. Receiver operator curve analyses assessed the performance of each biomarker in discriminating disease states. Results For UC patients, elevated monocyte counts, C-reactive protein (CRP), and decreased lymphocyte counts and lymphocyte/monocyte ratio (LMR) significantly differed between subjects with active and inactive UC. LMR of 3.1 was 76% sensitive and had a specificity of 67% for active UC. For CD patients, higher values of neutrophils, monocytes, neutrophil/lymphocyte ratio, CRP, fibrinogen, and lower values of LMR and hemoglobin were significantly different between subjects with active and inactive CD. None of the biomarkers included had a good correlation with disease activity (area under the ROC Curve < 0.70). Conclusions A low LMR represents an inexpensive, readily available test with a promising value to identify disease activity in UC patients, whereas none of the inflammatory biomarkers showed a discriminative value in disease activity of CD.
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Abstract
BACKGROUND Psoriasis, psoriatic arthritis, spondyloarthritis, rheumatoid arthritis, ulcerative colitis, and Crohn disease share similar underlying pathophysiological processes, providing the opportunity to treat the patients using similar biological therapies. Failure of biological treatments due to underexposure can be managed by therapeutic drug monitoring. Adjusting the treatment based on pharmacokinetic monitoring can be further improved by taking pharmacodynamic parameters such as clinical and molecular markers into account. METHODS Here, we critically evaluate the existing evidence, the hurdles to be taken, and the opportunities for a widespread implementation of pharmacodynamic monitoring. RESULTS Pharmacodynamic monitoring typically is the monitoring of biochemical markers. A pharmacodynamic marker preferably is specific for the pharmacological action of a drug, but most of the time nonspecific pharmacodynamic markers are used, such as C-reactive protein and the erythrocyte sedimentation rate. Clinical pharmacodynamic markers typically evaluate physical variables or symptoms. Although physician-reported outcomes have been studied for a longer time and often have been shown to correlate well with molecular pharmacodynamic markers and treatment outcomes, the introduction of mobile health or mHealth technologies caused a shift toward patient-reported outcomes, with the associated challenge to consistently reflect the inflammatory state, thereby preventing undertreatment or unnecessary overdosing of patients. CONCLUSIONS The primary goal of pharmacodynamic monitoring is to optimize the response, but it can also have an impact on safety, costs, patient adherence, etc. Ideally, the constant remote monitoring of patient-reported disease activity is expected to become the standard, facilitated by mHealth technologies.
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Assessment of Patients' Future Outlook after Bowel Resection in Crohn's Disease. Gastroenterol Res Pract 2019; 2019:7674946. [PMID: 30728836 PMCID: PMC6343161 DOI: 10.1155/2019/7674946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background Many patients with Crohn's disease (CD) require surgery in their life. Their future outlook is crucial to psychological and mental health after surgery. This study is aimed at assessing CD patient's outlook after experiencing bowel resection and determining factors associated with patient's outlook. Methods We used an ad hoc questionnaire (modified WHOQOL-BREF) to assess patients' outlook for the future after bowel resection in CD. All patients who experienced bowel resection for CD from 2015 to 2017 were included in this study. Patients were divided into two groups according to the questionnaire. Patients who had a positive outlook were compared with those who had a negative outlook. The patients' view on timing of surgery was also recorded. Results Of 114 eligible patients surveyed, 103 (90.4%) responded. 65 (63.1%) reported that the timing of surgery was appropriate, and 26 patients felt it should have been performed earlier, while remaining 12 preferred a later surgery. 61 (59.2%) patients had a positive outlook of their future lives, while 42 patients had a negative outlook. Factors as the financial burden, employment status, patients' view on timing of surgery, and clinical recurrence were associated with patients' outlook. In the multivariate analysis, only clinical recurrence was an independent risk factor for patient's future outlook. Conclusion From this survey, it is clear that most patients who underwent an elective bowel resection for CD are satisfied with their timing of surgery. Patients who have clinical recurrence carry a significant negative outlook for their future life. Postoperative management which focuses on preventing clinical recurrence may enhance patients' outlook for the future.
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Sun X, Yuan L, Li Y, Shen B, Xie H, Liu X. Association of granulomas in mesenteric lymph nodes in Crohn's disease with younger age and transmural inflammation. J Gastroenterol Hepatol 2017; 32:1463-1468. [PMID: 28087973 DOI: 10.1111/jgh.13735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Mesenteric lymph nodes were usually removed during bowel resection surgery for Crohn's disease (CD). Mesenteric lymph node (MLN) granuloma predicted postoperative disease recurrence in patients with CD after ileocolic resection (ICR). This study was aimed to identify factors associated with MLN granulomas in a cohort of CD patients who underwent ICR. METHODS The study group consisted of 18 patients with CD who underwent the index ICR between 2004 and 2012 and had MLN granulomas. The control group included 32 cases negative for MLN granulomas, which were randomly selected from the same period. Clinicodemographic and histological features were compared in these two groups. RESULTS The presence of MLN granuloma was associated with younger age, perianal disease, and ileocolic disease. Gender, body mass index, smoking status, disease duration, extraintestinal manifestation, length of bowel resected, total number of nodes examined, medical treatment, and indications for surgery were not significantly different between the groups. The presence of MLN granuloma was associated with mural granuloma, transmural inflammation, mural abscess, hypertrophy of the muscularis propria, fibrosis of the muscularis propria, and serosal fibrosis in the small bowel. The multivariable analysis confirms that MLN granuloma was associated with age and transmural inflammation. CONCLUSIONS In CD patients who underwent the index ICR, the presence of MLN granuloma was associated with younger age and transmural inflammation. Our current results suggest that the detection of MLN granulomas may be enhanced in patients at higher risk, that is, younger patients or those with transmural inflammation on imaging or histopathology.
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Affiliation(s)
- Xingwen Sun
- Universitätsmedizin, Georg-August-University of Göttingen, Göttingen, Germany
| | - Lisi Yuan
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yi Li
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bo Shen
- Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hao Xie
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xiuli Liu
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Raftery T, Merrick M, Healy M, Mahmud N, O'Morain C, Smith S, McNamara D, O'Sullivan M. Vitamin D Status Is Associated with Intestinal Inflammation as Measured by Fecal Calprotectin in Crohn's Disease in Clinical Remission. Dig Dis Sci 2015; 60:2427-35. [PMID: 25757449 DOI: 10.1007/s10620-015-3620-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/27/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin D, as potential immune modulator, has been implicated as an environmental risk factor for Crohn's disease (CD). Vitamin D status may be associated with disease risk, severity, activity, and progression. While associations between circulating 25OHD and markers of disease activity and inflammation in CD have been reported, the results are inconsistent. AIM To determine the association between vitamin D status and markers of disease activity and inflammation in CD. METHODS One hundred and nineteen CD patients' active and inactive diseases were enrolled in the cross-sectional study. Subject demographics and clinical data were collected. A serum sample was collected for 25OHD and CRP analysis, and a stool sample was collected for fecal calprotectin (FC) measurement. RESULTS The mean serum 25OHD concentration of the group was 59.8 (24.9) nmol/L. After controlling for confounding variables, serum 25OHD inversely correlated with FC (r = -0.207, P = 0.030), particularly among those in clinical remission (r = -0.242, P = 0.022). The association between FC and 25OHD was further confirmed by linear regression (r = 31.3 %, P < 0.001). FC was lower in patients with 25OHD levels ≥75 nmol/L compared with levels <25 nmol/L [FC: 32.2 (16.3-98.2) vs 100.0 (34.4-213.5) μg/g, P = 0.004]. In the current study, however, 25OHD was not significantly associated with either CRP or CDAI. CONCLUSION Circulating 25OHD was significantly inversely associated with intestinal inflammation as determined by FC in CD. Subgroup analysis confirmed the association among those in clinical remission, but not in those with active disease. 25OHD was not associated with disease activity score (CDAI) or systemic inflammation (CRP). Vitamin D intervention studies are warranted to determine whether raising serum 25OHD levels in patients with CD may reduce intestinal inflammation as measured by FC.
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Affiliation(s)
- Tara Raftery
- Department of Medicine, Trinity Centre for Health Science, St. James's Hospital, Dublin, Ireland
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Therapeutic drug monitoring of infliximab and mucosal healing in inflammatory bowel disease: a prospective study. Inflamm Bowel Dis 2013; 19:2568-76. [PMID: 24013361 DOI: 10.1097/mib.0b013e3182a77b41] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Data on the value of therapeutic drug monitoring of infliximab (IFX) to predict mucosal healing (MH) in inflammatory bowel diseases (IBD) are scarce. METHODS All consecutive patients with IBD receiving ongoing IFX (5 mg/kg) treatment and developing secondary failure to IFX were enrolled in a prospective study between June 2010 and May 2011. IFX trough levels, antibodies to IFX concentrations, C-reactive protein levels, and fecal calprotectin were measured before IFX optimization and at week 8. A proctosigmoidoscopy was performed on the day of first IFX optimization and at week 8 in all patients with ulcerative colitis (UC). MH was defined by fecal calprotectin <250 μg/g stools in Crohn's disease (CD) and by an endoscopic Mayo score of 0 or 1 in UC. RESULTS This study included 52 patients with IBD: 34 patients with CD (mean Crohn's Disease Activity Index, 300; mean C-reactive protein, 28 ± 10 mg/L; mean fecal calprotectin, 705 ± 300 μg/g) and 18 patients with UC (mean Simple Clinical Colitis Activity Index, 7; mean Mayo endoscopic score, 3). After IFX dose intensification, half of CD and UC patients achieved MH. Increase in IFX trough levels (called "delta IFX" in micrograms per milliliter) was associated with MH in both CD and UC (P = 0.001). A delta IFX >0.5 μg/mL was associated with MH (sensitivity [se], 0.88; specificity [sp], 0.77; P = 0.0001, area under the receiver operating characteristic curve, 0.89). On multivariate analysis, the only factor associated with MH after IFX optimization was a delta IFX >0.5 µg/mL (likelihood ratio = 2.02; 95% confidence interval, 1.01-4.08; P = 0.048) in patients with IBD. CONCLUSIONS Therapeutic drug monitoring of IFX strongly predicts the likelihood of achieving MH following IFX dose intensification in both CD and UC.
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Sewitch MJ, Abrahamowicz M, Bitton A, Daly D, Wild GE, Cohen A, Katz S, Szego PL, Dobkin PL. Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. Am J Gastroenterol 2001; 96:1470-9. [PMID: 11374685 DOI: 10.1111/j.1572-0241.2001.03800.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objectives of this study were to compare the psychological status of patients in active and inactive disease states, to assess social support, and to identify correlates of psychological distress in patients with inflammatory bowel disease (IBD). METHODS This cross-sectional study was conducted in 200 patients (mean age 36.7 yr [SD = 14.8], 119 [59.5%] female) with long-standing IBD who were seen in tertiary care. Psychosocial assessments included psychological distress (Symptom Checklist-90R), social support (Social Support Questionnaire-6), perceived stress (Perceived Stress Scale-10), and recent minor stressful events (Weekly Stress Inventory). Disease activity was assessed with the Harvey Bradshaw Index. RESULTS Patients reported higher levels of satisfaction with social support and smaller network sizes compared with normative values. Using multiple linear regression, the independent correlates of psychological distress (p = 0.0001; adjusted R2 = 0.62) were as follows: active disease (p = 0.0234), less time since diagnosis (p = 0.0012), and greater number (p = 0.0001) and impact of stressful events (p = 0.0003). A statistically significant interaction term (p = 0.0171) revealed that the relationship between psychological distress and perceived stress changes depending on the level of satisfaction with social support. For patients with low levels of perceived stress, satisfaction with social support did not affect levels of psychological distress. However, for patients who experienced moderate to high levels of perceived stress, high satisfaction with social support decreased the level of psychological distress. CONCLUSIONS These findings suggest that strategies aimed at improving social support can have a favorable impact on psychological distress and, ultimately, can improve health outcomes in patients with IBD.
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Affiliation(s)
- M J Sewitch
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
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Abstract
UNLABELLED Knowledge of the presence and the degree of inflammation in Crohn's disease would be useful in multicentre therapeutic trials. Objectives; The purpose of the present study was two fold, a) to determine the relationship between clinical assessment of activity by two clinicians with four previously published indices, the Crohn's disease activity index (CDAI), the Van Hees activity index (AI), the simple index of Harvey and Bradsaw (SI) and the Fielding index and b) for the first time, to study the internal correlation between these four indices. METHODS A hundred and ninety-four assessments were performed on 56 patients with Crohn's disease. Following each clinical assessment, the aforementioned indices were calculated. RESULTS Both clinicians gave the same rating of activity in 81% (157) of assessments. A good relationship was observed between the median indical values and the clinical gradings for all four indices. The best relationship was demonstrated with the AI with no overlap in 50% values with increasing grades of disease activity. All four indices demonstrated a good correlation with each other (p < 0.01). The best correlation was observed between more objective indices the AI and the Fielding index (r = 0.79) for first assessments only. Conclusion. The Van Hees AI is a reliable measure of inflammatory activity in Crohn's disease and would be useful in multicentre therapeutic trials.
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Affiliation(s)
- H Holloway
- Royal College of Surgeons, Dublin, Ireland
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Barclay GR, McKenzie H, Pennington J, Parratt D, Pennington CR. The effect of dietary yeast on the activity of stable chronic Crohn's disease. Scand J Gastroenterol 1992; 27:196-200. [PMID: 1502481 DOI: 10.3109/00365529208999948] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effect of dietary yeast on the activity of stable Crohn's disease was assessed in 19 patients. During the 1st month patients continued their usual diet (base-line period), but during the next 2 months dietary yeast was excluded except that during 1 month patients took baker's yeast capsules while for the other month they took placebo capsules. The patients' mean Pettit Crohn's disease activity index (CDAI) while taking baker's yeast (mean, 107.9; SE, 6.1) was significantly greater than during yeast exclusion (mean, 102.1; SE, 5.7; p less than 0.05). The mean of each patient's maximum CDAI during yeast exclusion (mean, 107.1; SE, 5.7) was significantly lower than those during the base-line (mean, 115.2; SE, 6.1; p less than 0.05) and baker's yeast inclusion periods (mean, 113.9; SE, 6.7; p less than 0.05). Patients with elevated yeast antibodies tended to develop a higher CDAI while receiving baker's yeast (13 of 15). These results suggest that dietary yeast may affect the activity of Crohn's disease.
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Affiliation(s)
- G R Barclay
- Dept. of Clinical Pharmacology, Ninewells Hospital, Dundee, Scotland
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Affiliation(s)
- F D Bartholomeusz
- Department of Medicine, Queen Elizabeth Hospital, Woodville, South Australia
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Abstract
Current Crohn's disease activity indices are not suitable for survey research because they rely on information from the laboratory or physical examination. We used data from a multicenter controlled trial of adjuvant sulfasalazine to develop an index of Crohn's disease activity based on information which could be obtained exclusively by interview. The study population consisted of 89 actively symptomatic patients seen on 1082 occasions in eight medical centers. Multiple regression analyses identified three variables which predicted the ratings of physicians: stool frequency, abdominal pain and sense of well-being. The new index correlated very well (r = 0.87, p less than 0.001) with the Crohn's Disease Activity Index from which it was derived. The index may be used in epidemiologic studies to accurately place patients into quartiles of disease severity which correspond to similar quartiles of the CDAI.
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Affiliation(s)
- R S Sandler
- Department of Medicine, University of North Carolina, Chapel Hill 27599-7080
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Reibnegger G, Bollbach R, Fuchs D, Hausen A, Judmaier G, Prior C, Rotthauwe HW, Werner ER, Wachter H. A simple index relating clinical activity in Crohn's disease with T cell activation: hematocrit, frequency of liquid stools and urinary neopterin as parameters. Immunobiology 1986; 173:1-11. [PMID: 3492436 DOI: 10.1016/s0171-2985(86)80084-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Crohn's disease is characterized by alternating acute and quiescent periods. Several indices for activity of the inflammatory process have been proposed to have criteria for prognosis of the clinical course and therapeutic efficacy. Neopterin is specifically released from human monocytes-macrophages after induction by interferon-gamma secreted from activated human T lymphocytes. Thus, urinary neopterin excretion is elevated in diseases involving activation of cellular immunity. Fifteen clinical and laboratory parameters, including urinary neopterin levels, collected from 35 visits of patients with Crohn's disease, were compared using multiple linear regression analysis with a simple clinical activity index as reference. Prediction of clinical activity was best with the combination of hematocrit, weekly number of liquid stools and neopterin. A simple triple-parametric Crohn's disease activity index was established on the basis of this result. Its quality was tested on independent data obtained from 25 repeat visits of 13 of these patients. A comparison with the well-known Crohn's Disease Activity Index (CDAI) was performed. The results obtained with the proposed activity index were slightly better than those with the eight-parametric CDAI for the data from the first as well as from the repeat visits. We conclude that our simple index is a reliable and easily accessible measure for clinical activity in patients with Crohn's disease.
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Chesner IM. Diet and Crohn's disease. Lancet 1985; 2:899-900. [PMID: 2864617 DOI: 10.1016/s0140-6736(85)90170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ambrose NS, Allan RN, Keighley MR, Burdon DW, Youngs D, Barnes P, Lennard-Jones JE. Antibiotic therapy for treatment in relapse of intestinal Crohn's disease. A prospective randomized study. Dis Colon Rectum 1985; 28:81-5. [PMID: 3882364 DOI: 10.1007/bf02552649] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We have undertaken a prospective randomized trial of one month's antimicrobial therapy for patients with symptomatic relapse of Crohn's disease. Criteria for entry included two major symptoms: fever, abdominal pain, diarrhea, weight loss, abdominal mass or complications (excluding perianal disease); and two hematologic abnormalities: hemoglobin, ESR, albumin, C reactive protein, iron, or total iron binding capacity. Patients were monitored for the aforementioned clinical and hematologic (hemoglobin, albumin, CRP) parameters over six weeks and for changes in fecal flora. Randomization was to four groups: metronidazole alone (M), cotrimoxazole alone (C), metronidazole and cotrimoxazole (C plus M), or double placebo (P). Seventy-two patients entered the study (18 = M, 16 = C, 21 = C plus M, 17 = P). After two weeks, improvement was reported as follows: M = 67 percent, C = 17 percent, C plus M = 71 percent, P = 35 percent. In the metronidazole group, two patients required surgery and one had troublesome side effects. In the cotrimoxazole group, two had side effects. In the combined group (C plus M), four had troublesome side effects and two of the placebo group (P) required operation. By four weeks, there was no difference in response among the groups: (M = 44 percent, C = 62 percent, C plus M = 57 percent, P = 41 percent). Antimicrobials had no effect on fecal flora or hematologic parameters. These results indicate that antimicrobials have little therapeutic potential for relapse of intestinal Crohn's disease.
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