摘要： Background Recent studies report increased risks of both cancer and mortality in paediatric onset inflammatory bowel disease (pIBD) but the reproducibility of this is unknown. Aim To estimate the risk of cancer and mortality in the Danish and Finnish pIBD population in a 23-year period compared to the general population. Methods The pIBD population was defined as individuals registered in the national patient registries with a diagnosis of Crohn's disease (CD), ulcerative colitis (UC) or IBD-unclassified before their 18th birthday from 1992 to 2014. This cohort was cross referenced with the national cancer and mortality registries identifying all pIBD patients who subsequently developed cancer and/ or died and followed up to the end of 2014. Risk estimates are presented as standardised incidence ratios calculated based on incidence figures from the populations. Results Six thousand six hundred and eight-nine patients with pIBD were identified (median age at follow-up 22.3 years;median follow-up: 9.6 years [interquartile range: 4.8-16.0]). Seventy-two subsequently developed cancer and 65 died. The standardised incidence ratio of cancer in general was 2.6 (95% CI: 1.8-3.7) and 2.5 (95% CI: 1.8-3.4) in CD and UC, respectively. The standardised mortality ratios were 2.2 (95% CI: 1.4-3.4) and 3.7 (95% CI: 2.7-5.0) in CD and UC, respectively. The leading causes for mortality were cancer, suicide and infections. Conclusions We found an increased risk of cancer and mortality in pIBD. This underlines the importance of cancer surveillance programs and assessment of mental health in the standard of care in adolescent pIBD patients.

关键词： Pyogenic sacroiliitis   IBD   SI joint  

摘要： Although sacroiliitis is not uncommon in patients with inflammatory bowel diseases (IBD), bacterial infection of the sacroiliac joint is rare. The diagnosis is often delayed because of lowclinical suspicion, a vague clinical picture and poorly defined localization of symptoms. We report a case of pyogenic sacroiliitis in a patient with Crohn's disease caused by Clostridia spp. and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness. (C) 2019 Elsevier Inc. All rights reserved.

摘要： The inflammatory bowel diseases commonly affect individuals during their peak reproductive years. Patients are often concerned about the impact of medical therapies on their ability to conceive, effect on the fetus, as well as the ability to breastfeed, which has led to poor medical adherence during pregnancy. However, most medications are safe, and discontinuation may lead to active disease, which is associated with adverse materno-fetal outcomes. The anti-TNF biologic therapies, infliximab and adalimumab have been extensively studied in the context of pregnancy. They are actively transferred to the placenta during the second and third trimesters;these have not been associated with an increased rate of congenital abnormalities or fetal death. The minimal amounts of drug that are transferred to breast milk are proteolyzed by the infant's digestive system with no reported short- or long-term adverse effects. There is a paucity of clinical data for the other approved anti-TNF agents or newer anti-integrin (vedolizumab) and anti-interleukin (ustekinumab) therapies used in the management of inflammatory bowel disease;however, no significant safety signals have been documented thus far. The new oral small molecule therapy, tofacitinib is teratogenic in animal models and is contra-indicated in patients attempting pregnancy. It is important that patients, as well as physicians managing patients with these conditions, be aware of the impact of these medical therapies during pregnancy.

关键词： Administrative data   Crohn's disease   Epidemiology   Hospitalization rates   Ulcerative colitis  

摘要： Introduction: In this study, we aimed to determine the hospitalization rates of Inflammatory Bowel Disease (IBD) in a southern-european country and its associated charges over a period of 16 years. Methods: We identified all discharges with a primary diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) between 2000 and 2015 in data provided by the Central Administration of Health Services (ACSS). National estimates of hospitalization rates were assessed and adjusted to gender, age, population, and hospitalizations. Hospitalization charges were also assessed. Results: There were an estimated 31 358 and 16 669 discharges for CD and UC, respectively. From 2000 to 2015, hospitalization rates per 100000 habitants increased for CD (8.4-11.2) and remained stable for UC (4.4-4.9). The hospitalization rate for IBD increased slightly over time (12.8 per 100 000 habitants in 2000 and 16.1 in 2015). Annual total hospitalization charges amounted to 4.0M(sic) in 2000 and 5.7M(sic) in 2015. This increase was mainly due to a rise in the total expenses of CD-related hospitalizations. Conclusion: CD hospitalization rates per 100000 inhabitants increased over time while remaining constant for UC. Hospitalization charges for IBD increased approximately 2.0M(sic) during the study period, representing an important burden in the national healthcare system. (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

关键词： CD11b   HIF-1 alpha   STAT3   B cells   IBD  

摘要： B cells have been reported to have a suppressive function in autoimmune diseases, which appears to require an increase of CD11b expression on B cells. However, little is known how CD11b is induced in B cells to play the function. In this study, we found that the high expression of CD11b in B cells occurred not only in the mucosal immune organs, but also in systemically immune organs such as the spleen during dextran sulfate sodium (DSS)-induced colitis. Since the inflammatory lesions in mouse models of inflammatory bowel disease (IBD) were revealed to be significantly hypoxic or even anoxic, the B cells from colitic mice Peyer's patches (PP) were investigated to express higher levels of hypoxia-inducible factor-1 alpha (HIF-1 alpha) than naive B cells from wildtype (WT) mice. HIF-1 alpha siRNA transfection or HIF-1 alpha protein inhibition led to decreased CD11b expression at both the mRNA and protein levels in vitro. B cells with HIF-1 alpha specific knockdown were then adoptively transferred to Rag-1(-/-) mice. The result displayed that CD11b expression was decreased in B cells and an exacerbated colitis occurred. The bio-informatics promoter analysis and ChIP assay showed that HIF-1 alpha was the critical transcription factor for CD11b and cooperatively formed a complex with the p-STAT3 homodimers to bind onto hypoxia-responsive element (HRE) regions, which was guaranteed by MEK/ERK pathway activation and IL-10 secretion. In conclusion, our study demonstrated the key function of the hypoxia-associated transcription factor HIF-1 alpha together with p-STAT3 in driving CD11b transcription in B cells and controlling B cell's protective activity in experimental inflammatory bowel disease (IBD).

关键词： Inflammatory bowel disease   Latent tuberculosis infection   Tuberculin skin test   Interferon gamma release assay  

摘要： Background and AimsTo compare tuberculin skin test (TST) and interferon gamma release assay (IGRA) in the screening of LTBI among patients with inflammatory bowel disease (IBD) in an endemic area for tuberculosis, to evaluate the need for repeating tests during anti-TNF, therapy, and to check whether the results may be affected by *** cross-sectional study of 110 IBD patients and 64 controls was conducted in Rio de Janeiro, Brazil. The TST was administered after the Quantiferon(((R)))-TB Gold In-tube test was *** and IGRA agreement was poor regarding diagnosis (kappa: control=0.318;UC=0.202;and CD=-0.093), anti-TNF therapy (kappa: with anti-TNF=0.150;w/o anti-TNF=-0.123), and immunosuppressive therapy (IST) (kappa: with IS=-0.088;w/o IS=0.146). Indeterminate IGRA was reported in four CD patients on IST. Follow-up tests after anti-TNF identified conversion in 8.62% using TST and 20.0% using IGRA. Considering IGRA as a criterion standard, TST showed low sensitivity (19.05%) and positive predictive value (PPV) (21.05%). LTBI detection remarkably improved when IGRA was added to TST (sensitivity of 80.95% and PPV of 53.13%). Results were particularly relevant among CD patients where rates started from zero to reach sensitivity and PPV of more than 60%.ConclusionIGRA alone was more effective to detect LTBI than TST alone and had an overall remarkable added value as an add-on sequential test, particularly in CD patients. While cost-effectiveness of these strategies remains to be evaluated, IGRA appears to be justified in CD prior to and during anti-TNF therapy, where tuberculosis is endemic.

关键词： Magnetic resonance imaging   Inflammatory bowel disease   Visceral pain   Transcranial direct current stimulation  

摘要： Background: Chronic pain is known to be associated with functional and structural changes in the brain. Inflammatory bowel disease (IBD) presents with chronic abdominal pain in almost 35% of all patients. This study investigates structural and functional changes in magnetic resonance imaging (MRI) after transcranial direct current stimulation (tDCS) applied to ameliorate pain in IBD. Methods: This phase-III, placebo-controlled, randomized study included 36 patients with IBD and chronic pain. MRI scans were performed before and following tDCS, which was applied for 5 days. Results/conclusion: For the first time, this study revealed an association of changes in resting-state functional MRI and pain reduction in IBD. There was a significant increase in functional connectivity after active tDCS within the visual medial and the right frontoparietal network being connected with the amygdala, the insula, and the primary somatosensory cortex indicating central pain mechanisms in IBD. Moreover, tDCS offers a novel therapeutic strategy for abdominal pain. (C) 2019 The Authors. Published by Elsevier Inc.

关键词： Inflammatory bowel disease   Medical home   Personalized medicine   Hospitalization   Confocal laser endomicroscopy  

摘要： Background and AimsIBD patients with inadequately treated disease often relapse and require hospitalizations for further management. The purpose of this practice review was to determine whether personalized IBD care improved patient outcomes as measured by IBD-related *** dedicated IBD clinic was created for personalized patient care in a tertiary veterans health care center in 2014. In the first year, the care program consisted of patient-centered medical home (PCMH). In the second year, personalized biologic therapy was incorporated into the program, based on the severity of mucosal barrier dysfunction measured by probe-based confocal laser endomicroscopy (pCLE) analysis of the terminal ileum during colonoscopy. IBD-related hospitalizations during these 2years were compared to the year before the care *** IBD-related admissions at baseline, year 1 and 2 of the program were: total number of admissions of 25, 24, 8 (P=0.03) per year, total number of hospital days of 177, 144, 31days per year (P<0.01), median length of stay 7, 4, and 2days per visit (P=0.013), respectively. Patients had significant increases in serum hemoglobin (11.52.7, 11.9 +/- 2.6, 14.0 +/- 1.4g/dl;P=0.035), albumin (2.7 +/- 0.7, 3.0 +/- 0.6g/dl 3.7 +/- 0.8g/dl;P=0.031) and body mass index (26.6 +/- 2.9, 28.1 +/- 5.9;34.0 +/- 10.8;P=0.047).Conclusions Personalized IBD care incorporating a PCMH model and tailored biologic therapy based on pCLE findings of mucosal barrier dysfunction significantly reduced IBD-related hospitalizations.