关键词： Inflammatory bowel disease   Sleep   Oximetry   Polysomnography   Crohn's disease  

摘要： BackgroundPoor sleep quality is associated with adverse health consequences. Sleep disturbances can impact the immune function and inflammatory processes. Little is known about sleep disturbances in patients with inflammatory bowel disease (IBD), while not in flare, i.e., *** prospectively explore the sleep quality of patients with an inactive *** pilot study included 36 consecutive patients with IBD and 27 healthy volunteers. All IBD patients had an inactive disease. Participants underwent an overnight ambulatory polysomnography. Data on disease duration, medications, complications, and treatment were collected from the medical *** mean age of the IBD and the control groups was 3915 and 34.6 +/- 9.6years. A significantly less rapid eye movement (REM) sleep was noted in the IBD group vs. control (23.7 vs. 27.8%, p=0.047);light sleep percentage and REM latency were also longer in the IBD group. Moreover, oxygen desaturation below 90% was more common in the IBD group. All other sleep parameters including respiratory disturbance index, apnea-hypopnea index, number of wakes, sleep latency, and snoring strength were similar in both *** Inactive IBD is associated with sleep disturbances. A larger prospective study should be conducted to confirm these findings.

关键词： inflammatory bowel disease genetics   osteoporosis   genome-wide association analysis  

摘要： Background and AimPatients with inflammatory bowel disease (IBD) are at a high risk of low bone mineral density (BMD). Reportedly, clinical and genetic factors cause low BMD in Caucasians;however, studies in non-Caucasian populations remain scarce. MethodsClinical risk factors for low BMD were investigated in 266 Japanese patients with IBD, and a genome-wide association analysis (GWAS) was performed using linear regression with associated clinical factors as covariates. Genotyping was performed using a population-optimized genotyping array (Japonica array((R))). After quality control, the genotype data of 4384682 single-nucleotide polymorphisms (SNPs) from 254 patients with IBD were used for GWAS. ResultsBody mass index, age, and disease duration were independently associated with the BMD of the femoral neck (P=1.41E-13, 1.04E-5, and 1.58E-3, respectively), and body mass index and sex were associated with the BMD of the lumbar spine (P=6.90E-10 and 6.84E-3, respectively). In GWAS, 118 and 42 candidate SNPs of the femoral neck and lumbar spine, respectively, were identified. Among 118, 111 candidate SNPs of the femoral neck were located within the SLC22A23 gene, which is a known IBD susceptibility gene (minimum P=1.42E-07). Among 42, 18 candidate SNPs of the lumbar spine were located within the MECOM gene, which is associated with osteopenia (minimum P=5.86E-07). Interestingly, none of the known loci showed a significant association with BMD. ConclusionsAlthough clinical risk factors for low BMD in IBD were similar to those in the general population, genetic risk factors were rather different.

关键词： Inflammatory Bowel Disease   Patient experience   Qualitative review   Nursing  

摘要： Background: Inflammatory Bowel Disease is a chronic, untreatable condition represented by two illnesses, Crohn's and Ulcerative Colitis. Despite high incidence in well-developed industrialised countries, and the significant impact of symptoms on patients quality of life, little is known about living with Inflammatory Bowel Disease. Aim: To explore the patients' experiences of living with Inflammatory Bowel Disease. Design: A qualitative systematic review. Data sources: CINAHL, Medline, British Nursing Index and PsycINFO were searched using the following keywords: Inflammatory Bowel Disease AND experiences. We have limited the search to studies published in English from 2000 to 2017. Review method: Thematic synthesis. Results: Data from 23 studies, identified that fatigue, incontinence and uncertainty about future, body image, and lack of information from healthcare professionals dominated the experiences of those living with Inflammatory Bowel Disease. Also, patients living with Inflammatory Bowel Disease were reluctant to disclose their illness due to lack of public awareness and stigma surrounding symptoms. From these, an overarching theme has been identified: Living in isolation and exclusion. Conclusion: Patients with Inflammatory Bowel Disease face a variety of problems, often their priorities and those of healthcare professionals differ greatly. Healthcare professionals have little evidence needed to provide adequate, holistic care to this group. With a rise in the Inflammatory Bowel Disease population in newly industrialised countries it is estimated that the condition is turning into a global disease, potentially making long term care unsustainable. More evidence is needed to understand the concerns of this group.

关键词： Clostridium difficile   Risk factor   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Cytomegalovirus   Colectomy  

摘要： Background and AimsClostridium difficile infection (CDI) incidence and risk factors in patients with inflammatory bowel disease (IBD) have been extensively studied. However, data describing CDI in Chinese patients with IBD are limited. We investigated the cumulative incidence, risk factors, and outcomes of CDI in Chinese IBD *** conducted a retrospective, case-control study of patients hospitalized with IBD and CDI at Peking Union Medical College Hospital from January 2010 to December 2015. CDI was diagnosed based on the presence of active symptoms and positive enzyme immunoassay-based stool test results for C. difficile toxin A or B (CDAB). Controls were selected from CDAB-negative patients with IBD and matched by age, gender, phenotypes of IBD and the same time period of CDAB testing at a 1:2 or 1:3 *** identified 60 (7.41%) cases of CDI among 810 patients with IBD, and 137 control cases were selected. Univariate analysis revealed that IBD patients with CDI had higher rates of concurrent corticosteroid use, proton pump inhibitor, antibiotic use, recent hospitalization, parenteral nutrition support, and cytomegalovirus (CMV) coinfection (P<0.05). Multivariate analysis revealed that concurrent corticosteroid use (odds ratio [OR]=6.803, 95% confidence interval [CI]=2.901-15.954, P<0.001) and hospitalization within 1month (OR=3.028, 95% CI=1.225-7.480, P=0.016) were associated with CDI. CMV and C. difficile coinfection (hazard ratio [HR]=4.185, 95% CI=1.492-11.736, P=0.007) as well as disease severity (HR 2.070, 95% CI=1.006-4.261, P=0.048) were independently associated with colectomy following *** patients with concurrent corticosteroid use and recent hospitalization are at a higher risk of CDI. CMV and C. difficile coinfection is associated with poorer outcomes.

关键词： Crohn disease   growth hormone resistance   TH17 cytokines   ulcerative colitis  

摘要： Objective: Fatigue is common among patients with inflammatory bowel disease (IBD). Proinflammatory cytokines are elevated in chronic inflammation and can induce "sickness behaviors,'' such as fatigue. Chronic inflammatory states also lead to growth hormone resistance, demonstrated by low levels of insulin-like growth factor (IGF-1) and elevated growth hormone. This study evaluated the relationship between IGF-1, proinflam-matory cytokine levels, and fatigue in patients with IBD. Methods: In this prospective study children with IBD, ages 10 to 16 years, were recruited from a subspecialty ambulatory clinic. Participants and their parents completed age-appropriate generic and disease-specific health-related quality of life (HRQOL) instruments. Serum samples obtained at the same encounter were analyzed for Th17 cytokine and IGF-1 levels. HRQOL scores were compared to a healthy sample and HRQOL scores and cytokine levels were compared by IGF-1 z score quartiles. Results: A total of 67 patients with IBD were recruited, median age of 13.7 years (interquartile range, 11.7-15.3). Forty-eight (72%) had inactive disease based on Physician Global Assessment. Patients with IBD reported lower generic HRQOL (P = 0.0006) and more fatigue (P = 0.0004) than a healthy sample. Patients with IGF-1 z scores in the lowest quartile had significantly lower disease-specific HRQOL (P = 0.01) and more fatigue (P = 0.02) than the remainder of the cohort. Serum interleukin (IL)-10, IL-17A, IL-6, and interferon-gamma were significantly higher in patients with IBD with IGF-1 z scores in the lowest quartile (P < 0.05). Conclusions: Children with subclinical IBD experience more fatigue and lower generic HRQOL than healthy children. Lower IGF-1 z scores are associated with more fatigue, and this relationship may be mediated through proinflammatory cytokines.

关键词： Crohn's disease   Inflammatory bowel disease   Therapy   Ulcerative colitis  

摘要： Inflammatory bowel disease (IBD) is a chronic heterogeneous group of diseases that has undergone major advances in the understanding of its etiology and pathogenesis in recent years. The development of biologics had resulted in better overall management of the disease, including lower rates of surgery and better long-term clinical and patient-reported outcomes. Treatment modalities have either been newly developed or extrapolated from their approved use for a different indication. Modes of action and treatment targets have varied as well. Treatments such as vedolizumab and ustekinumab, as well as second-generation corticosteroids have been approved by the US Food and Drug Administration (FDA) for the treatment of IBD. Other agents are currently being developed at various stages of clinical trials including anti-adhesion agents such as etrolizumab and abrilumab, JAK inhibitors such as tofacitinib, and anti-trafficking molecules. Toll-like receptors and phosphatidylcholine are also new promising emerging targets that are being investigated in phase 3 clinical trials. It is projected that many therapies will become available in the coming years if supported by the results of current clinical trials. This will provide IBD patients with a wide array of options and allow physicians to choose the best therapies for each individual patient.

关键词： Secukinumab   Oral aphthous ulcers   Tocilizumab   Inflammatory bowel disease  

摘要： Background. - Secukinumab, a humanized monoclonal antibody targeting interleukin 17A, has been associated with the development of inflammatory bowel diseases. We report a case of a female patient developing recurrent oral ulcers prior to inflammatory bowel disease induced by secukinumab. The patient had developed similar oral ulcers 6 years earlier while on tocilizumab (targeting IL6R), suggesting an immunological link between the two episodes. Patients and methods. - A 36-year-old female patient had refractory spondylarthrosis. In 2010, she had presented oral aphthous ulcers during treatment with tocilizumab. In 2011, tocilizumab was stopped and the ulcers resolved. In 2016, secukinumab was introduced and led to recurrence of oral aphthous ulcers followed by ileitis-pancolitis. Corticosteroids and ustekinumab resulted in partial remission. Discussion. - The patient developed inflammatory bowel disease during treatment with secukinumab, preceded by recurrent oral aphthous ulcers. She had presented similar oral ulcers 6 years earlier while on a treatment targeting IL6R. IL6 is a pleiotropic cytokine that may activate the Th17 pathway. Thus, tocilizumab could have induced an "anti-11.17-like" effect, accounting for the occurrence of oral aphthous ulcers, possibly related to mild inflammatory bowel disease. Conclusion. - The occurrence of oral ulcers during treatment with secukinumab may herald inflammatory bowel disease. In patients with a previous history of recurrent aphthous stomatitis, especially where induced by previous biologics, consideration must be given to the risk-benefit ratio of prescribing an anti-IL17 antibody. (C) 2018 Elsevier Masson SAS. Alt rights reserved.

关键词： clinical outcomes   follow-up loss   inflammatory bowel disease   predictors  

摘要： Background and AimNonadherence is a risk factor of disease worsening in inflammatory bowel disease (IBD). We analyzed the frequency, predictors, and clinical outcomes of patients with IBD who are lost to follow-up in outpatient clinics. MethodsMedical records of 784 IBD patients visiting our IBD clinic between January 2010 and December 2015 were reviewed retrospectively. Overall, 285 newly diagnosed IBD patients who were followed up for at least 12months were included in the analysis. ResultsFor 285 IBD patients (161 ulcerative colitis and 124 Crohn's disease), the mean disease duration was 66.334.0months (7-137months). Forty-two patients (14.7%;27 ulcerative colitis and 15 Crohn's disease) were lost to follow-up. On multivariate regression analysis, travel time to clinic (odds ratio, 2.37;95% confidence interval, 1.63-3.45;P=0.01) and C-reactive protein levels at diagnosis (odds ratio, 0.63;95% confidence interval, 0.43-0.68;P=0.01) were significantly associated with follow-up loss. Among the 42 patients lost to follow-up, 36 (85.7%) revisited the clinic. The cause of revisit was disease flare-up in 22 patients (61.1%). Step-up treatment was needed in 15 patients (41.7%). Steroid was introduced in 14 patients (38.9%). Azathioprine and an antitumor necrosis factor agent were newly prescribed in three patients (8.3%) and one patient (2.8%), respectively. ConclusionsFollow-up loss rate for IBD patients in remission state was 14.7%, and the predictors were far from hospital and low C-reactive protein levels. Because most of follow-up loss patients experienced flare-up, clinicians need to try to encourage patients to keep their adherence.

关键词： Urine   Emphysema   Plastic surgery   Abdomen   Arthritis   Crohns disease   Mutation   Tuberculosis   Proteins  

摘要： Skin biopsy under hematoxylin and eosin staining showed mild increase in collagen and marked reduction in elastin fibers under orcein stain with fragmentation and elastolysis of elastin in the mid and deep dermis suggestive of cutis laxa [Figure 2]. Generalized acquired cutis laxa can be idiopathic or associated with infections, drugs, sarcoidosis, amyloidosis, systemic lupus erythematosus, glomerulonephritis, mesangial IgA nephropathy, paraproteinemia, multiple myeloma and Hodgkin’s disease. [4] Our patient with generalized cutis laxa was associated with IgA nephropathy, Crohn’s disease, and inflammatory polyarthritis suggesting that elastic tissue destruction may be an immune-mediated mechanism, as seen with these autoimmune disorders.