关键词： Mortality   Premature death   inflammatory bowel disease   Biological therapy   Complications of inflammatory bowel disease  

摘要： BackgroundStudies examining the mortality risk of inflammatory bowel disease (IBD) have yielded conflicting results, and most do not account for recent advancements made in the treatment of Crohn's disease (CD) and ulcerative colitis (UC). We aim to assess the overall, premature, and cause-specific mortality in IBD patients over a 17-year time period and to evaluate any differences since the introduction of biologic *** death record case-control study was performed to explore the odds of premature death (before age 65) and all-cause mortality among those with IBD. Cases consisted of IBD patients (1,129 with CD and 841 with UC) who died in New York State (NYS) from 1993 to 2010. Controls (n=7880) were matched 4:1 on the basis of sex and zip code from those who died in NYS in the same time frame, without an IBD *** with matched controls, those with CD (OR 1.56, CI 95% 1.34-1.82), but not UC (OR 0.72, CI 95% 0.59-0.89), were more likely to die prematurely. Both those with UC and CD were more likely to die from a gastrointestinal cause (CD OR 15.28, 95% CI 12.11-19.27;UC OR 14.02, 95% CI 10.76-18.26). There was no difference in the cause or age of death before and after the introduction of anti-TNF agents in those with *** CD and UC cases were more likely to die of a gastrointestinal etiology, and CD patients were more likely to die prematurely. There was no significant difference in the premature death, average age of death, and cause of death in this IBD population after the availability of anti-TNF therapy.

摘要： While it appears that there are a variety of factors that exacerbate IBD, it is frustrating that symptoms can persist and worsen even when environmental insults are removed. We suggest that there may be a positive feedback loop which perpetuates the inflammatory response in IBD patients. The loop is triggered by vitamin D deficiency which reduces calcium uptake. Lowered vitamin D and calcium interfere with anti-inflammatory pathways. Inflammation of the mucosa inhibits absorption of calcium and thus perpetuates the reduced anti-inflammatory response. A number of predictions follow from this hypothesis and are supported by geographic and lifestyle patterns in IBD incidence and prevalence.

关键词： Inflammatory bowel disease   Carcinoembroyonic antigen   Adherent-InvasiveEscherichia Coli   Epithelial cells   Bacteria  

摘要： Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a chronic intestinal inflammatory condition with increasing incidence worldwide and whose pathogenesis remains largely unknown. The collected evidence indicates that genetic, environmental and microbial factors and a dysregulated immune response are responsible for the disease. IBD has an early onset and long term sufferers present a higher risk of developing colitis associated cancer (CAC). The carcinoembryonic antigen-related adhesion molecules (CEACAM) are a subgroup of the CEA family, found in a range of different cell types and organs including epithelial cells in the intestine. They can act as intercellular adhesions molecules for e. g. bacteria and soluble antigens. CEACAMs are involved in a number of different processes including cell adhesion, proliferation, differentiation and tumour suppression. Some CEACAMs such as CEACAM1, CEACAM5 and CEACAM6 are highly associated with cancer and are even recognised as valid clinical markers for certain cancer forms. However, their role in IBD pathogenesis is less understood. The purpose of this review is to provide a comprehensive summary of published literature on CEACAMs and intestinal inflammation (IBD). The interactions between CEACAMs and bacteria adhesion in relation to IBD pathophysiology will be addressed and potential new therapeutic and diagnostic opportunities will be identified.

关键词： Azathioprine   Inflammatory bowel disease   Withdrawal   Remission  

摘要： BackgroundThe benefits of immunosuppressants for sustaining remission and preventing flares of IBD are well known. However, optimal timing for withdrawal has not been *** objective of this study was to calculate the risk of relapse and predictors after withdrawal of azathioprine (AZA) monotherapy in patients who sustain deep *** was a multicenter observational study of patients with IBD in remission whose immunosuppressant had been withdrawn. We recorded demographic variables, disease data, laboratory values, and the results of imaging tests performed at withdrawal and, in patients who relapsed, time to relapse and the efficacy of reintroducing the ***-five patients were included (35 UC and 60 CD). The mean duration of AZA treatment was 87 and 77months for UC and CD, respectively. Endoscopic remission was evaluated in 23 patients with UC and 35 with CD. After AZA withdrawal, 91% patients with UC and 67% with CD received high doses of salicylates. A total of 26 patients relapsed. The cumulative relapse rate at 5years was 46% for CD and UC. AZA was reintroduced in 19 patients, of whom 14 responded. Predictors of relapse were corticosteroid dependence, early introduction of AZA (CD), and late introduction of AZA (UC).ConclusionsAlmost half of the patients in whom AZA was withdrawn were in remission at 5years. The candidates for withdrawal could be better identified based on corticosteroid dependence, previous surgery, timing of initiation, and indication for AZA.

关键词： Asia   epidemiology   incidence   inflammatory bowel disease   prevalence  

摘要： Background and Aim Little is known regarding the exact burden of inflammatory bowel disease (IBD) in Asian countries because previous epidemiologic studies were hospital based. We aimed to develop and validate an operational definition of IBD cases from health insurance claims data and to examine the epidemiological features of IBD in Korea. Methods We analyzed stratified sample data from the Korean Health Insurance Review and Assessment (2010-2016) database using 12 different definitions and applied the best definition to the entire (2007-2016) dataset. Results The definition that combined the International Classification of Disease 10th revision code with IBD-specific medications had the best performance characteristics among the 12 tested definitions. During the 8-year study period, IBD prevalence increased from 25 345 in 2009 to 47 444 in 2016. Over that period, the prevalence of Crohn's disease increased 1.9-fold (from 16.0/100 000 in 2009 to 29.6/100 000 in 2016) and that of ulcerative colitis increased 1.6-fold (from 41.4/100 000 in 2009 to 66.0/100 000 in 2016). Similarly, the estimated incidence of Crohn's disease also increased 1.2-fold (from 2.4 to 2.9 per 100 000) and that of ulcerative colitis rose 1.3-fold (from 4.0 to 5.3 per 100 000). During the study period, the predominant increase in IBD incidence was among younger individuals, especially those aged < 30 years. Conclusion Patients with IBD can be accurately identified using Korean insurance claims data by combining information regarding the International Classification of Disease 10th revision codes and the IBD medications used. The prevalence of IBD continues to increase, with an apparent shift toward younger (< 30 years) age groups.

关键词： Bioactive peptides   Food proteins   Immunomodulation   Inflammation   Inflammatory bowel disease   Intestinal mucosa  

摘要： Background: Inflammatory bowel disease (IBD) comprises a group of chronic inflammatory disorders of the gastrointestinal tract which precise aetiology remains unknown. Diet is one of the main environmental factors involved in IBD as it modulates both the gut microbiota and the mucosal immune system. The gastrointestinal tract is therefore the main target of bioactive compounds, such as food-derived bioactive peptides. Scope and approach: The present review provides an overview on the physiological relevance of food proteins, hydrolysates and peptides in the digestive system and explores the preventive and therapeutic role that they can play in IBD. Findings and insights from studies on cell cultures, animal models and human clinical trials are summarised and discussed. Key findings and conclusions: The gastrointestinal mucosa presents unique mechanisms of immune tolerance towards nutrients and commensals under a delicate balance, which is nevertheless dysregulated in IBD. Counteracting this imbalance, dietary peptides carry a range of biological activities that might provide positive impact on gastrointestinal homeostasis. The anti-inflammatory, antioxidant and immunomodulatory properties of peptides from diverse food sources has been broadly evaluated in vitro. Protective mechanism of action through modulation of the pro-/anti-inflammatory and tolerogenic profile of immune responses has been demonstrated in animal models both in resting conditions and in IBD-like inflammation. However, there is still limited evidence in the human setting to support their bioactivity. This review highlights the impact of bioactive peptides in gastrointestinal health and encourages more robust information in clinical trials to ultimately elucidate their role as functional compounds in human IBD.

关键词： vedolizumab   alpha 4 beta 7 integrin   Crohn's   ulcerative colitis   spondyloarthritis   spondylarthritis   ankylosing spondylitis   axial SpA   enthesitis   mucosal vascular addressin cell adhesion molecule-1 (MADCAM-1)  

摘要： Objectives. Vedolizumab (VDZ) blocks alpha 4 beta 7 integrin and is licenced for the treatment of IBD. It has been associated with mild SpA-related features, including sacroiliitis and synovitis. Herein we report a series of cases demonstrating the emergence of severe SpA-associated enthesitis/osteitis following successful IBD therapy with VDZ. Methods. We evaluated 11 VDZ-treated patients with IBD across seven centres who developed severe active SpA and/or enthesopathy, with the aim of characterizing the VDZ-associated SpA or entheseal flares. Imaging features demonstrating particularly severe disease were recorded. Results. De novo SpA developed in 9 of 11 patients and flare of known SpA in 2 patients, with 4 patients requiring hospitalization due to disease severity. Available data showed that one of seven cases were HLA-B27 positive. The median time from VDZ initiation to flare was 12 weeks, with IBD well controlled in 7 of 10 patients (no data for 1 patient) at flare. Severe SpA enthesitis/osteitis was evident on MRI or US, including acute sacroiliitis (n = 5), extensive vertebral osteitis (n = 1), peri-facetal oedema (n = 1) and isolated peripheral enthesitis (n = 3). Due to arthritis severity, VDZ was discontinued in 9 of 11 patients and a change in therapy, including alternative anti-TNF, was initiated. Conclusion. Severe SpA, predominantly HLA-B27 negative, with osteitis/enthesitis may occur under successful VDZ treatment for IBD, including in subjects with prior anti-TNF therapy for intestinal disease.

摘要： Inflammatory bowel disease has a wide range of possible oral manifestations, many of which overlap with those seen in other conditions, including orofacial granulomatosis. The precise etiology remains unclear, as is the exact relationship between orofacial granulomatosis and Crohn's disease. Overall, there is growing evidence that orofacial granulomatosis and oral Crohn's disease are distinct clinical disorders with optimal management requiring a multidisciplinary approach with input from appropriate specialists in oral medicine, gastroenterology, allergy, dietetics, and clinical psychology. This review details the etiopathogenesis, clinical presentation, epidemiology, extra-intestinal, and oral manifestations of inflammatory bowel disease and orofacial granulomatosis. It also assesses the current role of investigations in the diagnosis of orofacial granulomatosis and critically reviews the available evidence in relation to medical and surgical interventions for the condition, and its relationship to Crohn's disease.