关键词： inflammatory bowel disease   colitis   gut microbiota   dextran sulfate sodium   Clostridium difficile   Pyungwi-san  

摘要： Several lines of evidence indicate that inflammatory bowel disease (IBD) is associated with Clostridium difficile (CD) infection as a consequence of gut dysbiosis. Currently available treatments of IBD are either not very effective or have adverse effects. Pyungwi-san (PWS), a traditional Chinese herbal formulation, has long been used to treat gastrointestinal disorders. The present study was conducted to investigate the efficacy of PWS against dextran sulfate sodium (DSS) + CD-induced IBD in mice. The animals received DSS in drinking water for seven days to produce DSS-induced acute colitis. In the DSS + CD group, the DSS-fed animals were orally administered with CD spores twice during the DSS treatment period. We observed that exposure of DSS + CD-treated animals to PWS significantly decreased the disease activity index;prevented the shortening of colonic length and increases in spleen size and weight;restored colonic histological parameters by significantly increasing mucus thickness, crypt depth, and goblet cell numbers;protected the tight junction proteins;improved the profiles of pro-inflammatory and anti-inflammatory cytokines;and normalized the abundance ratio of the Firmicutes/Bacteroidetes in the gut. Thus, PWS exerted a number of protective effects on DSS + CD-induced colitis, which might be mediated via restoration of a balance in gut microbial communities.

关键词： Prognosis   Biological Therapy   Disease Progression   Treatment  

摘要： BACKGROUND & AIMS: It is not clear whether the co-occurrence of immune-mediated inflammatory diseases (IMIDs) affects the course of inflammatory bowel diseases (IBD). We investigated the occurrence of IMIDs in relation to onset of IBD and the effects of concurrent IMIDs on IBD outcomes in a nationwide study of the Danish population. METHODS: We used a nationwide cohort of all individuals diagnosed with IBD, including Crohn's disease (CD) or ulcerative colitis (UC), in Denmark from 2007 through 2016 (n = 14,377). Patients were match with individuals without IBD from the general population (controls, n = 71,885). All cohort members were followed from birth until 2016, their migration, or their death. The occurrence of IMIDs was assessed using the Danish national patient register and Registry of Medicinal Products Statistics. RESULTS: A total of 3,235 patients with a diagnosis of IBD (22.5%) has also received a diagnosis of an IMID;most IMIDs occurred before the onset of IBD (n = 2,600, 80.3%). The most common IMIDs observed were psoriasis, asthma, type 1 diabetes, and iridocyclitis. Patients with IBD treated with infliximab were at reduced risk of developing IMIDs (CD adjusted odds ratio [aOR], 0.52;95% CI, 0.34-0.81 and UC aOR, 0.47;95% CI, 0.29-0.76). Co-occurrence of IMIDs increased the risk of surgery in patients with CD that developed IMIDs after CD onset (aOR, 2.30;95% CI, 1.46-4.20) but not in UC. CONCLUSIONS: In a nationwide study of the Danish population, 22.5% of patients with IBD also had at least 1 concurrent IMID. Co-occurrence of IMIDs increased the risk of surgery in patients with CD.

关键词： Vitamin D   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Supplementation   Sun exposure  

摘要： Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory disorder of the gastrointestinal tract consisting two principal categories, ulcerative colitis (UC) and Crohn's disease (CD). The precise etiology of IBD remains unknown. Vitamin D is an important micronutrient that plays a critical biological role in various processes in human tissues. However, the relationship between disruption of the gut microbiota and the development of IBD is unclear. Some studies suggest that IBD is the cause of disrupted gut microbiota while others propose that gut microbiota itself can lead to development of IBD. Regardless of this complexity, it has emerged that vitamin D is an immunoregulatory factor that plays a significant role in the pathogenesis of IBD by affecting the gut microbiome and the inflammatory response. It has been reported that 38.1% of CD patients and 31.6% of UC patients suffer from vitamin D deficiency (VDD). In this review, we aimed to evaluate the association between VDD and IBD, summarizing recent clinical studies examining the effect of low vitamin D and the role of vitamin D supplementation on IBD clinical outcomes.

关键词： Biosimilar   Crohn's disease   CT-P13   Inflammatory bowel disease   Infliximab   Ulcerative colitis  

摘要： Background: Patients' perspectives after switching from infliximab to a biosimilar have yet to be assessed. Aim: To assess patients' perspectives in a prospective manner after switching from infliximab to CT-P13. Methods: 113 consecutive patients with inflammatory bowel disease (IBD) on maintenance therapy with infliximab were switched to CT-P13. Patients' perspectives were assessed by questionnaires, including the Beliefs about Medicines Questionnaire (BMQ) and FACIT-F (questionnaire regarding fatigue), and patient-reported outcomes (IBD disability index) at the inclusion and after the fourth CT-P13 infusion. Results: After one year, the patients' perspectives did not change after the switch according to BMQ-general, BMQ-specific necessity and BMQ-specific concerns subscales. No difference was observed in the mean IBD-DI score, while a significant improvement in fatigue was observed according to the FACIT-F questionnaire. Patients' concerns were raised about the use of biosimilars and the risks of switching with a significant improvement after switching (65% vs. 42%, respectively, p = 0.01). Fourteen (12.4%) patients experienced loss of response to CT-P13, including 12 with restoration of steroid-free clinical remission after CT-P13 dose optimization. Conclusion: Although some concerns were reported, no difference was observed in patients' perspectives after switching from infliximab to CT-P13. (c) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

关键词： anti-tumor necrosis factor   interferon-gamma release assays   latent tuberculosis   pediatric inflammatory bowel disease  

摘要： Objectives: The aim of the study was to analyze the diagnostic accuracy and utility of QuantiFERON-TB Gold In-Tube, an interferon-gamma release assay (IGRA), as a screening tool for latent tuberculosis infection (LTBI) in pediatric patients with inflammatory bowel disease (IBD) undergoing treatment with anti-tumor necrosis factor (anti-TNF) medications. To describe cases of tuberculosis in the pediatric IBD population, TB treatment courses, outcomes, and their effect on IBD management. Methods: A single-center, retrospective cohort study of pediatric IBD patients who underwent tuberculosis screening. IGRA testing from 2011 to 2017 were analyzed to determine result rates, characteristics, and outcomes. Results: One thousand seven hundred fifty-four (1,754) tests were performed on 859 patients. One thousand six hundred thirty-four (1,634) tests were negative, 9 were positive, and 111 were indeterminate. Eight of 9 positive tests resulted during repeat annual screening while receiving IBD treatment. Five patients were treated for latent tuberculosis infection (LTBI), and 4 were false-positives. IBD therapy was interrupted in 3 patients, with no negative long-term outcomes. We report 1 known false-negative, in a patient who developed disseminated TB on anti-TNF therapy. Indeterminate testing rates were higher at IBD diagnosis than during treatment (10.3% vs 5.3%, P < 0.001). Follow-up testing of indeterminate results was negative in all patients retested, with 14 patients lost to follow-up. No patient with indeterminate testing developed TB. Conclusions: IGRAs are a useful tool to screen for LTBI, both before anti-TNF therapy and during treatment. Results should be used in concert with detailed history and examination. Positive and indeterminate results should be promptly repeated for timely TB diagnosis and to minimize interruptions in IBD therapy.

关键词： Inflammatory bowel disease   Extraintestinal   Skin lesion   Paradoxical reaction   Anti-tumor necrosis factor  

摘要： Inflammatory bowel disease (IBD) is associated with a number of extraintestinal complications, including skin lesions. Most reports have shown that skin lesions are found in 10-15% of IBD cases, although this depends on the definition of skin lesions. The representative skin lesions in patients with IBD are erythema nodosum, pyoderma gangrenosum, Sweet's syndrome, and so on. These lesions are often associated with IBD progression, and intestinal lesions in particular require appropriate treatment. Recently, another clinical issue regarding skin lesions in patients with IBD, a so-called paradoxical reaction, during the treatment with anti-tumor necrosis factor (TNF)-alpha agents has emerged. These reactions are termed paradoxical reactions because the skin lesions sometimes resemble psoriasis, although the anti-TNF-alpha agents have been historically used to treat psoriasis. Paradoxical reactions are reportedly found in approximately 5-10% of patients using anti-TNF-alpha agents and are no longer rare. Now that the use of biologics is at its culmination, reports regarding paradoxical reactions are predicted to increase in number;thus, we must recognize skin lesions with IBD patients including this type of adverse events and manage them appropriately while consulting with dermatologists.

关键词： Sunlight exposure   Inflammatory bowel disease   Vitamin D  

摘要： Introduction: Sunlight exposure is the main source of vitamin D. Our aim was to describe both sun exposure and sun protection behaviour in a series of patients with inflammatory bowel disease (IBD), and to study their potential association with vitamin D concentration. Patients and methods: A cross sectional, observational study. The clinical-demographic variables were obtained via clinical interviews and medical history review. The sunlight exposure assessment was carried out using the Sun Exposure Questionnaire and the concentration of 25-hydroxy vitamin D (25OHD) was measured by an electro-chemiluminescence immunoassay. Questionnaires were conducted on quality of life, physical activity, weekly vitamin D intake and sun protection behaviour. Results: 149 patients were included. In 69% of patients, deficient or insufficient 25OHD values were recorded. 67% showed low sun exposure. A modest significant correlation was observed between the total score of the solar exposure questionnaire and the 25OHD concentration in the complete series (r = 0.226, P = .006) and in the summer (r = 0.274, P = .01). The sun protection behaviour questionnaire score did not influence the 25OHD concentration. In the multivariate analysis, only the presence of clinical activity was associated with low sun exposure (OR = 3.23). Discussion: Sun exposure according to the questionnaire used was low, was associated with the presence of clinical activity and was weakly correlated with serum 25OHD concentration. More studies are needed to explore the use of individual questionnaires for sun exposure and its relationship with vitamin D in patients with IBD. (C) 2019 Elsevier Espana, S.L.U. All rights reserved.

关键词： Tissue engineering   Intestine tissue   Inflammatory bowel disease   Intestinal immune system   Colonoids   Monocyte-derived macrophages silk  

摘要： An in vitro model of intestinal epithelium with an immune component was bioengineered to mimic immunologic responses seen in inflammatory bowel disease. While intestinal immune phenomena can be modeled in transwells and 2D culture systems, 3D tissue models improve physiological relevance by providing a 3D substrate which enable migration of macrophages towards the epithelium. An intestinal epithelial layer comprised of non-transformed human colon organoid cells and a subepithelial layer laden with monocyte-derived macrophages was bioengineered to mimic native intestinal mucosa cell organization using spongy biomaterial scaffolds. Confluent monolayers with microvilli, a mucus layer, and infiltration of macrophages to the basal side of the epithelium were observed. Inflammation, induced by E. coli O111:B4 lipopolysaccharide and interferon gamma resulted in morphological changes to the epithelium, resulting in ball-like structures, decreased epithelial coverage, and increased migration of macrophages to the epithelium. Analysis of cytokines present in the inflamed tissue model demonstrated significantly upregulated secretion of pro-inflammatory cytokines that are often associated with active inflammatory bowel disease, including CXCL10, IL-beta, IL-6, MCP-2, and MIP-1 beta. The macrophage layer enhanced epithelial and biochemical responses to inflammatory insult, and this new tissue system may be useful to study and develop potential therapies for inflammatory bowel disease.

关键词： Inflammatory bowel disease   Celiac disease   Bone mineral density   Fractures   Osteoporosis  

摘要： Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitecture deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Several gastrointestinal disorders have been associated with osteoporosis including inflammatory bowel disease and celiac disease. Different factors can explain low bone density and fractures in these patients.

摘要： Fecal microbiota transplantation (FMT) represents the most effective means of therapeutically manipulating the gastrointestinal microbiome. Originally employed as a treatment of last-resort in patients with life-threatening Clostridioides difficile Infection (CDI), FMT gained widespread acceptance during the CDI epidemic, where it achieved resolution rates approaching 100%. Following our newfound appreciation for the role of the gut microbiome in both health and disease and owing to FMT's unique mechanism/s of action, FMT is rapidly advancing as an effective treatment for a number of conditions in which the gastrointestinal microbiome is thought to play a role. We review the role of FMT from its beginnings in CDI to its expansion into inflammatory bowel disease, irritable bowel syndrome, and colon cancer.