关键词： Inflammatory bowel disease   Frailty   Function   Treatment   Anti-tumor necrosis factor  

摘要： Background Frailty may be a risk factor for complications in inflammatory bowel diseases (IBD) patients. We examined the impact of treatment on IBD patients who were frail prior to treatment and identified predictors of post-treatment change in frailty. Methods In an electronic health record-based cohort of IBD patients initiating anti-tumor necrosis factor (TNF)-alpha agents, we applied a validated claims-based frailty index to determine frailty in the 1 year prior to and after treatment initiation. We characterized treatment non-response using a composite outcome of IBD-related hospitalization, surgery, change in therapy, or initiation of systemic steroids. We constructed multivariable logistic regression models to identify determinants of post-treatment frailty. Results The 1210 patients initiating anti-TNF therapy had a median age of 30 years;20% were >= 50 years. In the first year after anti-TNF initiation, 40% were non-responders. Many more treatment non-responders were frail in the year following treatment compared with treatment responders (27% vs 7%, p < 0.001). Pre-treatment frailty (OR 2.01, 95% CI 1.35-3.00) and prior IBD-related hospitalization (OR 1.63, 95% CI 1.15-2.30) were independently predictive of higher likelihood of post-treatment frailty. Therapy response was associated with a lower likelihood (OR 0.24, 95% CI 0.16-0.34) of post-treatment frailty. Nearly 85% of patients who were frail prior to treatment demonstrated improvement in frailty following treatment Conclusions Response to anti-TNF therapy is an important determinant of post-treatment frailty in patients with IBD. Our findings suggest that effectively treating inflammatory states in older patients with IBD may improve frailty.

摘要： Background While the incidence of inflammatory bowel disease (IBD) has stabilised in the West, it is still increasing in several newly industrialised countries. Aims To investigate whether the environmental and dietary risk factors for IBD differ between Eastern and Western populations Methods We systematically searched PubMed, Embase, and Web of Science for studies published from inception through June 30, 2020. Data were pooled using a random effects model. Results Overall, 255 studies were assessed. We identified 25 risk factors for IBD, seven of which were noted in both Eastern and Western populations: family history of Crohn's disease [CD] or ulcerative colitis [UC], former smoking (CD/UC), smoking (CD), appendicectomy (CD), tonsillectomy (CD), meat and meat products (CD), and vitamin D deficiency (UC). The remaining factors, including urban living, current smoking, antibiotics, oral contraceptives, caesarean section, isotretinoin, total energy, fat, cholesterol, fatty acids and their sub-classifications, eggs, and soft drinks, were associated with an increased risk of IBD in Western or Eastern populations only. We identified 21 protective factors for IBD, among which eight were common in the East and West: farm animals (CD/UC), Helicobacter pylori infection (CD/UC), multiple births (CD), physical activity (CD), history of breastfeeding (CD), pets (UC), current smoking (UC), and coffee intake (UC). Ten factors conferred protection against IBD in Western populations only, whereas eight factors conferred protection against IBD in Eastern populations only. Conclusions Numerous environmental and dietary factors influenced the development of IBD in both Western and Eastern populations, whereas certain factors influenced IBD risk differently in these populations.

摘要： Background How contraceptive formulation, dose, duration of therapy and mode of delivery affects the risk of inflammatory bowel disease (IBD) is poorly described. Aim To examine associations between types of hormonal contraception and development of IBD. Methods This was a nested case-control study using IQVIA Medical Research Data. Women aged 15-49 years with a new diagnosis of IBD were matched with up to six controls by age, practice and year. Odds ratios (OR) and 95% confidence intervals (95% CI) for incident IBD and use of contraception were calculated. Results 4932 incident cases of IBD were matched to 29 340 controls. Use of combined oral contraceptive pills (COCPs) was associated with the development of Crohn's disease and ulcerative colitis (OR 1.60 [1.41-1.82] and 1.30 [1.15-1.45], respectively). Each additional month of COCP exposure per year of follow-up increased risk of Crohn's disease by 6.4% (5.1%-7.7%) and ulcerative colitis by 3.3% (2.1%-4.4%). Progestogen-only pills had no effect on Crohn's disease risk (OR 1.09 [0.84-1.40]) but there was a modest association with ulcerative colitis (OR 1.35 [1.12-1.64]). Parenteral contraception was not associated with the development of Crohn's disease or ulcerative colitis (OR 1.15 [0.99-1.47] and 1.17 [0.98-1.39], respectively). Conclusions We observed an increase in the risk of IBD with increasing duration of exposure to COCPs. Progestogen-only pills were not associated with Crohn's disease but there was a modest association with ulcerative colitis. There was no association between parenteral progestogen-only contraception and IBD. These findings are broadly consistent with a hypothesis that the oestrogen component of contraception may drive IBD pathogenesis.

摘要： LINKED CONTENT This article is linked to Zhao et al papers. To view these articles, visit https://***/10.1111/apt.16723

关键词： Inflammatory bowel disease   Ulcerative colitis   Hyaluronan   Targeted nanocarriers   Drug delivery  

摘要： Delivering drugs directly to the inflamed intestinal sites to treat inflammatory bowel disease (IBD), particularly Cmhn's and ulcerative colitis, is highly challenging. Recent advances in colitis therapy medications are expanding opportunities for improving local on-site drug availability by minimising the associated systemic side-effects. Drug delivery with targeted carrier systems has shown the potential to increase site-specificity, stability, and therapeutic efficacy. Herein, we report the development of a strong anionic charged inflammation targeted nanocarriers (IT-NCs) loaded with an immunosuppressant model drug. This system showed preferential adhesion on a charge-modified surface in vitro, and in both dextran sulfate sodium (DSS) and TNBS colitis mice in vivo models. IT-NCs showed improved colitis phenotype therapeutic efficacy in both animal models compared to free drug. Furthermore, ex vivo study of colon tissue biopsies from patients with colitis revealed that IT-NCs adhered preferentially to inflamed biopsies compared to normal. Together, our results suggest that IT-NCs have promising therapeutic potential as delivery carriers' in colitis management.

关键词： Crohn disease   healthcare   patient outcomes   ulcerative colitis  

摘要： Objective: To evaluate the impact of structured transition from pediatric to adult inflammatory bowel disease (IBD) services on objective patient outcomes, including disease flares, admission rates, and healthcare resource use. Methods: A retrospective observational study in 11 United Kingdom gastroenterology centers. Transition patients attended >= 2 visits to the gastroenterology service with both pediatric and adult personnel jointly present;non-transition patients transferred to adult services without joint visits. Data were collected from medical records for the 12-month periods before and after the date of the first visit involving adult IBD services (index visit). Results: A total of 129 patients were included: 95 transition patients and 34 non-transition patients. In the 12 months post-index visit, transition patients had fewer disease flares (P = 0.05), were more likely to be steroid-free (71% vs 41%, P < 0.05), and were less likely to have an emergency department visit leading to hospital admission (5% vs 18%, P < 0.05). During this period, the mean estimated overall cost of care per patient was 1644.22 pound in the transition group and 1827.32 pound in the non-transition group (P = 0.21). Conclusion: Structured transition from pediatric to adult IBD care services was associated with positive and cost-neutral outcomes in patients with pediatric IBD.

关键词： Microfluidics   Microcapsule   Metal organic framework   Enzyme mimetic   Inflammatory bowel disease  

摘要： Metal organic frameworks (MOFs) with physicochemical properties and adjustable structures have been proposed as very attractive materials. The studies on development of such functional materials tended to fabricate featured MOF objects with fascinating catalytic capabilities to utilize their biomedical values. In this paper, we present novel biocompatible manganese metal organic framework (Mn-MOF)-based catalase mimetics with microfluidic microcapsule encapsulation for intravital inflammatory bowel disease (IBD) treatment. Phosphoserine, a component of the cell membrane, served as an organic ligand to ensure biocompatibility of Mn-MOF. Owing to the core-shell structure of the microcapsule, the Mn-MOF exhibited a well-organized distribution and controlled release features, which could protect them from gastric juice and provide function in the intestine. Upon reaching the sites of the inflammatory bowel, Mn-MOF could effectively scavenge reactive oxygen species (ROS) over-produced by neutrophils and macrophages under various gastrointestinal pH environments, protecting intestinal epithelial cells from ROS damage. The Mn-MOF-encapsulated microcapsules exhibited high performances in treating spontaneous IBD in interleukin-10-deficient mice by relieving the oxidative stress, reducing the inflammation, and restoring the intestinal barrier. These results indicate that the functional Mn-MOF-encapsulated microcapsules have practical applications in the treatment of ROS-associated diseases. (c) 2021 Elsevier Inc. All rights reserved.

关键词： Inflammatory bowel disease   Pancreatitis   Extraintestinal manifestations   Crohn’   s disease   Ulcerative colitis  

摘要： Inflammatory bowel disease (IBD) can involve multiple organ systems, and pancreatic manifestations of IBD are not uncommon. The incidence of several pancreatic diseases is more frequent in patients with Crohn's disease and ulcerative colitis than in the general population. Pancreatic manifestations in IBD include a heterogeneous group of disorders and abnormalities ranging from mild, self-limited disorders to severe diseases. Asymptomatic elevation of amylase and/or lipase is common. The risk of acute pancreatitis in patients with IBD is increased due to the higher incidence of cholelithiasis and drug-induced pancreatitis in this population. Patients with IBD commonly have altered pancreatic histology and chronic pancreatic exocrine dysfunction. Diagnosing acute pancreatitis in patients with IBD is challenging. In this review, we discuss the manifestations and possible causes of pancreatic abnormalities in patients with IBD.