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da Silva Júnior RT, Apolonio JS, de Souza Nascimento JO, da Costa BT, Malheiro LH, Silva Luz M, de Carvalho LS, da Silva Santos C, Freire de Melo F. Crohn's disease and clinical management today: How it does? World J Methodol 2023; 13:399-413. [PMID: 38229938 PMCID: PMC10789097 DOI: 10.5662/wjm.v13.i5.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
Crohn's Disease (CD) is an Inflammatory Bowel Disease and is characterized by an immune-mediated nature. Its etiology results from the interaction between genetic, enviromental and microbial factors. Regarding pathophysiology, it involves high levels of interleukin (IL)-12, IL-17, and Th1 profile, along with loss of tolerance mechanisms, an increase in pro-inflammatory interleukins, beyond the possibility to affect any part of the gastrointestinal tract. Its symptoms include abdominal pain, chronic diarrhea, weight loss, anorexia, and fatigue, as well as blood in the stool or rectum. Additionally, conditions comprising musculoskeletal, cutaneous, ocular, hepatic, and hematological alterations may be associated with this scenario and extra-intestinal presentation, such as erythema nodosum, anterior uveitis, osteoporosis, and arthritis can also occur. Today, clinical history, exams as fecal calprotectin, ileocolonocopy, and capsule endoscopy can be performed in the diagnosis investigation, along with treatments to induce and maintain remission. In this sense, anti-inflammatory drugs, such as corticosteroids, immunomodulators, and biological agents, as well as surgery and non-pharmacological interventions plays a role in its therapy. The aim of this review is to bring more current evidence to clinical management of CD, as well as to briefly discuss aspects of its pathophysiology, surveillance, and associated disorders.
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Affiliation(s)
| | - Jonathan Santos Apolonio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Bruna Teixeira da Costa
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luciano Hasimoto Malheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Marcel Silva Luz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lorena Sousa de Carvalho
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cleiton da Silva Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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García-Serrano C, Artigues-Barberà E, Mirada G, Estany P, Sol J, Ortega Bravo M. Impact of an Intervention to Promote the Vaccination of Patients with Inflammatory Bowel Disease. Vaccines (Basel) 2023; 11:1649. [PMID: 38005981 PMCID: PMC10674651 DOI: 10.3390/vaccines11111649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) have a dysregulated immune system, being at high risk of opportunistic infections. Low vaccination rates hinder the prevention of such diseases. Therefore, we implemented an intervention to increase vaccination rates, and we aimed to evaluate the effect. We determined the change in professionals and the change in the vaccination rates after the intervention. A quasi-experimental study was carried out using data from 31 December 2016 to 31 December 2021. First, healthcare professionals specializing in IBD agreed on a vaccination protocol; then, this protocol was passed on to the professionals involved in vaccination. We evaluated the perception of knowledge, capacity, and intention to vaccinate patients with IBD among the professionals before and after the intervention with a survey. We also described the effectiveness of the intervention for already diagnosed patients and compared the vaccination rates between patients diagnosed prior to the intervention and newly diagnosed patients. The intervention resulted in an improved perception of knowledge, capacity, and intention to vaccinate patients with IBD among the professionals (p < 0.05). Moreover, during the post-intervention period, in the 315 patients, the vaccination rate increased for all immune-preventable diseases (p < 0.05). The professionals positively valued the intervention, and compliance with the recommended vaccination protocol in patients with IBD improved significantly.
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Affiliation(s)
- Cristina García-Serrano
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Multidisciplinary Research Group on Therapeutics and Interventions in Primary Care (RETICAP Group), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Eva Artigues-Barberà
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Multidisciplinary Research Group on Therapeutics and Interventions in Primary Care (RETICAP Group), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
- Facultat d’Infermeria i Fisioteràpia, Universitat de Lleida, 25198 Lleida, Spain;
| | - Gloria Mirada
- Facultat d’Infermeria i Fisioteràpia, Universitat de Lleida, 25198 Lleida, Spain;
- Agència de Salut Pública de Catalunya, 08005 Lleida, Spain
| | - Pepi Estany
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
| | - Joaquim Sol
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Unitat de Suport a la Recerca de Lleida, Fundació Institut Universitari d’Investigació per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran, 44, 25007 Lleida, Spain
- Instituto de Investigación Biomédica de Lleida Fundación Dr. Pifarré (IRB Lleida), 25198 Lleida, Spain
| | - Marta Ortega Bravo
- Atenció Primària Institut Català de la Salut, Atenció Primària, 25007 Lleida, Spain; (C.G.-S.); (P.E.); (J.S.)
- Multidisciplinary Research Group on Therapeutics and Interventions in Primary Care (RETICAP Group), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
- Facultat de Medicina, Universitat de Lleida, Pl. de Víctor Siurana, 1, 25003 Lleida, Spain
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Mishra J, Stubbs M, Kuang L, Vara N, Kumar P, Kumar N. Inflammatory Bowel Disease Therapeutics: A Focus on Probiotic Engineering. Mediators Inflamm 2022; 2022:9621668. [PMID: 35082553 PMCID: PMC8786545 DOI: 10.1155/2022/9621668] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of gastrointestinal (GI) tract with dysregulated mucosal immune functions and disturbed commensal ecosystem of the intestinal lumen. IBD is categorized into two major subsets: Crohn's disease (CD) and ulcerative colitis (UC). Though advent of biologics has shifted the treatment with relatively longer remission compared to small molecule pharmaceuticals, patients still suffer from long-term complications. Since gut-microbiome is now accepted as another human organ holding potential for long-lasting human health, probiotics, and its engineering hold great promises to treat several previously untreatable chronic inflammatory conditions including IBD. Several emerging biological engineering tools have unlimited potential to manipulate probiotic bacterial system. These can produce useful therapeutic biologics with a goal to either ameliorate and/or treat previously untreatable chronic inflammatory conditions. As gut-microbiome is diverse and vary in different ethnic, geographic, and cultural human population, it will be important to develop vision for personalized probiotic treatment and develop the technology thereof to make personalized probiotic options a reality. The aim of this review paper is to present an overview of the current knowledge on both pharmacological and nonpharmacological IBD treatment modalities with a special emphasis on probiotic strains that are developed through the probiotic engineering. These engineered probiotics contain the most anti-inflammatory cytokines found within the human immune response and are currently being used to treat the intestinal inflammation in IBD for the IBD treatment.
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Affiliation(s)
- Jayshree Mishra
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Madyson Stubbs
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Longxiang Kuang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Nitza Vara
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Priyam Kumar
- Santa Gertrudis Academy High School, Kingsville, Texas, USA
| | - Narendra Kumar
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
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Ryu HH, Chang K, Kim N, Lee HS, Hwang SW, Park SH, Yang DH, Byeon JS, Myung SJ, Yang SK, Ye BD. Insufficient vaccination and inadequate immunization rates among Korean patients with inflammatory bowel diseases. Medicine (Baltimore) 2021; 100:e27714. [PMID: 34766576 PMCID: PMC10545296 DOI: 10.1097/md.0000000000027714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/02/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT This study aimed to evaluate self-reported vaccination rates, immunity, knowledge of and attitudes toward vaccination among Korean patients with inflammatory bowel disease (IBD) as well as to identify factors associated with proper vaccination.Between November 2013 and February 2015, consecutive patients with IBD were invited to complete a standardized questionnaire on vaccination. Moreover, immune status for common vaccine-preventable diseases was evaluated via serologic tests.A total of 310 patients with IBD were invited to the questionnaire survey and 287 patients (92.6%) who completed the questionnaires were finally enrolled (men, 188 [65.5%], median age at survey, 29.9 years [interquartile range, 22.3-39.2], ulcerative colitis: Crohn disease = 165:122]. Self-reported vaccine uptake rates were as follows: hepatitis A virus (HAV; 13.2%), hepatitis B virus (HBV; 35.2%), seasonal influenza (43.2%), pneumococcus (4.9%). Most of the patients (87.1%) did not know that proper vaccination has been recommended for patients with IBD. Up to 64.8% and 32.8% of patients were negative for IgG anti-HAV antibody and IgG HBV surface antibody, respectively. In a multivariable analysis, newspaper subscription (aOR [adjusted odds ratio] 2.185, 95% confidence interval [CI] 1.136-4.203, P = .019), ever recommendation of vaccination by a physician (aOR 2.456, 95% CI 1.240-4.862, P = .010), and use of anti-tumor necrosis factor agents (aOR 4.966, 95% CI 1.098-22.464, P = .037) showed a significant association with uptake of adult vaccines recommended for patients with IBD.Vaccine uptake rates, positivity of antibody to HAV and HBV, and knowledge of patients with IBD regarding vaccination were not sufficient. Proper educational information and recommendation from physicians could enhance awareness among patients with IBD about the need for vaccination and thereby improve vaccination rates.Trial registration number: NCT01984879.
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Affiliation(s)
- Han Hee Ryu
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kiju Chang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho-Su Lee
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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D’Amelio R, Asero R, Cassatella MA, Laganà B, Lunardi C, Migliorini P, Nisini R, Parronchi P, Quinti I, Racanelli V, Senna G, Vacca A, Maggi E. Anti-COVID-19 Vaccination in Patients with Autoimmune-Autoinflammatory Disorders and Primary/Secondary Immunodeficiencies: The Position of the Task Force on Behalf of the Italian Immunological Societies. Biomedicines 2021; 9:1163. [PMID: 34572349 PMCID: PMC8465958 DOI: 10.3390/biomedicines9091163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has represented an unprecedented challenge for humankind from health, economic, and social viewpoints. In February 2020, Italy was the first western country to be deeply hit by the pandemic and suffered the highest case/fatality rate among western countries. Brand new anti-COVID-19 vaccines have been developed and made available in <1-year from the viral sequence publication. Patients with compromised immune systems, such as autoimmune-autoinflammatory disorders (AIAIDs), primary (PIDs) and secondary (SIDs) immunodeficiencies, have received careful attention for a long time regarding their capacity to safely respond to traditional vaccines. The Italian Immunological Societies, therefore, have promptly faced the issues of safety, immunogenicity, and efficacy/effectiveness of the innovative COVID-19 vaccines, as well as priority to vaccine access, in patients with AIADs, PIDs, and SIDs, by organizing an ad-hoc Task Force. Patients with AIADs, PIDs, and SIDs: (1) Do not present contraindications to COVID-19 vaccines if a mRNA vaccine is used and administered in a stabilized disease phase without active infection. (2) Should usually not discontinue immunosuppressive therapy, which may be modulated depending on the patient's clinical condition. (3) When eligible, should have a priority access to vaccination. In fact, immunizing these patients may have relevant social/health consequences, since these patients, if infected, may develop chronic infection, which prolongs viral spread and facilitates the emergence of viral variants.
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Affiliation(s)
- Raffaele D’Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica S. Carlo di Paderno Dugnano, Via Ospedale 21, 20037 Milano, Italy;
| | - Marco Antonio Cassatella
- Sezione di Patologia Generale, Dipartimento di Medicina, Università di Verona, Strada Le Grazie 4, 37134 Verona, Italy;
| | - Bruno Laganà
- UOC Medicina Interna, Dipartimento di Medicina Clinica e Molecolare, AOU S. Andrea, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Claudio Lunardi
- Responsabile Unità di Malattie Autoimmunitarie, Dipartimento di Medicina, AOU Policlinico G.B. Rossi, Borgo Roma, Università di Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy;
| | - Paola Migliorini
- Direttore Unità Operativa di Immunoallergologia Clinica, Dipartimento di Medicina Clinica e Sperimentale, Azienda Ospedaliero Universitaria Pisana, Università di Pisa, Via Roma 67, 56126 Pisa, Italy;
| | - Roberto Nisini
- Direttore Reparto Immunologia, Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Paola Parronchi
- Direttore SOD Immunologia e Terapie Cellulari, Dipartimento di Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Largo Brambilla 3, 50134 Firenze, Italy;
| | - Isabella Quinti
- Responsabile UOD Centro di Riferimento Regionale per le Immunodeficienze, Dipartimento di Medicina Molecolare, AOU Policlinico Umberto I, Sapienza Università di Roma, Viale dell’Università 37, 00161 Rome, Italy;
| | - Vito Racanelli
- UOC Medicina Interna “Guido Baccelli”, Dipartimento di Scienze Biomediche ed Oncologia Umana, AOU Policlinico, Università di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Gianenrico Senna
- Direttore USD Allergologia, Dipartimento di Medicina, AOU Policlinico G.B. Rossi, Borgo Roma, Università di Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy;
| | - Angelo Vacca
- Direttore UOC Medicina Interna “Guido Baccelli”, Dipartimento di Scienze Biomediche ed Oncologia Umana, AOU Policlinico, Università di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Enrico Maggi
- Unità di Immunità Traslazionale, Dipartimento di Immunologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Viale di S. Paolo 15, 00146 Rome, Italy
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