关键词： Periodontitis   Inflammatory bowel disease   Cytokines  

摘要： This study assessed the cytokine expression in gingival and intestinal tissues from periodontitis patients with inflammatory bowel disease (IBD) and evaluated if IBD activity is a covariate to the amount of gingival cytokines. Paired gingival and intestinal tissues were collected from 21 patients and homogenised using a cell disruptor. Cytokine expression (IL-1 beta, IL-4, IL-6, IL-10, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IL-17A, IL-17F, IFN-gamma, sCD40L, and TNF-alpha) was evaluated using bead-based multiplex technology. An inflammation score was developed using the intestinal cytokines that showed good accuracy to discriminate IBD active patients from those in remission and then a similar score was applied to gingival tissue. IL-4, IL-10 and IL-21 expressions were significantly increased in gingival tissue from patients with an active disease as compared to those with a disease in remission. The inflammation score (mean value of IL-18, IL-6, IL-21, and 5CD40L) was significantly higher in gingival tissue from patients with IBD activity. There was a significant correlation between gingival and intestinal inflammation scores (rho = 0.548;P = 0.01). Significantly higher IL-23 and IFN-gamma levels and lower IL-31 and TNF-alpha levels were observed in gingival tissues than in intestinal ones. Activity of inflammatory bowel disease influenced the cytokine expression in gingival tissue. (C) 2017 Elsevier Ltd. All rights reserved.

关键词： MENTAL depression   QUALITY of life   INFLAMMATORY bowel diseases   CROHN'S disease   ULCERATIVE colitis  

摘要： See "Association of Inflammatory Bowel Disease (IBD) with Depressive Symptoms in the United States Population and Independent Predictors of Depressive Symptoms in an IBD Population: A NHANES Study" by Sanjay Bhandari, et al.

关键词： IBD - Inflammatory Bowel Disease   MMAS-8 - Modified Morisky Adherence Scale-8   CCKNOW - Crohn's and Colitis Knowledge assessment questionnaire   OPD - Outpatient Department  

摘要： Objective: To evaluate whether clinical pharmacist's interventions have any impact on medication adherence of patients having inflammatory bowel disease and to assess the awareness of patients about their disease and the significance of medications they use. Materials and Methods: A prospective, interventional follow up study was conducted in the outpatients visiting Gastroenterology and Hepatology department of Amrita Institute of Medical Sciences, Kochi. To assess the level of medication adherence and patient's awareness, MMAS-8 and CCKNOW has been utilized. Once this baseline information's were collected, counselling was given to patients and they were supplemented with pill cards and patient information leaflets as educational material. During the follow up visit, all the above parameters were reassessed and compared with the baseline visit. Result: About 110 IBD patients have participated in this study. In baseline visit, 6.36% patients had low adherence, 62.73% patients had medium adherence, 30.91% patients had high adherence. During follow up visit, after intervention by clinical pharamcist, 3.64% patients had low adherence, 18.18% patients had medium adherence and 78.18 % patients had high adherence. From this study, it was notified that the average score of CCKNOW was only 8.15 in the beginning. Later on, it was escalated to 11.65 during the revisit periods. Conclusion: Knowledge of patients about their disease and medications were insufficient during baseline visit. Adherence to medication was found to be poor among IBD patients. Counselling provided by clinical pharmacist about the importance of medication adherence and provision of information leaflets and pill cards lead to an improvement in medication adherence and knowledge of IBD patients.

关键词： Arterial stiffness   Cardiovascular disease   Inflammation   IBD   Pulse wave velocity   PWV  

摘要： In adults with inflammatory bowel disease (IBD), the incidence of cardiovascular events is increased, leading to long-term morbidity. Arterial stiffness (AS) measured by pulse wave velocity (PWV) is a validated early precursor of cardiovascular disease (CVD), and measurement of PWV was shown to be a feasible test in children. The aim of this study was to assess AS in children with IBD. In this prospective study, we determined PWV between the carotid and femoral artery (PWVcf) in 25 children and adolescents with IBD (11 females, median age 14.1 years, median disease duration 2.8 years). The majority (68%) of the subjects were in clinical remission, and 48% received anti-tumor necrosis factor alpha (TNF alpha) treatment. AS was not increased in this cohort of children and adolescents with IBD, who did not have signs of cardiovascular disease, such as arterial hypertension. Conclusion: PWV seems to be normal in children with IBD in remission or with mild disease activity. Larger studies should assess its potential role as a valid and non-invasive follow-up marker in children with IBD, to avoid cardiovascular complications.

关键词： TREATMENT of abdominal pain   SYSTEMATIC reviews (Medical research)   INFLAMMATORY bowel disease treatment   DISEASE remission   STRESS management  

摘要： Background: Abdominal pain is frequently reported by people with inflammatory bowel disease (IBD), including in remission. Pain is an under-treated symptom. Aim: To systematically review evidence on interventions (excluding disease-modifying interventions) for abdominal pain management in IBD. Methods: Databases (MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Cochrane Library) were searched (February 2016). Two researchers independently screened references and extracted data. Results: Fifteen papers were included: 13 intervention studies and two cross-sectional surveys. A variety of psychological, dietary and pharmacological interventions were reported. Four of six studies reported pain reduction with psychological intervention including individualised and group-based relaxation, disease anxiety-related Cognitive Behavioural Therapy and stress management. Both psychologistled and self-directed stress management in inactive Crohn's disease reduced pain compared with controls (symptom frequency reduction index=-26.7, -11.3 and 17.2 at 6-month follow-up, respectively). Two dietary interventions (alcoholic drinks with high sugar content and fermentable carbohydrate with prebiotic properties) had an effect on abdominal pain. Antibiotics (for patients with bacterial overgrowth) and transdermal nicotine patches reduced abdominal pain. Current and past cannabis users report it relieves pain. One controlled trial of cannabis reduced SF-36 and EQ-5D pain scores (1.84 and 0.7, respectively). These results must be treated with caution: data were derived from predominantly small uncontrolled studies of moderate to low quality. Conclusions: Few interventions have been tested for IBD abdominal pain. The limited evidence suggests that relaxation and changing cognitions are promising, possibly with individualised dietary changes. There is a need to develop interventions for abdominal pain management in IBD.

关键词： Inflammatory Bowel Diseases   Surgery  

摘要： The article offers information on treatment for Inflammatory Bowel Disease (IBD) focusing on ileoanal pouch surgery. The area of IBD surgery that is a demanding procedure for coloproctologists and gastroenterologists is mentioned. The number of pouch procedures under ileal pouch registry carried out in Great Britain is discussed. The complications of pouch surgery including pouchitis and peri-pouch sepsis is offered focusing on quality practices in health care.

关键词： Inflammatory bowel disease   Adolescents   Self-management   Intervention  

摘要： Purpose: This study examined the feasibility and impact of a multicomponent adherence intervention among youth with Inflammatory Bowel Disease (IBD) who presented to clinic with poor adherence. Design and Methods: Medical providers referred twelve adolescents for the intervention, who participated in 4 weekly visits with a caregiver aimed at improving adherence. Results: Intervention session attendance was 100% and the intervention was rated as feasible and acceptable. Mean adherence increased 12% from baseline to post-intervention (p < 0.01), and 6% from baseline to 1-month follow-up (p < 0.025). A generalized linear model revealed significantly greater adherence from baseline to post-intervention (p < 0.001), and from baseline to 1-month follow-up (p < 0.01). Logistic Regression revealed a nearly 2: 1 odds ratio during post-intervention when compared to the Baseline period (p < 0.001). Conclusions: Findings suggest that the delivery of a multicompoment adherence intervention to poorly adherent youth with IBD can result in significant improvements in their adherence to oral medication. Practice Implications: An intervention individually tailored to each family's unique adherence barriers is a feasible and promising treatment approach for improving medication adherence among nonadherent youth seen in clinical care. (C) 2017 Elsevier Inc. All rights reserved.

关键词： Bayesian   dosing   infliximab   pharmacokinetics   pharmacometrics  

摘要： Infliximab is an anti-tumour necrosis factor alpha monoclonal antibody used to treat inflammatory diseases. Many patients fail during induction and others respond initially but relapse during maintenance therapy. Although anti-drug antibodies (ADA) are associated with some clinical failures, there is evidence that some failures may be due to subtherapeutic exposure. Adapting doses based on clinical outcomes and trough concentrations can improve response and reduce the proportion that develop ADA, but identification of appropriate doses in the presence of time-varying patient factors is complicated. Several adaptive dosing strategies (label recommendations versus therapeutic drug monitoring with an established stepwise algorithm or proportional dose adjustments or Bayesian population pharmacokinetic model-based dosing) were simulated on a virtual population (constructed with time-varying covariates and random effects on individual pharmacokinetic parameters) using R to assess their relative performance. Strategies were evaluated on their ability to maintain trough infliximab concentrations above an established target, 3 mg/L, during maintenance phase. Model-based dosing was superior in maintaining target trough concentrations, showing individuals in maintenance achieving concentrations above the target faster and a lower proportion of individuals who developed ADA. Model-based dosing results were consistent across a range of baseline covariate groups. This in silico assessment of adaptive dosing strategies demonstrated that, when challenged with dynamic covariate and random effect changes occurring in individual pharmacokinetic parameters, model-based approaches were superior to other strategies. Model-based dosing has not been tested clinically;however, the potential benefits of model-based dosing for infliximab suggest that it should be investigated to reduce subtherapeutic exposure.

关键词： Crohn disease   Inflammatory bowel disease   Molecular targets   Therapy targets   Colitis, ulcerative  

摘要： Therapy for inflammatory bowel disease (IBD) has changed, with several new agents being evaluated. The era of anti-tumor necrosis factor (anti-TNF) antibody therapy saw remarkable progress in IBD therapy. Some patients, however, do not respond to anti-TNF treatment, or their response decreases over time. This phenomenon highlights the need to identify new molecular targets for therapy in IBD. The targets of new therapeutic molecules in IBD must aim to restore immune dysregulation by the inhibition of proinflammatory cytokines (TNF-alpha, interleukin [IL]-6, IL-13, IL-17, IL-18, and IL-21) and augmentation of the effect of anti-inflammatory cytokines (IL-10, IL-11, and transforming growth factor beta) and to pursue new anti-inflammatory targets, such as regulatory T-cell therapy, Smad7 antisense, Janus-activated kinase inhibition, Toll-like receptor stimulation, leukocyte adhesion, and blockade of T-cell homing via integrins and mucosal addressin cellular adhesion molecule-1. In addition, potential molecular targets could restore mucosal barrier function and stimulate mucosal healing. Despite these potential targets, the value and clinical significance of most new molecules remain unclear, and clinical efficacy and safety must be better defined before their implementation in clinical practice. This article aims to review the promising and emerging molecular targets that could be clinically meaningful for novel therapeutic approaches.