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Daenen F, Baert F, McParland J, Trost Z, Schillemans A, Tanghe A, Vervoort T. Child appraisals of injustice in the context of acute and chronic pain: An interpretative phenomenological analysis. Eur J Pain 2024; 28:54-69. [PMID: 37381085 DOI: 10.1002/ejp.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Recent research has found child pain-related injustice appraisals to be associated with adverse pain-related outcomes. However, this evidence is mainly based on research using a measure developed for adults in the context of accident-related injuries, which may not translate to paediatric pain populations. Research on the phenomenology of child pain-related injustice appraisals is lacking. This study aimed to examine the phenomenology of pain-related injustice appraisals among both pain-free children and children living with chronic pain, to compare and contrast their experiences. METHODS Two focus groups were held with pain-free children (n = 16), and three focus groups were held with paediatric chronic pain patients attending a rehabilitation centre (n = 15) in Belgium. Interpretative phenomenological analysis was applied. RESULTS Two injustice-related themes were generated from the focus groups with pain-free children: (1) 'Someone else is at fault' and (2) 'I am in pain and he is not'. Two injustice-related themes were generated from the focus groups with paediatric chronic pain patients: (1) 'People don't see my pain' and (2) 'I am missing out because of my pain'. CONCLUSIONS This study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric pain patients. Findings highlight the interpersonal nature of lived injustice experiences caused by chronic pain, which is not fully captured by existing child pain-related injustice measures. Findings further suggest that pain-related injustice notions may not be extrapolated from a chronic to an acute pain context. SIGNIFICANCE The current study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric chronic pain patients. Findings highlight the interpersonal nature of injustice appraisals that are specific to the experience of chronic rather than acute pain. These appraisals are not fully captured by current child pain-related injustice measures.
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Affiliation(s)
- F Daenen
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - F Baert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - J McParland
- Department of Psychology, Glasgow Caledonian University, Glasgow, UK
| | - Z Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - A Schillemans
- Zeepreventorium, Health Centre De Haan, De Haan, Belgium
| | - A Tanghe
- Zeepreventorium, Health Centre De Haan, De Haan, Belgium
| | - T Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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2
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Baert F, Baert D, Pouillon L, Bossuyt P. Quality outcome measures project in IBD: a proof-of-concept benchmarking study in three Belgian IBD units. Acta Gastroenterol Belg 2023; 86:521-526. [PMID: 38240546 DOI: 10.51821/86.4.11830] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Introduction Current treatment modalities in IBD allow us to render normal quality of life to most patients. Ideally, structured digital care pathways can be harmonised in order to measure (semi-) automatically key outcome quality indicators and compare between institutions. Materials and methods Key quality criteria were selected through a consensus process and aligned with the ICHOM quality criteria in IBD, including clinical parameters, PROMs, quality of life, health care utilisation and productivity. Results Measurements of the 11 selected key quality criteria were integrated in the structured care pathways of three IBD units. All patients received (at least) twice a year three questionnaires (PRO2 or SCCAI, ICHOM criteria and IBD Disk) through the electronic application to collect necessary information ahead of their planned outpatient clinic. In addition, interpretation of biomarkers was automated, and more difficult outcome indicators were manually added by the caregiver during the visit in anticipation of adaptations to or improvements of the electronic record. All information was collected centrally electronically in a structured way allowing benchmarking between the three centres, and stored for future retrospective research. Conclusion A (partially) automated benchmarking for measuring quality of care is feasible. It provides an objective assessment of IBD care, enables benchmarking between centres and facilitates quality improvements projects.
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Affiliation(s)
- F Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - D Baert
- Department of Gastroenterology, AZ Maria Middelares, Ghent, Belgium
| | - L Pouillon
- Department of Gastroenterology, Imelda ziekenhuis, Bonheiden, Belgium
| | - P Bossuyt
- Department of Gastroenterology, Imelda ziekenhuis, Bonheiden, Belgium
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3
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Panaccione R, Ferrante M, Feagan BG, Sandborn W, Panes J, Peyrin-Biroulet L, Colombel J, Schreiber S, Dubinsky M, Baert F, Hisamatsu T, Neimark E, Huang B, Liao X, Song A, Berg S, Duan W, Pang Y, Pivorunas V, Kligys K, Wallace K, D’Haens G. A37 EFFICACY AND SAFETY OF RISANKIZUMAB AS MAINTENANCE THERAPY IN PATIENTS WITH CROHN’S DISEASE: 52 WEEK RESULTS FROM THE PHASE 3 FORTIFY STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859234 DOI: 10.1093/jcag/gwab049.036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Risankizumab (RZB), an anti-IL-23 p19 inhibitor, was well-tolerated and superior to placebo (PBO) in inducing clinical remission and endoscopic response in patients (pts) with moderate-to-severe Crohn’s disease (CD) in two phase 3 studies at 12 weeks. Aims FORTIFY (NCT03105102), was a 52-week (wk) phase 3 double-blind, re-randomized responder withdrawal study that evaluated the efficacy and safety of continuing RZB as subcutaneous (SC) maintenance therapy versus withdrawal to placebo in pts achieving induction response to RZB Methods Week 12 IV RZB responders were re-randomized 1:1:1 to: RZB SC 360mg (N=141), RZB 180mg (N=157), or PBO (withdrawal from IV RZB; N=164) every 8wks for 52wks. Co-primary endpoints were clinical remission (per CD Activity Index [CDAI] (US); or stool frequency/abdominal pain score [SF/APS] (OUS) and endoscopic response at wk52. Other clinical and endoscopic endpoints, inflammatory biomarkers, RZB serum levels, and safety were assessed over time. Results Rates of clinical remission (CDAI, SF/APS) and clinical response were similar for RZB and PBO groups through wk24, with rates lower for PBO thereafter. At wk52, clinical remission (CDAI, SF/APS) and endoscopic response rates were significantly higher with RZB 360mg than PBO ( P<0.01); RZB 180mg was superior to PBO for clinical remission per CDAI and endoscopic response ( P<0.01). Endoscopic remission and deep remission rates increased over time with 360mg, remained steady with 180mg, and decreased with PBO. Mean fecal calprotectin (FCP) and C-reactive protein (CRP) levels decreased with SC RZB, but increased with PBO, over 52wks. Exposure-adjusted event rates (per 100 pts-years) of serious adverse event (AE) were generally similar among groups (360mg, 21.0 E/100PY and 180mg, 19.5 E/100PY vs PBO, 19.3 E/100PY), as were AEs leading to drug discontinuation (4.8 E/100PY and 2.4 E/100PY vs 3.7 E/100PY), and serious infections (6.0 E/100PY and 3.0 E/100PY vs 5.0 E/100PY). Conclusions In pts with moderate-to-severe CD, a robust pharmacodynamic effect on the IL-23 pathway after 12wks RZB IV induction was maintained with RZB SC maintenance therapy. The durability of RZB was demonstrated with high rates of efficacy over the 52-wk study. RZB was superior to PBO for achieving clinical remission and endoscopic response at wk52. Results for the more stringent endpoints (endoscopic remission\deep remission) and persistent improvements in inflammatory biomarkers are consistent with a dose response relationship. Continued RZB SC maintenance treatment was generally safe and well-tolerated. Funding Agencies AbbVie
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Affiliation(s)
| | - M Ferrante
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven Campus Gasthuisberg, Leuven, Flanders, Belgium
| | | | - W Sandborn
- University of California San Diego, La Jolla, CA
| | - J Panes
- Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | | | | | - S Schreiber
- Universitatsklinikum Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | | | - F Baert
- AZ Delta vzw, Roeselare, West-Vlaanderen, Belgium
| | - T Hisamatsu
- Kyorin Daigaku Igakubu Daigakuin Igaku Kenkyuka, Mitaka, Tokyo, Japan
| | | | - B Huang
- AbbVie Inc, North Chicago, IL
| | - X Liao
- AbbVie Inc, North Chicago, IL
| | - A Song
- AbbVie Inc, North Chicago, IL
| | - S Berg
- AbbVie Inc, North Chicago, IL
| | - W Duan
- AbbVie Inc, North Chicago, IL
| | - Y Pang
- AbbVie Inc, North Chicago, IL
| | | | | | | | - G D’Haens
- Universiteit van Amsterdam, Amsterdam, Noord-Holland, Netherlands
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Baert F, Matthys C, Maselyne J, Van Poucke C, Van Coillie E, Bergmans B, Vlaemynck G. Parkinson's disease patients' short chain fatty acids production capacity after in vitro fecal fiber fermentation. NPJ Parkinsons Dis 2021; 7:72. [PMID: 34389734 PMCID: PMC8363715 DOI: 10.1038/s41531-021-00215-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
Animal models indicate that butyrate might reduce motor symptoms in Parkinson's disease. Some dietary fibers are butyrogenic, but in Parkinson's disease patients their butyrate stimulating capacity is unknown. Therefore, we investigated different fiber supplements' effects on short-chain fatty acid production, along with potential underlying mechanisms, in Parkinson's patients and age-matched healthy controls. Finally, it was investigated if this butyrate production could be confirmed by using fiber-rich vegetables. Different fibers (n = 40) were evaluated by in vitro fermentation experiments with fecal samples of Parkinson's patients (n = 24) and age-matched healthy volunteers (n = 39). Short-chain fatty acid production was analyzed by headspace solid-phase micro-extraction gas chromatography-mass spectrometry. Clostridium coccoides and C. leptum were quantified through 16S-rRNA gene-targeted group-specific qPCR. Factors influencing short-chain fatty acid production were investigated using linear mixed models. After fiber fermentation, butyrate concentration varied between 25.6 ± 16.5 µmol/g and 203.8 ± 91.9 µmol/g for Parkinson's patients and between 52.7 ± 13.0 µmol/g and 229.5 ± 42.8 µmol/g for controls. Inulin had the largest effect, while xanthan gum had the lowest production. Similar to fiber supplements, inulin-rich vegetables, but also fungal β-glucans, stimulated butyrate production most of all vegetable fibers. Parkinson's disease diagnosis limited short-chain fatty acid production and was negatively associated with butyrate producers. Butyrate kinetics during 48 h fermentation demonstrated a time lag effect in Parkinson's patients, especially in fructo-oligosaccharide fermentation. Butyrate production can be stimulated in Parkinson's patients, however, remains reduced compared to healthy controls. This is a first step in investigating dietary fiber's potential to increase short-chain fatty acids in Parkinson's disease.
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Affiliation(s)
- Florence Baert
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Melle, Belgium ,grid.5596.f0000 0001 0668 7884Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, O&N I, Leuven, Belgium
| | - Christophe Matthys
- grid.5596.f0000 0001 0668 7884Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, O&N I, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Endocrinology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Jarissa Maselyne
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Melle, Belgium
| | - Christof Van Poucke
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Melle, Belgium
| | - Els Van Coillie
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Melle, Belgium
| | - Bruno Bergmans
- grid.420036.30000 0004 0626 3792Department of Neurology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium ,Department of Neurology, University Hospitals Ghent, Ghent, Belgium
| | - Geertrui Vlaemynck
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Melle, Belgium
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Baert F, Vlaemynck G, Beeckman AS, Van Weyenberg S, Matthys C. Dysphagia management in Parkinson's disease: Comparison of the effect of thickening agents on taste, aroma, and texture. J Food Sci 2021; 86:1039-1047. [PMID: 33521981 DOI: 10.1111/1750-3841.15595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/01/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
Dysphagia is a frequent symptom in Parkinson's disease (PD). Thickening liquids facilitates safe swallowing, however, low treatment compliance is a major issue, due to patients' dislike of thickened liquids. Some studies suggest a negative impact of gum-based thickeners, currently most used in clinical practice, on sensory properties compared to starch-based thickeners. This has not yet been investigated in PD. This study's aim was to compare taste, texture, and aroma of gum-based and starch-based thickened soups in participants with PD. Gum-based resource thicken up clear (RTUC) and starch-based kitchen products potato starch (PS) and quinoa flour (QF) were evaluated in broccoli soup. Texture, aroma, and taste were characterized by rheology, volatile, and sensory profiling. Thickened soups were evaluated in participants with PD and controls through a paired comparison test. Reduced release of 61.4%, 46.2%, and 38.5% of volatiles was observed after thickening with RTUC, PS, and QF, respectively. Overall taste intensity was reduced in RTUC- and PS-thickened soup, respectively. Taste and aroma of PS-thickened soup were considered more intense by 70.3% and 63.8% of all participants, respectively (n = 36 PD, n = 41 controls), 56.3% preferred the PS-thickened soup's texture . Taste and aroma of QF-thickened soup were considered more intense by 68.1% and 65.6% of all participants, respectively (n = 47 PD, n = 31 controls), 58.0% preferred the QF-thickened soup's texture. Starch-based thickeners demonstrated higher taste and aroma intensity. However, volatile and sensory profiling demonstrated reduced taste and aroma in all thickeners. Combining kitchen products with flavor enhancers may increase palatability of thickened beverages.
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Affiliation(s)
- Florence Baert
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium.,Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, KU Leuven, O&N I Herestraat 49 - box 902, Leuven, 3000, Belgium
| | - Geertrui Vlaemynck
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium
| | - Anne-Sophie Beeckman
- Speech Language Therapy, Postgraduate Course Dysphagia, Artevelde University of Applied Sciences, Campus Kantienberg, Voetweg 66, Gent, 9000, Belgium.,Speech Language Therapy, AZ Maria Middelares, Buitenring Sint-Denijs 30, Gent, 9000, Belgium
| | - Stephanie Van Weyenberg
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, KU Leuven, O&N I Herestraat 49 - box 902, Leuven, 3000, Belgium.,Department of Endocrinology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, 3000, Belgium
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6
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Baert F, Matthys C, Mellaerts R, Lemaître D, Vlaemynck G, Foulon V. Dietary Intake of Parkinson's Disease Patients. Front Nutr 2020; 7:105. [PMID: 32793623 PMCID: PMC7385303 DOI: 10.3389/fnut.2020.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background and Aims: Dietary management, as an adjuvant therapy in Parkinson's disease (PD), provides clear benefits to patients. However, baseline information about the usual dietary intake of Parkinson's patients is lacking. Methods: We conducted an observational cross-sectional study, investigating the dietary intake in Belgian PD patients, as well as their medication use and knowledge of possible food-drug interactions. A dietary record of 2 non-consecutive days, allowing the calculation of usual intake, was used. Medication use and knowledge of food-drug interactions were investigated using a self-administered questionnaire. Results: The nutrient (both macro and micro) intake in this study was similar to the dietary pattern of the general Belgian population. However, results showed that the PD population had a high dietary fiber intake of 26.2 ± 7.7 g/day, which is in line with the recommended intake. The majority of the PD patients had an inadequate intake of vitamin D and iron (respectively, 55.9 and 76.5% of all participants). When looking into the knowledge about food-drug interactions, the majority of the PD patients claimed to be aware of the food-drug interaction between dietary proteins and levodopa. However, only 18.2% of the patients took all doses of levodopa out of meals. Conclusion: Our results show that monitoring of dietary intake in PD patients is of importance to detect possible micronutrient insufficiencies. Patients should receive professional guidance in optimizing their diet to accommodate for different complaints inherent to PD, including constipation. Furthermore, the knowledge of patients regarding the importance of correct medication intake should be improved.
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Affiliation(s)
- Florence Baert
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Melle, Belgium.,Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, University of Leuven, Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, University of Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Randy Mellaerts
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium.,Parki's KookAtelier, Leuven, Belgium
| | - Dirk Lemaître
- Parki's KookAtelier, Leuven, Belgium.,Nutrition and Dietetics, UC Leuven-Limburg, Leuven, Belgium
| | - Geertrui Vlaemynck
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Melle, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Bossuyt P, Baert F, Coenegrachts JL, De Vos M, Dewit O, Ferrante M, Fontaine F, Mana F, Vandervoort J, Moreels T. Ulcerative colitis treatment : an insight into daily clinical practice. Acta Gastroenterol Belg 2019; 82:365-372. [PMID: 31566323] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The natural history of ulcerative colitis (UC) is unpredictable. Factors associated with the need for different types of step-up therapy in UC patients failing on 5-aminosalicylic acid (5-ASA) or corticosteroids are understudied. AIMS Describe step-up therapy in patients with UC the first year after failing on 5-ASA or corticosteroids. METHODS A Belgian, multi-center, prospective, non-interventional observational study comprising adult UC patients failing on 5-ASA or corticosteroids and naïve to immunomodulators/ biologicals. During a 12 months follow-up, patient characteristics, demography, medical therapy, biomarkers, therapy adherence and quality of life (QoL) were assessed. RESULTS After 1 year, 35% of the patients were on biological therapy. Use of anti-TNF differed depending on baseline treatment: corticosteroid-refractory patients (55.8%), 5-ASA refractory (20.0%), and corticosteroid-dependent (16.0%) patients (p<0.001). The decision to start a line of therapy was based on the Mayo combined severity but not on biomarkers like faecal calprotectin, haemoglobin, CRP, albumin, platelets, and number of extraintestinal manifestations. At year 1, 84.2% of the patients had only mild UC or remission and a significant improvement of fatigue (p=0.004) and IBDQ scores (p<0.001) were observed implying an improved QoL. CONCLUSION Treatment step-up, based on clinical scores in immunomodulatory and anti-TNF naïve patients with UC, provides good clinical outcomes and QoL.
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Affiliation(s)
- P Bossuyt
- Department of Gastroenterology, Imelda GI Clinical Research, Imelda General Hospital, Bonheiden, Belgium
| | - F Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - J L Coenegrachts
- Department of Gastroenterology, Jessa Ziekenhuis, Hasselt, Belgium
| | - M De Vos
- Department of Gastroenterology, University Hospitals Gent, Gent, Belgium
| | - O Dewit
- Department of Gastroenterology, UCL Saint Luc, Brussel, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - F Fontaine
- Department of Gastroenterology, Clinique Saint Joseph, Liège, Belgium
| | - F Mana
- Department of Gastroenterology, UZ Brussel, Brussel, Belgium
| | - J Vandervoort
- Department of Gastroenterology, OLV Ziekenhuis, Aalst, Belgium
| | - T Moreels
- Department of Gastroenterology, UCL Saint Luc, Brussel, Belgium
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Baert F, Stubbe D, D’hooge E, Packeu A, Hendrickx M. Updating the Taxonomy of Dermatophytes of the BCCM/IHEM Collection According to the New Standard: A Phylogenetic Approach. Mycopathologia 2019; 185:161-168. [DOI: 10.1007/s11046-019-00338-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
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Panaccione R, Colombel J, Bossuyt P, Baert F, Vanasek T, Danalioglu A, Novacek G, Armuzzi A, Reinisch W, Johnson S, Buessing M, Neimark E, Petersson J, Robinson AM, Thakkar RB, Lee W, Skup M, D’Haens G. A68 COST EFFECTIVENESS OF TIGHT CONTROL FOR CROHN’S DISEASE WITH ADALIMUMAB-BASED TREATMENT: ECONOMIC EVALUATION OF CALM TRIAL FROM CANADIAN PERSPECTIVE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Affiliation(s)
| | - J Colombel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - P Bossuyt
- Imelda General Hospital, Bonheiden, Belgium
| | - F Baert
- AZ Delta Roeselare, Menen, Belgium
| | - T Vanasek
- Hepato-Gastroenterologie HK, s.r.o., Hradec Králové , Czechia
| | | | - G Novacek
- Medical University of Vienna, Vienna, Austria
| | - A Armuzzi
- Presidio Columbus Fondazione Policlinico Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - W Reinisch
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | - W Lee
- AbbVie Inc., North Chicago, IL
| | - M Skup
- AbbVie Inc., North Chicago, IL
| | - G D’Haens
- IBD Unit, Academic Medical Center, Amsterdam, Netherlands
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Vancleef L, Thijs T, Baert F, Ceulemans LJ, Canovai E, Wang Q, Steensels S, Segers A, Farré R, Pirenne J, Lannoo M, Tack J, Depoortere I. Obesity Impairs Oligopeptide/Amino Acid-Induced Ghrelin Release and Smooth Muscle Contractions in the Human Proximal Stomach. Mol Nutr Food Res 2018; 62. [DOI: 10.1002/mnfr.201700804] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/29/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Laurien Vancleef
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Theo Thijs
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Florence Baert
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Laurens J. Ceulemans
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Emilio Canovai
- Abdominal Transplant Surgery; University Hospital Gasthuisberg; Leuven Belgium
| | - Qiaoling Wang
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Sandra Steensels
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Anneleen Segers
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Ricard Farré
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Jacques Pirenne
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Matthias Lannoo
- Abdominal Surgery; University Hospital Gasthuisberg; Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
| | - Inge Depoortere
- Translational Research Center for Gastrointestinal Disorders; Department of Clinical & Experimental Medicine; University of Leuven; Leuven Belgium
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Franchimont D, Ferrante M, Louis E, De Vos M, Dewit O, Van Hootegem P, Moreels T, Liefferinckx C, Bossuyt P, Baert F, Rahier JF, Vermeire S. Belgian IBD research group (BIRD) position statement 2017 on the use of biosimilars in inflammatory bowel diseases (IBD). Acta Gastroenterol Belg 2018; 81:49-53. [PMID: 29562378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- D Franchimont
- Department of Gastroenterology, Hopital Erasme Brussels, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - E Louis
- Department of Gastroenterology, Centre Hospitalier Universitaire de Liege, Belgium
| | - M De Vos
- Department of Gastroenterology - Ghent University Hospital - Ghent University, Belgium
| | - O Dewit
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc UCL Bruxelles, Belgium
| | - P Van Hootegem
- Department of Gastroenterology, AZ Sint Lucas Brugge, Belgium
| | - T Moreels
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc UCL Bruxelles, Belgium
| | - C Liefferinckx
- Department of Gastroenterology, Hopital Erasme Brussels, Belgium
| | - P Bossuyt
- Department of Gastroenterology, Imeldaziekenhuis, Bonheiden, Belgium
| | - F Baert
- Department of Gastroenterology, AZ Delta Roeselare, Belgium
| | - J F Rahier
- Department of Gastroenterology, CHU UCL Mont-Godinne, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
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12
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De Ruyck E, Baert F, Ghillebert G. An uncommon cause of coffee ground emesis : necrotizing enteritis with pneumatosis intestinalis. Acta Gastroenterol Belg 2018; 81:111-112. [PMID: 29562389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- E De Ruyck
- University Hospital of Ghent, Departement of Gastroenterology, Ghent, Belgium
| | - F Baert
- Department of Gastroenterology, AZ Delta Roeselaere-Menen, Roeselaere
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13
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Peeters H, Louis E, Baert F, Dewit O, Coche JC, Ferrante M, Lambrecht G, Colard A, Van Gossum A, Bossuyt P, Moreels T, Vander Cruyssen B, Gils A, De Vos M. Efficacy of switching to infliximab in patients with Crohn's disease with loss of response to adalimumab. Acta Gastroenterol Belg 2018; 81:15-21. [PMID: 29562373] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Anti-TNF monoclonal antibodies are a cornerstone in the treatment of Crohn's disease. Prospective data on switching from the subcutaneous and human adalimumab (ADM) to the intravenous and chimeric infliximab (IFX) are scarce. PATIENTS AND METHODS In this prospective, observational, multicentre cohort study we included 21 patients with loss of response to ADM despite at least 4 consecutive weekly injections. Clinical response (CDAI drop≥70 points) and remission (CDAI≤150) were assessed after switching from ADM to IFX after 10 weeks, 6 and 12 months. Predictive factors of response/remission, the need for therapy intensification, discontinuation and safety were investigated. RESULTS Short-term response and remission (10 weeks) were seen in 57% and 48% respectively. Mid- and long-term clinical response and remission were achieved in 40% and 25% after 6 months and in 45% and 20% after 12 months respectively. At 12 months, 81% still were on IFX. IFX therapy intensification was needed in half of the patients at 6 months and three quarter of patients at 12 months. Undetectable ADM trough levels (despite weekly injections) were a predictive factor for short-term response and remission to IFX. About half of the patients with response at week 10 maintained response at 6 and 12 months. CONCLUSIONS Switching from ADM to IFX can be efficacious in patients with loss of response, in particular in case of undetectable ADM trough levels. The majority of patients however will need IFX therapy intensification during their first year of treatment.
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Affiliation(s)
| | - E Louis
- University Hospital CHU, Liège, Belgium
| | - F Baert
- AZ Delta, Roeselare, Belgium
| | - O Dewit
- Hôpital Universitaire St-Luc, Bruxelles, Belgium
| | - J C Coche
- Clinique St-Pierre, Ottignies, Belgium
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14
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Vermeire S, Louis E, Dewit O, Franchimont D, Moreels T, Ferrante M, Rahier JF, Van Hootegem P, De Vos M, Mana F, Baert F. Clinical and scientific aspects related to biosimilars in inflammatory bowel diseases (IBD): position document of the Belgian IBD Research & Development Group (BIRD). Acta Gastroenterol Belg 2015; 78:26-29. [PMID: 26118575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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15
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Baert F, Vande Casteele N, Tops S, Noman M, Van Assche G, Rutgeerts P, Gils A, Vermeire S, Ferrante M. Prior response to infliximab and early serum drug concentrations predict effects of adalimumab in ulcerative colitis. Aliment Pharmacol Ther 2014; 40:1324-32. [PMID: 25277873 DOI: 10.1111/apt.12968] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 04/29/2014] [Revised: 06/02/2014] [Accepted: 09/05/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data for adalimumab in ulcerative colitis after prior use of infliximab are scarce. AIMS To study adalimumab response rates and predictors of response in ulcerative colitis, including drug concentrations. METHODS In this single centre cohort study 73 UC patients, previously exposed to infliximab, were assessed for response to adalimumab at weeks 12 and 52. Serum samples prior to week 12 were available and included in multivariate analysis to predict response. RESULTS Overall clinical response at week 12 and 52 were 75% and 52%, respectively. Adalimumab was continued without need for dose escalation throughout year 1 in 16 patients, 22 needed dose escalation and 35 discontinued treatment within 1 year. Prior response to infliximab and early serum concentrations correlated with response. Receiver operator characteristic curve analysis yielded optimal adalimumab concentrations of 4.58 μg/mL for week 12 and 7.0 μg/mL for week 52. Independent predictors for response at week 12 were primary response to infliximab [odds ratio (OR) 8.33; 95% confidence interval (CI) 1.8-33.3; P = 0.006] and an adalimumab concentration ≥4.58 μg/mL at week 4 (OR 4.85; 95% CI 1.3-18.6; P = 0.009). Positive predictors for week 52 response were primary response to infliximab (OR 5.2; 95% CI 1.14-23.8; P = 0.034) and adalimumab concentration at week 4 of ≥7 μg/mL (OR 3.56; 95% CI 1.17-10.79; P = 0.025). CONCLUSION Prior response to infliximab and high early adalimumab serum concentrations predict week 12 and year 1 responses to adalimumab in ulcerative colitis.
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Affiliation(s)
- F Baert
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
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16
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De Greef E, Mahachie John JM, Hoffman I, Smets F, Van Biervliet S, Scaillon M, Hauser B, Paquot I, Alliet P, Arts W, Dewit O, Peeters H, Baert F, D'Haens G, Rahier JF, Etienne I, Bauraind O, Van Gossum A, Vermeire S, Fontaine F, Muls V, Louis E, Van de Mierop F, Coche JC, Van Steen K, Veereman G. Profile of pediatric Crohn's disease in Belgium. J Crohns Colitis 2013; 7:e588-98. [PMID: 23664896 DOI: 10.1016/j.crohns.2013.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 08/24/2012] [Revised: 04/12/2013] [Accepted: 04/13/2013] [Indexed: 02/08/2023]
Abstract
AIM A Belgian registry for pediatric Crohn's disease, BELCRO, was created. This first report aims at describing disease presentation and phenotype and determining associations between variables at diagnosis and registration in the database. METHODS Through a collaborative network, children with previously established Crohn's disease and newly diagnosed children and adolescents (under 18 y of age) were recruited over a 2 year period. Data were collected by 23 centers and entered in a database. Statistical association tests analyzed relationships between variables of interest at diagnosis. RESULTS Two hundred fifty-five patients were included. Median age at diagnosis was 12.5 y (range: 1.6-18 y); median duration of symptoms prior to diagnosis was 3 m (range: 1-12 m). Neonatal history and previous medical history did not influence disease onset nor disease behavior. Fifty three % of these patients presented with a BMI z-score < -1. CRP was an independent predictor of disease severity. Steroids were widely used as initial treatment in moderate to severe and extensive disease. Over time, immunomodulators and biological were prescribed more frequently, reflecting a lower prescription rate for steroids and 5-ASA. A positive family history was the sole significant determinant for earlier use of immunosuppression. CONCLUSION In Belgium, the median age of children presenting with Crohn's disease is 12.5 y. Faltering growth, extensive disease and upper GI involvement are frequent. CRP is an independent predictive factor of disease activity. A positive family history appears to be the main determinant for initial treatment choice.
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Affiliation(s)
- E De Greef
- Pediatric Gastroenterology, Queen Paola Children's Hospital, Antwerp, Belgium; Pediatric Gastroenterology, UZB, Brussels, Belgium.
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17
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Dooremont D, Decaestecker J, De Wulf D, Ghillebert G, Van Vlierberghe H, Van Dorpe J, Baert F. Azathioprine induced serious portal hypertension: a case series of three IBD patients and review of the literature. Acta Gastroenterol Belg 2013; 76:342-346. [PMID: 24261031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report 3 male IBD patients (2 Crohn's Disease, 1 Ulcerative Colitis) developing thrombocytopenia and splenomegaly on azathioprine treatment. All patients were diagnosed with significant portal hypertension due to histological proven nodular regenerative hyperplasia (NRH) of the liver. In two of three patients, liver function tests remained completely normal. In addition we provide a short literature review of azathioprine induced NRH covering etiology, imaging, pathology, prognosis and treatment.
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Affiliation(s)
- D Dooremont
- Dept of Gastroenterology at H.-Hart ziekenhuis Roeselare-Menen VZW, Roeselare, Belgium.
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De Vos M, Dewit O, D'Haens G, Baert F, Fontaine F, Vermeire S, Franchimont D, Moreels T, Staessen D, Terriere L, Vander Cruyssen B, Louis E. Fast and sharp decrease in calprotectin predicts remission by infliximab in anti-TNF naïve patients with ulcerative colitis. J Crohns Colitis 2012; 6:557-62. [PMID: 22398050 DOI: 10.1016/j.crohns.2011.11.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 09/22/2011] [Accepted: 11/02/2011] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the effect of infliximab induction therapy on calprotectin levels in patients with ulcerative colitis (UC). PATIENTS AND METHODS In this prospective study 53 patients with active UC from 17 centers were treated with infliximab therapy (5 mg/kg) at baseline, week 2, and week 6. Faecal calprotectin was measured every week. Sigmoidoscopies were performed at baseline, week 6 and week 10. RESULTS Median calprotectin levels decreased from 1260 (IQR 278.5- 3418) at baseline to 72.5 (IQR 18.5 - 463) at week 10 (p<0.001). After 10 weeks, infliximab therapy induced endoscopic remission and a decrease in calprotectin to<50 mg/kg or at least a 80% decrease from baseline level in 58% of patients. A significant and steep decrease of calprotectin levels was seen at week 2 for patients with an endoscopic remission at week 10 as compared to patients who did not show a remission. (p<0.001). At week 10 an excellent correlation was found between endoscopic remission and clinical Mayo score reflected by an AUC of ROC analyses of 0.94 (0.87-1) and with calprotectin measurements (AUC 0.91 (0.81-1)) : all patients with calprotectin levels <50 mg/kg, and a normal clinical Mayo score (=0) were in endoscopic remission. CONCLUSIONS Infliximab induces a fast and significant decrease of faecal calprotectin levels in anti-TNF naïve patients with ulcerative colitis predictive for remission of disease.
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Affiliation(s)
- M De Vos
- Ghent University Hospital, Gent, Belgium.
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19
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Van Assche G, Baert F, Vermeire S. Commentary: BMI and the need for adalimumab dose escalation in Crohn's disease. Aliment Pharmacol Ther 2012; 35:848; discussion 849. [PMID: 22404407 DOI: 10.1111/j.1365-2036.2012.05023.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/08/2022]
Affiliation(s)
- G Van Assche
- Division of Gastroenterology, University Hospitals Leuven, Belgium.
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20
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Abstract
Collagenous and lymphocytic colitis are well-described conditions causing chronic watery diarrhoea. A peak incidence from 60 to 70 years of age with a female predominance mainly in collagenous colitis is observed. Both conditions are characterised by a (near) normal colonoscopy, but with specific histologic findings on colonic biopsies. Histopathologically, both conditions are characterised by distinct epithelial abnormalities and a dense lymphoplasmocytic infiltrate. Distinct features consist of a characteristic collagen band deposition in the subepithelial layer in collagenous colitis and a markedly increased number of intra-epithelial lymphocytes in lymphocytic colitis. Although most cases are idiopathic, certain drugs can induce microscopic colitis. In addition, either condition can be associated with coeliac disease. For a long time patients with microscopic colitis were treated with non-specific anti-diarrhoeal agents, anti-inflammatory agents such as mesalazine, or systemic steroids, but with disappointing results. Bismuth subsalicylate was reported to be effective in a small controlled series of patients with collagenous colitis. Now, randomised controlled trials have shown the effectiveness of budesonide over placebo in collagenous colitis and more recently in lymphocytic colitis. The histologic response is variable, but a decrease in the subepithelial collagen layer and a decrease in the lymphoplasmocytic infiltrate in the lamina propria is observed in about half of the patients. In general, patients respond within 2 weeks with no major side effects. However, relapse is common (63-80% of patients) when budesonide is stopped. Longer-term treatment is effective but does not seem to reduce relapse rates upon discontinuation.
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Affiliation(s)
- F Temmerman
- Department of Internal Medicine, Section of Gastroenterology, H. Hart Ziekenhuis Roeselare, Menen, Belgium
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21
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Abstract
Abrikossoff tumours or granular cell tumours are rare and usually benign tumours. The oesophagus is a rare location (0.001% of all tumours). The macroscopic appearance is typical (yellow, firm, well circumscribed submucosal neoplasm-like with reduced vascular patterns) but due to the rarity of this lesion, it can be mistaken with other similar lesions. This is the report of a case of a 47-year-old female with a granular cell tumour of the distal oesophagus. In this case, the Abrikossoff tumour is clinically, radiologically en histologically benign. According to the fact that there is low evidence in the literature for removing such Lesions in patient without symptoms, it was decided to be conservative. In this paper we discuss the case with review of the Literature with emphasis on the diagnosis, evaluation and management.
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Affiliation(s)
- F Marolleau
- Departement of Gastroenterology, Heilig Hart Ziekenhuis, Roeselare, Belgium.
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22
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Sánchez-Ruiz X, Alvarez-Larena A, Jaime C, Piniella JF, Redondo J, Virgili A, Sanchez-Ferrando F, Germain G, Baert F. Molecular and Crystal Structure of the 1:1 Complex of Adamantanone with β-Cyclodextrin. Supramol Chem 2008. [DOI: 10.1080/10610279908559288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/22/2022]
Affiliation(s)
| | - A. Alvarez-Larena
- b Departament de Geologia , Universitat Autònoma de Barcelona , 08193, Bellaterra, Spain
| | | | - J. F. Piniella
- b Departament de Geologia , Universitat Autònoma de Barcelona , 08193, Bellaterra, Spain
| | | | | | | | - G. Germain
- c Unité de Chimie Physique Moléculaire et de Cristallographie , Université de Louvain , B1348, Louvain la Neuve, Belgium
| | - F. Baert
- d Laboratoired de Physique Fondamentale , Bldg. P5 Université de Lille 159650, Villeneuve d'Asq, France
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23
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Eleftheriadis N, Lambrecht G, D'Haens G, Baert F, Cabooter M, Louis E, Assche GV, Schurmans P, Caenepeel P, Outryve MV, Lammens P, Gossum AV, De Vos M. Maintenance therapy for ulcerative colitis has no impact on changes in the extent of ulcerative colitis. J Crohns Colitis 2007; 1:21-7. [PMID: 21172180 DOI: 10.1016/j.crohns.2007.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 05/07/2007] [Accepted: 06/01/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Although the efficacy of maintenance remission therapy in ulcerative colitis (UC) has been proved in many studies, little is known about its possible effect on the extent of the disease. The aim of the present multicenter Belgian study was to evaluate the potential role of UC maintenance therapy on the colonic extension of the disease. MATERIALS AND METHODS A total of 98 patients, 56 males, 42 females, mean age 52 years, range 22-82 years, from 12 medical centers in Belgium, with an acute exacerbation of well-established, endoscopically and histologically proven left-sided UC, were included. The colonic extension was endoscopically determined at the time of the initial diagnosis and at the actual flare-up. The mean duration of UC was 93+72 months, median was 84 months, and range was 3-372 months. Active smoking was reported in only 7% of patients, while the majority were no-smokers (63%) or ex-smokers (30%). The median colonic extension at the time of initial diagnosis was 25 cm, range 2-70 cm from the anal merge. Sixty-six percent of the patients had quiescent disease without flare-ups during last year. The χ(2)-test was used for statistical analysis. RESULTS 29/98 (29.6%) patients had not used any maintenance therapy in the last 3 months before the actual exacerbation. The most commonly used maintenance therapy was 5-ASA (43%), while combined therapy with 5-ASA, corticosteroids or immunosuppresives (mainly azathioprine) in all possible combinations was reported by 29.6% of patients. The extent of UC had not changed in 50.7% and 51.7% of patients, respectively, with and without maintaining therapy (NS, p=0.99). Some degree of regression was observed in, respectively, 21.7% and 20.7% (NS, p=0.99), and some degree of extension in, respectively, 27.5% and 27.6% (NS, p=0.99). Furthermore, no relationship was found between changes in colonic extent and type of maintaining therapy, smoking habits or disease activity during the last year before the acute exacerbation. A tendency of beneficial effect of maintenance therapy on disease extent was observed in patients with continuous active disease of short duration. CONCLUSIONS According to this multicenter study, maintenance remission therapy for left-sided UC was not found to have a statistically significant effect on colonic extension. Further long-term studies are necessary to confirm these results.
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Affiliation(s)
- N Eleftheriadis
- Department of Gastroenterology, Ghent University Hospital (UZ Gent), De Pintelaan 185 9000 Gent, Belgium
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24
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D'Haens G, Hommes D, Engels L, Baert F, van der Waaij L, Connor P, Ramage J, Dewit O, Palmen M, Stephenson D, Joseph R. Once daily MMX mesalazine for the treatment of mild-to-moderate ulcerative colitis: a phase II, dose-ranging study. Aliment Pharmacol Ther 2006; 24:1087-97. [PMID: 16984503 DOI: 10.1111/j.1365-2036.2006.03082.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND SPD476 (MMX mesalazine), is a novel, once daily, high-strength mesalazine formulation (1.2 g/tablet) that utilizes Multi Matrix System (MMX) technology to delay and extend delivery of the active drug throughout the colon. AIM To assess the safety and efficacy of MMX mesalazine in patients with mild-to-moderately active ulcerative colitis, in a pilot, phase II, randomized, multicentre, double-blind, parallel-group, dose-ranging study (SPD476-202). METHODS Thirty-eight patients with mild-to-moderately active ulcerative colitis were randomized to MMX mesalazine 1.2, 2.4 or 4.8 g/day given once daily for 8 weeks. Remission ulcerative colitis-disease activity index (UC-DAI) < or =1, a score of 0 for rectal bleeding and stool frequency, and > or =1 -point reduction in sigmoidoscopy score from baseline was the primary end point. RESULTS Week 8 remission rates were 0%, 31% and 18% of patients receiving MMX mesalazine 1.2, 2.4 and 4.8 g/day respectively. No statistically significant difference in remission was observed between treatment groups. MMX mesalazine 2.4 and 4.8 g/day groups demonstrated greater improvement in overall UC-DAI and component scores from baseline, compared with the 1.2 g/day group. CONCLUSION MMX mesalazine given as 2.4 or 4.8 g/day once daily is well tolerated and effective for the treatment of mild-to-moderately active ulcerative colitis.
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Affiliation(s)
- G D'Haens
- Department of Gastroenterology, Imelda General Hospital, Imelda GI Clinical Research Center, Imeldalaan, Bonheiden, Belgium.
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25
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Sellier C, Bodart JF, Flament S, Baert F, Gannon J, Vilain JP. Intracellular acidification delays hormonal G2/M transition and inhibits G2/M transition triggered by thiophosphorylated MAPK in Xenopus oocytes. J Cell Biochem 2006; 98:287-300. [PMID: 16408274 DOI: 10.1002/jcb.20764] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Xenopus oocyte maturation is analogous to G2/M transition and characterized by germinal vesicle breakdown (GVBD), spindle formation, activation of MPF and Mos-Xp42(Mpk1) pathways. It is accompanied prior to GVBD by a transient increase in intracellular pH. We determined that a well known acidifying compound, NH(4)Cl, delayed progesterone-induced GVBD in a dose-dependent manner. GVBD(50) was delayed up to 2.3-fold by 10 mM NH(4)Cl. Cyclin B2 phosphorylation, Cdk1 Tyr15 dephosphorylation as well as p39(Mos) accumulation, Xp42(Mpk1) and p90(Rsk) phosphorylation induced by progesterone were also delayed by incubation of oocyte in NH(4)Cl. The delay induced by NH(4)Cl was prevented by injection of MOPS buffer pH 7.7. In contrast to acidifying medium, alkalyzing treatment such as Tris buffer pH 9 injections, accelerated GVBD, MPF and Xp42(Mpk1) activation, indicating that pHi changes control early steps of G2/M dynamics. When injected in an immature recipient oocyte, egg cytoplasm triggers GVBD through MPF auto-amplification, independently of protein synthesis. In these conditions, GVBD and Xp42(Mpk1) activation were delayed by high concentration of NH(4)Cl, which never prevented or delayed MPF activation. Strickingly, NH(4)Cl strongly inhibited thiophosphorylated active MAPK-induced GVBD and MPF activation. Nevertheless, Tris pH 9 did not have any effects on egg cytoplasm- or active MAPK-induced GVBD. Taken together, our results suggest that dynamic of early events driving Xp42(Mpk1) and MPF activation induced by progesterone may be negatively or positively regulated by pH(i) changes. However Xp42(Mpk1) pathway was inhibited by acidification alone. Finally, MPF auto-amplification loop was not sensitive to pH(i) changes.
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Affiliation(s)
- C Sellier
- Laboratoire de Biologie du Développement, EA 1033, IFR 118, Université des Sciences et Technologies de Lille, SN3, Villeneuve d'Ascq, France
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Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, Hommes DW, Lochs H, Angelucci E, Cocco A, Vucelic B, Hildebrand H, Kolacek S, Riis L, Lukas M, de Franchis R, Hamilton M, Jantschek G, Michetti P, O'Morain C, Anwar MM, Freitas JL, Mouzas IA, Baert F, Mitchell R, Hawkey CJ. European evidence based consensus on the diagnosis and management of Crohn's disease: special situations. Gut 2006; 55 Suppl 1:i36-58. [PMID: 16481630 PMCID: PMC1859996 DOI: 10.1136/gut.2005.081950c] [Citation(s) in RCA: 328] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on definitions and diagnosis reports on the aims and methods of the consensus, as well as sections on diagnosis, pathology, and classification of Crohn's disease. The second section on current management addresses treatment of active disease, maintenance of medically induced remission, and surgery of Crohn's disease.
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Affiliation(s)
- R Caprilli
- John Radcliffe Hospital, Oxford OX3 9DU, UK
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27
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Gryspeerdt S, Lefere P, Herman M, Deman R, Rutgeerts L, Ghillebert G, Baert F, Baekelandt M, Van Holsbeeck B. CT colonography with fecal tagging after incomplete colonoscopy. Eur Radiol 2005; 15:1192-202. [PMID: 15702335 DOI: 10.1007/s00330-005-2644-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Revised: 12/27/2004] [Accepted: 12/30/2004] [Indexed: 01/31/2023]
Abstract
The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann-Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.
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Affiliation(s)
- S Gryspeerdt
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium.
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Abstract
The conventional medical treatment of IBD consists of aminosalicylates, corticosteroids, immunosuppressive drugs (azathioprine, 6-mercaptopurin, methotrexate, cyclosporin) and antibiotics. The only drugs able to modify the disease course are azathioprine, its metabolite 6-mercaptopurin and methotrexate. However, these drugs have a slow onset of action and are associated with important side-effects in some patients, necessitating the discontinuation of the drug. Moreover, up to 60% of patients do not respond to these drugs long-term. Fortunately, the management of IBD has entered a new era in the beginning of the 1990s with the development of new biological therapies, selectively blocking the inflammatory cascade. The novel molecules have arisen from the increasing knowledge about the disease pathogenesis and their production has been precipitated by the techniques of molecular biology. Infliximab, the first available biological for Crohn's disease has certainly revolutionised standard treatment. Because of its profound clinical, endoscopic and histological effects, the standard step up approach in the treatment of IBD has been challenged. A large array of new rationally designed biologicals, with a better safety profile and equally selectively acting is underway, and is likely to change our current practise even more dramatically in the next decade.
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Affiliation(s)
- F Baert
- Department of Gastroenterology, at the University Hospital Gasthuisberg, Leuven, Belgium
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Peeters M, Van Laethem JL, Baert F, Canon JL, De Grève J, Kalantari H, Dhont P, Van Cutsem E. Phase II study of irinotecan + 5FU/FA for patients with previously treated advanced gastric cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Peeters
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
| | - J. L. Van Laethem
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
| | - F. Baert
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
| | - J. L. Canon
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
| | - J. De Grève
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
| | - H. Kalantari
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
| | - P. Dhont
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
| | - E. Van Cutsem
- Ghent University Hospital, Ghent, Belgium; Erasme University Hospital, Brussels, Belgium; H.Hart Hospital, Roeselare, Belgium; Clinique Notre Dame, Charleroi, Belgium; Academisch Ziekenhuis Brussels University, Ghent, Belgium; Centre Hospitalier Peltzer La Tourelle, Verviers, Belgium; Aventis Pharma, Brussels, Belgium; University Hospital Gasthuisberg, Leuven, Belgium
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Polus M, Peeters M, Baert F, Vergauwe P, Kalantari H, Hendrickx K, Collignon J, Van Maele P, Vandeputte L, Van Laethem JL. CPT-11 and mitomycin-C in heavily pre-treated patients with metastatic colorectal cancer: A Belgian multicentre phase II study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Polus
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - M. Peeters
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - F. Baert
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - P. Vergauwe
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - H. Kalantari
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - K. Hendrickx
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - J. Collignon
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - P. Van Maele
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - L. Vandeputte
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
| | - J. L. Van Laethem
- Sart Tilman University Hospital, Liege, Belgium; University Hospital, Ghent, Belgium; Heilig Hartziekenhuis, Roeselare, Belgium; AZ Groeninge, Kortrijk, Belgium; CHPT, Verviers, Belgium; OLVZ, Aalst, Belgium; CHR, Huy, Belgium; Clin. Saint-Jean, Brussels, Belgium; Sint Josefs Kliniek, Izegem, Belgium; Erasme University Hospital, Brussels, Belgium
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31
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Baert F, Guelzim A, Poblet JM, Wiest R, Demuynck J, Benard M. Dynamic, static, and theoretical electron deformation density for binuclear transition-metal complexes: dicobalt hexacarbonyl acetylene. Inorg Chem 2002. [DOI: 10.1021/ic00231a024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lemahieu WP, Verbanck J, Baert F, Rutgeerts L, Ghillebert G, Deman R, Tanghe W. Postmenopausal bleeding and nipple congestion heralding ovarian metastases of a primary colonic adenocarcinoma. Am J Gastroenterol 2000; 95:3336-7. [PMID: 11095388 DOI: 10.1111/j.1572-0241.2000.03333.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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34
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Van Laethem JL, Baert F, Buset M, de Hemptine B, De Ronde T, Honoré P, Lerut T, Scaillet P, Van Cutsem E. Curative management of adenocarcinoma of the oesophagus and oesogastric junction--current recommendations of the Belgian Working Group. Acta Gastroenterol Belg 2000; 63:304-6. [PMID: 11189997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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35
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Craninx M, D'Haens G, Cokelaere K, Baert F, Penninckx F, D'Hoore A, Ectors N, Rutgeerts P, Geboes K. Crohn's disease and intestinal endometriosis: an intriguing co-existence. Eur J Gastroenterol Hepatol 2000; 12:217-21. [PMID: 10741938 DOI: 10.1097/00042737-200012020-00014] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We present a series of eight female patients who came to surgery for complicated Crohn's disease of the terminal ileum (n = 7) or colon (n = 1). Indications for surgery were medically intractable disease in three, steroid dependence in four and ileal perforation in one. RESULTS Histological examination using routine haematoxylin-eosin stained sections revealed the presence of intestinal endometriosis of the ileum (n = 6), colon (n = 1) or ileum and rectum (n = 1) in addition to the typical features of Crohn's disease. In particular, chronic transmural inflammation was observed in locations other than the endometriotic deposits, which were confined to the serosa in three, the muscularis propria in two, both the serosa and the muscularis propria in one and the serosa, muscularis propria and submucosa in two. In none of these patients had the diagnosis of intestinal endometriosis been suspected pre-operatively based on clinical (gynaecological) or radiological tests. CONCLUSION Intestinal endometriosis and Crohn's disease can occur simultaneously. The diagnosis is often only made after surgical resection of the diseased segment. In Crohn's disease, endometriosis of the terminal ileum seems more common.
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Affiliation(s)
- M Craninx
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
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36
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Abstract
The incidence and prevalence of IBD increase in our Western populations. Standard therapy with glucocorticosteroids and 5-ASA formulations allow control in only about half of the patients with substantial toxicity for the former drug. Since it became apparent that both UC and Crohn's disease are disorders mediated through abnormalities in the mucosal immune system immunosuppression and immunomodulation have become current practice in the treatment of refractory IBD. In UC cyclosporin is the main immunosuppressive agent. In Crohn's disease azathioprine is the mainstay of therapy for refractory disease. Recently anti-TNF strategies have been developed which hold great promise for the treatment of Crohn's disease.
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Affiliation(s)
- P Rutgeerts
- Department of Medicine, University Hospital, Leuven, Belgium
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Baert F, Wouters K, D'Haens G, Hoang P, Naegels S, D'Heygere F, Holvoet J, Louis E, Devos M, Geboes K. Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis. Gut 1999; 45:375-81. [PMID: 10446105 PMCID: PMC1727642 DOI: 10.1136/gut.45.3.375] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS It is not known whether lymphocytic colitis and collagenous colitis represent different clinical entities or constitute part of a spectrum of disease. METHODS Detailed clinical features and histological findings were compared in a large series of patients with confirmed lymphocytic and collagenous colitis. RESULTS Histological diagnosis was confirmed in 96 patients with collagenous colitis and 80 with lymphocytic colitis. Twenty eight per cent of patients with collagenous colitis and 26% of patients with lymphocytic colitis had overlapping but less pronounced histological features. Both groups were equal in terms of age, use of aspirin and non-steroidal anti-inflammatory drugs, associated autoimmune conditions, arthritis, diarrhoea, and abdominal pain. The male:female ratio was 27:73 for collagenous colitis and 45:55 for lymphocytic colitis (p=0.013). Twenty five per cent of patients with collagenous colitis compared with 14% of patients with lymphocytic colitis were active smokers; only 8.3% of patients with collagenous colitis had stopped smoking compared with 23% of patients with lymphocytic colitis (p=0.013). Drug induced disease was suspected for ticlopidine (two collagenous colitis, four lymphocytic colitis) and flutamide (four lymphocytic colitis). Mean duration of symptoms before diagnosis was two months for lymphocytic colitis and four months for collagenous colitis. Overall prognosis was generally mild; 84% of patients with lymphocytic colitis and 74% of patients with collagenous colitis reported resolution or significant improvement (p=0.033). CONCLUSIONS Collagenous and lymphocytic colitis are similar but not identical. Patients with lymphocytic colitis present somewhat earlier and are less likely to be active smokers. Symptoms are milder and more likely to disappear in lymphocytic colitis. Ticlopidine and flutamide should be added to the list of drugs inducing colitis.
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Affiliation(s)
- F Baert
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
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Belaiche J, Louis E, D'Haens G, Cabooter M, Naegels S, De Vos M, Fontaine F, Schurmans P, Baert F, De Reuck M, Fiasse R, Holvoet J, Schmit A, Van Outryve M. Acute lower gastrointestinal bleeding in Crohn's disease: characteristics of a unique series of 34 patients. Belgian IBD Research Group. Am J Gastroenterol 1999; 94:2177-81. [PMID: 10445546 DOI: 10.1111/j.1572-0241.1999.01291.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease, which represents a diagnostic and therapeutic challenge. The aim of this study was to define epidemiological characteristics and therapeutic options of hemorrhagic forms of Crohn's disease. METHODS Thirty-four cases of hemorrhagic forms of Crohn's disease were studied retrospectively. Acute lower gastrointestinal hemorrhage was defined as acute rectal bleeding originating in diseased bowel and requiring a transfusion of at least 2 units of red blood cells within 24 h. Upper gastrointestinal tract hemorrhage or anal lesions and postoperative bleeding were excluded. RESULTS Mean age at time of hemorrhage was 34.2 +/- 14 yr. Mean duration of disease before the hemorrhage was 5.6 +/- 6 yr. The hemorrhage occurred during a flare up of the disease in 35% of cases. The hemorrhage revealed Crohn's disease in 23.5% of cases. The hemorrhage was more frequent in colonic disease (85%) than in isolated small bowel disease (15%) (p < 0.0001). The origin of bleeding was identified in 65% of cases, by colonoscopy (60%), by angiography (3 patients), or at surgery (1 patient). The bleeding lesion was an ulcer in 95% of cases, most often in the left colon. The treatment was surgical in 20.5% (colectomy in 36%), endoscopical (7 patients, including 5 successes), or medical. Hemorrhage recurred in 12 patients (35%) within a mean time of 3 yr (4 days-8 yr), requiring surgery in 3 cases. No death was observed. CONCLUSIONS This study performed in a series characterized by a nonsurgical recruitment, the largest to date, shows that hemorrhagic forms of Crohn's disease may reveal disease in 23.5%, occurs in quiescent Crohn's disease in two-thirds of cases. Given the potential efficacy of endoscopical or medical treatment, as well as the absence of mortality, a conservative approach may be suggested as first-line therapy in the majority of patients.
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Affiliation(s)
- J Belaiche
- Department of Gastroenterology CHU Sart Tilman, Liège, Belgium
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D'haens G, Van Deventer S, Van Hogezand R, Chalmers D, Kothe C, Baert F, Braakman T, Schaible T, Geboes K, Rutgeerts P. Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn's disease: A European multicenter trial. Gastroenterology 1999; 116:1029-34. [PMID: 10220494 DOI: 10.1016/s0016-5085(99)70005-3] [Citation(s) in RCA: 496] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Tumor necrosis factor (TNF) is a pivotal cytokine in intestinal inflammation. Controlled trials using a chimeric anti-TNF antibody (infliximab) have shown its efficacy in refractory Crohn's disease. METHODS Endoscopic and histological response to infliximab was investigated in a multicenter, randomized, double-blind, and placebo-controlled trial including 30 patients with active Crohn's disease undergoing ileocolonoscopy before and 4 weeks after intravenous administration of 5, 10, or 20 mg/kg of infliximab or placebo as a single infusion. Lesions were scored by means of the validated Crohn's Disease Endoscopic Index of Severity (CDEIS). Endoscopic biopsy specimens were taken during both procedures from 9 of 30 patients and scored by a single gastrointestinal pathologist. RESULTS CDEIS scores decreased significantly in most infliximab-treated patients without an apparent dose response. No endoscopic improvement was observed in the placebo group. The changes in CDEIS correlated highly with those of the Crohn's Disease Activity Index. At a histological level, disappearance of the inflammatory infiltrate was observed in infliximab-treated patients but not in placebo-treated ones; however, architectural changes persisted in most patients. Strictures developed in several patients. CONCLUSIONS Clinical improvement after infliximab therapy in active Crohn's disease is accompanied by significant healing of endoscopic lesions and disappearance of the mucosal inflammatory infiltrate.
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Affiliation(s)
- G D'haens
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
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Abstract
BACKGROUND Recent trials suggested that methotrexate may be effective in refractory Crohn's disease (CD). We analyzed the data of 20 patients treated with methotrexate because of corticodependent or refractory CD. METHODS Between January 1995 and June 1997, 20 azathioprine-resistant or -intolerant patients with active CD requiring continuous glucocorticosteroid treatment were treated with parenteral methotrexate. Clinical response was assessed by the Harvey-Bradshaw clinical activity index. Concomitant steroid use and steroid withdrawal rates were recorded. Patients were assessed at 12 weeks, 6 months, 9 months, and 12 months after the start of methotrexate therapy. RESULTS At 12 weeks, a clinical response was obtained in 14/20 patients (70%). These response rates decreased to 10/20 patients at 6 months, 8/17 patients at 9 months, and 4/14 evaluable patients at 12 months. In initial responders (n = 14), maintenance of remission was observed in 9/14, 6/11, and 3/9 patients at 6, 9, and 12 months, respectively. Methotrexate allowed corticosteroid tapering in 85% of patients and discontinuation in 60% of patients at 6 months. Side effects were rather frequent but usually mild and prompted discontinuation in two patients. CONCLUSIONS In this retrospective study, parenteral methotrexate appeared to be effective in inducing a clinical response in 70% of azathioprine-resistant or -intolerant CD patients and often permitted corticosteroid tapering, with an acceptable short-term toxicity. The potential of methotrexate to maintain long-term remission in refractory patients, however, appears less convincing.
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Affiliation(s)
- L Vandeputte
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
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Sánchez-ruiz X, Alvarez-Larena A, Jaime C, Piniella JF, Redondo J, Virgili A, Sánchez-ferrando F, Germain G, Baert F. Molecular and Crystal Structure of the 1:1 Complex of Adamantanone with β-Cyclodextrin. Supramol Chem 1999. [DOI: 10.1080/10610279908048709] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- P Rutgeerts
- Department of Medicine, University Hospital, Leuven, Belgium
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Verbanck J, Ghillebert G, Rutgeerts L, Baert F, Goethals C, Schepkens H, Geldhof K, Surmont I. Ultrasound-guided puncture of the gallbladder for acute cholecystitis. Acta Gastroenterol Belg 1998; 61:151-2. [PMID: 9658597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We performed a US-guided aspiration of the gallbladder in 27 patients with an acute cholecystitis and severe concurrent disease, not responding to IV antibiotics and supportive therapy. Twenty six of the 27 patients improved after the procedure. One patient died 7 days after the procedure due to multi organ failure; in the others immediate surgery could be avoided. Three patients experienced local pain after the procedure; no other puncture related complications were encountered. Long-term results (mean follow up 18 months; range 2-36 months) were excellent in 20/26 survivors with no biliary complications or need for elective cholecystectomy. Six of the 26 patients needed subsequent cholecystectomy for relapse or incomplete cure.
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Affiliation(s)
- J Verbanck
- Department of Internal Medicine, H. Hartziekenhuis, Roeselare
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Abstract
While 5-ASA and corticosteroids are still the mainstay of treatment, more potent immunosuppressive agents should be considered in refractory and steroid dependant patients not amenable to surgery. The activity and side effect profile of 6-MP/azathioprine, methotrexate and cyclosporine are now well established. Other agents such as mycophenolaat-mophetil, FK 506 and combination therapies may provide additional benefits in the future. Advances in the field of mucosal immunology have prompted interest in more specific immunologic approaches. Recombinant genetic engineering techniques enable us to test cytokines, anti cytokines, anti adhesion molecules etc. some of which with very promising clinical results. More data on long term safety and specific indications should be awaited before broader use of these agents can be advocated. An updated review is given from the current immunological based treatment modalities for both Crohn's disease and ulcerative colitis.
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Affiliation(s)
- F Baert
- Department of Intemal Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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D'Haens GR, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P. Early lesions of recurrent Crohn's disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 1998; 114:262-7. [PMID: 9453485 DOI: 10.1016/s0016-5085(98)70476-7] [Citation(s) in RCA: 578] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Postoperative recurrence of Crohn's disease may be triggered by agents in the fecal stream. The aim of this study was to examine intestinal mucosal inflammation induced by contact with intestinal fluids in surgically excluded ileum. METHODS The effects of infusion of intestinal luminal contents into excluded ileum in 3 patients with Crohn's disease who had undergone a curative ileocolonic resection with ileocolonic anastomosis and temporary protective proximal loop ileostomy were studied by histopathology and electron microscopy. RESULTS Contact with intestinal fluids for 8 days induced focal infiltration of mononuclear cells, eosinophils, and polymorphonuclear cells in the lamina propria, small vessels, and epithelium in the excluded neoterminal ileum that was previously normal. Epithelial HLA-DR expression increased, and mononuclear cells expressed the KP-1 antigen associated with activation. Marked up-regulation of RFD-7, RFD-9, intercellular adhesion molecule 1, and lymphocyte function-associated antigen 1 was observed after infusion, reflecting epithelioid transformation and transendothelial lymphocyte recruitment. At the ultrastructural level, dilatation of the endoplasmic reticulum and Golgi apparatus occurred in epithelial cells, where also basally located transport vesicles were identified. CONCLUSIONS Intestinal contents trigger postoperative recurrence of Crohn's disease in the terminal ileum proximal to the ileocolonic anastomosis in the first days after surgery.
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Affiliation(s)
- G R D'Haens
- Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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Guelzim A, Khrifi S, Baert F, Saadioui M, Asfari Z, Vicens J. 1,3-Di(ethoxy-ethoxy-methoxy)calix[4]arene. Acta Crystallogr C 1997. [DOI: 10.1107/s0108270197007105] [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: 11/10/2022] Open
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Peeters M, Geypens B, Claus D, Nevens H, Ghoos Y, Verbeke G, Baert F, Vermeire S, Vlietinck R, Rutgeerts P. Clustering of increased small intestinal permeability in families with Crohn's disease. Gastroenterology 1997; 113:802-7. [PMID: 9287971 DOI: 10.1016/s0016-5085(97)70174-4] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Small intestinal permeability is increased in a proportion of patients with Crohn's disease (CD) and a subset of their healthy relatives. A primary permeability defect was postulated in the pathogenesis of the disease. The aim of this study was to identify a possible genetic pattern in the distribution of CD and/or abnormal permeability. METHODS Differential urinary excretion of lactulose and mannitol (L/ M) in complete CD families was determined. Controls included healthy families and families with ulcerative colitis. Pedigrees were used to compare the distribution of CD and/or increased permeability. RESULTS The L/M was significantly increased in patients with CD. Seventeen of 67 first-degree relatives (25%) had a ratio greater than the upper limit (P95 = 0.0170). Permeability results of CD families showed a highly significant familial aggregation. The lack of a genetic pattern in relation with CD and occurrence of disturbed permeability especially within generation, points toward a shared environmental factor. Five of 14 healthy spouses (36%) of patients with CD had also an increased permeability, and prevalence of increased permeability was not higher in families with known familial occurrence (P = 0.85). CONCLUSIONS This large family study confirms an increased permeability in a subset of healthy relatives of patients with CD. However, the absence of a typical family pattern and the high prevalence in spouses is in favor of a common nongenetic factor or a subclinical disease manifestation.
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Affiliation(s)
- M Peeters
- Center for Gastrointestinal Research, Leuven, Belgium
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D'Haens G, Geboes K, Peeters M, Baert F, Ectors N, Rutgeerts P. Patchy cecal inflammation associated with distal ulcerative colitis: a prospective endoscopic study. Am J Gastroenterol 1997; 92:1275-9. [PMID: 9260788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It is generally believed that the mucosal inflammation in ulcerative colitis is characterized by a diffuse, continuous involvement starting from the rectum without "skip areas." It was the aim of this study to examine 20 patients with established "left-sided ulcerative colitis" prospectively by ileocolonoscopy with biopsies to determine the extent and the continuity of the mucosal inflammation and the incidence of skip lesions in ulcerative colitis. METHODS Twenty patients with left-sided ulcerative colitis underwent a complete ileocolonoscopy with biopsies of the terminal ileum and all colonic segments. The patients remained in clinical follow-up for at least 8 yr after the initial examination. RESULTS The upper margin of inflammation was sharply demarcated in 6 patients and gradual in 14. Segmental inflammation, separated from the distal inflamed segment by apparently uninvolved mucosa, was found in 15 patients (75%) and always included the area around the appendiceal orifice. The correlation between endoscopic abnormalities and histological changes was excellent. CONCLUSION In so-called "left-sided" ulcerative colitis distal involvement may be accompanied by more proximal areas of inflammation, particularly in the periappendiceal area of the cecum.
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Affiliation(s)
- G D'Haens
- Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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Peeters M, Nevens H, Baert F, Hiele M, de Meyer AM, Vlietinck R, Rutgeerts P. Familial aggregation in Crohn's disease: increased age-adjusted risk and concordance in clinical characteristics. Gastroenterology 1996; 111:597-603. [PMID: 8780562 DOI: 10.1053/gast.1996.v111.pm8780562] [Citation(s) in RCA: 202] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND & AIMS Because the mode of Crohn's disease inheritance is unknown, age-adjusted risk estimates and knowledge of disease characteristics will aid genetic counseling and modeling. The aim of this study is to determine the prevalence of familial occurrence of inflammatory bowel disease in first-degree relatives of patients with Crohn's disease and estimate their age-adjusted risks. It also evaluates agreement in disease characteristics between generations within families with a history of Crohn's disease. METHODS Six hundred forty patients with Crohn's disease and 800 control subjects were questioned about the occurrence of inflammatory bowel disease in their first-degree relatives. Agreement for age at diagnosis, initial disease location, disease behavior, and number of bowel resections was determined in 68 families with two or more members affected and compared with data in 100 unrelated patients with Crohn's disease. RESULTS Probands with Crohn's disease had a more frequent positive family history than controls. The age at diagnosis between probands with and without a positive family history was insignificant. Crude and age-adjusted risk elements were higher in relatives of patients, especially daughters, compared with those of controls. The age at diagnosis was older for parents than offspring but similar between siblings. Initial disease location was especially striking between siblings. CONCLUSIONS This study confirms familial aggregation and a high degree of disease concordance in Crohn's disease. The age at diagnosis and initial disease location was especially strong within generations.
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Affiliation(s)
- M Peeters
- Center for Gastrointestinal Research, University of Leuven, Belgium
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Fkyerat A, Guelzim A, Baert F, Zyss J, Périgaud A. Assessment of the polarizabilities ( alpha, beta ) of a nonlinear optical compound. Phys Rev B Condens Matter 1996; 53:16236-16246. [PMID: 9983457 DOI: 10.1103/physrevb.53.16236] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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