关键词： Inflammatory bowel disease   Dysplasia   Endoscopic resection  

摘要： Long-standing intestinal inflammation in patients with inflammatory bowel disease (IBD) induces dysplastic change in the intestinal mucosa and increases the risk of subsequent colorectal cancer. The evolving endoscopic techniques and technologies, including dye spraying methods and high-definition images, have been replacing random biopsies and have been revealed as more practical and efficient for detection of dysplasia in IBD patients. In addition, they have potential usefulness in detailed characterization of lesions and in the assessment of endoscopic resectability. Most dysplastic lesions without an unclear margin, definite ulceration, non-lifting sign, and high index of malignant change with suspicion for lymph node or distant metastases can be removed endoscopically. However, endoscopic resection of dysplasia in chronic IBD patients is usually difficult because it is often complicated by submucosal fibrosis. In patients with dysplasias that demonstrate submucosa fibrosis or a large size (>= 20 mm), endoscopic submucosal dissection (ESD) or ESD with snaring (simplified or hybrid ESD) is an alternative option and may avoid a colectomy. However, a standardized endoscopic therapeutic approach for dysplasia in IBD has not been established yet, and dedicated specialized endoscopists with interest in IBD are needed to fully investigate recent emerging techniques and technologies.

关键词： Cost of illness   Gastroenterology   Inflammatory bowel disease   Pharmacoeconomics  

摘要： Frequent relapses sometimes necessitating hospitalization and the absence of pharmacological cure contribute to substantial healthcare costs in inflammatory bowel diseases (IBDs). The costs of health care in Indian patients with IBD are unknown. To evaluate the annual costs for treating Crohn's disease and ulcerative colitis. A prevalence-based, micro-costing method was used to assess the components of annual costs in a prospective, observational study conducted in a tertiary healthcare center enrolled over a 24-month period beginning of July 2014. At enrollment, 43/59 (72.88%) patients with UC and 18/25 (72%) with CD were in remission. The annual median (IQR) cost per UC and CD patient in remission was INR 43,140 (34,357-51,031) [USD $707 (563-836)] and INR 43,763.5 (32,202-57,372) [USD $717 (527-940)], respectively, and in active disease was INR 52,436.5 (49,229-67,567.75) [$859 (807-1107)] and INR 72,145 (49,447-92,212) [USD $1182 (811-1512)], respectively. Compared with remission, active disease had a 1.4-fold higher cost for CD as compared to UC. In both groups, the greatest component of direct costs was drugs. Thirteen (22%) and 7 (28%) patients with UC and CD needed hospitalization accounting for 23.1 and 20.4% of the total costs, respectively. At one year, direct costs surmounted indirect costs in UC and CD (p < 0.001). Productivity losses contributed to 18.5 and 16% of the overall costs for UC and CD, respectively. This first, panoptic, health economic study for IBD from India shows that the costs are driven by medication, productivity losses, and not merely hospitalization alone.

关键词： Hypoxia   Inflammation   Metabolite   Microbiota   Nucleotide  

摘要： The intestinal mucosa provides a selective barrier between the anaerobic lumen and a highly metabolic lamina propria. A number of recent studies indicate that acute inflammation of the mucosa can result in tissue hypoxia and associated shifts in tissue metabolism. The activation of hypoxiainducible factor (HIF) under these conditions has been demonstrated to function as an endogenous molecular cue to promote resolution of inflammation, particularly through the orchestration of barrier repair toward homeostasis. Given the central role of oxygen in tissue metabolism, ongoing studies have defined metabolic endpoints of HIF stabilization as important biomarkers of disease activity. Such findings make HIF and HIF-associated metabolic pathways particularly attractive therapeutic targets in inflammatory bowel disease (IBD). Here, we review the recent literature related to tissue metabolism in IBD.

关键词： Children   diet   fruit   inflammatory bowel disease   Saudi Arabia  

摘要： Background/Aim: Inflammatory bowel disease (IBD) is increasing in Saudi Arabia but there's little knowledge about its risk factors. Our aim is to investigate the dietary risk factors of this disease in Saudi children. Patients and Methods: The children investigated for IBD were prospectively enrolled. Those with confirmed IBD were designated cases and the others were controls. The average food frequency intake at least 3 months before onset of illness was obtained by direct interview and recorded on a modified food frequency questionnaire. Fast food, sweet gaseous soft drinks, fruits, and vegetables were selected. Statistical analysis included descriptive statistics, multivariate logistic regression was used, and the odds ratio was calculated to report the statistical significance of the results. Results: A total of 91 children, 52 IBD (38 CD, 14 UC) and 39 controls were enrolled. Consumption of fast food and sweet gaseous drinks was more frequent in children with IBD than controls, whereas consumption of fruits and vegetables was less frequent in children with IBD. Only less fruits consumption was significantly associated with IBD as the odds of children getting IBD was 2.89 (1.06, 7.87). Conclusions: We report statistically significant positive association between less fruits consumption and IBD. Awaiting the results of larger sample size and more quantitative studies, the benefits of frequent fruit consumptions should be part of public health education.

关键词： Structured report   Standardized report   Inflammatory bowel disease   Enterography   CT  

摘要： Purpose: To compare the content and accuracy of structured reporting (SR) versus non-structured reporting (NSR) for computed tomographic enterography (CTE) of inflammatory bowel disease (IBD). Materials and methods: This IRB-approved, HIPAA-compliant, retrospective study included 30 adult subjects (15 male, 15 female;mean age 41.9 years) with IBD imaged with CTE. Nine radiologists (3 faculty, 3 abdominal imaging fellows, and 3 senior radiology residents) independently interpreted all examinations using both NSR and SR, separated by four weeks. Reports were assessed for documentation of 15 key reporting features and a subset of 5 features was assessed for accuracy. Thirty faculty reports (15 NSR [5 per reader] and 15 SR [5 per reader]) were randomly selected for review by three referring physicians, who independently rated quality metrics for each report. Results: NSR documented the presence or absence of 8.2 +/- 2.2 key features, while SR documented 14.6 +/- 0.5 features (p < 0.001). SR resulted in increased documentation of 13 of 15 features including stricture (p < 0.001), fistula (p < 0.001), fluid collection (p = 0.003), and perianal disease (p < 0.001). Among a subset of five features, accuracy for diagnosing multifocal disease was minimally increased when using SR (76% NSR vs. 83% SR;p = 0.01), but accuracy for other features was not affected by report type. Referring physicians significantly preferred SR based on ease of information extraction (p < 0.01). Conclusion: Structured reporting of CTE for IBD improved documentation of key reporting features for trainees and faculty, though there was minimal impact on accuracy. Referring physicians subjectively preferred the structured reports.

关键词： CLE   Intestinal Barrier Function   Small Intestine   Leaky Gut  

摘要： BACKGROUND & AIMS: Many patients with inflammatory bowel diseases (IBD) have ongoing bowel symptoms of diarrhea or abdominal pain despite mucosal healing. We investigated whether impaired intestinal permeability contributes to these symptoms. METHODS: We performed a prospective study of intestinal permeability, measured by endoscopic confocal laser endomicroscopy in 110 consecutive subjects (31 with ulcerative colitis [UC], 57 with Crohn's disease [CD], and 22 healthy individuals [controls]) in Sydney, Australia from May 2009 and September 2015. Symptomatic CD was defined by a CD Activity Index score of 150 or more and symptomatic UC by a partial Mayo score of 2 or more. Mucosal healing was defined as CD Endoscopic Index of Severity of 0 in CD or Mayo endoscopic sub-score of 0-1 for patients with UC. Intestinal permeability was quantified by the Confocal Leak Score (CLS;range: 0=no impaired permeability to 100=complete loss of barrier function). The primary endpoint was intestinal permeability in patients with symptomatic IBD in mucosal healing vs patients with asymptomatic IBD in mucosal healing. We determined the sensitivity and specificity of CLS in determining symptoms based on receiver operating characteristic analysis. RESULTS: Ongoing bowel symptoms were present in 16.3% of patients with IBD and mucosal healing (15.4% of patients with CD, 17.4% with UC). Patients with symptomatic IBD had a significantly higher median CLS (19.0) than patients with asymptomatic IBD (7.3;P<.001) or controls (5.9, P<.001). There were no significant differences between patients with IBD in remission vs controls (P=.261). Median CLS was significantly higher in patients with symptomatic than asymptomatic CD (17.7 vs 8.1;P=.009) and patients with symptomatic than asymptomatic UC (22.2 vs 6.9;P=.021). A CLS of 13.1 or more identified ongoing bowel symptoms in patients with IBD and mucosal healing with 95.2% sensitivity and 97.6% specificity;the receiver operating characteristic area u

关键词： Increase   Discharges   Crohn's disease   Ulcerative colitis  

摘要： To determine the number of annual hospital discharges for inflammatory bowel diseases in Chile. The hypothesis is that there is a significant increase in the hospital discharges due to this disease from 2001 to 2012. This is a descriptive study. Data were obtained from the Web site of the Department of Health Statistics. All hospital discharges from 2001 to 2012 were included. The following variables were analyzed: length of stay, hospital mortality, and eventual surgical procedure. Data are presented as descriptive statistics. The B-coefficient was calculated to establish the significance of the annual trend. There were 13,001 hospital discharges with the diagnosis of ulcerative colitis or Crohn's disease, corresponding to 0.067% of all hospital discharges in the whole period. Within these discharges, 31.2% were Crohn's disease and 68.8% were ulcerative colitis. At least one surgical procedure was performed in 12.9% of the hospitalizations. There was a significant increase in the annual rate of hospital discharges from 5.25 in 2001 to 8.64 per 100 thousand inhabitants in 2012. This increase was from 1.68 to 3.11 in Crohn's disease and from 3.58 to 5.53 in ulcerative colitis. However, a decrease was observed in length of stay, need of surgical treatment and in-hospital mortality. From 2001 until 2012, there has been a significant increase in hospital discharges for inflammatory bowel diseases in Chile, associated with a decrease in length of stay, need of surgery and in-hospital mortality.

关键词： Inflammatory bowel disease   surgical outcomes   bowel preparation  

摘要： AimThe purpose of this study was to determine if bowel preparation influences outcomes in patients with inflammatory bowel disease undergoing surgery. MethodsThe database of the American College of Surgeons National Surgical Quality Improvement Program, Procedure Targeted Colectomy, from 2012 to 2014 was analyzed. Inflammatory bowel disease patients undergoing colorectal resection with or without bowel preparation were included in the study. ResultsIn all, 3679 patients with inflammatory bowel disease were identified. 42.5% had no bowel preparation, 21.5% had mechanical bowel preparation only, 8.8% had oral antibiotic bowel preparation only and 27.2% had combined mechanical and oral antibiotic preparation. Combined mechanical and oral antibiotic preparation is associated with lower rates of anastomotic leak, ileus, surgical site infection, organ space infection, wound dehiscence and sepsis/septic shock. ConclusionCombined mechanical and oral antibiotic preparation for inflammatory bowel disease patients undergoing colectomy is associated with decreased rates of surgical site infection, anastomotic leak, ileus. Combined bowel preparation should be the standard of care for inflammatory bowel disease patients undergoing colorectal resection.

关键词： Asthma   Effect Measure Modification   Age at Diagnosis   Crohn's Disease   Ulcerative Colitis  

摘要： BACKGROUND & AIMS: Asthma and the inflammatory bowel diseases (IBD) each arise through complex interactions between genetic and environmental factors, and share many environmental risk factors. We examined the association between asthma and Crohn's disease or ulcerative colitis. METHODS: We performed a population-based case-control study using health administrative data from the province of Alberta, Canada. The odds of a diagnosis of asthma preceding the diagnosis of either Crohn's disease (N [3087) or ulcerative colitis (N [2377) were compared with the odds of diagnosis of asthma among persons without IBD (N [402,800) using logistic regression. Effect measure modification by age at diagnosis of IBD (16 years or less, 17-40 years, or older than 40 years) was tested using a likelihood ratio test. RESULTS: A diagnosis of asthma was associated with increased odds of incident Crohn's disease (adjusted odds ratio [OR], 1.45;95% confidence interval [CI], 1.31-1.60). No effect measure modification was observed for age at diagnosis for Crohn's disease (P = .42). However, we observed effect measure modification by age at diagnosis for ulcerative colitis (P = .0103), with an adjusted OR of 1.49 (95% CI, 1.08-2.07) among individuals diagnosed at an age of 16 years or less (OR) and an adjusted OR of 1.57 (95% CI, 1.31-1.89) among individuals diagnosed at an age older than 40 years. However, there was no association between asthma and ulcerative colitis among individuals diagnosed between ages 17 and 40 (adjusted OR, 1.05;95% CI, 0.86-1.26). CONCLUSIONS: In a population-based case-control study, we associated asthma with Crohn's disease, and with early and late-onset ulcerative colitis.

关键词： Spondyloarthritis   Treatment   Arthritis   Inflammation  

摘要： First of all, merely 36 out of 53 patients with inflammatory bowel disease (IBD) completed the 6-week induction phase at the last recorded observation, which makes the interpretation of data premature. [...]as stated in our paper, mean time to flare in our patients was calculated at 64 days after the initiation of vedolizumab, ranging up to 114 days in these selected cases. In any case, the efficacy of vedolizumab in IBD-associated joint disease, if any, does not seem to measure up to the efficacy of anti-tumour necrosis factor reported previously in over 60% in IBD-related arthritis. 5 6 The lack of mucosal vascular addressin cell adhesion molecule 1 (MADCAM-1) expression in synovial tissue despite the presence of [alpha]4[beta]7 on synovial T cells in SpA, which contrasts with the gut-specific interaction with MADCAM-1, provides scientific rationale for a differential response on joint versus gut symptoms. 7 8 In conclusion, the overall efficacy of vedolizumab in IBD-associated SpA remains unclear.