关键词： Crohn's disease   Diet   Dietary practices   Inflammatory bowel disease   Ulcerative colitis  

摘要： The etiology of inflammatory bowel disease (IBD) remains elusive but it is believed to result from incompletely understood interactions between environmental triggers in a potentially genetically susceptible host and a subsequent aberrant immune response. Its incidence is increasing worldwide at an unprecedented rate, outpacing what genetic influences alone could instigate. The increasingly integral role played by eating in social life has led patients to gravitate to diet and food in their consultations with physicians and other health care professionals, in an attempt to improve, control, or even "cure" IBD through diet. Diet is a modifiable factor, and both patients and healthcare professionals have fuelled resurgent interest in the role of diet in maintaining IBD remission. Despite significant and increasing interest, there is a lack of credible evidence to support dietary modification or restrictions to prevent relapse of IBD. However, recent studies have shown that more than half of the patients believe that diet plays an important role in triggering relapse, leading to self-imposed dietary restrictions, some of which can have adverse consequences. This underpins the need for physicians and health care professionals to have a better understanding of dietary practices, in triggering, perpetuating, and improving IBD. This review examines and discusses the evidence behind this.

关键词： Algorithms, treatment   Microbiome   Calprotectin   Glucocorticoids   Biologics  

摘要： Inflammatory bowel diseases (IBD) are complex diseases. Epidemiological studies suggest rising incidences in industrialized countries. The article is based on a literature search in PubMed and is oriented on the current guidelines published by the European Crohn's and Colitis Organisation. IBD are characterized by chronic diarrhoea, abdominal pain and peranal haemorrhage. Extraintestinal manifestations commonly affect joints, skin, eyes and bile tracts. Early diagnosis and therapeutic intervention determine individual patient outcome. Medical treatment currently includes aminosalicylates, corticosteroids, thiopurines, calcineurin inhibitors and biologicals. IBDs require anti-inflammatory and if necessary immunosuppressive therapy. Due to extraintestinal complications and the possible need for surgical intervention, an interdisciplinary approach is important.

关键词： Crohn disease   Immediate postoperative outcomes   Inflammatory bowel disease   Length of stay   Lumbar fusion   Ulcerative colitis  

摘要： BACKGROUND CONTEXT: The United States Centers for Disease Control and Prevention estimates the prevalence of inflammatory bowel disease (IBD) at more than 3.1 million people. As diagnostic techniques and treatment options for IBD improve, the prevalence of IBD is expected to increase. For spine surgeons, patients with IBD have a unique complication profile because patients with IBD may present with poor nutritional status and because the medications used to manage IBD have been associated with poor vertebral bone mineralization and immunosuppression. Presently, there are very limited data regarding perioperative outcomes among patients with IBD who undergo spinal surgery. The present study begins to address this knowledge gap by describing trends in patients with IBD undergoing lumbar fusion and by quantifying the association between IBD and immediate postoperative outcomes using a large, national database. PURPOSE: To advance our understanding of the potential pitfalls and risks associated with lumbar fusion surgery in patients with IBD. DESIGN/SETTING: Retrospective cross-sectional analysis. PATIENT SAMPLE: The Nationwide Inpatient Sample (NIS) database was queried from 1998 to 2011 to identify adult patients (18+) who underwent primary lumbar fusion operations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding. OUTCOME MEASURES: Incidence of lumbar fusion procedures, prevalence of IBD, complication rates, length of stay, and total hospital charges. METHODS: The annual number of primary lumbar fusion operations performed between 1998 and 2011 was obtained from the NIS database. Patients younger than 18 years of age were excluded. The prevalence of IBD in this population (both Crohn disease and ulcerative colitis) was determined using ICD-9-CM codes. Logistic regression models were estimated to determine the association between IBD and the odds of postoperative medical and surgical complications, while controllin

关键词： capsule endoscopy   colonoscopy   Crohn disease   inflammatory bowel diseases   ulcerative colitis  

摘要： Colon capsule endoscopy (CCE) is designed for direct visualization of the colonic mucosa through passive propulsion. The role of CCE in the detection of colonic polyps has been extensively evaluated. As mucosal healing has emerged as a pivotal target for treatment of inflammatory bowel disease (IBD), there is increasing data to suggest that CCE can also be used in the monitoring of mucosal inflammation in patients with active IBD, particularly in ulcerative colitis (UC) and Crohn's disease (CD). Despite advantages such as its non-invasive nature, patient's comfort, safety, and access to anatomical regions not easily reached by conventional endoscopy, CE has limitations including the lack of ability to obtain biopsies or therapeutic capabilities and no control over movement. In this review, the role and diagnostic value of CCE on diagnosis and monitoring of UC and CD patients, its safety and limitations are discussed.

关键词： INFLAMMATORY bowel disease treatment   ALLOPURINOL   DRUG efficacy   AZATHIOPRINE   CLINICAL trials  

摘要： Linked Content This article is linked to Friedman et al and Friedman and Sparrow papers. To view these articles visit https://***/10.1111/apt.14571 and https://***/10.1111/apt.14798.

关键词： Inflammatory Bowel Disease   Health-related quality of life   Elderly   Short Inflammatory Bowel Disease Questionnaire  

摘要： Health-related quality of life (HRQoL) is significantly impacted in patients with inflammatory bowel disease (IBD). Many studies have assessed HRQoL in patients of all ages, and few focus on the elderly. To determine the influence of advanced age (> 65 years) and age at diagnosis on patients with IBD. This is a retrospective study of prospectively collected data from a single IBD tertiary referral center. Patients had disease activity indices [Harvey-Bradshaw index (HBI), Ulcerative Colitis Disease Activity Index (UCDAI), and Short Inflammatory Bowel Disease Questionnaire (SIBDQ)] recorded during every clinic visit. Three groups of patients: > 65 years, 41-64 years, and < 40 years with > 5 SIBDQ entries were included. Influence of disease type, disease duration, extent of involvement, and comorbidities such as cardiovascular (CV) disease, pulmonary disease, diabetes mellitus (DM), and psychological disorders were noted as confounders. Statistical analysis was performed using ANOVA, Pearson correlation, and logistic regression model. Disease severity indices significantly affected SIBDQ score in both Crohn's disease (CD) and ulcerative colitis (UC) (p < 0.001 for HBI in CD, p < 0.001 UCDAI in UC). Disease extent (p = 0.011) and psychological disorders (p < 0.001) significantly affected SIBDQ score in CD. Chronological age, age at diagnosis, disease duration, number of clinic visits, CV disease, pulmonary disease, and DM were not significant predictors of SIBDQ score (p > 0.05). HRQoL was negatively influenced by disease extent and psychological disorders in CD but not in UC patients. Advanced age was not a predictor of poor HRQoL in both CD and UC.

关键词： FC   fecal calprotectin   IBD   inflammatory bowel disease   IBS   irritable bowel syndrome  

关键词： Anti-TNF alpha   Inflammatory bowel disease   Liver transplantation  

摘要： Background: There is a lack of consensus regarding the treatment of inflammatory bowel disease (IBD) after liver transplantation (LT) forprimary sclerosing cholangitis (PSC). Aim: To investigate the safety and effectiveness of anti-TNF therapy in patients with IBD after a LT for PSC. Methods: We reviewed the medical files of all of the IBD patients who underwent a LT for PSC and who were treated with anti-TNF therapy at 23 French liver transplantation centers between 1989 and 2012. Results: Eighteen patients (12 with ulcerative colitis and 6 who had Crohn's disease) were recruited at 9 LT centers. All of these patients received infliximab or adalimumab following their LT, and the median duration of their anti-TNF treatment was 10.4 months. The most frequent concomitant immunosuppressive treatment comprised a combination of tacrolimus and corticosteroids. Following anti-TNF therapy induction, a clinical response was seen in 16/18 patients (89%) and clinical remission in 10 (56%). At the end of the anti-TNF treatment or at the last follow-up examination (the median follow-up was 20.9 months), a clinical response was achieved in 12 patients (67%) and clinical remission in 7 (39%). A significant endoscopic improvement was observed in 9 out of 14 patients and a complete mucosal healing in 3 out of 14 patients (21%). Six patients experienced a severe infection. These were due to cholangitis, cytomegalovirus (CMV) infection, Clostridium difficile, cryptosporidiosis, or Enterococcus faecalis. Three patients developed colorectal cancer after LT, and two patients died during the follow-up period. Conclusions: Anti-TNF therapy proved to be effective for treating IBD after LT for PSC. However, as 17% of the patients developed colorectal cancer during the follow-up, colonoscopic annual surveillance is recommended after LT, as specified in the current guidelines. (c) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.