关键词： Giant cell arteritis   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Vasculitis  

摘要： Background: Giant cell arteritis (GCA) is an autoimmune disorder which primarily affects large vessels, whilst inflammatory bowel diseases (IBD) mainly target the gut. Co-existence of the two maladies has been reported sporadically in the literature;therefore the purpose of this study was to assess the authenticity of such an association in a large, cross-sectional study. Methods: Utilizing data derived from the Clalit Health Services' registry, the largest health maintenance organization in Israel, we compared the proportion of CD and UC in GCA patients with age-and gender-matched controls. Univariate analysis was performed using Chi-square and student t-test and a multivariate analysis was performed using a logistic regression model. Results: The study included 3938 GCA patients and 21,623 age-and gender-matched controls. GCA patients had a significantly increased proportion of both CD and UC in comparison with controls (0.79% vs. 0.12% and 0.84% vs. 0.21%, P-value <.001, respectively). The strength of the association between GCA and IBD was negatively correlated with the patients' age;thus the association was more robust amongst middle-aged patients (ages 50-69, OR = 8.13) than in elderly patients (ages 70-85, OR = 3.81). The association between GCA and IBD remained significant when evaluated independently of confounding factors (OR = 2.63, P-value <.001). Conclusions: The probability that GCA patients also suffer from IBD is increased in comparison with age-and gender-matched controls. Our findings indicate that this association is more prominent in middle-aged patients (50-69 years of age). Screening for IBD amongst GCA patients in this age group may be warranted.

摘要： Randomized controlled trials (RCTs) have demonstrated that therapies targeting tumor necrosis factor (TNF) and α₄β₇ integrin are effective when given as monotherapy in inducing and/or maintaining remission in patients with ulcerative colitis (UC) or Crohn's disease (CD), but data from RCTs are less clear on whether concomitant immunomodulator (IM) therapy confers additional benefit. In CD, RCT data are mixed, [1,2] as are results of systematic reviews and meta-analyses, showing no benefit overall, [3] minimal benefit with individual agents, [4] and comparative benefit over some monotherapies but not others. [5] For example, concomitant azathioprine with infliximab is more effective than either drug alone in patients with CD naive to both drugs, [2] but whether combination therapy is more effective than monotherapy with infliximab in nonnaive patients, or with other approved biologic drugs in any population, remains unknown. In UC, RCTs have shown that the benefit may be limited to specific populations, [6] whereas systematic reviews suggest no benefit at all. [7] .◆ (Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.)

关键词： gastrointestinal   gut mucosal immunology   immune mediated diseases  

摘要： Introduction Very early onset inflammatory bowel disease (VEOIBD) may correlate with multiple immunodeficiencies, including severe combined immunodeficiency (SCID), common variable immunodeficiency (CVID), chronic granulomatous disease (CGD), Wiskott-Aldrich syndrome (WAS), and IL-10 signaling defects. It may be difficult to differentiate between intestinal inflammation and immune dysfunction leading to systemic symptoms and elevated inflammatory markers. This patient, a 5-year-old male with very early onset Crohn’s disease, chronic lung disease, 1p36 duplication, failure to thrive, eczema, and systemic infections including Candidemia, Klebsiella bacteremia, histoplasmosis, recurring pneumonia, multiple upper respiratory and sinus infections, and recurring IBD flares, presented due to concern for underlying primary *** Description After the patient was noted to have multiple systemic infections—fungemia, bacteremia, pneumonia, and sinusitis—laboratory studies were undertaken to evaluate for primary immunodeficiency. Workup was significant for elevated IgG, IgA, IgD, ESR, and CRP. Whole exome sequencing (including MVK testing and specific examination of established and candidate VEOIBD genes), IL-10, NK function, lymphocyte subsets, vaccine titers, oxidative burst, and WAS workup were within normal *** VEOIBD may be seen in conjunction with immunodeficiency, but it is often difficult to attribute laboratory findings to intestinal inflammation versus underlying immunodeficiency. In this patient, the latter is supported by multiple severe infections. While WAS, CGD, and B- and T-cell dysfunction are unlikely given laboratory findings, elevated IgD can be found in hyper-IgD syndrome and VEOIBD, although history is negative for recurring fever, skin lesions, or abnormal MVK testing. Given this complex clinical picture, the cause is likely multifactorial.

关键词： Contact investigation   Disseminated tuberculosis   Inflammatory bowel disease  

摘要： Purpose: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals. Methods: A 4-year-old child without Bacille Calmette-Guérin vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts. Results: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB. Conclusion: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI. © 2018 by The Korean Pediatric Society. All rights reserved.

关键词： Crohn's disease   Faecal calprotectin   Inflammatory bowel disease   Predictive values ulcerative colitis  

摘要： Aim: The faecal calprotectin (FC) test is increasingly being used in clinical practice to help select children with gastrointestinal symptoms who might have inflammatory bowel disease (IBD) and benefit from endoscopies. We provide an overview of the advantages and limitations of the FC test. Methods: PubMed was searched for meta-analyses that had investigated the diagnostic accuracy of the FC test and the pooled sensitivity and specificity for distinguishing IBD from non-IBD patients were used to calculate likelihood ratios (LR). These were applied to practical examples to explain how easily clinicians can use the results to modify pre-test probabilities of IBD and generate post-test probabilities for IBD. Results: The positive LR and negative LR of the FC test were 2.8 and 0.015, respectively. The usefulness of the FC test depended on the pre-test probability of IBD. When the pretest probability of IBD was low, a positive FC test did not necessarily indicate IBD. However, because of the very small negative LR, a negative FC result virtually ruled out IBD in most cases. Conclusion: The FC test should not be used indiscriminately in children with gastrointestinal symptoms but should be targeted at those who are likely to have IBD.

关键词： Ulcerative Colitis   Patient-Centered Medical Home   Value-Based Care   Gastroenterologist   Psychiatric Care  

摘要： BACKGROUND & AIMS: Specialty medical homes (SMHs) are a new health care model in which a multidisciplinary team and specialists manage patients with chronic diseases. As part of a large integrated payer-provider network, we formed an inflammatory bowel diseases (IBDs) SMH and investigated its effects on health care use, disease activity, and quality of life (QoL). METHODS: We performed a retrospective analysis of 322 patients (58% female;mean age, 34.6 y;62% with Crohn's disease;32% with prior IBD surgery) enrolled in an IBD SMH, in conjunction with the University of Pittsburgh Medical Center Health Plan, from June 2015 through July 2016. Patients had at least 1 year of follow up. We evaluated changes in numbers of emergency department visits and hospitalizations from the year before vs after SMH enrollment. Secondary measures included IBD activity assessments and QoL. RESULTS: Compared to the year before IBD SMH enrollment, patients had a 47.3% reduction in emergency department visits (P < .0001) and a 35.9% reduction in hospitalizations (P = .008). In the year following IBD SMH enrollment, patients had significant reductions in the median Harvey-Bradshaw Index score (reduced from 4 to 3.5;P = .002), and median ulcerative colitis activity index score (from 4 to 3;P = .0003), and increases in QoL (median short inflammatory bowel disease questionnaire score increased from 50 to 51.8;P < .0001). Patients in the most extreme (highest and lowest) quartiles had the most improvement when we compared scores at baseline vs after enrollment. Based on multivariable regression analysis, use of corticosteroids (odds ratio [OR], 2.72;95% CI, 1.32-5.66;P = .007) or opioids (OR, 3.20;95% CI, 1.32-7.78;P = .01), and low QoL (OR, 4.44;95% CI, 1.08-18.250;P = .04) at enrollment were significantly associated with persistent emergency department visits and hospitalizations. CONCLUSIONS: We found development of an IBD SMH to be feasible and significantly reduce unplanned care and diseas

关键词： letter   Inflammatory Bowel Diseases   gluten-sensitivity   Intestinal Diseases   Patients  

摘要： Linked Content This article is linked to McIlroy et al paper. To view these article visit https://***/10.1111/apt.14384.

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

摘要： Objectives To identify similarities and differences between the pediatric-onset and adult-onset Inflammatory Bowel Disease (IBD) based cohorts and further characterize the pediatric cohort. Methods A retrospective analysis of pediatric patients attending the tertiary referral care gastroenterology center from 2004 to 2016 was conducted. All the patients were clinically evaluated, investigated and followed up at the centre. Results Sixty five patients with pediatric IBD were compared with 216 patients with adult-onset IBD. The Ulcerative colitis: Crohn's disease (UC:CD) ratio was higher in adult-onset population (2.29:1 vs. 1.7:1). Predominant symptoms in pediatric UC were diarrhea and passage of blood in stools;whereas those in pediatric CD were abdominal pain and failure to gain weight. Ulcerative proctitis was less common (2.4% vs. 18.8%;p = 0.009) and an extensive disease (pancolitis) was more common in the pediatric population (73.1% vs. 30.2%;p < 0.00001). Adult CD had higher L3 (33.3% vs. 46.1%;p = 0.28) disease;whereas in pediatric CD, L1 disease (37.5% vs. 32.3%;p = 0.65) was predominant. There was no difference with respect to penetrating and stricturing complications of CD in adults vs. children (20.8% vs. 23.1%;p = 0.974). 5-ASA agents were used more commonly in the pediatric IBD population (96.9% vs. 79.9%;p = 0.0034) as compared to adults whereas corticosteroids (87.5% vs. 76.9%;p = 0.28) and infliximab (25% vs. 9.2%;p = 0.054) were used more frequently in the pediatric CD subgroup as compared to adult CD subgroup. Conclusions IBD has significant disease heterogeneity according to the age of onset. Pediatric IBD has distinctive features that set it apart from adult-onset IBD.

关键词： Crohn's disease   faecal calprotectin   inflammatory bowel disease   paediatric   ulcerative colitis  

摘要： Paediatric inflammatory bowel disease (PIBD), consisting of Crohn's disease, ulcerative colitis and inflammatory bowel disease unclassified, is a chronic inflammatory condition associated with significant morbidity. The incidence of PIBD is increasing and disease phenotype remains more severe than adult onset disease. Diagnosis of PIBD is often slow and requires referral to specialist services;however, the emergence of faecal calprotectin as a tool for prioritizing further investigation, alongside improved use of treatments (including anti-TNF monoclonal antibody therapy) is changing diagnosis and management. Whilst significant challenges remain in the longer-term treatment of PIBD, including growth, nutrition and management of refractory disease there remains a strong research focus on understanding underlying disease pathogenesis and a move towards personalized medicine. This review describes investigations, diagnosis and management of PIBD and presents the most up to date evidence on nutritional and medical management. © 2018 Elsevier Ltd