关键词： ACE inhibitors   angiotensin II receptor blockers   colitis   inflammatory bowel diseases   renin-angiotensin system  

摘要： Inflammatory bowel diseases (IBDs) are chronic disorders of the gastrointestinal tract, which manifest in recurring gastrointestinal inflammation. The current treatment options of IBD are not curative and are lacking in aspects like prevention of fibrosis. New treatment options are needed to fulfil the unmet needs and provide alternatives to drugs with resistances and side effects. Drugs targeting the renin-angiotensin system (RAS), besides being antihypertensive, also possess anti-inflammatory and antifibrotic properties and could offer an inexpensive alternative to control inflammation and fibrosis in the gut. RAS inhibitors have been effective in preventing and alleviating colitis in preclinical studies, but available human data are still sparse. This review outlines the pathophysiological functions of RAS in the gut and summarizes preclinical studies utilizing pharmacological RAS inhibitors in the treatment of experimental colitis. We discuss the alterations in intestinal RAS and the available evidence of the benefits of RAS inhibitors for IBD patients. Retrospective studies comparing IBD patients using ACE inhibitors or angiotensin II receptor blockers have provided optimistic results regarding a milder disease course and fewer hospitalizations and corticosteroid use in patients using RAS inhibitors. Prospective studies are needed to evaluate the effectiveness of these promising medications in the treatment of IBD.

关键词： coronavirus disease 2019   pediatric inflammatory bowel disease   seroconversion   severe acute respiratory syndrome coronavirus 2  

摘要： Understanding coronavirus disease 2019 (COVID-19) in pediatric inflammatory bowel disease (PIBD) is important. We describe a single-center cohort of COVID-19 PIBD patients where seroconversion against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was examined. Immunosuppressed PIBD patients at Texas Children's Hospital who tested positive for SARS-CoV-2 by nasopharyngeal reverse transcriptase polymerase chain reaction were included in the study. The clinical course of IBD, concurrent medications, COVID-19 related symptoms, SARS-CoV-2 testing date, and SARS-CoV-2 immunoglobulin G (IgG) antibody testing date and result were examined. Of 14 SARS-CoV-2 positive PIBD patients, 12 were tested for qualitative anti-SARS-CoV-2 IgG (seven with transient COVID-19 symptoms, five asymptomatic). All symptomatic (7/7) and 60% of asymptomatic (3/5) patients seroconverted. No patients required hospitalization attributed to COVID-19. High rates of COVID-19 seroconversion occurred in immunosuppressed and symptomatic PIBD patients. More research to evaluate the significance of COVID-19 seroconversion is needed.

关键词： Trehalosomes   Green   Phospholipids   Trehalose   Colon targeting   Oxidative stress and inflammatory biomarkers  

摘要： The use of non-steroidal anti-inflammatory drugs (NSAIDs) in inflammatory bowel diseases (IBDs) are contradictory between their beneficial effect in alleviating inflammation, and injurious outcomes in aggravating the symptoms of colitis. The study aimed to formulate trehalosomes (THs);innovative green trehalose-based nanocarriers, to alleviate the inflammation symptoms that might be provoked by NSAIDs in IBDs;as trehalose was proved to lighten the inflammation and the oxidative stress response, besides its resistance to the acidic conditions that rises its potentiality as a means for colon targeting. THs were fabricated using L-alpha-phosphatidylcholine (PL), trehalose, and transcutol, in a single step circumventing the incorporation of any organic solvent and loaded with Tenoxicam (TXM) as a model anti-inflammatory medication. A full 23 factorial design, using Design-Expert (R) software, was established to optimize the formulation variables. The optimized formulation composed of trehalose: PL at a weight ratio of 1:1, 377.72 mg transcutol, and sonicated for 4 min, possessed a spherical shape with a size of 268.61 nm and EE% of 97.83% and released 70.22% of its drug content over 24 h. The supreme protective action of TXM loaded THs compared to TXM suspension and drug-free THs was revealed by the suppression of the inflammatory biomarkers and the improved histopathology of the colonic tissue in male New Zealand rabbits. IL-1ss, IL-6, and TNF-alpha levels were notably dampened with TXM loaded THs, and oxidative stress markers, measured as GSH and MDA, were significantly altered. The study indicates the successful role of green THs in colon targeting and its anti-inflammatory characteristics in protecting against possible NSAIDs-driven exacerbation of colitis.

关键词： Histologic Healing   Ulcerative Colitis   Relapse  

摘要： BACKGROUND: Endoscopic remission is a recognized therapeutic endpoint in inflammatory bowel disease (IBD;Crohn's disease (CD), ulcerative colitis (UC)). The impact of persistent histologic activity on long-term outcomes is less clear and limited by small studies. METHODS: We performed a systematic search of PubMed and Embase to identify eligible studies examining the association between histologic activity and relapse in patients with CD or UC in endoscopic remission. Studies were pooled together using random effects meta-analysis per the DerSimonian and Laird inverse variance method. The impact of different histologic scales, cut-offs, and individual features were examined. FINDINGS: Our meta-analysis included 28 studies contributing 2,806 patients (2677 UC;129 CD). In UC, histologically active disease was associated with an overall increased risk of relapse (OR, 2.41;95% CI, 1.91-3.04), with a similar effect noted in the subgroup with endoscopic Mayo endoscopic score of 0 vs 0 or 1. More rigorous Geboes cut-offs demonstrated numerically stronger impact on relapse rates-Geboes <3.1 (OR, 2.40;95% CI, 1.57-3.65), Geboes <2.1 (OR, 3.91;95% CI, 2.21-6.91) and Geboes 0 (OR, 7.40;95% CI, 2.00-18.27). Among individual histologic features, basal plasmacytosis (OR, 1.94), neutrophilic infiltrations (OR, 2.30), mucin depletion (OR, 2.05), and crypt architectural irregularities (OR, 2.22) predicted relapse. There was no association between histologic activity and relapse in CD. CONCLUSIONS: In patients with UC in endoscopic remission, persistent histologic activity is associated with higher rates of relapse. Greater degree of normalization may have a stronger impact.

关键词： health disparity   quality improvement   race   steroid-sparing therapy  

摘要： Objectives: Corticosteroids have long been used to treat inflammatory bowel disease. However, cumulative corticosteroid exposure is associated with adverse effects, particularly in growing children. Professional guidelines recommend steroid-sparing strategies. It remains unknown whether corticosteroid use has decreased in children with inflammatory bowel disease. Methods: We performed retrospective cohort study using data from 2007 to 2018 from the international multi-center ImproveCareNow Network, a pediatric inflammatory bowel disease quality improvement collaborative. Pediatric patients diagnosed with inflammatory bowel disease were included. Patients with missing diagnosis or corticosteroid use data were excluded. We performed serial cross-sectional analyses of period prevalence and used multivariate regression models. Results: 27,321 patients were included (65% Crohn disease, 28% ulcerative colitis, 7% indeterminate colitis). Corticosteroids were used in 10,206 (37%). Corticosteroid use decreased from 28% (2007) to 12% (2018). Black patients received corticosteroids more commonly than white patients. This disparity improved as corticosteroid use decreased in both groups. Most corticosteroid use occurred <120 days after diagnosis. Corticosteroid or 5-aminosalicylate use <120 days after diagnosis predicted later corticosteroid use. Anti-tumor necrosis factor-alpha medication use <120 days after diagnosis was associated with a reduction in corticosteroid use. As corticosteroid use decreased, steroid-sparing therapy use increased and height and weight z scores improved, particularly among children with Crohn disease. Despite improvement across the network, variation in corticosteroid usage remains. Conclusions: Corticosteroid use among pediatric patients with inflammatory bowel disease in the ImproveCareNow Network has decreased over time. Racial disparities in corticosteroid use were found, but gradually improved.

关键词： bioelectrical impedance analysis   children   dual energy X‐   ray absorptiometry   inflammatory bowel disease   skinfold equation   three‐   compartment model  

摘要： Aim To assess different techniques to measure body composition in paediatric patients with inflammatory bowel disease using dual energy X-ray absorptiometry as a reference method. We hypothesised that a three-compartment model may demonstrate superiority over other methods as skinfold thickness equations and bioelectrical impedance analysis. Methods Body composition was assessed using skinfold thickness equations, bioelectrical impedance analysis and the three-compartment model. Data obtained with these methods were compared to the results obtained by dual energy X-ray absorptiometry. Statistical analysis was performed using Spearman's correlation and Bland-Altman's limits of agreement method. Results Twenty-one paediatric patients with inflammatory bowel disease were included: 11 females and 10 males;mean age for the entire group: 14.3 years, range 12-16 years. In children with inflammatory bowel disease, skinfold thickness equations, bioelectrical impedance analysis and the three-compartment model showed reliable measurements with small differences in the percentage of total body fat and good limits of agreements. Conclusion The assessment of body composition using bioelectrical impedance analysis provides a valid and accurate method in children with inflammatory bowel disease as compared to dual energy X-ray absorptiometry. In the future, superiority of 3-compartment model in research and clinical settings of nutritional intervention and disease status in children with inflammatory bowel disease remains to be demonstrated.

关键词： Medicine/Public Health   general   Pediatrics   Pediatric Surgery  

摘要： Background: The coronavirus disease (COVID-19) pandemic affects medical care worldwide, including patients with inflammatory bowel disease (IBD). Thus, we aimed to assess its impact on health care provision, fear of infection, adherence to medical treatment, and compliance with preventative instructions in children and adolescents with IBD. Methods: A cross-sectional telephonic survey using a Likert scale-based questionnaire was conducted among all pediatric patients with IBD from a single tertiary medical center. Results: A total of 244 pediatric patients with IBD were included in the study, reporting a high rate of fear of severe COVID-19 infection due to IBD or IBD medications (198, 81.1%). Most of the patients obeyed the Ministry of Health instructions (228, 93.4%), while almost 50% took additional protective measures including avoidance of school and complete lockdown. Concerns regarding the attendance of regular clinics (116, 47.5%) and emergency room in case of IBD exacerbation (178, 73%) were frequently reported. Only 7 patients (2.9%) changed or discontinued their IBD treatment due to COVID-19. Conclusion: We noted several distinct features of the COVID-19 pandemic effect on pediatric patients with IBD including a high rate of fear of severe COVID-19 infection, fear of attending necessary medical facilities, and high rate of avoidance of social activities. Impact: Pediatric patients with IBD have a high rate of fear of severe COVID-19 infection, fear of attending necessary medical facilities, and a high rate of avoidance of social activities. Medication adherence rate in pediatric patients with IBD during the pandemic is similar to the adherence rate among adults with IBD. Almost 50% of pediatric patients with IBD took additional protective measures including avoidance of school and voluntary lockdown during the COVID-19 pandemic.

关键词： Inflammatory bowel disease   Oral health   DPSI (Dutch Periodontal Screening Index)   DMFT (Decayed   Missing   Filled Teeth)   Crohn’   s disease   Ulcerative colitis  

摘要： Objectives Although bowel symptoms are often predominant, inflammatory bowel disease (IBD) patients can have several oral manifestations. The aim of this study was to investigate the prevalence of dental caries and periodontal disease in patients with Crohn's disease (CD) and ulcerative colitis (UC) compared to an age and gender-matched control group of patients without IBD. Material and methods The DMFT (Decayed, Missing, Filled Teeth) scores and the DPSI (Dutch Periodontal Screening Index) of 229 IBD patients were retrieved from the electronic health record patient database axiUm at the Academic Centre for Dentistry Amsterdam (ACTA) and were compared to the DMFT scores and DPSI from age and gender-matched non-IBD patients from the same database. Results The total DMFT index was significantly higher in the IBD group compared to the control group. When CD and UC were analyzed separately, a statistically significant increased DMFT index was observed in CD patients but not in UC patients. The DPSI did not differ significantly between the IBD and non-IBD groups for each of the sextants. However, in every sextant, IBD patients were more frequently edentulous compared to the control patients. Conclusion CD patients have significantly more dental health problems compared to a control group. Periodontal disease did not differ significantly between IBD and non-IBD groups as determined by the DPSI.

关键词： ankylosing spondylitis   Inflammation   epidemiology  

摘要： The association between ankylosing spondylitis and other diseases has been extensively assessed.1 2 Recently a cohort study conducted by Schreiber et al published in Annals of the Rheumatic Diseases found that the new-onset cases of inflammatory bowel disease were uncommon in patients with ankylosing spondylitis on secukinumab therapy (1.13%, 9/794).3 In order to examine the association between ankylosing spondylitis and inflammatory bowel disease in a different country, a preliminary cohort study was undertaken using the 2005–2012 database of the Taiwan National Health Insurance Programme with 23 million residents living in Taiwan.4 Subjects ages 20–84 with a new diagnosis of ankylosing spondylitis were identified as the ankylosing spondylitis group (International Classification of Diseases, Ninth Revision code (ICD-9 code 720.0)). Table 1 presents that the overall incidence of inflammatory bowel disease was lower in the ankylosing spondylitis group than in the non-ankylosing spondylitis group, but without reaching statistical significance (1.41 vs 1.79 per 1000 person-years, incidence rate ratio 0.79, 95% CI 0.48 to 1.28; p=0.332). Incidence rates of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis treated with secukinumab: a retrospective analysis of pooled data from 21 clinical trials.