关键词： Colorectal surgery   Inflammatory bowel disease   Laparoscopy   Minimally invasive surgery   Outcomes  

摘要： Background: The relapsing and remitting nature of inflammatory bowel disease (IBD) predisposes patients to the development of fibrotic strictures, which must often be managed surgically. Laparoscopy provides the potential for enhanced perioperative care. Previous studies comparing morbidity and trends of open versus laparoscopic resection have been constrained by length of study and sample size. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, patients with primary diagnosis of IBD undergoing surgical resection from 2005 to 2015 were identified. Morbidity and mortality rates were then compared between open and laparoscopic resections using multiple logistic regression analyses. Results: A total of 10,699 resections were performed on IBD patients;4816 (45.0%) of which were performed laparoscopically. The use of laparoscopy increased annually from 20.9% in 2005 to 55.4% in 2015. Comparing laparoscopic versus open, all 30-d outcomes tended to favor laparoscopy with the exception of operating room time, which was equal between the two groups. The difference in 30-d outcomes was statistically significant in laparoscopy versus open technique for pneumonia (1.0% versus 2.0%), ventilator use >48 h (0.6% versus 1.9%), acute renal failure (0.1% versus 0.4%), renal insufficiency (0.2% versus 0.6%), superficial surgical site infection (4.6% versus 7.7%), deep incisional surgical site infection (1.1% versus 1.8%), organ space infection (5.4% versus 7.3%), urinary tract infection (1.3% versus 2.2%), death (0.2% versus 0.7%), and length of hospital stay (6.4 versus 9.4 d). Conclusions: These data not only display trends that indicate that the number of laparoscopic resections for IBD have increased over time but are associated with favorable complication rates, operating time, and length of hospital stay, suggesting that laparoscopy may be a safer option for treatment of fibrotic strictures associated with IBD. (C) 2018 Elsevi

关键词： Crohn's disease   Ulcerative colitis   Age at diagnosis   Educational level   Surgery  

摘要： BackgroundDelayed diagnosis seems to be common in inflammatory bowel diseases (IBD). The study was carried out to investigate the diagnostic delay and associated risk factors in Austrian IBD *** amulticenter cross-sectional study adult patients with IBD attending 18Austrian outpatient clinics completed amulti-item questionnaire that recorded medical and socioeconomic characteristics. The study outcome was diagnostic delay defined as the period from symptom onset to diagnosis of *** of 1286 patients (Crohn's disease 830, ulcerative colitis 435, inflammatory bowel disease unclassified 21;females 651) with amedian age of 40years (interquartile range 31-52years) and amedian disease duration of 10years (4-18years) were analyzed. The median diagnostic delay was 6months (2-23months) in Crohn's disease and 3months (1-10months) in ulcerative colitis (p<0.001). In the multivariable regression analysis Crohn's disease, greater age at diagnosis and ahigh educational level (compared to middle degree level) were independently associated with longer diagnostic *** diagnostic delay was longer in Crohn's disease than in ulcerative colitis patients and was associated with greater age at diagnosis and ahigher educational level.

关键词： adalimumab   infliximab   pediatric   surgery   vedolizumab  

摘要： Objectives: There has been limited investigation of pediatric patients with inflammatory bowel disease (IBD) who have been treated with biologic agents and undergo operative management. Postoperative complications in the adult setting have been mixed and in the pediatric population the data have been limited. This study compares children with IBD treated with biologic agents to patients treated with nonbiologic therapy before bowel resection. Methods: This is a single-center, retrospective chart review study of 62 children with IBD who underwent bowel resection between 2001 and 2017. Analysis included patient demographics, medications used before surgery, incidence of postoperative complications, indication for surgery, type of operation, and additional surgeries required. Postoperative complications were defined as superficial skin infection, leak at anastomotic site, intra-abdominal abscess, wound dehiscence, and so on. Complications were compared based on medical therapy. Results: Of the 62 children reviewed, 21 carried the diagnosis of ulcerative colitis, 40 had Crohn disease, and 1 had IBD-unspecified. Thirty-seven of the patients were treated with infliximab, adalimumab, or vedolizumab before their bowel resection. There were 4 complications documented within 30 days of the operation, with an overall complication rate of 6.45%. There were 2 complications in each of the cohorts, including intra-abdominal abscess (2), abdominal wall abscess (1), and pouchitis (1). Conclusion: The number of complications was the same between those who did and did not receive a preoperative biologic agent. This study suggests that biologics may be safe to use in patients undergoing bowel resection.

关键词： Clostridium difficile   Crohn disease   fecal microbiota transplant   inflammatory bowel disease   ulcerative colitis  

摘要： Objectives: Recurrent Clostridium difficile infection (RCDI) increases morbidity and mortality in patients with inflammatory bowel disease (IBD). Fecal microbiota transplant (FMT) is known to be very effective for RCDI in non-IBD patients with cure rates up to 91%. The same success rates of FMT have not been reported in patients with IBD with RCDI, and the data in pediatrics are limited. We aimed to determine the effectiveness of FMT for RCDI in established pediatric patients with IBD. Methods: We performed a retrospective chart review of pediatric patients with IBD and RCDI (>= 3 episodes) who underwent FMT via colonoscopy at a tertiary care IBD center. The primary outcome was the rate of RCDI within 60 days post-FMT. The secondary outcomes were recurrence rate by 6 months, rate of colectomy, and time to recurrence. Results: Of the 8 eligible patients, 6 had ulcerative colitis, 1 had IBD-unspecified, and 1 had Crohn disease. Median (interquartile range) age was 13 (11-14) years. All patients were on vancomycin at FMT. Two patients (25%) had RCDI by 60 days post-FMT and another 3 patients had RCDI between 60 days and 6 months. The median time to recurrence was 101 (40-139) days. Two patients (25%) who developed recurrence went to colectomy after FMT. Conclusions: With a cure rate of 75% at 60 days, FMT administered for the treatment of RCDI may be an effective treatment option in pediatric IBD. However, there appears to be a significant rate of late recurrence of C difficile infection after 60 days in these patients.

关键词： Crohn's disease   Ulcerative colitis   Adalimumab   Persistence   Retention rate   Safety  

摘要： BackgroundReal-life data of retention rate and persistence of adalimumab in inflammatory bowel disease are still *** analyze retention rate, persistence, and safety of adalimumab in a 9-year real-life cohort of inflammatory bowel disease *** this observational, retrospective single-center study, all adult patients treated with adalimumab as the first- and second-line biological treatment for steroid-dependent or refractory inflammatory bowel disease between March 2008 and March 2017 were included. Primary outcomes were persistence, retention rate, and adverse events;the secondary outcome was the identification of predictors of ***-six out of 181 patients (53%) withdrew their first course of adalimumab. The retention rate was 47% and 46.9% in Crohn's disease and ulcerative colitis patients, respectively;median persistence was 26 and 24months in CD and UC patients, respectively. The cumulative probability of treatment persistence was 80.2%, 54.5%, and 29.6% and 69.6%, 40.4%, and 21.5% in CD and UC patients, respectively. The incidence rate of any adverse event was 12.5/100 patients-year;severe adverse events were 1.7/100 patients-year. The Cox regression revealed that CD patients with baseline disease duration>72months have a higher likelihood for withdrawal due to failure and/or adverse events (HR 1.62, 95% CI 1-2.62, p=0.04);no predictors of discontinuation were found in *** showed a great persistence in the first 12months of therapy and excellent safety profile. Early treatment of CD patients could increase efficacy and reduce the adverse event rate.

关键词： Intestinal Diseases   golimumab   KEYWORD   Opportunistic Infections   Adverse Reaction   Virus Diseases   Infliximab   Biological Therapy   Adalimumab   Adverse Event   Inflammatory Bowel Diseases   Crohn Disease  

摘要： Background Biological therapy is currently widely used to treat IBD. Infliximab, adalimumab and golimumab are currently licensed anti-TNF therapies. Biosimilar anti-TNF monoclonal antibodies are increasingly used. Anti-TNF therapies are widely used and their adverse effects are well characterised, and may cause significant morbidity and mortality in a small proportion of exposed patients. Gastroenterologists need to understand the mechanisms for these effects, recognise these swiftly and manage such events appropriately. Aim To cover the range of potential adverse reactions as a result of biologic therapy and specifically management of these events. Methods A Medline and Pubmed search was undertaken. Search terms included were "anti-TNF," "infliximab" or "adalimumab" or "golimumab" combined with the keywords "ulcerative colitis" or "Crohn's disease" or "inflammatory bowel disease" and then narrowed to articles containing the keywords "complications," "side effects" or "adverse events" or "safety profile." International guidelines were also reviewed where relevant. Results Adverse events discussed in this review include infusion reactions, blood disorders and infections (including bacterial, viral, fungal and opportunistic infections) as well as autoimmune, dermatological disorders, cardiac and neurological conditions. Malignancies including solid organ, haematological and those linked to viral disease are discussed. Conclusions Anti-TNF therapy has wide-ranging effects on the immune system resulting in a spectrum of potential adverse events in a small proportion of patients. Research advances are improving the understanding, recognition and management of these adverse events.

关键词： cholinergic anti-inflammatory pathway   enteric nervous system   inflammatory bowel disease   macrophages   vagal nerve stimulation  

摘要： Over the past decades, there has been an increasing understanding of cellular and molecular mechanisms that mediate modulation of the immune system by the autonomic nervous system. The discovery that vagal nerve stimulation (VNS) attenuates endotoxin-induced experimental sepsis paved the way for further studies investigating neuro-immune interaction. In particular, great attention is now given to intestinal macrophages: several studies report the existence of both intrinsic and extrinsic neural mechanisms by which intestinal immune homoeostasis can be regulated in different layers of the intestine, mainly by affecting macrophage activation through neurotransmitter release. Given the important role of inflammation in numerous disease processes, such as inflammatory bowel disease (IBD), cholinergic anti-inflammatory mechanisms are under intense investigation both from a basic and clinical science perspective in immune-mediated diseases such as IBD. This review discusses recent insights on the cross-talk between enteric neurons and the immune system, especially focusing on macrophages, and provides an overview of basic and translational aspects of the cholinergic anti-inflammatory response as therapeutic alternative to reinstall immune homoeostasis in intestinal chronic inflammation.

关键词： circulating biomarker   inflammatory bowel disease   microRNA classifier   microRNA-146b-5p  

摘要： Background Owing to the importance of early treatment, simple and reliable methods for monitoring inflammatory bowel disease (IBD) are needed. Aims To determine whether circulating microRNAs are reliable biomarkers for IBD monitoring. Methods Serum levels of 17 candidate microRNAs were measured by quantitative real-time polymerase chain reaction in a discovery cohort (n = 120). Differentially expressed serum microRNAs were further investigated in an independent training cohort (n = 341). Correlations between relative microRNA levels and disease activity were evaluated. A disease control group was included to investigate the specificity of microRNA. Logistical regression was used to construct a microRNA classifier to identify endoscopic activity. Its predictive value was explored in the validation cohort (n = 66) using the area under the receiver operating characteristic curve (AUC). Results Serum microRNA146b-5p (miR-146b-5p) expression was 2.87- and 2.72-fold higher in patients with Crohn's disease and ulcerative colitis, respectively, than in healthy controls. Serum miR-146b-5p was significantly correlated with disease activity and was more specific than C-reactive protein (CRP). A classifier was built for Crohn's disease, ie P [Endoscopically active] = 11+e2.937-0.737(miR-146b-5p)-0.008PLT, with a greater AUC of 0.869 [0.764-0.940] than that for CRP (0.680 [0.554-0.790]) (P = 0.0043). Conclusions MiR-146b-5p may better reflect mucosal inflammation in IBD than CRP. The Crohn's disease classifier developed in this study may be valuable for identifying endoscopic activity in patients with Crohn's disease.

关键词： Ulcerative colitis   Crohn's Disease   Ileal pouch-anal anastomosis   Dysplasia   Rectal cancer   Intestinal lymphoma   Squamous cell cancer   Anal cancer   Small bowel cancer   Mucosectomy  

摘要： Patients with inflammatory bowel disease who undergo ileal pouch-anal anastomosis are at finite risk of developing neoplasia of various parts of the pouch. In this review article, we will describe different forms of pelvic pouch-related cancers, with a focus on diagnosis and management of small bowel adenocarcinomas of the pouch body, rectal neoplasia of the rectal cuff and anal transition zone, small intestinal lymphoma of the pouch, and anal dysplasia and squamous cell cancer of the anal canal. (C) 2019 Elsevier Inc. All rights reserved.