关键词： Association (Psychology)   Crohn Disease   Chpher(0)   Chlorine   disease activity   Mucositis   clinical outcome   Vitamin D Deficiency   Relapse  

摘要： Background Vitamin D deficiency is highly prevalent among patients with IBD, however, data on its association with clinical outcomes are conflicting. Aim To perform a systematic review and meta-analysis to explore the association of low vitamin D status with clinical outcomes in patients with IBD. Methods We searched PubMed, Embase, Scopus and Web of Science from inception to February 2018 for observational studies evaluating the association of low 25(OH)D status on IBD disease activity, mucosal inflammation, clinical relapse and quality of life. Odds ratios (ORs) were pooled and analysed using a random effects model. Results Twenty-seven studies were eligible for inclusion comprising 8316 IBD patients (3115 ulcerative colitis, 5201 Crohn's disease). Among IBD patients, low 25(OH)D status was associated with increased odds of disease activity (OR 1.53, 95% CI 1.32-1.77, I-2 = 0%), mucosal inflammation (OR 1.25, 95% CI 1.06-1.47, I-2 = 0%), low quality of life (QOL) scores (OR 1.30, 95% CI 1.06-1.60, I-2 = 0%) and future clinical relapse (OR 1.23, 95% CI 1.03-1.47, I-2 = 0%). In subgroup analysis, low vitamin D status was associated with Crohn's disease activity (OR 1.66, 95% CI 1.36-2.03, I-2 = 0%), mucosal inflammation (OR 1.39, 95% CI 1.03-1.85, I-2 = 0%), clinical relapse (OR 1.35, 95% CI 1.14-1.59, I-2 = 0%), and low QOL scores (OR 1.25, 95% CI 1.04-1.50, I-2 = 0%) and ulcerative colitis disease activity (OR 1.47, 95% CI 1.03-2.09, I-2 = 0%) and clinical relapse (OR 1.20, 95% 1.01-1.43, I-2 = 0%). Conclusions Low 25(OH)D status is a biomarker for disease activity and predictor of poor clinical outcomes in IBD patients.

关键词： CD4(+) T-cells   inflammatory bowel disease   FOXP3   lamin A   C   regulatory T-cell  

摘要： The mechanisms by which lamin A/C in CD4(+) T-cells control intestinal homeostasis and can cause inflammatory bowel disease (IBD) are unknown. Here, we explore lamin A/C in a mouse model of IBD. Adoptive transfer to Rag1(-/-) mice of Lmna(-/-) CD4(+) T-cells, which have enhanced regulatory T-cells (Treg) differentiation and function, induced less severe IBD than wild-type T-cells. Lamin A/C deficiency in CD4(+) T-cells enhanced transcription of the Treg master regulator FOXP3, thus promoting Treg differentiation, and reduced Th1 polarization, due to epigenetic changes in the Th1 master regulator T-bet. In mesenteric lymph nodes, retinoic acid (RA) released by CD103(+) dendritic cells downregulated lamin A/C in CD4(+) T-cells, enhancing Treg differentiation. However, non-RA-producing CD103(-) dendritic cells predominated in peripheral lymph nodes, facilitating lamin A/C expression in CD4(+) T-cells and therefore Th1 differentiation. Our findings establish lamin A/C as a key regulator of Th differentiation in physiological conditions and show it as a potential immune-regulatory target in IBD. (c) 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

关键词： biologic medications   Crohn's disease   ulcerative colitis   colectomy  

摘要： Aim Patients with inflammatory bowel disease and their physicians must navigate ever-increasing options for treatment. The aim of this study was to elucidate the key drivers of treatment decision-making in inflammatory bowel disease. Methods We conducted qualitative semi-structured in-person interviews of 20 adult patients undergoing treatment for inflammatory bowel disease at an academic medical centre who either recently initiated biologic therapy or underwent an operation or surgical evaluation. Interviews were audio-recorded, transcribed verbatim, iteratively coded, and discussed to consensus by five researchers. We used thematic analysis to explore factors influencing decision-making. Results Four major themes emerged as key drivers of treatment decision-making: perceived clinical state and disease severity, the patient-physician relationship, knowledge, attitudes and beliefs about treatment options, and social isolation and stigma. Patients described experiencing a clinical turning point as the impetus for proceeding with a previously undesired treatment such as infusion medication or surgery. Patients reported delays in care or diagnosis, inadequate communication with their physicians, and lack of control over their disease management. Patients often stated that they considered surgery to be the treatment of last resort, which further compounded the complexity of making treatment decisions. Conclusion Patients described multiple barriers to making informed and collaborative decisions about treatment, especially when considering surgical options. Our study reveals a need for more comprehensive communication between the patient and their physician about the range of medical and surgical treatment options. We recommend a patient-centred approach toward the decision-making process that accounts for patient decision-making preferences, causes of social stress, and clinical status.

关键词： Corneal thickness   corneal volume   dry eye tests   pentacam   inflammatory bowel disease  

摘要： Purpose: To evaluate detailed corneal parameters of inflammatory bowel disease (IBD) patients, including Crohn's disease (CD) and ulcerative colitis (UC) patients, and to assess associations between anterior segment values and other clinical variables. Methods: This prospective cross-sectional case-control study at a tertiary referral center included 30 CD patients, 36 UC patients and 80 age- and gender-matched controls with no ocular symptoms or ocular surface disorders. All study participants underwent a comprehensive ophthalmological evaluation with special interest in dry eye disease (DED). Corneal parameters were evaluated by Pentacam. Results: The mean age of CD patients, UC patients, and controls was 45.80 +/- 11.55 years, 52.00 +/- 16.05, and 50.68 +/- 14.62, respectively. The average disease duration was 12.72 +/- 5.83 years for CD patients and 15.94 +/- 10.09 years for UC patients. All pachymetric (center, apex and thinnest) and corneal volume (CV) measurements were significantly decreased, while anterior chamber angle width (ACA) values were significantly increased on both sides in all IBD patients compared to those in controls (p < .05). In addition, several anterior segment parameters were altered unilaterally in CD or UC patients. Negative correlations were found between corneal parameters and Schirmer I test values. Conclusions: Our investigations suggest that IBD patients have thinner corneas compared to that of controls. The coexistence of reduced tear quantity seems to have an additional impact on the thinning of the cornea in IBD patients. Early recognition of corneal impairments, a possible extraintestinal manifestation of IBD, should be included in the disease checkup to reduce vision-threatening developments.

摘要： Background. Inflammatory bowel diseases (IBD) comprise two chronic relapsing intestinal disorders: Crohn's disease (CD) and ulcerative colitis (UC). IBD are the result of an abnormal inflammatory response to intestinal microbes in a genetically susceptible host. Clinically, rectal bleeding, severe diarrhea, weight loss and abdominal pain characterize IBD. Moreover, IBD are associated with a variety of extraintestinal manifestations (EIM). Increased risk of arterial and venous thrombosis in IBD patients, with a 3-fold higher risk for development venous thromboembolism is one of the most important EIM in terms of morbidity and mortality. Although the mechanisms underlying the increased thrombotic risk in IBD are not completely understood, there is evidence of abnormalities in coagulation, fibrinolysis and platelet function. However, in this context, the contribution of the vessel wall has been less explored. Endothelial dysfunction (ED) and abnormal activation of RhoA/Rho kinase (ROCK) pathway have been shown to participate in multiple pathological processes associated with thrombotic complications. We hypothesize that in IBD, the chronic inflammatory process settles the conditions for a chronic endothelial stimulation and increased ROCK activation contributing to the pathogenesis of thrombotic complications in IBD. Objectives. The main objective of this work was to demonstrate evidence of ED in patients with IBD and activation of RhoA/Rho kinase pathway. Methods. We studied 67 IBD patients (aged 18-77 years, mean age 37 years) who met inclusion criteria and age and healthy controls (aged 24-65 years, mean age 32 years). Diagnosis was based on standard clinical, radiological, endoscopic, and histological criteria. Activity of the disease was assessed by Mayo or Harvey Bradshaw Score (UC and CD, respectively). Endothelial cell damage was determined by enumerating circulating endothelial cells (CECs) and levels of circulating biomarkers: soluble intercellular adhesion m

摘要： Introduction: Venous thromboembolism (VTE) is a known complication in children with inflammatory bowel disease (IBD) and can be associated with significant morbidity and mortality. Central lines, inflammation, hospital stays, and protein losses are among risk factors that contribute to this elevated risk. While it is known that children with IBD have an increased VTE risk, there are no standard guidelines for prevention of this unwanted complication. Decreasing the rate of hospital-acquired VTE in all hospitalized children is of national interest, especially in this unique patient population. However, there are no clear data regarding the true impact of VTE on the pediatric IBD population to guide practitioners in prevention and management. Given that IBD patients are known to have an increased risk of VTE, we sought to assess the burden associated with VTE development in hospitalized IBD patients. Methods: The Pediatric Health Information System database (PHIS), a database that includes both clinical and resource utilization data for over 45 children's hospitals, was utilized to gather inpatient data from 2009-2017. ICD9 (IBD - ***, *** and VTE - 325, 415.1x, 451.x, 452, 453.0-.9, and 572.1) and ICD10 (IBD - K50.0-.919, K51.0-.919 and VTE - I80.0-.9, I81, I82.0-.91, I63.6, I67.6) diagnostic codes for IBD and VTE were applied to identify hospitalized IBD patients who experienced a VTE event. First admissions during the time period were used to avoid capturing the same VTE event more than once. Demographic data, as well as data regarding hospitalization, were reviewed. The Institutional Review Board of Weill Cornell Medicine approved this study. Results: 19,004 first admissions were identified for patients with IBD. Of those, 475 had documented episodes of VTE, demonstrating an incidence of having a VTE at first admission of 2.5%. There were no significant differences in gender, age at first admission, ethnicity, or geographic region between hospitalized IBD pa

关键词： Epidemiology   Inflammatory bowel disease   Validation   National Patient Register   Procedure code  

摘要： Background About 50% of patients with Crohn's disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes. Methods Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 randomly selected patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated. Results In total, 158 surgical procedure codes were registered in the NPR. One hundred fifty-five of these, representing 60 different procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant with the patient charts, corresponding to a PPV of 96.8% (95%CI = 93.9-99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI = 88.7-98.6), 100% (95%CI = 100-100) and 98.1% (95%CI = 93.1-100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI = 89.6-99.3). The specificity of the NPR was 98.5% (95%CI = 97.6-100). Conclusions Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery.

关键词： Dietary inflammatory index   Empirically derived inflammatory pattern   Inflammatory bowel disease   Disease activity  

摘要： Background Diet is an important modulator of inflammation, which is associated with inflammatory bowel disease (IBD). In this study, we examined whether the inflammatory properties of diets are associated with disease activity in patients with IBD. Methods A cross-sectional study was conducted on 143 IBD patients, including 32 patients with Crohn's disease (CD) and 111 patients with ulcerative colitis (UC). Dietary intakes were assessed by a valid 168-item food frequency questionnaire (FFQ). The inflammatory potential of the diet was assessed by calculating the two scores of Dietary Inflammatory Index (DII (R)), and the Empirical Dietary Inflammatory Pattern (EDIP), and CD and UC disease activity were determined by the Crohn's disease activity index (CDAI) and the Mayo score, respectively. Associations of the inflammatory indices as median and as tertiles with disease activity were analyzed using logistic regression in a univariate model and after adjusting for total energy intake (continuous), type of disease (CD and UC) and drug consumption (no drugs, single drug, and multiple drugs). Results Sixty-four IBD patients (44.8%) in this study had active *** DII (R) score and the EDIP did not differ significantly between active and inactive patients (- 1.45 +/- 1.04 vs.- 1.20 +/- 1.24;0.56 +/- 0.22 vs. 0.53 +/- 0.28, respectively). After adjusting for energy intake, drug use, and IBD type, the odds (95%CIs) of active disease among patients in tertile 3 compared to those in tertile 1 were 0.84 (0.32-2.17) for DII and 1.50 (0.61-3.72) for EDIP;neither of which were statistically significantly different from the rates in tertile 1. Conclusions Although point estimates were in the expected direction of increased risk, the inflammatory potential of diet, assessed using DII or EDIP, was not associated with severity of disease in IBD patients. Whether diet-related inflammation affects disease activity in patients with IBD deserves further investigations.

关键词： Inflammatory bowel disease   Colonic contractility   Alternating current biosusceptometry  

摘要： Aims: Inflammatory bowel disease is a chronic relapsing inflammation that affects the gastrointestinal tract, causing changes in colonic motility. The evolution of these changes is not completely understood and possibly related to symptoms that appear in different degrees of the intestinal inflammation. Therefore, our aim is evaluate during 14 days of assessment aspects of colonic contractility using 2,4,6-trinitrobenzenesulfonic acid (TNBS) model of inflammation in rats and associate the inflammatory process with colonic motility. Methods: Contractility and inflammatory parameters were assessed in the same animal in six different moments: before intestinal inflammation induction, 2, 5, 8, 11, and 14 days after induction. The mechanical activity was determined by alternating current biosusceptometry (ACB) and subdivided into rhythmic propagating ripples (RPR) and rhythmic propulsive motor complexes (RPMC). We assessed inflammation by determining myeloperoxidase activity in feces. Results: Transient and permanent changes were observed in colonic motility as a function of the inflammatory process evaluated through myeloperoxidase activity. We identified two contraction profiles: RPR and RPMC. The microscopic analysis demonstrated a depth of damage caused by an injury that was associated with changes in motility. Conclusions: We implemented a robust and adequate (specific) signal processing to quantify two measured colonic frequency patterns. Thus, we performed a detailed temporal analysis of the consequences of TNBS-induced inflammation on colonic motility in rats. Our approach enables further long-term assessments in the same animal with different mechanisms and duration of injury, remission, treatments and their motor consequences.