摘要： Introduction Patients with inflammatory bowel disease (IBD) may be at higher risk of colorectal cancer (CRC), but it is unclear whether they have worse surgical and oncological outcomes compared with patients with sporadic colorectal cancer (SCRC). The aim of this paper is to determine whether there are differences in surgical and oncological outcomes following treatment for IBD-CRC and SCRC. Methods A tertiary referral hospital ' s cancer database from 2004 to 2014 was retrospectively reviewed. Patient records as well as electronic radiological, pathological and administrative sources were used to collect data on patient demographics, tumour characteristics, surgical treatment, cancer recurrence and survival. Survival analyses (Kaplan Meier and Cox regression) were carried out to compare disease free and overall survival between IBD-CRC and SCRC patient groups. Results A total of 1911 patients underwent surgery for CRC over the study period. Of these, 81 patients (4.2%) had a diagnosis of IBD. There was a significant difference in terms of patient demographics and surgical outcomes between the two groups. Colorectal cancer patients with IBD were younger at time of diagnosis (median age IBD-CRC 57 years, median age SCRC 69 years, P < .001), were more likely to have an open procedure (P < .001), had a higher rate of stoma formation (P < .001) and had a longer length of hospital stay (P = <.001). Patients with IBD-CRC more frequently exhibited poorly differentiated tumours (30.9% compared with 10.0%, P < .001). South Asian patients had a higher rate of IBD-CRC than SCRC (33.3% compared with 17.4%, P = .015). At the end of follow up 69.2% (n = 1266/1830) of sporadic and 81.5% (n = 66/81) patients were alive. In this institutional case series, IBD was not demonstrated to be an independent predictor of disease free survival (HR 0.67, CI 0.33-1.36, P = .267) or overall survival (HR 0.78, 95% CI 0.46-1.30, P = .335). Conclusion Patient and tumour characteristic differences

关键词： Crohn's disease   Digestive signs and symptoms  

摘要： Objectives Extraintestinal manifestations (EIM) are common complications of inflammatory bowel disease (IBD) associated with morbidity and reduced quality of life (QOL). The aim of this study was to identify and validate predictors for EIM in children with IBD. Methods The medical records of children with IBD were retrospectively reviewed, and EIM present before diagnosis and those detected during follow-up, were recorded. Results One-hundred children were included, and their median age (interquartile range) was 13.9 (11.9-15.2) years. Forty-six (46%) children had EIM, including 10 (10%) whose EIM was present before diagnosis and 36 (36%) during follow-up. The most common EIMs were aphthous stomatitis (18%), arthralgia (14%), dermatologic manifestations (8%), and arthritis (6%). A body mass index in the lower or upper quartile (hazard ratio [HR] 9.30 and 23.71, respectively, p < 0.001), moderate-to-severe disease activity (HR 4.43, p < 0.001), extensive Crohn's disease (HR 3.43, p = 0.025), lower hemoglobin level (HR 2.29, p < 0.001), lower albumin level (HR 2.86, p = 0.029), and higher C-reactive protein level (HR 1.04, p < 0.001) at diagnosis were identified as risk factors for EIM during follow-up. Conclusions Identification of risk factors at IBD diagnosis may help healthcare providers to predict EIM in children with IBD and to improve their management for lessening morbidity and enhancing QOL.

关键词： Crohn's Disease   Ulcerative Colitis   Deescalation   Withdrawal   Cessation   Treatment Discontinuation  

摘要： De-escalation of immunomodulators and biologic agents in inflammatory bowel disease is frequently discussed with patients and must weigh the risk of continued medical therapy with the risk of disease recurrence. Risk factors for disease flare after withdrawal of inflammatory bowel disease medications such as disease activity at de-escalation, disease prognostic features, and prior course of disease have been identified predominately in retrospective studies, allowing for risk stratification of patients. This review evaluates the published literature regarding therapeutic de-escalation and provides a framework for physicians to apply this to clinical practice. Prospective trials are underway and planned, which should provide further insight into this treatment paradigm and better inform patient selection for this strategy.

关键词： Crohn's disease   Ulcerative colitis   IBD   PD4   Smad7   Apremilast   Mongersen  

摘要： In the last decades, the better understanding of inflammatory bowel diseases (IBD) pathogenesis has contributed to the identification of new therapeutic targets that can be modulated to induce and maintain disease remission. Monoclonal antibodies against tumor necrosis factor, interleukin (IL)-12/IL-23p40, and the integrin alpha 457 and inhibitors of Janus kinase molecules are valid compounds to limit the function of molecules implicated in the control of IBD-related inflammation. However, not all patients respond to treatment with such drugs, some of them lose response over time and others develop serious side effects, such as infections or malignancies, which lead to the discontinuation of the therapy. Thus, an intensive research is ongoing with the goal to identify new targets and develop novel therapeutic options. In this context, restoration of TGF-beta activity and inhibition of phosphodiesterase 4 (PD4) represent two relevant strategies. TGF-beta is an immunesuppressive cytokine, whose activity is severely impaired in IBD due to the abundance of the intracellular inhibitor Smad7. Knockdown of Smad7 with a specific antisense oligonucleotide restores TGF-beta signalling and dampens effector immune responses in pre-clinical studies and initial clinical trials in Crohn's disease patients, even though a recent phase 3 trial was discontinued due to an apparent inefficacy. PD4 inhibition determines the increase of intracellular levels of cyclic adenosine monophosphate, a mechanism that decreases pro-inflammatory cytokine production. A recent phase 2 study has shown that oral administration of PD4 associates with clinical benefit in patients with ulcerative colitis. In this article, we review the rationale and the available data relative to the use of these two agents in IBD.

关键词： Inflammatory bowel disease   Biologics   Persistence   Switching  

摘要： Background Data on real-life patterns of biologic use for inflammatory bowel disease (IBD) are scarce. Aims We aimed to examine the patterns of biologic use and the factors associated with non-persistence and switching of biologics in Korean IBD patients. Methods Using National Health Insurance claims, we collected data on patients who were diagnosed with IBD and exposed to biologics between 2010 and 2016. Results Among 1838 patients with Crohn's disease (CD), 1237 and 601 started with infliximab and adalimumab, respectively. Among 1125 patients with ulcerative colitis (UC), 774, 294, and 57 initiated infliximab, adalimumab, and golimumab, respectively. Rates of non-persistence and switching were higher in UC than in CD. One- and 3-year non-persistence rates were 14.2% and 26.5% in CD and 35.4% and 53.4% in UC, respectively. One- and 3-year switching rates were 3.7% and 10.1% in CD and 15.6% and 22.0% in UC, respectively. In both CD and UC, infliximab and adalimumab initiators showed similar persistence rates, whereas adalimumab initiators had a higher risk of switching than infliximab initiators. In UC, golimumab initiators had a higher risk of non-persistence and switching than infliximab initiators. Steroid use at biologic initiation was associated with an increased risk of non-persistence and switching in both CD and UC. UC patients who started biologic treatment at tertiary hospitals were more likely to continue treatment than those who started at general hospitals/community hospitals/clinics. Conclusions In real-world clinical practice settings, discontinuation of biologics occurred frequently in IBD patients, and switching of biologics was common in UC patients.

关键词： Inflammatory bowel disease   IBD   Ulcerative colitis   UC   IPAA   Pouch  

摘要： The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of ulcerative colitis management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines;rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of ulcerative colitis. The committee was able to identify some points of major disagreement and suggested strategies to improve the quality of available data and acceptance of guidelines.

关键词： vedolizumab   entyvio   dose intensification   ulcerative colitis   crohn's disease   inflammatory bowel disease  

摘要： Background Despite the proven efficacy of vedolizumab (VDZ) for ulcerative colitis (UC) and Crohn's disease (CD), suboptimal response is commonly encountered. However, data regarding the effectiveness of dose intensification (by interval shortening) to achieve response are limited. Objectives We evaluated the effectiveness of dose intensification at achieving response in patients with a previously suboptimal response to VDZ. Additionally, we aimed to identify predictors of response to this strategy. Methods We performed a retrospective cohort study of patients who underwent VDZ dose intensification for suboptimal response. Clinical disease activity was evaluated at the point of dose intensification (baseline) and at weeks 12 and 24. Response was defined as Harvey-Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI) reduction of >= 3, and remission as HBI Results A total of 36 patients received dose intensification to 4-weekly infusions: 18 CD, 14 UC and 4 inflammatory bowel disease-unclassified (analysed in the UC group). Median SCCAI scores fell from 6 (range 0-11) at baseline to 4 (0-6, p=0.008) at week 24, while HBI scores did not change significantly (4 (0-27) and 3 (0-8), p=0.092). Overall median C reactive protein (CRP) fell from 6 mg/L (1-23) to 2 mg/L (1-17, p=0.011). Of 20 patients with clinically active disease at baseline, 10 (50%) responded, of whom 4 (20%) achieved remission at week 24. Univariate analysis demonstrated low baseline CRP (p=0.045) and response at week 12 (0.020) were associated with week 24 response. Conclusions Our findings demonstrate VDZ dose intensification to be effective at achieving clinical response in half of patients. Low baseline CRP and response at week 12 are potential predictors of week 24 response.

关键词： Epidemiology   Progression   Colon   Inflammation  

摘要： Background & Aims Microscopic colitis shares pathogenetic mechanisms with inflammatory bowel disease (IBD). We studied the association between microscopic colitis and risk of incident IBD using data from a nationwide cohort study. Methods We conducted a prospective cohort study of all adults who received a diagnosis of microscopic colitis from 1990 through 2017 in Sweden and risk of incident IBD. Cases of microscopic colitis (n= 13,957) were identified through Systematized Nomenclature of Medicine codes from the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, which included gastrointestinal pathology reports from all of Sweden’s 28 centers. Individuals with microscopic colitis were matched to 5 general population controls (n = 66,820) and to unaffected siblings (n =13,943). Cox regression was used to estimate adjusted hazard ratio (aHRs) and 95% confidence intervals (CIs). Results Through December of 2017, we identified 323 incident cases of ulcerative colitis (UC) and 108 incident cases of Crohn’s disease (CD) in patients with microscopic colitis compared with 94 UC and 42 CD cases in population comparators. Mean times from diagnosis of microscopic colitis to diagnosis of CD was 3.3 ± 3.2 years and to diagnosis of UC was 3.2 ± 3.5 years. In multivariable models, microscopic colitis was associated with an aHR of 12.6 (95% CI 8.8–18.1) for CD, 17.3 (95% CI 13.7–21.8) for UC, and 16.8 (95% CI 13.9–20.3) for IBD. The 10-year absolute excess risks of CD and UC were 0.9 (95% CI 0.7–1.1) and 2.6 (95% CI 2.2–2.9) percentage points, respectively. In sensitivity analyses, comparing patients with microscopic colitis with their unaffected siblings, the aHRs of CD and UC were 5.4 (95% CI 3.2–9.2) and 9.4 (95% CI 6.4–13.8), respectively. Conclusions In a population-based study in Sweden, we found a significant increase in risk of incident IBD among patients with microscopic colitis. Future studies should focus on potential mechanisms underl