关键词： TREATMENT of diarrhea   INFLAMMATORY bowel diseases  

摘要： reply: We thank Drs. Janecke, Heinz-Erian, and Müller for their attention to our work ([1][1]). We apologize to the many investigators whose work we could not cite due to the limitations of this particular type of publication (a brief review) and gratefully acknowledge their contributions to the

关键词： B cell   Bcl2-like protein 12   inflammatory bowel disease   intestine   tumor necrosis factor  

摘要： The pathogenesis of the immune regulation dysfunction is unclear. Bcl2-like protein 12 (Bcl2L12) has immune suppression function. This study tests a hypothesis that tumor necrosis factor (TNF) increases Bcl2L12 to suppress the expression of interleukin (IL) 10 in peripheral B cells of patients with inflammatory bowel disease (IBD). In this study, peripheral blood samples were collected from IBD patients and healthy controls. B cells were isolated from the blood samples. The expression of IL-10 and Bcl2L12 in B cells was analyzed by quantitative reverse transcription polymerase chain reaction and Western blotting. We observed that the expression of Bcl2L12 in the peripheral B cells was higher in IBD patients than that in healthy controls. The IL-10 levels in B cells were negatively correlated with the expression of Bcl2L12. Exposure of B cells to TNF in the culture enhanced the expression of Bcl2L12. The Bcl2L12 mediated the effects of TNF on suppression of IL-10 in B cells. In conclusion, Bcl2L12 mediates the effects of TNF to suppress the expression of IL-10 in B cells. The data suggest that Bcl2L12 may be a therapeutic target for the treatment of IBD.

关键词： Basal plasmacytosis   diagnosis   eosinophils   immunohistochemistry   inflammatory bowel disease  

摘要： Basal plasmacytosis is an early-onset and highly predictive feature of inflammatory bowel disease (IBD), but may have several restrictions in routine histology. Considering evidences about cooperation between eosinophils and plasma cells in IBD pathogenesis, we investigated immunostain of these two cells as a marker of disease. 343 samplings from 83 patients (52 IBD, 31 non-IBD colitis) were evaluated. The sections were stained with monoclonal antibodies against plasma cells (CD138 and MUM1), and eosinophils (CD193). Eosinophilia-associated basal plasmacytosis (EBP) was related with the histologic diagnosis of IBD (90.3% IBD and 35.4% non-IBD colitides, p < 0.005, sensitivity 90.4%). A strong relation was detected between the occurrence of EBP and (i) the achieving of a complete endoscopic mapping;(ii) the presence of other characteristic lesions of IBD in single segmental sampling, although EBP was evident in more than 40% of samples without other IBD-related lesions. EBP is a sensitive histologic feature of IBD, especially at the first endoscopic sampling, even in the absence of the other characteristic histologic lesions, and may help in formulating a more precise diagnosis in this setting.

关键词： Obesity   Gastric bypass   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis  

关键词： Crohn's disease   ulcerative colitis   dietary management   nutritional adequacy   microbiota   gluten   functional gastrointestinal symptoms  

摘要： Irritable bowel syndrome (IBS)-like symptoms are not uncommon in patients with quiescent inflammatory bowel disease (IBD). While gluten-free diet is applied by patients, there are no reported interventional studies. The low-FODMAP diet, on the other hand, has efficacy similar to that seen in patients with IBS in three unblinded or observational studies of IBD cohorts who had well-controlled inflammatory disease and in one small randomized cross-over study. FODMAP intake by patients with IBD is not elevated, and, in one study, fructan intakes were lower in patients with Crohn's disease than in controls. There is no clear relationship between the level of FODMAP intake and intestinal inflammation. The risk of compromising nutritional status with a restrictive diet must be seriously considered especially as under-nutrition is already common in this patient population. The effects of FODMAPs on the gut microbiota of patients with Crohn's disease mimic that in IBS, with a balance between prebiosis from the addition of FODMAPs and loss of prebiosis from their reduction. As undernutrition is common in IBD, the use of restrictive diets should be supervised by a dietitian. Thus, low-FODMAP diet is a viable option for IBS-like symptoms but should be carefully supervised to mitigate risk.

关键词： cancer   inflammatory bowel disease   liver transplantation   sclerosing cholangitis  

摘要： Background & Aims: Epidemiological data on primary sclerosing cholangitis (PSC) outside the Northern hemisphere are limited. Similarly, the impact of inflammatory bowel disease (IBD) on PSC outcomes remains unclear. We aimed to study the epidemiology and outcomes of PSC patients with and without IBD in an Australian cohort. Methods: We retrospectively studied PSC patients attending two tertiary referral hospitals over 20years. Diagnosis of PSC was made according to international guidelines by positive cholangiography and/or liver biopsy (for small duct PSC) with supporting clinical and laboratory evidence. Results: Of 208 PSC patients (61% male) were studied (2271patient-years follow-up). The median age of PSC diagnosis was similar for PSC-IBD and PSC-only patients (40years vs 42years, P=.35). All 33 deaths occurred in PSC-IBD patients while there were no deaths in PSC-only patients (21% vs 0%, P<.01). However, there were no significant differences in liver transplantation (PSC-only 25% vs PSC-IBD 31%, P=.45) and transplant-free survival between PSC-only and PSC-IBD patients (P=.43). On multivariate Cox regression, only elevated international normalized ratio (INR) was associated with a greater risk of death or liver transplant (HR 2.0, 95% CI 1.1-3.6, P=.02). Development of gastrointestinal malignancy was higher in the PSC-IBD group compared to PSC-only group (22% vs 2%, P<.01). Conclusion: Australian PSC patients have similar characteristics compared to European and North American cohorts. IBD is a significant predictor of gastrointestinal malignancies. Deaths were more common in PSC-IBD but overall transplant-free survival remained similar in PSC-IBD and PSC-only groups. An elevated INR was an independent predictor of death or liver transplantation.

关键词： Irritable Bowel Syndrome   QOL   CD   UC   Prevalence  

摘要： BACKGROUND & AIMS: Symptoms compatible with irritable bowel syndrome (IBS) are common in patients with inflammatory bowel disease (IBD), but it is unclear whether this relates to occult IBD activity. We attempted to resolve this issue in a secondary care population by using a cross-sectional study design. METHODS: We analyzed Rome III IBS symptoms, disease activity indices, and psychological, somatization, and quality of life data from 378 consecutive, unselected adult patients with IBD seen in clinics at St James's University Hospital in Leeds, United Kingdom from November 2012 through June 2015. Participants provided a stool sample for fecal calprotectin (FC) analysis;levels >= 250 mu g/g were used to define mucosal inflammation. By using symptom data and FC levels we identified 4 distinct groups of patients: those with true IBS-type symptoms (IBS-type symptoms with FC levels <250 mu g/g, regardless of disease activity indices), quiescent IBD (no IBS-type symptoms with FC levels <250 mu g/g, regardless of disease activity indices), occult inflammation (normal disease activity indices and FC levels >= 250 mu g/g, regardless of IBS symptom status), or active IBD (abnormal disease activity indices with FC levels >= 250 mg/g, regardless of IBS symptom status). We compared characteristics between these groups. RESULTS: Fifty-seven of 206 patients with Crohn's disease (27.7%) and 34 of 172 patients with ulcerative colitis (19.8%) had true IBS-type symptoms. Levels of psychological comorbidity and somatization were significantly higher among patients with true IBS-type symptoms than patients with quiescent IBD or occult inflammation. Quality of life levels were also significantly reduced compared with patients with quiescent disease or occult inflammation and were similar to those of patients with active IBD. By using FC levels >= 100 mu g/g to define mucosal inflammation, we found a similar effect of IBS-type symptoms on psychological health and quality of life. CONCLUS

关键词： Adenocarcinoma   Ulcerative Colitis   Crohn's Disease   Lynch Syndrome  

摘要： Lynch syndrome and inflammatory bowel diseases (IBD) are associated with an increased risk of colorectal cancer (CRC). However, it is not clear whether the risk of CRC is even higher for patients with a combination of Lynch syndrome and IBD. We investigated the risk for CRC in this subgroup by establishing a Lynch syndrome cohort from the Radboud University Medical Center (Nijmegen, The Netherlands) and the Academic Medical Center (Amsterdam, The Netherlands). Patients with heterozygous germline mutations in MLH1, MSH2 (and EPCAM deletion-mediated MSH2 methylation), MSH6, or PMS2 who were tested and/or treated from 1998 through 2014 were included. Patients who developed IBD were identified by linkage of this cohort to the Dutch nationwide Pathology Registry (PALGA). Subsequently, we compared the risk of CRC between Lynch syndrome patients with IBD and without IBD. Of 1046 patients with Lynch syndrome, 15 developed IBD (1.4%). Patients with Lynch syndrome and IBD were significantly younger (median age, 38.0 y) than patients with Lynch syndrome without IBD (median age, 52.0 y;P = .001). Nevertheless, a similar proportion of patients in each group developed CRC: 4 of the 15 patients (26.7%) with Lynch syndrome and IBD compared with 311 of the 1031 patients (30.2%) with Lynch syndrome without IBD. Patients with Lynch syndrome and IBD developed CRC at a younger age (median age, 36.0 y) than patients with Lynch syndrome without IBD (median age, 46.0 y;P = .045). However, the cumulative incidence of CRC was similar between groups (P = .121). All patients with Lynch syndrome and IBD who developed CRC had ulcerative colitis, producing a higher cumulative incidence of CRC for this IBD subgroup (P < .001). In conclusion, patients with Lynch syndrome and IBD develop CRC risk at a younger age than patients without IBD;patients with ulcerative colitis are at especially high risk.

关键词： Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Healthcare utilization   Health service utilization   Outcomes research  

摘要： Identifying patient-level and disease-specific predictors of healthcare utilization in inflammatory bowel disease (IBD) may allow targeted interventions to reduce costs and improve outcomes. To identify demographic and clinical predictors of healthcare utilization among veterans with IBD. We conducted a single-center cross-sectional study of veterans with IBD from 1998 to 2010. Demographics and disease characteristics were abstracted by manual chart review. Annual number of IBD-related visits was estimated by dividing total number of IBD-related inpatient and outpatient encounters by duration of IBD care. Associations between predictors of utilization were determined using stepwise multivariable linear regression. Overall, 676 patients (56% ulcerative colitis (UC), 42% Crohn's disease (CD), and 2% IBD unclassified (IBDU)) had mean 3.08 IBD-related encounters annually. CD patients had 3.59 encounters compared to 2.73 in UC (p < 0.01). In the multivariable model, Hispanics had less visits compared to Caucasians and African-Americans (2.09 vs. 3.09 vs. 3.42), current smokers had more visits than never smokers (3.54 vs. 2.43, p = 0.05), and first IBD visit at age < 40 had more visits than age > 65 (3.84 vs. 1.75, p = 0.04). UC pancolitis was associated with more visits than proctitis (3.47 vs. 2.15, p = 0.04). CD penetrating phenotype was associated with more encounters than inflammatory type (4.68 vs. 4.15, p = 0.04). We found that current tobacco use, age < 40 at first IBD visit, UC pancolitis, and CD fistuilizing phenotype in addition to Caucasian and African-American race were independent predictors of increased healthcare utilization. Interventions should be targeted at these groups to decrease healthcare utilization and costs.