Inflammatory bowel disease(IBD)is entering a potentially new era of combined therapeutics.Triantafillidis et al provide an insightful review of the current state of combination therapy,with a focus on the use of a com...Inflammatory bowel disease(IBD)is entering a potentially new era of combined therapeutics.Triantafillidis et al provide an insightful review of the current state of combination therapy,with a focus on the use of a combined biologic and immunomodulator,as well as emerging data on the future potential of dual-biologic therapy(DBT).While current evidence for DBT is limited,encouraging safety profiles and ongoing trials suggest a brighter future for this approach.The importance of controlled trials should be stressed in establishing new treatment paradigms.Ongoing prospective randomized trials of DBT and perhaps future combinations of biologics and small molecule therapies will hopefully guide the next generation of IBD care.展开更多
AIM: To evaluate the completion rate and diagnostic yield of the Pill Cam SB2-ex in comparison to the Pill Cam SB2.METHODS:Two hundred cases using the 8-h Pill Cam SB2 were retrospectively compared to 200 cases using ...AIM: To evaluate the completion rate and diagnostic yield of the Pill Cam SB2-ex in comparison to the Pill Cam SB2.METHODS:Two hundred cases using the 8-h Pill Cam SB2 were retrospectively compared to 200 cases using the 12 h Pill Cam SB2-ex at a tertiary academic center.Endoscopically placed capsules were excluded from the study.Demographic information,indications for capsule endoscopy,capsule type,study length,completion of exam,clinically significant findings,timestamp of most distant finding,and significant findings beyond 8 h were recorded.RESULTS:The 8 and 12 h capsule groups were well matched respectively for both age(70.90±14.19vs 71.93±13.80,P=0.46)and gender(45.5%vs48%male,P=0.69).The most common indications for the procedure in both groups were anemia and obscure gastrointestinal bleeding.Pill Cam SB2-ex had a significantly higher completion rate than Pill Cam SB2(88%vs 79.5%,P=0.03).Overall,the diagnostic yield was greater for the 8 h capsule(48.5%for SB2vs 35%for SB2-ex,P=0.01).In 4/70(5.7%)of abnormal SB2-ex exams the clinically significant findingwas noted in the small bowel beyond the 8 h mark.CONCLUSION:In our study,we found the Pill Cam SB2-ex to have a significantly increased completion rate,though without any improvement in diagnostic yield compared to the Pill Cam SB2.展开更多
AIM: To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer (CC) or high grade dyspla...AIM: To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer (CC) or high grade dysplasia (HGD).展开更多
The first cases of a novel corona virus infection were reported in Wuhan China in December of 2019,followed by the declaration of an international pandemic by the World Health Organization in March 2020.Early reports ...The first cases of a novel corona virus infection were reported in Wuhan China in December of 2019,followed by the declaration of an international pandemic by the World Health Organization in March 2020.Early reports of the virus,now known as severe acute respiratory syndrome coronavirus 2,and its clinical disease coronavirus disease 2019(COVID-19),has shown higher rates of morbidity and mortality in the elderly and those with pre-existing medical conditions.Of particular concern is the safety of those with compromised immune systems.Inflammatory Bowel disease(IBD)is itself caused by a disordered immune response,with the most effective medical therapies being immune suppressing or modifying.As such,the risk of COVID-19,virus related outcomes,and appropriate management of IBD patients during the global pandemic is of immediate concern to gastroenterologists worldwide.There has been a rapid accumulation of clinical data and expert opinion on the topic.This review will highlight the latest source information on clinical observation/outcomes of the IBD population and provide a concise summary of the most up to date perspectives on IBD management in the age of COVID-19.展开更多
Inflammatory bowel disease(IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options availabl...Inflammatory bowel disease(IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.展开更多
To describe all abnormal histological findings and their associated endoscopic presentation in patients using mycophenolate mofetil (MMF). METHODSA retrospective review of all individuals prescribed MMF within 6 mo of...To describe all abnormal histological findings and their associated endoscopic presentation in patients using mycophenolate mofetil (MMF). METHODSA retrospective review of all individuals prescribed MMF within 6 mo of a colonoscopy or flexible sigmoidoscopy between 07/2009 and 09/2015 was performed within Northwell Health system. Records were analyzed for age, gender, procedure indication, MMF indication, and both gross and microscopic findings. Only reports with abnormal histology were included. RESULTSOne hundred and eighty-four procedures from 170 patients were found, of which 39 met inclusion criteria. Fifty-one point three percent were female. MMF was used for solid organ transplant in 71.8%. Diarrhea was the indication for 71.8% of colonoscopies. Fifty-nine percent of reports revealed gross and microscopic abnormalities while 41.0% had only microscopic findings. Only 11 patients’ reports (28.2%) indicated a specific histopathology of MMF colitis. Among the entire group, only 23.1% of abnormal histology was isolated proximal to the splenic flexure. CONCLUSIONOur results demonstrate a high rate of left sided disease and microscopic findings without gross mucosal abnormalities among patients using MMF. Also, a broader definition of MMF-colonopathy may be appropriate, with a majority of our abnormal histology falling outside of the more narrowly defined MMF-colitis category. Given the high frequency of isolated microscopic abnormalities and distal disease, sigmoidoscopy with random biopsies may be an appropriate, less invasive initial endoscopic examination in selected MMF patients.展开更多
Hereditary diffuse gastric cancer(HDGC) is an inherited form of gastric cancer that carries a poor prognosis. Most HDGCs are caused by an autosomal dominant genetic mutation in the CDH1 gene, which carries a 70%-80% l...Hereditary diffuse gastric cancer(HDGC) is an inherited form of gastric cancer that carries a poor prognosis. Most HDGCs are caused by an autosomal dominant genetic mutation in the CDH1 gene, which carries a 70%-80% lifetime risk of gastric cancer. Given its submucosal origin, endoscopic surveillance is an unreliable means of early detection, and prophylactic gastrectomy is recommended for CDH1 positive individuals older than age 20 years. We describe the case of a male with recurrent gastric cancer who was diagnosed with HDGC secondary to the CDH1 mutation, and we also describe the patient's pedigree and outcomes of recommended genetic testing.展开更多
文摘Inflammatory bowel disease(IBD)is entering a potentially new era of combined therapeutics.Triantafillidis et al provide an insightful review of the current state of combination therapy,with a focus on the use of a combined biologic and immunomodulator,as well as emerging data on the future potential of dual-biologic therapy(DBT).While current evidence for DBT is limited,encouraging safety profiles and ongoing trials suggest a brighter future for this approach.The importance of controlled trials should be stressed in establishing new treatment paradigms.Ongoing prospective randomized trials of DBT and perhaps future combinations of biologics and small molecule therapies will hopefully guide the next generation of IBD care.
文摘AIM: To evaluate the completion rate and diagnostic yield of the Pill Cam SB2-ex in comparison to the Pill Cam SB2.METHODS:Two hundred cases using the 8-h Pill Cam SB2 were retrospectively compared to 200 cases using the 12 h Pill Cam SB2-ex at a tertiary academic center.Endoscopically placed capsules were excluded from the study.Demographic information,indications for capsule endoscopy,capsule type,study length,completion of exam,clinically significant findings,timestamp of most distant finding,and significant findings beyond 8 h were recorded.RESULTS:The 8 and 12 h capsule groups were well matched respectively for both age(70.90±14.19vs 71.93±13.80,P=0.46)and gender(45.5%vs48%male,P=0.69).The most common indications for the procedure in both groups were anemia and obscure gastrointestinal bleeding.Pill Cam SB2-ex had a significantly higher completion rate than Pill Cam SB2(88%vs 79.5%,P=0.03).Overall,the diagnostic yield was greater for the 8 h capsule(48.5%for SB2vs 35%for SB2-ex,P=0.01).In 4/70(5.7%)of abnormal SB2-ex exams the clinically significant findingwas noted in the small bowel beyond the 8 h mark.CONCLUSION:In our study,we found the Pill Cam SB2-ex to have a significantly increased completion rate,though without any improvement in diagnostic yield compared to the Pill Cam SB2.
文摘AIM: To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer (CC) or high grade dysplasia (HGD).
文摘The first cases of a novel corona virus infection were reported in Wuhan China in December of 2019,followed by the declaration of an international pandemic by the World Health Organization in March 2020.Early reports of the virus,now known as severe acute respiratory syndrome coronavirus 2,and its clinical disease coronavirus disease 2019(COVID-19),has shown higher rates of morbidity and mortality in the elderly and those with pre-existing medical conditions.Of particular concern is the safety of those with compromised immune systems.Inflammatory Bowel disease(IBD)is itself caused by a disordered immune response,with the most effective medical therapies being immune suppressing or modifying.As such,the risk of COVID-19,virus related outcomes,and appropriate management of IBD patients during the global pandemic is of immediate concern to gastroenterologists worldwide.There has been a rapid accumulation of clinical data and expert opinion on the topic.This review will highlight the latest source information on clinical observation/outcomes of the IBD population and provide a concise summary of the most up to date perspectives on IBD management in the age of COVID-19.
文摘Inflammatory bowel disease(IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.
文摘To describe all abnormal histological findings and their associated endoscopic presentation in patients using mycophenolate mofetil (MMF). METHODSA retrospective review of all individuals prescribed MMF within 6 mo of a colonoscopy or flexible sigmoidoscopy between 07/2009 and 09/2015 was performed within Northwell Health system. Records were analyzed for age, gender, procedure indication, MMF indication, and both gross and microscopic findings. Only reports with abnormal histology were included. RESULTSOne hundred and eighty-four procedures from 170 patients were found, of which 39 met inclusion criteria. Fifty-one point three percent were female. MMF was used for solid organ transplant in 71.8%. Diarrhea was the indication for 71.8% of colonoscopies. Fifty-nine percent of reports revealed gross and microscopic abnormalities while 41.0% had only microscopic findings. Only 11 patients’ reports (28.2%) indicated a specific histopathology of MMF colitis. Among the entire group, only 23.1% of abnormal histology was isolated proximal to the splenic flexure. CONCLUSIONOur results demonstrate a high rate of left sided disease and microscopic findings without gross mucosal abnormalities among patients using MMF. Also, a broader definition of MMF-colonopathy may be appropriate, with a majority of our abnormal histology falling outside of the more narrowly defined MMF-colitis category. Given the high frequency of isolated microscopic abnormalities and distal disease, sigmoidoscopy with random biopsies may be an appropriate, less invasive initial endoscopic examination in selected MMF patients.
文摘Hereditary diffuse gastric cancer(HDGC) is an inherited form of gastric cancer that carries a poor prognosis. Most HDGCs are caused by an autosomal dominant genetic mutation in the CDH1 gene, which carries a 70%-80% lifetime risk of gastric cancer. Given its submucosal origin, endoscopic surveillance is an unreliable means of early detection, and prophylactic gastrectomy is recommended for CDH1 positive individuals older than age 20 years. We describe the case of a male with recurrent gastric cancer who was diagnosed with HDGC secondary to the CDH1 mutation, and we also describe the patient's pedigree and outcomes of recommended genetic testing.
