摘要： Iron defciency anemia (IDA) represents the most common extra-intestinal complication in patients with chronic infammatory bowel diseases (IBD) [1, 2]. Iron defciency (ID), even without anemia, negatively impacts on patients’ quality of life, and is associated with the development of various comorbidities and an increased risk of hospitalization [3]. Thus, timely correction of ID, before anemia develops, is a major goal in IBD patients

关键词： ART   assisted reproductive technology   CD   Crohn’s disease   IBD   inflammatory bowel disease   IPAA   ileal pouch-anal anastomosis   MFM   maternal–fetal medicine   OB/GYN   obstetrician/gynecologist   UC   ulcerative colitis  

关键词： Transition of care   Adolescent   Crohn's disease   Ulcerative colitis  

摘要： Introduction and aim: The transitional process of young patients affected by inflammatory bowel disease from pediatric to adult care is a crucial step. Our study aimed to investigate the 1-year success outcome of this transitional process. Methods: From 2013 to 2018, we evaluated the transitional process of patients with Crohn's disease or ulcerative colitis. For each patient, the following parameters 12 months before and 12 months after the transition were evaluated: Body Mass Index, disease activity and smoker status, number of outpatient visits and the pharmacological therapy, the number of disease exacerbations, hospitalizations and surgical interventions. Results: We enrolled 106 patients with IBD. No statistically significant difference was found between patients' Body Mass Index before and after transition. There was a significant reduction in the number of exacerbations and hospitalizations in the 12 months post-transition (pre-transition exacerbations: 0.74 +/- 0.79, post-transition exacerbations: 0.35 +/- 0.57, p < 0.001;pre-transition hospitalizations: 0.28 +/- 0.44, post-transition hospitalizations: 0.1 +/- 0.3, p < 0.001). In contrast, there was no significant difference in the number of outpatient visits (3.40 +/- 1.4 vs 3.25 +/- 1.2;p = ns) and of patients undergoing surgery (0.9% vs 1.8%, p = ns). Conclusion: The parameters used as success indicators of the transition program confirm the achievement of continuity of care from Pediatrics to adult Gastroenterology, in a critical phase of the natural history of IBD patients. (c) 2018 Editrice Gastroenterologica Italiana S. r. l. Published by Elsevier Ltd. All rights reserved.

关键词： inflammatory bowel disease   quality of life  

关键词： Biopsychosocial screening   Children   Integrated care   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis  

摘要： Objective: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. Methods: We performed a cross-sectional study of children (aged 8-17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. Results: Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter rater reliability (median r = 0.87) and internal consistency (a = 0.91) for the total complexity index. Ratings of 2-3 on the pIBD-INTERMED "mental health/cognitive threat" item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17-24.36);CBCL-Externalizing scale OR = 24.79, 95% CI 5.00-122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70-43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00-45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. Conclusions: The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.

关键词： inflammatory bowel disease   red flag   spondyloarthritis  

摘要： Collaboration between gastroenterologists and rheumatologists is recommended for the correct management of patients with associated spondyloarthritis (SpA) and inflammatory bowel disease (IBD). We aimed to establish the appropriateness of several red flags for a prompt specialist referral. A systematic review of the literature was performed using the GRADE method to describe the prevalence of co-existing IBD-SpA and the diagnostic accuracy of red flags proposed by a steering committee. Then, a consensus among expert gastroenterologists and rheumatologists (10 in the steering committee and 13 in the expert panel) was obtained using the RAND method to confirm the appropriateness of each red flag as 'major' (one sufficient for patient referral) or 'minor' (at least three needed for patient referral) criteria for specialist referral. The review of the literature confirmed the high prevalence of co-existing IBD-SpA. Positive and negative predictive values of red flags were not calculated, given the lack of available data. A consensus among gastroenterology and rheumatology specialists was used to confirm the appropriateness of each red flag. Major criteria to refer patients with SpA to the gastroenterologist included: rectal bleeding, chronic abdominal pain, perianal fistula or abscess, chronic diarrhoea and nocturnal symptoms. Major criteria to refer patients with IBD to the rheumatologist included: chronic low back pain, dactylitis, enthesitis and pain/swelling of peripheral joints. Several major and minor red flags have been identified for the diagnosis of co-existing IBD-SpA. The use of red flags in routine clinical practice may avoid diagnostic delay and reduce clinic overload.

关键词： infliximab   mass spectrometry   therapeutic drug monitoring  

摘要： Aims Therapeutic drug monitoring (TDM) of infliximab (IFX) appears to be beneficial for patients with inflammatory bowel disease (IBD). However, the recommended target concentrations depend partly on the method used to quantify IFX. Since we recently developed a liquid chromatography-tandem mass spectrometry method to quantify IFX, we aimed to determine IFX trough concentrations (Cmin) associated with biological remission. Methods We retrospectively measured IFX Cmin in sera from 55 patients with IBD, on IFX maintenance therapy, and for whom demographic, biological and clinical data were collected from medical records. A threshold of IFX Cmin associated with biological remission (defined by C-reactive protein < 5 mg l(-1) and faecal calprotectin <150 mu g g(-1)) was determined using receiver operating characteristics analysis. Results IFX Cmin ranged from <1 mg l(-1) to 57.2 mg l(-1). IFX Cmin were higher (P = 0.038) in patients with biological remission and a cut-off of IFX Cmin set to 6.2 mg l(-1) was associated with biological remission (sensitivity = 0.75, 95% confidence interval 0.58-0.75;specificity = 0.61, 95% confidence interval 0.39-0.83). Conclusion Liquid chromatography-tandem mass spectrometry measurement of IFX Cmin and the determination of a new threshold of IFX Cmin associated with biological remission are new steps towards IFX treatment personalization in patients with IBD.

关键词： INFLAMMATORY bowel diseases   CROHN’S disease   ULCERATIVE colitis   TUMOR necrosis factor receptors   THERAPEUTICS  

摘要： Crohn's disease and ulcerative colitis are driven by both common and distinct underlying mechanisms of pathobiology. Both diseases, exhibit heterogeneity underscored by the variable clinical responses to therapeutic interventions. We aimed to identify disease-driving pathways and classify individuals into subpopulations that differ in their pathobiology and response to treatment. We applied hierarchical clustering of enrichment scores derived from gene set variation analysis of signatures representative of various immunological processes and activated cell types, to a colonic biopsy dataset that included healthy volunteers, Crohn's disease and ulcerative colitis patients. Patient stratification at baseline or after anti-TNF treatment in clinical responders and non-responders was queried. Signatures with significantly different enrichment scores were identified using a general linear model. Comparisons to healthy controls were made at baseline in all participants and then separately in responders and non-responders. Fifty-nine percent of the signatures were commonly enriched in both conditions at baseline, supporting the notion of a disease continuum within ulcerative colitis and Crohn's disease. Signatures included T cells, macrophages, neutrophil activation and poly:IC signatures, representing acute inflammation and a complex mix of potential disease-driving biology. Collectively, identification of significantly enriched signatures allowed establishment of an inflammatory bowel disease molecular activity score which uses biopsy transcriptomics as a surrogate marker to accurately track disease severity. This score separated diseased from healthy samples, enabled discrimination of clinical responders and non-responders at baseline with 100% specificity and 78.8% sensitivity, and was validated in an independent data set that showed comparable classification. Comparing responders and non-responders separately at baseline to controls, 43% and 70% of signatures were enri

关键词： Drug development   Irritable bowel syndrome  

摘要： A new drug restores a compromised intestinal barrier and ameliorates colitis in mice by modulating paracellular permeability through a newly discovered mechanism.