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Kawakami A, Tanaka M, Sakagami K, Choong LM, Kunisaki R, Maeda S, Bjarnason I, Ito H, Hayee B. Daily life difficulties among patients with ulcerative colitis in Japan and the United Kingdom: A comparative study. Medicine (Baltimore) 2022; 101:e30216. [PMID: 36107533 PMCID: PMC9439749 DOI: 10.1097/md.0000000000030268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The difficulty of life scale (DLS) instrument is used to measure specific life problems in patients with ulcerative colitis (UC). Importantly, health care providers should consider the characteristics of the country in which they support patients with UC. This cross-cultural comparison study investigated DLS among patients with UC in Japan and the United Kingdom (UK). Outpatients attending one hospital in London and one in Osaka were included. We collected patient information using the DLS questionnaire, which comprises 18 items in three domains. Mean differences between Japan and the UK were compared for the total score and each domain of the DLS. Variables with P < .05 in univariate analysis were entered into a multiple regression model. We included 142 patients from Japan and 100 patients from the UK in the analysis. Univariate results showed that UK patients had more difficulties than Japanese patients in all three domains. Multivariate results showed that only "decline of vitality or vigor" showed significantly lower difficulty scores in Japanese patients. Having four or more bowel movements per day, visible bleeding, and being a homemaker or unemployed were significantly associated with greater difficulty according to the DLS total score. The level of daily life difficulties assessed using the DLS was greater among patients in the UK than among Japanese patients. This comparative study between patients with UC in Japan and the UK demonstrated certain country-related features for domain 3, "decline of vitality or vigor," of the DLS. The reasons why UK patients felt greater decline in vitality or vigor may be that these patients may have symptoms other than bowel symptoms; also, Japanese patients are more hesitant to express discomfort. The findings of this study might lead to a better understanding of culturally sensitive perceptions of daily life difficulties in UC.
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Affiliation(s)
- Aki Kawakami
- Department of Gastroenterology, King’s College Hospital, London, United Kingdom
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- *Correspondence: Makoto Tanaka, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan (e-mail: )
| | | | - Lee Meng Choong
- Department of Gastroenterology, King’s College Hospital, London, United Kingdom
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ingvar Bjarnason
- Department of Gastroenterology, King’s College Hospital, London, United Kingdom
| | | | - Bu’Hussain Hayee
- Department of Gastroenterology, King’s College Hospital, London, United Kingdom
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Graham JJ, Mukherjee S, Yuksel M, Sanabria Mateos R, Si T, Huang Z, Huang X, Arbuq H, Patel V, McPhail MJ, Zen Y, Heaton ND, Longhi MS, Heneghan MA, Liberal R, Vergani D, Mieli-Vergani G, Ma Y, Hayee B. Aberrant hepatic trafficking of gut-derived T cells is not specific to primary sclerosing cholangitis. Hepatology 2022; 75:518-530. [PMID: 34633679 PMCID: PMC8844147 DOI: 10.1002/hep.32193] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The "gut homing" hypothesis suggests the pathogenesis of primary sclerosing cholangitis (PSC) is driven by aberrant hepatic expression of gut adhesion molecules and subsequent recruitment of gut-derived T cells to the liver. However, inconsistencies lie within this theory including an absence of investigations and comparisons with other chronic liver diseases (CLD). Here, we examine "the gut homing theory" in patients with PSC with associated inflammatory bowel disease (PSC-IBD) and across multiple inflammatory liver diseases. APPROACH AND RESULTS Expression of MAdCAM-1, CCL25, and E-Cadherin were assessed histologically and using RT-PCR on explanted liver tissue from patients with CLD undergoing OLT and in normal liver. Liver mononuclear cells were isolated from explanted tissue samples and the expression of gut homing integrins and cytokines on hepatic infiltrating gut-derived T cells was assessed using flow cytometry. Hepatic expression of MAdCAM-1, CCL25 and E-Cadherin was up-regulated in all CLDs compared with normal liver. There were no differences between disease groups. Frequencies of α4β7, αEβ7, CCR9, and GPR15 expressing hepatic T cells was increased in PSC-IBD, but also in CLD controls, compared with normal liver. β7 expressing hepatic T cells displayed an increased inflammatory phenotype compared with β7 negative cells, although this inflammatory cytokine profile was present in both the inflamed and normal liver. CONCLUSIONS These findings refute the widely accepted "gut homing" hypothesis as the primary driver of PSC and indicate that aberrant hepatic recruitment of gut-derived T cells is not unique to PSC, but is a panetiological feature of CLD.
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Affiliation(s)
- Jonathon J Graham
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Sujit Mukherjee
- Section of Hepatology, Department of Metabolism Digestion and Reproduction, Faculty of Medicine, Imperial College London
| | - Muhammad Yuksel
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Rebeca Sanabria Mateos
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Tengfei Si
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Zenlin Huang
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Xiahong Huang
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Hadil Arbuq
- Liver Histopathology Laboratory, Institute of Liver Studies, King’s College London, London
| | - Vishal Patel
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Mark J McPhail
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Yoh Zen
- Liver Histopathology Laboratory, Institute of Liver Studies, King’s College London, London
| | - Nigel D Heaton
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Maria Serena Longhi
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Michael A Heneghan
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Rodrigo Liberal
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Diego Vergani
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Giorgina Mieli-Vergani
- Paediatric Liver, GI and Nutrition Centre, Mowat Labs, King’s College London Faculty of Life Sciences & Medicine at King’s College Hospital, London, UK
| | - Yun Ma
- Institute of Liver Studies, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Bu’Hussain Hayee
- Department of Gastroenterology, King’s College Hospital, School of Immunology & Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
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Kawakami A, Tanaka M, Choong LM, Kunisaki R, Maeda S, Bjarnason I, Hayee B. Self-Reported Medication Adherence Among Patients with Ulcerative Colitis in Japan and the United Kingdom: A Secondary Analysis for Cross-Cultural Comparison. Patient Prefer Adherence 2022; 16:671-678. [PMID: 35300355 PMCID: PMC8922444 DOI: 10.2147/ppa.s346309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/19/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Non-adherence to medication was reported by 28% of Japanese patients with ulcerative colitis, but in the United Kingdom, patients with inflammatory bowel disease have lower medication adherence, which increases clinical relapse risk. The objective of this study was to compare medication adherence among patients with ulcerative colitis in Japan with previously reported results and patients in the United Kingdom. PATIENTS AND METHODS This cross-cultural comparison study investigated medication adherence among 100 ulcerative colitis patients in the United Kingdom and 432 ulcerative colitis patients in Japan. Adherence was assessed using The Morisky Medication Adherence Scale-8 questionnaire. Patient clinical features were collected from medical records and the questionnaire. Distribution of responses for each item, questionnaire total score, difference in ratio for each item between Japanese and UK patients, and difference in percentage of low/medium/high adherence between Japanese and UK patients were compared. RESULTS The proportion of low/medium or high adherence was significantly different between countries (42.6% and 7.4% [Japan] vs 24.0% and 76.0% [United Kingdom]; p<0.01). Significantly more Japanese patients reported taking medication correctly the day before the questionnaire compared with UK patients. CONCLUSION UK patients were more likely to not take medication when they felt their symptoms were under control compared with Japanese patients. UK patients perceived it was more difficult to remember to take the medication than Japanese patients. This study highlights culturally sensitive medication-taking behaviors in Japanese and UK patients with ulcerative colitis.
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Affiliation(s)
- Aki Kawakami
- Department of Gastroenterology, King’s College Hospital, London, UK
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan
- Correspondence: Makoto Tanaka, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan, Tel +81-3-5803-4507, Fax +81-3-5803-4507, Email
| | - Lee Meng Choong
- Department of Gastroenterology, King’s College Hospital, London, UK
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ingvar Bjarnason
- Department of Gastroenterology, King’s College Hospital, London, UK
| | - Bu’Hussain Hayee
- Department of Gastroenterology, King’s College Hospital, London, UK
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Emmanuel A, Haji A, Gulati S, Moorhead J, Papagrigoriadis S, Hayee B, Diaz-Cano S. Histopathological features for coexistent invasive cancer in large colorectal adenomatous polyps. BJS Open 2021; 5:6299994. [PMID: 34131706 PMCID: PMC8205855 DOI: 10.1093/bjsopen/zraa053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Histopathological features associated with coexistent invasive adenocarcinoma in large colorectal adenomas have not been described. This study aimed to determine the association of histopathological features in areas of low-grade dysplasia with coexistent invasive adenocarcinoma. Methods High-grade lesions (containing high-grade dysplasia or adenocarcinoma) from a cohort of large (at least 20 mm) colorectal adenomas removed by endoscopic resection were subjected to detailed histopathological analysis. The histopathological features in low-grade areas with coexistent adenocarcinoma were reviewed and their diagnostic performance was evaluated. Results Seventy-four high-grade lesions from 401 endoscopic resections of large adenomas were included. In the low-grade dysplastic areas, a coexistent invasive adenocarcinoma was associated significantly with a cribriform or trabecular growth pattern (P < 0.001), high nuclear grade (P < 0.001), multifocal intraluminal necrosis (P < 0.001), atypical mitotic figures (P = 0.006), infiltrative lesion edges (P < 0.001), a broad fibrous band (P = 0.001), ulceration (P < 0.001), expansile nodules (P < 0.001) and an extensive tumour-infiltrating lymphocyte pattern (P = 0.04). Lesions with coexistent invasive adenocarcinoma harboured at least one of these features. The area under the receiver operating characteristic curve (AUROC) for coexistent invasive adenocarcinoma, using frequencies of adverse histopathological factors in low-grade areas, was 0.92. The presence of two or more of these adverse histopathological features in low-grade areas had a sensitivity of 86 per cent and a specificity of 84 per cent for coexistent invasive adenocarcinoma. Conclusion Several histopathological features in low-grade dysplastic areas of adenomas could be predictive of coexistent adenocarcinoma.
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Affiliation(s)
- A Emmanuel
- Department of Colorectal Surgery and King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - A Haji
- Department of Colorectal Surgery and King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - S Gulati
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - J Moorhead
- Department of Histopathology, King's College Hospital NHS Foundation Trust, London, UK
| | - S Papagrigoriadis
- Department of Colorectal Surgery and King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - B Hayee
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - S Diaz-Cano
- Department of Histopathology, King's College Hospital NHS Foundation Trust, London, UK
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Habib Bedwani N, English W, Coda S, Akinlade F, Elzayat I, Seward EW, Hayee B, Hanson M, Banerjee S. Developing a prioritization model for endoscopy and colorectal cancer 2-week wait referrals during the COVID-19 pandemic-is faecal immunochemical testing the answer? Br J Surg 2021; 108:e18-e19. [PMID: 33640923 PMCID: PMC7799311 DOI: 10.1093/bjs/znaa045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N Habib Bedwani
- Department of Surgery, Digestive Disease Centre, Queens Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - W English
- Department of Surgery, Digestive Disease Centre, Queens Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.,National Bowel Research Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - S Coda
- Department of Endoscopy and Bowel Cancer Screening Programme, Digestive Disease Centre, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - F Akinlade
- Department of Biochemistry, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - I Elzayat
- Department of Surgery, Digestive Disease Centre, Queens Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - E W Seward
- Department of Gastroenterology, University College Hospital, London, UK
| | - B Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
| | - M Hanson
- Department of Surgery, Digestive Disease Centre, Queens Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - S Banerjee
- Department of Surgery, Digestive Disease Centre, Queens Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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Tavabie O, Clough J, Blackwell J, Bashyam M, Martin H, Soubieres A, Direkze N, Graham D, Groves C, Preston S, DeMartino S, Gill U, Hayee B, Joshi D. IDDF2020-ABS-0163 Reduced survival post-endoscopy for upper gastrointestinal bleeding in the COVID-19 era is a secondary effect of the response to the global pandemic. Abstracts 2020. [DOI: 10.1136/gutjnl-2020-iddf.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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van Baar ACG, Holleman F, Crenier L, Haidry R, Magee C, Hopkins D, Rodriguez Grunert L, Galvao Neto M, Vignolo P, Hayee B, Mertens A, Bisschops R, Tijssen J, Nieuwdorp M, Guidone C, Costamagna G, Devière J, Bergman JJGHM. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study. Gut 2020; 69:295-303. [PMID: 31331994 PMCID: PMC6984054 DOI: 10.1136/gutjnl-2019-318349] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/19/2019] [Accepted: 06/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve glycaemic control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes. DMR involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa. This multicentre study evaluates safety and feasibility of DMR and its effect on glycaemia at 24 weeks and 12 months. METHODS International multicentre, open-label study. Patients (BMI 24-40) with T2D (HbA1c 59-86 mmol/mol (7.5%-10.0%)) on stable oral glucose-lowering medication underwent DMR. Glucose-lowering medication was kept stable for at least 24 weeks post DMR. During follow-up, HbA1c, fasting plasma glucose (FPG), weight, hepatic transaminases, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), adverse events (AEs) and treatment satisfaction were determined and analysed using repeated measures analysis of variance with Bonferroni correction. RESULTS Forty-six patients were included of whom 37 (80%) underwent complete DMR and 36 were finally analysed; in remaining patients, mainly technical issues were observed. Twenty-four patients had at least one AE (52%) related to DMR. Of these, 81% were mild. One SAE and no unanticipated AEs were reported. Twenty-four weeks post DMR (n=36), HbA1c (-10±2 mmol/mol (-0.9%±0.2%), p<0.001), FPG (-1.7±0.5 mmol/L, p<0.001) and HOMA-IR improved (-2.9±1.1, p<0.001), weight was modestly reduced (-2.5±0.6 kg, p<0.001) and hepatic transaminase levels decreased. Effects were sustained at 12 months. Change in HbA1c did not correlate with modest weight loss. Diabetes treatment satisfaction scores improved significantly. CONCLUSIONS In this multicentre study, DMR was found to be a feasible and safe endoscopic procedure that elicited durable glycaemic improvement in suboptimally controlled T2D patients using oral glucose-lowering medication irrespective of weight loss. Effects on the liver are examined further. TRIAL REGISTRATION NUMBER NCT02413567.
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Affiliation(s)
- Annieke C G van Baar
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Laurent Crenier
- Endocrinology, Erasme University Hospital, Brussels, Belgium
| | - Rehan Haidry
- Gastroenterology, University College Hospital, London, UK
| | - Cormac Magee
- Centre for Obesity Research, Department of Medicine, University College Hospital, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, UK
| | | | - Manoel Galvao Neto
- Bariatric Endoscopy Service, Gastro Obeso Center, Sao Paulo, Brazil,College of Medicine, Florida International University, Miami, Florida, USA
| | - Paulina Vignolo
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | | | - Ann Mertens
- Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - Raf Bisschops
- Gastroenterology and Hepatology, Catholic University of Leuven, Leuven, Belgium
| | - Jan Tijssen
- Cardiology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Internal and Vascular Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Caterina Guidone
- Internal Medicine, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Roma, Italy
| | - Jacques Devière
- Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Jacques J G H M Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
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Gulati S, Emmanuel A, Patel M, Williams S, Haji A, Hayee B, Neumann H. Artificial intelligence in luminal endoscopy. Ther Adv Gastrointest Endosc 2020; 13:2631774520935220. [PMID: 32637935 PMCID: PMC7315657 DOI: 10.1177/2631774520935220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence is a strong focus of interest for global health development. Diagnostic endoscopy is an attractive substrate for artificial intelligence with a real potential to improve patient care through standardisation of endoscopic diagnosis and to serve as an adjunct to enhanced imaging diagnosis. The possibility to amass large data to refine algorithms makes adoption of artificial intelligence into global practice a potential reality. Initial studies in luminal endoscopy involve machine learning and are retrospective. Improvement in diagnostic performance is appreciable through the adoption of deep learning. Research foci in the upper gastrointestinal tract include the diagnosis of neoplasia, including Barrett's, squamous cell and gastric where prospective and real-time artificial intelligence studies have been completed demonstrating a benefit of artificial intelligence-augmented endoscopy. Deep learning applied to small bowel capsule endoscopy also appears to enhance pathology detection and reduce capsule reading time. Prospective evaluation including the first randomised trial has been performed in the colon, demonstrating improved polyp and adenoma detection rates; however, these appear to be relevant to small polyps. There are potential additional roles of artificial intelligence relevant to improving the quality of endoscopic examinations, training and triaging of referrals. Further large-scale, multicentre and cross-platform validation studies are required for the robust incorporation of artificial intelligence-augmented diagnostic luminal endoscopy into our routine clinical practice.
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Affiliation(s)
- Shraddha Gulati
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Andrew Emmanuel
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Mehul Patel
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Sophie Williams
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Amyn Haji
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Bu’Hussain Hayee
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Helmut Neumann
- Department of Interdisciplinary Endoscopy, University Hospital Mainz, 55131 Mainz, Germany
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9
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Tavabie O, Clough JN, Blackwell J, Bashyam M, Martin H, Soubieres A, Direkze N, Graham D, Groves C, Preston SL, DeMartino S, Gill US, Hayee B, Joshi D. Reduced Survival After Gastrointestinal Bleed Endoscopy in the COVID-19 Era Is a Secondary Effect of the Global Pandemic: A Retrospective Cohort Study. SSRN Journal 2020. [DOI: 10.2139/ssrn.3627299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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10
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Alkandari A, Thayalasekaran S, Bhandari M, Przybysz A, Bugajski M, Bassett P, Kandiah K, Subramaniam S, Galtieri P, Maselli R, Spychalski M, Hayee B, Haji A, Repici A, Kaminski M, Bhandari P. Endoscopic Resections in Inflammatory Bowel Disease: A Multicentre European Outcomes Study. J Crohns Colitis 2019; 13:1394-1400. [PMID: 30994915 DOI: 10.1093/ecco-jcc/jjz075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease is associated with an increased risk of colorectal cancer, with estimates ranging 2-18%, depending on the duration of colitis. The management of neoplasia in colitis remains controversial. Current guidelines recommend endoscopic resection if the lesion is clearly visible with distinct margins. Colectomy is recommended if complete endoscopic resection is not guaranteed. We aimed to assess the outcomes of all neoplastic endoscopic resections in inflammatory bowel disease. METHODS This was a multicentre retrospective cohort study of 119 lesions of visible dysplasia in 93 patients, resected endoscopically in inflammatory bowel disease. RESULTS A total of 6/65 [9.2%] lesions <20 mm in size were treated by ESD [endoscopic submucosal dissection] compared with 59/65 [90.8%] lesions <20 mm treated by EMR [endoscopic mucosal resection]; 16/51 [31.4%] lesions >20 mm in size were treated by EMR vs 35/51 [68.6%] by ESD. Almost all patients [97%] without fibrosis were treated by EMR, and patients with fibrosis were treated by ESD [87%], p < 0.001. In all, 49/78 [63%] lesions treated by EMR were resected en-bloc and 27/41 [65.9%] of the ESD/KAR [knife-assisted resection] cases were resected en-bloc, compared with 15/41 [36.6%] resected piecemeal. Seven recurrences occurred in the cohort. Seven complications occurred in the cohort; six were managed endoscopically and one patient with a delayed perforation underwent surgery. CONCLUSIONS Larger lesions with fibrosis are best treated by ESD, whereas smaller lesions without fibrosis are best managed by EMR. Both EMR and ESD are feasible in the management of endoscopic resections in colitis.
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Affiliation(s)
- A Alkandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - S Thayalasekaran
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - M Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - A Przybysz
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - M Bugajski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - P Bassett
- Statistics, Statsconsultancy, Amersham, UK
| | - K Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - S Subramaniam
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - P Galtieri
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - R Maselli
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - M Spychalski
- University of Lodz, Center of Bowel Treatment, Brzeziny, Poland
| | - B Hayee
- Department of Gastroenterology, Kings Institute of Therapeutic Endoscopy, London, UK
| | - A Haji
- Department of Gastroenterology, Kings Institute of Therapeutic Endoscopy, London, UK
| | - A Repici
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - M Kaminski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - P Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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11
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Moulton CD, Pavlidis P, Norton C, Norton S, Pariante C, Hayee B, Powell N. Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation? Clin Exp Immunol 2019; 197:308-318. [PMID: 30762873 DOI: 10.1111/cei.13276] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 12/17/2022] Open
Abstract
Depressive symptoms are reported by more than 20% of people with inflammatory bowel disease (IBD), while sleep difficulties and fatigue are even more common. Co-morbid depressive symptoms predict a poor IBD course, including increased risk of relapse and surgery, which is inconsistently improved by psychological treatments. Rather than being distinct systems, there is compelling evidence for bidirectional communication between gut and brain, driven by neural, metabolic, endocrine and inflammatory mediators. An emerging concept is that depressive symptoms may be mechanistically linked to excess inflammation and dysregulation of the gut-brain axis. Given the close link between the intestinal microbiota and host immune responses, patients prone to shifts in their intestinal microbiome, including smokers, those with poor diet and early life stress, may be exposed to exaggerated immune responses. Excess inflammation is associated with brain changes (depressive symptoms, fatigue, sleep difficulties) and worsening gastrointestinal symptoms, which are exacerbated by psychological distress. Equally, treatments both for depressive symptoms and IBD provide opportunities to break this cycle by reducing the causes and effects of inflammation. As well as addressing potential risk factors such as smoking and diet, treatments to alter the microbiome may reduce depressive symptoms. Observational evidence suggests that anti-inflammatory treatments for IBD may improve co-morbid depressive symptoms correlating with reduction in inflammation. With a growing range of treatments targeting inflammation centrally, peripherally and in the gut, IBD provides a unique model to understand the interplay between brain and gut in the pathogenesis of depressive symptoms, both in IBD and in the whole population.
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Affiliation(s)
- C D Moulton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Pavlidis
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
| | - C Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - S Norton
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Hayee
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - N Powell
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
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12
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Ibraheim H, Dhillon AS, Koumoutsos I, Gulati S, Hayee B. Curriculum review: colorectal cancer surveillance and management of dysplasia in IBD. Frontline Gastroenterol 2018; 9:271-277. [PMID: 30245789 PMCID: PMC6145437 DOI: 10.1136/flgastro-2017-100919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/20/2017] [Accepted: 01/14/2018] [Indexed: 02/04/2023] Open
Abstract
The significantly increased risk of colorectal cancer (CRC) in longstanding colonic inflammatory bowel disease (IBD) justifies the need for endoscopic surveillance. Unlike sporadic CRC, IBD-related CRC does not always follow the predictable sequence of low-grade to high-grade dysplasia and finally to invasive carcinoma, probably because the genetic events shared by both diseases occur in different sequences and frequencies. Surveillance is recommended for patients who have had colonic disease for at least 8-10 years either annually, every 3 years or every 5 years with the interval dependant on the presence of additional risk factors. Currently, the recommended endoscopic strategy is high-definition chromoendoscopy with targeted biopsies, although the associated lengthier procedure time and need for experienced endoscopists has limited its uniform uptake in daily practice. There is no clear consensus on the management of dysplasia, which continues to be a challenging area particularly when endoscopically invisible. Management options include complete resection (and/or referral to a tertiary centre), close surveillance or proctocolectomy. Technical advances in endoscopic imaging such as confocal laser endomicroscopy, show exciting potential in increasing dysplasia detection rates but are still far from being routinely used in clinical practice.
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Affiliation(s)
| | | | | | - Shraddha Gulati
- King’s Institute of Therapeutic Endoscopy, King’s College London, London, UK
| | - Bu’Hussain Hayee
- King’s Institute of Therapeutic Endoscopy, King’s College London, London, UK
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13
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Pavlidis P, Graham J, Gulati S, Dubois P, Heneghan M, Joshi D, Hayee B. Letter: vedolizumab for autoimmune liver disease associated inflammatory bowel disease. Aliment Pharmacol Ther 2018; 47:1422-1423. [PMID: 29676010 DOI: 10.1111/apt.14603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- P Pavlidis
- Department of Gastroenterology, King's College Hospital, London, UK
| | - J Graham
- Institute of Liver Studies, King's College Hospital, London, UK
| | - S Gulati
- Department of Gastroenterology, King's College Hospital, London, UK
| | - P Dubois
- Department of Gastroenterology, King's College Hospital, London, UK
| | - M Heneghan
- Institute of Liver Studies, King's College Hospital, London, UK
| | - D Joshi
- Institute of Liver Studies, King's College Hospital, London, UK
| | - B Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
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14
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Onoufriadis A, Stone K, Katsiamides A, Amar A, Omar Y, de Lange KM, Taylor K, Barrett JC, Pollok R, Hayee B, Mansfield JC, Sanderson JD, Simpson MA, Mathew CG, Prescott NJ. Exome Sequencing and Genotyping Identify a Rare Variant in NLRP7 Gene Associated With Ulcerative Colitis. J Crohns Colitis 2018; 12:321-326. [PMID: 29211899 PMCID: PMC6290881 DOI: 10.1093/ecco-jcc/jjx157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/30/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Although genome-wide association studies [GWAS] in inflammatory bowel disease [IBD] have identified a large number of common disease susceptibility alleles for both Crohn's disease [CD] and ulcerative colitis [UC], a substantial fraction of IBD heritability remains unexplained, suggesting that rare coding genetic variants may also have a role in pathogenesis. We used high-throughput sequencing in families with multiple cases of IBD, followed by genotyping of cases and controls, to investigate whether rare protein-altering genetic variants are associated with susceptibility to IBD. METHODS Whole-exome sequencing was carried out in 10 families in whom three or more individuals were affected with IBD. A stepwise filtering approach was applied to exome variants, to identify potential causal variants. Follow-up genotyping was performed in 6025 IBD cases [2948 CD; 3077 UC] and 7238 controls. RESULTS Our exome variant analysis revealed coding variants in the NLRP7 gene that were present in affected individuals in two distinct families. Genotyping of the two variants, p.S361L and p.R801H, in IBD cases and controls showed that the p.S361L variant was significantly associated with an increased risk of ulcerative colitis [odds ratio 4.79, p = 0.0039] and IBD [odds ratio 3.17, p = 0.037]. A combined analysis of both variants showed suggestive association with an increased risk of IBD [odds ratio 2.77, p = 0.018]. CONCLUSIONS The results suggest that NLRP7 signalling and inflammasome formation may be a significant component in the pathogenesis of IBD.
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Affiliation(s)
| | - Kristina Stone
- Department of Medical and Molecular Genetics, King’s College London, London, UK
| | - Antreas Katsiamides
- Department of Medical and Molecular Genetics, King’s College London, London, UK
| | - Ariella Amar
- Department of Medical and Molecular Genetics, King’s College London, London, UK
| | - Yasmin Omar
- Department of Medical and Molecular Genetics, King’s College London, London, UK
| | | | - Kirstin Taylor
- Department of Medical and Molecular Genetics, King’s College London, London, UK
| | | | - Richard Pollok
- Department Gastroenterology and Hepatology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Bu’Hussain Hayee
- IBD Service, King’s College Hospital NHS Foundation Trust, London, UK
| | - John C Mansfield
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy D Sanderson
- Department of Gastroenterology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Michael A Simpson
- Department of Medical and Molecular Genetics, King’s College London, London, UK
| | - Christopher G Mathew
- Department of Medical and Molecular Genetics, King’s College London, London, UK,Sydney Brenner Institute for Molecular Bioscience, University of Witwatersrand, Johannesburg, South Africa
| | - Natalie J Prescott
- Department of Medical and Molecular Genetics, King’s College London, London, UK,Corresponding author: Natalie J. Prescott, PhD, Department of Medical and Molecular Genetics, Faculty of Life Sciences & Medicine, King’s College London, 7th Floor, Tower Wing, Guy’s Hospital, London, SE1 9RT. E-mail:
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15
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Selinger CP, Parkes GC, Bassi A, Fogden E, Hayee B, Limdi JK, Ludlow H, McLaughlin S, Patel P, Smith M, Raine T. A multi-centre audit of excess steroid use in 1176 patients with inflammatory bowel disease. Aliment Pharmacol Ther 2017; 46:964-973. [PMID: 28949018 DOI: 10.1111/apt.14334] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/01/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Corticosteroids are central to inducing remission in inflammatory bowel disease (IBD) but are ineffective maintenance agents. AIM To benchmark steroid usage in British outpatients and assess factors associated with excess exposure. METHODS We recorded steroid use in unselected IBD outpatients. Cases meeting criteria for steroid dependency or excess were blind peer reviewed to determine whether steroid prescriptions were avoidable. Associations between steroid use and patient/institutional factors were analysed. RESULTS Of 1176 patients, 30% received steroids in the prior 12 months. 14.9% had steroid dependency or excess, which was more common in moderate/severe ulcerative colitis (UC) than Crohn's disease (CD) (42.6% vs 28.1%; P = .027). Steroid dependency or excess was deemed avoidable in 49.1%. The annual incidence of inappropriate steroid excess was 7.1%. Mixed-effects logistic regression analysis revealed independent predictors of inappropriate steroid excess. The odds ratio (OR, 95%CI) for moderate/severe compared to mild/quiescent disease activity was 4.59 (1.53-20.64) for UC and 4.60 (2.21-12.00) for CD. In CD, lower rates of inappropriate steroid excess were found in centres with an IBD multi-disciplinary team (OR 0.62 [0.46-0.91]), whilst dedicated IBD clinics protected against inappropriate steroid excess in UC (OR 0.64, 95% CI 0.21-0.94). The total number of GI trainees was associated with rates of inappropriate steroid excess. CONCLUSIONS Steroid dependency or excess occurred in 14.9% of British IBD patients (in 7.1% potentially avoidable). We demonstrated positive effects of service configurations (IBD multi-disciplinary team, dedicated IBD clinics). Routine recording of steroid dependency or excess is feasible and should be considered a quality metric.
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Affiliation(s)
| | - G C Parkes
- Royal London Hospital, Barts Heath, London, UK
| | - A Bassi
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | - E Fogden
- Sandwell and West Birmingham Hospitals, Birmingham, UK
| | - B Hayee
- King's College Hospital NHS Foundation Trust, London, UK
| | - J K Limdi
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - H Ludlow
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S McLaughlin
- The Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK
| | - P Patel
- Epsom and St Helier University Hospitals NHS, Epsom, UK
| | - M Smith
- Brighton and Sussex University Hospitals, Brighton, UK
| | - T Raine
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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16
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Westerouen van Meeteren MJ, Hayee B, Inderson A, van der Meulen AE, Altwegg R, van Hoek B, Pageaux GP, Stijnen T, Stein D, Maljaars PWJ. Safety of Anti-TNF Treatment in Liver Transplant Recipients: A Systematic Review and Meta-analysis. J Crohns Colitis 2017; 11:1146-1151. [PMID: 28482085 DOI: 10.1093/ecco-jcc/jjx057] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/21/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Little is known about the risk of serious infection when combining anti-tumour necrosis factor [TNF] therapy for refractory inflammatory bowel disease [IBD] with immunosuppression after liver transplantation [LT]. Our aim was to investigate the infection risk in this patient group by systematic review and meta-analysis of the available data. METHODS A search was conducted for full papers and conference proceedings through September 2015, regarding liver transplant recipients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale [NOS]. Two reviewers independently extracted patient data [age, duration of follow-up, number of all infections, number of serious infections, time since transplant]. As an additional control population, primary sclerosing cholangitis [PSC]-IBD patients from the Leiden University Medical Center [LUMC] LT cohort were used. Poisson regression was used to compare serious infections (according to International Conference on Harmonisation [ICH] definition) per patien-year follow-up between the anti-TNF and control groups. RESULTS In all 465 articles and abstracts were identified, of which eight were included. These contained 53 post-LT patients on anti-TNF therapy and 23 post-LT patients not exposed to anti-TNF therapy. From the LUMC LT-cohort, 41 PSC patients with PSC-IBD not exposed to anti-TNF therapy were included as control population. The infection rate for TNF-exposed patients was 0.168 serious infections per patient year, compared with 0.149 in the control patients (rate ratio 1.12 [95% confidence interval: 0.233-5.404, P = 0.886]. When correcting for time since transplant, the infection rate was 0.194 in the TNF-exposed vs 0.115 in the non-exposed [p = 0.219]. CONCLUSIONS No significant increase in the rate of serious infection was observed in LT recipients with PSC-IBD during exposure to anti-TNF therapy.
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Affiliation(s)
| | - B Hayee
- King's College Hospital, Department of Gastroenterology, London, UK
| | - A Inderson
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
| | - A E van der Meulen
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
| | - R Altwegg
- University Hospital of St Eloi, Department of Hepatology and Gastroenterology, Montpellier, France
| | - B van Hoek
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
| | - G P Pageaux
- University Hospital of St Eloi, Department of Hepatology and Gastroenterology, Montpellier, France
| | - T Stijnen
- Leiden University Medical Centre, Department of Medical Statistics, Leiden, The Netherlands
| | - D Stein
- Medical College of Wisconsin, Department of Gastroenterology and Hepatology, Milwaukee, WI, USA
| | - P W J Maljaars
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
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17
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Abstract
Peroral endoscopic myotomy (POEM) is an established treatment for primary achalasia. It has gained endorsement from the American Society for Gastrointestinal Endoscopy with increasing clinical acceptance since the first procedure, performed in Japan in 2008. The first successful POEM in the UK was performed in November 2013 at King's College Hospital and this article presents the first UK case series. Prospective data were collected at 3 and 12-24 months for consecutive patients undergoing POEM. Post-POEM gastro-oesophageal reflux health-related quality of life scale (GORD-HRQoL) score was recorded. Statistical comparisons were made using paired non-parametric testing. In an initial series of 33 consecutive prospectively followed patients (12 female; 49.5±13 years; median follow-up 9 (3-28) months; 58% having had previous intervention), a 91% success rate has been achieved at 3 months. To date, 16 patients have reached the 12-month time point, with 13 (81%) sustaining response. This case series compares well with international cohorts and demonstrates excellent long-term safety and favourable efficacy.
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Affiliation(s)
| | | | - Haruhiro Inoue
- Digestive Diseases Centre, Showa University Koto-Toyosu Hospital, Tokyo, Japan
| | | | - Amyn Haji
- King’s Institute of Therapeutic Endoscopy, London, UK
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18
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Pavlidis P, Powell N, Vincent RP, Ehrlich D, Bjarnason I, Hayee B. Systematic review: bile acids and intestinal inflammation-luminal aggressors or regulators of mucosal defence? Aliment Pharmacol Ther 2015. [PMID: 26223936 DOI: 10.1111/apt.13333] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD), comprising Crohn's disease and ulcerative colitis (UC), are chronic conditions attributed to an aberrant immune response to luminal triggers. Recently, published work suggests a pathogenic role for bile acids in this context. AIM To perform a systematic review of studies investigating the role of bile acids in intestinal inflammation and present potentially relevant clinical implications. METHODS Pubmed search for English language articles published up to May 2015. Terms used were: 'bile', 'bile acid', 'barrier', 'small bowel injury', 'Crohn's' and 'colitis'. RESULTS Experimental studies support a variable role for bile acids in intestinal barrier homoeostasis. This may be attributed to different physicochemical properties, variable effects on epithelia and immune cells via bile acids-specific receptors, or through a cross-talk with the gut microbiome. A reduction in the bile acids pool, with lower concentrations of secondary forms, has been recognised for some time in Crohn's disease and associated to ileal dysfunction and bile acids malabsorption. Recent work suggests that these changes, including an increase in sulphated forms, are related to inflammatory activity in both Crohn's disease and UC. The detrimental effects of 'western diet' elements such as emulsifiers and fat, which have been implicated in the development of the current IBD and obesity epidemics, may also be bile acid-mediated. CONCLUSIONS Although there are only a few observational clinical studies to support an interaction, in vivo human and animal studies support an association between bile acids metabolism, the gut microbiome and intestinal inflammation. This may well prove to have significant diagnostic and therapeutic implications.
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Affiliation(s)
- P Pavlidis
- Department of Gastroenterology, King's College Hospital, London, UK
| | - N Powell
- Division of Transplantation and Mucosal Biology, King's College London, London, UK
| | - R P Vincent
- Department of Biochemistry, King's College Hospital, London, UK
| | - D Ehrlich
- Centre of Host-Microbiome Interactions, King's College London, London, UK
| | - I Bjarnason
- Department of Gastroenterology, King's College Hospital, London, UK
| | - B Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
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19
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Pissas D, Ypsilantis E, Papagrigoriadis S, Hayee B, Haji A. Endoscopic management of iatrogenic perforations during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for colorectal polyps: a case series. Therap Adv Gastroenterol 2015; 8:176-81. [PMID: 26136835 PMCID: PMC4480568 DOI: 10.1177/1756283x15576844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Iatrogenic perforation during therapeutic colonoscopy, reported in up to 1% of endoscopic mucosal resections (EMRs) and up to 14% of endoscopic submucosal dissections (ESDs), has conventionally been an indication for surgery. AIMS We present a case series of successful endoscopic management of iatrogenic colorectal perforation during EMR and ESD, demonstrating the feasibility and safety of the method. METHODS Retrospective analysis of a database of patients undergoing EMR and ESD for colorectal polyps in a tertiary referral centre in the United Kingdom. RESULTS Four cases of perforation were identified (two EMRs and two ESDs) in a series of 218 procedures (1.8%), all detected at the time of endoscopy and managed with endoscopic clips. Patients were observed in hospital and treated with antibiotics. Their median length of stay was 3 days (range 2-6 days), with no mortality or need for surgery. CONCLUSION Surgery is no longer the first choice in the management of iatrogenic perforations during EMR and ESD for colorectal polyps; in selected patients with small perforations and minimal extraluminal contamination, conservative management with application of endoscopic clips, antibiotics and close patient monitoring constitute a safe and effective treatment option, avoiding the morbidity of major surgery.
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Affiliation(s)
- Dimitrios Pissas
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Efthymios Ypsilantis
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Savvas Papagrigoriadis
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Bu’Hussain Hayee
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Amyn Haji
- Department of Colorectal Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
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20
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Hutchings P, Lee K, Watson K, Hayee B, Elston C. 216 Gastrostomy button primary placement using an endoscopically guided gastropexy technique in cystic fibrosis: A single centre's early experience. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Inoue H, Kaga M, Ikeda H, Sato C, Sato H, Minami H, Santi EG, Hayee B, Eleftheriadis N. Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification. Ann Gastroenterol 2015; 28:41-48. [PMID: 25608626 PMCID: PMC4290003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 09/02/2014] [Indexed: 10/29/2022] Open
Abstract
Recent developments in image-enhancement technology have enabled clear visualization of the microvascular structure of the esophageal mucosa. In particular, intrapapillary capillary loops (IPCLs) are observed as brown loops on magnification endoscopy with narrow-band imaging (NBI). IPCLs demonstrate characteristic morphological changes according to the structural irregularity of esophageal epithelium and cancer infiltration, summarized in the IPCL classification. In this review, the process from the first endoscopic description of IPCLs to the eventual development of the IPCL classification is described and discussed, particularly focusing on early stage squamous cell carcinoma of the esophagus.
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Affiliation(s)
- Haruhiro Inoue
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
| | - Makoto Kaga
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
| | - Haruo Ikeda
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
| | - Chiaki Sato
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
| | - Hiroki Sato
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
| | - Hitomi Minami
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
| | - Esperanza Grace Santi
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
| | - Bu’Hussain Hayee
- Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Nikolas Eleftheriadis
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Makoto Kaga, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Hitomi Minami, Esperanza Grace Santi, Nikolas Eleftheriadis)
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22
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Roos D, van Buul JD, Tool ATJ, Matute JD, Marchal CM, Hayee B, Köker MY, de Boer M, van Leeuwen K, Segal AW, Pick E, Dinauer MC. Two CGD Families with a Hypomorphic Mutation in the Activation Domain of p67 phox. J Clin Cell Immunol 2014; 5:1000231. [PMID: 25937994 PMCID: PMC4414043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
STUDY BACKGROUND Chronic granulomatous Disease (CGD) is a rare immunodeficiency caused by a defect in the leukocyte NADPH oxidase. This enzyme generates superoxide, which is needed for the killing of bacteria and fungi by phagocytic leukocytes. Most CGD patients have mutations in CYBB, the X-linked gene that encodes gp91phox, the catalytic subunit of the leukocyte NADPH oxidase. We report here three autosomal recessive CGD patients from two families with a homozygous mutation in NCF2, the gene that encodes p67phox, the activator subunit of the NADPH oxidase. METHODS Leukocyte NADPH oxidase activity, expression of oxidase components and gene sequences were measured with standard methods. The mutation found in the patients' NCF2 gene was expressed as Ala202Val-p67phox in K562 cells to measure its effect on NADPH oxidase activity. Translocation of the mutated p67phox from the cytosol of the patients' neutrophils to the plasma membrane was measured by confocal microscopy and by Western blotting after membrane purification. RESULTS The exceptional feature of the A67 CGD patients reported here is that the p.Ala202Val mutation in the activation domain of p67phox was clearly hypomorphic: substantial expression of p67phox protein was noted and the NADPH oxidase activity in the neutrophils of the patients was 20-70% of normal, dependent on the stimulus used to activate the cells. The extent of Ala202Val-p67phox translocation to the plasma membrane during cell activation was also stimulus dependent. Ala202Val-p67phox in K562 cells mediated only about 3% of normal oxidase activity compared to cells transfected with the wild-type p67phox. CONCLUSION The mutation found in NCF2 is the cause of the decreased NADPH oxidase activity and the (mild) clinical problems of the patients. We propose that the p.Ala202Val mutation has changed the conformation of the activation domain of p67phox, resulting in reduced activation of gp91phox.
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Affiliation(s)
- Dirk Roos
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap D van Buul
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton TJ Tool
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Juan D Matute
- Departments of Pediatrics (Hematology/Oncology), Microbiology/Immunology, and Medical and Molecular Genetics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christophe M Marchal
- Departments of Pediatrics (Hematology/Oncology), Microbiology/Immunology, and Medical and Molecular Genetics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bu’Hussain Hayee
- Department of Medicine, University College London, London, United Kingdom
| | - M Yavuz Köker
- Department of Immunology and Immunology Laboratory, Faculty of Medicine, University of Erciyes, Kayseri, Turkey
| | - Martin de Boer
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Karin van Leeuwen
- Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anthony W Segal
- Department of Medicine, University College London, London, United Kingdom
| | - Edgar Pick
- Julius Friedrich Cohnheim Laboratory of Phagocyte Research, Sackler School of Medicine, Tel Aviv University, Israel
| | - Mary C Dinauer
- Departments of Pediatrics (Hematology/Oncology), Microbiology/Immunology, and Medical and Molecular Genetics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Inoue H, Ito H, Ikeda H, Sato C, Sato H, Phalanusitthepha C, Hayee B, Eleftheriadis N, Kudo SE. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014; 27:346-351. [PMID: 25330784 PMCID: PMC4188931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/08/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In our previous case report of circumferential mucosal resection for short-segment Barrett's esophagus with high-grade dysplasia, symptoms of gastro-esophageal reflux disease (GERD) were significantly improved. This observation suggests that anti-reflux mucosectomy (ARMS) could represent an effective anti-reflux procedure, with the advantage that no artificial devices or prostheses would be left in situ. METHODS In this pilot study, 10 patients with treatment-refractory GERD received ARMS, 2 of whom circumferential, and the remaining 8 crescentic. RESULTS Key symptoms of GERD improved significantly after ARMS. In the DeMeester score, mean heartburn score decreased from 2.7 to 0.3 (P=0.0011), regurgitation score from 2.5 to 0.3 (P=0.0022), and total score from 5.2 to 0.67 (P=0.0011). At endoscopic examination, the flap valve grade decreased from 3.2 to 1.2 (P=0.0152). In 24-h esophageal pH monitoring the fraction of time at pH <4 improved from 29.1% to 3.1% (P=0.1). Fraction time absorbance more than >0.14 of bile reflux was controlled from 52% to 4% (P=0.05). In 2 cases of total circumferential resection, repeat balloon dilation was necessary to control stenosis. In all cases, proton pump inhibitor prescription could be discontinued with no ill effects. CONCLUSION This initial case series demonstrated the potential anti-reflux effect of ARMS, with a crescentic mucosal resection appearing adequate. Further longitudinal study of patients without sliding hiatus hernia will be required to establish ARMS as an effective technique to control GERD in this setting.
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Affiliation(s)
- Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis)
| | - Hiroaki Ito
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis)
| | - Haruo Ikeda
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis)
| | - Chiaki Sato
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis)
| | - Hiroki Sato
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis)
| | - Chainarong Phalanusitthepha
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis)
| | - Bu’Hussain Hayee
- Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK (Bu’Hussain Hayee)
| | - Nikolas Eleftheriadis
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan (Haruhiro Inoue, Hiroaki Ito, Haruo Ikeda, Chiaki Sato, Hiroki Sato, P. Chainarong, Nikolas Eleftheriadis)
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (Shin-ei Kudo)
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Hayee B, Rahman FZ, Tempero J, McCartney S, Bloom SL, Segal AW, Smith AM. The neutrophil respiratory burst and bacterial digestion in Crohn's disease. Dig Dis Sci 2011; 56:1482-8. [PMID: 20936355 PMCID: PMC4568317 DOI: 10.1007/s10620-010-1426-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 09/09/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neutrophils are a key part of the innate immune defence against microbes, using the respiratory burst (RB) to optimise killing and digestion. Previous studies of the neutrophil RB in Crohn's disease (CD) have yielded conflicting results. METHODS Superoxide production in response to phorbol-myristyl acetate (PMA) was measured in neutrophils from 100 patients with CD compared to 50 healthy controls (HCs) and 50 patients with ulcerative colitis (UC). A further 22 CD and 10 HCs were studied using f-Met-Leu-Phe (fMLP), and digestion of E. coli by neutrophils was also evaluated. RESULTS The mean ± SEM PMA-stimulated RB (nmol O(2)/10(6) cells/min) was 10.86 ± 0.26 in HCs, 9.76 ± 0.23 in CD (P=0.02) and 10.04 ± 0.28 in UC (P=0.09 vs HC and 0.47 vs CD). No significant effect of age, gender or medication was observed. The RB in three patients with presumed CD was found to be in the range expected in patients with inherited neutrophil disorders. Stimulation with fMLP was calcium dependent and attenuated in patients on 5-ASA. Digestion of E. coli by neutrophils was not different in HC vs CD (21.6 vs 20.53%, P=0.60). CONCLUSION The significant reduction in neutrophil RB in CD does not appear to result in defective bacterial digestion and is therefore unlikely play a major role in pathogenesis. Three patients in this cohort of patients with presumed idiopathic CD were found to have a profound defect of the neutrophil RB. A high index of suspicion for such patients is prudent, as their prognosis can be improved by altering or augmenting the conventional treatment regimens employed for CD.
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Affiliation(s)
- Bu’Hussain Hayee
- Department of Molecular Medicine, University College London, WC1E 6JJ London, UK
| | - Farooq Z. Rahman
- Department of Molecular Medicine, University College London, WC1E 6JJ London, UK
| | - Jane Tempero
- Department of Molecular Medicine, University College London, WC1E 6JJ London, UK
| | - Sara McCartney
- Department of Gastroenterology, UCLH NHS Foundation Trust, London NW1 2BU, UK
| | - Stuart L. Bloom
- Department of Gastroenterology, UCLH NHS Foundation Trust, London NW1 2BU, UK
| | - Anthony W. Segal
- Department of Molecular Medicine, University College London, WC1E 6JJ London, UK
| | - Andrew M. Smith
- Department of Molecular Medicine, University College London, WC1E 6JJ London, UK
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Anumakonda V, Hayee B, Chung-Faye G. Remission and relapse of Crohn's disease following autologous haematopoietic stem cell transplantation for non-Hodgkin's lymphoma. Gut 2007; 56:1325. [PMID: 17438083 PMCID: PMC1954955 DOI: 10.1136/gut.2006.111377] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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