摘要： BackgroundFew studies have addressed recent trends in hospitalization costs for inflammatory bowel disease (IBD).ObjectiveWe explored trends and described patient and hospital factors associated with hospitalization costs for *** data from the 2003-2014 National Inpatient Sample for adults aged18years, we estimated costs using multivariable linear models and assessed linear trends by time periods using piecewise linear *** 2014, there were an estimated 56,290 hospitalizations for Crohn's disease (CD), with a mean cost of US$11,345 and median cost of US$7592;and 33,585 hospitalizations for ulcerative colitis (UC), with a mean cost of US$13,412 and median cost of US$8873. Higher costs were observed among Hispanic [adjusted cost ratio (ACR)=1.07;95% confidence interval (CI)=1.00-1.14;p=0.04] or other non-Hispanic (ACR=1.09;95% CI=1.02-1.17;p=0.01) CD patients than for non-Hispanic White CD patients. For UC patients, higher costs were observed among men (ACR=1.09;95% CI=1.05-1.13;p<0.001) compared with women and among patients aged 35-44years, 45-54years, and 55-64years compared with those aged 18-24years. Among all patients, factors associated with higher costs included higher household income, more comorbidities, and hospitals that were government nonfederal versus private, were large versus small, and were located in the West versus Northeast regions. From 2003 to 2008, total costs increased annually by 3% for CD (1.03;95% CI=1.02-1.05;p<0.001) and 4% for UC (1.04;95% CI=1.02-1.06;p<0.001), but remained unchanged from 2008 to *** findings are important to identify IBD patients with higher hospitalization costs and to inform policy plans on hospital resource allocation.

关键词： Anatomy   Biology and life sciences   Colitis   Dermatology   Diagnostic medicine   Digestive system   Erythema   Gastroenterology and hepatology   Gastrointestinal tract   Immunology   Immunomodulation   Inflammatory bowel disease   Medicine and health sciences   Pathology and laboratory medicine   Pyoderma   Research Article   Signs and symptoms   Skin diseases   Ulcerative colitis   Ulcers  

摘要： Background/Aims Extraintestinal cutaneous manifestations of IBD represent a severe disease complication and an early and accurate treatment might positively influence the disease course. Using the patient collective of the Swiss IBD Cohort Study (SIBDCS), we analysed epidemiological as well as clinical factors being associated with the onset of pyoderma gangrenosum, erythema nodosum and aphthous ulcers in IBD patients. Methods We included 3266 SIBDCs patients, 1840 with Crohn's disease (CD) and 1426 with ulcerative colitis (UC) or IBD unclassified (IBDU) and analysed the association of cutaneous manifestations with age, age at diagnosis time, type of disease, gender, family history, HLA-allotype, smoking, intestinal disease activity, therapy and other extraintestinal manifestations (EIM). Results 354 CD patients and 136 UC/IBDU patients presented with skin manifestations at any time during their disease course. In both, CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations. For CD, we also detected a positive family history as associated factor. As an indicator of more intensive intestinal disease activity, patients with cutaneous manifestations of IBD needed more frequently therapy with antibiotics, steroids, immunomodulators and anti-TNF. Multivariate analysis revealed female gender, younger age at diagnosis and presence of other extraintestinal manifestations as factors being associated with skin EIM in IBD patients and anti-TNF as well as immunomodulatory treatment in CD patients. Conclusion Our results suggest that young females with a positive family history of IBD might be at increased risk for the onset of skin manifestations and require a careful screening for such complications.

关键词： cyanocobalamin   methylcobalamin   gut microbiome   inflammatory bowel disease   Enterobacteriaceae  

摘要： Patients with inflammatory bowel disease (IBD) are usually advised to supplement various types of vitamin B-12, because vitamin B-12 is generally absorbed in the colon. Thus, in the current study, the influence of cyanocobalamin (CNCBL) or methylcobalamin (MECBL) ingestion on IBD symptoms will be investigated. Then, whether and how the application of various cobalamins would modify the taxonomic and functional composition of the gut microbiome in mice will be examined carefully. Dextran-sulfate-sodium-induced IBD mice were treated with MECBL or CNCBL;disease activity index (DAI) scores and intestinal inflammatory conditions of mice were evaluated. Fecal samples were collected;microbiota composition was determined with a 16s rRNA analysis;functional profiles were predicted by phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt);and short-chain fatty acids were measured. The consequence of higher relative abundances of Enterobacteriaceae and isomeric short-chain fatty acids by cobalamin treatment revealed that a high concentration of CNCBL but not MECBL supplementation obviously aggravated IBD. A microbial ecosystem rich in Escherichia/Shigella and low in Lactobacillus, Blautia, and Clostridium XVIII was observed in IBD mice after a high concentration of CNCBL supplementation. In cobalamin-dependent enzymes, CNCBL was more efficient in the adenosylcobalamin system than MECBL and vice versa in the MECBL system. The distinct effects of various cobalamins were associated with the distribution and efficiency of vitamin-B-12-dependent riboswitches. CNCBL had a strong inhibitory effect on all riboswitches, especially on btuB and pocR riboswitches from Enterobacteriaceae. CNCBL aggravated IBD via enhancing the proportion of Enterobacteriaceae organisms through riboswitch and enzyme systems. The present study provides a critical reference for offering a suitable amount and type of cobalamin during a symbiotic condition.

关键词： Anatomy   Asia   Autoimmune diseases   Biology and life sciences   Chemical compounds   Chemistry   Clinical immunology   Clinical medicine   Colitis   Colon   Critical care and emergency medicine   Crohn's disease   Digestive system   Epidemiology   Gastroenterology and hepatology   Gastrointestinal tract   Geographical locations   Immunology   Inflammatory bowel disease   Medical risk factors   Medicine and health sciences   Organic chemistry   Organic compounds   People and places   Physical sciences   Research Article   South Korea   Steroids   Ulcerative colitis  

摘要： Background The use of biologics in inflammatory bowel disease (IBD) has increased recently. However, studies on whether the proportion of IBD patient visits to the emergency department (ED) has decreased are scarce. We investigated the trends in IBD-related ED visits and hospitalization rates. Methods Medical records of IBD-related visits to the ambulatory department (AD) and the ED of the Seoul National University Bundang Hospital in 2007, 2009, 2012, and 2014 were reviewed. Multiple-variable logistic regression analysis was used to identify significant risk factors for hospitalization. Results The proportion of IBD patients who visited ED was 12.3% in 2007, 9.7% in 2009, 8.3% in 2012, and 6.4% in 2014 (P = 0.002). The most common chief complaints were abdominal pain (66.9%) in Crohn's disease (CD) patients and hematochezia (36.5%) in ulcerative colitis (UC) patients. The hospitalization rate following ED visits was 47.2% in CD patients and 55.6% in UC patients (P = 0.100). Multiple-variable analysis showed that significant risk factors associated with hospitalization in CD were aggressive disease behavior (odds ratio[OR] 3.54, P = 0.017) and presence of steroid exposure (OR 2.35, P = 0.047). Elevated C-reactive protein (CRP) (>0.5 mg/dL) (OR 5.40, P = 0.016) was the only risk factor associated with hospitalization in UC. Conclusions The proportion of ED visits decreased from 2007 to 2014;there was no significant change in hospitalization rates. Disease behavior/presence of steroid exposure and elevated CRP were associated with hospitalization among CD and UC patients who visited the ED, respectively.

摘要： Microbiota are thought to influence the development and progression of inflammatory bowel disease (IBD), but determining generalizable effects of microbiota on IBD etiology requires larger-scale functional analyses. We colonized germ-free mice with intestinal microbiotas from 30 healthy and IBD donors and determined the homeostatic intestinal T cell response to each microbiota. Compared to microbiotas from healthy donors, transfer of IBD microbiotas into germ-free mice increased numbers of intestinal Th17 cells and Th2 cells and decreased numbers of ROR gamma t(+) Treg cells. Colonization with IBD microbiotas exacerbated disease in a model where colitis is induced upon transfer of naive T cells into Rag1(-/-) mice. The proportions of Th17 and ROR gamma t(+) Treg cells induced by each microbiota were predictive of human disease status and accounted for disease severity in the Rag1(-/-) colitis model. Thus, an impact on intestinal Th17 and ROR gamma t(+) Treg cell compartments emerges as a unifying feature of IBD microbiotas, suggesting a general mechanism for microbial contribution to IBD pathogenesis.

关键词： Inflammatory bowel diseases   irritable bowel syndrome   quality of life   sleep  

摘要： Background: Inflammatory bowel disease (IBD) as a chronic and debilitating disease is affected by sleep disturbance which increases the risk of malignancy. Sleep disturbance is more common in irritable bowel syndrome (IBS) and few reported studies have assessed its role in IBD. We evaluated the effect of IBS on sleep quality and quality of life (QOL) of IBD patients in clinical remission. Methods: In a cross-sectional study, 115 IBD patients in clinical remission aged from 14 to 70 years referred to gastroenterology outpatient departments and private gastroenterology offices from 2007 to 2016. Patients considered in four groups (with/without IBS). The Revised "Rome III criteria" used for diagnosing IBS. Pittsburgh Sleep Quality Index questionnaire and the health-related QOL questionnaire used for evaluating sleep quality and QOL. Results: About 85 (73.9%) cases had ulcerative colitis (UC) and 30 (26.1%) cases had Crohn's disease (CD). Forty (34.8%) cases had IBD + IBS. Poor sleep quality in UC + IBS (OR: 0.018, P = 0.003) and UC (OR: 0.016, P = 0.002) was less than CD. Diseases extent in left side colitis (OR: 0.064, P = 0.016) were less than with pancolitis. Sleep quality affected by quality of life (IBDQ) (P = 0.048). Mean quality of life (IBDQ) in patients who had poor sleep was 11% less than those with good sleep. Conclusions: The syndrome of IBS affects the sleep quality of IBD in clinical remission, especially in CD. Its additive effect with IBD may worsen symptoms that correlated with sleep disturbance, such as pain, psychological and physical condition, and QOL.

摘要： In this issue of Immunity, Britton et al. (2019) demonstrate that the colonization of germ-free mice with microbiotas from inflammatory bowel disease patients induces an altered ratio of ROR gamma t(+) regulatory T cells to T(h17) effector cells and recapitulates human disease severity in colitis-susceptible mice.

关键词： ColoPulse   Budesonide   IBD   Drug targeting   Ileo-colonic  

摘要： Up to 50% of Crohn's disease and ulcerative colitis patients suffer from ileo-colonic inflammation. Topically delivered budesonide is an effective treatment but in vitro as well as clinical data suggest that oral formulations currently used in clinical practice are not optimal to treat the ileo-colon. The aim of this in vitro study was to develop ileo-colonic-targeted zero-order sustained-release tablets containing 3 mg or 9 mg budesonide. Targeted delivery was achieved by coating the tablets with the ColoPulse technology (ColoPulse 3 mg or ColoPulse 9 mg, respectively). Tablets were tested in a 10-h gastrointestinal simulation system for site-specific release, zero-order release kinetics (R-2 >= 0.950), release rate, and completeness of release (>= 80%). Release profiles of the novel formulations were compared with Entocort, Budenofalk, and Cortiment (budesonide MMX). ColoPulse 3 mg and 9 mg were targeted to the simulated ileo-colon, budesonide release was complete and in a sustained zero-order manner, and both formulations complied with a 6-month accelerated stability study. None of the formulations currently used in clinical practice targeted the ileo-colon. These in vitro results are discussed in light of clinical data. ColoPulse 3 mg and 9 mg are novel interesting formulations for the treatment of the entire ileo-colon in inflammatory bowel disease.

关键词： Adverse events   Autoimmune diseases   Biology and life sciences   Cancers and neoplasms   Chemical compounds   Chemistry   Clinical immunology   Clinical medicine   Clinical research design   Colitis   Colonoscopy   Colorectal cancer   Crohn's disease   Digestive system procedures   Gastroenterology and hepatology   Immunology   Immunomodulation   Inflammatory bowel disease   Medicine and health sciences   Oncology   Phosphates   Physical sciences   Research and analysis methods   Research Article   Research design   Sodium phosphate   Surgical and invasive medical procedures   Ulcerative colitis  

摘要： Background and aims Prior studies suggest that colonoscopy may exacerbate inflammatory bowel disease (IBD) symptoms. Thus, our study aimed to determine risk of emergency room (ER) visits associated with colonoscopy among IBD patients and evaluate potential modifiers of this risk. Methods The study population included IBD patients in the Multi-Payer Claims Database who were >20 years old and had a colonoscopy from 2007-2010. We used a self-controlled risk interval design and mixed-effects Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI) comparing the incidence of ER visits in the 1-4 weeks following colonoscopy (risk interval) to the incidence of ER visits in the 7-10 weeks after colonoscopy (control interval). We also conducted stratified analyses by patient characteristics, bowel preparation type, and medication. Results There were 212,205 IBD patients with at least 1 colonoscopy from 2007-2010, and 3,699 had an ER visit during the risk and/or control interval. The risk of an ER visit was higher in the 4-week risk interval following colonoscopy compared to the control interval (RR = 1.24;95% CI: 1.17-1.32). The effect was strongest in those <41 years old (RR = 1.60;95% CI: 1.21-2.11), in women (RR = 1.32;95% CI: 1.21-1.44), and in those with sodium phosphate bowel preparation (RR = 2.09;95% CI: 1.02-4.29). Patients using immunomodulators had no increased risk of ER visits (RR = 0.75;95% CI: 0.35-1.59). Conclusions Our results suggest that there is an increased risk of ER visits following colonoscopy among IBD patients, but that immunomodulators and mild bowel preparation agents may mitigate this risk.

关键词： Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Genome   Microbiome   Transcriptome   Dataset  

摘要： BackgroundInflammatory bowel disease (IBD) is a chronic complex disease of the gastrointestinal tract. Patients with IBD can experience a wide range of symptoms, but the pathophysiological mechanisms that cause these individual differences in clinical presentation remain largely unknown. In consequence, IBD is currently classified into subtypes using clinical characteristics. If we are to develop a more targeted treatment approach, molecular subtypes of IBD need to be discovered that can be used as new drug targets. To achieve this, we need multiple layers of molecular data generated from the same IBD *** and contentWe initiated the 1000IBD project (https://***) to prospectively follow more than 1000 IBD patients from the Northern provinces of the Netherlands. For these patients, we have collected a uniquely large number of phenotypes and generated multi-omics profiles. To date, 1215 participants have been enrolled in the project and enrolment is on-going. Phenotype data collected for these participants includes information on dietary and environmental factors, drug responses and adverse drug events. Genome information has been generated using genotyping (ImmunoChip, Global Screening Array and HumanExomeChip) and sequencing (whole exome sequencing and targeted resequencing of IBD susceptibility loci), transcriptome information generated using RNA-sequencing of intestinal biopsies and microbiome information generated using both sequencing of the 16S rRNA gene and whole genome shotgun metagenomic *** and discussionAll molecular data generated within the 1000IBD project will be shared on the European Genome-Phenome Archive (https://***, accession no: EGAS00001002702). The first data release, detailed in this announcement and released simultaneously with this publication, will contain basic phenotypes for 1215 participants, genotypes of 314 participants and gut microbiome data from stool samples (315 participants) and