关键词： Biologics   Crohn's disease   Immunosuppressants   Ulcerative colitis   Vaccines  

摘要： Objectives: The treatment of inflammatory bowel disease (IBD) has been revolutionized by the use of immunomodulatory agents. Although these potent drugs are effective in controlling disease activity, they also cause an increased risk of new infections or reactivation of latent infections. On these premises, we aimed to provide guidance on the definitions of immunocompromised patients, opportunistic infections and the risk factors associated with their occurrence in an IBD context, and to suggest the proper screening tests for infectious diseases and the vaccination schedules to perform before and/or during therapy with immunomodulators. Methods: All the most recent evidences - filtered by the combined work of gastroenterologists and infectious disease experts - were summarized with the aim to provide a practical standpoint for the physician. Results: A systematic screening of all infections which may arise during therapy with immunomodulator drugs is necessary in all patients with IBD. Conclusions: The ideal timing to perform screening tests and vaccinations is at the diagnosis of the disease, regardless of its severity at onset, because the course of IBD and its treatment may vary over time, and an immunocompromised status may hamper efficacy and/or possibility to perform all necessary vaccines. (C) 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

关键词： Cytomegalovirus infection   Inflammatory bowel disease   Anti-TNF alpha agents   Immunomodulators  

摘要： Anti-TNF alpha agents emerged in inflammatory bowel disease (IBD) as an effective option in situations that, otherwise, would be refractory to medical therapy. Cytomegalovirus infection may present with a high spectrum of manifestations and lead to high morbidity and mortality. However, its clinical significance in IBD course remains unknown and data on its association with anti-TNF alpha are limited. This study aims to evaluate cytomegalovirus (CMV) infection/disease in patients with IBD treated with anti-TNF alpha;if possible, possible risk factors associated with CMV infection/disease in IBD patients under anti-TNF alpha as well as the influence of CMV infection/disease in IBD course would be determined. During three consecutive years, all IBD patients starting infliximab in our department were included. Cytomegalovirus status before anti-TNF alpha was evaluated. Data regarding IBD, therapeutic and IBD course after infliximab, were recorded. CMV analysis was performed with polymerase chain reaction (PCR)-cytomegalovirus in peripheral blood and colonoscopy with biopsies (histopathology/immunohistochemistry). We included 29 patients: female-83%;Crohn's disease-51.8%, ulcerative colitis-44.8%, non-classified colitis-3.4%;23 cytomegalovirus seropositive. Median follow-up: 19 months (3-36). During follow-up, 14 patients were under combination therapy with azathioprine and 5 did at least 1 cycle of corticosteroids. Twenty-one patients responded to infliximab. We registered 8 exacerbations of IBD. Four patients discontinued infliximab: none had CMV infection. We documented 1 case of intestinal cytomegalovirus infection-detected in biopsies performed per protocol in an asymptomatic UC patient, who responded to valganciclovir without infliximab discontinuation. Infliximab, with/without immunosuppression, does not confer an increased risk of (re)activation of cytomegalovirus. Cytomegalovirus was not responsible neither for significant morbidity nor mortality in IBD.

关键词： barrier function   STEADY-STATE CONDITIONS   Intestinal Diseases   Candidate Gene Analysis  

摘要： Intestinal homeostasis disturbance through intestinal barrier disruption presumably plays a key rote in inflammatory bowel disease (IBD) development. Genetic and candidate gene analyses in an Il10-deficient IBD mouse model system identified Cd14 as a potentially protective candidate gene. The role of Cd14 in colitis development was determined using dextran sulfate sodium (DSS) induced acute and an Il10-deficiency induced chronic model of intestinal inflammation. Intestinal permeability was investigated by fluorescein isothiocyanate dextran uptake assay, quantitative RT-PCR analysis of tight junction proteins, myosin tight chain kinase, and proinflammatory cytokine expression. Immunohistological staining of occludin, Ki-67, NF-kappa B-p65,and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay was performed, and intestinal inflammation severity was evaluated histologically. Untreated B6-Cd14(-/-) mice and wild-type controls did not differ in intestinal barrier function. However, DSS-treated Cd14-deficient and B6-Il10(-/-)Cd14(-/-) mice exhibited more severe intestinal barrier disruption, with increased histological scores and proinflammatory cytokine expression, compared to controls. Therefore, Cd14 deficiency did not influence epithelial integrity under steady-state conditions but caused intestinal barrier dysfunction under inflammation. As expected, CD14 overexpression increased barrier integrity. No difference in intestinal epithelial NF-kappa B trans location was observed between the investigated groups. Intestinal myosin light chain kinase expression decreased in Cd14-deficient mice under steady-state conditions and in the chronic model, whereas no difference was detected in the DSS models. Thus, CD14 plays a protective role in IBD development by enhancing intestinal barrier function.

关键词： INFLAMMATORY bowel diseases   PATIENTS   HEREDITARY nonpolyposis colorectal cancer   COLON cancer risk factors   AMINO compounds   DYSPLASIA  

摘要： BackgroundThe relationship of 5-aminosalicylates' use with the risk of colorectal neoplasia in patients with inflammatory bowel disease (IBD) has been the focus of a growing body of research. AimTo investigate this association through an updated meta-analysis of observational studies. MethodsPubMed, Scopus and major conference proceedings were searched up to December 2016. The identified studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates were calculated using random-effect models. Detailed subgroup analyses were performed. The GRADE approach was used to assess the quality of evidence. ResultsThirty-one independent observational studies including 2137 cases of colorectal neoplasia (of which 76% were cancers) were incorporated. Between-study heterogeneity was moderate, while strong suspicion of small-study effects was raised. The overall analysis revealed a protective association between 5-aminosalicylates' use and colorectal neoplasia (RR=0.57, 95% CI: 0.45-0.71). When the analysis was stratified according to study design and setting, the association was significant in cohort (RR=0.65, 95% CI: 0.43-0.99;n=10) and case-control studies (RR=0.53, 95% CI: 0.40-0.70;n=21), population-based (RR=0.70, 95% CI: 0.52-0.94;n=12) and hospital-based studies (RR=0.46, 95% CI: 0.34-0.61;n=19). Exposure to 5-aminosalicylates was protective against cancer (RR=0.58, 95% CI: 0.45-0.74) and dysplasia (RR=0.54, 95% CI: 0.35-0.84). The reduction in colorectal neoplasia risk was strong in ulcerative colitis (RR=0.50, 95% CI: 0.38-0.64), but nonsignificant in Crohn's disease (RR=0.76, 95% CI: 0.43-1.33). Mesalazine (mesalamine) use was protective (RR=0.70, 95% CI: 0.51-0.94) with evidence of a dose-effect. The effect of sulfasalazine was marginally nonsignificant (RR=0.72, 95% CI: 0.51-1.01). ConclusionsOur findings support a potential chemopreventive role of 5-aminosalicylates in IBD. Further, high-quality prospective research is warranted.

关键词： TUMOR necrosis factor   INFLIXIMAB   INFLAMMATORY bowel diseases   MUCOUS membrane   META-analysis  

摘要： Linked Content This article is linked to Komaki et al and Felwick and Cummings papers. To view these articles visit https://***/10.1111/apt.13990 and https://***/10.1111/apt.14050. [ABSTRACT FROM AUTHOR]

关键词： vitamin therapy   Inflammatory Bowel Diseases   Intestinal Diseases   Vitamin D   Medicine  

摘要： Linked Content This article is linked to Winter et al paper. To view this article visit https://***/10.1111/apt.13936. [ABSTRACT FROM AUTHOR]

关键词： CD   Crohn’s disease   HS   hidradenitis suppurativa   IBD   inflammatory bowel disease   ICD   International Classification of Diseases   OR   odds ratio   UC   ulcerative colitis  

摘要： Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. In small studies, inflammatory bowel disease has been associated with the increased prevalence of HS, but the data on the concurrence of inflammatory bowel disease in patients with HS are limited. We therefore investigated the prevalence and risk of inflammatory bowel disease in patients with HS compared with the general population. The study linked all Danish individuals aged similar to 18 years in nationwide registers. Adjusted odds ratios and adjusted hazard ratios were estimated by logistic regression and Cox regression, respectively. The study comprised 7,732 patients with HS and 4,354,137 subjects from the general population. The prevalence (HS vs. general population) was 0.8% and 0.3% (odds ratio 2.04;1.59-2.62) for Crohn's disease and 1.3% and 0.7% (odds ratio 1.75;1.44-2.13) for ulcerative colitis. The risk of new-onset Crohn's disease (hazard ratio 2.19;1.44-3.34) and ulcerative colitis (hazard ratio 1.63;1.18-2.27) was significantly increased among patients with HS. In conclusion, HS was significantly associated with the presence and risk of new-onset inflammatory bowel disease, although the prevalence remained low. Gastrointestinal complaints in patients with HS should warrant further clinical examination.

摘要： Patients with inflammatory bowel disease who experience abdominal pain and gastrointestinal symptoms often seek care in the emergency department (ED). These patients commonly undergo abdominopelvic computed tomography (CT) as part of their evaluation, and the rate of imaging appears to be increasing without a corresponding increase in identification of clinically actionable findings or effect on disposition. Studies demonstrate that the yield of CT tends to be fairly high. Yet, because inflammatory bowel disease is often diagnosed at an early age, these patients are repeatedly imaged during their lifetime, a subset of whom accumulate high levels of ionizing radiation exposure, increasing their risk of cancer. This compounds an already increased risk of cancer in these patients because of inflammatory bowel disease alone. Lack of intimate knowledge of a patient's disease phenotype and disease progression contributes to uncertainty in distinguishing between an inflammatory exacerbation;a complication such as obstruction, abscess, perforation, fistula, or stricture;and a noninflammatory-bowel-disease-related condition. This uncertainty can lead to overuse of imaging with CT. Limited availability of and lack of awareness of alternate imaging modalities and strategies may prevent providers from pursuing strategies that avoid ionizing radiation. In this article, we review options for imaging inflammatory bowel disease patients in the ED and attempts undertaken to risk stratify these patients, and we discuss ways in which details of a patient's disease might guide imaging decisionmaking.

关键词： Inflammatory bowel disease   Quality of life   Ulcerative colitis   Crohn's disease   Patient organization  

摘要： Inflammatory bowel disease (IBD) has a significant negative impact on quality of life (QOL);however, the direct impact of IBD on several aspects of patients' lives is unknown. The IMPACT survey was conducted in Europe in 2010-2011 to determine this impact. We conducted the IMPACT survey in Japan and compared the results between subgroups of patients with ulcerative colitis (UC) and Crohn's disease (CD). The 52-item IMPACT survey questionnaire assessing treatment and the impact of IBD on patients' lives was translated into Japanese and administered to IBD patients recruited through patient advocacy groups. Between June 2013 and January 2014, 172 Japanese IBD patients completed the questionnaire (including 84 UC and 83 CD patients). Half of all patients (84/172, 48.8 %) were satisfied with their treatment plan, and half of those who had undergone surgery were satisfied with the outcome (46/87, 52.9 %). Although 34.9 % (60/172) of patients had not been hospitalized in 5 years, 50.0 % (86/172) had been hospitalized for more than 10 days. During the most recent flare, 49.4 % (85/172) of patients had to reschedule appointments because of IBD. Moreover, 32.0 % (55/172) of patients had to make adjustments such as working part-time or at home to avoid taking sick days;35.5 % (61/172) of patients felt that they had lost a job because of IBD. Our survey results indicate that IBD patients' lives and social activities are affected by the deterioration of QOL due to IBD and its symptoms.