关键词： Inflammatory bowel disease   Incidence   Ulcerative colitis   Crohn's disease   Epidemiology  

关键词： inflammatory bowel disease   ulcerative colitis   Crohn's disease   n-3 polyunsaturated fatty acids   omega-3 fatty acids  

摘要： Eating habits have changed dramatically over the years, leading to an imbalance in the ratio of n-6/n-3 polyunsaturated fatty acids (PUFAs) in favour of n-6 PUFAs, particularly in the Western diet. Meanwhile, the incidence of inflammatory bowel disease (IBD) is increasing worldwide. Recent epidemiological data indicate the potential beneficial effect of n-3 PUFAs in ulcerative colitis (UC) prevention, whereas consumption of a higher ratio of n-6 PUFAs versus n-3 PUFAs has been associated with an increased UC incidence. The long-chain dietary n-3 PUFAs are the major components of n-3 fish oil and have been shown to have anti-inflammatory properties in several chronic inflammatory disorders, being involved in the regulation of immunological and inflammatory responses. Despite experimental evidence implying biological plausibility, clinical data are still controversial, especially in Crohn's disease. Clinical trials of fish-oil derivatives in IBD have produced mixed results, showing beneficial effects, but failing to demonstrate a clear protective effect in preventing clinical relapse. Such data are insufficient to make a recommendation for the use of n-3 PUFAs in clinical practice. Here, we present the findings of a comprehensive literature search on the role of n-3 PUFAs in IBD development and treatment, and highlight new therapeutic perspectives.

关键词： Inflammatory bowel diseases   Pediatric   Outcomes   Surgery   Complications   Epidemiology  

摘要： The incidence and prevalence of childhood-onset inflammatory bowel diseases (IBD), including subtypes Crohn's disease and ulcerative colitis, have risen dramatically in recent years, and have emerged globally as important pediatric chronic diseases. Therefore, health care providers are more frequently encountering very young children with IBD, a chronic and incurable condition requiring life-long therapy. These children are living long lives with IBD and therefore knowledge of long-term outcomes is increasingly important to better counsel families and determine the best course of treatment. This review summarizes the current knowledge and literature surrounding long-term outcomes of pediatric IBD, with emphasis on the following areas: need for surgery due to complicated disease behavior, risk of disease remission and recurrence, mental health and psychosocial well-being, educational outcomes, linear growth impairment, cancer risk, and mortality. In addition, we review recent research about predicting negative long-term outcomes in children with IBD. (C) 2017 Elsevier Inc. All rights reserved.

关键词： Inflammatory bowel disease   Biologics   Anti-adhesion molecules   Anti-cytokine   Small molecules drugs  

摘要： Inflammatory bowel disease (IBD), including Crohn's disease (CD) and Ulcerative Colitis (UC), are immune mediated conditions associated with progressive damage of the inflamed gut tissue, and have a considerable impact on the patient's quality of life. The pathogenesis remains uncertain, but it is clear that complex mechanisms associated with host and lumina] factors are involved, generating an unbalance between pro- and anti-inflammatory signaling. It is well established that the purpose of an adequate and complete control of the intestinal inflammation measured not only by clinical symptoms, but also with more objective data such as fecal biomarkers (calprotectin) and endoscopy. The treat to target approach possibly correlates with minor risk for complications associated with IBD, specially surgery and cancer. The most studied inflammatory pathway in IBD, is described to be dependent of the pro-inflammatory cytokine tumor necrosis factor-alfa (TNF-alpha), and compose the first line studies for development of biological drugs, in this case, targeting specifically the action of TNF-alpha. Even though, the use of anti-TNFs drugs are associated with improvement of the inflammation in some patients, a great portion do not respond at first or lose response over time. These findings made clear about the possibility of other mechanisms involved in perpetuating the chronic inflammatory state. Many years of intensive research have led to the identification of different inflammatory pathways that form the basis of the intensive drug development that we are experiencing today. These novel drugs include agents that target leukocyte trafficking, Interleukin (IL) 23, Janus kinases (JAK), Sphingosine 1 phosphate (SIP) and Smad7, an inhibitor of the immunosuppressive cytokine transforming growth factor beta 1 (TGF-beta 1). In this manuscript, we aim to review the most promising late-stage drug candidates for the treatment of IBD. (C) 2017 Published by Elsevier Ltd.

关键词： Advance   Circadian   Delay   Light   Sleep  

摘要： There is increasing evidence that sleep and circadian disruption can worsen the disease course in inflammatory bowel disease (IBD). Sleep and circadian disruption are prevalent in society and are associated with worse outcomes in IBD. Emerging research suggests sleep and circadian disruption can affect key components in IBD disease flares, including intestinal permeability, translocation of bacterial endotoxins, intestinal dysbiosis, and proinflammatory cytokines. Much of this research has been conducted in animal models. There is a clear need for large randomized controlled trials in human patients with IBD, where the potential for chronotherapeutic strategies to improve disease course can be tested.

关键词： Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Extra intestinal manifestations  

摘要： Inflammatory bowel disease (IBD) is primarily a disease of the gastrointestinal tract, though it can often affect other organ systems. These extraintestinal manifestations occur in a quarter to one-third of patients with Crohn's disease and ulcerative colitis. While musculoskeletal and dermatologic manifestations are the most common, it is also important to be cognizant of head, eye, ear, nose, and throat (HEENT) manifestations and educate IBD patients about them. Here we review the ocular manifestations in conjunction with the lesser-known but increasingly recognized ENT manifestations. Considering the lack of randomized controlled trials in treating HEENT manifestations of IBD, this review is primarily based on case reports, case series, and expert opinion with a particular focus on the newer literature supporting use of anti-TNF agents.

关键词： Inflammatory bowel disease   Children   Bone biopsy   Bone mineralization   Osteoporosis  

摘要： Inflammatory bowel disease (IBD) affects many organ systems including the skeleton. In children with IBD, bone mineral density (BMD) and bone turnover are frequently low. Disturbances in bone mineralization density distribution (BMDD) are linked to alterations in bone material strength;however, BMDD has not previously been reported in children with chronic inflammatory disorders. The aim of this study was to characterize BMDD based on quantitative backscatter electron imaging in cancellous (Cn.) and cortical (Ct.) compartments from trans-iliac biopsy samples from a cohort of 20 treatment-naive children at the time of their IBD diagnosis (12 males, mean age 14.5 +/- 23 years). The outcomes were compared to pediatric reference BMDD data and correlation with revisited biochemical and histomorphometric outcomes was analyzed. BMDD in treatment-naive children with IBD was shifted toward higher calcium concentrations compared to reference: (i) In cancellous bone, the most frequent calcium concentration (*** + 2.8%, p = 0.004) and the portion of highly mineralized bone (*** + 52%, p = 0.009) were increased. (ii) In cortical bone, the mineralization heterogeneity (*** + 17.0%, p = 0.001) and *** (+30.4%, p = 0.006) were increased. (iii) Furthermore, significant correlations with serum alkaline phosphatase (ALP), bone-specific alkaline phosphatase (bsALP), and urinary crosslinked N-telopeptide of type I collagen (uNTX) were observed: the higher CaMean (the average calcium concentration), CaPeak and CaHigh, the lower were ALP, bsALP, and uNTX (p-value from <0.001 to 0.05). Children with treatment-naive IBD have decreased bone turnover leading to a higher bone matrix mineralization density, findings which may contribute to compromised bone strength. (C) 2017 Elsevier Inc. All rights reserved.

关键词： digestive endoscopy   granulomatous colitis   primary immunodeficiency   very-early-onset IBD (VEO IBD)  

摘要： Background: Chronic granulomatous disease (CGD) is a primary immunodeficiency of phagocytes, characterized by life-threatening infections and hyperinflammation. Due to survival improvement, inflammatory bowel disease (IBD) is becoming increasingly relevant. Here, we report our 20 year experience. Methods: We retrospectively analyzed clinic, endoscopic, and histologic features, as well as the management of CGD-IBD patients referred to the Bambino GesU Children's Hospital in Rome, Italy. Results: Of 20 patients with CGD, 9 presented with CGD-IBD at diagnosis and/or during follow-up. Symptoms occurred at a median age of 16 years (range 3.2-42), with a median delay of 6 months for endoscopic confirmation. Patients mainly complained of nonspecific diarrhea (55%), with discrepancy between symptom paucity and severe endoscopic appearance, mainly represented by extensive colonic involvement (44%). Histology revealed at least 2 characteristic features (epithelioid granulomas, pigmented macrophages, and increased eosinophils) in 78% of patients. Eight of 9 patients received oral mesalamine, and 5 required systemic steroids. One patient received azathioprine due to steroid dependence. No patient required biological therapy or surgery. Clinical remission was obtained in all patients, but the majority complained of mild relapses. Two episodes of severe infection occurred early after steroid therapy. Conclusions: Penetrance of CGD-IBD increases with age. Clinical manifestations may be subtle, and clinicians should have a low threshold to recommend endoscopy. Treatment with NSAIDs and/or steroids achieves a good response, but relapses usually occur. Infection surveillance is mandatory during treatment, to prevent opportunistic infections. A close collaboration between pediatric immunologists and gastroenterologists is pivotal, including combined follow-up.

关键词： Inflammatory bowel disease   IBD   Bxercise   Inflammatory disorders   Physical activity  

摘要： There is sparse information regarding exercise and inflammatory bowel disease (IBD). Furthermore, the importance of regular exercise in the optimal management of IBD has not received attention in guidelines and is often overlooked by practitioners. This article summarizes evidence regarding the health benefits of exercise, guidelines regarding exercise in the general population and populations with chronic inflammatory disorder, limitations regarding exercise capacity in patients with IBD, the association of lack of exercise with IBD pathogenesis, the role of exercise in beneficially modulating the IBD clinical course, and extraintestinal benefits of exercise in patients with IBD.

关键词： Delphi method   Inflammatory bowel disease   Integrated management   Spondyloarthrit is   Therapy  

摘要： Background: Treatment of patients with coexisting spondyloarthritis (SpA) and inflammatory bowel disease (IBD) often requires multidisciplinary collaboration between gastroenterologists and rheumatologists. Aim: To describe the results of the first Delphi consensus to define shared therapeutic strategies for the best management of patients with coexisting SpA and IBD. Methods: A scientific steering committee of 10 Italian experts in the field of SpA and IBD developed 27 statements on 5 possible clinical scenarios and selected 40 specialists from across Italy, both gastroenterologists and rheumatologists, to vote them using a Delphi method. Each participant expressed a level of agreement on each statement using a 5-point scale (1 = "absolutely disagree";5 = "absolutely agree"). Total cumulative agreement was defined as the sum of the percentage of responses to items 4 ("agree") and 5 ("absolutely agree"). Total cumulative agreement >70% defined consensus for each statement. Results: After the first round, positive consensus was reached for 22 statements. Statements without consensus were discussed in a plenary session before the second vote. Positive consensus was then reached in all statements, with final total cumulative agreement ranging from 80% to 100%. Conclusion: This is the first Delphi consensus defining specific treatment algorithms for patients with coexisting SpA and IBD. 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.