关键词： Clinical management   Crohn's disease   Medical education   Professional updating   Ulcerative colitis  

摘要： Background: Little is known about the unmet needs of physicians caring for patients with inflammatory bowel disease (IBD). Aims: This study explored the practical difficulties and needs for professional updating of Italian IBD physicians. Methods: A questionnaire was distributed to 600 physicians attending IG-IBD meetings. Results: 280 physicians completed the questionnaire (46.7%). On a 5-point Likert scale (from 1, strongly disagree to 5, strongly agree), they identified the most problematic issues in managing IBD patients as increasing bureaucracy (3.9), lack of extra-gastroenterological IBD expertise (3.4), lack of diagnostic techniques (3.1) and budget limitations (2.9). The most lacking techniques, ranked from 1 (greatest need) to 9 (lowest need), were: anti-drug antibody and trough level assays (2.7), device-assisted enteroscopy (3.1), exploration under anaesthesia (3.2), MR enterography (3.2), and bowel ultrasonography (3.3). About professional updating, respondents indicated (on a 5-point Likert scale) that helpful topics were practical medicine (4.3), managing difficult patients (4.1), and guidelines (4.0). The most desired modality for updating was residential courses on clinical practice (4.3). Conclusion: Several factors potentially limit the best management of IBD patients in Italy. Satisfying these unmet needs could improve care for IBD patients. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

关键词： children   Crohn disease   epidemiology   pediatric inflammatory bowel disease   ulcerative colitis  

摘要： Supplemental Digital Content is available in the text

关键词： CAN   colitis-associated neoplasia   CD   Crohn’s disease   CI   confidence interval   EBD   endoscopic balloon dilation   EL   evidence level   ESt   endoscopic stricturotomy   ESD   endoscopic submucosal dissection   GR   grade of recommendation   IBD   inflammatory bowel disease   IPAA   ileal pouch-anal anastomosis   IQR   interquartile range   OTSC   over-the-scope clip   SCENIC   Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in IBD patients   TNF   tumor necrosis factor   TTSC   Through-the-scope clips  

摘要： Interventional (or therapeutic) inflammatory bowel disease (IBD) endoscopy has an expanding role in the treatment of disease and surgical adverse events. Endoscopic therapy has been explored and used in the management of strictures, fistulas/abscesses, colitis-associated neoplasia, postsurgical acute or chronic leaks, and obstructions. The endoscopic therapeutic modalities include balloon dilation, stricturotomy, stent placement, fistulotomy, fistula injection and clipping, sinusotomy, EMR, and endoscopic submucosal dissection. With a better understanding of the disease course of IBD, improved long-term impact of medical therapy, and advances in endoscopic technology, we can foresee interventional IBD becoming an integrated part of the multidisciplinary approach to patients with complex IBD.

关键词： Infliximab   Reaction rates   Administration, Intravenous   Inflammatory Bowel Diseases   Intestinal Diseases   Patients  

摘要： INTRODUCTION:Infliximab for inflammatory bowel disease (IBD) is FDA-approved to be administered 2 h or more. We adopted a new protocol to infuse infliximab over 1 h and in this study, we aimed to determine the safety of a 1-h ***:This retrospective cohort included adult IBD patients who received infliximab between June and December 2017 and compared reaction rates of 1-h maintenance infusions to that of 2-h maintenance ***:A total of 551 infusions were administered to 179 patients. The infusion groups demonstrated no significant differences in reaction ***:Infliximab infusion over 1 h is well-tolerated.

关键词： Inflammatory bowel disease   Outcome   Self-efficacy   Transfer   Transition  

摘要： Aim It can be difficult for adolescents with inflammatory bowel disease (IBD) to make the transition from paediatric to adult care. We studied the outcomes of this process and defined what constituted a successful transition. Methods In 2008, 50 adolescents who attended our IBD transition clinic completed IBD-yourself, a self-efficacy questionnaire that we had previously developed and validated. We approached the subjects in 2014, two to six years after they transferred to adult care, and 35 agreed to take part in the current study. The outcome of transition was assessed by our newly developed Transition Yourself Score. In addition, the relationship between self-efficacy and the outcome of the transition was measured. Results The mean age of the patients was 21.8 years, and 69% suffered from Crohn's disease. The transition process was successful in 63% of cases, moderately successful in 31% and failed in 6%. A successful transition was associated with effective use of medication and clinical remission at the time of transfer, but could not be predicted by self-efficacy. The Transition Yourself Score will be validated in future studies. Conclusion Nearly two-thirds (63%) of the adolescents who attended the IBD transition clinic had a successful transition to adult care.

关键词： Pneumocystis jirovecii   Pneumonia   Intestinal Diseases   Lung   Inflammatory Bowel Diseases   Comorbidity  

关键词： colitis-associated cancer   inflammatory bowel disease   lentinan   TLR4  

摘要： In this study, we investigated the therapeutic potential of lentinan in mouse models of inflammatory bowel disease (IBD) and colitis-associated cancer (CAC). Lentinan decreased the disease activity index and macroscopic and microscopic colon tissue damage in dextran sulphate sodium (DSS)-induced or TNBS-induced models of colitis. High-dose lentinan was more effective than salicylazosulfapyridine in the mouse models of colitis. Lentinan decreased the number of tumours, inflammatory cell infiltration, atypical hyperplasia and nuclear atypia in azoxymethane/DSS-induced CAC model. It also decreased the expression of pro-inflammatory cytokines, such as IL-13 and CD30L, in IBD and CAC model mice possibly by inhibiting Toll-like receptor 4 (TLR4)/NF-kappa B signalling and the expression of colon cancer markers, such as carcinoembryonic antigen, cytokeratin 8, CK18 and p53, in CAC model mice. In addition, lentinan restored the intestinal bacterial microbiotal community structure in IBD model mice. Thus, it shows therapeutic potential in IBD and CAC model mice possibly by inhibiting TLR4/NF-kappa B signalling-mediated inflammatory responses and disruption of the intestinal microbiotal structure.

关键词： Subset   letter   Inflammatory Bowel Diseases   Venous Thromboembolism   Intestinal Diseases   Patients  

摘要： Linked ContentThis article is linked to Chu et al papers. To view these articles, visit https://***/10.1111/apt.15010 and https://***/10.1111/apt.15103.

关键词： Inflammatory bowel diseases   Ulcerative colitis   Crohn's disease   Cytomegalovirus colitis   Diagnostic algorithm  

摘要： PurposeThe optimal method for detecting CMV colitis in patients with inflammatory bowel disease (IBD) has not been established. We wanted to investigate which diagnostic test would be most accurate when defining CMV colitis rather by the further clinical course than by using another diagnostic *** consecutive patients with moderately or severely active IBD who had been tested for CMV by PCR, histology, or antigenemia assay at the two campuses CBF and CCM of the Charite - Universitatsmedizin Berlin between September 2006 and September 2009 were included in this retrospective study. During that time, in patients with a positive CMV test, immunosuppressive treatment of any kind was immediately reduced and antiviral treatment was started. This allowed identifying patients who responded to antiviral treatment and those who only responded to later escalation of immunosuppressive *** hundred and nine patients were identified, out of whom nine were considered to have clinically relevant CMV colitis. Sensitivity and specificity were 1 and 0.94 for CMV PCR and 0.5 and 1 for pp65 antigen immunofluorescence assay from peripheral blood, 0.67 and 0.98 for immunohistochemistry, and 0.17 and 0.98 for hematoxylin-eosin staining. When using absence of leukocytosis, splenomegaly, and steroid refractory disease as clinical parameters to test for CMV colitis, blood CMV PCR and immunohistochemistry were able to exclude CMV colitis in negative patients with a 75% likelihood of positive patients to have clinically relevant CMV ***-based CMV PCR together with simple clinical parameters can exclude clinically relevant CMV colitis at a high specificity.