摘要： A 64-year-old man presented with a 10-day history of painful cutaneous plaques in the groin and oral mucosa. He also had a history of ulcerative rectocolitis, successfully treated with mesalazine and azathioprine. Physical examination revealed confluent exudative plaques with snail-track erosions and short-lived pustules, distributed bilaterally in the groin (a) and on all visible oral mucosa including the cheek linings and the vestibules (b and c). Multiple biopsies revealed dense eosinophilic and neutrophilic inflammatory infiltrate in the dermis of the left groin and oral mucosa. Complete blood count revealed peripheral eosinophilia. The patient was diagnosed with pyodermatitis-pyostomatitis vegetans following an exacerbation of ulcerative rectocolitis, and the cutaneous and mucosal lesions were the first signs of disease recurrence. He was treated with 40 mg oral prednisolone daily, a steroid mouthwash, and 0.05% topical clobetasol propionate. Symptoms were immediately relieved, and skin lesions resolved thereafter. Pyodermatitis-pyostomatitis vegetans is a rare, chronic, inflammatory dermatosis and the association with inflammatory bowel disease occurs in approximately 70% of cases. (Informed consent was obtained from the patient to publish these images.)

关键词： inflammatory bowel disease   dietary patterns   dietary index   Mediterranean diet   diet inflammatory index  

摘要： Diet is one of the most critical factors for inflammatory bowel disease (IBD). A whole dietary pattern should be considered when doing nutrient-based research to preserve the potential for synergism between nutrients. Dietary indices are important tools to evaluate diet quality, and we investigated the associations of it with IBD. Fourteen studies on the relation between index-based dietary patterns and IBD were included. 6 studies showed the relation between index-based dietary patterns and IBD risk, 7 studies explored the dietary indices and progression of IBD, and 1 study investigated the relationship between index and all-cause mortality in IBD patients. These results implied that a high score on the Mediterranean diet was negatively associated with risk and progression of IBD. However, a diet with high inflammatory potential could increase risk and aggravate disease activity in IBD. Dietary scores have the potential to evaluate the association between overall diet quality and risk and progression of IBD. Future randomized controlled trials are required to confirm the effect of the change in dietary score.

ISBN: (纸本)9787117319447

关键词： abnormalities of uterine cervix   cervical cancer   inflammatory bowel disease   meta-analysis  

摘要： Background Previous studies provided inconsistent results regarding the association between inflammatory bowel disease (IBD) and risk of abnormalities of uterine cervix. The study aimed to make a meta-analysis to evaluate the association between IBD and risk of abnormalities of uterine cervix. Methods Articles published until April 2021 and regarding the association between IBD and risk of abnormalities of uterine cervix were searched in the following databases: PubMed, Web of Science, EMBASE, Medline, and Google Scholar. Odds ratios (ORs) from case-control studies and relative risks (RRs) from cohort studies with their 95% confidence intervals (CIs) were computed to generate a pooled effect size and 95% CI using STATA 12.0 software. Results The present study finally included seven cohort studies (including 94 144 IBD patients and 53 661 004 HC) and four case-control studies (including 20 267 cases and 60 034 matched controls). The meta-analysis indicated a positive association between IBD and risk of abnormalities of uterine cervix with a random-effects model (OR/RR = 2.46, 95% CI 1.55-3.91, I-2 = 91.8%, p < 0.001). However, no significant association between IBD and risk of cervical cancer was showed in the study with a random-effects model (OR/RR = 1.54, 95% CI 0.83-2.85, I-2 = 82.2%, p < 0.001). Conclusion In conclusion, IBD is associated with a 146% higher risk of abnormalities of uterine cervix. However, the study demonstrated no significant association between IBD and risk of cervical cancer. Thus, a conventional screening for abnormalities of uterine cervix is essential for IBD patients.

关键词： CD   operative report   synoptic report  

摘要： Aim Ileocolic resection (ICR) is the most commonly performed operation in Crohn's disease (CD) patients. The surgical report is a vital tool for accessing information to gauge a patient's long-term prognosis and guide treatment decisions. Dictated narrative reports are the traditional method for surgical documentation but often lack essential information. The objective was to assess the quality of operation note in CD patients undergoing ICR. Method This was a multi-institutional retrospective cohort collaborative study involving four tertiary inflammatory bowel disease referral centres in the USA and Canada. The patients were consecutive CD patients undergoing ICR between 2014 and 2020. There were no interventions. The main outcome measures were the variability and frequency of 28 critical items in the operation note. Results An analysis of 400 consecutive operation reports in four institutions (n = 100/institution) revealed significant variability in almost all variables. The initial surgical approach and wound protector use were the most consistently or frequently reported across all inflammatory bowel disease centres. The limitation was that this was a retrospective cohort study with inevitable selection bias. Conclusions This study highlights the need for synoptic reporting in CD patients undergoing ICR.

关键词： Vedolizumab   Real-world data   Predictors   Biologics   Decision-making  

摘要： Purpose We characterized the profile of Crohn's disease (CD) or ulcerative colitis (UC) biologic-naive patients (starting a new therapy with vedolizumab or TNF alpha-antagonists), their baseline disease activity predictors, and their perception of the quality of life (HRQoL). Methods The VEDOIBD-Study is a real-world study on the effectiveness of vedolizumab vs other biologics as induction and maintenance therapy for CD and UC. A total of 627 CD and 546 UC patients were enrolled from IBD-experienced centers across Germany. In both biologic-naive vedolizumab (n=397) and anti-TNF (n=359) patients, CD and UC disease severity and HRQoL predictors were analyzed with logistic regression. The results were reported as odds ratio (OR) and 95% confidence interval (CI). Results When compared to biologic-naive anti-TNF patients, a first biological therapy with vedolizumab was considered for older CD patients, with a less complicated though longer disease course, and with a history of comorbidities. No differences in (unmet) needs were observed among patients with UC. The presence of extra-intestinal manifestations in biologic-naive anti-TNF patients with CD (OR (95% CI): 3.83 (1.69-8.68)) and, in both biologic-naive groups of patients with UC, stool frequency (2.00 (1.25-3.19);1.82 (1.10-3.02), respectively) and rectal bleeding (2.24 (1.20-4.18);1.92 (1.19-3.11), respectively) emerged as the most important predictors of disease severity, which in turn were also significantly associated with a worse HRQoL. Conclusion This study highlights the existence of unmet medical needs of patients with CD or UC, for whom a new biological therapy is planned as part of the VEDOIBD-Study, which considerably impacts their HRQoL.

关键词： Crohn&apos   s disease   functional healing   inflammation   molecular imaging   mucosal healing   ulcerative colitis  

摘要： The therapeutic goal in inflammatory bowel disease (IBD) patients has shifted from controlling the clinical activity alone to managing other associated problems. The concept of mucosal healing (MH) and deep remission (DR) are advocated and regarded as new therapeutic goals in IBD. However, the definition of MH still remains controversial. It is unclear whether or not the histological structures or functional factors should be included in the definition of DR in addition to clinical remission and MH. The classifications of white-light imaging (e.g. Mayo endoscopic subscore, UCEIS, CD Endoscopic Index of Severity, simple Endoscopic Score-CD) have been proposed and are now widely used to assess the severity as well as the MH of inflammation in IBD. In ulcerative colitis, magnifying chromoendoscopy has been shown to be useful to assess the MH of inflammation while other types of image-enhanced endoscopy, such as narrow-band imaging, have not. Endocytoscopy and confocal laser endomicroscopy (CLE) are also applied to assess the activity in IBD. These endoscopic procedures can estimate MH with more precision through observing the details of superficial structures, such as crypt openings. In addition, CLE can partially assess the mucosal function by detecting fluorescence leakage. Molecular imaging can possibly detect the molecules associated with inflammation, intestinal regeneration and differentiation, and various functions including the intestinal barrier and mucus secretion. These novel procedures may improve the diagnosis strategy of DR through the assessment of DR-associated factors such as the histological structures and functional factors in the near future.

摘要： Background Poor immune responses are frequently observed in patients with inflammatory bowel disease (IBD) receiving established vaccines;risk factors include immunosuppressants and active disease. Aims To summarise available information regarding immune responses achieved in patients with IBD receiving established vaccines. Using this information, to identify risk factors in the IBD population related to poor vaccine-induced immunity that may be applicable to vaccines against COVID-19. Methods We undertook a literature review on immunity to currently recommended vaccines for patients with IBD and to COVID-19 vaccines and summarised the relevant literature. Results Patients with IBD have reduced immune responses following vaccination compared to the general population. Factors including the use of immunomodulators and anti-TNF agents reduce response rates. Patients with IBD should be vaccinated against COVID-19 at the earliest opportunity as recommended by International Advisory Committees, and vaccination should not be deferred because a patient is receiving immune-modifying therapies. Antibody titres to COVID-19 vaccines appear to be reduced in patients receiving anti-TNF therapy, especially in combination with immunomodulators after one vaccination. Therefore, we should optimise any established risk factors that could impact response to vaccination in patients with IBD before vaccination. Conclusions Ideally, patients with IBD should be vaccinated at the earliest opportunity against COVID-19. Patients should be in remission and, if possible, have their corticosteroid dose minimised before vaccination. Further research is required to determine the impact of different biologics on vaccine response to COVID-19 and the potential for booster vaccines or heterologous prime-boost vaccinations in the IBD population.