BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe in...BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.展开更多
Patients with inflammatory bowel diseases (IBD) represent heterogeneous groups with different characteristics and different clinical course. A great deal of effort is made to discover proxies for more severe disease n...Patients with inflammatory bowel diseases (IBD) represent heterogeneous groups with different characteristics and different clinical course. A great deal of effort is made to discover proxies for more severe disease needing more intense treatment and early intervention to gain the maximum therapeutic benefit. Endoscopy remains an invaluable method in assessment of patients with IBD. Pseudopolyps are often encountered during endoscopy and, although they are a well described entity, their presence is of unclear importance. In one of our recent studies and in conjunction with one study with a large cohort of patients with IBD and pseudopolyps, patients with pseudopolyps were found to face a higher inflammatory burden in terms of receiving more intense biological treatment. This letter comes as a comment and proposition regarding the concept of reevaluation of pseudopolyps as a promising marker in IBD scores.展开更多
Clostridium difficile(C.difficile)infection(CDI)is the leading identifiable cause of antibiotic-associated diarrhea.While there is an alarming trend of increasing incidence and severity of CDI in the United States and...Clostridium difficile(C.difficile)infection(CDI)is the leading identifiable cause of antibiotic-associated diarrhea.While there is an alarming trend of increasing incidence and severity of CDI in the United States and Europe,superimposed CDI in patients with inflammatory bowel disease(IBD)has drawn considerable attention in the gastrointestinal community.The majority of IBD patients appear to contract CDI as outpatients.C.difficile affects disease course of IBD in several ways,including triggering disease flares,sustaining activity,and in some cases,acting as an"innocent"bystander.Despite its wide spectrum of presentations,CDI has been reported to be associated with a longer duration of hospitalization and a higher mortality in IBD patients.IBD patients with restorative proctocolectomy or with diverting ileostomy are not immune to CDI of the small bowel or ileal pouch.Whether immunomodulator or corticosteroid therapy for IBD should be continued in patients with superimposed CDI is controversial.It appears that more adverse outcomes was observed among patients treated by a combination of immunomodulators and antibiotics than those treated by antibiotics alone.The use of biologic agents does not appear to increase the risk of acquisition of CDI.For CDI in the setting of underlying IBD,vancomycin appears to be more efficacious than metronidazole.Randomized controlled trials are required to clearly define the appropriate management for CDI in patients with IBD.展开更多
Patients with IBD frequently have hematologic abnormalities suggestive of JAK2 mutated MPNs, but are traditionally classified as reactive processes. Haplotype 46/1 is a well-characterized genetic predisposition, commo...Patients with IBD frequently have hematologic abnormalities suggestive of JAK2 mutated MPNs, but are traditionally classified as reactive processes. Haplotype 46/1 is a well-characterized genetic predisposition, common to both inflammatory bowel disease (IBD) and myeloproliferative neoplasms (MPN). In view of this shared genetic predisposition, we measured the frequency of the JAK2V617F mutation in IBD patients with thrombocytosis or erythrocytosis, in order to ascertain whether a higher than expected proportion of these patients may in fact have underlying MPNs. 1121 patients were identified with an active diagnosis of Crohn’s disease or ulcerative colitis, of which 474 had either thrombocytosis or erythrocytosis. Patients with abnormal counts were tested for the JAK2V617F mutation during routine follow-up visits. Interim analysis of first 23 patients tested was performed to assess whether the JAK2V617F positivity rate was statistically significant compared with known expected frequencies in a comparable control population. Of 23 patients, 13 patients had thrombocytosis and 10 had erythrocytosis. Three patients with thrombocytosis (23%), and 1 patient with erythrocytosis (10%), tested positive for JAK2V617F, exceeding the expected thresholds for statistical significance. In patients with IBD and thrombocytosis or erythrocytosis, a meaningful proportion may harbor an undiagnosed MPN, as indicated by clonal abnormalities such as JAK2V617F. These findings imply the need for increased testing of these patients for clonal hematologic abnormalities, and importantly, if found, suggest the need for therapeutic strategies with drugs, such as JAK2 inhibitors, in patients with both MPN and IBD.展开更多
Inflammatory bowel diseases(IBDs)are complex chronic disorders of the gastrointestinal tract with the following two subtypes:Crohn's disease and ulcerative colitis.Disease presentation and progression within and a...Inflammatory bowel diseases(IBDs)are complex chronic disorders of the gastrointestinal tract with the following two subtypes:Crohn's disease and ulcerative colitis.Disease presentation and progression within and across IBDs,especially Crohn's disease,are highly heterogeneous in the location,severity of inflammation,intestinal stenosis and obstruction,and extraintestinal manifestations.Clinical classifications fail to accurately predict the disease course and response to therapies.To date,most IBD genetic associations are derived from individuals of European ancestries,leading to a limitation of the discovery and application of IBD genetics in the rest of the world populations.In this mini-review,we summarize the latest progress of genome-wide association studies of IBD across global ancestries especially the Chinese population,the similarities and differences in genetic architecture between European and East Asian ancestries,as well as,the clinical significances relevant to IBD genetic study.展开更多
Perianal fistulas can occur to up to one-third of patients with Crohn's disease(CD) leading to significant disabling disease and morbidity. Fistulising perianal CD treatment often necessitates a combined pharmacol...Perianal fistulas can occur to up to one-third of patients with Crohn's disease(CD) leading to significant disabling disease and morbidity. Fistulising perianal CD treatment often necessitates a combined pharmacological and surgical approach. Anti-tumor necrosis factor(anti-TNF) therapy, particularly infliximab, has been shown to be very effective for both perianal and internal fistulising CD. Nevertheless, current data suggest that sustained remission and long-term complete fistula healing can be achieved in only 30% to 50% of patients. Moreover, these percentages refer mostly to clinical rather than deep remission, defined as endoscopic and radiologic remission, which is quickly emerging as the preferred goal of therapy. Unfortunately, the therapeutic options for perianal fistulising CD are still limited. As such, it would be of great value to be able to predict, and more importantly, prevent treatment failure in these patients by early and continued optimization of antiTNF therapy. Similar to ulcerative colitis and luminal CD, recent data demonstrate that higher infliximab concentrations are associated with better clinical outcomes in patients with perianal fistulising CD. This suggests that therapeutic drug monitoring and a treatto-trough therapeutic approach may emerge as the new standard of care for optimizing anti-TNF therapy in patients with perianal fistulising CD.展开更多
To evaluate brain involvement in quiescent Crohn’s disease (CD) patients with fatigue using quantitative magnetic resonance imaging (MRI).METHODSMultiple MRI techniques were used to assess cerebral changes in 20 quie...To evaluate brain involvement in quiescent Crohn’s disease (CD) patients with fatigue using quantitative magnetic resonance imaging (MRI).METHODSMultiple MRI techniques were used to assess cerebral changes in 20 quiescent CD patients with fatigue (defined with at least 6 points out of an 11-point numeric rating scale compared with 17 healthy age and gender matched controls without fatigue. Furthermore, mental status was assessed by cognitive functioning, based on the neuropsychological inventory including the different domains global cognitive functioning, memory and executive functioning and in addition mood and quality of life scores. Cognitive functioning and mood status were correlated with MRI findings in the both study groups.RESULTSReduced glutamate + glutamine (Glx = Glu + Gln) concentrations (P = 0.02) and ratios to total creatine (P = 0.02) were found in CD patients compared with controls. Significant increased Cerebral Blood Flow (P = 0.05) was found in CD patients (53.08 ± 6.14 mL/100 g/min) compared with controls (47.60 ± 8.62 mL/100 g/min). CD patients encountered significantly more depressive symptoms (P < 0.001). Cognitive functioning scores related to memory (P = 0.007) and executive functioning (P = 0.02) were lower in CD patients and both scores showed correlation with depression and anxiety. No correlation was found subcortical volumes between CD patients and controls in the T<sub>1</sub>-weighted analysis. In addition, no correlation was found between mental status and MRI findings.CONCLUSIONThis work shows evidence for perfusion, neurochemical and mental differences in the brain of CD patients with fatigue compared with healthy controls.展开更多
Patients with Crohn’s disease frequently suffer from fistula resulting from adverse sequelae of persistent complicated active disease or surgical intervention.Fistula affects a patient’s quality of life and is direc...Patients with Crohn’s disease frequently suffer from fistula resulting from adverse sequelae of persistent complicated active disease or surgical intervention.Fistula affects a patient’s quality of life and is directly associated with the need for surgical intervention.Diagnosis of fistula can be made through CT enterography,MR enterography,gastrograffin-based imaging,and transanal ultrasound.Treatment for fistula mainly consists of medication,endoscopic procedures,and surgery.There are emerging approaches under current investigation,such as stem cell therapy.The results showed a decent response in patients with perianal and rectovaginal fistula with minimal side effects.Further investigation is still needed for other internal fistula.展开更多
Neutrophils are considered as complex innate immune cells and play a critical role in maintaining intestinal mucosal homeostasis.They exert robust pro-inflammatory effects and recruit other immune cells in the acute p...Neutrophils are considered as complex innate immune cells and play a critical role in maintaining intestinal mucosal homeostasis.They exert robust pro-inflammatory effects and recruit other immune cells in the acute phase of pathogen infection and intestinal inflammation,but paradoxically,they also limit exogenousmicrobial invasion and facilitate mucosal restoration.Hyperactivation or dysfunction of neutrophils results in abnormal immune responses,leading to multiple autoimmune and inflammatory diseases including systemic lupus erythematosus,rheumatoid arthritis,and inflammatory bowel diseases(IBD).As a refractory intestinal inflammatory disease,the pathogenesis and progression of IBD are associated with complicated immune response processes in which neutrophils are profoundly involved.However,the consensus on potential roles of neutrophils in modulating pathogenic and repair processes of IBD remains not fully understood.Accumulated infiltrating neutrophils cross the epithelial barrier and contribute to microbial dysbiosis,aggravated intestinal architectural damage,compromised resolution of intestinal inflammation and increased risk of thrombosis during IBD.Paradoxically,activated neutrophils are also associated with effective elimination of invaded microbiota,promoted angiogenesis and tissue restoration of gutmucosa in IBD.Here,we discuss the beneficial and detrimental roles of neutrophils in the onset and resolution of intestinalmucosal inflammation,hoping to provide a precise overview of neutrophil functions in the pathogenesis of IBD.展开更多
Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical tre...Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical treatments.Currently,the main applications of interventional IBD are(i)strictures;(ii)fistulas and abscesses;(iii)bleeding lesions,bezoars,foreign bodies,and polyps;(iv)post-operative complications such as acute and chronic anastomotic leaks;and(v)colitis-associated neoplasia.The endoscopic treatment modalities include balloon dilation,stricturotomy,strictureplasty,fistulotomy,incision and drainage(of fistula and abscess),sinusotomy,septectomy,banding ligation,clipping,polypectomy,endoscopic mucosal resection,and endoscopic submucosal dissection.The field of interventional IBD is evolving with a better understanding of the underlying disease process,advances in endoscopic technology,and interest and proper training of next-generation IBD interventionalists.展开更多
Background:Vedolizumab was demonstrated to be safe and effective in adults with moderately to severely active inflammatory bowel disease(IBD)in clinical trials.However,there are limited data regarding its efficacy and...Background:Vedolizumab was demonstrated to be safe and effective in adults with moderately to severely active inflammatory bowel disease(IBD)in clinical trials.However,there are limited data regarding its efficacy and safety in elderly patients.Methods:This was a case-control study comparing the efficacy(measured by rates of mucosal healing and need for IBD surgery)and safety of vedolizumab in IBD among patients65 years of age(the elderly group)vs those<65 years(the control group).The two groups were matched individually on a 1:4 ratio based on gender and type of IBD.Conditional logistic regression was used for stratified analysis to calculate odds ratios and confidence intervals.Results:We included 25 IBD patients in the elderly group and 100 matched patients in the comparison group.Eighty patients had Crohn’s disease and 45 had ulcerative colitis.At baseline,the groups were comparable with regard to duration of IBD,prior anti-TNF therapy,and prior IBD surgery.The rate of mucosal healing on follow-up endoscopy was comparable between the elderly and control groups(50%vs 53%,P=0.507).Although more patients in the elderly group required IBD-related surgery while on vedolizumab,the difference did not reach statistical significance(40%vs 19%,P=0.282).Rates of vedolizumab-related adverse effects—rash,arthralgia,infections,infusion reactions,and dyspnea—were comparable between the two groups(all P>0.05).Conclusions:In a real-world setting,vedolizumab was demonstrated to have an efficacy and safety profile among elderly IBD patients that were comparable to younger controls.展开更多
Background:Patients with inflammatory bowel diseases frequently require surgery,but immunotherapies used in disease management may increase the risk of post-operative complications.We investigated frequencies of post-...Background:Patients with inflammatory bowel diseases frequently require surgery,but immunotherapies used in disease management may increase the risk of post-operative complications.We investigated frequencies of post-operative complications in patients who received vedolizumab—a gut-selective antibody approved for the treatment of moderately to severely active ulcerative colitis and Crohn’s disease—in clinical-trial and post-marketing settings.Methods:This post hoc analysis of safety data from GEMINI 1,GEMINI 2,and long-term safety studies included patients who had had colectomy or bowel surgery/resection.Data from the post-marketing Vedolizumab Global Safety Database were also analysed(data cutoff point:19 May 2016).Adverse events relating to post-operative complications were identified using Medical Dictionary for Regulatory Activities preferred terms.Results:Of 58 total surgeries in patients included in GEMINI 1 and GEMINI 2,post-operative complications were reported for 3/51 vedolizumab-treated patients(5.9%)and 1/7 placebo-treated patients(14.3%).In the long-term safety study,157/2,243 patients(7%)had colectomy or bowel surgery/resection;of these 157 patients who underwent surgery,11(7%)experienced a post-operative complication.Median time between last pre-operative vedolizumab dose and surgery was 23 days in GEMINI 1,20 days in GEMINI 2,and 39–40 days in the long-termsafety study.In the post-marketing setting,based on data covering approximately 46,978 patient-years of vedolizumab exposure,post-operative complications were reported in 19 patients.Conclusions:In clinical trials,complications of colectomy and bowel surgery/resection appeared infrequent,with minimal difference between vedolizumab and placebo.The frequency of post-operative complications in the post-marketing setting appears low.展开更多
Background and objective:Inflammatory bowel disease(IBD)is associated with an increased risk of colorectal cancer(CRC).This study aimed to analyse the trends in rates of resection for IBD-related CRC in the USA.Method...Background and objective:Inflammatory bowel disease(IBD)is associated with an increased risk of colorectal cancer(CRC).This study aimed to analyse the trends in rates of resection for IBD-related CRC in the USA.Methods:We used the Nationwide Inpatient Sample from 1995 to 2012.Temporal trends in age-adjusted rates of resection for CRC in the setting of IBD were analysed using multivariate Joinpoint regression models.The primary outcome was surgical resection of CRC in the setting of IBD.Results:We included 3597168 IBD discharges in the present study,of which 275479 underwent CRC resection between 1995 and 2012.The annual CRC resection rates among IBD population decreased significantly from 1995 to 2012.This decrease was significant in all age groups with an annual decrease of 393(P<0.001),359(P<0.001),293(P<0.001)and 159(P<0.001)per 100000 IBD discharges between 1995 and 2012 for age groups 18–39,40–49,50–74 and>75 years,respectively.The annual IBD-CRC resection rate per 100000 IBD discharges for proximal CRC decreased by 149(P<0.001),130(P<0.001),95(P<0.001)and 50(P<0.001),respectively,and the annual distal CRC resections per 100000 IBD discharges decreased by 104(P<0.001),123(P<0.001),123(P<0.001)and 82(P<0.001),respectively,for age groups 18–39,40–49,50–74 and>75 years,between 1995 and 2012.On multivariate Poisson regression analysis,after adjustment for age and sex,CRC resections decreased by 3.9%each year from 1995 to 2012.Conclusions:CRC resection rates among IBD patients have continued to decrease annually from 1995 to 2012.There is a population-level decrease in resection of both proximal and distal CRC reflecting a decreasing incidence of IBD-related CRC incidence in the USA.展开更多
Backgrounds:Endoscopic stricturotomy(ESt)has been shown to be effective in treating inflammatory bowel disease(IBD)-associated anastomotic strictures.However,the outcome of ESt in benign,non-IBD conditions has not bee...Backgrounds:Endoscopic stricturotomy(ESt)has been shown to be effective in treating inflammatory bowel disease(IBD)-associated anastomotic strictures.However,the outcome of ESt in benign,non-IBD conditions has not been described.The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures.Methods:Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted.The primary outcomes were surgery-free survival and procedure-related complications.Results:A total of 49 IBD and 15 non-IBD patients were included in this study.The IBD group included 25 patients with Crohn’s disease and 24 with ulcerative colitis and ileal pouches.Underlying diseases in the non-IBD group included colorectal cancer(n=7),diverticulitis(n=5),large bowel prolapse(n=2),and constipation(n=1).Immediate technical success was achieved in all patients in both groups.Bleeding complications occurred on five occasions(4.7%per procedure)in the IBD group,while no complication occurred in the non-IBD group(P=0.20).Stricture improvement on follow-up endoscopy was found in 10(20.4%)and 5(33.3%)patients in the IBD and non-IBD groups,respectively(P=0.32).Six(12.2%)patients in the IBD group and four(26.7%)patients in the non-IBD group eventually required stricture-related surgery(P=0.23).IBD patients appeared to have a higher tendency formaintaining surgery-free after the procedure than non-IBD patients(P=0.08).Conclusions:Endoscopic stricturotomy was shown to have comparable outcomes,though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.展开更多
Introduction Bowel stricture is a common complication in patients with Crohn’s disease(CD),which often requires surgery[1,2].Notably,25%of patients develop at least one small bowel stricture[3].Endoscopic interventio...Introduction Bowel stricture is a common complication in patients with Crohn’s disease(CD),which often requires surgery[1,2].Notably,25%of patients develop at least one small bowel stricture[3].Endoscopic intervention has emerged as a feasible and minimally invasive adjunct or alternative to surgery.However,endoscopic intervention for small bowel strictures poses a technical challenge for gastroenterologists.Deep small bowel strictures beyond the terminal ileum are only accessible to device-assisted enteroscopy,including balloon-assisted enteroscopy(BAE).BAE-based endoscopic balloon dilation(EBD)has been reported to be safe and effective for small bowel strictures from CD[4].展开更多
Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is incre...Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation.Moreover,the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and,consequently,its low risk of inducing hepatic encephalopathy.In the future,propofol could become the preferred sedation agent,especially for routine colonoscopy.Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam.Among opioids,pethidine and fentanyl are the most popular.A number of other substances have been tested in several clinical trials with promising results.Among them,newer opioids,such as remifentanil,enable a faster recovery.The controversy regarding the administration of sedation by an endoscopist or an experienced nurse,as well as the optimal staffing of en-doscopy units,continues to be a matter of discussion.Safe sedation in special clinical circumstances,such as in the cases of obese,pregnant,and elderly individuals,as well as patients with chronic lung,renal or liver disease,requires modification of the dose of the drugs used for sedation.In the great majority of patients,sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide.In this review,an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.展开更多
BACKGROUND Over the last 40 years,with accumulating evidence demonstrating a significant increase in the incidence of ulcerative colitis(UC)in China,the number of studies on UC has been rapidly increasing.But it still...BACKGROUND Over the last 40 years,with accumulating evidence demonstrating a significant increase in the incidence of ulcerative colitis(UC)in China,the number of studies on UC has been rapidly increasing.But it still lacks a comprehensive metaanalysis of publications regarding UC for the last four decades in China.Thus,a bibliometric analysis of UC is warranted to investigate the trend and distribution of the publications on UC in China in recent years.And it is supposed that the number of the papers related to UC increased by year.AIM To investigate the current status of research output from Chinese studies related to UC during the period of 1978 to 2017,with special attention paid to the distribution of publication dates,journals,regions,and research organizations.METHODS Publications on UC were searched in the Chinese periodical database SinoMed from January 1978 to December 2017.The search term used for retrieval was“ulcerative colitis”.The language of the publications was restricted to English or Chinese.The studies have to be performed in China.Then,a bibliometric analysis was performed on the distribution of publication dates,journals,regions,and research organizations with EndNote,Excel,MySQL,and GraphPad Prism.RESULTS A total of 16257 papers matched the search criteria,which included 7561 papers published in core journals,4641 evidence-based articles,and 4177 publications of randomized controlled trials.These papers were mainly published in Chinese Journal of Coloproctology,World Chinese Journal of Digestology,Chinese Journal of Digestion,Chinese Journal of Integrated Traditional and Western Medicine on Digestion,and Modern Journal of Integrated Traditional Chinese and Western Medicine.In particular,the majority of these organizations were located in Jiangsu,Henan,Shandong,and Guangdong Provinces which are rich areas or have the largest population per province.Most of these studies were conducted by academic institutions.CONCLUSION Over the past four decades,the output of research into UC in China has increased significantly,with academic institutions playing a central role in the academic field,but the number and quality of these researches vary substantially among different regions.展开更多
The natural history of Crohn’s disease(CD)dictates that patients re-quire long-term medical therapy for induction and maintenance to relieve their symptoms,improve health-related quality of life,pre-vent tissue damag...The natural history of Crohn’s disease(CD)dictates that patients re-quire long-term medical therapy for induction and maintenance to relieve their symptoms,improve health-related quality of life,pre-vent tissue damage,lessen the risk for neoplasia,and reduce hospi-talization and surgery.For the past quarter of a century,medical management of CD has evolved from corticosteroids for induction and immunomodulators formaintenance to antitumor necrosis fac-tor,anti-integrin,and anti-interleukin biological agents and,in the near future,small molecule agents,for both induction and mainte-nance.Despite advances inmedical therapy,themajority of patients with CDwould eventually require surgerywith incision and drainage of abscesses and fistulas,bowel resection and anastomosis,strictur-eplasty,or fecal diversion.Surgery will reset the clock for the disease course of CD and most patients require post-operative medical ther-apy to prevent disease recurrence.Colonoscopy plays a key role in disease monitoring and assessment of treatment response before and after surgery.Endoscopy also plays an important role in the treatment of CD-or its surgery-associated structural complications,such as primary or anastomotic strictures,abscesses,and fistulas.展开更多
AIM:To explore the anti-inflammatory potential of adeno-associated virus-mediated delivery of Tregitope 167 in an experimental colitis model.METHODS:The trinitrobenzene sulfonate(TNBS) model of induced colitis was use...AIM:To explore the anti-inflammatory potential of adeno-associated virus-mediated delivery of Tregitope 167 in an experimental colitis model.METHODS:The trinitrobenzene sulfonate(TNBS) model of induced colitis was used in Balb/c mice.Subsequently after intravenous adeno-associated virusmediated regulatory T-cell epitopes(Tregitope) delivery,acute colitis was initiated by intra-rectal administration of 1.5 mg TNBS in 40% ethanol followed by a second treatment with TNBS(0.75 mg in 20% ethanol) 8 d later.Control groups included mice not treated with TNBS(healthy control group) and mice treated by TNBS only(diseased group).At the time of sacrifice colon weight,the disease activity index and histology damage score were determined.Immunohistochemical staining of the colonic tissues was performed to asses the cellular infiltrate and the presence of transcription factor forkhead Box-P3(Foxp3).Thymus,mesenteric lymph nodes,liver and spleen tissue were collected and the corresponding lymphocyte populations were further assessed by flow cytometry analysis for the expression of CD4+ T cell and regulatory T cell associated markers.RESULTS:The Tregitope 167 treated mice gained an average of 4% over their initial body weight at the time of sacrifice.In contrast,the mice treated with TNBS alone(no Tregitope) developed colitis,and lost 4% of their initial body weight at the time of sacrifice(P < 0.01).The body weight increase that had been observed in the mice pre-treated with Tregitope 167 was substantiated by a lower disease activity index and a decreased colon weight as compared to the diseased control group(P < 0.01 and P < 0.001,respectively).Immunohistochemical staining of the colonic tissues for CD4+ showed that inflammatory cell infiltrates were present in TNBS treated mice with or without administration with tregitope 167 and that these cellular infiltrates consisted mainly of CD4+ cells.For both TNBS treated groups CD4+ T cell infiltrates were observed in the sub-epithelial layer and the lamina propria.CD4+ T cell infiltrates were also present in the muscularis mucosa layer of the diseased control mice,but were absent in the Tregitope 167 treated group.Numerous Foxp3 positive cells were detected in the lamina propria and sub-epithelium of the colon sections from mice treated with Tregitope 167.Furthermore,the Foxp3 and glycoprotein A repetitions predominant markers were significantly increased in the CD4+ T lymphocyte population in the thymus of the mice pre-treated with adeno-associated virus serotype 5(cytomegalovirus promoter-Tregitope 167),as cytomegalovirus promoter compared to lymphocyte populations in the thymus of diseased and the healthy control mice(P < 0.05 and P < 0.001,respectively).CONCLUSION:This study identifies adeno-associated virus-mediated delivery of regulatory T-cell epitope 167 as a novel anti-inflammatory approach with the capacity to decrease intestinal inflammation and induce longterm remission in inflammatory bowel disease.展开更多
Crohn’s disease(CD)and ulcerative colitis(UC)are relapsing and remitting chronic inflammatory diseases of the gastrointestinal tract.Although surgery for UC can provide a cure,surgery for CD is rarely curative.In the...Crohn’s disease(CD)and ulcerative colitis(UC)are relapsing and remitting chronic inflammatory diseases of the gastrointestinal tract.Although surgery for UC can provide a cure,surgery for CD is rarely curative.In the past few decades,research has identified risk factors for postsurgical CD recurrence,enabling patient risk stratification to guide monitoring and prophylactic treatment to prevent CD recurrence.A MEDLINE literature review identified articles regarding post-operative monitoring of CD recurrence after resection surgery.In this review,we discuss the evidence on risk factors for postoperative CD recurrence as well as suggestions on post-operative management.展开更多
文摘BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.
文摘Patients with inflammatory bowel diseases (IBD) represent heterogeneous groups with different characteristics and different clinical course. A great deal of effort is made to discover proxies for more severe disease needing more intense treatment and early intervention to gain the maximum therapeutic benefit. Endoscopy remains an invaluable method in assessment of patients with IBD. Pseudopolyps are often encountered during endoscopy and, although they are a well described entity, their presence is of unclear importance. In one of our recent studies and in conjunction with one study with a large cohort of patients with IBD and pseudopolyps, patients with pseudopolyps were found to face a higher inflammatory burden in terms of receiving more intense biological treatment. This letter comes as a comment and proposition regarding the concept of reevaluation of pseudopolyps as a promising marker in IBD scores.
文摘Clostridium difficile(C.difficile)infection(CDI)is the leading identifiable cause of antibiotic-associated diarrhea.While there is an alarming trend of increasing incidence and severity of CDI in the United States and Europe,superimposed CDI in patients with inflammatory bowel disease(IBD)has drawn considerable attention in the gastrointestinal community.The majority of IBD patients appear to contract CDI as outpatients.C.difficile affects disease course of IBD in several ways,including triggering disease flares,sustaining activity,and in some cases,acting as an"innocent"bystander.Despite its wide spectrum of presentations,CDI has been reported to be associated with a longer duration of hospitalization and a higher mortality in IBD patients.IBD patients with restorative proctocolectomy or with diverting ileostomy are not immune to CDI of the small bowel or ileal pouch.Whether immunomodulator or corticosteroid therapy for IBD should be continued in patients with superimposed CDI is controversial.It appears that more adverse outcomes was observed among patients treated by a combination of immunomodulators and antibiotics than those treated by antibiotics alone.The use of biologic agents does not appear to increase the risk of acquisition of CDI.For CDI in the setting of underlying IBD,vancomycin appears to be more efficacious than metronidazole.Randomized controlled trials are required to clearly define the appropriate management for CDI in patients with IBD.
文摘Patients with IBD frequently have hematologic abnormalities suggestive of JAK2 mutated MPNs, but are traditionally classified as reactive processes. Haplotype 46/1 is a well-characterized genetic predisposition, common to both inflammatory bowel disease (IBD) and myeloproliferative neoplasms (MPN). In view of this shared genetic predisposition, we measured the frequency of the JAK2V617F mutation in IBD patients with thrombocytosis or erythrocytosis, in order to ascertain whether a higher than expected proportion of these patients may in fact have underlying MPNs. 1121 patients were identified with an active diagnosis of Crohn’s disease or ulcerative colitis, of which 474 had either thrombocytosis or erythrocytosis. Patients with abnormal counts were tested for the JAK2V617F mutation during routine follow-up visits. Interim analysis of first 23 patients tested was performed to assess whether the JAK2V617F positivity rate was statistically significant compared with known expected frequencies in a comparable control population. Of 23 patients, 13 patients had thrombocytosis and 10 had erythrocytosis. Three patients with thrombocytosis (23%), and 1 patient with erythrocytosis (10%), tested positive for JAK2V617F, exceeding the expected thresholds for statistical significance. In patients with IBD and thrombocytosis or erythrocytosis, a meaningful proportion may harbor an undiagnosed MPN, as indicated by clonal abnormalities such as JAK2V617F. These findings imply the need for increased testing of these patients for clonal hematologic abnormalities, and importantly, if found, suggest the need for therapeutic strategies with drugs, such as JAK2 inhibitors, in patients with both MPN and IBD.
基金supported by the Shanghai Hospital Development Center Foundation(Grant No.SHDC12022118)the National Natural Science Foundation of China(Grant No.91942312).
文摘Inflammatory bowel diseases(IBDs)are complex chronic disorders of the gastrointestinal tract with the following two subtypes:Crohn's disease and ulcerative colitis.Disease presentation and progression within and across IBDs,especially Crohn's disease,are highly heterogeneous in the location,severity of inflammation,intestinal stenosis and obstruction,and extraintestinal manifestations.Clinical classifications fail to accurately predict the disease course and response to therapies.To date,most IBD genetic associations are derived from individuals of European ancestries,leading to a limitation of the discovery and application of IBD genetics in the rest of the world populations.In this mini-review,we summarize the latest progress of genome-wide association studies of IBD across global ancestries especially the Chinese population,the similarities and differences in genetic architecture between European and East Asian ancestries,as well as,the clinical significances relevant to IBD genetic study.
文摘Perianal fistulas can occur to up to one-third of patients with Crohn's disease(CD) leading to significant disabling disease and morbidity. Fistulising perianal CD treatment often necessitates a combined pharmacological and surgical approach. Anti-tumor necrosis factor(anti-TNF) therapy, particularly infliximab, has been shown to be very effective for both perianal and internal fistulising CD. Nevertheless, current data suggest that sustained remission and long-term complete fistula healing can be achieved in only 30% to 50% of patients. Moreover, these percentages refer mostly to clinical rather than deep remission, defined as endoscopic and radiologic remission, which is quickly emerging as the preferred goal of therapy. Unfortunately, the therapeutic options for perianal fistulising CD are still limited. As such, it would be of great value to be able to predict, and more importantly, prevent treatment failure in these patients by early and continued optimization of antiTNF therapy. Similar to ulcerative colitis and luminal CD, recent data demonstrate that higher infliximab concentrations are associated with better clinical outcomes in patients with perianal fistulising CD. This suggests that therapeutic drug monitoring and a treatto-trough therapeutic approach may emerge as the new standard of care for optimizing anti-TNF therapy in patients with perianal fistulising CD.
文摘To evaluate brain involvement in quiescent Crohn’s disease (CD) patients with fatigue using quantitative magnetic resonance imaging (MRI).METHODSMultiple MRI techniques were used to assess cerebral changes in 20 quiescent CD patients with fatigue (defined with at least 6 points out of an 11-point numeric rating scale compared with 17 healthy age and gender matched controls without fatigue. Furthermore, mental status was assessed by cognitive functioning, based on the neuropsychological inventory including the different domains global cognitive functioning, memory and executive functioning and in addition mood and quality of life scores. Cognitive functioning and mood status were correlated with MRI findings in the both study groups.RESULTSReduced glutamate + glutamine (Glx = Glu + Gln) concentrations (P = 0.02) and ratios to total creatine (P = 0.02) were found in CD patients compared with controls. Significant increased Cerebral Blood Flow (P = 0.05) was found in CD patients (53.08 ± 6.14 mL/100 g/min) compared with controls (47.60 ± 8.62 mL/100 g/min). CD patients encountered significantly more depressive symptoms (P < 0.001). Cognitive functioning scores related to memory (P = 0.007) and executive functioning (P = 0.02) were lower in CD patients and both scores showed correlation with depression and anxiety. No correlation was found subcortical volumes between CD patients and controls in the T<sub>1</sub>-weighted analysis. In addition, no correlation was found between mental status and MRI findings.CONCLUSIONThis work shows evidence for perfusion, neurochemical and mental differences in the brain of CD patients with fatigue compared with healthy controls.
文摘Patients with Crohn’s disease frequently suffer from fistula resulting from adverse sequelae of persistent complicated active disease or surgical intervention.Fistula affects a patient’s quality of life and is directly associated with the need for surgical intervention.Diagnosis of fistula can be made through CT enterography,MR enterography,gastrograffin-based imaging,and transanal ultrasound.Treatment for fistula mainly consists of medication,endoscopic procedures,and surgery.There are emerging approaches under current investigation,such as stem cell therapy.The results showed a decent response in patients with perianal and rectovaginal fistula with minimal side effects.Further investigation is still needed for other internal fistula.
基金This work is supported by the National Natural Science Foundation of China(Grants No.81630017 and 91942312).
文摘Neutrophils are considered as complex innate immune cells and play a critical role in maintaining intestinal mucosal homeostasis.They exert robust pro-inflammatory effects and recruit other immune cells in the acute phase of pathogen infection and intestinal inflammation,but paradoxically,they also limit exogenousmicrobial invasion and facilitate mucosal restoration.Hyperactivation or dysfunction of neutrophils results in abnormal immune responses,leading to multiple autoimmune and inflammatory diseases including systemic lupus erythematosus,rheumatoid arthritis,and inflammatory bowel diseases(IBD).As a refractory intestinal inflammatory disease,the pathogenesis and progression of IBD are associated with complicated immune response processes in which neutrophils are profoundly involved.However,the consensus on potential roles of neutrophils in modulating pathogenic and repair processes of IBD remains not fully understood.Accumulated infiltrating neutrophils cross the epithelial barrier and contribute to microbial dysbiosis,aggravated intestinal architectural damage,compromised resolution of intestinal inflammation and increased risk of thrombosis during IBD.Paradoxically,activated neutrophils are also associated with effective elimination of invaded microbiota,promoted angiogenesis and tissue restoration of gutmucosa in IBD.Here,we discuss the beneficial and detrimental roles of neutrophils in the onset and resolution of intestinalmucosal inflammation,hoping to provide a precise overview of neutrophil functions in the pathogenesis of IBD.
文摘Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical treatments.Currently,the main applications of interventional IBD are(i)strictures;(ii)fistulas and abscesses;(iii)bleeding lesions,bezoars,foreign bodies,and polyps;(iv)post-operative complications such as acute and chronic anastomotic leaks;and(v)colitis-associated neoplasia.The endoscopic treatment modalities include balloon dilation,stricturotomy,strictureplasty,fistulotomy,incision and drainage(of fistula and abscess),sinusotomy,septectomy,banding ligation,clipping,polypectomy,endoscopic mucosal resection,and endoscopic submucosal dissection.The field of interventional IBD is evolving with a better understanding of the underlying disease process,advances in endoscopic technology,and interest and proper training of next-generation IBD interventionalists.
文摘Background:Vedolizumab was demonstrated to be safe and effective in adults with moderately to severely active inflammatory bowel disease(IBD)in clinical trials.However,there are limited data regarding its efficacy and safety in elderly patients.Methods:This was a case-control study comparing the efficacy(measured by rates of mucosal healing and need for IBD surgery)and safety of vedolizumab in IBD among patients65 years of age(the elderly group)vs those<65 years(the control group).The two groups were matched individually on a 1:4 ratio based on gender and type of IBD.Conditional logistic regression was used for stratified analysis to calculate odds ratios and confidence intervals.Results:We included 25 IBD patients in the elderly group and 100 matched patients in the comparison group.Eighty patients had Crohn’s disease and 45 had ulcerative colitis.At baseline,the groups were comparable with regard to duration of IBD,prior anti-TNF therapy,and prior IBD surgery.The rate of mucosal healing on follow-up endoscopy was comparable between the elderly and control groups(50%vs 53%,P=0.507).Although more patients in the elderly group required IBD-related surgery while on vedolizumab,the difference did not reach statistical significance(40%vs 19%,P=0.282).Rates of vedolizumab-related adverse effects—rash,arthralgia,infections,infusion reactions,and dyspnea—were comparable between the two groups(all P>0.05).Conclusions:In a real-world setting,vedolizumab was demonstrated to have an efficacy and safety profile among elderly IBD patients that were comparable to younger controls.
基金This work was supported by Takeda Pharmaceutical Company Ltd.
文摘Background:Patients with inflammatory bowel diseases frequently require surgery,but immunotherapies used in disease management may increase the risk of post-operative complications.We investigated frequencies of post-operative complications in patients who received vedolizumab—a gut-selective antibody approved for the treatment of moderately to severely active ulcerative colitis and Crohn’s disease—in clinical-trial and post-marketing settings.Methods:This post hoc analysis of safety data from GEMINI 1,GEMINI 2,and long-term safety studies included patients who had had colectomy or bowel surgery/resection.Data from the post-marketing Vedolizumab Global Safety Database were also analysed(data cutoff point:19 May 2016).Adverse events relating to post-operative complications were identified using Medical Dictionary for Regulatory Activities preferred terms.Results:Of 58 total surgeries in patients included in GEMINI 1 and GEMINI 2,post-operative complications were reported for 3/51 vedolizumab-treated patients(5.9%)and 1/7 placebo-treated patients(14.3%).In the long-term safety study,157/2,243 patients(7%)had colectomy or bowel surgery/resection;of these 157 patients who underwent surgery,11(7%)experienced a post-operative complication.Median time between last pre-operative vedolizumab dose and surgery was 23 days in GEMINI 1,20 days in GEMINI 2,and 39–40 days in the long-termsafety study.In the post-marketing setting,based on data covering approximately 46,978 patient-years of vedolizumab exposure,post-operative complications were reported in 19 patients.Conclusions:In clinical trials,complications of colectomy and bowel surgery/resection appeared infrequent,with minimal difference between vedolizumab and placebo.The frequency of post-operative complications in the post-marketing setting appears low.
文摘Background and objective:Inflammatory bowel disease(IBD)is associated with an increased risk of colorectal cancer(CRC).This study aimed to analyse the trends in rates of resection for IBD-related CRC in the USA.Methods:We used the Nationwide Inpatient Sample from 1995 to 2012.Temporal trends in age-adjusted rates of resection for CRC in the setting of IBD were analysed using multivariate Joinpoint regression models.The primary outcome was surgical resection of CRC in the setting of IBD.Results:We included 3597168 IBD discharges in the present study,of which 275479 underwent CRC resection between 1995 and 2012.The annual CRC resection rates among IBD population decreased significantly from 1995 to 2012.This decrease was significant in all age groups with an annual decrease of 393(P<0.001),359(P<0.001),293(P<0.001)and 159(P<0.001)per 100000 IBD discharges between 1995 and 2012 for age groups 18–39,40–49,50–74 and>75 years,respectively.The annual IBD-CRC resection rate per 100000 IBD discharges for proximal CRC decreased by 149(P<0.001),130(P<0.001),95(P<0.001)and 50(P<0.001),respectively,and the annual distal CRC resections per 100000 IBD discharges decreased by 104(P<0.001),123(P<0.001),123(P<0.001)and 82(P<0.001),respectively,for age groups 18–39,40–49,50–74 and>75 years,between 1995 and 2012.On multivariate Poisson regression analysis,after adjustment for age and sex,CRC resections decreased by 3.9%each year from 1995 to 2012.Conclusions:CRC resection rates among IBD patients have continued to decrease annually from 1995 to 2012.There is a population-level decrease in resection of both proximal and distal CRC reflecting a decreasing incidence of IBD-related CRC incidence in the USA.
基金Dr Bo Shen is supported by the Ed and Joey Story Endowed ChairThis study was presented as a poster at the American College of Gastroenterology(October 2017,Orlando,Florida).
文摘Backgrounds:Endoscopic stricturotomy(ESt)has been shown to be effective in treating inflammatory bowel disease(IBD)-associated anastomotic strictures.However,the outcome of ESt in benign,non-IBD conditions has not been described.The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures.Methods:Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted.The primary outcomes were surgery-free survival and procedure-related complications.Results:A total of 49 IBD and 15 non-IBD patients were included in this study.The IBD group included 25 patients with Crohn’s disease and 24 with ulcerative colitis and ileal pouches.Underlying diseases in the non-IBD group included colorectal cancer(n=7),diverticulitis(n=5),large bowel prolapse(n=2),and constipation(n=1).Immediate technical success was achieved in all patients in both groups.Bleeding complications occurred on five occasions(4.7%per procedure)in the IBD group,while no complication occurred in the non-IBD group(P=0.20).Stricture improvement on follow-up endoscopy was found in 10(20.4%)and 5(33.3%)patients in the IBD and non-IBD groups,respectively(P=0.32).Six(12.2%)patients in the IBD group and four(26.7%)patients in the non-IBD group eventually required stricture-related surgery(P=0.23).IBD patients appeared to have a higher tendency formaintaining surgery-free after the procedure than non-IBD patients(P=0.08).Conclusions:Endoscopic stricturotomy was shown to have comparable outcomes,though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.
基金supported in part by the National Natural Science Foundation of China[grant numbers 81870382,82100544]Guangdong Basic and Applied Basic Research Foundation[grant number 2020A1515111102]+2 种基金China Postdoctoral Science Foundation[grant number 2021M703743]Postdoctoral Foundation of the Sixth Hospital of Sun Yat-sen University[grant number R20210217202112997]National Key Clinical Discipline.
文摘Introduction Bowel stricture is a common complication in patients with Crohn’s disease(CD),which often requires surgery[1,2].Notably,25%of patients develop at least one small bowel stricture[3].Endoscopic intervention has emerged as a feasible and minimally invasive adjunct or alternative to surgery.However,endoscopic intervention for small bowel strictures poses a technical challenge for gastroenterologists.Deep small bowel strictures beyond the terminal ileum are only accessible to device-assisted enteroscopy,including balloon-assisted enteroscopy(BAE).BAE-based endoscopic balloon dilation(EBD)has been reported to be safe and effective for small bowel strictures from CD[4].
文摘Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation.Moreover,the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and,consequently,its low risk of inducing hepatic encephalopathy.In the future,propofol could become the preferred sedation agent,especially for routine colonoscopy.Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam.Among opioids,pethidine and fentanyl are the most popular.A number of other substances have been tested in several clinical trials with promising results.Among them,newer opioids,such as remifentanil,enable a faster recovery.The controversy regarding the administration of sedation by an endoscopist or an experienced nurse,as well as the optimal staffing of en-doscopy units,continues to be a matter of discussion.Safe sedation in special clinical circumstances,such as in the cases of obese,pregnant,and elderly individuals,as well as patients with chronic lung,renal or liver disease,requires modification of the dose of the drugs used for sedation.In the great majority of patients,sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide.In this review,an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.
基金Supported by National Natural Science Foundation of China,No.815705021.3.5.Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC18037.
文摘BACKGROUND Over the last 40 years,with accumulating evidence demonstrating a significant increase in the incidence of ulcerative colitis(UC)in China,the number of studies on UC has been rapidly increasing.But it still lacks a comprehensive metaanalysis of publications regarding UC for the last four decades in China.Thus,a bibliometric analysis of UC is warranted to investigate the trend and distribution of the publications on UC in China in recent years.And it is supposed that the number of the papers related to UC increased by year.AIM To investigate the current status of research output from Chinese studies related to UC during the period of 1978 to 2017,with special attention paid to the distribution of publication dates,journals,regions,and research organizations.METHODS Publications on UC were searched in the Chinese periodical database SinoMed from January 1978 to December 2017.The search term used for retrieval was“ulcerative colitis”.The language of the publications was restricted to English or Chinese.The studies have to be performed in China.Then,a bibliometric analysis was performed on the distribution of publication dates,journals,regions,and research organizations with EndNote,Excel,MySQL,and GraphPad Prism.RESULTS A total of 16257 papers matched the search criteria,which included 7561 papers published in core journals,4641 evidence-based articles,and 4177 publications of randomized controlled trials.These papers were mainly published in Chinese Journal of Coloproctology,World Chinese Journal of Digestology,Chinese Journal of Digestion,Chinese Journal of Integrated Traditional and Western Medicine on Digestion,and Modern Journal of Integrated Traditional Chinese and Western Medicine.In particular,the majority of these organizations were located in Jiangsu,Henan,Shandong,and Guangdong Provinces which are rich areas or have the largest population per province.Most of these studies were conducted by academic institutions.CONCLUSION Over the past four decades,the output of research into UC in China has increased significantly,with academic institutions playing a central role in the academic field,but the number and quality of these researches vary substantially among different regions.
文摘The natural history of Crohn’s disease(CD)dictates that patients re-quire long-term medical therapy for induction and maintenance to relieve their symptoms,improve health-related quality of life,pre-vent tissue damage,lessen the risk for neoplasia,and reduce hospi-talization and surgery.For the past quarter of a century,medical management of CD has evolved from corticosteroids for induction and immunomodulators formaintenance to antitumor necrosis fac-tor,anti-integrin,and anti-interleukin biological agents and,in the near future,small molecule agents,for both induction and mainte-nance.Despite advances inmedical therapy,themajority of patients with CDwould eventually require surgerywith incision and drainage of abscesses and fistulas,bowel resection and anastomosis,strictur-eplasty,or fecal diversion.Surgery will reset the clock for the disease course of CD and most patients require post-operative medical ther-apy to prevent disease recurrence.Colonoscopy plays a key role in disease monitoring and assessment of treatment response before and after surgery.Endoscopy also plays an important role in the treatment of CD-or its surgery-associated structural complications,such as primary or anastomotic strictures,abscesses,and fistulas.
基金Supported by Grant from the Broad Medical Research Program of The Broad Foundation,No. IBD-029 5R
文摘AIM:To explore the anti-inflammatory potential of adeno-associated virus-mediated delivery of Tregitope 167 in an experimental colitis model.METHODS:The trinitrobenzene sulfonate(TNBS) model of induced colitis was used in Balb/c mice.Subsequently after intravenous adeno-associated virusmediated regulatory T-cell epitopes(Tregitope) delivery,acute colitis was initiated by intra-rectal administration of 1.5 mg TNBS in 40% ethanol followed by a second treatment with TNBS(0.75 mg in 20% ethanol) 8 d later.Control groups included mice not treated with TNBS(healthy control group) and mice treated by TNBS only(diseased group).At the time of sacrifice colon weight,the disease activity index and histology damage score were determined.Immunohistochemical staining of the colonic tissues was performed to asses the cellular infiltrate and the presence of transcription factor forkhead Box-P3(Foxp3).Thymus,mesenteric lymph nodes,liver and spleen tissue were collected and the corresponding lymphocyte populations were further assessed by flow cytometry analysis for the expression of CD4+ T cell and regulatory T cell associated markers.RESULTS:The Tregitope 167 treated mice gained an average of 4% over their initial body weight at the time of sacrifice.In contrast,the mice treated with TNBS alone(no Tregitope) developed colitis,and lost 4% of their initial body weight at the time of sacrifice(P < 0.01).The body weight increase that had been observed in the mice pre-treated with Tregitope 167 was substantiated by a lower disease activity index and a decreased colon weight as compared to the diseased control group(P < 0.01 and P < 0.001,respectively).Immunohistochemical staining of the colonic tissues for CD4+ showed that inflammatory cell infiltrates were present in TNBS treated mice with or without administration with tregitope 167 and that these cellular infiltrates consisted mainly of CD4+ cells.For both TNBS treated groups CD4+ T cell infiltrates were observed in the sub-epithelial layer and the lamina propria.CD4+ T cell infiltrates were also present in the muscularis mucosa layer of the diseased control mice,but were absent in the Tregitope 167 treated group.Numerous Foxp3 positive cells were detected in the lamina propria and sub-epithelium of the colon sections from mice treated with Tregitope 167.Furthermore,the Foxp3 and glycoprotein A repetitions predominant markers were significantly increased in the CD4+ T lymphocyte population in the thymus of the mice pre-treated with adeno-associated virus serotype 5(cytomegalovirus promoter-Tregitope 167),as cytomegalovirus promoter compared to lymphocyte populations in the thymus of diseased and the healthy control mice(P < 0.05 and P < 0.001,respectively).CONCLUSION:This study identifies adeno-associated virus-mediated delivery of regulatory T-cell epitope 167 as a novel anti-inflammatory approach with the capacity to decrease intestinal inflammation and induce longterm remission in inflammatory bowel disease.
文摘Crohn’s disease(CD)and ulcerative colitis(UC)are relapsing and remitting chronic inflammatory diseases of the gastrointestinal tract.Although surgery for UC can provide a cure,surgery for CD is rarely curative.In the past few decades,research has identified risk factors for postsurgical CD recurrence,enabling patient risk stratification to guide monitoring and prophylactic treatment to prevent CD recurrence.A MEDLINE literature review identified articles regarding post-operative monitoring of CD recurrence after resection surgery.In this review,we discuss the evidence on risk factors for postoperative CD recurrence as well as suggestions on post-operative management.
