摘要： Introduction Studies of target organs at the time of acute graft versus host disease (GVHD) are needed to identify novel inflammatory and regulatory *** We performed a prospective transcriptome analysis of gastrointestinal (GI) biopsies at diagnosis of acute GI GVHD and compared these to bone marrow transplant (BMT) patients without GVHD. Allogeneic BMT patients ≥2 years old undergoing endoscopy for clinical indications had 2 additional rectosigmoid mucosal biopsies for transcriptome *** data from 211 ulcerative colitis (UC) patients were included to uncover genes and pathways shared between GVHD and UC. Rectal biopsies from 20 children without inflammatory bowel disease (IBD) served as *** Twenty-one patients underwent endoscopy pre (n=5) or post BMT (n=16). Median age of patients was 13.5 years (range 4.5 -25 years). Four patients were excluded from analyses (pre BMT colitis n=3, no lower GI biopsy n=1).Nine patients had acute GI GVHD, while 8 patients did not (Table 1).  Principal component analysis shows patient clustering of those with and without GVHD, suggesting distinct transcriptomic mechanisms driving disease (Figure 1A). We identified 1310 significant genes, 144 of which were downregulated and 1266 upregulated in acute GVHD compared to no GVHD (Figure 1B). Top upregulated biological processes in GVHD revealed an innate antimicrobial response and associated cytokine signaling, notable for interferons. Top 20 differentially expressed genes in acute GVHD (Table 2), include CXCL9, CXCL10 and CXCL11, which are chemokines involved in GVHD, and IDO1 which regulates tryptophan *** hundred and ninety shared genes were upregulated, and 126 genes were downregulated in GVHD and UC. Notable shared downregulated pathways involved butyrate metabolism (Table 3).  DUOXA2, a gene involved in regulating innate antimicrobial responses in IBD, was the top upregulated genes in pediatric IBD and was the second highest dif

关键词： Inflammatory bowel disease   Colorectal cancer   Stage   Survival  

摘要： Background: Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). However, there are few data comparing outcomes between IBD and non-IBD-associated CRC. Methods: Retrospective cohort study of patients with CRC identified from the Veteran Affairs (VA) Central Cancer Registry from 1998 to 2012 linked to national VA administrative claims to identify patients with IBD using a previously validated algorithm. The association between IBD status and stage of disease and overall risk of death were evaluated using multivariable logistic and Cox regression, respectively. Results: Among 34,570 CRC patients, 217 had IBD. IBD patients were significantly younger for both colon and rectal cancer. IBD patients who developed rectal cancer were significantly more likely to present with locally advanced or metastatic disease (P = 0.007), but there was no difference in stage among patients with colon cancer. This difference persisted after multivariable adjustment (overall-odds ratio [OR] 1.40, 95% confidence interval [1.03-1.90];colon-OR 1.22 [0.84-1.78];rectum-OR 2.04 [1.22-3.40]). Total colectomy was more commonly performed among IBD patients. Overall, IBD was associated with a 52% increased risk of death (hazard ratio 1.52 [1.21-1.91]). Conclusions: Although IBD is associated with more advanced stage at diagnosis for rectal cancer, it is associated with a worse survival primarily in patients with colon cancer. Further work is needed to better understand the reason for these observed differences between IBD and non-IBD patients and to better delineate the impact of endoscopic surveillance on CRC care and outcomes in IBD patients. Published by Elsevier Inc.

关键词： Functional gastrointestinal disorders   Inflammatory bowel disease   Irritable bowel syndrome  

摘要： Gut-brain dysregulation has been recognized by the scientific community as being crucial to the understanding of chronic gastrointestinal conditions, and this has translated into the practice of a newly established discipline, psychogastroenterology. Along with psychotherapy, antidepressants (a subtype of central neuromodulators) have been proposed as treatments for gut-brain disorders that might benefit both psychological and gastrointestinal health. Antidepressants have been found to be effective for the treatment of comorbid anxiety and depression, pain and impaired sleep. Although the efficacy of antidepressants is well established in disorders of gut-brain interaction (DGBI), evidence is only now emerging in IBD. This Perspective discusses the use of antidepressants in DGBI and IBD, focusing on how what we have learnt about the role of antidepressants in DGBI could be applied to help optimize the management of IBD. This Perspective discusses the use of antidepressants in disorders of gut-brain interaction (DGBI) and IBD, focusing on how what we have learnt about the role of antidepressants in DGBI could help optimize the management of IBD.

关键词： Crohn's disease   indigo naturalis   inflammatory bowel disease   Qing-Dai   ulcerative colitis  

摘要： Background and Aim Indigo naturalis (IN) is a traditional Chinese herbal medicine reported to be effective in inducing remission in ulcerative colitis (UC). We conducted a retrospective observational study to investigate the efficacy and safety of IN for induction and maintenance therapy in patients with inflammatory bowel disease. Methods Data were collected from the electric medical records of patients with inflammatory bowel disease who had started IN treatment between March 2015 and April 2017 at Kyushu University Hospital. Clinical response and remission rates were assessed based on the clinical activity index determined by Rachmilewitz index or Crohn's disease (CD) activity index. Cumulative IN continuation rates were estimated using the Kaplan-Meier method. Overall adverse events (AEs) during follow-up were also analyzed. Results Seventeen UC patients and eight CD patients were enrolled. Clinical response and remission rates at week 8 were 94.1% and 88.2% in UC patients and 37.5% and 25.0% in CD patients, respectively. Clinical remission rates, as assessed through non-responders imputation analyses at weeks 52 and 104, were 76.4% and 70.4% in UC patients and 25.0% and 25.0% in CD patients, respectively. Ten patients (40%) experienced AEs during follow-up. Three patients (12%) experienced severe AEs, including acute colitis requiring hospitalization in two patients and acute colitis with intussusception requiring surgery in one patient. Conclusions Indigo naturalis showed favorable therapeutic efficacy in UC, whereas its therapeutic efficacy in CD appeared to be modest. The risk of severe AEs should be recognized for IN treatment.

关键词： Crohn's Disease   Ulcerative Colitis   Vaginitis   Female Patient  

摘要： BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) affect 200-400 people per 100,000 in the United States, about half of whom are women. We aimed to define the prevalence of vulvovaginal symptoms and association with IBD activity in a large cohort of women. METHODS: Women more than 18 years old with IBD (1250) completed an online survey querying the presence and severity of vulvar or vaginal itch, burn, or irritation, vaginal discharge or dryness, and vulvovaginal pain. The survey collected information on demographic features and IBD activity (categorized using the Manitoba index). Women with and without symptoms were compared using bivariate analyses. Logistic regression evaluated associations between IBD severity and vulvovaginal symptoms, adjusted for diagnosis, menopause, smoking, depression, and use of medications to treat IBD. RESULTS: A total of 512 (41%) women reported at least 1 moderate-severe vulvovaginal symptom. All vulvovaginal symptoms except vaginal dryness were more common in women with active IBD. In a multivariate model controlled for menopause, smoking, t-score from the PROMIS depression instrument, and use of IBD medications, women with constant or frequent active IBD, based on Manitoba index scores, had increased odds for moderate-severe vulvovaginal symptoms (odds ratio, 1.68;95% CI, 1.22-2.32) compared to women in remission. Vulvovaginal discomfort frequently or always decreased interest in sex (n =336;28%) or ability to have sex (n=207;16%). CONCLUSIONS: In an online survey of 1250 women, we found that women with more active IBD have increased prevalence of vulvovaginal discomfort, compared to women in remission. These symptoms affect sexual health.

关键词： Crohn disease   dietary therapy   exclusive enteral nutrition   inflammatory bowel disease   nutritional therapy   ulcerative colitis  

摘要： Uses of nutritional therapies for inflammatory bowel disease (IBD) are of tremendous interest to the lay and professional communities. This interest currently outweighs the scientific basis for deciding on a particular therapy for any given patient. Some nutritional therapies have credible reports, in peer-review journals, validating their use for some patients. The broad pediatric gastroenterology community in the United States has, however, been unable or unwilling to agree on the details necessary to disseminate the most effective therapies with adequate reliability and validity to implement these interventions successfully. The well-established importance of the appropriate use of nutritional interventions for the treatment of undernutrition and maintenance of optimal nutrition is not an issue. A consensus and widely applicable solution for nutrition as therapy for IBD is, however, not imminent. In the interim, we aim to help the science-based reader to evaluate manuscripts appearing in our journals and to use this information to make rational, informed therapeutic decisions. We outline the current limited evidence base and make recommendations to advance the field of nutritional therapy in IBD.

关键词： Crohn disease   ulcerative colitis   very early-onset inflammatory bowel disease  

摘要： The rate of pediatric inflammatory bowel disease (IBD) has been increasing over the last decade and this increase has occurred most rapidly in the youngest children diagnosed <6 years, known as very early-onset inflammatory bowel disease (VEO-IBD). These children can present with more extensive and severe disease than older children and adults. The contribution of host genetics in this population is underscored by the young age of onset and the distinct, aggressive phenotype. In fact, monogenic defects, often involving primary immunodeficiency genes, have been identified in children with VEO-IBD and have led to targeted and life-saving therapy. This position paper will discuss the phenotype of VEO-IBD and outline the approach and evaluation for these children and what factors should trigger concern for an underlying immunodeficiency. We will then review the immunological assays and genetic studies that can facilitate the identification of the underlying diagnosis in patients with VEO-IBD and how this evaluation may lead to directed therapies. The position paper will also aid the pediatric gastroenterologist in recognizing when a patient should be referred to a center specializing in the care of these patients. These guidelines are intended for pediatricians, allied health professionals caring for children, pediatric gastroenterologists, pediatric pathologists, and immunologists.

摘要： Psychiatric distress is a predictor of higher medical resource utilization and costs in inflammatory bowel disease (IBD).[1] Targeting symptoms of anxiety and depression (A&D) may improve clinical outcomes.[2] Association between A&D and clinical recurrence was previously demonstrated.[3] Some clinical factors thought to influence development of A&D and healthcare utilization in IBD were pointed out, namely surgical history, disease complications, smoking, and female gender.[4] IBD patients with depression (22.2%) were more likely to be female, lack social support, have active disease, and exhibit less positive emotional recognition bias. [Extracted from the article]

关键词： Multiple outcome meta-analysis   Crohn's disease   Ulcerative colitis   Microarray   Gene expression   Differentially expressed genes  

摘要： We performed a multivariate meta-analysis of microarray data in Crohn's disease (CD) and Ulcerative colitis (UC), which are the main forms of inflammatory bowel disease (IBD). They share similar symptoms but differ in the location and extent of inflammation and in complications. We identified 249 differentially expressed genes (DEGs) in CD and 38 in UC at a false discovery rate of 1%. 20 of the DEGs were common to both diseases. A multivariate test identified 260 DEGs associated with IBD, 53 of which were not found in any of the disorders. We identified important molecular pathways implicated in the pathogenesis of IBD, such as the JAK/STAT and interferon-gamma signaling pathways, genes involved in cell adhesion, apoptosis and carcinogenesis. Among others, BCAT1 and GZMB are interesting novel DEGs that deserve further investigation in experimental models. The method could also be useful to other cases of meta-analysis of gene expression data.