关键词： Vedolizumab   Combination therapy   Immunomodulator   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis  

摘要： Vedolizumab (VDZ) has demonstrated long-term efficacy in Crohn's disease (CD) and ulcerative colitis (UC) in phase III trials. Our aim was to evaluate the efficacy of VDZ at week 54 in inflammatory bowel disease (IBD) in a multicenter cohort of patients. Adult patients completing induction therapy with VDZ were eligible for this study. Clinical response and remission was assessed using the Harvey-Bradshaw Index (HBI) for CD, the Simple Clinical Colitis Activity Index for UC and physician assessment. Among 136 total patients (96 CD and 40 UC), 76 (56%) demonstrated clinical response or remission at week 54. In univariate analysis, for patients with CD concomitant initiation of immunomodulator therapy (2.71, 95% CI 1.11-6.57), the addition of an immunomodulator (OR 11.49, 3.16-41.75) and CRP < 3 (4.92, 95% CI 1.99-12.15) was associated with increased odds of clinical response or remission at week 54. For UC patients, hospitalization after VDZ induction was associated with decreased odds of response or remission at week 54 (OR 0.22, 95% CI 0.05-0.88). On multivariate analysis in CD, addition of an immunomodulator (OR 8.33, 95% CI 2.15-32.26) remained significant predictors of clinical response or remission at week 54. Among a multicenter cohort of patients with IBD demonstrating primary response to VDZ, the addition of combination therapy with an immunomodulator is a significant predictor of clinical response or remission at week 54 in patients with CD.

关键词： cancer therapy   Prostate Cancer   Inflammatory Bowel Diseases   distress signal   Intestinal Diseases  

摘要： OBJECTIVE To investigate the influences of inflammatory bowel disease (IBD), a rare but morbid disease with increasing incidence, on prostate cancer management decisions. We examined whether prostate cancer treatment differed for men with IBD, and whether treatment choice was associated with risk of IBD flare. MATERIALS AND METHODS Using Veterans Health Administration cancer registry and administrative data, we identified 52,311 men diagnosed with prostate cancer from 2005 to 2008. We used International Classification of Diseases-9 codes and pharmacy and utilization data to identify IBD diagnoses, IBD-directed therapy, and flares (glucocorticoid escalation, hospitalization, and surgical intervention). We compared characteristics across men with and without IBD, and used multivariable regression to examine IBD flares after treatment according to treatment type. RESULTS Two hundred and forty men (0.5%) had IBD prior to prostate cancer diagnosis. Compared to non-IBD patients, IBD patients were more likely Caucasian (P <.001) with lower-risk cancer (P =.02). Surgery was more common in IBD patients (41% vs 28%, P <.001). In the year following prostate cancer treatment, 18% of IBD patients experienced flares. After adjustment, the only predictor of flare in the year after treatment was flare in the year prior to treatment (adjusted odds ratio, 12.5;95% confidence interval, 5.4-29.2). CONCLUSION IBD patients were more likely to have lower-risk disease and be treated with surgery. Choice of prostate cancer treatment did not predict flares in the subsequent year. Better understanding of the intersection of IBD and prostate cancer can help inform treatment decisions for the increasing number of men managing both diseases. Published by Elsevier Inc.

关键词： Bone density   Crohn's disease   Dual-energy X-ray absorptiometry   Ulcerative Colitis  

摘要： Background: Inflammatory bowel disease (IBD) is known to pose a risk for low bone mineral density (BMD) in children and adults. We aimed to evaluate the impact of pediatric-onset IBD on BMD in adulthood. Methods: Records of pediatric-IBD patients were retrospectively reviewed for documentation of dualenergy X-ray absorptiometry (DXA) scans in adulthood. BMD was expressed as z-score. Results: Sixty one patients were included. Mean (+/- SD) age at diagnosis was 14.7 (+/- 2.4) years. Mean age at first DXA scan in adulthood was 23.9 years (+/- 4.8). Median BMD z-score was -1.2 SD (IQR, -1.8 to -0.4), significantly lower than expected in normal population (p < 0.001). Osteopenia (BMD z-score =-1 SD) was noted in 44.3% (n = 27), and osteoporosis (BMD z-score =-2.5 SD) in 8.2% (n = 5). Bone-status showed no correlation with age, disease severity, vitamin D status at diagnosis, IBD subtype or duration of disease. Positive correlation (r = 0.306) was identified between low weight z-score at diagnosis and abnormal bone-status in adulthood. Among 36 patients with multiple DXA scans, there was no significant change in BMD during follow-up of 2.4 years. Conclusions: Osteopenia and osteoporosis are frequent in adult IBD patients with pediatric-onset disease and correlates with low weight z-score at diagnosis. (C) 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

关键词： carcinoma of the skin   Cohort Studies   Immunocompromised Host   Inflammatory Bowel Diseases   Immunomodulators   Intestinal Diseases   Immunomodulation  

摘要： BackgroundRecent studies report an increased risk of non-melanoma skin cancer (NMSC) in immunosuppressed patients with inflammatory bowel disease (IBD). Concurrently, paediatric IBD incidence is rising, with more patients now exposed to immunomodulators from a younger age. ObjectivesTo investigate NMSC incidence and to examine the risk associated with immunomodulators in the development of NMSC in patients with IBD. MethodsThis was a retrospective single-centre cohort study. Patients with IBD attending a tertiary adult hospital from 1994 to 2013 were included. Skin cancer incidence was compared with population data from the National Cancer Registry of Ireland (NCRI) to calculate standardized incidence ratio (SIR). Logistic regression was utilized for risk factor analysis. ResultsTwo thousand and fifty-three patients with IBD were studied. The SIR for NMSC in patients with IBD taking immunomodulators overall was 1.8 (95% CI: 1.0-2.7) with age-specific rates significantly elevated across certain age categories. Exposure to thiopurines (OR: 5.26, 95% CI: 2.15-12.93, P < 0.001) and in particular thiopurines and/or tumour necrosis factor alpha (TNF-) inhibitors (OR: 6.45, 95% CI: 2.69-15.95, P < 0.001) was significantly associated with NMSC. The majority (82%) of those exposed to a TNF- inhibitor also had thiopurine exposure. ConclusionsCompliance with skin cancer preventative measures should be highlighted to all patients with IBD. There should be a low threshold for dermatology referral for immunosuppressed patients, particularly those with a history of exposure to dual immunomodulators from a young age.

关键词： DEVELOP Registry   Cancer Risk   Tumor Necrosis Factor Antagonist   Anti-TNF  

摘要： BACKGROUND AND AIMS: Immunosuppressive therapy for inflammatory bowel disease (IBD) in pediatric patients is thought to increase the risk of malignancy and lymphoproliferative disorders, including hemophagocytic lymphohistiocytosis (HLH). We compared unadjusted incidence rates of malignancy and HLH in pediatric patients with IBD exposed to infliximab (IFX) with patients not exposed to biologics and calculated standardized incidence ratios (SIRs). METHODS: We collected and analyzed data from 5766 participants in a prospective study of long-term outcomes of pediatric patients with IBD (NCT00606346), from May 31, 2007 through June 30, 2016. Patients were 17 years old or younger and had Crohn's disease, ulcerative colitis, or IBD-unclassified with 24,543.0 patient-years of follow-up. We estimated incidence rates for malignancy and HLH as events/1000 patient-years of followup. We calculated age-, sex-, and race-adjusted SIRs, with 95% confidence intervals (CIs), using the Surveillance, Epidemiology, and End Results Program (SEER) database. RESULTS: Thirteen of the 15 patients who developed a malignancy and all 5 of the patients who developed HLH had been exposed to thiopurines;10 patients with malignancy had also been exposed to a biologic agent. Unadjusted incidence rates showed no increased risk of malignancy (0.46/1000 patient-years) or HLH (0.0/1000 patient-years) in patients exposed to IFX as the only biologic vs those unexposed to biologics (malignancy: 1.12/1000 patient-years;HLH: 0.56/1000 patient-years). SIRs did not demonstrate an increased risk of malignancy among patients exposed to IFX (SIR, 1.69;95% CI, 0.46-4.32) vs patients not exposed to a biologic agent (SIR, 2.17;95% CI, 0.59-5.56), even when patients were stratified by thiopurine exposure. CONCLUSIONS: In determination of age-, sex-, and race-adjusted SIRs using data from a large clinical study and the SEER database, we found that IFX exposure did not associate with increased risk of malignancy or HLH

关键词： Crohn's disease   education   inflammatory bowel disease   knowledge   ulcerative colitis  

摘要： Aims and objectivesTo assess disease-related knowledge among patients with inflammatory bowel disease and to identify the factors that are possibly associated with the knowledge level. BackgroundDisease-related knowledge can positively influence the acceptance of the disease, increase treatment compliance and improve the quality of life in patients with inflammatory bowel disease. DesignAn observational, cross-sectional study was conducted and prospectively included patients from the inflammatory bowel disease programme between October 2014-July 2015. MethodsA Spanish-translated version of the 24-item Crohn's and Colitis Knowledge score was used to assess disease-related knowledge. Patients also completed a demographic and clinical questionnaire. ResultsA total of 203 patients were included, 62% were female, and 66% were diagnosed with ulcerative colitis;the median age was 34years (range 18-79), and the median disease duration was fouryears. The median disease-related knowledge score was 9 (range 1-20). Only 29% of the patients answered more than 50% of the questions correctly. Lower disease-related knowledge was observed in questions related to pregnancy/fertility and surgery/complications. Patients older than 50years, with ulcerative colitis, with disease durations less than fiveyears and patients without histories of surgery exhibited lower disease-related knowledge. There was no association between the knowledge scores and the educational levels. ConclusionsThe patients who attended our inflammatory bowel disease programme exhibited poor disease-related knowledge that was similar to the knowledge levels that have been observed in developed countries. It is necessary to assess patient knowledge to develop educational strategies and evaluate the influences of these strategies on patient compliance and quality of life. Relevance to clinical practiceThese results will allow the inflammatory bowel disease team to develop educational programmes that account for the di

关键词： Inflammatory bowel disease   Ulcerative colitis   Crohn disease   Dysplasia   Colorectal cancer   Colitis   Colitis-associated cancer  

摘要： Inflammatory bowel disease is associated with an increased risk of dysplasia and cancer. Improvements in medical management and endoscopic surveillance have reduced these risks. Patients can develop cancer even in the absence of dysplasia or with indefinite or low-grade dysplasia. Most guidelines recommend starting surveillance colonoscopy 6 to 10 years after initial diagnosis with interval surveillance afterward every 1 to 5 years depending on risk and/or individual characteristics. Most patients should undergo total proctocolectomy with end ileostomy or reconstruction with ilea! pouch anal anastomosis because segmental and subtotal resections carry a higher risk of metachronous cancers.

关键词： INFLAMMATORY bowel disease diagnosis   DISEASE incidence   EPIDEMIOLOGY   CHILDREN'S health   PHENOTYPE  

摘要： Background: The incidence of paediatric inflammatory bowel disease diagnosed before age 10 years is reportedly increasing, but national data are limited. Aim: To characterise the epidemiology, phenotype and clinical outcomes of children diagnosed with inflammatory bowel disease before age 10 years, and compare with data from children diagnosed aged 10-16 years. Methods: A review of all Irish cases of early onset inflammatory bowel disease (diagnosis <10 years, EO-IBD) presenting between January 2000 and December 2014 was undertaken and compared to a cohort of later onset paediatric inflammatory bowel disease patients (diagnosis between 10 and 16 years, LO-IBD). Diagnostic investigations, phenotype, treatments, and long-term clinical and surgical outcomes were analysed. Results: One hundred and ninety children (99 male) with EO-IBD were identified;92 (48%) CD, 77 (41%) UC and 21 (11%) IBDU. The incidence of EO-IBD increased by 0.6 per 100 000 per year (0.8-3.2 per 100 000 per year), with a significant increase in UC by 0.06 per 100 000 per year (P=.02). Males with CD had more upper GI disease (L4a;48% vs 21%;P=.007), more extensive disease distribution (L3 +/- L4;31% vs 11%;P=.05) and more severe disease activity at presentation (52% vs 31%;P=.05) than females. Fewer patients with early onset than later onset Crohn's disease had ileocolonic disease (L3;10% vs 20%;P<.001). More relapses were observed in the first year post-diagnosis in early onset than later onset IBD (1.02 vs 0.5 mean relapses;P<.001). Conclusions: EO-IBD is increasing in incidence. Males have more extensive and severe disease phenotypes, and younger patients have higher relapse rates than older children. Further research to explain these findings is warranted.

关键词： cholecalciferol   Crohn's disease   ergocalciferol   inflammatory bowel diseases   ulcerative colitis   vitamin D   vitamin D deficiency  

摘要： Vitamin D is a secosteroid hormone that possesses immunomodulatory properties and has been demonstrated to potentially influence inflammatory bowel disease (IBD) pathogenesis and activity. Epidemiologic data have associated vitamin D deficiency with an increased risk of IBD, hospitalizations, surgery, and loss of response to biologic therapy. Conversely, IBD itself can lead to vitamin D deficiency. This bidirectional relationship between vitamin D and IBD suggests the need for monitoring and repletion of vitamin D, as needed, in the IBD patient. This review discusses the role of vitamin D in IBD and provides practical guidance on vitamin D repletion.