关键词： MSCT   重建   小肠疾病  

摘要： 目的:探讨口服法低剂量MSCT肠道造影在小肠疾病中的应用价值。方法对52例小肠疾病的患者口服造影剂后,行低剂量(30-80mA)及常规剂量(150-200mA)多层螺旋CT扫描,然后运用多平面重建(MPR)进行定位、定性诊断,并与临床诊断或手术病理结果对照。结果 52例患者中有25例炎症、16例肿瘤,4例肠系膜肿瘤、7例其它病变。所有患者接受放射容积CT指数(CTDIw)约2.9-7.7m Gy,平均约5.3m Gy,明显少于25m Gy,辐射剂量明显减少(p<0.05),有统计学意义,图像质量能够达到诊断标准。结论口服法低剂量MSCT肠道造影能清晰地显示小肠及周围结构,对明确病变部位及诊断有非常重要的临床价值。

关键词： Cell Adhesion   Drug   IBD   Inhibitor  

摘要： Background and aims: Phase 3 trials have shown the efficacy of vedolizumab, which binds to integrin α4-β7, in patients with Crohn’s disease (CD) or ulcerative colitis (UC). We investigated the effectiveness and safety of vedolizumab in patients who failed anti-tumor necrosis factor therapy. Methods: From June through December 2014, there were 173 patients with CD and 121 patients with UC who were included in a multicenter nominative compassionate early access program granted by French regulatory agencies. This program provided patients with access to vedolizumab before it was authorized for marketing. Vedolizumab (300 mg) was administered intravenously at weeks 0, 2, and 6, and then every 8 weeks. Disease activity was assessed using the Harvey-Bradshaw Index for CD and the partial Mayo Clinic score for UC. We report results obtained after the 14-week induction phase. Results: Among the 294 patients treated with vedolizumab (mean age, 39.5 ± 14.0 y;mean disease duration, 10.8 ± 7.6 y;concomitant steroids, 44% of cases), 276 completed the induction period, however, 18 discontinued vedolizumab because of a lack of response (n = 14), infusion-related reaction (n=2), or infections (n=2). At week 14, 31% of patients with CD were in steroid-free clinical remission and 51% had a response;among patients with UC, 36% were in steroidfree clinical remission and 50% had a response. No deaths were reported. Severe adverse events occurred in 24 patients (8.2%), including 15 (5.1%) that led to vedolizumab discontinuation (1 case of pulmonary tuberculosis and 1 rectal adenocarcinoma). Conclusions: In a cohort of patients with CD or UC who failed previous anti-tumor necrosis factor therapy, approximately one third of patients achieved steroid-free clinical remission after 14 weeks of induction therapy with vedolizumab. This agent had an acceptable safety profile in these patients. © 2017, Lavoisier.

关键词： 肛肠疾病   中药熏洗   技术规范  

摘要： 目的:探讨肛肠病手术后采用技术规范化的中药熏洗的止痛疗效。方法:在2015年1月~2016年1月选取来我院进行肛肠疾病手术的患者160例作为研究对象,分成4组,都采用同样的中药原液。A组用30℃进行熏洗15min,B组用30℃熏洗30min,C组用40℃熏洗15min,D组用40℃熏洗30min。对各组疼痛状况进行记录。结果:D组止痛效果优于其他组,尤其是对于肛周疾病。结论:采用40℃的温度对痔疮术后患者进行熏洗15min效果最好,采用40℃温度对肛瘘患者进行熏洗30min效果最佳。

关键词： MICRORNA   INFLAMMATORY bowel diseases   GENETIC polymorphisms   PHENOTYPE   CLINICAL trials   GENETIC aspects  

摘要： Background Inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), are multifactorial disorders that result from a dysregulated inflammatory response to environmental factors in genetically predisposed individuals. Recently, microRNAs (miRNAs) have been shown to be involved in the development of IBDs. Aims We investigated common variants in five miRNA genes in a cohort of Italian IBD patients, to evaluate their possible role in the disease's susceptibility and phenotype manifestations. Methods The analysis included 267 CD patients, 207 UC patients, and 298 matched healthy controls. Polymorphisms in the MIR122, MIR499, MIR146A, MIR196A2, and MIR124A genes were evaluated by allelic discrimination assay. Results We did not find associations between mir polymorphisms and IBD susceptibility. In both diseases, rs17669 and rs11614913 (MIR122 and MIR196A2) seem to contribute to clinical phenotypes: ileal location in CD (odds ratio [OR] = 1.82, p = 0.03;OR = 0.51, p = 0.01), and left-sided extent in UC (OR = 0.43, p = 0.05;OR = 0.28, p = 0.002). In CD, the MIR124A polymorphism (rs531564) contributed to colon location (p = 0.03, OR = 2.74). Finally, the variant allele of rs11614913 was associated with early age at onset in both diseases (p = 0.05 and p = 0.02). Conclusions We showed for the first time that polymorphisms in MIR122, MIR196A2, and MIR124A could play a role in clinical phenotype modulation in IBD.

关键词： Crohn's disease   Symptoms   Treatment expectations   Ulcerative colitis  

摘要： Background: There is currently little evidence about what treatment objectives most interest patients with inflammatory bowel disease (IBD). Aims: To determine patient preferences regarding IBD treatment objectives, specially the attributes they value most and the symptoms to be controlled as a priority. Methods: Prospective, observational, anonymous study conducted in 117 outpatients with Crohn's disease or ulcerative colitis. Results: The most important treatment objectives from the patients' perspective were: improving quality of life (40.2% of patients), and completely resolving symptoms (33.3%). Only 12.8% of patients indicated having a completely normal colonoscopy as a preferred objective. The symptoms the patients considered to be most important when prioritizing their control were: abdominal pain (23.1% of patients), and bowel movement urgency (17.1%). The preferred treatment objectives were similar for Crohn's disease and ulcerative colitis patients. Conclusions: Improving quality of life and completely controlling symptoms are the priority treatment objectives for IBD patients, with abdominal pain being the most important symptom. Conversely, therapeutic objective target goals proposed by physicians, such as healing the mucosal lesions, are not a priority for most patients. This indicates that there are discrepancies between patient and physician expectations, which should be taken into account if a patient-centered care model is to be implemented. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

关键词： Crohn's Disease   Ulcerative Colitis   Gene-Environment Interaction   Microbiota  

摘要： The inflammatory bowel diseases (IBDs) are contemporary conditions of industrialized societies. The prevalence of IBD continues to increase steadily in Western countries, and newly industrialized countries have a rapidly increasing incidence. The global spread of IBD appears to associate with Westernization of diets and environments, which affects the intestinal microbiome and increases the risk of IBD in genetically susceptible individuals. It is important to increase our understanding of these events to slow progression of IBD. We present a long-term plan to develop interventions that slow or stop the global increase in the incidence of IBD.

关键词： Multiple sclerosis   Demyelination   Inflammatory bowel diseases   Crohn's disease   Ulcerative colitis   Co-existence  

摘要： The association between multiple sclerosis ( MS) and inflammatory bowel disease (IBD) has been suggested, apart from their common epidemiological and immunological patterns, also due to observations of increased incidence of both IBD among MS patients and MS among IBD patients. We estimated the risk of concurrent IBD and MS comorbidity, using data from all available case-control studies. We calculated the corresponding Risk ratios (RRs) in each included case-control study to express the risk of IBD and MS concurrence at a given population. We performed additional subgroup analyses according to the type of registry from which the data of the cases were exported ( IBD or MS registry) and the IBD type ( Crohn's disease, CD or Ulcerative colitis, UC). We included 10 studies, comprising a total of 1,086,430 patients ( 0.08% of them with concurrent IBD and MS). Pooled RR for IBD/ MS comorbitity was 1.54 ( 95% CI 1.40- 1.67;p<0.0001) with no differences ( p=0.91) among IBD and MS registries ( RR 1.53, 95% CI 1.36- 1.72, p<0.001 for MS comorbidity in IBD patients vs. RR 1.55, 95% CI 1.32- 1.81, p<0.001 for IBD comorbidity in MS patients). No difference was also found on the risk of MS comorbidity among patients with CD or UC ( RR 1.52, 95% CI 1.34- 1.72, p<0.001 vs. RR 1.55, 95% CI 1.38- 1.74, p<0.001;p for subgroup differences: 0.84). In all analyses no evidence of heterogeneity or publication bias was detected. Both IBD and MS patients seem to have a fifty-percent increased risk of MS or IBD comorbidity, respectively, with no apparent differences between patients with CD or UC.

关键词： INFLAMMATORY bowel diseases   ENDOSCOPY  

摘要： The decision of whether or not to use chromoendoscopy with targeted biopsy (CETB) to detect dysplasia in patients with inflammatory bowel disease (IBD) ought to follow the principle of rational decision-making. But many, including key opinion leaders, are still on the fence. In order to understand how this phenomenon against rational decision-making is occurring, let’s look at [Fig. 1]. Suppose there are 100 gold coins scattered somewhat obscurely in a room. People can follow pathway A or B to find them. Using rational decision-making, people will likely follow pathway A, which has an expected yield of 91 gold coins, rather than pathway B, which has an expected yield of only nine gold coins. Finding dysplasia is a lot more important than finding gold. Therefore, use of the same rational decision-making principle and evidence-based medicine (EBM) ought to be even more important. If these principles were followed, CETB ought to be practiced more widely as EBM shows that use of CETB in 100 patients with dysplasia would be expected to identify 91 patients, as compared to random biopsy, which would be expected to identify only nine patients (ten times more patients!). Why do people go against rational decision-making and EBM, and instead do random biopsies? Perhaps there are barriers that prevent them from using CETB.

关键词： Inflammatory Bowel Diseases   Hematopoietic Stem Cell Transplantation   Mesenchymal Stem Cell Transplantation  

摘要： Autologous hematopoietic stem cell transplantation (HSCT) and mesenchymal stromal cell therapy have been proposed for patients with refractory Crohn's disease (CD) and fistulizing CD, respectively. Will these highly advanced techniques be available only for select patients, at specialized centers, or is further clinical development justified, with the aim of offering widespread, more definitive therapeutic options for often very difficult to treat disease? Patients with CD who are eligible for HSCT have typically been failed by most approved therapies, have undergone multiple surgeries, and have coped with years of disease activity and poor quality of life. The objective of HSCT is to immediately shut down the immune response and allow the transplanted stem cells to develop into self-tolerant lymphocytes. For patients with fistulizing CD, mesenchymal stromal cell therapy deposits MSCs locally, into fistulizing tracts, to down-regulate the local immune response and induce wound healing. Recent trials have produced promising results for HSCT and mesenchymal stromal cell therapy as alternatives to systemic therapies and antibiotics for patients with inflammatory bowel diseases, but are these immunotherapies ready for prime time?

关键词： Crohn disease   diagnostic delay   pediatric inflammatory bowel diseases   ulcerative colitis  

摘要： We evaluated the diagnostic delay (time from first symptoms to diagnosis) in 100 pediatric patients with Crohn disease (CD) and 75 patients with ulcerative colitis (UC). Median (interquartile range) diagnostic delay in patients with CD was 4 (2-8) (range 0-82) months compared with 2 (1-7) (range 0-52) months in patients with UC (P = 0.003). The time interval from first physician visit to inflammatory bowel disease diagnosis was longer in patients with CD and UC when compared to the time interval from symptom onset to first physician visit (CD: median 3 vs 1 months, P < 0.001;UC: median 2 vs 0 months, P < 0.001). No specific risk factors were identified for the length of diagnostic delay. Measures should be taken to reduce diagnostic delay.