关键词： Infectious disease   Risk factors   Immunosuppressive treatment  

摘要： Purpose Recognizing patients with inflammatory bowel disease who are prone to infection would enable the adjustment of the type and intensity of immunosuppressive treatment. The aim of this study was to identify a clinical profile of risk for infections in IBD patients, based on the interaction of immunosuppressive treatment with factors inherent to the patient. Methods A case-control study was performed among patients older than 18 years. Patients with any significant infection (any kind of severe or recurrent infection according to standard clinical criteria or a critical enough infection according to the patient) were defined as cases. Both cases and controls were randomly selected in a 1:3 ratio. All the period from diagnosis to the end of recruitment (June 2016) was analyzed. Risk factors for infection were identified by logistic regression analysis;the strength of association was reported by odds ratio (OR) with 95% confidence interval (95%CI). Results A total of 112 cases and 270 controls were included. The independent risk factors for significant infection are the number of immunosuppressants (one drug: OR 1.28, 95% CI 0.53-3.11, two drugs: OR 2.37, 95% CI 1.01-5,56, and three drugs: OR 5.84, 95% CI 1.57-21.72), body mass index (OR 1.08;95 %CI 1,01-1,16), the degree of comorbidity (OR 1.52;95% CI 1.04-2.21), and the intensity of inflammatory activity (OR 1.43;95% CI 1.19-1.71). Conclusions Regardless of immunosuppression, several patient factors such as comorbidity, body mass index, or the inflammatory activity of the disease determine the individual risk of infectious complications and should be considered for an adequate risk assessment.

关键词： Crohn's disease   Ulcerative colitis   Systemic steroids   Hospitalization   Surgery   Adjuvant therapy  

摘要： Alterations of intestinal microflora are involved in the pathogenesis and natural history of inflammatory bowel diseases (IBDs). Manipulation of human gut microbiota with probiotics may be a therapeutic option. In this retrospective cohort study, the benefits of probiotic use in reducing adverse events were analyzed. Data from clinical charts of IBD patients followed up for at least 36 months were retrieved. The occurrence of adverse events including the need for systemic steroids, hospitalization, and surgery related to IBD was analyzed according to age, gender, body mass index, treatments, IBD phenotype, disease duration, and probiotic use. The amount of probiotic use was calculated as the ratio of time under probiotic treatment to the disease duration starting from the date of the first probiotic administration and expressed as a percentage. Patients were stratified according to the percentage of probiotic use as <= 24%, 25-74%, and >= 75%, and the number of adverse events per patient-years was calculated. Results were adjusted for Crohn's disease (CD) and ulcerative colitis (UC) by multivariate analysis including study variables. Data from 200 patients (78 CD, 122 UC;117 females;mean age 40.6 +/- 15.3 years;mean disease duration 12.1 +/- 8.7 years) were available. CD patients taking probiotics for 25-74% of the disease duration experienced a 64% reduction in total adverse events. The need for systemic steroids, hospitalization, and surgery dropped to zero events per person-year in UC patients and decreased by 93% (p < 0.001) in CD patients taking probiotics for >= 75% of the disease duration. Our findings suggest that the use of probiotics may be an additional therapeutic tool in patients with IBD.

关键词： chronic disease   inflammatory bowel disease   perfectionism   psychosocial  

摘要： Objectives: The aim of this prospective cross-sectional study was to examine perfectionism, disease self-management, and psychosocial outcomes in a sample of adolescents with inflammatory bowel disease (IBD). Methods: Adolescent patients with IBD and caregivers were enrolled in the study. Patients completed the Child and Adolescent Perfectionism Scale, the Strengths and Difficulties Questionnaire (SDQ), and the TRANSITION-Q. Parents completed the Multidimensional Perfectionism Scale and the parent form of the SDQ. Health care providers reported on disease activity using the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn Disease Activity Index (PCDAI). Results: Ninety adolescents (mean age 15.17 +/- 1.49, range = 12-18) with diagnosed IBD (51 CD, 37 UC, and 2 IBD-U) and 76 primary caregivers participated in the study. Results indicated high rates of self-oriented perfectionism in adolescents with IBD (59% of sample reported elevated rates;33% of sample in the clinical range). After accounting for age, sex, and disease activity, self-oriented perfectionistic striving was associated with better disease self-management;nonetheless, adolescent and parent perfectionistic strivings were also related to higher adolescent internalizing symptoms (standardized beta = 0.22 and 0.29, respectively). Additionally, perfectionistic concerns (self-critical and socially prescribed perfectionism) were associated with higher rates of adolescent-reported externalizing symptoms (standardized beta 0.30 and 0.24). Further, multilevel mixed modelling found no differences within-dyad in relation to perfectionism, but documented that adolescents report higher levels of externalizing symptoms compared with parents. Conclusions: The present study explores the prevalence and presentation of perfectionism in a sample of adolescents with IBD. Results suggest dimensions of perfectionism are differentially associated with psychosocial and disease management outcomes, sugg

关键词： Endoscopic balloon dilation   Inflammatory bowel disease   Crohn's disease  

摘要： Background There is no information regarding the outcome of Crohn's disease (CD) patients treated with endoscopic balloon dilation (EBD) in non-referral hospitals, nor on the efficacy of EBD in ulcerative colitis (UC). We report herein the results of the largest series published to date. Aim To assess the efficacy and safety of EBD for inflammatory bowel disease (IBD) stenosis performed in 19 hospitals with different levels of complexity and to determine factors related to therapeutic success. Methods We identified IBD patients undergoing EBD in the ENEIDA database. Efficacy of EBD was compared between CD and UC and between secondary and tertiary hospitals. Predictive factors of therapeutic success were assessed with multivariate analysis. Results Four-hundred dilations (41.2% anastomotic) were performed in 187 IBD patients (13 UC/Indeterminate colitis). Technical and therapeutic success per dilation was achieved in 79.5% and 55.3%, respectively. Therapeutic success per patient was achieved in 78.1% of cases (median follow-up: 40 months) with 49.7% requiring more than one dilation. No differences related to either diagnosis or hospital complexity was found. Technical success [OR 4.12 (95%CI 2.4-7.1)] and not receiving anti-TNF at the time of dilation [OR 1.7 (95% CI 1.1-2.6)] were independently related to therapeutic success per dilation. A stricture length <= 2 cm [HR 2.43 (95% CI 1.11-5.31)] was a predictive factor of long-term success per patient. The rate of major complications was 1.3%. Conclusions EBD can be performed with similar efficacy and safety in hospitals with differing levels of complexity and it might be a suitable treatment for UC with short stenosis. To achieve a technical success and the short length of the stenosis seem to be critical for long-term therapeutic success.

关键词： Crohn's disease   CT-P13   Patient education   Ulcerative colitis  

摘要： Background: To lighten the burden on health-care spending, switching from the infliximab originator to a biosimilar in patients with inflammatory bowel disease (IBD) is advocated. However, the uptake of biosimilars lacks initiatives aimed at educating patients. Aims: To explore the impact of a gastroenterologist's interview on IBD patients' acceptance for switching from infliximab bio-originator Remicade (R) to its biosimilar CT-P13 Inflectra (R). Methods: After the interview of 138 included patients, 120 properly responded to a self-administered questionnaire to collect consent about the switch and relevant data. French national IBD patients' association (Association Francois Aupetit) provided an information sheet on biosimilars. Results: 93 (67.0%) out of 138 and 82 (68.3%) out of 120 patients switched treatment. 114 (79.8%) had never heard about biosimilars. Paradoxically, having heard about biosimilars was associated with a poorer chance to switch (Odds Ratio OR [95% CI] = 0.13 [0.02-0.72]). On the contrary, the more satisfied about generics, the more patients accepted the switch (OR [95% CI] = 1.31 [1.01-1.69]). There were 1.47 (Relative Risk RR [95% CI] = 1.47 [1.07-2.01]) times more chance to agree to the switch if the interview modified the patient's opinion on biosimilars. Conclusion: This study confirms that an organized information provided to the patient is a contributive way to enhance patient's acceptance of biosimilars in IBD. (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

关键词： Escherichia coli   AIEC   Crohn's Disease   IBD   Phylogeny  

摘要： There is increased evidence demonstrating the association between Crohn's Disease (CD), a type of Inflammatory Bowel Disease (IBD), and non-diarrheagenic Adherent/Invasive Escherichia coil (AIEC) isolates. AIEC strains are phenotypically characterized by their adhesion, invasion and intra-macrophage survival capabilities. In the present study, the genomes of five AIEC strains isolated from individuals without IBD (four from healthy donors and one from peritoneal liquid) were sequenced and compared with AIEC prototype strains (LF82 and NRG857c), and with extra-intestinal uropathogenic strain (UPEC CFT073). Non-IBD-AIEC strains showed an Average Nucleotide Identity up to 98% compared with control strains. Blast identities of the five non-IBD-AIEC strains were higher when compared to AIEC and UPEC reference strains than with another E. coli pathotypes, suggesting a relationship between them. The SNPs phylogeny grouped the five non-IBD-AIEC strains in one separated cluster, which indicates the emergence of these strains apart from the AIEC group. Additionally, four genomic islands not previously reported in AIEC strains were identified. An incomplete Type VI secretion system was found in non-IBD-AIEC strains;however, the Type II secretion system was complete. Several groups of genes reported in AIEC strains were searched in the five non-IBD-AIEC strains, and the presence of fimA, fliC, fuhD, chuA, irp2 and cvaC were confirmed. Other virulence factors were detected in non-IBD-AIEC strains, which were absent in AIEC reference strains, including EhaG, non-fimbrial adhesin 1, PapG, F17D-G, YehA/D, FeuC, IucD, CbtA, VgrG-1, Cnfl and H1yE. Based on the differences in virulence determinants and SNPs, it is plausible to suggest that non-IBD AIEC strains belong to a different pathotype.

关键词： Diseases   Urogenital diseases  

摘要： Background Patients with inflammatory bowel disease (IBD) are at increased risk of gastrointestinal and extraintestinal malignancies. However, the associations between IBD and prostate cancer (PCa) risk remain conflicting. Methods We conducted a systematic literature search in PubMed, EMBASE, and Web of Science databases. According to the inclusion and exclusion criteria, a total of nine studies were included in the meta-analysis. The pooled standardized incidence ratios (SIRs) or relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated to determine the relationship of IBD and PCa risk. Results For cohort studies, the pooled SIR was 1.33 (95% CI = 1.03-1.71). The further subgroup analysis showed that the PCa risk was higher in patients with ulcerative colitis (UC) (pooled SIR = 1.58, 95% CI = 1.08-2.30), but not in patients with Crohn's disease (CD) (pooled SIR = 1.12, 95% CI = 0.97-1.31). Besides, for the three case-control studies, the results indicated that compared with normal group, the pooled RR of PCa was 1.81 for the patients with IBD (95% CI = 1.43-2.29). In addition, sensitivity analysis indicated that the results were robust and no significant publication bias were observed. Conclusions Our findings based on the large and multicenter samples strongly indicated that men with IBD especial UC have significantly elevated PCa risk. Future efforts are needed to define the mechanism underlying the link between IBD and PCa or clinically significant PCa risk.

关键词： Basal plasmacytosis   Crohn's disease   Dysplasia   Granulomas   Histopathological report   Mucosal healing   Ulcerative colitis  

摘要： Diagnosis of the inflammatory bowel diseases ulcerative colitis (UC) and Crohn's disease (CD) relies mainly on the histopathological examination of endoscopic biopsies of the gastrointestinal tract. To facilitate the accurate diagnosis of these two conditions, this paper addresses key issues on the: (A) gastrointestinal biopsy procedure, (B) histomorphological characteristics of UC and CD, and (C) diagnosis of dysplasia. The 13 statements presented here represent the consensus of two groups of Italian pathologists (IG-IBD and GIPAD). (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

摘要： LINKED CONTENTThis article is linked to Choi et al paper. To view this article, visit https://***/10.1111/apt.15446.

摘要： MicroRNA (miR)-219a-5p has been implicated in the development of numerous progression of carcinoma and autoimmune diseases. However, whether miR-219a-5p is involved in the pathogenesis of inflammatory bowel disease (IBD) remains elusive. In this study, we demonstrated that miR-219a-5p expression was significantly decreased in the inflamed intestinal mucosa and peripheral blood (PB)-CD4(+) T cells from patients with IBD. Proinflammatory cytokines (e.g., IL-6, IL-12, IL-23 and TNF-alpha) inhibited miR-219a-5p expression in CD4(+) T cells in vitro. Lentivirus-mediated miR-219a-5p downregulation facilitated Th1/Th17 cell differentiation, whereas miR-219a-5p overexpression exerted an opposite effect. Luciferase assays confirmed that ETS variant 5 (ETV5) was a functional target of miR-219a-5p and ETV5 expression was significantly increased in the inflamed intestinal mucosa and PB-CD4(+) T cells from IBD patients. ETV5 overexpression enhanced Th1/Th17 immune response through upregulating the phosphorylation of STAT3 and STAT4. Importantly, supplementation of miR-219a-5p ameliorated TNBS-induced intestinal mucosal inflammation, characterized by decreased IFN-gamma(+) CD4(+) T cells and IL-17A(+) CD4(+) T cells infiltration in the colonic lamina propria. Our data thus reveal a novel mechanism whereby miR-219a-5p suppresses intestinal inflammation through inhibiting Th1/Th17-mediated immune responses. miR-219a-5p might be a target for the treatment of IBD.