关键词： Inflammatory bowel disease   Crohn's disease   ulcerative colitis   vedolizumab   drug monitoring  

摘要： Background and aims: The efficacy of vedolizumab (VDZ) has been demonstrated in clinical trials. The aim of this report is to evaluate the long-term effectiveness and safety of VDZ in a real-world cohort and to explore possible associations between concentration measurements of VDZ and treatment effectiveness. Methods: This is a prospective clinical follow-up including all adult patients with ulcerative colitis (UC) and Crohn's disease (CD) treated with VDZ from October 2014 until September 2017 at a single center in Norway. The patients were followed for at least 14 weeks or until termination of treatment. Clinical and biochemical activity were obtained at every infusion throughout follow-up. Plasma measurements of VDZ (p-VDZ) were performed before every infusion during maintenance therapy. Results: In total, 71 patients received VDZ. Improvement of CRP and hemoglobin was observed in CD but not in UC, whereas Partial Mayo Score improved in UC while no change in Harvey Bradshaw Index was revealed in CD. Furthermore, CRP at baseline was negatively correlated with p-VDZ at week 14 in CD but not in UC patients. Conclusion: Improvement of biochemical markers of inflammation was observed in CD while clinical activity scores improved in UC patients. For CD, baseline CRP was correlated with lower concentrations of p-VDZ at week 14.

关键词： Clinical manifestation   inflammatory bowel disease   China   infant   phenotypic characteristics  

摘要： A retrospective analysis of the phenotypic characteristics, clinical manifestations, investigations and interleukin-10 receptor (IL-10R) status of inflammatory bowel disease (IBD) in infants and children under 2 years of age in Liaoning Province, China between January 2015 and October 2016 is described. Six patients without a family history of IBD were diagnosed with Crohn disease, and IL-10R mutations were detected in five of them. Compound heterozygous patients with IL-10R mutations had severe clinical manifestations, were resistant to standard medication for IBD and had a poor prognosis as haematopoietic stem cell transplantation (HSCT) was not undertaken. Two of these patients died of suspected septicaemia. IBD in infants and children under 2 years of age is life-threatening when patients with IL-10R mutations do not receive allogeneic HSCT.

摘要： The article reviews the article on hybrid imaging such as positron emission tomography (PET)/computed tomography (CT) for grading inflammation in Crohn's disease (CD).

关键词： Inflammatory bowel disease   Crohn's disease   ulcerative colitis   indeterminate colitis   inflammatory bowel disease unclassified   IBD-U   register-based definition  

摘要： Aim: To investigate inflammatory bowel disease (IBD) register-based subtype classifications over a patient's disease course and over time. Methods: We examined International Classification of Diseases coding in patients with >= 2 IBD diagnostic listings in the National Patient Register 2002-2014 (n = 44,302). Results: 18% of the patients changed diagnosis (17% of adults, 29% of children) during a median follow-up of 3.8 years. Of visits with diagnoses of Crohn's disease (CD) or ulcerative colitis (UC), 97% were followed by the same diagnosis, whereas 67% of visits with diagnosis IBD-unclassified (IBD-U) were followed by another IBD-U diagnosis. Patients with any diagnostic change changed mostly once (47%) or twice (31%), 39% from UC to CD, 33% from CD to UC and 30% to or from IBD-U. Using a classification algorithm based on the first two diagnoses ('incident classification'), suited for prospective cohort studies, the proportion adult patients with CD, UC, and IBD-U 2002-2014 were 29%, 62%, and 10% (43%, 45%, and 12% in children). A classification model incorporating additional information from surgeries and giving weight to the last 5 years of visits ('prevalent classification'), suited for description of a study population at end of follow-up, classified 31% of adult cases as CD, 58% as UC and 11% as IBD-U (44%, 38%, and 18% in children). Conclusions: IBD subtype changed in 18% during follow-up. The proportion with CD increased and UC decreased from definition at start to end of follow-up. IBD-U was more common in children.

关键词： Bacteria   E. coli   etiology   dysbiosis   immune system   IBD  

摘要： Hosts and microbes have co-evolved over millions of years. Inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic immune-mediated diseases. Although the etiology of IBD remains an enigma, various studies have proposed the involvement of mucosa-associated Escherichia coli (E. coli) strains in the pathogenesis of IBD. E. coli, a usual inhabitant of the intestine, causes disease after acquiring virulence factors;however, the mechanisms underlying this phenomenon are not well understood. In the present review, we will discuss recent findings on how gut E. coli regulates and controls gut homeostasis and the pathogenesis of IBD. We will also summarize current knowledge regarding the cause, mechanism, genetics, and environmental factors involved in the regulation of IBD. Furthermore, we will discuss the possibility of alterations in innate and acquired immunity during the course of disease as well as possible treatment.

关键词： Probiotics   inflammatory bowel diseases   ulcerative colitis   Crohn's disease  

摘要： Inflammatory bowel diseases (IBD) encompass ulcerative colitis (UC), Crohn's disease (CD) and indeterminate colitis (IC), characterising chronic inflammation in the gastrointestinal tract, associated with changes in the immune system and in the intestinal microbiota. Thus, probiotics may offer an alternative or adjuvant approach to conventional therapy. The present review aims to summarise the mechanisms of action of probiotics in IBD and their therapeutic effects. Most of the studies suggest that probiotics are effective in the treatment of UC, especially when several strains are concomitantly administered. Species of Lactobacillus and Bifidobacterium genres are the most commonly used, and some studies even indicate that it is possible to replace medical therapy with probiotic supplementation. Regarding CD, the results of clinical trials are controversial and do not support the use of probiotics in this disease. In conclusion, probiotic supplementation is a promising adjuvant treatment in UC, but not in CD.

关键词： Inflammatory bowel disease   Crohn's disease   ulcerative colitis   paediatric   low   to middle-income countries   surgery   medical management   very early onset  

摘要： Inflammatory bowel disease (IBD) should be considered in any child with a persistently altered bowel habit. Growth failure may be a consequence and there may also be extra-intestinal manifestations. Oesophago-gastroduodenoscopy and colonoscopy and conventional histopathology are the diagnostic tools of choice in IBD. The identification and management of children with IBD in resource-poor settings is difficult and there are few data on its prevalence in low- and middle-income countries. The main challenges are a lack of resources and infrastructure including trained personnel in settings where there are other priorities for maintaining the health and wellbeing of children. The identification and management of children with inflammatory bowel conditions often depends on the enthusiasm, skill and commitment of a few dedicated individuals.

关键词： Nicotinamide phosphoribosyltransferase (Nampt)   pre-B factor (PBEF)   visfatin   inflammatory bowel disease (IBD)   Crohn's disease   ulcerative colitis   mucosal healing   biomarker   hypoxia   epithelial-to-mesenchymal transition  

摘要： Nicotinamide phosphoribosyltransferase's (Nampt) association with inflammatory bowel disease (IBD) is unclear. The study was aimed at unraveling Nampt's clinical and diagnostic relevance. The serum concentration (Luminex-xMAP (R) technology) was measured in 113 patients with Crohn's disease (CD), 127 with ulcerative colitis (UC) and 60 non-IBD controls: 40 healthy individuals and 20 with irritable bowel syndrome (IBS). The leukocyte (44 CD/37 UC/19 IBS) and bowel expression (186 samples) was also evaluated (RT-qPCR). All were referred to IBD phenotype, activity, treatment, and inflammatory/nutritional/angiogenic/hypoxia indices. Serum-Nampt and leukocyte-Nampt were positively correlated and were more elevated in active-IBD than in IBS, with leukocyte-Nampt being a fair differential marker. Serum-Nampt in UC positively correlated with its clinical and endoscopic activity as well as with pro-inflammatory cytokines. Serum-Nampt 1.54 ng/mL was a good indicator of mucosal healing. The expression of Nampt was up-regulated both in inflamed and quiescent colon and reflected, similarly to leukocyte-Nampt, the clinical activity of IBD. Bowel-Nampt was independently associated with IL1B and hypoxia-inducible factor 1 (HIF1A) expression in inflamed bowel but with FGF2 expression in quiescent bowel. In summary, Nampt's elevation in IBD at local and systemic levels, and protein and mRNA levels, reflects IBD activity and is associated with inflammation, hypoxia (active) and tissue repair (inactive disease).

摘要： The management of the inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, has been revolutionised in the last decade by the availability of efficacious medical therapies and by the adoption of effective new treatment strategies utilising these agents. The most effective medical therapies are immunomodulators (thiopurines and methotrexate) and biologic agents (anti-tumour necrosis factor agents and adhesion molecule inhibitors), often used in combination. The most significant advance in treatment strategy has been the gradual adoption of a treat-to target approach in which treatment goals extend beyond symptom control to the objective normalisation of inflammatory biomarkers. This means that patients are asked to undergo regularly scheduled investigations to assess the activity of their disease. Although colonoscopy remains the gold-standard investigation in IBD it is invasive, costly and carries small risks. Therefore, non-invasive investigations to monitor disease activity in IBD are required and have been developed in recent years; these include fecal tests and intestinal ultrasound. Fecal tests measure calprotectin, a protein in neutrophils in the gastrointestinal tract for which the sensitivity and specificity of measuring intestinal inflammation is high, especially for colonic disease. Fecal calprotectin tests are cumbersome, not popular with patients, and not currently reimbursed by Medicare, costing patients ≈ $85/test – during periods of active disease these may need to be repeated 3-6 monthly. Intestinal ultrasound has emerged as a highly accurate and practical means of performing tight disease monitoring in IBD in the last 5 years. Although it was initially used predominantly for small bowel disease, accuracy for colonic disease is also excellent, meaning it is useful for both Crohn's disease and ulcerative colitis. There is no need for fasting nor bowel preparation, there is minimal if any discomfort, the tests is easily repeated an

关键词： Adipocytokines   Adiponectin   Inflammation   Bowel disease  

摘要： In just over a generation overweight and obesity has become a worldwide health concern. The ramifications for this on future health care costs and longevity are consequent, whilst increased adiposity is a harbinger for diabetes, kidney and bone failure, and cancer. An area of intense interest where the role of adiposity is avidly discussed is in inflammatory bowel disease (IBD), which presents mainly as Crohn's disease (CD) and ulcerative colitis (UC). Studies in patients associating IBD with a western diet are divergent. Nevertheless, elegant studies have found gene polymorphisms in humans that in murine models parallel the inflammatory and gut micro-biome changes seen in IBD patients. However, an area not to be ignored are the alterations in adipocyte function with ensuing adiposity, in particular and a focus of this review, the dysregulation of the levels of adipocytokines such as leptin and adiponectin. Herein, we present and discuss the known influences of a western diet on IBD in patients and rodent models and how adipocytokines could influence the IBD disease process.