关键词： HOMOCYSTEINE   FOLIC acid   INFLAMMATORY bowel diseases   SULFUR in animal nutrition   AMINO acids  

关键词： Administration   Costs and cost analysis   Denmark   Intravenous   Iron   Iron deficiency anemia  

摘要： IntroductionThe incidence of inflammatory bowel disease (IBD) in Denmark is among the highest in the world, with Crohn's disease and ulcerative colitis occurring at rates of 9.1 and 18.6 per 100,000 person-years respectively in 2010-2013. Anemia is the most prevalent extraintestinal complication of IBD, most commonly caused by iron deficiency. In treating IBD-associated iron deficiency anemia (IDA), intravenous iron is more effective and better tolerated and shows a faster response than oral iron. The present study evaluated resource use and costs associated with using iron isomaltoside (Monofer;IIM) versus ferric carboxymaltose (Ferinject;FCM) in patients with IDA and IBD in *** budget impact model was developed to evaluate the cost of IIM compared with FCM from a Danish healthcare payer perspective. Iron deficits were modeled using dosing tables and a joint distribution of bodyweight [mean 75.4kg, standard deviation (SD) 17.4kg] and hemoglobin (mean 10.8g/dL, SD 1.4g/dl) based on observational data from patients with IBD. Retreatment frequency was modeled using a pooled retrospective analysis of randomized trial data, and costs were modeled using diagnosis-related groups with an outpatient infusion cost of DKK *** IIM required 1.2 infusions (per treatment) to correct the mean iron deficit compared with 1.6 with FCM. Treating 2.54 patients with IIM would therefore avoid one infusion compared with FCM. Patients using IIM required multiple infusions in 25.0% of cases compared with 64.3% with FCM. Over 5years, total estimated costs were DKK 21,406 per patient with IIM compared with DKK 28,137 with FCM, corresponding to savings of DKK 6731 with *** IIM in place of FCM markedly reduced the number of iron infusions required in patients with IBD and IDA in Denmark. The reduction in infusions was accompanied by reductions in cost compared with *** A/S.

关键词： Very early onset   Inflammatory bowel disease   Monogenic disease   Whole-exome sequencing   Targeted therapy   Personalized care  

摘要： Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, of which ulcerative colitis and Crohn's disease are the 2 most prevailing entities. Very early onset IBD (VEO-IBD) children diagnosed with IBD under age 6 years. Although the etiology of IBD is mostly unknown, it involves a complex interaction among host genetics, microbiota, environmental factors, and aberrant immune responses. Advances in the understanding of the genetic contribution, which appears to be much more significant in younger children, gives us a useful insight into the pathogenesis and potential future therapeutic targets in IBD.

关键词： Inflammatory bowel disease   Crohn's disease   ulcerative colitis   surgery   consensus   clinical guideline  

摘要： Aim There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. Methods Results Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. All aspects of surgical care for IBD have been included along with 157 recommendations for management. Conclusion These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

关键词： clostridium difficile infections   feces   inflammatory bowel disease   lipiarmycin   pharmacokinetics   plasma drug concentration   safety  

摘要： Objectives: Inflammatory bowel disease (IBD) poses an increased risk for Clostridium difficile infection (CDI). Fidaxomicin has demonstrated non-inferiority to vancomycin for initial clinical cure of CDI in patients without IBD;however, lack of data has caused concerns regarding potential systemic absorption of fidaxomicin in patients with IBD. Methods: The plasma pharmacokinetics (PK) of fidaxomicin and its primary metabolite OP-1118 were evaluated in a multicentre, open-label, single-arm, Phase IIIb/IV study enrolling patients with active IBD and CDI. Patients received fidaxomicin, 200 mg twice daily for 10 days. The primary and secondary endpoints were, respectively, plasma and stool PK of fidaxomicin and OP-1118 on Days 1, 5 and 10 of treatment. Other secondary endpoints included safety of fidaxomicin treatment (assessed until Day 180). ClinicalTrials. gov identifier: NCT02437591. Results: Median T-max of fidaxomicin and OP-1118 for the PK analysis set (PKAS;24 patients) was 1-2 h across Days 1, 5 and 10. C-max ranges were 1.2-154 ng/mL for fidaxomicin and 4.7-555 ng/mL for OP-1118 across Days 1, 5 and 10 (PKAS). The ranges of concentrations in stool were 17.8-2170 mu g/g for fidaxomicin and 0-1940 mu g/g for OP-1118. Sixty percent (15/25) of patients experienced treatment-emergent adverse events (TEAEs), none of which led to treatment discontinuation or death. Conclusions: Maximum fidaxomicin and OP-1118 plasma concentrations observed in this study population suggest no increase in absorption, compared with patients without IBD. Incidence of TEAEs was similar to previous Phase III trials, suggesting that fidaxomicin is comparatively well tolerated in patients with IBD.

关键词： anaemia   children   Crohn's disease   hepcidin   inflammatory bowel disease   ulcerative colitis  

摘要： Aim: Hepcidin is a central regulator of iron homeostasis. Its production is also influenced by systemic inflammation. The aims of this study were to compare hepcidin levels in paediatric patients newly diagnosed with Crohn's disease (CD) and ulcerative colitis (UC) and to determine the association of hepcidin levels with laboratory and clinical parameters of inflammatory bowel disease (IBD) activity. Methods: Children with newly diagnosed IBD between January 2012 and September 2016 were enrolled in this comparative cross-sectional study. We analysed levels of serum hepcidin, C-reactive protein, iron, ferritin, soluble transferrin receptors, blood count and faecal calprotectin in all subjects. Serum hepcidin levels were measured by reverse-phase liquid chromatography. The Paediatric Crohn's Disease Activity Index was used to evaluate CD in children, and Paediatric Ulcerative Colitis Activity Index was used for the assessment of UC disease activity. Results: Subjects with CD (n = 53) had significantly higher serum hepcidin levels compared with subjects with UC (n = 23) -22.6 ng/mL (range 8.5-65.0) versus 6.5 ng/mL (range 2.4-25.8) (P < 0.05). Hepcidin was independently associated with ferritin levels in all IBD patients (P < 0.05). Moreover, there was a significant positive correlation between hepcidin and platelet count (P < 0.05) in children with CD and a negative correlation between hepcidin and faecal calprotectin (P < 0.05) in children with UC. Conclusion: Different hepcidin levels between children with newly diagnosed CD and UC suggest the distinct contribution of iron deficiency and/or systemic inflammation to anaemia and may help clinicians choose the best anti-anaemic treatment.

摘要： Objectives: The gut microbiota in patients with inflammatory bowel disease (IBD) are perturbed in both composition and function. The vaginal microbiome and its role in the reproductive health of women with IBD is less well described. We aim to 1) compare the vaginal microbiota of women with IBD to healthy controls and 2) evaluate the association between IBD severity and composition of the vaginal microbiota. Methods: Women with ulcerative colitis (UC), Crohn’s disease (CD), and indeterminate colitis (IC) enrolled in a longitudinal cohort study provided self-collected vaginal swabs. Healthy controls underwent provider-collected vaginal swabs at annual gynecologic exams. All participants completed surveys on health history and IBD symptoms if applicable. Microbiota were characterized by sequencing the V4 region of the 16S rRNA gene. Operational Taxonomic Unit assignments were made using the biobakery 16S uparse workflow. Associations between patient characteristics and microbial community composition (using Bray Curtis distance) were evaluated by PERMANOVA, and with individual taxa by MaAsLiN. Women with > 50% of sequences from Lactobacillus species were considered to have a Lactobacillus dominant microbiome. This was compared between groups using chi-square or logistic regression. Results: The cohort included 59 women with IBD (28 UC, 27 CD, 4 IC) and 27 controls. A majority, 76 (88%) were Caucasian; 27 (46%) with IBD and 6 (22%) controls were menopausal. In the overall cohort, the composition of the vaginal microbiota did not vary significantly by IBD diagnosis or severity of IBD but did vary by age (p= 0.001). After stratifying by menopause, Bray-Curtis dissimilarity was significantly associated with IBD diagnosis in premenopausal women (p=0.02) but not postmenopausal women (p=0.1). Lactobacillus dominance varied by IBD diagnosis: UC 11/28 (39%), CD 11/25 (44%), IC 1/4 (25%), controls 27/27 (100%) (p<0.001). In a multivariable model adjusted for menopause, Lactobac

关键词： Inflammatory bowel disease   Circadian rhythms   Chronotype   Crohn's disease   Ulcerative colitis   Sleep debt  

摘要： The preference of the sleep/wake cycle can be grouped into categories or chronotypes. Inflammatory bowel disease (IBD) has been linked to poor sleep quality which correlates with disease severity. Social jet lag (SJL) is the difference between sleep timing on work and free days and is a marker for circadian misalignment which has been linked to increased inflammation. We investigated whether chronotype, SJL, sleep debt (SD), and food timing were associated with an IBD specific complications and a lower quality of life. Overall, 191 subjects (115 IBD subjects and 76 healthy controls (HC)) completed the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), Munich ChronoType Questionnaire (MCTQ), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and a structured Food Timing Questionnaire. Later chronotype (by MEQ) was associated with a worse SIBDQ (r = -0.209;P < 0.05). SJL was increased in IBD at 1.32 h +/- 1.03 vs. 1.05 h +/- 0.97 in HC, P < 0.05, when adjusted for age. SJL (>2 h) was present in 40% of severe/complicated Crohn's patients (fistulizing or structuring Crohn's or history of Crohn's related surgery) compared to only 16% of uncomplicated Crohn's patients (P < 0.05). Sleep debt was increased in IBD subjects compared to HC at 21.90 m +/- 25.37 vs. 11.49 m +/- 13.58, P < 0.05. IBD subjects with inconsistent breakfast or dinner times had lower SIBDQ scores (4.78 +/- 1.28 vs. 5.49 +/- 1.02, P < 0.05;4.95 +/- 0.31 vs. 5.42 +/- 0.32, P < 0.05 respectively). In summary, later chronotype, and markers of circadian misalignment (social jet lag, sleep debt, and inconsistent meal timing) were associated with IBD disease specific complications and/or lower quality of life. (c) 2018 Elsevier B.V. All rights reserved.

关键词： Meta-Analysis   Prebiotics   Intestinal Diseases   Review, Systematic   Robustness   Trials   Demonstrate   Functional foods   experimentation   Inflammatory Bowel Diseases  

关键词： cost-sharing   health expenditure   heathcare utlization   inflammatory bowel disease  

摘要： Objectives (1) To identify the cost-driving factors of health expenditure in inflammatory bowel disease (IBD), (2) to determine the effect of different cost-sharing levels on outpatient visits and (3) to determine the effect of different cost-sharing levels on medication adherence among patients with IBD. Method Key findings This was a retrospective, longitudinal study in which data were collected from 1999 to 2013 using the Medical Expenditure Panel Survey. The study sample included all patients who had IBD, were at least 18 years old, and had insurance. A comprehensive list of demographic factors was assessed to identify cost-driving factors associated with high level of expenditure in IBD. Two logistic regression models were built to examine the association between outpatient cost sharing and number of outpatient visits, and between prescription cost sharing and medication adherence. Statistical significance was evaluated at P Significant cost-driving factors included age, body mass index, education, income, quality of life, Charlson Comorbidity Index and region. The study found that low outpatient cost sharing was associated significantly with high level of outpatient visits. However, different levels of prescription cost sharing had no significant relationship with medication adherence. Conclusions The finding confirms the existence of financial barriers to care in IBD, which may lead to suboptimal outpatient and, thus, the rapid worsening of the diseases. The finding of cost-driving factors allows the identification of high-risk group for high expenditure, which can be used for future cost-saving strategy.