关键词： Disease Progression   Depression   Inflammatory Bowel Diseases   Review, Systematic   Meta-Analysis  

摘要： Background: Despite a higher prevalence of psychosocial morbidity in Inflammatory Bowel Disease (IBD), the association between depressive state and disease course in IBD is poorly understood. Aim: To investigate the impact of depressive state on disease course in IBD. Methods: We conducted a systematic review in MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and PsychINFO for prospective studies evaluating the impact of baseline depressive state on subsequent disease course in adult IBD. Results: Eleven studies matched our entry criteria, representing 3194 patients with IBD. Three reported on patients with ulcerative colitis (UC), four included patients with Crohn's disease (CD) exclusively, and four studies included both UC and CD. Five studies reported an association between depressive state and disease course. None of the UC-specific studies found any association. In three of four CD-specific studies, a relationship between depressive state and worsening disease course was found. In four of five studies including patients in remission at baseline, no association between depressive state and disease course was found. Pooled analysis of IBD studies with patients in clinical remission at baseline identified no association between depressive state and disease course (HR 1.04, 95% CI: 0.97-1.12). Conclusion: There is limited evidence to support an association between depressive state and subsequent deterioration in disease course in IBD, but what data that exist are more supportive of an association with CD than UC. Baseline disease activity may be an important factor in this relationship. Further studies are needed to understand the relationship between mental health and outcomes in IBD.

关键词： Crohn Disease   Cohort Studies   access program   Inflammatory Bowel Diseases   Intestinal Diseases   vedolizumab  

摘要： Background: We recently showed that vedolizumab is effective in patients with Crohn's disease (CD) and ulcerative colitis (UC) with prior anti-TNF failure in a multicentre compassionate early-access programme before marketing authorisation was granted to vedolizumab. Aims: To assess effectiveness and safety of vedolizumab at week 54 in patients UC and CD. Methods: Between June and December 2014, 173 patients with Crohn's disease (CD) and 121 with ulcerative colitis (UC) were treated with vedolizumab induction therapy. Among those 294 patients, 272 completed the induction period and were evaluated at the week 14 visit (161 patients with CD and 111 with UC). Disease activity was assessed using the Harvey-Bradshaw Index for CD and the partial Mayo Clinic score for UC. The primary outcome was steroid-free clinical remission at week 54. Results: At week 54, steroid-free clinical remission rates at week 54 were 27.2% and 40.5% in patients with CD and UC respectively. In addition, the sustained steroid-free clinical remission (from week 14 to week 54) rates were 8.1% and 19.0% respectively. No deaths were observed. Severe adverse events occurred in 17 (7.2%) patients, including six (2.5%) leading to vedolizumab discontinuation. Conclusion: Vedolizumab is able to maintain steroid-free clinical remission in up to one-third of patients with UC and CD at week 54 with a reasonable safety profile. A significant number of patients experienced loss of response during the first year of treatment, particularly in patients with CD.

关键词： Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Colorectal cancer   Single-nucleotide polymorphism   Meta-analysis  

摘要： To assess the correlation between single-nucleotide polymorphisms (SNPs) and inflammatory bowel disease (IBD)-associated colorectal cancer (CRC) in IBD patients. A systematic search of PubMed, EmBase, and Cochrane databases was performed. Five genetic models (allelic, dominant, recessive, heterozygous and homozygous models) were used to analyze the associations, and trial sequential analysis was used to analyze the robustness of the results. We collected and analyzed the results of seven trials including a total of 2287 patients in our meta-analysis. A total of 8 SNPs were tested in IBD patients. For rs1800629 of TNF-alpha, the allelic model showed that polymorphism at this locus significantly increased the risk of IBD-associated CRC in IBD patients (OR 4.45, 95% CI 3.18-6.21, P < 0.001). The results also showed a significant association between rs1800629 and an IBD-associated CRC population (heterozygous model: OR 4.335, 95% CI 2.329-8.069, P < 0.001;homozygous model: OR 11.5, 95% CI 2.498-52.592, P = 0.002;dominant model: OR 4.986, 95% CI 2.754-9.026, P < 0.001;recessive model: OR 7.208, 95% CI 1.588-32.72, P = 0.01). Other studies have found that mutation of rs1143627 of IL1B (allelic model: OR 2.97;95% CI 1.74-5.05, P < 0.001) and rs1050152 of OCTN1 (allelic model: OR 1.637, 95% CI 1.078-2.485, P = 0.021) increased the proportion of IBD-associated CRC in the population. Moreover, there were significant associations between IBD-associated CRC and ITLN rs2274910, gene desert rs1551398 and rs4871611, FCGR2A rs1801274, and S100-Z rs7712957 in the allelic model. Associations between SNPs and the proportion of IBD-associated CRC in IBD patients were examined, and further investigation of additional SNPs and their association with the risk of morbidity is needed.

关键词： IBD   Inadequate gestational weight gain   Adverse pregnancy outcome   PIANO cohort   Disease activity  

摘要： Malnutrition and weight loss are common features of patients with inflammatory bowel disease (IBD). To explore the impact of inadequate gestational weight gain (GWG) on adverse outcomes among IBD mothers in the prospective US pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) cohort. The PIANO cohort comprises 559 and 363 pregnant mothers with Crohn's disease (CD) and ulcerative colitis (UC), respectively, enrolled between 2006 and 2014. The mothers were followed during and after pregnancy to ascertain medication, measurement of disease activity and complications during pregnancy and at delivery. Inadequate GWG was based on US Institute of Medicine recommendations. The associations between inadequate GWG and adverse pregnancy outcomes in maternal IBD were analyzed, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity. Maternal CD and UC with inadequate GWG had a 2.5-fold increased risk of preterm birth (OR 2.5, CI 1.3, 4.9 and OR 2.5, CI 1.2, 5.6). Furthermore, an increased risk of intrauterine growth restriction and a trend for small for gestational age were demonstrated in CD but not in UC (OR 3.3, CI 1.1, 10.0, OR 4.5, CI 0.8, 24.3, p = 0.08). Flares increased risk of inadequate GWG (OR 1.6, CI 1.2, 2.3, p = 0.002) but did not change the associations between inadequate GWG and adverse pregnancy outcomes in our models. The US PIANO cohort demonstrated that inadequate GWG was a strong independent predictor of adverse pregnancy outcomes in IBD mothers.

关键词： Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Leukocyte differentials   Disease activity   Biomarkers  

摘要： Background: This study aimed at evaluating whether leukocyte differentials could serve as effective biomarkers for disease activity in IBD. Methods: A total of 100 subjects were prospectively enrolled, including 36 patients with CD, 34 patients with UC, and 30 healthy controls (HC). Leukocyte differentials were determined by CytoDiff Flow Cytometry analysis. Results: Total neutrophil counts, monocyte/lymphocyte ratio (M/L), and CD16(-) monocyte/lymphocyte ratio (CD16(-) M/L) were significantly higher in active UC patients compared with quiescent UC patients and HC. A cut-off value of 0.25 in M/L exhibited the best overall accuracy of 82.4% with an AUC of 0.846 in differentiating active UC from quiescent UC. Total leukocyte counts were significantly decreased in active CD patients, while total monocyte counts and total CD16(-) monocyte counts were significantly increased in active CD patients compared with quiescent CD patients and HC. A cut-off value of 0.25 in CD16(-) M/L displayed the best AUC of 0.886 (overall accuracy of 86.1%) in differentiating active CD from quiescent CD. Conclusions: Our data suggest that CD16(-) M/L could serve as promising biomarkers for distinguishing active disease from quiescent disease in both UC and CD. In addition, they could be used as supplements to other disease activity indicators, such as hsCRP and ESR.

关键词： Bariatric surgery   Crohn's disease   Gastric bypass   IBD   Inflammatory bowel disease   Sleeve gastrectomy   Ulcerative colitis   Weight loss  

关键词： Positron emission tomography   PET/CT   F-18-FDG   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis  

摘要： Objective markers of disease activity are crucial for clinical decision making in patients with chronic inflammatory bowel diseases (IBD). We aimed to perform an updated systematic review on the clinical role of F-18-FDG PET in evaluating disease activity in patients with IBD and a bivariate meta-analysis on its accuracy in this setting. A comprehensive computer literature search of studies published through December 2016 about the clinical role of F-18-FDG PET in patients with IBD was performed using the following search algorithm: A) PET OR positron emission tomography OR FDG AND B) inflammatory bowel OR Crohn OR ulcerative colitis OR IBD. All included articles were reviewed. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of F-18-FDG PET in evaluating disease activity in patients with IBD on a per-segment-based analysis were calculated. Furthermore, the summary receiver operating characteristic (sROC) curve has been evaluated. Twenty-three studies on the use of F-18-FDG PET in evaluating disease activity in patients with IBD (584 cases) were discussed in the systematic review. The meta-analysis of nine selected studies provided the following results on a per-segment-based analysis: sensitivity was 85.6% [95% confidence interval (95% CI) 76-92%], specificity 85.5% (95% CI 75-92%), LR+ 5.59 (95% CI 3.29-9.5), LR- 0.15 (95% CI 0.07-0.32), DOR 34.64 (95% CI 13.03-92.08). Heterogeneity among the selected studies was found. F-18-FDG PET demonstrated good accuracy in evaluating the disease activity in patients with IBD and this method could have a clinical impact in patients with IBD. Large multicenter studies and cost-effectiveness analyses are needed to confirm the role of this functional imaging method in this setting.

关键词： Crohn's   Origin   Pediatric   Ulcerative colitis  

摘要： Data on inflammatory bowel disease (IBD) phenotypes among the Arab population in Israel or in the neighboring Arab countries is scarce. We aimed to assess differences in disease phenotype among Arab and Jewish children living in Israel. We performed a retrospective chart review of pediatric IBD cases, which were diagnosed at the Schneider Children's Medical Center and Ha'Emek Medical Center in Israel between 2000 and 2014. Demographic, clinical, and phenotypic variables were compared between Arabs and Jews from Eastern (Sephardic) and Western (Ashkenazi) origin. Seventy-one Arab children with IBD were compared with 165 Ashkenazi and 158 Sephardic Jewish children. Age and gender did not differ between groups. Sephardic and Ashkenazi Jewish Crohn's disease (CD) patients had significantly more stenotic behavior (24 and 26 vs. 5%, p = 0.03) and less fistulzing perianal disease (15 and 11 vs. 31%, p = 0.014) compared with Arab patients. Arab children with ulcerative colitis (UC) had more severe disease at diagnosis compared to Sephardic and Ashkenazi Jews reflected by higher Pediatric UC Activity Index (45 vs. 35 and 35, respectively, p = 0.03). Arab patients had significantly lower proportion of anti-Saccharomyces cerevisiae antibodies positivity (in CD) and perinuclear anti-neutrophil cytoplasmic antibodies positivity (in UC) than both Sephardic and Ashkenazi Jewish children (23 vs. 53 and 65%, p = 0.002 and 35 vs. 60 and 75%, respectively, p = 0.002). Arab and Jewish children with IBD differ in disease characteristics and severity. Whether genetic or environmental factors are the cause for these differences is yet to be determined.

关键词： IBD   Epidemiology   Health Care Outcomes   Risk Factors  

摘要： BACKGROUND & AIMS: Studies of Clostridium difficile infections (CDIs) among individuals with inflammatory bowel disease (IBD) have used data from single centers or CDI administrative data codes of limited diagnostic accuracy. We determined the incidence, risk factors, and outcomes after CDI in a population-based cohort of patients with IBD and laboratory confirmation diagnoses of CDI. METHODS: We searched the University of Manitoba IBD Epidemiology Database and Manitoba Health CDI databases to identify individuals with CDI, with or without IBD, from July 1, 2005 through March 31, 2014. Time trends of incidence were assessed using joinpoint regression. Multivariable Cox regression analyses were performed to assess differences in CDI incidence rates and mortality after CDI between individuals with and without IBD. Conditional logistic regression was performed to determine predictors of CDI among individuals with IBD. RESULTS: Individuals with IBD had a 4.8-fold increase in risk of CDI than individuals without IBD;we found no difference between individuals with ulcerative colitis vs Crohn's disease. There was no increase in CDI incidence over the study time period in either group. Among individuals with IBD, exposure to corticosteroids, infliximab or adalimumab, metronidazole, hospitalizations, higher ambulatory care visits, shorter duration of IBD, and higher comorbidities were associated with an increased risk of CDI. Although CDI increased mortality among individuals with and without IBD, there was lower mortality after CDI among individuals with IBD than without IBD (hazard ratio, 0.65;95% confidence interval, 0.44 - 0.96). CONCLUSIONS: CDI incidence is no longer increasing among individuals with IBD. We identified unique risk factors for CDI in patients with IBD. CDI is associated with a greater increase in mortality among individuals without IBD than with IBD.

关键词： Crohn's disease   Pediatric   Inflammatory bowel disease   Exclusive enteral nutrition   Nutrition  

摘要： Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract caused by a dysregulated immune response to the fecal microbiota. Very early-onset inflammatory bowel disease (VEO-IBD) refers to a subgroup of pediatric patients with IBD diagnosed before 6 years of age. This subgroup is often characterized by increased severity, aggressive progression, strong family history of IBD, and often poor response to conventional treatments. Nutritional therapies have been utilized to treat IBD, but their role in VEO-IBD is unclear. Disease behavior in VEO-IBD is often different from disease in adolescents and adults, as it is often restricted to the colon and refractory to standard medical therapies. Up to 25% of VEO-IBD patients have an identified underlying immunodeficiency, which may impact response to therapy. While specific mutations in interleukin 10 (IL-10), the IL-10 receptor (IL-10R), and mutations in NCF2, XIAP, LRBA, and TTC7 have been identified in VEO-IBD, polymorphisms in these genes are also associated with increased risk of developing IBD in adolescence or adulthood. We describe two cases in which infants presenting with VEO-IBD achieved clinical remission using exclusive enteral nutrition, a formula-based diet which has been shown to induce remission in older children with active Crohn's disease.