关键词： INFLAMMATORY bowel diseases   ENDOSCOPY   LOGISTIC regression analysis  

摘要： Background Characterization of colonic lesions in inflammatory bowel disease (IBD) remains challenging. We developed an endoscopic classification of visual characteristics to identify colitis-associated neoplasia using multimodal advanced endoscopic imaging (Frankfurt Advanced Chromoendoscopic IBD LEsions [FACILE] classification). Methods The study was conducted in three phases: 1) development-an expert panel defined endoscopic signs and predictors of dysplasia in IBD and, using multivariable logistic regression created the FACILE classification;2) validation-using 60 IBD lesions from an image library, two assessments of diagnostic accuracy for neoplasia were performed and interobserver agreement between experts using FACILE was determined;3) reproducibility-the reproducibility of the FACILE classification was tested in gastroenterologists, trainees, and junior doctors after completion of a training module. Results The experts initially selected criteria such as morphology, color, surface, vessel architecture, signs of inflammation, and lesion border. Multivariable logistic regression confirmed that nonpolypoid lesion, irregular vessel architecture, irregular surface pattern, and signs of inflammation within the lesion were predictors of dysplasia. Area under the curve of this logistic model using a bootstrapped estimate was 0.76 (0.73-0.78). The training module resulted in improved accuracy and kappa agreement in all nonexperts, though in trainees and junior doctors the kappa agreement was still moderate and poor, respectively. Conclusion We developed, validated, and demonstrated reproducibility of a new endoscopic classification (FACILE) for the diagnosis of dysplasia in IBD using all imaging modalities. Flat shape, irregular surface and vascular patterns, and signs of inflammation predicted dysplasia. The diagnostic performance of all nonexpert participants improved after a training module.

关键词： Inflammatory bowel disease   Chitinase-3-like 1 protein   Gastrointestinal tract   Inflammation   Immune response  

摘要： The incidence of inflammatory bowel disease (IBD) is steadily increasing. IBD is characterized by chronic inflammation of the gastrointestinal tract and is divided into the two main entities Crohn's disease (CD) and ulcerative colitis (UC). Genetic predispositions, environmental factors and a dysregulated immune response are known to be involved at the beginning of IBD. However, their etiopathogenesis is not yet fully understood. Over the last ten years, there has been increasing evidence of the involvement of the member of the 18-glycosylhydrolase family chitinase-3-like protein 1 (CHI3L1) in IBD. CHI3L1 is associated with various diseases such as cancer and chronic inflammatory diseases including rheumatoid arthritis or IBD as well as neurological diseases where it can act as a chemoattractant, mitogen or growth factor. This review will focus on the role of autoimmunity to CHI3L1 in IBD in the context of its expression in inflamed colonic epithelia and interaction with intestinal microbiota. Further, it will provide insights into the interaction of CHI3L1 with different mechanisms of the innate and adaptive immune response in IBD.

关键词： white light endoscopy   Intestinal Diseases   chromoendoscopy   Patients   liquid diet   bowel preparation   Inflammatory Bowel Diseases  

摘要： Background and Aims: Chromoendoscopy (CE) has been shown to generate both a superior diagnostic yield and dysplasia detection rate than conventional white-light endoscopy and requires a high-quality bowel preparation. The aim of this study was to identify predictors of the ability to perform CE in patients with inflammatory bowel disease (IBD). Methods: We performed an observational study of patients with IBD undergoing colorectal cancer surveillance examinations with CE. Same-day colonoscopy surveys were used to collect patient and procedural variables. Multivariate logistic regression was used to establish odds ratios of successful completion of CE. Results: Eighty-eight patients with IBD were enrolled. We found that patients who did not follow a clear liquid diet before colonoscopy had much lower odds of being able to undergo CE (odds ratio, 0.106;95% confidence interval, 0.013-0.845;P<.034). Further, we found that previously identified risk factors (older age, history of diabetes mellitus, the timing and split dosing of preparation solution, and procedure time (AM or PM), chronic narcotic use, and history of constipation) for inadequate bowel preparation were not associated with the ability to perform CE. Conclusions: Following a clear liquid diet the entire day before the procedure was highly predictive of the ability to perform CE. However, established risk factors for inadequate bowel preparation did not inhibit the ability to perform CE in our population. Endoscopists performing CE should consider recommending that patients follow a clear liquid diet the entire day before their examination.

关键词： carcinoid   inflammatory bowel disease   microcarcinoid   neuroendocrine cell micronests   neuroendocrine proliferations   neuroendocrine tumours  

摘要： AimsA wide spectrum of well-differentiated neuroendocrine proliferations (NEPs) are observed in inflammatory bowel disease (IBD), ranging from neuroendocrine tumours (NETs) to microscopic neuroendocrine cell clusters, best described as neuroendocrine cell micronests (NCMs). Finding NCMs in surveillance biopsies of IBD patients often poses a diagnostic conundrum. While such lesions may have been referred to as microcarcinoids' in the literature, it is unclear whether these represent early neoplasms. The study was undertaken to characterise NCMs and to differentiate NCMs from NETs. Methods and resultsInstitutional surgical pathology archives were searched to identify cases of NEPs in IBD patients. Clinicopathological features were examined. NCMs were defined as scattered, indistinct neuroendocrine cell clusters without confluent growth or new stroma formation, located in the lamina propria and muscularis mucosae. NETs were defined as discrete, mass-forming lesions. Seventeen NEPs were identified, including eight NCMs and nine NETs. All NEPs were incidentally discovered. While NETs were commonly found in the rectum and appendix, NCMs were only noted in the rectosigmoid area. Unlike NETs, NCMs could not be measured as a discrete lesion as these clusters were non-confluent and scattered. None of the patients with NCMs developed NETs after a mean follow-up of 4.1years (range=0.5-21.0years). None of the NETs showed NCMs in the background mucosa. ConclusionsNCMs have distinct pathological features, are not associated with NETs in IBD patients and should not be misinterpreted as microcarcinoids'. Identification of NCMs in surveillance biopsies may not require further clinical work-up or invasive procedures usually performed for NETs.

关键词： Inflammatory bowel disease   Anti-tumour necrosis factor   Infliximab   Adalimumab   Treatment withdrawal  

摘要： Anti-tumour necrosis factor a therapy in inflammatory bowel disease has been shown to be effective in clinical practice. After more than a decade using these therapies the question arises about whether there is an appropriate time to suspend these therapies, and how this should be done. This review aims to evaluate the current evidence on these topics concerning anti-tumour necrosis factor a therapies, and eventually identify conditions and subgroups of patients that could potentially be candidates for withdrawal. (C) 2018 Elsevier Espana, S.L.U. All rights reserved.

关键词： behavior therapy   cognitive   inflammatory bowel diseases   meta-analysis   nursing   quality of life  

摘要： Aims This systematic review and meta-analysis aimed to evaluate the effects of cognitive-behavioural therapy in patients with inflammatory bowel diseases. Methods Cochrane Library, Web of Science, Pubmed, EMBASE, and CINAHL were searched up to June 2017, as well as grey literature and databases hand searches. Quality assessment, heterogeneity, sensitivity analysis, and publication bias were performed. Stata12.0 software was used for pooled estimates. Results Seven eligible reports were included in the final analysis. Inflammatory Bowel Disease Questionnaire score was higher in the cognitive-behavioural therapy group than in the control group at the final follow-up in inflammatory bowel disease patients (P = 0.008). There was no statistically significant difference in the Crohn's Disease Activity Index (P = 0.751), Simple Clinical Colitis Activity Index score (P = 0.747), State Anxiety score (P = 0.988), Trait Anxiety score (P = 0.681), and Perceived Stress Questionnaire score (P = 0.936) at the final point of follow-up. A funnel plot showed no publication bias (P = 0.98). Conclusion Cognitive-behavioural therapy appeared to support higher quality of life in inflammatory bowel disease patients compared with a control group at the final follow-up point but had no effect on disease activity, anxiety, or perceived stress in patients with inflammatory bowel disease. Cognitive-behavioural therapy can be an acceptable adjunctive therapy for inflammatory bowel disease patients, but the effect of cognitive-behavioural therapy is limited.

关键词： Diagnostic testing   Nucleic acid detection   Overdiagnosis   Complications  

摘要： Background and AimsGastrointestinal pathogen panels (GPPs) are increasingly being used for evaluation of diarrhea. The impact of these tests on patients with inflammatory bowel diseases (IBD) is unknown. We performed a time-interrupted cohort study comparing GPPs and conventional stool evaluation in patients with IBD with *** included 268 consecutive patients with IBD who underwent GPP (BioFire Diagnostics((R))) (n=134) or conventional stool culture and Clostridium difficile polymerase chain reaction testing (n=134) during suspected IBD flare between 2012 and 2016. Primary outcome was composite of 30-day IBD-related hospitalization, surgery, or emergency department visit;secondary outcome was IBD treatment ***, 41/134 (30.6%) patients tested positive on GPP (18 C. difficile, 17 other bacterial infections, and 6 viral pathogens) versus 14/134 patients (10.4%, all C. difficile) testing positive on conventional testing. Rate of IBD treatment modification in response to stool testing was lower in GPP group as compared conventional stool testing group (35.1 vs. 64.2%, p<0.01). On multivariate analysis, diagnostic evaluation with GPP was associated with three times higher odds of IBD-related hospitalization/surgery/ED visit (95% CI, 1.27-7.14), as compared to conventional stool testing. This negative impact was partly mediated by differences in ordering provider specialty, with non-gastroenterologists more likely to order GPP as compared to *** patients with suspected flare of IBD, GPPs have higher pathogen detection rate and lead to lower rate of IBD treatment modification. A diagnostic testing strategy based on GPPs is associated with higher hospital-related healthcare utilization as compared to conventional stool testing, particularly when utilized by non-gastroenterologists.

关键词： Bispecific antibody   Crohn's disease   Inflammatory bowel disease   Monoclonal antibody   Colitis, ulcerative  

摘要： Targeting various disease pathways using monoclonal antibodies (mAbs) has transformed the treatment paradigm for inflammatory bowel disease (IBD), with these agents exhibiting improved efficacy over corticosteroids or immunosuppressive therapies. Antibodies targeting tumor necrosis factor alpha (TNF-alpha) were the first approved biologics for IBD, followed by the more recent approval of antibodies targeting the alpha 4 beta 7 integrin heterodimer and ustekinumab, which targets the p40 subunit of interleukin-23. Current efforts are focused on the development of additional biologics targeting these known and other newly discovered pathways. Still significant unmet needs remain, as a large proportion of patients either fail to achieve remission or fail to respond altogether. Both Crohn's disease and ulcerative colitis are complex and heterogeneous diseases with several molecular pathways involved in disease pathophysiology. We propose an additional therapeutic approach to the treatment of IBD, bispecific antibodies (BsAbs), which combine two distinct binding specificities within a single biologic to allow the simultaneous targeting of multiple disease-causing cytokines or pathways. Although primarily used in oncology thus far, the unique combinatorial mechanism of action of BsAbs may provide new therapeutic options for a broad range of clinical applications, including autoimmune and inflammatory diseases. This review will discuss the current status of BsAb development in general and potentially therapeutic application in IBD.