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Lin D, Jin Y, Shao X, Xu Y, Ma G, Jiang Y, Xu Y, Jiang Y, Hu D. Global, regional, and national burden of inflammatory bowel disease, 1990-2021: Insights from the global burden of disease 2021. Int J Colorectal Dis 2024; 39:139. [PMID: 39243331 PMCID: PMC11380638 DOI: 10.1007/s00384-024-04711-x] [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] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE The prevalence of inflammatory bowel disease (IBD) is on the rise worldwide. We utilizes data from the Global Burden of Diseases (GBD) 2021 to analyze the national-level burden of IBD, trends in disease incidence, and epidemiological characteristics. METHODS Detailed information on IBD was gathered from 204 countries and territories spanning 1990 to 2021, sourced from the GBD 2021. Calculations were performed for incidence rates, mortality rates, disease-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs). These trends were analyzed based on region, nationality, age, gender, and World Bank income level stratifications. RESULTS The global age-standardised incident rate (ASIR) of IBD increased from 4.22 per 100000 in 1990 to 4.45 per 100000 in 2021. However, the age-standardised mortality rate (ASMR) decreased from 0.60 per 100000 in 1990 to 0.52 per 100000 in 2021. Similarly, the age-standardised DALYs rate decreased from 21.55 per 100000 in 1990 to 18.07 per 100000 in 2021. Gender comparisons showed negligible differences in disease burden. The greatest increase in IBD-associated ASIR and ASMR occurred in World Bank upper-middle income region (EAPCs, 1.25) and World Bank high-income region (EAPCs, 1.00), respectively. Regionally, East Asia experienced the largest increase in ASIR (EAPCs, 2.89). Among 204 countries, China had the greatest increases in ASIR (EAPCs, 2.93), Netherlands had the highest ASMR in 2021 (2.21 per 100000). CONCLUSIONS Global incidence rate of IBD have been increasing from 1990 to 2021, while the DALYs and mortality have been decreasing. The escalating incident rates in select Asian regions deserves further attention.
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Affiliation(s)
- Daopo Lin
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yang Jin
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiaoxiao Shao
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuan Xu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Guolong Ma
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yi Jiang
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yinghe Xu
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang Province, China.
| | - Yongpo Jiang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang Province, China.
| | - Dingyuan Hu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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Sequier L, Caron B, Loeuille D, Honap S, Jairath V, Netter P, Danese S, Sibilia J, Peyrin-Biroulet L. Systematic review: Methotrexate-A poorly understood and underused medication in inflammatory bowel disease. Aliment Pharmacol Ther 2024; 60:686-700. [PMID: 39076140 DOI: 10.1111/apt.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/14/2024] [Accepted: 07/21/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Methotrexate, an immunosuppressant used for the treatment of inflammatory bowel disease (IBD) for over 30 years, remains underused compared to thiopurines. AIMS To review the efficacy, safety, optimal dosing and delivery regimens of methotrexate in adults with IBD. METHODS We conducted a systematic review of studies involving patients with IBD treated with methotrexate from inception to August 2023. All studies were included from the MEDLINE database via PubMed. RESULTS For Crohn's disease, we included eight randomised controlled trials (RCTs) and 17 observational studies. Parenteral methotrexate effectively increased remission rates in steroid-dependent patients at 25 mg/week for 16 weeks and at 15 mg/week for maintenance. Methotrexate can be used in combination with anti-tumour necrosis factor (TNF) agents to reduce immunogenicity. Data comparing thiopurines and methotrexate remain scarce. For ulcerative colitis (UC), we included five RCTs and 10 observational studies were included; there was no evidence to support the use of methotrexate in (UC). We extracted safety data from 17 studies; mild-to-moderate adverse effects were common. The incidence of liver fibrosis or cirrhosis was low. CONCLUSION Methotrexate is effective at inducing and maintaining remission in steroid-refractory Crohn's disease and can reduce anti-TNF-induced immunogenicity when used in combination therapy. Data regarding tolerance and safety are reassuring. These findings challenge preconceived ideas on methotrexate and suggest that it is a valid first-line conventional option for the treatment of mild-to-moderate Crohn's disease.
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Affiliation(s)
- Léa Sequier
- Department of Gastroenterology and Hepatology, Nîmes University Hospital, Carémeau Hospital, Nîmes, France
- Department of Gastroenterology and Hepatology A, Saint-Éloi Hospital, Montpellier, France
| | - Bénédicte Caron
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, Nancy, France
- INFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA) UMR 7365 CNRS, University of Lorraine, Nancy, France
| | - Sailish Honap
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Patrick Netter
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA) UMR 7365 CNRS, University of Lorraine, Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Immunology, Transplantation and Infectious Disease, Università Vita-Salute San Raffaele, Milan, Italy
| | - Jean Sibilia
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, Nancy, France
- INFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy, France
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3
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Angriman I, Sampietro GM. Ileocaecal Crohn's disease. To resect or not to resect, is that the question? Dig Liver Dis 2024; 56:1298-1300. [PMID: 38734567 DOI: 10.1016/j.dld.2024.04.029] [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] [Received: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Imerio Angriman
- General Surgery Unit 3, Padua University Hospital, Padua, Italy
| | - Gianluca M Sampietro
- Division of General and HPB Surgery, Rho Memorial Hospital, ASST Rhodense, Rho Milano, Italy.
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Farge D, Pugnet G, Allez M, Castilla-Llorente C, Chatelus E, Cintas P, Faucher-Barbey C, Labauge P, Labeyrie C, Lioure B, Maria A, Michonneau D, Puyade M, Talouarn M, Terriou L, Treton X, Wojtasik G, Zephir H, Marjanovic Z. French protocol for the diagnosis and management of hematopoietic stem cell transplantation in autoimmune diseases. Rev Med Interne 2024; 45:79-99. [PMID: 38220493 DOI: 10.1016/j.revmed.2023.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) for severe ADs was developed over the past 25years and is now validated by national and international medical societies for severe early systemic sclerosis (SSc) and relapsing-remitting multiple sclerosis (MS) and available as part of routine care in accredited center. HSCT is also recommended, with varying levels of evidence, as an alternative treatment for several ADs, when refractory to conventional therapy, including specific cases of connective tissue diseases or vasculitis, inflammatory neurological diseases, and more rarely severe refractory Crohn's disease. The aim of this document was to provide guidelines for the current indications, procedures and follow-up of HSCT in ADs. Patient safety considerations are central to guidance on patient selection and conditioning, always validated at the national MATHEC multidisciplinary team meeting (MDTM) based on recent (less than 3months) thorough patient evaluation. HSCT procedural aspects and follow-up are then carried out within appropriately experienced and Joint Accreditation Committee of International Society for Cellular Therapy and SFGM-TC accredited centres in close collaboration with the ADs specialist. These French recommendations were performed according to HAS/FAI2R standard operating procedures and coordinated by the Île-de-France MATHEC Reference Centre for Rare Systemic Autoimmune Diseases (CRMR MATHEC) within the Filière FAI2R and in association with the Filière MaRIH. The task force consisted of 3 patients and 64 clinical experts from various specialties and French centres. These data-derived and consensus-derived recommendations will help clinicians to propose HSCT for their severe ADs patients in an evidence-based way. These recommendations also give directions for future clinical research in this area. These recommendations will be updated according to newly emerging data. Of note, other cell therapies that have not yet been approved for clinical practice or are the subject of ongoing clinical research will not be addressed in this document.
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Affiliation(s)
- D Farge
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de Médecine Interne (UF 04) : CRMR MATHEC, maladies auto-immunes et thérapie cellulaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Department of Medicine, McGill University, H3A 1A1, Montreal, Canada.
| | - G Pugnet
- Service de médecine interne et immunologie clinique, pôle hospitalo-universitaire des maladies digestives, CHU Rangueil, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - M Allez
- AP-HP, hôpital Saint-Louis, service d'hépato-gastro-entérologie, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Castilla-Llorente
- Gustave-Roussy cancer center, département d'hématologie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - E Chatelus
- Département de rhumatologie, hôpitaux universitaires de Strasbourg, Strasbourg, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, Strasbourg, France
| | - P Cintas
- CHU Toulouse Purpan, service de neurologie, place du Dr-Baylac, 31059 Toulouse cedex 9, France
| | - C Faucher-Barbey
- Direction prélèvements et greffes de CSH, Direction médicale et scientifique, Agence de la biomédecine, 93212 St-Denis/La Plaine, France
| | - P Labauge
- CRC SEP, service de neurologie, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - C Labeyrie
- AP-HP, CHU de Bicêtre, service de neurologie, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - B Lioure
- Département d'onco-hématologie, université de Strasbourg, ICANS, Strasbourg, France
| | - A Maria
- Médecine interne & immuno-oncologie (MedI2O), Institute for Regenerative Medicine & Biotherapy (IRMB), hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, Montpellier, France; IRMB, Inserm U1183, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier, France
| | - D Michonneau
- Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Service d'hématologie-greffe, AP-HP, hôpital Saint-Louis, institut de recherche Saint-Louis, Paris, France
| | - M Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de La-Miletrie, 86021 Poitiers, France
| | - M Talouarn
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - L Terriou
- CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre de référence des maladies auto-immunes et auto-inflammatoires rares (CERAINO), 59000 Lille, France
| | - X Treton
- Université de Paris, hôpital Beaujon, service de gastro-entérologie, MICI et assistance nutritive, DMU DIGEST, 100, boulevard Leclerc, 92110 Clichy, France
| | - G Wojtasik
- Université de Lille, Inserm, CHU de Lille, service de médecine interne et immunologie clinique, Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institut de recherche translationnelle sur l'inflammation, Lille, France
| | - H Zephir
- CHU de Lille, université de Lille, pôle des neurosciences et de l'appareil locomoteur, Lille Inflammation Research International Center (LIRIC), UMR 995, rue Émile-Laine, 59000 Lille, France
| | - Z Marjanovic
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Zhang N, Chan ML, Li J, Brohawn PZ, Sun B, Vainshtein I, Roskos LK, Faggioni R, Savic RM. Combining pharmacometric models with predictive and prognostic biomarkers for precision therapy in Crohn's disease: A case study of brazikumab. CPT Pharmacometrics Syst Pharmacol 2023; 12:1945-1959. [PMID: 37691451 PMCID: PMC10725267 DOI: 10.1002/psp4.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/11/2023] [Accepted: 07/11/2023] [Indexed: 09/12/2023] Open
Abstract
Pharmacometric models were used to investigate the utility of biomarkers in predicting the efficacy (Crohn's Disease Activity Index [CDAI]) of brazikumab and provide a data-driven framework for precision therapy for Crohn's disease (CD). In a phase IIa trial in patients with moderate to severe CD, treatment with brazikumab, an anti-interleukin 23 monoclonal antibody, was associated with clinical improvement. Brazikumab treatment effect was determined to be dependent on the baseline IL-22 (BIL22) or baseline C-reactive protein (BCRP; predictive biomarkers), and placebo effect was found to be correlated with the baseline CDAI (a prognostic biomarker). A maximal total inhibition on CDAI input function of 50.6% and 42.4% was predicted for patients with extremely high BIL22 or BCRP, compared to a maximal total inhibition of 20.9% and 17.8% for patients with extremely low BIL22 or BCRP, respectively, which were mainly due to the placebo effect. We demonstrated that model-derived baseline biomarker levels that achieve 50% of maximum unbound systemic concentration of 22.8 pg/mL and 8.03 mg/L for BIL22 and BCRP as the cutoffs to select subpopulations can effectively identify high-response subgroup patients with improved separation of responders when compared to using the median values as the cutoff. This work exemplifies the utility of pharmacometrics to quantify biomarker-driven responses in biologic therapies and distinguish between predictive and prognostic biomarkers, complementing clinical efforts of identifying subpopulations with higher likelihood of response to brazikumab.
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Affiliation(s)
- Nan Zhang
- Department of Bioengineering and Therapeutic SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ming Liang Chan
- Department of Bioengineering and Therapeutic SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jing Li
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Philip Z. Brohawn
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology (R&I), BioPharmaceutical R&D, AstraZenecaGaithersburgMarylandUSA
| | - Bo Sun
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Inna Vainshtein
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Lorin K. Roskos
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Raffaella Faggioni
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Rada M. Savic
- Department of Bioengineering and Therapeutic SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Sipeki N, Kovats PJ, Deutschmann C, Schierack P, Roggenbuck D, Papp M. Location-based prediction model for Crohn's disease regarding a novel serological marker, anti-chitinase 3-like 1 autoantibodies. World J Gastroenterol 2023; 29:5728-5750. [PMID: 38075846 PMCID: PMC10701337 DOI: 10.3748/wjg.v29.i42.5728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Defective neutrophil regulation in inflammatory bowel disease (IBD) is thought to play an important role in the onset or manifestation of IBD, as it could lead to damage of the intestinal mucosal barrier by the infiltration of neutrophils in the inflamed mucosa and the accumulation of pathogens. Like neutrophils in the context of innate immune responses, immunoglobulin A (IgA) as an acquired immune response partakes in the defense of the intestinal epithelium. Under normal conditions, IgA contributes to the elimination of microbes, but in connection with the loss of tolerance to chitinase 3-like 1 (CHI3L1) in IBD, IgA could participate in CHI3L1-mediated improved adhesion and invasion of potentially pathogenic microorganisms. The tolerance brake to CHI3L1 and the occurrence of IgA autoantibodies to this particular target, the exact role and underlying mechanisms of CHI3L1 in the pathogenesis of IBD are still unclear. AIM To determine the predictive potential of Ig subtypes of a novel serological marker, anti-CHI3L1 autoantibodies (aCHI3L1) in determining the disease phenotype, therapeutic strategy and long-term disease course in a prospective referral cohort of adult IBD patients. METHODS Sera of 257 Crohn's disease (CD) and 180 ulcerative colitis (UC) patients from a tertiary IBD referral center of Hungary (Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen) were assayed for IgG, IgA, and secretory IgA (sIgA) type aCHI3L1 by enzyme-linked immunosorbent assay using recombinant CHI3L1, along with 86 healthy controls (HCONT). RESULTS The IgA type was more prevalent in CD than in UC (29.2% vs 11.1%) or HCONT (2.83%; P < 0.0001 for both). However, sIgA subtype aCHI3L1 positivity was higher in both CD and UC patients than in HCONT (39.3% and 32.8% vs 4.65%, respectively; P < 0.0001). The presence of both IgA and sIgA aCHI3L1 antibodies was associated with colonic involvement (P < 0.0001 and P = 0.038, respectively) in patients with CD. Complicated disease behavior at sample procurement was associated with aCHI3L1 sIgA positivity (57.1% vs 36.0%, P = 0.009). IgA type aCH3L1 was more prevalent in patients with frequent relapse during the disease course in the CD group (46.9% vs 25.7%, P = 0.005). In a group of patients with concomitant presence of pure inflammatory luminal disease and colon involvement at the time of diagnosis, positivity for IgA or sIgA type aCH3L1 predicted faster progression towards a complicated disease course in time-dependent models. This association disappeared after merging subgroups of different disease locations. CONCLUSION CHI3L1 is a novel neutrophil autoantigenic target in IBD. The consideration of antibody classes along with location-based prediction may transform the future of serology in IBD.
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Affiliation(s)
- Nora Sipeki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen H-4032, Hungary
| | - Patricia Julianna Kovats
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen H-4032, Hungary
- Kálmán Laki Doctoral School, Faculty of Medicine, University of Debrecen, Debrecen H-4032, Hungary
| | - Claudia Deutschmann
- Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg 01968, Germany
| | - Peter Schierack
- Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg 01968, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg 01968, Germany
| | - Dirk Roggenbuck
- Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg 01968, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg 01968, Germany
- Medipan GmbH & GA Generic Assays GmbH, Dahlewitz-Berlin 15827, Germany
| | - Maria Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen H-4032, Hungary
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Li R, Li X, Zhou H, Shi Y, Wang F, Wu T, Liang J. Successful treatment of a refractory intestinal Behcet's disease with an oncology history by Vedolizumab: a case report and literature review. Front Immunol 2023; 14:1205046. [PMID: 37287984 PMCID: PMC10242066 DOI: 10.3389/fimmu.2023.1205046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Objective Behçet's Disease (BD) is an intractable systemic vasculitis. When accompanied by intestinal symptoms, the prognosis is usually poor. 5-Aminosalicylic acid (5-ASA), corticosteroids, immunosuppressive drugs, and anti-tumor necrosis factor-α (anti-TNF-α) biologics are standard therapies to induce or maintain remission for intestinal BD. However, they might not be effective in refractory cases. Safety should also be considered when patients have an oncology history. Regarding the pathogenesis of intestinal BD and the specific targeting effect of vedolizumab (VDZ) on the inflammation of the ileum tract, previous case reports suggested that VDZ might be a potential treatment for refractory intestinal BD. Methods We report a 50-year-old woman patient with intestinal BD who had oral and genital ulcers, joint pain, and intestinal involvement for about 20 years. The patient responds well to anti-TNF-α biologics but not to conventional drugs. However, biologics treatment was discontinued due to the occurrence of colon cancer. Results VDZ was intravenously administered at a dose of 300 mg at 0, 2, and 6 weeks and then every eight weeks. At the 6-month follow-up, the patient reported significant improvement in abdominal pain and arthralgia. We observed complete healing of intestinal mucosal ulcers under endoscopy. However, her oral and vulvar ulcers remained unresolved, which disappeared after adding thalidomide. Conclusion VDZ may be a safe and effective option for refractory intestinal BD patients who do not respond well to conventional treatments, especially those with an oncology history.
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Affiliation(s)
| | | | | | | | | | - Tong Wu
- *Correspondence: Tong Wu, ; Jie Liang,
| | - Jie Liang
- *Correspondence: Tong Wu, ; Jie Liang,
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Carvello M, D'Hoore A, Maroli A, Cuenca C, Vermeire S, Danese S, Bislenghi G, Spinelli A. Postoperative Complications Are Associated With an Early and Increased Rate of Disease Recurrence After Surgery for Crohn's Disease. Dis Colon Rectum 2023; 66:691-699. [PMID: 36538675 DOI: 10.1097/dcr.0000000000002446] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several potential risk factors for Crohn's disease recurrence after surgery have been identified, including age at diagnosis, disease phenotype, and smoking. Despite the clinical relevance, few studies investigated the role of postoperative complications as a possible risk factor for disease recurrence. OBJECTIVE To investigate the association between postoperative complications and recurrence in Crohn's disease patients after primary ileocolic resection. DESIGN This was a retrospective case-control study. SETTING This study was conducted at 2 tertiary academic centers. PATIENTS We included 262 patients undergoing primary ileocolic resection for Crohn's disease between January 2008 and December 2018 and allocated the patients into recurrent (145) and nonrecurrent (117) groups according to endoscopic findings. MAIN OUTCOME MEASURES Postoperative complications were assessed as possible risk factors for endoscopic recurrence after surgery by univariable and multivariable analyses. The effect of postoperative complications on endoscopic and clinical recurrence was evaluated by Kaplan-Meier and Cox regression analyses. RESULTS On binary logistic regression analysis, smoking (OR = 1.84; 95% CI, 1.02-3.32; p = 0.04), penetrating phenotype (OR = 3.14; 95% CI, 1.58-6.22; p < 0.01), perianal disease (OR = 4.03; 95% CI, 1.75-9.25; p = 0.001), and postoperative complications (OR = 2.23; 95% CI, 1.19-4.17; p = 0.01) were found to be independent risk factors for endoscopic recurrence. Postoperative complications (HR = 1.45; 95% CI, 1.02-2.05; p = 0.03) and penetrating disease (HR = 1.73; 95% CI, 1.24-2.40; p = 0.001) significantly reduced the time to endoscopic recurrence; postoperative complications (HR = 1.6; 95% CI, 1.02-2.88; p = 0.04) and penetrating disease (HR = 207.10; 95% CI, 88.41-542.370; p < 0.0001) significantly shortened the time to clinical recurrence. LIMITATIONS This study was limited by its retrospective design. CONCLUSIONS Postoperative complications are independent risk factors for endoscopic recurrence after primary surgery for Crohn's disease, affecting the rate and timing of endoscopic and clinical disease recurrence. See Video Abstract at http://links.lww.com/DCR/C48 . LAS COMPLICACIONES POSOPERATORIAS ESTN ASOCIADAS CON UNA TASA TEMPRANA Y AUMENTADA DE RECURRENCIA DE LA ENFERMEDAD DESPUS DE LA CIRUGA PARA LA ENFERMEDAD DE CROHN ANTECEDENTES: Se han identificado varios factores de riesgo potenciales para la recurrencia de la enfermedad de Crohn después de la cirugía, incluida la edad en el momento del diagnóstico, el fenotipo de la enfermedad y el tabaquismo. A pesar de la relevancia clínica, pocos estudios investigaron el papel de las complicaciones postoperatorias como posible factor de riesgo para la recurrencia de la enfermedad.OBJETIVO: Investigar la asociación entre las complicaciones postoperatorias y la recurrencia en pacientes con enfermedad de Crohn después de la resección ileocólica primaria.DISEÑO: Este fue un estudio retrospectivo de casos y controles.AJUSTE: Este estudio se realizó en dos centros académicos terciarios.PACIENTES: Incluimos 262 pacientes sometidos a resección ileocólica primaria por enfermedad de Crohn entre Enero de 2008 y Diciembre de 2018 y los asignamos en grupos recurrentes (145) y no recurrentes (117) según los hallazgos endoscópicos.PRINCIPALES MEDIDAS DE RESULTADO: Las complicaciones posoperatorias se evaluaron como posibles factores de riesgo de recurrencia endoscópica después de la cirugía mediante análisis univariable y multivariable. El efecto de las complicaciones posoperatorias sobre la recurrencia endoscópica y clínica se evaluó mediante análisis de regresión de Kaplan-Meier y Cox.RESULTADOS: En el análisis, tabaquismo (OR = 1,84; IC 95%: 1,02-3,32; p = 0,04), fenotipo penetrante (OR = 3,14; IC 95%: 1,58-6,22; p < 0,01), enfermedad perianal (OR = 4,03; IC 95%: 1,75-9,25; p = 0,001) y las complicaciones postoperatorias (OR = 2,23; IC 95%: 1,19-4,17; p = 0,01) fueron factores de riesgo independientes para la recurrencia endoscópica. Las complicaciones posoperatorias (HR = 1,45; IC 95%: 1,02-2,05; p = 0,03) y la enfermedad penetrante (HR = 1,73; IC 95%: 1,24-2,40; p = 0,001) redujeron significativamente el tiempo hasta la recurrencia endoscópica; las complicaciones posoperatorias (HR= 1,6; IC 95%: 1,02-2,88; p = 0,04) y la enfermedad penetrante (HR = 207,10; IC 95%: 88,41-542,37; p < 0,0001) acortaron significativamente el tiempo hasta la recurrencia clínica.LIMITACIONES: Este estudio estuvo limitado por su diseño retrospectivo.CONCLUSIONES: Las complicaciones postoperatorias son factores de riesgo independientes para la recurrencia endoscópica después de la cirugía primaria para la enfermedad de Crohn, lo que afecta la tasa y el momento de la recurrencia endoscópica y clínica de la enfermedad. Consulte el Video Resumen en http://links.lww.com/DCR/C48 . (Traducción-Dr. Yesenia Rojas-Khalil ).
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Affiliation(s)
- Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano, Milan, Italy
| | - Andre D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Annalisa Maroli
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano, Milan, Italy
| | - Carlota Cuenca
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Severine Vermeire
- Division of Gastroenterology and Hepatology, University Hospitals Leuven and TARGID, University of Leuven, Herestaat, Louvain, Belgium
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano, Milan, Italy
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9
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Prognostic Factors of Biologic Therapy in Pediatric IBD. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101558. [PMID: 36291494 PMCID: PMC9600413 DOI: 10.3390/children9101558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
This was a retrospective cohort study aimed at identifying parameters measured at diagnosis of pediatric IBD to predict subsequent biologic therapy, as an equivalent to an unfavorable clinical course. Identification of predictors of poor outcomes is an important issue in current ECCO guidelines on pIBD. The study population consisted of 119 children with Crohn’s disease and 112 with ulcerative colitis, diagnosed and monitored for at least 1 year from 2009–2019. The population was divided into the study groups separately: 39 children with CD and 14 with UC who received biologics before the age of 18 y compared to 80 with CD and 98 with UC who did not. The combined analysis of 53 biologic therapy recipients vs. 178 non-recipients with IBD was also conducted. Logistic regression tests (OR, RR) and sensitivity, specificity, PPV, and NPV were used. Factors significantly correlated with subsequent biologic therapy were perianal disease, complicated disease behavior, high PCDAI (CD), fatigue, hypoalbuminemia, high PUCAI (UC) and fever, fatigue, hypoalbuminemia, hypoproteinemia, and elevated CRP (IBD). Marginally significant factors were ileocecal disease, elevated serum IgA, anemia, and L4a–L4b coexistence. Apart from parameters already accepted as POPO (B2/3, perianal disease), interesting observations are the significance of IgA, L4a–L4b in CD, and hypoalbuminemia in UC.
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10
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Comparison of Diagnostic Performance of Ultrasonography and Magnetic Resonance Enterography in the Assessment of Active Bowel Lesions in Patients with Crohn’s Disease: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12082008. [PMID: 36010359 PMCID: PMC9407121 DOI: 10.3390/diagnostics12082008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to evaluate and compare the diagnostic performances of ultrasonography (US) and magnetic resonance enterography (MRE) in assessing active bowel lesions in patients with Crohn’s disease (CD). Materials and Methods: We searched PubMed and EMBASE for studies in which US and MRE were used to assess active bowel lesions in CD patients. Bivariate random effect meta-analytic methods were used to estimate pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. We performed a meta-regression analysis to explore the source of study heterogeneity. Results: Eleven studies involving 752 patients were included. US exhibited a pooled sensitivity of 86% (95% confidence interval (CI) 72–94), pooled specificity of 88% (95% CI 78–94), and HSROC of 0.93 in 10 studies. MRE exhibited a pooled sensitivity of 88% (95% CI 76–95), pooled specificity of 87% (95% CI 73–95), and an HSROC of 0.94 in eight studies. In seven studies comparing the diagnostic performances of US and MRE, the summary sensitivity of US and MRE were 86% (95% CI 65–96, I2 = 92.1) and 86% (95% CI 72–93, I2 = 88.1) (p = 0.841), respectively. The summary specificity of US and MRE were 87% (95% CI 78–93, I2 = 79.8%) and 84% (72–90, I2 = 72.5%) (p = 0.431), respectively, which showed no statistical differences. On meta-regression analysis, studies from Europe (p = 0.002), those that used linear US probes (p = 0.012), those on small bowel lesions (p = 0.01), and those with outcomes as combined features (active inflammation) reported higher US sensitivity than those from other regions, those that used both linear and convex US probes, those on small and large bowels, and those with outcome as one feature (bowel wall thickening or ulcer). Studies with pediatric patients (p = 0.001), those with reference standards including US (p = 0.001), and outcomes as combined features (p = 0.01) reported higher MRE specificity than those with adult populations, reference standards other than the US, and outcomes as one feature. Conclusions: In spite of considerable heterogeneity in the included studies, both US and MRE can diagnose active bowel lesions with comparable diagnostic accuracy in patients with CD. The study region, type of US probe, lesion location, investigated outcome for US sensitivity and study population, reference standards, and investigated outcomes for MRE specificity were potential sources of heterogeneity.
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11
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Innocenti T, Roselli J, Taylor A, Dragoni G, Lynch EN, Campani C, Gottin M, Bagnoli S, Macrì G, Rogai F, Milani S, Galli A, Milla M. Pregnancy outcomes in inflammatory bowel disease: Data from a large cohort survey. J Dig Dis 2022; 23:473-481. [PMID: 36156857 PMCID: PMC10092249 DOI: 10.1111/1751-2980.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Inflammatory bowel disease (IBD) can affect young and reproductively active patients. Our aim was to analyze pregnancy outcomes in a large cohort of women with IBD. METHODS All women with at least one pregnancy were given a questionnaire regarding the outcome of their pregnancy. They were divided into IBD pregnancies and controls depending on whether pregnancy occurred within or over 10 years prior to the diagnosis of IBD. RESULTS Three hundred questionnaires were analyzed for a total of 478 pregnancies that led to live-born babies. Age at conception was older in IBD women than in the controls. Active smoking was more frequent in the control group. The risk of intrauterine growth restriction (IUGR) was higher in IBD pregnancies (odds ratio [OR] 3.028, 95% confidence interval [CI] 1.245-7.370, P = 0.013). The week of gestation at delivery was lower in the IBD population. And the risk of cesarean section was higher in IBD pregnancies (OR 1.963, 95% CI 1.274-3.028, P = 0.002). Among women with IBD pregnancy, the risk of preterm birth was higher in patients with active disease at the time of conception (OR 4.088, 95% CI 1.112-15.025, P = 0.030), but lower in patients who continued regular therapy during pregnancy. Similarly, the risk of urgent cesarean section was reduced in the case of disease remission, while the risk of a planned cesarean delivery was higher in patients with perianal disease (OR 11.314, 95% CI 3.550-36.058, P < 0.01). CONCLUSIONS Our study shows a higher risk of IUGR, cesarean section, and poor blood pressure control in IBD pregnancies. We emphasize the importance of achieving disease remission before considering pregnancy.
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Affiliation(s)
- Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jenny Roselli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alice Taylor
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Gottin
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Siro Bagnoli
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Macrì
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Rogai
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Monica Milla
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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12
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Aljabban J, Rohr M, Borkowski VJ, Nemer M, Cohen E, Hashi N, Aljabban H, Boateng E, Syed S, Mohammed M, Mukhtar A, Hadley D, Panahiazar M. Probing predilection to Crohn's disease and Crohn's disease flares: A crowd-sourced bioinformatics approach. J Pathol Inform 2022; 13:100094. [PMID: 36268056 PMCID: PMC9576970 DOI: 10.1016/j.jpi.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Crohn's Disease (CD) is an inflammatory disease of the gastrointestinal tract that affects millions of patients. While great strides have been made in treatment, namely in biologic therapy such as anti-TNF drugs, CD remains a significant health burden. Method We conducted two meta-analyses using our STARGEO platform to tag samples from Gene Expression Omnibus. One analysis compares inactive colonic biopsies from CD patients to colonic biopsies from healthy patients as a control and the other compares colonic biopsies from active CD lesions to inactive lesions. Separate tags were created to tag colonic samples from inflamed biopsies (total of 65 samples) and quiescent tissue in CD patients (total of 39 samples), and healthy tissue from non-CD patients (total of 30 samples). Results from the two meta-analyses were analyzed using Ingenuity Pathway Analysis. Results For the inactive CD vs healthy tissue analysis, we noted FXR/RXR and LXR/RXR activation, superpathway of citrulline metabolism, and atherosclerosis signaling as top canonical pathways. The top upstream regulators include genes implicated in innate immunity, such as TLR3 and HNRNPA2B1, and sterol regulation through SREBF2. In addition, the sterol regulator SREBF2, lipid metabolism was the top disease network identified in IPA (Fig. 1). Top upregulated genes hold implications in innate immunity (DUOX2, REG1A/1B/3A) and cellular transport and absorption (ABCG5, NPC1L1, FOLH1, and SLC6A14). Top downregulated genes largely held roles in cell adhesion and integrity, including claudin 8, PAQR5, and PRKACB.For the active vs inactive CD analysis, we found immune cell adhesion and diapedesis, hepatic fibrosis/hepatic stellate cell activation, LPS/IL-1 inhibition of RXR function, and atherosclerosis as top canonical pathways. Top upstream regulators included inflammatory mediators LPS, TNF, IL1B, and TGFB1. Top upregulated genes function in the immune response such as IL6, CXCL1, CXCR2, MMP1/7/12, and PTGS2. Downregulated genes dealt with cellular metabolism and transport such as CPO, RBP2, G6PC, PCK1, GSTA1, and MEP1B. Conclusion Our results build off established and recently described research in the field of CD. We demonstrate the use of our user-friendly platform, STARGEO, in investigating disease and finding therapeutic avenues.
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Affiliation(s)
- Jihad Aljabban
- University of Wisconsin Hospitals and Clinics, Madison, WI, United States,Corresponding author.
| | - Michael Rohr
- University of Central Florida College of Medicine, Orlando, FL, United States
| | | | - Mary Nemer
- University of Wisconsin Hospitals and Clinics, Madison, WI, United States
| | - Eli Cohen
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Naima Hashi
- Mayo Clinic Minnesota, Rochester, MN, United States
| | | | - Emmanuel Boateng
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Saad Syed
- Northwestern Memorial Hospital, Chicago, IL, United States
| | | | - Ali Mukhtar
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Dexter Hadley
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Maryam Panahiazar
- University of California San Francisco, San Francisco, CA, United States
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13
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Chen Y, Shen J. Core indicators of an evaluation and guidance system for quality of care in inflammatory bowel disease centers: A critical review. EClinicalMedicine 2022; 46:101382. [PMID: 35434585 PMCID: PMC9011022 DOI: 10.1016/j.eclinm.2022.101382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/18/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023] Open
Abstract
The mission of the IBD Quality Care Evaluation Center (IBDQCC) is to establish indicators of quality of care (QoC), certify IBD units to generate a network of IBD quality care, and eventually improve the national level of IBD healthcare. The final list of 28 core and 13 secondary IBD QoC indicators suitable for the healthcare system in China were selected using a Delphi consensus methodology. Units that met all core indicators were qualified as "regional"; units that met all core indicators together with more than 50% of the secondary indicators received a rating of "excellence." Using the selected QoC core indicators for certifying IBD units, a network of IBD quality care units covering the majority of IBD patients in China was established. Funding This work was financially supported by Cultivation Funding for Clinical Scientific Research Innovation, Renji Hospital, School of Medicine, Shanghai Jiaotong University (RJPY-LX-004), National Natural Science Foundation of China (No. 81,770,545), Shanghai Science and Technology Innovation Initiative (21SQBS02302), and Cultivated Funding for Clinical Research Innovation, Renji Hospital, School of Medicine, Shanghai Jiaotong University (RJPY-LX-004).
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Affiliation(s)
- Yueying Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai 200127, China
| | - Jun Shen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai 200127, China
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14
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Yu Y, Zhao H, Luo Y, Lou J, Chen J, Fang Y. Poor Concordance Between Clinical Activity and Endoscopic Severity in Pediatric Crohn's Disease: Before and After Induction Therapy. Dig Dis Sci 2022; 67:997-1006. [PMID: 33818661 DOI: 10.1007/s10620-021-06917-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES AND STUDY Endoscopic assessments of disease activity are important to diagnose and evaluate treatment responses in patients with Crohn's disease (CD). However, the invasiveness of endoscopy limits the application of this technique in routine examination. Thus, interest has been increasing in identifying noninvasive surrogate markers to predict endoscopic CD activity. METHODS We retrospectively analyzed pediatric patients with new-onset CD from January 2013 to December 2018 at Zhejiang University Affiliated Children's Hospital. The disease severity was scored according to the Crohn's Disease Endoscopic Index of Severity (CDEIS). Routine blood tests were determined individually. Clinical activity was assessed based on the Pediatric Crohn's Disease Activity Index (PCDAI). RESULTS A total of 91 patients with CD had undergone one or more ileocolonoscopies (n = 146), the mean CDEIS for all the pediatric patients with CD was 7.0 (95% CI 5.7-8.2), and the mean PCDAI was 20.9 (95% CI 18.3-23.5). Pearson's linear analysis of the CDEIS and PCDAI in pediatric patients with CD showed a moderate correlation (r = 0.508, P < 0.001). Weak correlations were found between the PCDAI and CDEIS at the first diagnosis (r = 0.408, P < 0.001) and after completing induction therapy (r = 0.286, P < 0.05). Routine blood tests also did not correlate well with the CDEIS. CONCLUSIONS This study identified weak correlations between the PCDAI and CDEIS in assessing pediatric patients with CD severity both at first diagnosis and after induction therapy. A comprehensive assessment of PCDAI, CDEIS and multiple laboratory factors should be performed at diagnosis and during the follow-up of patients with CD.
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Affiliation(s)
- Yu Yu
- Department of Gastroenterology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 3333 Bin Sheng Road, Binjiang District, Hangzhou City, 310051, Zhejiang Province, China
| | - Hong Zhao
- Department of Gastroenterology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 3333 Bin Sheng Road, Binjiang District, Hangzhou City, 310051, Zhejiang Province, China
| | - Youyou Luo
- Department of Gastroenterology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 3333 Bin Sheng Road, Binjiang District, Hangzhou City, 310051, Zhejiang Province, China
| | - Jingan Lou
- Department of Gastroenterology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 3333 Bin Sheng Road, Binjiang District, Hangzhou City, 310051, Zhejiang Province, China
| | - Jie Chen
- Department of Gastroenterology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 3333 Bin Sheng Road, Binjiang District, Hangzhou City, 310051, Zhejiang Province, China.
| | - Youhong Fang
- Department of Gastroenterology, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 3333 Bin Sheng Road, Binjiang District, Hangzhou City, 310051, Zhejiang Province, China
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15
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Hilon J, Alstad T, Hasséus B, Kashani H. Phenotype of Crohn's disease according to the Montreal classification in relation to dental health status. Scand J Gastroenterol 2022; 57:183-189. [PMID: 34726554 DOI: 10.1080/00365521.2021.1995481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The relationship between oral health and Crohn's disease is uncertain. Previous studies have yielded contradictory results, reflecting perhaps the different phenotypes of the disease. The aim of the present study was to describe and analyse the dental status of a group of patients with Crohn's disease (CD), considering the positions of the inflammatory loci and disease phenotype. METHODS In total, 47 patients with Crohn's disease (18 males and 30 females; mean age. 48.7 years; range, 23-61 years) were consecutively recruited to this study. Interviews and clinical examinations were performed to assess dental status, medication, smoking history, heredity of inflammatory bowel disease (IBD), duration of disease, oral mucosal manifestations of Crohn's disease. Furthermore, data on subjective health assessments and family status, along with medical histories from the patients were obtained through questionnaires. The disease phenotypes were assessed and classified according to the Montreal classification. The data on oral health status were first correlated with the Montreal classifications of IBD, and, thereafter, all the collected data were included in a multivariate generalised linear model. RESULTS The dental status of the patients was comparable to that of the Swedish average. No statistically significant associations were found between oral status and the different CD phenotypes. However, within the Montreal classification, there were significantly fewer teeth in those patients with perianal lesions than in those without such lesions, and there was a significant correlation between deeper pocket depth and problems with strictures and penetrations. No significant differences (p = .074) between the patients with CD (N = 47) and controls (N = 38) were found regarding the presence of oral mucosal lesions. CONCLUSION Dental health may be adversely affected in severe cases of CD whereas most of the remaining patients with CD appear to have a level of dental health that is comparable to that in the general population.
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Affiliation(s)
- Jack Hilon
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Torgny Alstad
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hossein Kashani
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.5.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications.
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Fei B, Zhou L, Zhang Y, Luo L, Chen Y. Application value of tissue tuberculosis antigen combined with Xpert MTB/RIF detection in differential diagnoses of intestinal tuberculosis and Crohn's disease. BMC Infect Dis 2021; 21:498. [PMID: 34049506 PMCID: PMC8161674 DOI: 10.1186/s12879-021-06210-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 05/19/2021] [Indexed: 01/28/2023] Open
Abstract
Background The purpose of this study was to examine the value of Xpert MTB/RIF assay and detection of additional Mycobacterium tuberculosis complex (MTBC) species antigens from intestinal tissue samples in differentiating intestinal tuberculosis (ITB) from Crohn’s disease (CD). Methods Several clinical specimens of intestinal tissue obtained by either endoscopic biopsy or surgical excision were used for mycobacteriologic solid cultures,Xpert MTB/RIF assays, immunohistochemistry, and histological examinations. Four antigens (38KDa, ESAT-6, MPT64, and Ag85 complex) of MTBC in the intestinal tissue were detected by immunohistochemical analysis. Results The study included 42 patients with ITB and 46 with CD. Perianal lesions and longitudinal ulcers were more common in patients with CD, while caseating granuloma and annular ulcers were more common in patients with ITB. The positive rate of MTBC detected by Xpert MTB/RIF in intestinal tissues of patients with ITB was 33.33%, which was significantly higher than that in patients with CD and that detected using acid-fast staining smears. It was also higher than that detected by tissue MTBC culture, but the difference was not statistically significant. The positive MPT64 expression rate in patients with ITB was 40.48%, which was significantly higher than that observed in patients with CD. The sensitivity of parallelly combined detection of tuberculosis protein MPT64 and Xpert MTB/RIF in diagnosing ITB was 50.0%. Conclusions The detection of Xpert MTB/RIF in intestinal tissue is a rapid and useful method for establishing an early diagnosis of ITB. The detection of MTBC using Xpert MTB/RIF and MPT64 antigen in intestinal tissues has a definitive value in the differential diagnosis ofITB and CD. The combination of these two methods can improve the detection sensitivity.
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Affiliation(s)
- Baoying Fei
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China.
| | - Lin Zhou
- Departments of Minimally Invasive Surgery, Tuberculous Experimental Center, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China
| | - Yu Zhang
- Department of Gastroenterology, Zhejiang Province People's Hospital, Hangzhou, 310014, Zhejiang, China
| | - Linhe Luo
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China
| | - Yuanyuan Chen
- Tuberculosis Diagnosis and Treatment Center, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China
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Machado APDF, Geraldi MV, do Nascimento RDP, Moya AMTM, Vezza T, Diez-Echave P, Gálvez JJ, Cazarin CBB, Maróstica Júnior MR. Polyphenols from food by-products: An alternative or complementary therapy to IBD conventional treatments. Food Res Int 2021; 140:110018. [PMID: 33648249 DOI: 10.1016/j.foodres.2020.110018] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases (IBD) are illnesses characterized by chronic intestinal inflammation and microbial dysbiosis that have emerged as a public health challenge worldwide. It comprises two main conditions: Crohn's disease and ulcerative colitis. Currently, conventional therapy to treat IBD are not free from side effects, such as liver and kidney toxicity, drug resistance, and allergic reactions. In view of this, there is growing research for alternative and complementary therapies that, in addition to acting in the prevention or the control of the disease, do not compromise the quality of life and health of individuals. In this sense, a growing body of evidence has confirmed the benefits of natural phenolic compounds in intestinal health. Phenolic compounds or polyphenols are molecules widely distributed throughout the plant kingdom (flowers, vegetables, leaves, and fruits), including plant materials remaining of the handling and food industrial processing, referred to in the scientific literature as by-products, food waste, or bagasse. Since by-products are low-cost, abundant, easily accessible, safe, and rich in bioactive compounds, it becomes an exciting option to extract, concentrate or isolate phenolic compounds to be posteriorly applied in the therapeutic approach of IBD. In this article, we have reviewed the main phenolic compounds present in various plants and by-products that have shown beneficial and/or promising effects in experimental pre-clinical, clinical, and in vitro research with IBD. In addition, we have mentioned and suggested several plants and by-products originated and produced in Latin America that could be part of future research as good sources of specific phenolic compounds to be applied in the prevention and development of alternative treatments for IBD. This review may offer a valuable reference for studies related to IBD administering phenolic compounds from natural, cheap, and easily accessible raw and undervalued materials.
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Affiliation(s)
| | - Marina Vilar Geraldi
- University of Campinas, School of Food Engineering, 80 Monteiro Lobato Street, 13083-862 Campinas, SP, Brazil
| | | | | | - Teresa Vezza
- University of Granada, Department of Pharmacology, CIBER-EHD, Institute of Biosanitary Research of Granada (ibs.GRANADA), Biomedical Research Center (CIBM), Campus de la Salud, 18071 Granada, Spain
| | - Patricia Diez-Echave
- University of Granada, Department of Pharmacology, CIBER-EHD, Institute of Biosanitary Research of Granada (ibs.GRANADA), Biomedical Research Center (CIBM), Campus de la Salud, 18071 Granada, Spain
| | - Julio Juan Gálvez
- University of Granada, Department of Pharmacology, CIBER-EHD, Institute of Biosanitary Research of Granada (ibs.GRANADA), Biomedical Research Center (CIBM), Campus de la Salud, 18071 Granada, Spain
| | - Cinthia Bau Betim Cazarin
- University of Campinas, School of Food Engineering, 80 Monteiro Lobato Street, 13083-862 Campinas, SP, Brazil
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Bhatnagar G, Rodriguez-Justo M, Higginson A, Bassett P, Windsor A, Cohen R, Halligan S, Taylor SA. Inflammation and fibrosis in Crohn's disease: location-matched histological correlation of small bowel ultrasound features. Abdom Radiol (NY) 2021; 46:144-155. [PMID: 32564208 PMCID: PMC7864849 DOI: 10.1007/s00261-020-02603-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the utility of mural and extramural sonographic features of Crohn's Disease as potential imaging biomarkers of inflammation and fibrosis against whole-mount histological sections. METHODS Twelve Crohn's disease patients (Mean age 35(25-69), 7 males) underwent small bowel ultrasound prior to small bowel resection. Two radiologists in consensus graded multiple parameters including mural, mucosal and submucosal thickness, submucosal/mesenteric echogenicity and clarity and mural Doppler signal in 50 selected bowel cross-sections. Matching with histological sampling sites was facilitated via scanning of the resected specimen. A histopathologist scored acute and chronic inflammation, and fibrosis (using histological scoring systems) following analysis of whole mount block sections. The association between sonographic observations and histopathological scores was examined via univariable and multivariable analysis. RESULTS In univariate analyses, bowel wall thickness (regression co-efficient and 95% CI 0.8 (0.3, 1.3) p = 0.001), mesenteric fat echogenicity (8.7(3.0, 14.5) p = 0.005), submucosal layer thickness (7.4(1.2, 13.5) p = 0.02), submucosal layer clarity (4.4(0.6, 8.2) p = 0.02) and mucosal layer thickness (4.6(1.8, 7.4) p = 0.001) were all significantly associated with acute inflammation. Mesenteric fat echogenicity (674(8.67, 52404) p = 0.009), submucosal layer thickness (79.9(2.16, 2951) p = 0.02) and mucosal layer thickness (13.6(1.54, 121) p = 0.02) were significantly associated with chronic inflammation. Submucosal layer echogenicity (p = 0.03), clarity (25.0(1.76, 356) p = 0.02) and mucosal layer thickness (53.8(3.19, 908) p = 0.006) were significantly associated with fibrosis. In multivariate analyses, wall and mucosal thickness remained significantly associated with acute inflammation (p = 0.02), mesenteric fat echogenicity with chronic inflammation (p = 0.009) and mucosal thickness (p = 0.006) with fibrosis. CONCLUSION Multiple sonographic parameters are associated with histological phenotypes in Crohn's disease although there is overlap between ultrasonic stigmata of acute inflammation, chronic inflammation and fibrosis.
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Affiliation(s)
- Gauraang Bhatnagar
- grid.83440.3b0000000121901201Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Manuel Rodriguez-Justo
- grid.439749.40000 0004 0612 2754Department of Histology, University College Hospitals, London, UK
| | - Antony Higginson
- grid.415470.30000 0004 0392 0072Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Alastair Windsor
- grid.439749.40000 0004 0612 2754Department of Colorectal Surgery, University College Hospitals, London, UK
| | - Richard Cohen
- grid.439749.40000 0004 0612 2754Department of Colorectal Surgery, University College Hospitals, London, UK
| | - Steve Halligan
- grid.83440.3b0000000121901201Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Stuart A. Taylor
- grid.83440.3b0000000121901201Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
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20
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Olfatifar M, Asadzadeh Aghdaei H, Pourhoseingholi MA, Balaii H, Hashemi Nazari S, Shahrokh S, Sabour S, Ivanchuk M, Ivanchuk P, Khodakarim S, Zali MR, Rohani P, Mehralian G. Description of the inflammatory bowel disease natural history in Tehran province, Iran: Mixed panel approaches. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2021; 14:S66-S74. [PMID: 35154604 PMCID: PMC8817742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/29/2021] [Indexed: 10/25/2022]
Abstract
AIM Description of the inflammatory bowel disease natural history in Tehran province. BACKGROUND Inflammatory bowel disease (IBD) is a non-homogeneous disorder with an unpredictable natural history that impairs a patient's quality of life over the course of their life. As a result, providing evidence for efficient patient management is critical. METHODS In this case series study, 198 IBD patients who were visited in our clinic at least three times routinely from Oct 2015 to May 2020 were included. Then, two panel-based approaches, the Multi-State Model (MSM) and random-effect ordered logistic, were used to deduce the clinical course of IBD, which included remission, mild, moderate to severe, and surgical states. RESULTS For ulcerative colitis (UC), women had a slightly poorer condition for remission but better for moderate to severe and a faster transition from moderate to severe to mild (HR=1.490, 95% CI: 1.02-2.16) compared to men. For Crohn's disease (CD), they had a better condition for remission but a slightly poorer condition for the severe state and higher transition from mild to moderate to severe (HR=1.221, 95% CI: 0.471-3.22) than men. Oral 5-ASA had better efficacy in people with remission and/or mild states but not for those with moderate to severe states, especially in CD (mild to moderate to serve, HR=1.526, 95% CI: 0.59-3.89). Immunosuppressive drugs were better for patients with lower disease severity, especially with UC (mild to remission, HR=1.258, 95% CI: 0.75-2.09). CONCLUSION Panel approaches have the potential efficacy to tackle the unpredictable clinical course of IBD (UC/CD). Hence, we highly recommend that our findings be included into the Iranian routine clinical environment of IBD and/or that related studies be conducted in Iran and other regions to gain a better understanding of the natural history of IBD.
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Affiliation(s)
- Meysam Olfatifar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedieh Balaii
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Centre, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Shahrokh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Safety Promotions and Injury, Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maria Ivanchuk
- Biological Physics and Medical Informatics Department, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Pavlo Ivanchuk
- Internal Medicine, Physical Rehabilitation, Sports Medicine and Physical Training Department, Bukovinian State Medical University, Chernivtsi, Ukrain
| | - Soheila Khodakarim
- Department of Biostatistics, School of Medicine, Shiraz University of Medical sciences, Shiraz, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Pediatric's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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21
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Gonzalez-Montpetit E, Ripollés T, Martinez-Pérez MJ, Vizuete J, Martín G, Blanc E. Ultrasound findings of Crohn's disease: correlation with MR enterography. Abdom Radiol (NY) 2021; 46:156-167. [PMID: 32607648 DOI: 10.1007/s00261-020-02622-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
Crohn's disease is a chronic inflammatory bowel disease characterized by periods of relative inactivity alternating with acute flare-ups. Imaging techniques play a fundamental role in the diagnosis and follow-up of Crohn's disease, providing information on the extent of disease, disease activity, and the presence of extramural complications. Because of the frequent re-evaluation required by the relapsing nature of Crohn's disease and the relative young age at which most patients are diagnosed, techniques that use ionizing radiation are best avoided in monitoring this population. Thus, magnetic resonance enterography (MRE) and ultrasonography (US) are the preferable techniques. Various studies have demonstrated that US is accurate in assessing the gut. Despite some clear advantages over MRE, US has long been underused in the evaluation of intestinal disease. This review presents an overview of the main imaging findings in Crohn's disease, correlating representative US images with MRE and surgical pathology specimens. We conclude that US reliably depicts both bowel-related and mesenteric features of Crohn's disease and US findings correlate strongly with MRE findings.
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Affiliation(s)
- Estefania Gonzalez-Montpetit
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain.
- Abdominal Imaging, Centre IDI Girona, Hospital Universitario Doctor Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain.
| | - Tomás Ripollés
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - María J Martinez-Pérez
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - José Vizuete
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Gregorio Martín
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Esther Blanc
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
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22
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Diet Advice for Crohn's Disease: FODMAP and Beyond. Nutrients 2020; 12:nu12123751. [PMID: 33291329 PMCID: PMC7762196 DOI: 10.3390/nu12123751] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD) is a chronic, progressive, and destructive granulomatous inflammatory bowel disorder that can involve any part of the gastrointestinal tract. It has been presumed that different types of diet might improve gastrointestinal symptoms in CD patients. The aim of this review was to clarify the efficiency and indications of a low-“fermentable oligo-, di-, mono-saccharides and polyols” (FODMAP) diet (LFD) in CD and to further analyze the available data on other types of diets. PubMed, Cochrane Library, EMBASE and WILEY databases were screened for relevant publications regarding the effect of FODMAP diets on CD. Our search identified 12 articles analyzing the effect of an LFD in CD, 5 articles analyzing the effect of a Mediterranean diet (MD), 2 articles analyzing the effect of a vegetarian diet (VD), and 2 articles analyzing the effect of a low-lactose diet (LLD). The majority of the studies included in this review show the significant efficiency of the LFD in CD patients. We found significant evidence demonstrating that the LFD has a favorable impact on gastrointestinal symptoms in CD patients. Notwithstanding the evidence, it remains to be established if an LFD is more efficient than other types of diets in the short term and especially in the long term.
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Gupta A, Pratap Mouli V, Mohta S, Kante B, Kalaivani M, Madhu D, Sahu P, Kumar S, Sharma R, Sahni P, Das P, Gupta SD, Makharia G, Kedia S, Ahuja V. Antitubercular Therapy Given to Differentiate Crohn's Disease From Intestinal Tuberculosis Predisposes to Stricture Formation. J Crohns Colitis 2020; 14:1611-1618. [PMID: 32369567 DOI: 10.1093/ecco-jcc/jjaa091] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Treatment trial with antitubercular therapy [ATT] is a common strategy in tuberculosis-endemic countries in case of a diagnostic dilemma between intestinal tuberculosis and Crohn's disease [CD]. Our aim was to determine the long-term clinical course of patients who received ATT before an eventual diagnosis of CD was made. METHODS We performed retrospective comparison between CD patients who received ≥6 months of ATT vs those who did not receive ATT. Outcomes assessed were change in disease behaviour during follow-up, requirement of surgery and medication use. RESULTS In all, 760 patients with CD were screened for the study and, after propensity matching for location and behaviour of disease, 79 patients in each group were compared. Progression from inflammatory [B1] to stricturing/fistulising [B2/B3] phenotype was increased among CD patients who received ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 41.8%, 51.9%, 6.3% at follow-up, respectively] as compared with those who did not receive ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 72.2%, 27.8%, 0% at follow-up, respectively] with an odds ratio of 11.05[3.17-38.56]. The usage of 5-aminosalocylates, steroids, immunosuppressants and anti-tumour necrosis factor was similar between both the groups. On survival analysis, CD patients who received ATT had a lower probability of remaining free of surgery [45%] than those who did not [76%] at 14 years of follow-up (hazard ratio [HR] = 3.22, 95% confidence interval [CI], 1.46-7.12, p = 0.004]. CONCLUSIONS Crohn's disease patients diagnosed after a trial with antitubercular therapy had an unfavourable long-term disease course with higher rate of stricture formation and less chance of remaining free of surgery.
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Affiliation(s)
- Akshita Gupta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Venigalla Pratap Mouli
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Mohta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Madhu
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Pabitra Sahu
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Kumar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Schuster IP, Mutz H, Perera S, Perera R, Taub E, Rajapakse R. Influence of Pharmaceutical Direct-to-Consumer Advertisement on Medical Treatment of Inflammatory Bowel Disease-An Outpatient Survey-Based Study. CROHN'S & COLITIS 360 2020; 2:otaa054. [PMID: 36777750 PMCID: PMC9802367 DOI: 10.1093/crocol/otaa054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 11/14/2022] Open
Abstract
Background The management of inflammatory bowel disease (IBD) has become much more complex as our understanding of the disease pathology has improved and as new novel therapeutic options come into play. A factor that has not been studied in the management of this disease is the role that Direct-To-Consumer Advertisement (DTCA) plays in patients' decisions regarding their treatment options. Here we investigate the very role this mode of television advertisement has on influencing our patients. Methods Following formal institutional review board approval, we devised a prospective, single institution, survey-based study in our university-based outpatient gastroenterology clinic. Surveys included major demographic features along with questions pertaining to patients' interactions with various advertisements. Surveys were collected over a 3-month period. Results Overall, 103 surveys were collected. The data were not normally distributed. Fifty-three patients were female, and 40 patients were male. Eighty-one percent of patients with IBD were not affected in any way by advertisements with regard to influencing their decision to start new therapies. A subgroup analysis revealed that various parameters including age, sex, and marital status played a role in how DTCA influences patients with regard to their IBD treatments. Discussion This study demonstrates that overall patients are not significantly influenced by DTCAs; however, some cohorts are influenced in more ways than others. This study highlights the importance of understanding the role DTCA plays in influencing our patients with IBD and sets the foundation for further inquiry into this very interesting relationship.
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Affiliation(s)
- Isaiah P Schuster
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA,Address correspondence to: Isaiah P. Schuster, MD, HSC, Level 17, Rm 060, Stony Brook, NY 11794-8173 ()
| | - Hugo Mutz
- Stony Brook University Hospital, Stony Brook, New York, USA
| | | | - Royce Perera
- Stony Brook University Hospital, Stony Brook, New York, USA
| | - Erin Taub
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Ramona Rajapakse
- Zucker School of Medicine at Hofstra, Northwell, Mather Gastroenterology, Port Jefferson, New York, USA
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25
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Manzella CR, Jayawardena D, Pagani W, Li Y, Alrefai WA, Bauer J, Jung B, Weber CR, Gill RK. Serum Serotonin Differentiates Between Disease Activity States in Crohn's Patients. Inflamm Bowel Dis 2020; 26:1607-1618. [PMID: 32844174 PMCID: PMC7500525 DOI: 10.1093/ibd/izaa208] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diagnosis and monitoring of inflammatory bowel diseases (IBDs) utilize invasive methods including endoscopy and tissue biopsy, with blood tests being less specific for IBDs. Substantial evidence has implicated involvement of the neurohormone serotonin (5-hydroxytryptamine, 5-HT) in the pathophysiology of IBDs. The current study investigated whether serum 5-HT is elevated in patients with active ulcerative colitis (UC) or Crohn's disease (CD). METHODS Serum samples were obtained from a German cohort of 96 CD and UC patients with active disease, refractory disease, or remission of disease based upon their disease activity index (DAI) and disease history. High pressure liquid chromatography with tandemmass spectrometry was used to measure 5-HT, tryptophan (TRP), and kynurenine (KYN) levels in the serum samples, and Luminex Multiplex ELISA was used to measure cytokine levels. Intestinal mucosal biopsies were obtained from a separate cohort of healthy and CD patients, and the immunoreactivity of the serotonin transporter (SERT) was determined. RESULTS There was no statistically significant difference in TRP or KYN levels between disease categories in either UC or CD. Interestingly, 5-HT levels were significantly elevated in patients with active CD but not active UC when compared with the levels in remission or refractory disease. Serum 5-HT was superior to C-reactive protein and circulating cytokines in differentiating between disease categories in CD. Additionally, SERT immunoreactivity was decreased in the ileum and colon of patients with CD compared to healthy controls. CONCLUSION We have shown that the serum 5-HT can differentiate between active disease and refractory disease or remission among CD patients, emphasizing the potential suitability of serum 5-HT as an auxiliary measure in diagnosing active CD.
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Affiliation(s)
- Christopher R Manzella
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Dulari Jayawardena
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Wilfredo Pagani
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ye Li
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Waddah A Alrefai
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Jessica Bauer
- Department of Medicine, University of Washington, WA, USA
| | - Barbara Jung
- Department of Medicine, University of Washington, WA, USA
| | | | - Ravinder K Gill
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
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Walczak M, Lykowska-Szuber L, Plucinska M, Stawczyk-Eder K, Zakerska-Banaszak O, Eder P, Krela-Kazmierczak I, Michalak M, Zywicki M, Karlowski WM, Szalata M, Dobrowolska A, Slomski R, Skrzypczak-Zielinska M. Is Polymorphism in the Apoptosis and Inflammatory Pathway Genes Associated With a Primary Response to Anti-TNF Therapy in Crohn's Disease Patients? Front Pharmacol 2020; 11:1207. [PMID: 32922288 PMCID: PMC7456829 DOI: 10.3389/fphar.2020.01207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/24/2020] [Indexed: 12/18/2022] Open
Abstract
Anti-tumor necrosis factor (TNF) therapy is used for the induction and maintenance of remission in Crohn’s disease (CD) patients. However, primary nonresponders to initial treatment constitute 20%–40% of cases. The causes of this phenomenon are still unknown. In this study, we aimed to determine the genetic predictors of the variable reactions of CD patients to anti-TNF therapy. Using long-range PCR libraries and the next-generation sequencing (NGS) method, we performed broad pharmacogenetic studies including a panel of 23 genes (TNFRSF1A, TNFRSF1B, CASP9, FCGR3A, LTA, TNF, FAS, ADAM17, IL17A, IL6, MMP1, MMP3, S100A8, S100A9, S100A12, TLR2, TLR4, TLR9, CD14, IL23R, IL23, IL1R, and IL1B) in a group of 107 diagnosed and clinically characterized CD patients following anti-TNF therapy. In the studied group, we indicated, in total, 598 single nucleotide variants for all analyzed genomic targets. Twelve patients (11.2%) did not respond to the induction therapy, which was associated with alleles in 11 loci located in FCGR3A (rs7539036, rs6672453, rs373184583, and rs12128686), IL1R (rs2041747), TNFRSF1B (rs5746053), IL1B (rs1071676, rs1143639, rs1143637, and rs1143634), and FAS (rs7896789) genes. After multiple comparison corrections, the results were not statistically significant, however for nonresponders the alleles distribution for those loci presented large differences and specified scheme compared to responders and populations. These findings require further investigation in an independent larger cohort before introducing them for a clinical setting, however, we identified an interesting direction. Polymorphism of the FCGR3A, IL1R, TNFRSF1B, IL1B, and FAS genes could be a predictor of the primary response to anti-TNF therapy in CD patients.
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Affiliation(s)
- Michal Walczak
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Liliana Lykowska-Szuber
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marianna Plucinska
- Department of Computational Biology, Faculty of Biology, Institute of Molecular Biology and Biotechnology, Adam Mickiewicz University, Poznan, Poland
| | - Kamila Stawczyk-Eder
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Iwona Krela-Kazmierczak
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Zywicki
- Department of Computational Biology, Faculty of Biology, Institute of Molecular Biology and Biotechnology, Adam Mickiewicz University, Poznan, Poland
| | - Wojciech M Karlowski
- Department of Computational Biology, Faculty of Biology, Institute of Molecular Biology and Biotechnology, Adam Mickiewicz University, Poznan, Poland
| | - Marlena Szalata
- Department of Biochemistry and Biotechnology, University of Life Sciences, Poznan, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Slomski
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
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Zittan E, Gralnek IM, Berns MS. The New Proactive Approach and Precision Medicine in Crohn's Disease. Biomedicines 2020; 8:biomedicines8070193. [PMID: 32635316 PMCID: PMC7400127 DOI: 10.3390/biomedicines8070193] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022] Open
Abstract
The proactive approach to Crohn's disease (CD) management advocates moving toward algorithmic tight-control scenarios that are designed for each CD phenotype to guide remission induction, maintenance therapy, active monitoring, and multidisciplinary care to manage the complexities of each inflammatory bowel disease (IBD) patient. This requires accurate initial clinical, laboratory, radiological, endoscopic, and/or tissue diagnosis for proper phenotypic stratification of each CD patient. A substantial proportion of patients in symptomatic remission have been reported to demonstrate evidence of active disease, with elevated fecal calprotectin(FC) and C-reactive protein (CRP) levels as a hallmark for mucosal inflammation. Active mucosal inflammation, and elevated CRP and fecal calprotectin (FC) have been shown to be good predictors of clinical relapse, disease progression, and complications in IBD patients. The next frontier of treatment is personalized medicine or precision medicine to help solve the problem of IBD heterogeneity and variable responses to treatment. Personalized medicine has the potential to increase the efficacy and/or reduce potential adverse effects of treatment for each CD phenotype. However, there is currently an unmet need for better elucidation of the inflammatory biopathways and genetic signatures of each IBD phenotype, so personalized medicine can specifically target the underlying cause of the disease and provide maximal efficacy to each patient.
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Affiliation(s)
- Eran Zittan
- Ellen and Pinchas Mamber Institute of Gastroenterology and Liver Diseases, IBD unit, Emek Medical Center, Afula 1834111, Israel;
- Correspondence:
| | - Ian M. Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Liver Diseases, IBD unit, Emek Medical Center, Afula 1834111, Israel;
- Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa 31096, Israel;
| | - Marc S. Berns
- Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa 31096, Israel;
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Cura M, Torre A, Cueto Sarmiento K, Bollea Garlatti M, Riganti J, Puga M, Mazzuoccolo L. Pemphigus Vulgaris: A Retrospective Cohort Study of Clinical Features, Treatments, and Outcomes. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cura M, Torre A, Cueto Sarmiento K, Bollea Garlatti M, Riganti J, Puga M, Mazzuoccolo L. Pénfigo vulgar: estudio de cohorte retrospectivo de sus características clínicas, tratamientos empleados y evolución. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:398-407. [DOI: 10.1016/j.ad.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022] Open
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Abstract
Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory condition primarily involving the gastrointestinal tract. It includes Crohn's disease (CD), ulcerative colitis (UC), and a less common phenotype-indeterminate colitis. It is thought to result from a complex interplay of environmental, microbial, and host factors including genetic factors, although the exact mechanism is not known. Dietary factors have been shown to play a role in the pathogenesis of IBD and can potentially alter the intestinal microbiota as well as disrupt the immune function in the gut. CD is characterized by transmural inflammation, sometimes associated with granulomatous lesions, and involves the entire gastrointestinal tract but often spares the rectum. UC is characterized by mucosal inflammation typically confined to the colon and rectum. Although IBD is mostly seen in western world, recent data suggests that the incidence and prevalence are increasing worldwide. Enteral nutrition has been shown to be effective in inducing remission in pediatric population with CD; however, there is mixed data in adult population. Nutritional deficiencies such as vitamin D and zinc deficiency are often noted in IBD patients. Several extraintestinal manifestations are noted in patients with IBD. Some of them parallel with the disease activity and others are independent of the disease course. Assessment of IBD disease activity clinically, radiologically, if indicated, biochemically and endoscopically is important to guide therapy in IBD. To ensure comprehensive care, it is important to assess associated conditions such as nutritional and psychological well-being, as well as age appropriate health maintenance status prior to starting treatment for IBD. Several biologic agents including anti-tumor necrosis factor alpha (anti-TNF-α) drugs, anti-integrins, and antibodies to the p40 subunit of IL12/23 are approved for induction and maintenance of remission of IBD. Steroids are also often used for induction. Anti-metabolites and thiopurines are also useful either as monotherapy or in combination regimens. Potential side effects of anti-TNF-α drugs such as serious infections, malignancy, worsening of heart failure, and infusion-related reactions should be considered prior to starting these drugs. Anti-TNF-α drugs with or without immunomodulators (azathioprine, 6-mercaptopurine, methotrexate) are often used for the induction and maintenance of remission. Treating to target of endoscopic and clinical remission provides the best long-term outcomes. Our knowledge and understanding of IBD has grown significantly. However, there are several unanswered questions on pathogenesis, disease behavior, and drivers of inflammation in various patient subgroups which require further research.
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Ferreira TMR, Albuquerque A, Cancela Penna FG, Macedo Rosa R, Correia MITD, Barbosa AJA, Salles Cunha A, Ferrari MDLA. Effect of Oral Nutrition Supplements and TGF-β2 on Nutrition and Inflammatory Patterns in Patients With Active Crohn's Disease. Nutr Clin Pract 2019; 35:885-893. [PMID: 31840323 DOI: 10.1002/ncp.10448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is often associated with nutrition disorders. Many nutrition therapeutic alternatives have been studied. Nevertheless, the actual role of nutrition therapy is still controversial. The objective of this study was to assess the effects of nutrition supplementation with and without transforming growth factor-beta 2 (TGF-β2) on inflammatory, endoscopic, histopathologic, and nutrition parameters in active CD. MATERIALS AND METHODS Thirty-eight patients were allocated into 3 groups: group 1 (patients who received only nutrition orientation), group 2 (nutrition orientation and a normoproteic, normocaloric nutrition supplement), and group 3 (nutrition orientation and the nutritional supplement with TGF-β2). Clinical and nutrition evaluation, C-reactive protein (CRP) levels, and assessment of endoscopic and histologic parameters in the intestinal mucosa were performed before and after nutrition intervention. RESULTS The mean follow-up period was 3 months. In the beginning of the study, groups were homogeneous regarding age, gender, CD behavior and localization, and medication in use. In the end of the study, the Clinical Disease Activity Index score was reduced in groups 2 and 3; in group 3, a reduction in CRP levels and an improvement in histologic findings were observed. Among patients who received nutritional supplement, some anthropometric patterns were improved. CONCLUSION The results of the study indicate that nutritional supplementation improved nutrition and inflammatory patterns in patients with active CD. However, only patients receiving TGF-β2-enriched formula showed improvement in histologic parameters and significant reduction in CRP levels.
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Affiliation(s)
| | - Annanda Albuquerque
- Adult Health Post Graduation Program, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Rodrigo Macedo Rosa
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Aloísio Salles Cunha
- Department of Clinical Medicine, Universidade Federal de Minas Gerais, Medical School, Belo Horizonte, Brazil
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McVeigh L, Payne A. Inducing remission in paediatric Crohn's disease using nutritional therapies - A systematic review. J Hum Nutr Diet 2019; 33:170-186. [PMID: 31797471 DOI: 10.1111/jhn.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is known to be a safe and effective treatment option for managing active Crohn's disease (CD) in children, although no uniform protocol exists. The aim of this systematic review was to evaluate and compare the clinical effectiveness of aspects of EEN protocols to ascertain whether an optimum regimen can be identified. METHODS A systematic search of the Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHL and AMED was conducted for studies published between 1998 and 2018 that examined paediatric patients being treated with an enteral nutrition protocol to induce remission. Studies that included patients receiving concurrent medication for active disease were excluded. Quality assessment was performed using separate tools for randomised controlled trials, cohort studies and for studies without a control group. RESULTS Sixteen studies met the inclusion criteria. Of these, six found insufficient evidence to support use of a specific formula. One study examined the route of EEN, finding no difference between oral or nasogastric tube administration with respect to inducing remission. Three examined the use of partial enteral nutrition to induce remission, although conflicting results were seen. No studies explored the effect of length of treatment or energy prescription on remission rates CONCLUSIONS: An optimum enteral nutrition protocol for inducing remission cannot be identified. Further focused research is required by well designed, adequately powered prospective clinical trials to examine aspects of enteral feeding protocols that remain uncertain, including the use of partial enteral nutrition as a potential alternative to EEN.
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Affiliation(s)
- L McVeigh
- Nutrition and Dietetics Department, Bristol Royal Hospital for Children, Bristol, UK
| | - A Payne
- Faculty of Health & Human Sciences, School of Health Professions, The University of Plymouth, Plymouth, UK
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Santarpia L, Alfonsi L, Castiglione F, Pagano MC, Cioffi I, Rispo A, Sodo M, Contaldo F, Pasanisi F. Nutritional Rehabilitation in Patients with Malnutrition Due to Crohn's Disease. Nutrients 2019; 11:nu11122947. [PMID: 31817074 PMCID: PMC6950059 DOI: 10.3390/nu11122947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory bowel disease frequently associated with malabsorption and secondary protein-energy malnutrition (PEM). METHODS Biochemical and clinical data of 63 (34 females, 29 males) patients with PEM due to CD sent to our outpatient unit for nutritional evaluation were retrospectively analyzed. Patients were divided into two groups, according to disease activity. Thirty-eight patients (group A) had the active disease, and 25 patients (group B) suffered from malabsorption resulting from past intestinal resections due to CD. After a physical and hemato-biochemical evaluation at the first visit, all patients received disease-specific personalized dietetic indications. When indicated, oral nutritional supplements, oral/parenteral vitamins, micronutrients, and electrolytes, up to parenteral nutrition, were prescribed. RESULTS After 1, 3, and 6 months of nutritional therapy, body weight, body mass index (BMI), and serum butyryl-cholinesterase significantly improved in both groups. In 8 out of 13 (61.5%) patients with a cutaneous stoma, intestinal continuity was restored. CONCLUSIONS This study confirms the effectiveness of nutritional rehabilitation and provides information on the time required for nutritional treatment in patients with CD, both during the acute phase and after malabsorption due to intestinal resection.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
- Correspondence: ; Tel./Fax: +39-081-746-2333
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (F.C.); (A.R.)
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Iolanda Cioffi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (F.C.); (A.R.)
| | - Maurizio Sodo
- General and Transplantation Surgery, Department of Public Health, Federico II University Hospital, 80131 Naples, Italy;
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Via Pansini, 5, 80131 Naples, Italy; (L.A.); (M.C.P.); (I.C.); (F.C.); (F.P.)
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Chen ZX, Chen YL, Huang XM, Lin XT, He XW, Lan P. Risk factors for recurrence after bowel resection for Crohn’s disease. World J Gastrointest Pharmacol Ther 2019; 10:67-74. [PMID: 31692953 PMCID: PMC6829093 DOI: 10.4292/wjgpt.v10.i4.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/12/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complications of Crohn’s disease such as intestinal obstruction, fistula or perforation often need surgical treatment. Nearly 70%-80% patients with Crohn’s disease would receive surgical treatment during the lifetime. However, surgical treatment is incurable for Crohn’s disease. The challenge of recurrence postoperatively troubles both doctors and patients. Over 50% patients would suffer recurrence postoperatively. Some certain risk factors are associated with recurrence of Crohn’s disease.
AIM To evaluate the risk factors for endoscopic recurrence and clinical recurrence after bowel resection in Crohn’s disease.
METHODS Patients diagnosed Crohn’s disease and received intestinal resection between April 2007 and December 2013 were included in this study. Data on the general demographic information, preoperative clinical characteristics, surgical information, postoperative clinical characteristics were collected. Continuous data are expressed as median (inter quartile range), and categorical data as frequencies and percentages. Kaplan-Meier method was applied to estimate the impact of the clinical variables above on the cumulative rate of postoperative endoscopic recurrence and clinical recurrence, then log-rank test was applied to test the homogeneity of those clinical variables. Multivariate Cox proportional hazard regression analysis was performed to identify the risk factors of postoperative endoscopic recurrence and clinical recurrence.
RESULTS A total of 64 patients were included in this study. The median follow-up time for the patients was 17 (9.25-25.75) mo. In this period, 41 patients (64.1%) had endoscopic recurrence or clinical recurrence. Endoscopic recurrence occurred in 34 (59.6%) patients while clinical recurrence occurred in 28 (43.8%) patients, with the interval between the operation and recurrence of 13.0 (8.0-24.5) months and 17.0 (8.0-27.8) mo, respectively. In univariate analysis, diagnosis at younger age (P < 0.001), disease behavior of penetrating (P = 0.044) and preoperative use of anti-tumor necrosis factor (TNF) (P = 0.020) were significantly correlated with endoscopic recurrence, while complication with perianal lesions (P = 0.032) and preoperative use of immunomodulatory (P = 0.031) were significantly correlated with clinical recurrence. As to multivariate analysis, diagnostic age (P = 0.004), disease behavior (P = 0.041) and preoperative use of anti-TNF (P = 0.010) were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions (P = 0.023) was an independent prognostic factor for clinical recurrence.
CONCLUSION Diagnostic age, disease behavior, preoperative use of anti-TNF and complication with perianal lesions were independent risk factors for postoperative recurrence in Crohn’s disease.
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Affiliation(s)
- Ze-Xian Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Yong-Le Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Xiao-Ming Huang
- Department of Hepatobiliary Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Xu-Tao Lin
- Department of Endoscopy Center, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Xiao-Wen He
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
| | - Ping Lan
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
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Jairath V, Hokkanen SRK, Guizzetti L, Boxall N, Campbell-Hill S, Patel H. No increased risk of nephrotoxicity associated with 5-aminosalicylic acid in IBD: a population-based cohort and nested case-control study. Aliment Pharmacol Ther 2019; 50:416-424. [PMID: 31298421 DOI: 10.1111/apt.15408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is conflicting evidence about nephrotoxicity risk associated with 5-aminosalicylates for treatment of IBD. AIMS To determine population-based temporal trends for 5-aminosalicylates and estimated risk of nephrotoxicity associated with 5-aminosalicylate use for ulcerative colitis (UC) and Crohn's disease (CD). METHODS Retrospective cohort and nested case-control study, using the Health Improvement Network primary care database linked to hospital discharge coding for patients in England, 1996-2017. Nephrotoxicity risk analysis was a first recorded renal impairment diagnosis adjusted for key variables and was assessed between 2008 and 2017. RESULTS A total of 35 601 patients with prevalent UC or CD were included. The proportion of patients prescribed 5-aminosalicylates fell from 83% in 1996-1999 to 71% in 2012-2015 for UC patients and 64% to 45% for CD patients. Thirty per cent of patients had prolonged 5-aminosalicylate use. Between 2008 and 2017, the incident rate of nephrotoxicity was similar and stable for UC (12.6/1000 person-years) and CD (10.9/1000 person-years) patients. Multivariate analysis showed no evidence for association between current prescription of 5-aminosalicylate and nephrotoxicity in UC or CD patients, comparing ≤ 30 days prescription prior to index vs 31-≤180 days. However, active disease, disease duration, concomitant cardiovascular disease or diabetes and nephrotoxic drug use were independently associated with development of nephrotoxicity in UC and CD. CONCLUSIONS Despite the paucity of evidence for their benefit, 5-aminosalicylates were prescribed to approximately half of CD patients (30% prolonged therapy). Nephrotoxicity was rare in this patient cohort, and was not associated with 5-aminosalicylate use, but rather with disease status, comorbidity and use of nephrotoxic drugs.
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Affiliation(s)
- Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | | | | | - Sarah Campbell-Hill
- Evidence and Value Generation, Global Medical Affairs, Takeda Pharmaceuticals International Inc., London, UK
| | - Haridarshan Patel
- Evidence and Value Generation, Global Medical Affairs, Takeda Pharmaceuticals International Inc., Deerfield, Illinois
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Reisdorf WC, Xie Q, Zeng X, Xie W, Rajpal N, Hoang B, Burgert ME, Kumar V, Hurle MR, Rajpal DK, O’Donnell S, MacDonald TT, Vossenkämper A, Wang L, Reilly M, Votta BJ, Sanchez Y, Agarwal P. Preclinical evaluation of EPHX2 inhibition as a novel treatment for inflammatory bowel disease. PLoS One 2019; 14:e0215033. [PMID: 31002701 PMCID: PMC6474586 DOI: 10.1371/journal.pone.0215033] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
Epoxyeicosatrienoic acids (EETs) are signaling lipids produced by cytochrome P450 epoxygenation of arachidonic acid, which are metabolized by EPHX2 (epoxide hydrolase 2, alias soluble epoxide hydrolase or sEH). EETs have pleiotropic effects, including anti-inflammatory activity. Using a Connectivity Map (CMAP) approach, we identified an inverse-correlation between an exemplar EPHX2 inhibitor (EPHX2i) compound response and an inflammatory bowel disease patient-derived signature. To validate the gene-disease link, we tested a pre-clinical tool EPHX2i (GSK1910364) in a mouse disease model, where it showed improved outcomes comparable to or better than the positive control Cyclosporin A. Up-regulation of cytoprotective genes and down-regulation of proinflammatory cytokine production were observed in colon samples obtained from EPHX2i-treated mice. Follow-up immunohistochemistry analysis verified the presence of EPHX2 protein in infiltrated immune cells from Crohn's patient tissue biopsies. We further demonstrated that GSK2256294, a clinical EPHX2i, reduced the production of IL2, IL12p70, IL10 and TNFα in both ulcerative colitis and Crohn's disease patient-derived explant cultures. Interestingly, GSK2256294 reduced IL4 and IFNγ in ulcerative colitis, and IL1β in Crohn's disease specifically, suggesting potential differential effects of GSK2256294 in these two diseases. Taken together, these findings suggest a novel therapeutic use of EPHX2 inhibition for IBD.
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Affiliation(s)
- William C. Reisdorf
- Computational Biology, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
- * E-mail:
| | - Qing Xie
- Computational Biology, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Xin Zeng
- Target & Pathway Validation, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Wensheng Xie
- Target & Pathway Validation, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Neetu Rajpal
- Computational Biology, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Bao Hoang
- Exploratory Biomarkers, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Mark E. Burgert
- Research Statistics, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Vinod Kumar
- Computational Biology, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Mark R. Hurle
- Computational Biology, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Deepak K. Rajpal
- Computational Biology, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Sarah O’Donnell
- Centre for Digestive Diseases, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Anna Vossenkämper
- Centre for Immunobiology, Blizard Institute, QMUL, London, United Kingdom
| | - Lin Wang
- Pattern Recognition Receptor DPU, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Mike Reilly
- Pattern Recognition Receptor DPU, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Bart J. Votta
- Pattern Recognition Receptor DPU, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Yolanda Sanchez
- Stress and Repair DPU, Respiratory Therapy Area, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Pankaj Agarwal
- Computational Biology, GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
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Manfredi M, Conte E, Barberis E, Buzzi A, Robotti E, Caneparo V, Cecconi D, Brandi J, Vanni E, Finocchiaro M, Astegiano M, Gariglio M, Marengo E, De Andrea M. Integrated serum proteins and fatty acids analysis for putative biomarker discovery in inflammatory bowel disease. J Proteomics 2019; 195:138-149. [DOI: 10.1016/j.jprot.2018.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/19/2018] [Accepted: 10/31/2018] [Indexed: 12/30/2022]
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Guideline recommendations for treatment of patients with inflammatory bowel diseases are not implemented in clinical practice-results of a non-representative survey. Int J Colorectal Dis 2019; 34:431-440. [PMID: 30523398 DOI: 10.1007/s00384-018-3215-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a growing evidence for over-, under-, or misuse of health care in patients with inflammatory bowel disease. Most studies looked at treatment variability or used quality measures, which mostly capture supportive interventions rather than treatment of IBD in itself. We aimed to evaluate if current recommendations in clinical practice guidelines regarding the medical treatment of patients with inflammatory bowel diseases are being followed in Germany. METHODS A questionnaire was sent to 1901 patients insured with two large German statutory sickness funds and an ICD 10 diagnosis of Crohn's disease (CD) or ulcerative colitis (UC). The questionnaire asked about drug treatment, indications for drug treatment, provision of surveillance endoscopies in ulcerative colitis patients, and smoking status in Crohn's disease patients. RESULTS Out of 460 evaluable patients, 62.4% of UC patients and 53.9% of CD patients were treated with mesalamine according to guidelines, 91.3% of all patients were treated with glucocorticoids according to guideline recommendations, while only 75.6% received recommended immunosuppressive treatment. Of UC patients, 94.5% had surveillance colonoscopies at the recommended interval and 58.8% of CD patients were non-smokers. No predictor for overall treatment according to guidelines could be found while being of age older than 60 or being treated outside of a dedicated IBD clinic was associated with less immunosuppressive treatment. CONCLUSIONS A large proportion of patients with IBD do not receive drug treatment in accordance with clinical practice guidelines. Quality improvement measures are much needed.
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Yang X, Lovell JF, Zhang Y. Ingestible Contrast Agents for Gastrointestinal Imaging. Chembiochem 2019; 20:462-473. [PMID: 30421487 DOI: 10.1002/cbic.201800589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 12/17/2022]
Abstract
Gastrointestinal (GI) ailments cover a wide variety of diseases involving the esophagus, stomach, small intestine, large intestine, and rectum. They bring about many inconveniences in daily life in chronic diseases and can even be life threatening in acute cases. Rapid and safe detection approaches are essential for early diagnosis and timely management. Contrast agents for GI imaging can enhance contrast to distinguish abnormal lesions from normal structures. Computed tomography and magnetic resonance imaging are two important diagnostic tools for the evaluation of GI conditions. This review mainly involves several common GI diseases, including inflammatory diseases, intestinal tumors, diarrhea, constipation, and gastroesophageal reflux diseases. Selected contrast agents, such as barium sulfate, iodine-based agents, gadolinium-based agents, and others, are summarized. Going forward, continued endeavors are being made to develop more emerging contrast agents for other imaging modalities.
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Affiliation(s)
- Xingyue Yang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, 301636, China
| | - Jonathan F Lovell
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY, 14260, USA
| | - Yumiao Zhang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, 301636, China
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Pashazadeh P, Marjani A, Asadi J, Khoshnia M. Thiopurine Methyltransferase Genetic Polymorphisms and Activity and Metabolic Products of Azathioprine in Patients with Inflammatory Bowel Disease. Endocr Metab Immune Disord Drug Targets 2018; 19:541-547. [PMID: 30451123 DOI: 10.2174/1871530318666181119153522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/07/2022]
Abstract
BACKGROUND Thiopurine S-methyltransferase (TPMT) is a cytoplasmic enzyme that catalyzes thiopurine drugs such as 6-mercaptopurine, 6-thioguanine, and azathioprine. There is a correlation between thiopurine drug metabolism, response, and toxicity and genetic polymorphism of TPMT. The aim of this study is to assess TPMT genetic polymorphisms activity and metabolic products of AZA in patients with IBD. METHODS Blood samples were obtained from 50 IBD unrelated patients from a private laboratory. We used polymerase chain reaction-restriction length polymorphism (PCR-RFLP) and allele-specific PCRbased assays to determine the TPMT gene for the different variants. A high-performance liquid chromatography system (HPLC) was carried out to determine the whole blood 6-TGN concentration. Determination of serum TMPT activity was done by ELISA kit. RESULTS In IBD patients, 46/50 (92%) subjects were homozygous for the wild-type allele (TPMT*1/*1). Mutant TPMT*1/*2 and TPMT*1/*3C alleles were found in 4/46 (8%) and 3/47 (6%) of IBD patients, respectively. TPMT*1/*3B variant was not detected in any of the IBD patients. TPMT enzyme activity was higher in wild-type than that mutant variants TPMT*1/*2 and TPMT*1/*3C, suggesting that there are statistically significant differences between 6-TG levels and polymorphisms of TMPT enzyme. 6-TG levels significantly increased in IBD patients mutant variants TPMT*1/*2 and TPMT*1/*3C. CONCLUSIONS Our results showed that TPMT polymorphisms are associated with 6-TGN levels in patients using AZA. This study suggests that AZA dosage may be determined according to the high or low prevalence of a TPMT genotype. Moreover, the results present the determination of metabolite for assessing possible safe effective dosage of the drug.
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Affiliation(s)
- Paria Pashazadeh
- Metabolic Disorders Research Center, Department of Biochemistry and Biophysics, Gorgan Faulty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
| | - Abdoljalal Marjani
- Metabolic Disorders Research Center, Department of Biochemistry and Biophysics, Gorgan Faulty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
| | - Jahanbakhash Asadi
- Metabolic Disorders Research Center, Department of Biochemistry and Biophysics, Gorgan Faulty of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
| | - Masoud Khoshnia
- Golestan Research Center of Gasteroenterolgy and Hepatology, Golestan University of Medical Sciences, Gorgan, Golestan Province, Iran
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Pallotta N, Vincoli G, Pezzotti P, Giovannone M, Gigliozzi A, Badiali D, Vernia P, Corazziari ES. A risk score system to timely manage treatment in Crohn's disease: a cohort study. BMC Gastroenterol 2018; 18:164. [PMID: 30400823 PMCID: PMC6219027 DOI: 10.1186/s12876-018-0889-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/17/2018] [Indexed: 12/23/2022] Open
Abstract
Background Clinical severity and intestinal lesions of Crohn’s disease (CD) usually progress over time and require a step up adjustment of the therapy either to prevent or to treat complications. The aim of the study was to develop a simple risk scoring system to assess in individual CD patients the risk of disease progression and the need for more intensive treatment and monitoring. Methods Prospective cohort study (January 2002–September 2014) including 160 CD patients (93 female, median age 31 years; disease behavior (B)1 25%, B2 55.6%, B3 19.4%; location (L)1 61%, L3 31.9%, L2 6%; L4 0.6%; perianal disease 28.8%) seen at 6–12-month interval. Median follow-up 7.9 years (IQR: 4.3–10.5 years). Poisson models were used to evaluate predictors, at each clinical assessment, of having the following outcomes at the subsequent clinical assessment a) use of steroids; b) start of azathioprine; c) start of anti-TNF-α drugs; d) need of surgery. For each outcome 32 variables, including demographic and clinical characteristics of patients and assessment of CD intestinal lesions and complications, were evaluated as potential predictors. The predictors included in the model were chosen by a backward selection. Risk scores were calculated taking for each predictor the integer part of the Poisson model parameter. Results Considering 1464 clinical assessments 12 independent risk factors were identified, CD lesions, age at diagnosis < 40 years, stricturing behavior (B2), specific intestinal symptoms, female gender, BMI < 21, CDAI> 50, presence of inflammatory markers, no previous surgery or presence of termino-terminal anastomosis, current use of corticosteroid, no corticosteroid at first flare-up. Six of these predicted steroids use (score 0–9), three to start azathioprine (score 0–4); three to start anti-TNF-α drugs (score 0–4); six need of surgery (score 0–11). The predicted percentage risk to be treated with surgery within one year since the referral assessment varied from 1 to 28%; with azathioprine from 3 to 13%; with anti-TNF-α drugs from 2 to 15%. Conclusions These scores may provide a useful clinical tool for clinicians in the prognostic assessment and treatment adjustment of Crohn’s disease in any individual patient.
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Affiliation(s)
- Nadia Pallotta
- Dipartimento di Medicina Interna e Specialità Mediche, Università "Sapienza", Policlinico "Umberto I", V.le del Policlinico, 155, 00161, Rome, Italy.
| | - Giuseppina Vincoli
- Dipartimento di Medicina Interna e Specialità Mediche, Università "Sapienza", Policlinico "Umberto I", V.le del Policlinico, 155, 00161, Rome, Italy
| | - Patrizio Pezzotti
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Danilo Badiali
- Dipartimento di Medicina Interna e Specialità Mediche, Università "Sapienza", Policlinico "Umberto I", V.le del Policlinico, 155, 00161, Rome, Italy
| | - Piero Vernia
- Dipartimento di Medicina Interna e Specialità Mediche, Università "Sapienza", Policlinico "Umberto I", V.le del Policlinico, 155, 00161, Rome, Italy
| | - Enrico Stefano Corazziari
- Dipartimento di Medicina Interna e Specialità Mediche, Università "Sapienza", Policlinico "Umberto I", V.le del Policlinico, 155, 00161, Rome, Italy
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Marshall JH, Baker DM, Lee MJ, Jones GL, Lobo AJ, Brown SR. The assessment of online health videos for surgery in Crohn's disease. Colorectal Dis 2018; 20:606-613. [PMID: 29427466 DOI: 10.1111/codi.14045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
AIM YouTube™ is an open-access, nonpeer-reviewed video-hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's disease and to explore the viewer interactions with these videos. METHOD A search of YouTube™ was carried out using one search string. The 50 most viewed videos were identified and categorized by source and content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers. RESULTS The majority of videos were uploaded by patients (n = 21).The remainder were uploaded by individual healthcare professionals (n = 9), hospital/speciality associations (n = 18) and industry (n = 2). The median number of likes for patient videos was significantly higher than for hospital/speciality association videos (P < 0.001). Patient videos received more comments praising the video content (n = 27) and more comments asking for further information (n = 14). The median number of likes for 'experience of surgery' (P < 0.001) and 'experience of disease' (P = 0.0015) themed videos were significantly higher than for 'disease management' themed videos. CONCLUSION Crohn's disease patients use YouTube™ as a surgical information source. The content of patient-sourced videos focused on surgical and disease experience, suggesting that these themes are important to patients. Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient-centred videos combined with clinical evidence may be a good model for future videos.
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Affiliation(s)
- J H Marshall
- University of Sheffield Medical School, Sheffield, UK
| | - D M Baker
- University of Sheffield Medical School, Sheffield, UK
| | - M J Lee
- University of Sheffield Medical School, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - G L Jones
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Mould DR, Upton RN, Wojciechowski J, Phan BL, Tse S, Dubinsky MC. Dashboards for Therapeutic Monoclonal Antibodies: Learning and Confirming. AAPS JOURNAL 2018; 20:76. [PMID: 29904814 DOI: 10.1208/s12248-018-0237-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/25/2018] [Indexed: 02/08/2023]
Abstract
Inflammatory diseases (ID) are incurable, progressive diseases. Literature evidence cites increasing incidence of these diseases worldwide. When treatments with chemical immunosuppressive agents fail, patients are often treated with monoclonal antibodies (MAbs). However, MAb failure rates are generally high, with approximately half the patients being discontinued within 4 years, necessitating switching to another MAb. One potential cause of treatment failure is subtherapeutic exposure. Several studies demonstrated associations between trough MAb concentrations and clinical response, supporting the notion that improving drug exposure may result in improved outcomes. MAbs exhibit complex and highly variable pharmacokinetics in ID patients with numerous factors affecting clearance. Bayesian-guided dosing with dashboard systems is a new tool being investigated in the treatment of ID to reduce variability in exposure. Simulations suggest dashboards will be effective at maintaining patients at target troughs. However, when patients are dosed using doses or intervals outside those listed in prescribing information, there is concern that patients may have drug exposures beyond or below the ranges found to be safe and efficacious. This manuscript reviews the rationale behind dashboard development, evaluations of expected performance, and a simulated assessment of MAb exposure with dashboard-based dosing versus dosing based on the prescribing information. We introduce the concept of pharmacologic equivalence-if patients are dosed based on individual pharmacokinetics, the resulting exposure is consistent with exposures achieved using labeled dosing. We further show that dashboard-based dosing results in observed exposures that are generally contained within the range of exposures achieved with labeled dosing.
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Affiliation(s)
- Diane R Mould
- Projections Research Inc., 535 Springview Lane, Phoenixville, Pennsylvania, 19460, USA.
| | - Richard N Upton
- Projections Research Inc., 535 Springview Lane, Phoenixville, Pennsylvania, 19460, USA.,Australian Centre for Pharmacometrics, University of South Australia, Adelaide, SA, 5000, Australia
| | | | - Becky L Phan
- Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Stacy Tse
- Mount Sinai Hospital, New York, New York, 10029, USA
| | - Marla C Dubinsky
- Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
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Icht O, Yanai H, Ron Y, Rosner G, Yaron A, Waizbard A, Ziv-Baran T, Fishman S, Dotan I. Comparative Study of Two Cohorts of Newly Diagnosed Crohn's Disease Demonstrates Change in Therapeutic Strategies. Digestion 2018; 96:135-141. [PMID: 28848118 DOI: 10.1159/000477438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/09/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND There has been a paradigm shift in the treatment of Crohn's disease (CD) involving the rapid introduction of biologics and/or immunomodulators after diagnosis. We wished to assess whether this was applied to patients with newly diagnosed CD in a tertiary inflammatory bowel disease referral centre in Israel. METHODS Newly diagnosed CD patients were stratified into 2 groups: the early group was diagnosed between 2005 and 2007 and the late group was diagnosed between 2010 and 2012. Baseline demographics, medical and surgical treatments, disease course and complications during those 2 periods were analyzed. RESULTS Each group included 60 patients. Significantly higher rates of immunomodulators and biologics were administered to patients in the late group compared to the early group (81.7 and 36.7% compared to 56.7 and 18.3%, p = 0.004 and p = 0.021, respectively). On the other hand, steroid therapy was less prevalent in the late (36.7%) group compared to that of the early group (56.7%), p = 0.059. Medical and surgical CD outcomes, including exacerbations/hospitalizations and surgeries, were comparable for both groups. CONCLUSIONS There was a change in treatment strategy between 2005-2007 and 2010-2012, as reflected in higher proportions of biologics/immunomodulators for patients with newly diagnosed CD. This was associated with a steroid-sparing effect.
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Affiliation(s)
- Oded Icht
- IBD Centre, Department of Gastroenterology and Liver Diseases, Dana's Children Hospital, Tel Aviv Sourasky Medical Centre, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Adedokun OJ, Xu Z, Gasink C, Jacobstein D, Szapary P, Johanns J, Gao LL, Davis HM, Hanauer SB, Feagan BG, Ghosh S, Sandborn WJ. Pharmacokinetics and Exposure Response Relationships of Ustekinumab in Patients With Crohn's Disease. Gastroenterology 2018; 154:1660-1671. [PMID: 29409871 DOI: 10.1053/j.gastro.2018.01.043] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/19/2017] [Accepted: 01/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Ustekinumab is a monoclonal antibody that binds with high affinity to the p40 subunit of human interleukin 12 (IL12 and IL23) that has been approved for treatment of patients with moderate to severe Crohn's disease (CD). However, there are few data on its pharmacokinetic properties or the relationship between drug exposure levels and patient response. We collected data from 2 Phase 3 induction studies and 1 maintenance study to determine ustekinumab's pharmacokinetic features, relationship between exposure and response, and optimal serum concentrations for efficacy. METHODS We collected data on serum concentrations of ustekinumab and efficacy from induction studies of patients with moderate to severe CD given ustekinumab for 8 weeks following a single intravenous dose (either 130 mg or approximately 6 mg/kg). We collected the same data from a maintenance study of patients with a response to ustekinumab in the induction study who then received subcutaneous injections (90 mg) every 8 or 12 weeks for 44 weeks. At week 44 of the maintenance study (52 weeks after treatment began), patients were evaluated for the primary endpoint of clinical remission (defined as a CD activity index score below 150 points), endoscopic markers of efficacy, and serum level of C-reactive protein. Ustekinumab concentration data were categorized into quartiles and relationships between exposure and response were assessed. Optimal concentration cutoff values were evaluated using receiver operating characteristic curve analysis. RESULTS Serum concentrations of ustekinumab over time were proportional to dose and did not differ significantly between the induction studies. In the maintenance study, ustekinumab concentration reached the steady state by the second maintenance dose; the median trough concentration was approximately threefold higher in patients given ustekinumab at 8-week intervals compared with 12-week intervals. Ustekinumab serum concentrations associated with rates of clinical remission and endoscopic efficacy endpoints, correlated inversely with level of C-reactive protein, and did not associate with use of immunomodulators. Trough concentrations of ustekinumab of 0.8 (or even up to 1.4 μg/mL) or greater were associated with maintenance of clinical remission in a higher proportion of patients than patients with lower trough concentrations. CONCLUSIONS In an analysis of data from Phase 3 studies of patients with moderate to severe CD, we found serum concentrations of ustekinumab to be proportional to dose and associate with treatment efficacy. Concentrations of ustekinumab did not seem to be affected by cotreatment with immunomodulators. Clinicaltrials.gov no. NCT01369329 (UNITI 1), NCT01369342 (UNITI 2), and NCT01369355 (IM-UNITI).
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Affiliation(s)
| | - Zhenhua Xu
- Janssen Research & Development, LLC., Spring House, Pennsylvania
| | | | | | - Philippe Szapary
- Janssen Research & Development, LLC., Spring House, Pennsylvania
| | - Jewel Johanns
- Janssen Research & Development, LLC., Spring House, Pennsylvania
| | - Long-Long Gao
- Janssen Scientific Affairs, LLC, Spring House, Pennsylvania
| | - Hugh M Davis
- Janssen Research & Development, LLC., Spring House, Pennsylvania
| | - Stephen B Hanauer
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brian G Feagan
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Subrata Ghosh
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
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Hoekman DR, Stibbe JA, Baert FJ, Caenepeel P, Vergauwe P, De Vos M, Hommes DW, Benninga MA, Vermeire SA, D'Haens GR. Long-term Outcome of Early Combined Immunosuppression Versus Conventional Management in Newly Diagnosed Crohn's Disease. J Crohns Colitis 2018; 12:517-524. [PMID: 29401297 DOI: 10.1093/ecco-jcc/jjy014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Long-term outcomes of early combined immunosuppression [top-down] compared to conventional management [step-up] in recently diagnosed Crohn's disease [CD] are unknown. We aimed to investigate long-term outcomes of participants of the Step-up/Top-down-trial. METHODS Trial participants' medical records were reviewed retrospectively. For 16 semesters following the 2-year trial, we recorded: clinical activity, medication use, flares, hospitalization, surgery and fistulas. Colonoscopy reports were scored as: endoscopic remission, aphthous/small ulcers or large ulcers. The primary endpoint was the proportion of semesters in remission. RESULTS Data were available from 119/133 patients [step-up n = 60]. During a median follow-up of 8 years, clinical remission rates were similar (70% vs 73% [p = 0.85] in step-up and top-down patients, respectively). A shorter time to flare was observed in step-up patients [median five vs nine semesters, p = 0.01]. Cumulatively, 62% of step-up patients used corticosteroids compared to 41% of top-down patients [p = 0.02]. Anti-tumour necrosis factor [anti-TNF] use was higher in the step-up group [73% vs 54%, p = 0.04]. No differences were found in to time to CD hospitalization [respectively 13 vs 14 semesters, p = 0.30], new fistula [14 vs 15 semesters, p = 0.20] or CD surgery [14 vs 15 semesters, p = 0.25]. Mucosal healing 2 years after treatment was associated with a reduced anti-TNF use, but not with differences in other long-term outcomes. Endoscopic remission occurred at similar rates between groups. CONCLUSIONS Top-down treatment did not result in increased clinical remission during long-term follow-up, compared to step-up treatment. However, lower relapse rates and a reduced use of anti-TNF agents and corticosteroids were observed. No difference was found in rates of endoscopic remission, hospitalization, surgery or new fistulas.
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Affiliation(s)
- Daniël R Hoekman
- Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands
| | - Judith A Stibbe
- Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands
| | - Filip J Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Philip Caenepeel
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Martine De Vos
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Daniel W Hommes
- Department of Medicine, UCLA Center for Inflammatory Bowel Diseases, Los Angeles, USA
| | - Marc A Benninga
- Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands
| | - Severine A Vermeire
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Geert R D'Haens
- Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands
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Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol 2018; 113:481-517. [PMID: 29610508 DOI: 10.1038/ajg.2018.27] [Citation(s) in RCA: 767] [Impact Index Per Article: 127.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 01/11/2018] [Indexed: 02/06/2023]
Abstract
Crohn's disease is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. The incidence of Crohn's disease has steadily increased over the past several decades. The diagnosis and treatment of patients with Crohn's disease has evolved since the last practice guideline was published. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with Crohn's disease. These guidelines are established for clinical practice with the intent of suggesting preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When exercising clinical judgment, health-care providers should incorporate this guideline along with patient's needs, desires, and their values in order to fully and appropriately care for patients with Crohn's disease. This guideline is intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. To evaluate the level of evidence and strength of recommendations, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.
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Affiliation(s)
- Gary R Lichtenstein
- Department of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kim L Isaacs
- Department of Medicine, Division of Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Miguel D Regueiro
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren B Gerson
- Department of Medicine, Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhang D, Ma X, Wu H, Hong J, Zhang C, Wu L, Liu J, Zhu Y, Yang L, Wei K, Yan H. Efficacy of herb-partitioned moxibustion at Qihai (CV 6) and bilateral Tianshu (ST 25) on colonic damage and the TLR4/NF-κB signaling pathway in rats with Crohn's disease. J TRADIT CHIN MED 2018. [PMID: 32186061 DOI: 10.1016/j.jtcm.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To observe the effect of stimulating Qihai (CV 6) and bilateral Tianshu (ST 25) with herb-partitioned moxibustion (HPM) in rats with Crohn's disease (CD), and to investigate the possible anti-inflammatory mechanism of HPM. METHODS Forty rats were randomly divided into four groups (n = 10 rats per group): normal control (NC), model control (MC), mesalamine (MES), and HPM. The CD rat model was established in the MC, MES, and HPM groups by administering a mixture of trinitrobenzenesulfonic acid and alcohol via enema. The HPM group received HPM on Qihai (CV 6) and bilateral Tianshu (ST 25), while the MES group received intragastric mesalamine. Colonic histomorphological scores, and serum concentrations of tumor necrosis factor ¦Á (TNF-¦Á) and interleukin 1¦Â (IL-1¦Â) were assessed to evaluate the effects of HPM on colonic reparation and anti-inflammation. The expressions of Toll-like receptor 4 (TLR-4), nuclear factor ¦ÊB inhibitor ¦Á (I¦ÊB-¦Á), I¦ÊB kinase ¦Á/¦Â (IKK¦Á/¦Â), and NF-¦ÊB p65 were further analyzed to investigate the regulatory effects of the interventions on the TLR4/NF-¦ÊB pathway. RESULTS CD rats showed inflammatory colonic damage and increased serum concentrations of TNF-¦Á and IL-1¦Â. The expressions of TLR4, IKK¦Á/¦Â, and NF-¦ÊB p65 in the colons of CD rats were significantly increased compared with the NC group, while the expression of I¦ÊB¦Á (a key negative regulator of NF-¦ÊB p65) was decreased. HPM significantly mitigated colonic damage and reduced the serum concentrations of TNF-α and IL-1¦Â. HPM downregulated the expressions of TLR4, IKK¦Á/¦Â, and NF-¦ÊB p65 in the colon, and upregulated the expression of I¦ÊB¦Á. The effects of HPM in CD rats were similar to those of mesalamine. CONCLUSION HPM alleviates colonic inflammation in CD rats. This may be achieved through regulation of TLR4, which induces NF-¦ÊB signal transduction.
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Affiliation(s)
- Dan Zhang
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Xiaopeng Ma
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Huangan Wu
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Jue Hong
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Cuihong Zhang
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Lingxiang Wu
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Jie Liu
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Yi Zhu
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Ling Yang
- Key Laboratory for Acupuncture-Moxibustion and Immunological Effects, Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Kai Wei
- Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Huang Yan
- Department of Acupuncture and Moxibustion, Shanghai Huangpu Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 200010, China
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Tsui JJ, Huynh HQ. Is top-down therapy a more effective alternative to conventional step-up therapy for Crohn's disease? Ann Gastroenterol 2018; 31:413-424. [PMID: 29991886 PMCID: PMC6033752 DOI: 10.20524/aog.2018.0253] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/02/2018] [Indexed: 12/17/2022] Open
Abstract
The management of Crohn's disease involves immunosuppressive protocols in a step-up approach that progresses through a therapeutic pyramid with several tiers of medication. Medications at the top are considered more potent but present greater risk. A new top-down approach to therapy inverts this procedure, using top-tier drugs for initial treatment. A critical appraisal of the current literature relating to top-down therapy was performed to evaluate its merit. A literature search was conducted on PubMed, Ovid, and PubMed Central to identify studies of the efficacy of top-down therapy. Papers were appraised critically using the Scottish Intercollegiate Guidelines Network score to evaluate current evidence for the use of top-down therapy. Nineteen studies were identified, including six randomized controlled trials, thirteen cohort studies, and two cost-benefit studies. Early combined therapy involving both biologics and immunomodulators was found to be effective at improving patient outcomes; however, early biologics alone were not shown to have a clear benefit over step-up therapy. Likewise, the early use of immunomodulators alone showed inconsistent results with respect to efficacy in terms of both remission and surgical outcomes. Evidence for application in pediatric populations was also inconclusive. The cost-benefit analyses found that top-down therapy merits investigation, as it proved to be economical given current data. Top-down therapy has the potential of being a viable alternative to step-up therapy, but further studies are needed to determine the most appropriate patients to receive this treatment.
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Affiliation(s)
- Jonathan Jenkin Tsui
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK (Jonathan Jenkin Tsui)
| | - Hien Q Huynh
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada (Hien Q. Huynh)
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Tiwari V, Kedia S, Garg SK, Rampal R, Mouli VP, Purwar A, Mitra DK, Das P, Dattagupta S, Makharia G, Acharya SK, Ahuja V. CD4+ CD25+ FOXP3+ T cell frequency in the peripheral blood is a biomarker that distinguishes intestinal tuberculosis from Crohn's disease. PLoS One 2018; 13:e0193433. [PMID: 29489879 PMCID: PMC5830992 DOI: 10.1371/journal.pone.0193433] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Distinguishing between Crohn's Disease (CD) and Intestinal Tuberculosis (ITB) has been a challenging task for clinicians due to their similar presentation. CD4+FOXP3+ T regulatory cells (Tregs) have been reported to be increased in patients with pulmonary tuberculosis. However, there is no such data available in ITB. The aim of this study was to investigate the differential expression of FOXP3+ T cells in patients with ITB and CD and its utility as a biomarker. METHODS The study prospectively recruited 124 patients with CD, ITB and controls: ulcerative colitis (UC) and patients with only haemorrhoidal bleed. Frequency of CD4+CD25+FOXP3+ Tregs in peripheral blood (flow cytometry), FOXP3 mRNA expression in blood and colonic mucosa (qPCR) and FOXP3+ T cells in colonic mucosa (immunohistochemistry) were compared between controls, CD and ITB patients. RESULTS Frequency of CD4+CD25+FOXP3+ Treg cells in peripheral blood was significantly increased in ITB as compared to CD. Similarly, significant increase in FOXP3+ T cells and FOXP3 mRNA expression was observed in colonic mucosa of ITB as compared to CD. ROC curve showed that a value of >32.5% for FOXP3+ cells in peripheral blood could differentiate between CD and ITB with a sensitivity of 75% and a specificity of 90.6%. CONCLUSION Phenotypic enumeration of peripheral CD4+CD25+FOXP3+ Treg cells can be used as a non-invasive biomarker in clinics with a high diagnostic accuracy to differentiate between ITB and CD in regions where TB is endemic.
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Affiliation(s)
- Veena Tiwari
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Kumar Garg
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Rampal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - V. Pratap Mouli
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Anuja Purwar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - D. K. Mitra
- Department of HLA and Transplant Immunology, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S. Dattagupta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - S. K. Acharya
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
- * E-mail:
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