关键词： attachment   depression   inflammatory bowel disease   fatigue   gender  

摘要： Objectives: Fatigue is a common and disabling problem in inflammatory bowel disease. We sought to explore the possible determinants of inflammatory bowel disease-associated fatigue including demographic, psychological and disease variables. Methods: Surveys were distributed to 100 patients undergoing infliximab infusion for inflammatory bowel disease in an infusion lounge, assessing attachment style (Experiences in Close Relationships Revised scale), fatigue (Functional Assessment of Chronic Illness Therapy Fatigue - Fatigue Subscore), and depression and anxiety (Hospital Anxiety and Depression Scale). Disease severity was assessed via file review through an independent gastroenterologist rating (Harvey-Bradshaw Index). Results: There were 67 responses. Depression, as measured by the Hospital Anxiety and Depression Scale, was found to be highly correlated with fatigue (Functional Assessment of Chronic Illness Therapy Fatigue - Fatigue Subscore). Anxiety, insecure attachment, disease severity and female gender were moderately correlated with fatigue. In a hierarchical regression model, depression and female gender emerged as significant predictors of variance in fatigue scores. Conclusions: Depression was the strongest predictor of variance in fatigue scores. Gender as a cause of fatigue in inflammatory bowel disease requires further exploration. Attachment style, however, may still help clinicians to conceptualise help-seeking behaviour and clinician-patient relationships in medically unexplained symptoms.

关键词： CD   Crohn disease   CRC   colorectal cancer   HR   hazard ratio   IBD   inflammatory bowel disease   ICD-10   International Classification of Diseases, Tenth Revision   IQR   interquartile range   REP   Rochester Epidemiologic Project   SMR   standardized mortality ratio   UC   ulcerative colitis  

摘要： Objective: To determine the mortality of Crohn disease (CD) and ulcerative colitis (UC) and temporal trends in mortality. Patients and Methods: All 895 residents of Olmsted County, Minnesota, first diagnosed as having inflammatory bowel disease (IBD) (411 with CD and 484 with UC) from January 1, 1970, through December 31, 2010, were followed through June 30, 2016. Standardized mortality ratios (SMRs) were computed-expected rates were derived from the US 2010 background population. To determine overall and cause-specific mortality, each patient with IBD was matched with 5 county residents, and Cox regression analysis was used to assess time to death. Results: A total of 895 patients with IBD and 4475 patients without IBD were included. Seventy-four patients with CD died compared with 59.2 expected (SMR, 1.25;95% CI, 0.98-1.57), and 77 patients with UC died compared with 108.1 expected (SMR, 0.71;95% CI, 0.56-0.89). In CD, the risk of dying was significantly associated with diagnosis from 1970 through 1979 (SMR, 1.90;95% CI, 1.24-2.78). Of those diagnosed after 1980, the risk of dying in patients with CD was similar to the US background population. In UC, the risk of dying was less than expected in all periods of diagnosis. In the Cox regression analysis, overall mortality was not significantly higher in CD (hazard ratio [HR], 1.26;95% CI, 0.97-1.63) or UC (HR, 0.89;95% CI, 0.70-1.14) compared with the comparison cohort. The risk of dying of digestive diseases (HR, 3.70;95% CI, 1.24-11.0) and respiratory diseases (HR, 2.72;95% CI, 1.36-5.44) was increased in CD but not UC. Conclusion: In this cohort, overall mortality in patients with CD diagnosed after 1980 did not differ from that in the US background population. Overall mortality in patients with UC diagnosed from 1970 through 2010 was lower than the expected mortality. (C) 2018 Mayo Foundation for Medical Education and Research

关键词： Intestinal Diseases   Patients   Perception   Biosimilar Pharmaceuticals   Inflammatory Bowel Diseases   Nocebo Effect  

关键词： Crohn's disease   Imaging   Inflammatory bowel disease   Magnetic resonance cholangiography   Primary sclerosing cholangitis   Ulcerative colitis  

摘要： Background: Primary sclerosing cholangitis (PSC) is a major concern in inflammatory bowel disease (IBD). Aims: Evaluating the use of magnetic resonance cholangiography (MRC) as a screening tool for PSC in IBD patients. Methods: A single-center cohort study investigating systematic MRC to assess PSC in IBD patients with (cohort 1) and without (cohort 2) liver function tests (LFTs) abnormality, combined with a retrospective analysis of MRCs in a control group of non-IBD patients with abnormal LFTs (cohort 3). Results: In total, 420 patients (cohort 1: n = 203, cohort 2: n = 30, cohort 3: n = 187) underwent imaging. MRC was classified 'abnormal' in 49/203 (24.1%) patients in cohort 1, in 1/30 (3.3%) patients in cohort 2, and in 66/187 (35.3%) patients in cohort 3 (p < 0.004 for all comparisons). PSC was diagnosed in 20/203 (9.9%) patients in cohort 1, in 1/30 (3.3%) patients in cohort 2, and in 13/187 (7.0%) patients in cohort 3 (p = 0.44). Gamma-glutamyl transpeptidase was the only independent factor predicting the diagnosis of PSC in IBD (OR 1.8, 95% CI 1.3-2.5, p = 0.001). Conclusions: MRC revealed PSC in one tenth of IBD patients with abnormal LFTs and should be systematically performed in IBD patients with abnormal LFTs, especially if gamma-glutamyl transpeptidase level is elevated. (c) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

关键词： INFLAMMATORY bowel diseases   ADRENOCORTICAL hormones  

摘要： Linked ContentThis article is linked to Philpott et al and Wood and Henderson papers. To view these articles visit and .

关键词： Tripartite motif-containing 21   inflammatory bowel disease   CD4(+) T cells   mucosal inflammation   T(H)1   T(H)17  

摘要： Background: Tripartite motif-containing (TRIM) 21 has been implicated in the pathogenesis of several types of autoimmune diseases. Objective: We sought to elucidate TRIM21 expression in patients with inflammatory bowel diseases (IBDs) and its role in regulating intestinal mucosal inflammation. Methods: TRIM21 expression was analyzed in the inflamed mucosa of patients with IBDs by means of quantitative RT-PCR and immunohistochemistry. Peripheral blood CD4(+) T cells were transfected with lentivirus-expressing TRIM21 (LV-TRIM21) or LV-sh-TRIM21, and cytokine expression was determined by using quantitative RT-PCR and ELISA. TRIM21(-/-) mice were generated, and trinitrobenzene sulfonic acid- and CD45RB(high) CD4(+) T cell-induced colitis models were established to determine its role in induction of intestinal inflammation. Results: TRIM21 was expressed predominantly in CD4(+) T cells and decreased markedly in the inflamed mucosa of patients with IBDs compared with healthy control subjects. Ectopic expression of TRIM21 inhibited IBD CD4(+) T cells to differentiate into T(H)1 and T(H)17 cells, whereas downregulation of TRIM21 had the opposite effects. TRIM21(-/-) mice had more severe colitis after administration of trinitrobenzene sulfonic acid compared with wild-type mice, which was characterized by increased expression of IFN-gamma, TNF-alpha, and IL-17A in the colon. TRIM21(-/-) CD45RB(high) CD4(+) T cells reconstituted into recombination-activating gene (Rag1)(-/-) mice induced more severe colitis than in wild-type control mice. Mechanistically, interferon regulatory factor 3 was identified as a functional downstream target of TRIM21 in that silencing of interferon regulatory factor 3 suppressed TRIM21(-/-) CD4(+) T-cell differentiation into T(H)1 and T(H)17 cells. Conclusions: TRIM21 plays a protective role in mucosal inflammation through inhibiting T(H)1 and T(H)17 cell differentiation. Thus TRIM21 might serve as a potential therapeutic target for the treatment of I

关键词： excessive weight loss   Small Intestinal Obstruction   Inflammatory Bowel Diseases   Bariatric Surgery   UNIVERSITY OF CALIFORNIA   Patients  

摘要： Background: The convoluted relationship between obesity, bariatric surgery and inflammatory bowel disease (IBD) is of increasing interest. Aim: To analyse evidence regarding the role of bariatric surgery in the development of de novo IBD and its impact on clinical outcomes and safety in patients with established IBD. Methods: A PubMed/Medline search was performed to identify studies reporting the development of IBD after bariatric surgery and the outcomes of IBD patients after bariatric surgery. Results: Eighty patients were reported to have developed de novo IBD after bariatric surgery (21% ulcerative colitis [UC], 75% Crohn's disease [CD]), mostly females. Roux-en-Y gastric bypass was the most frequent bariatric technique (80%). Symptoms related to IBD occurred within 1 month and 16 years after surgery. Regarding patients with known IBD undergoing bariatric surgery, 60 patients (35 CD, 24 UC, and 1 unclassified colitis) have been reported. Sleeve gastrectomy was the most frequent bariatric procedure, particularly in CD patients. Acute flares after surgery were observed in only four UC patients. In addition, two retrospective population-based studies described perioperative outcomes of bariatric surgery on IBD patients, demonstrating only a significant increase in small bowel obstruction in these patients. Conclusions: Bariatric surgery in carefully selected patients with established IBD is technically feasible and probably safe. Development of de novo IBD should be taken into account in individuals with previous bariatric surgery who develop diarrhoea, anaemia or excessive weight loss.

关键词： inflammation   inflammatory bowel diseases   matrix metalloproteinases   monoclonal antibodies   tissue inhibitor of matrix metalloproteinase-2  

摘要： BackgroundGrowing evidence indicates tissue inhibitors of matrix metalloproteinases (TIMPs) as potential players in inflammatory bowel disease (IBD), but, no prospective data are available in IBD remission/relapse. Material & methodsIn this prospective pilot study, a cohort of IBD patients (n=32) was enrolled and treated with monoclonal anti-TNF- antibodies. Patients were clinically followed up for a median period of 54weeks. Serum circulating levels of C-reactive protein (CRP), TIMP-1 and -2, matrix metalloproteinase (MMP)-9 and -8, myeloperoxidase (MPO) and neutrophil elastase (NE) were assessed by ELISA at enrolment and at the end of the treatment. ResultsThe percentage (%) TIMP-2 reduction from baseline to end of treatment was independently associated with IBD remission at the end of treatment and follow-up as well. ROC curve analysis further confirmed the good prognostic accuracy of % TIMP-2 reduction over the treatment period. Conversely, no other change in inflammatory molecule concentrations was able to predict short- or long-term IBD remission. ConclusionsThis study indicates TIMP-2 reduction during IBD treatment with monoclonal anti-TNF- antibodies as a potential prognostic parameter of short and long term remission. To understand if TIMP-2 is an innocent biomarker or an active pathophysiological factor in IBD remains to be clarified.

关键词： kefir   extracellular vesicle   functional dairy food   irritable bowel syndrome  

摘要： Kefir is a fermented product from yeast and lactic acid bacteria, and has been associated with various health benefits including relieving inflammatory bowel disease. Recently, it has been shown that gram-positive bacteria produce extracellular vesicles (EV). The EV could be appearing as potentially important mediators of cell to cell interaction. In this study, we explored the role of kefir grain Lactobacillus-derived EV in modulating inflammation responses via alleviating the production of inflammatory cytokines in tumor necrosis factor-alpha (TNF-alpha)-induced inflammation in Caco-2 cells and the 2,4,6-trinitrobenzene sulfonic acid-induced inflammatory bowel disease mouse model. Kefir-derived Lactobacillus EV were isolated by ultracentrifugation of the culture medium of 3 different kefir-derived strains (i.e., Lactobacillus kefir, Lactobacillus kefiranofaciens, and Lactobacillus kefirgranum). Nanoparticle tracking analysis showed that the size of isolated kefir-derived Lactobacillus EV was within 80 to 400 nm, and kefir-derived Lactobacillus EV uptake into recipient Caco-2 cells was confirmed by fluorescence labeling. Treatment of each kefir-derived Lactobacillus EV onto TNF-alpha-stimulated Caco-2 cells significantly reduced the level of both mRNA expression and secretion of IL-8, and Western blot analysis revealed that such an effect was related to inhibition of TNE-alpha signaling mediated by reducing the phosphorylation of p65, a subunit of NF-kappa B. Subsequent administration of kefir-derived Lactobacillus EV into inflammatory bowel disease-induced mice significantly alleviated the body weight loss and rectal bleeding, and enhanced stool consistency. Histological examination showed that kefir-derived Lactobacillus EV substantially reduced the infiltration of transmural leukocytes and loss of goblet cells within the colon, and the serum level of myeloperoxidase was significantly lower in the EV-treated group than control group. Our study demonstrates that k