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Lehmann M, Weixler B, Elezkurtaj S, Loddenkemper C, Kühl AA, Siegmund B. Spatial Single Cell Profiling Using Imaging Mass Cytometry: Inflammatory Versus Penetrating Crohn's Disease. J Crohns Colitis 2024; 18:1305-1318. [PMID: 38465390 DOI: 10.1093/ecco-jcc/jjae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS Fistula formation is a major complication in Crohn's disease [CD] and the role of the immune cell compartment remains to be elucidated. Thus, we compared the immune cell compartment of CD fistula to inflammatory CD colitis using imaging mass cytometry [IMC] and immunofluorescence. METHODS A 36-marker panel including structural, functional, and lineage markers for use in IMC was established. This panel was applied to analyse paraffin-embedded CD fistula tract [n = 11], CD colitis [n = 10], and colon samples from non-inflamed controls [n = 12]. Computational methods for cell segmentation, dimensionality reduction, and cell type clustering were used to define cell populations for cell frequency, marker distribution, and spatial neighbourhood analysis. Multiplex immunofluorescence was used for higher resolution spatial analysis. RESULTS Analysis of cell frequencies in CD fistulas compared to CD colitis and control colonic samples revealed a significant increase in neutrophils, effector cytotoxic T cells, and inflammatory macrophages in CD fistula samples, whereas regulatory T cells were decreased. Neutrophils in CD fistula expressed significantly more matrix metalloproteinase 9 [MMP9], correlating with extracellular matrix remodelling. Neighbourhood analysis revealed a strong association between MMP9+ neutrophils and effector cytotoxic T cells in both CD fistulas and colitis. CONCLUSIONS This study presents the first highly multiplexed single cell analysis of the immune cell compartment of CD fistulas and their spatial context. It links immune cell dynamics, particularly MMP9+ neutrophils, to extracellular matrix remodelling in CD fistulas, offering insights into the complex network of cellular interactions and potential therapeutic targets for CD complications.
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Affiliation(s)
- Malte Lehmann
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sefer Elezkurtaj
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christopher Loddenkemper
- PathoTres, Gemeinschaftspraxis für Pathologie und Neuropathologie, Teltowkanalstr. 2, 12247, Berlin, Germany
| | - Anja A Kühl
- iPATH.Berlin, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
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Taatjes DJ, Roth J. In focus in HCB. Histochem Cell Biol 2024:10.1007/s00418-024-02315-8. [PMID: 39093410 DOI: 10.1007/s00418-024-02315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Affiliation(s)
- Douglas J Taatjes
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, 05405, USA.
| | - Jürgen Roth
- University of Zurich, CH-8091, Zurich, Switzerland
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Maggiori L, Laharie D. Controversies in medical vs surgical management of ileocecal crohn's disease. Dig Liver Dis 2024; 56:1301-1303. [PMID: 38616139 DOI: 10.1016/j.dld.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Léon Maggiori
- Departement of digestive surgery, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France.
| | - David Laharie
- Departement of gastroenterology, Hôpital Haut-Lévêque, CHU de Bordeaux, Université Bordeaux-Aquitaine, Bordeaux, France
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Rieder F, Baker ME, Bruining DH, Fidler JL, Ehman EC, Sheedy SP, Heiken JP, Ream JM, Holmes DR, Inoue A, Mohammadinejad P, Lee YS, Taylor SA, Stoker J, Zou G, Wang Z, Rémillard J, Carter RE, Ottichilo R, Atkinson N, Siddiqui MT, Sunkesula VC, Ma C, Parker CE, Panés J, Rimola J, Jairath V, Feagan BG, Fletcher JG. Reliability of MR Enterography Features for Describing Fibrostenosing Crohn Disease. Radiology 2024; 312:e233039. [PMID: 39105637 DOI: 10.1148/radiol.233039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Background Clinical decision making and drug development for fibrostenosing Crohn disease is constrained by a lack of imaging definitions, scoring conventions, and validated end points. Purpose To assess the reliability of MR enterography features to describe Crohn disease strictures and determine correlation with stricture severity. Materials and Methods A retrospective study of patients with symptomatic terminal ileal Crohn disease strictures who underwent MR enterography at tertiary care centers (Cleveland Clinic: September 2013 to November 2020; Mayo Clinic: February 2008 to March 2019) was conducted by using convenience sampling. In the development phase, blinded and trained radiologists independently evaluated 26 MR enterography features from baseline and follow-up examinations performed more than 6 months apart, with no bowel resection performed between examinations. Follow-up examinations closest to 12 months after baseline were selected. Reliability was assessed using the intraclass correlation coefficient (ICC). In the validation phase, after five features were redefined, reliability was re-estimated in an independent convenience sample using baseline examinations. Multivariable linear regression analysis identified features with at least moderate interrater reliability (ICC ≥0.41) that were independently associated with stricture severity. Results Ninety-nine (mean age, 40 years ± 14 [SD]; 50 male) patients were included in the development group and 51 (mean age, 45 years ± 16 [SD]; 35 female) patients were included in the validation group. In the development group, nine features had at least moderate interrater reliability. One additional feature demonstrated moderate reliability in the validation group. Stricture length (ICC = 0.85 [95% CI: 0.75, 0.91] and 0.91 [95% CI: 0.75, 0.96] in development and validation phase, respectively) and maximal associated small bowel dilation (ICC = 0.74 [95% CI: 0.63, 0.80] and 0.73 [95% CI: 0.58, 0.87] in development and validation group, respectively) had the highest interrater reliability. Stricture length, maximal stricture wall thickness, and maximal associated small bowel dilation were independently (regression coefficients, 0.09-3.97; P < .001) associated with stricture severity. Conclusion MR enterography definitions and scoring conventions for reliably assessing features of Crohn disease strictures were developed and validated, and feature correlation with stricture severity was determined. © RSNA, 2024 Supplemental material is available for this article. See also the article by Rieder and Ma et al in this issue. See also the editorial by Galgano and Summerlin in this issue.
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Affiliation(s)
- Florian Rieder
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Mark E Baker
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - David H Bruining
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jeff L Fidler
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Eric C Ehman
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Shannon P Sheedy
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jay P Heiken
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Justin M Ream
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - David R Holmes
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Akitoshi Inoue
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Payam Mohammadinejad
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Yong S Lee
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Stuart A Taylor
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jaap Stoker
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Guangyong Zou
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Zhongya Wang
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Julie Rémillard
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Rickey E Carter
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Ronald Ottichilo
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Norma Atkinson
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Mohamed Tausif Siddiqui
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Venkata C Sunkesula
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Christopher Ma
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Claire E Parker
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Julian Panés
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jordi Rimola
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Vipul Jairath
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Brian G Feagan
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Joel G Fletcher
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
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5
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Pal P, Reddy DN. Interventional endoscopy in inflammatory bowel disease: a comprehensive review. Gastroenterol Rep (Oxf) 2024; 12:goae075. [PMID: 39055373 PMCID: PMC11272179 DOI: 10.1093/gastro/goae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
Interventional endoscopy can play a key role in the multidisciplinary management of complex inflammatory bowel disease (IBD) as an adjunct to medical and surgical therapy. The primary role of interventional IBD (IIBD) includes the treatment of Crohn's disease-related stricture, fistula, and abscess. Endoscopic balloon dilation (EBD), endoscopic stricturotomy, and placement of endoscopic stents are different forms of endoscopic stricture therapy. EBD is the most widely used therapy whereas endoscopic stricturotomy has higher long-term efficacy than EBD. Fully covered and partially covered self-expanding metal stents are useful in long and refractory strictures whereas lumen-apposing metal stents can be used in short, and anastomotic strictures. Endoscopic fistula/abscess therapy includes endoscopic fistulotomy, seton placement, endoscopic ultrasound-guided drainage of rectal/pelvic abscess, and endoscopic injection of filling agents (fistula plug/glue/stem cell). Endoscopic seton placement and fistulotomy are mainly feasible in short, superficial, single tract fistula and in those with prior surgical seton placement. Similarly, endoscopic fistulotomy is usually feasible in short, superficial, single-tract fistula. Endoscopic closure therapies like over-the-scope clips, suturing, and self-expanding metal stent should be avoided for de novo/bowel to hollow organ fistulas. Other indications include management of postoperative complications in IBD such as management of surgical leaks and complications of pouchitis in ulcerative colitis. Additional indications include endoscopic resection of ulcerative colitis-associated neoplasia (by endoscopic mucosal resection, endoscopic submucosal dissection, and endoscopic full-thickness resection), retrieval of retained capsule endoscope, and control of bleeding. IIBD therapies can potentially act as a bridge between medical and surgical therapy for properly selected IBD patients.
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Affiliation(s)
- Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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6
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Shehab M, De Marco D, Lakatos PL, Bessissow T. The potential for medical therapies to address fistulizing Crohn's disease: a state-of-the-art review. Expert Opin Biol Ther 2024:1-14. [PMID: 39045643 DOI: 10.1080/14712598.2024.2383882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/25/2024] [Accepted: 07/20/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Crohn's disease (CD) is a chronic, relapsing immune mediated disease, which is one of the two major types of inflammatory bowel disease (IBD). Fistulizing CD poses a significant clinical challenge for physicians. Effective management of CD requires a multidisciplinary approach, involving a gastroenterologist and a GI surgeon while tailoring treatment to each patient's unique risk factors, clinical representations, and preferences. AREAS COVERED This comprehensive review explores the intricacies of fistulizing CD including its manifestations, types, impact on quality of life, management strategies, and novel therapies under investigation. EXPERT OPINION Antibiotics are often used as first-line therapy to treat symptoms. Biologics that selectively target TNF-α, such infliximab (IFX), have shown high efficacy in randomized controlled trials. However, more than 50% of patients lose response to IFX, prompting them to explore alternative strategies. Current options include adalimumab and certolizumab pegol combination therapies, as well as small-molecule drugs targeting Janus kinases such as Upadacitinib. Furthermore, a promising treatment for complex fistulas is mesenchymal stem cells such as Darvadstrocel (Alofisel), an allogeneic stem cell-based therapy. However, surgical interventions are necessary for complex cases or intra-abdominal complications. Setons and LIFT procedures are the most common surgical options.
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Affiliation(s)
- Mohammad Shehab
- Division of Gastroenterology, Department of Internal Medicine, Mubarak Al-Kabeer University Hospital, Kuwait University, Kuwait City, Kuwait
| | - Davide De Marco
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Canada
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Canada
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7
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Bhatnagar S, Schlachter L, Eckert D, Stodtmann S, Liu W, Lacerda AP, Mohamed MEF. Pharmacokinetics and Exposure-Response Analyses to Support Dose Selection of Upadacitinib in Crohn's Disease. Clin Pharmacol Ther 2024. [PMID: 38982567 DOI: 10.1002/cpt.3359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/09/2024] [Indexed: 07/11/2024]
Abstract
Upadacitinib, a selective Janus kinase inhibitor, is the first orally administered therapy approved for the treatment of Crohn's disease (CD). This work characterized the pharmacokinetics of upadacitinib in CD patients and evaluated the relationships between upadacitinib steady-state plasma exposures and efficacy as well as safety parameters during the 12-week induction and the 52-week maintenance periods, to provide dosing recommendations for the treatment of CD. Upadacitinib pharmacokinetics in CD patients administered the extended-release formulation were consistent with patient populations in other approved indications. None of the evaluated CD-specific patient characteristics (e.g., disease location and prior gastrointestinal surgeries) had a meaningful impact on upadacitinib pharmacokinetics. Exposure-response analyses during 12-week induction treatment showed that response across all evaluated efficacy end points were approaching a plateau at median plasma exposures associated with 45 mg QD. Analyses for the maintenance period demonstrated that 30 mg QD is predicted to provide an additional 8% to 10% benefit for endoscopic response and endoscopic remission compared with 15 mg QD in patients who failed biologics. The analyses for safety showed a statistically significant relationship between increasing upadacitinib plasma exposures and the percentage of patients experiencing >2 g/dL decrease in hemoglobin from Baseline during induction and showed shallow relationships for serious infections and herpes zoster during the maintenance period. These results demonstrated adequate absorption of the extended-release formulation of upadacitinib in CD patients. The exposure-response analyses confirmed that 45 mg QD dose maximized efficacy as induction treatment and supported the selection of 15 mg QD or 30 mg QD as the maintenance doses.
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Affiliation(s)
| | - Louisa Schlachter
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Doerthe Eckert
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Sven Stodtmann
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | - Wei Liu
- Clinical Pharmacology, AbbVie, North Chicago, Illinois, USA
| | - Ana P Lacerda
- Immunology Clinical Development, AbbVie, North Chicago, Illinois, USA
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8
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Sun Z, Cao L, Chen Y, Zhu W, Li Y. Long-term outcomes of intestinal penetrating Crohn's disease following successful nonoperative management. Eur J Gastroenterol Hepatol 2024; 36:867-874. [PMID: 38625818 DOI: 10.1097/meg.0000000000002775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
There is a paucity of data on the surgical or medical treatment for abscess/fistula complicating Crohn's disease after successful nonsurgical management. We conducted a cohort study to investigate the long-term outcomes and the risk factors for the requirement of subsequent surgical intervention in Crohn's disease patients with complicating fistulas/abscess following successful nonsurgical management. Data were collected on penetrating Crohn's disease experiencing successful nonsurgical treatment between December 2012 and December 2021. Long-term outcomes and risk factors of surgery were assessed by univariate and multivariate analysis, and subgroup analysis was performed based on penetrating phenotype including abscess, fistula, and phlegmon. A total of 523 penetrating Crohn's disease patients; there were 390, 125, and 60 patients complicated with fistulas, abscess, and phlegmon, respectively. Long-term outcomes showed that BMI < 18.5 (kg/m 2 ), the recurrent abscess, and stricture were independent risk factors of surgery. Biologics and resolution of abscess were independent protective factors of surgery. Furthermore, in 399 patients undergoing early surgery, stricture and BMI < 18.5 (kg/m 2 ) were independent risk factors, and biologics and abscess resolution were protective of the early surgery. Subgroup analysis based on fistula, abscess, and phlegmon phenotype also demonstrated that concomitant stricture was an independent risk factor and the use of biologics was protective of surgical resection. Our data indicate that biologics can delay the requirement of surgery and may be given to patients with penetrating complicating Crohn's disease who have been successfully treated nonoperatively, but surgical resection should be considered in the setting of malnutrition and stenosis formation.
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Affiliation(s)
- Zhenya Sun
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Lei Cao
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Yusheng Chen
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Weiming Zhu
- Department of Anorectal Surgery, IBD Therapeutic Center, Nanjing University of Chinese Medicine, Nanjing, PR China
| | - Yi Li
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
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9
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Levitte S, Khan I, Iyahen V, Ziai J, Gubatan J, Sheng R, Glickstein SB, Sun T, Park KT, McBride J, Keir M. Differential expression of small bowel TGFβ1 and TGFβ3 characterizes intestinal strictures in patients with fibrostenotic Crohn's disease. Histochem Cell Biol 2024:10.1007/s00418-024-02290-0. [PMID: 38705911 DOI: 10.1007/s00418-024-02290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
Small bowel strictures remain a debilitating consequence of Crohn's disease and contribute to poor outcomes for patients. Recently, TGFβ has been identified as an important driver of intestinal fibrosis. We studied the localization of TGFβ isoforms in ileal strictures of patients with Crohn's disease using in situ hybridization to understand TGFβ's role in stricture formation. The mucosa of strictures was characterized by higher TGFβ1 while the stricture submucosa showed higher TGFβ3 compared to normal ileum from patients without Crohn's disease (p = 0.02 and p = 0.044, respectively). We correlated these findings with single-cell transcriptomics which demonstrated that TGFβ3 transcripts overall are very rare, which may partially explain why its role in intestinal fibrosis has remained unclear to date. There were no significant differences in fibroblast or B cell TGFβ1 and/or TGFβ3 expression in inflamed vs. noninflamed ileum. We discuss the implications of these findings for therapeutic development strategies to treat patients with fibrostenotic Crohn's disease.
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Affiliation(s)
- Steven Levitte
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, 750 Welch Rd Ste 116, Palo Alto, CA, 94304, USA.
| | - Ibaad Khan
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | - James Ziai
- Genentech, Inc, South San Francisco, CA, USA
| | - John Gubatan
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA
| | | | | | - Tianhe Sun
- Genentech, Inc, South San Francisco, CA, USA
| | - K T Park
- Genentech, Inc, South San Francisco, CA, USA
| | | | - Mary Keir
- Genentech, Inc, South San Francisco, CA, USA
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10
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Noor NM, Lee JC, Bond S, Dowling F, Brezina B, Patel KV, Ahmad T, Banim PJ, Berrill JW, Cooney R, De La Revilla Negro J, de Silva S, Din S, Durai D, Gordon JN, Irving PM, Johnson M, Kent AJ, Kok KB, Moran GW, Mowat C, Patel P, Probert CS, Raine T, Saich R, Seward A, Sharpstone D, Smith MA, Subramanian S, Upponi SS, Wiles A, Williams HRT, van den Brink GR, Vermeire S, Jairath V, D'Haens GR, McKinney EF, Lyons PA, Lindsay JO, Kennedy NA, Smith KGC, Parkes M. A biomarker-stratified comparison of top-down versus accelerated step-up treatment strategies for patients with newly diagnosed Crohn's disease (PROFILE): a multicentre, open-label randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9:415-427. [PMID: 38402895 PMCID: PMC11001594 DOI: 10.1016/s2468-1253(24)00034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Management strategies and clinical outcomes vary substantially in patients newly diagnosed with Crohn's disease. We evaluated the use of a putative prognostic biomarker to guide therapy by assessing outcomes in patients randomised to either top-down (ie, early combined immunosuppression with infliximab and immunomodulator) or accelerated step-up (conventional) treatment strategies. METHODS PROFILE (PRedicting Outcomes For Crohn's disease using a moLecular biomarker) was a multicentre, open-label, biomarker-stratified, randomised controlled trial that enrolled adults with newly diagnosed active Crohn's disease (Harvey-Bradshaw Index ≥7, either elevated C-reactive protein or faecal calprotectin or both, and endoscopic evidence of active inflammation). Potential participants had blood drawn to be tested for a prognostic biomarker derived from T-cell transcriptional signatures (PredictSURE-IBD assay). Following testing, patients were randomly assigned, via a secure online platform, to top-down or accelerated step-up treatment stratified by biomarker subgroup (IBDhi or IBDlo), endoscopic inflammation (mild, moderate, or severe), and extent (colonic or other). Blinding to biomarker status was maintained throughout the trial. The primary endpoint was sustained steroid-free and surgery-free remission to week 48. Remission was defined by a composite of symptoms and inflammatory markers at all visits. Flare required active symptoms (HBI ≥5) plus raised inflammatory markers (CRP >upper limit of normal or faecal calprotectin ≥200 μg/g, or both), while remission was the converse-ie, quiescent symptoms (HBI <5) or resolved inflammatory markers (both CRP ≤ the upper limit of normal and calprotectin <200 μg/g) or both. Analyses were done in the full analysis (intention-to-treat) population. The trial has completed and is registered (ISRCTN11808228). FINDINGS Between Dec 29, 2017, and Jan 5, 2022, 386 patients (mean age 33·6 years [SD 13·2]; 179 [46%] female, 207 [54%] male) were randomised: 193 to the top-down group and 193 to the accelerated step-up group. Median time from diagnosis to trial enrolment was 12 days (range 0-191). Primary outcome data were available for 379 participants (189 in the top-down group; 190 in the accelerated step-up group). There was no biomarker-treatment interaction effect (absolute difference 1 percentage points, 95% CI -15 to 15; p=0·944). Sustained steroid-free and surgery-free remission was significantly more frequent in the top-down group than in the accelerated step-up group (149 [79%] of 189 patients vs 29 [15%] of 190 patients, absolute difference 64 percentage points, 95% CI 57 to 72; p<0·0001). There were fewer adverse events (including disease flares) and serious adverse events in the top-down group than in the accelerated step-up group (adverse events: 168 vs 315; serious adverse events: 15 vs 42), with fewer complications requiring abdominal surgery (one vs ten) and no difference in serious infections (three vs eight). INTERPRETATION Top-down treatment with combination infliximab plus immunomodulator achieved substantially better outcomes at 1 year than accelerated step-up treatment. The biomarker did not show clinical utility. Top-down treatment should be considered standard of care for patients with newly diagnosed active Crohn's disease. FUNDING Wellcome and PredictImmune Ltd.
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Affiliation(s)
- Nurulamin M Noor
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - James C Lee
- Genetic Mechanisms of Disease Laboratory, The Francis Crick Institute, London, UK; Department of Gastroenterology, UCL Institute of Liver and Digestive Diseases, Royal Free Hospital, London, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Francis Dowling
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Biljana Brezina
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Paul J Banim
- Department of Gastroenterology, James Paget University Hospital, Great Yarmouth, UK
| | - James W Berrill
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Rachel Cooney
- GI Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Juan De La Revilla Negro
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Shanika de Silva
- Department of Gastroenterology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Shahida Din
- Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Dharmaraj Durai
- Department of Gastroenterology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - John N Gordon
- Department of Gastroenterology, Royal Hampshire County Hospital, Winchester, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew Johnson
- Gastroenterology Department, Luton and Dunstable University Hospital, Luton, UK
| | - Alexandra J Kent
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Klaartje B Kok
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Gordon W Moran
- National Institute of Health Research Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals, Nottingham, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital, Dundee, Scotland, UK
| | - Pritash Patel
- Department of Gastroenterology, Epsom and St Helier University Hospitals, Carshalton, UK
| | - Chris S Probert
- Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rebecca Saich
- Department of Gastroenterology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Abigail Seward
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dan Sharpstone
- Department of Gastroenterology, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Melissa A Smith
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Sreedhar Subramanian
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sara S Upponi
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alan Wiles
- Department of Gastroenterology, The Queen Elizabeth Hospital King's Lynn NHS Trust, King's Lynn, UK
| | - Horace R T Williams
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | | | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, Department of Chronic Diseases and Metabolism, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Geert R D'Haens
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Eoin F McKinney
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK; PredictImmune Ltd, Babraham Research Campus, Cambridge, UK; Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - Paul A Lyons
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK; PredictImmune Ltd, Babraham Research Campus, Cambridge, UK; Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - James O Lindsay
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Kenneth G C Smith
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK; PredictImmune Ltd, Babraham Research Campus, Cambridge, UK; Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - Miles Parkes
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK.
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Yamamoto-Furusho JK, López-Gómez JG, Bosques-Padilla FJ, Martínez-Vázquez MA, De-León-Rendón JL. First Mexican Consensus on Crohn's disease. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:280-311. [PMID: 38762431 DOI: 10.1016/j.rgmxen.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/19/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Crohn's disease (CD) is a subtype of chronic and incurable inflammatory bowel disease. It can affect the entire gastrointestinal tract and its etiology is unknown. OBJECTIVE The aim of this consensus was to establish the most relevant aspects related to definitions, diagnosis, follow-up, medical treatment, and surgical treatment of Crohn's disease in Mexico. MATERIAL AND METHODS Mexican specialists in the areas of gastroenterology and inflammatory bowel disease were summoned. The consensus was divided into five modules, with 69 statements. Applying the Delphi panel method, the pre-meeting questions were sent to the participants, to be edited and weighted. At the face-to-face meeting, all the selected articles were shown, underlining their level of clinical evidence; all the statements were discussed, and a final vote was carried out, determining the percentage of agreement for each statement. RESULTS The first Mexican consensus on Crohn's disease was produced, in which recommendations for definitions, classifications, diagnostic aspects, follow-up, medical treatment, and surgical treatment were established. CONCLUSIONS Updated recommendations are provided that focus on definitions, classifications, diagnostic criteria, follow-up, and guidelines for conventional medical treatment, biologic therapy, and small molecule treatment, as well as surgical management.
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Affiliation(s)
- J K Yamamoto-Furusho
- Clínica de Enfermedad Inflamatoria Intestinal, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - J G López-Gómez
- Clínica de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - F J Bosques-Padilla
- Departamento de Gastroenterología, Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - J L De-León-Rendón
- Clínica de Enfermedad Inflamatoria Intestinal, Servicio de Coloproctología, Hospital General de México, Mexico City, Mexico
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12
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Chen YJ, He JS, Xiong SS, Li MY, Chen SL, Chen BL, Qiu Y, Xia QQ, He Y, Zeng ZR, Chen MH, Xie XY, Mao R. Bowel Stiffness Assessed by Shear-Wave Ultrasound Elastography Predicts Disease Behavior Progression in Patients With Crohn's Disease. Clin Transl Gastroenterol 2024; 15:e00684. [PMID: 38270207 DOI: 10.14309/ctg.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION There is a lack of reliable predictors of disease behavior progression in patients with Crohn's disease (CD). Real-time shear-wave elastography (SWE) is a novel method for evaluating tissue stiffness. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression. METHODS We retrospectively collected data from patients with CD with the nonstenotic nonpenetrating disease (B1 phenotype based on the Montreal classification). All patients underwent intestinal ultrasound at baseline and were followed up. The end point was defined as disease behavior progression to stricturing (B2) or penetrating (B3) disease. Cox regression analysis was performed for the association between baseline characteristics and subsequent end points. In addition, a multivariate nomogram was established to predict the risk of disease behavior progression quantitatively. RESULTS A total of 130 patients with CD with B1 phenotype were enrolled. Twenty-seven patients (20.8%) developed B2 or B3 disease, with a median follow-up of 33 months. Multivariate analysis identified that SWE was the only independent predictor of disease behavior progression (hazard ratio 1.08, 95% confidence interval 1.03-1.12, P = 0.001). A reverse of the HR appeared at the cutoff 12.75 kPa. The nomogram incorporating SWE and other clinical characteristics showed a good prediction performance (area under the curve = 0.792). DISCUSSION Intestinal stiffness assessed using SWE is an independent predictor of disease behavior progression in patients with CD. Patients with CD with SWE >12.75 kPa at diagnosis are prone to progress toward stricturing or penetrating diseases.
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Affiliation(s)
- Yu-Jun Chen
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jin-Shen He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shan-Shan Xiong
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Man-Ying Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shu-Ling Chen
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bai-Li Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Qing Xia
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Rong Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min-Hu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Hausmann M, Seuwen K, de Vallière C, Busch M, Ruiz PA, Rogler G. Role of pH-sensing receptors in colitis. Pflugers Arch 2024; 476:611-622. [PMID: 38514581 PMCID: PMC11006753 DOI: 10.1007/s00424-024-02943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
Low pH in the gut is associated with severe inflammation, fibrosis, and colorectal cancer (CRC) and is a hallmark of active inflammatory bowel disease (IBD). Subsequently, pH-sensing mechanisms are of interest for the understanding of IBD pathophysiology. Tissue hypoxia and acidosis-two contributing factors to disease pathophysiology-are linked to IBD, and understanding their interplay is highly relevant for the development of new therapeutic options. One member of the proton-sensing G protein-coupled receptor (GPCR) family, GPR65 (T-cell death-associated gene 8, TDAG8), was identified as a susceptibility gene for IBD in a large genome-wide association study. In response to acidic extracellular pH, GPR65 induces an anti-inflammatory response, whereas the two other proton-sensing receptors, GPR4 and GPR68 (ovarian cancer G protein-coupled receptor 1, OGR1), mediate pro-inflammatory responses. Here, we review the current knowledge on the role of these proton-sensing receptors in IBD and IBD-associated fibrosis and cancer, as well as colitis-associated cancer (CAC). We also describe emerging small molecule modulators of these receptors as therapeutic opportunities for the treatment of IBD.
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Affiliation(s)
- Martin Hausmann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091, Zurich, CH, Switzerland.
| | - Klaus Seuwen
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091, Zurich, CH, Switzerland
| | - Cheryl de Vallière
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091, Zurich, CH, Switzerland
| | - Moana Busch
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091, Zurich, CH, Switzerland
| | - Pedro A Ruiz
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091, Zurich, CH, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091, Zurich, CH, Switzerland
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Amadu M, Soldera J. Duodenal Crohn's disease: Case report and systematic review. World J Methodol 2024; 14:88619. [PMID: 38577197 PMCID: PMC10989410 DOI: 10.5662/wjm.v14.i1.88619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/16/2023] [Accepted: 01/18/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease, including ulcerative colitis, microscopic colitis, and Crohn's disease (CD), has a global impact. This review focuses on duodenal CD (DCD), a rare subtype affecting the duodenum. DCD's rarity and asymptomatic nature create diagnostic challenges, impacting prognosis and patient well-being. Delayed diagnosis can worsen DCD outcomes. AIM To report a rare case of DCD and to discuss the diagnostic challenges and its implications on prognosis. METHODS A systematic literature search, following the PRISMA statement, was conducted. Relevant studies were identified and analysed using specific Medical Subject Terms (MeSH) from PubMed/MEDLINE, American Journal of Gastroenterology, and the University of South Wales database. Data collection included information from radiology scans, endoscopy procedures, biopsies, and histopathology results. RESULTS The review considered 8 case reports and 1 observational study, involving 44 participants diagnosed with DCD, some of whom developed complications due to delayed diagnosis. Various diagnostic methods were employed, as there is no gold standard workup for DCD. Radiology scans [magnetic resonance imaging (MRI), computed tomography (CT), and upper gastrointestinal X-ray], endoscopy procedures (colonoscopy and esophagogastroduodenoscopy), biopsies, and clinical suspicions were utilized. CONCLUSION This review discusses DCD diagnosis challenges and the roles of CT, MRI, and fluoroscopy. It notes their limitations and compares findings with endoscopy and histopathology studies. Further research is needed to improve diagnosis, emphasizing scan interpretation, endoscopy procedures, and biopsies, especially in high-risk patients during routine endoscopy.
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Affiliation(s)
- Muniratu Amadu
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Vieujean S, Gillard R, Delanaye P, Seidel L, Bequet E, Salée C, Meuwis MA, Massot C, Pierre N, Meunier P, Cavalier E, Louis E. Matrix gla protein, a potential marker of tissue remodelling and physiological ageing of the gut in crohn's disease. Scand J Gastroenterol 2024; 59:296-303. [PMID: 38411457 DOI: 10.1080/00365521.2023.2286913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/19/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND The inactive dephosphorylated and uncarboxylated form of the matrix Gla protein (dp-ucMGP) has been shown to be increased in plasma of inflammatory bowel disease (IBD) patients. Our aim was to assess if the plasmatic level of dp-ucMGP could reflect disease endoscopic activity, presence of strictures and cumulative structural bowel damage in Crohn's disease (CD) patients. METHODS The plasmatic level of dp-ucMGP was measured in a monocentric cohort of prospectively recruited patients. The analysis was done by chemiluminescent immunoassay on blood samples collected the day of a planned ileocolonoscopy. In addition to classical clinical data (gender, age, body mass index (BMI), disease duration, current treatment), endoscopic data (disease location, Crohn's Disease Endoscopic Index of Severity (CDEIS), mucosal healing (MH), presence of 9 CD lesion types) and biological markers (faecal calprotectin and C-reactive protein (CRP)) were collected. The association between dp-ucMGP level and Lémann index was also investigated. Univariate linear regression was used to investigate the relationship between dp-ucMGP level and different parameters collected. RESULTS A total of 82 ileocolonoscopies and dp-ucMGP assays were performed in 75 CD patients (45 females; 37 ileocolonic, 19 ileal and 19 colonic diseases) between October 2012 and November 2019. A total of 24 patients (29.3%) showed MH. The dp-ucMGP levels were not associated with MH, CDEIS, faecal calprotectin or CRP levels. Plasmatic dp-ucMGP levels increased significantly with age (p = 0.0032), disease duration (p = 0.0033), corticosteroids use (p = 0.019) and tended to increase in patients with intestinal strictures (p = 0.086) but not with the Lémann index. CONCLUSION The significant increase of plasmatic dp-ucMGP levels with age, disease duration and the trend observed in patients with non-ulcerated strictures may suggest that this extracellular matrix protein could be a marker of tissue remodelling and physiological ageing of the gut.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Romain Gillard
- Department of Radiology, University Hospital CHU of Liège, Liège, Belgium
| | - Pierre Delanaye
- Department of Dialysis-Nephrology-Transplantation, University Hospital CHU of Liège, Liège, Belgium
| | - Laurence Seidel
- Biostatistics and Medico-economic Information Department, University of Liège, Liège, Belgium
| | - Emeline Bequet
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Citadelle Hospital and University Hospital of Liège & University of Liège, Liège, Belgium
| | - Catherine Salée
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Marie-Alice Meuwis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Charlotte Massot
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Nicolas Pierre
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Paul Meunier
- Department of Radiology, University Hospital CHU of Liège, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, Liège, Belgium
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
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Halloran BP, Reeson M, Teshima C, Kroeker K, Huang V, Dieleman L, Holmes P, Baumgart DC, Wong K, Hoentjen F, Peerani F, Zepeda-Gomez S. Stricture dilation via balloon-assisted endoscopy in Crohn's disease: approach and intraprocedural outcomes with the single-balloon and double-balloon systems. Therap Adv Gastroenterol 2024; 17:17562848241230904. [PMID: 38425369 PMCID: PMC10903206 DOI: 10.1177/17562848241230904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Despite recent emerging literature involving the utility of endoscopic balloon dilation (EBD) of strictures via balloon-assisted endoscopy (BAE), specifically regarding the management of Crohn's disease (CD), the optimal clinical approach with balloon systems has been largely neglected in academic literature. Objectives This study assesses the intra-procedural success and safety of EBD via BAE for small bowel CD strictures while detailing our clinical approach and technique. Secondarily, we compare the single-balloon endoscope (SBE) and double-balloon endoscope (DBE) systems for EBD-related outcomes. Design Retrospective consecutive patient cohort analysis. Methods We retrospectively assessed a consecutive small bowel CD patient cohort undergoing BAE at the University of Alberta Hospital endoscopy unit from 2013 to 2020. The primary endpoint discerned the safety and immediate success rate of EBD during endoscopy, and comparisons of the dilation parameters and efficacy of SBE versus DBE were assessed as secondary outcomes. Results During the study period, 87 patients (44 male) with a mean age of 56 ± 14.7 years underwent 179 endoscopic procedures (92 DBE and 87 SBE). Of 358 strictures encountered, 320 (89.4%) were successfully dilated and traversed. The mean maximum dilation diameter was 15.76 ± 2.10 mm. There were no perforations or major adverse events. Conclusion EBD via BAE is a safe procedure in small bowel CD with a high intraprocedural success rate. Overall, SBE had a higher success rate in traversing strictures before and after dilation using our technique. This analysis is limited by the retrospective nature of our study and must be balanced against the inherent benefits of the DBE system.
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Affiliation(s)
- Brendan P. Halloran
- Director of the Small Endoscopy Bowel Program, Division of Gastroenterology, Department of Medicine, University of Alberta, 130 University Campus NW, Edmonton, AB, Canada T6G2X8
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | | | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Vivian Huang
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Levinus Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Peter Holmes
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Daniel C. Baumgart
- Division of Gastroenterology
- Charité Medical Center – Virchow Hospital Berlin, Berlin, Germany
| | - Karen Wong
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Frank Hoentjen
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Farhad Peerani
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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Gordon M, Sinopoulou V, Akobeng AK, Sarian A, Moran GW. Infliximab for maintenance of medically-induced remission in Crohn's disease. Cochrane Database Syst Rev 2024; 2:CD012609. [PMID: 38372447 PMCID: PMC10875719 DOI: 10.1002/14651858.cd012609.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Infliximab is a monoclonal antibody that binds and neutralises tumour necrosis factor-alpha (TNF-α) which is present in high levels in the blood serum, mucosa and stool of patients with Crohn's disease. OBJECTIVES To determine the efficacy and safety of infliximab for maintaining remission in patients with Crohn's disease. SEARCH METHODS On 31 August, 2021 and 23 June, 2023, we searched CENTRAL, Embase, MEDLINE, ClinicalTrials.gov, and WHO ICTRP. SELECTION CRITERIA Randomised controlled trials (RCTs) in which infliximab was compared to placebo or another active comparator for maintenance, remission, or response in patients with Crohn's disease. DATA COLLECTION AND ANALYSIS Pairs of review authors independently selected studies and conducted data extraction and risk of bias assessment. We expressed outcomes as risk ratios and mean differences with 95% confidence intervals. We assessed the certainty of the evidence using GRADE. Our primary outcome was clinical relapse. Secondary outcomes were loss of clinical response, endoscopic relapse, and withdrawal due to serious and adverse events. MAIN RESULTS Nine RCTs with 1257 participants were included. They were conducted between 1999 and 2022; seven RCTs included biologically-naive patients, and the remaining two included a mix of naive/not naive patients. Three studies included patients in clinical remission, five included patients with a mix of activity scores, and one study included biologic responders with active disease at baseline. All studies allowed some form of concomitant medication during their duration. One study exclusively included patients with fistulating disease. The age of the participants ranged from 18 to 69 years old. All but one single-centre RCT were multicentre RCTs. Four studies were funded by pharmaceutical companies, two had a mix of commercial and public funding, and two had public funding. Infliximab is probably superior to placebo in preventing clinical relapse in patients who have mixed levels of clinical disease activity at baseline, and are not naive to biologics (56% vs 75%, RR 0.73, 95% CI 0.63 to 0.84, NNTB = 5, moderate-certainty evidence). We cannot draw any conclusions on loss of clinical response (RR 0.59, 95% CI 0.37 to 0.96), withdrawals due to adverse events (RR 0.66, 95% CI 0.37 to 1.19), or serious adverse events (RR 0.60, 95% CI 0.36 to 1.00) because the evidence is very low certainty. Infliximab combined with purine analogues is probably superior to purine analogues for clinical relapse (12% vs 59%, RR 0.20, 95% CI 0.10 to 0.42, NNTB = 2, moderate-certainty evidence), for patients in remission, and who are not naive to biologics. We cannot draw any conclusions on withdrawals due to adverse events (RR 0.47, 95% CI 0.15 to 1.49), and serious adverse events (RR 1.19, 95% CI 0.54 to 2.64) because the evidence is very low certainty. We cannot draw any conclusions about the effects of infliximab on serious adverse events compared to purine analogues (RR 0.79, 95% CI 0.37 to 1.68) for a population in remission at baseline because the evidence is very low certainty. There was no evidence available for the outcomes of clinical relapse, loss of clinical response, and withdrawal due to adverse events. Infliximab may be equivalent to biosimilar for clinical relapse (47% vs 40% RR 1.18, 95% CI 0.82 to 1.69), and it may be slightly less effective in averting loss of clinical response (49% vs 32%, RR 1.50, 95% CI 1.01 to 2.23, low-certainty evidence), for a population with mixed/low disease activity at baseline. Infliximab may be less effective than biosimilar in averting withdrawals due to adverse events (27% vs 0%, RR 20.73, 95% CI 2.86 to 150.33, low-certainty evidence). Infliximab may be equivalent to biosimilar for serious adverse events (10% vs 10%, RR 0.99, 95% CI 0.39 to 2.50, low-certainty evidence). We cannot draw any conclusions on the effects of subcutaneous biosimilar compared with intravenous biosimilar on clinical relapse (RR 1.01, 95% CI 0.65 to 1.57), loss of clinical response (RR 0.94, 95% CI 0.70 to 1.25), and withdrawals due to adverse events (RR 0.77, 95% CI 0.30 to 1.97) for an active disease population with clinical response at baseline because the evidence is of very low certainty. We cannot draw any conclusions on the effects of infliximab compared to adalimumab on loss of clinical response (RR 0.68, 95% CI 0.29 to 1.59), withdrawals due to adverse events (RR 0.10, 95% CI 0.01 to 0.72), serious adverse events (RR 0.09, 95% CI 0.01 to 1.54) for an active disease population with clinical response at baseline because the evidence is of very low certainty. There was no evidence available for the outcome of clinical relapse. AUTHORS' CONCLUSIONS Infliximab is probably more effective in preventing clinical relapse than placebo (moderate-certainty evidence). Infliximab in combination with purine analogues is probably more effective in preventing clinical and endoscopic relapse than purine analogues alone (moderate-certainty evidence). No conclusions can be drawn regarding prevention of loss of clinical response, occurrence of withdrawals due to adverse events, or total adverse events due to very low-certainty evidence for both of these comparisons. There may be little or no difference in prevention of clinical relapse, withdrawal due to adverse events or total adverse events between infliximab and a biosimilar (low-certainty evidence). Infliximab may lead to more loss of clinical response than a biosimilar (low-certainty evidence). We were unable to draw meaningful conclusions about other comparisons and outcomes related to missing data or very low-certainty evidence due to serious concerns about imprecision and risk of bias. Further research should focus on comparisons with other active therapies for maintaining remission, as well as ensuring adequate power calculations and reporting of methods.
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Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | | | - Anthony K Akobeng
- Pediatric Gastroenterology, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, Cornell University, Doha, Qatar
| | - Arni Sarian
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Gordon William Moran
- National Institute of Health Research Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals, Nottingham, UK
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Dudek P, Talar-Wojnarowska R. Current Approach to Risk Factors and Biomarkers of Intestinal Fibrosis in Inflammatory Bowel Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:305. [PMID: 38399592 PMCID: PMC10889938 DOI: 10.3390/medicina60020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Inflammatory bowel disease (IBD), especially Crohn's disease (CD), characterized by a chronic inflammatory process and progressive intestinal tissue damage, leads to the unrestrained proliferation of mesenchymal cells and the development of bowel strictures. Complications induced by fibrosis are related to high rates of morbidity and mortality and lead to a substantial number of hospitalizations and surgical procedures, generating high healthcare costs. The development of easily obtained, reliable fibrogenesis biomarkers is essential to provide an important complementary tool to existing diagnostic and prognostic methods in IBD management, guiding decisions on the intensification of pharmacotherapy, proceeding to surgical methods of treatment and monitoring the efficacy of anti-fibrotic therapy in the future. The most promising potential markers of fibrosis include cartilage oligomeric matrix protein (COMP), hepatocyte growth factor activator (HGFA), and fibronectin isoform- extra domain A (ED-A), as well as antibodies against granulocyte macrophage colony-stimulating factor (GM-CSF Ab), cathelicidin (LL-37), or circulatory miRNAs: miR-19a-3p and miR-19b-3p. This review summarizes the role of genetic predisposition, and risk factors and serological markers potentially contributing to the pathophysiology of fibrotic strictures in the course of IBD.
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Vitello A, Maida M, Shahini E, Macaluso FS, Orlando A, Grova M, Ramai D, Serviddio G, Facciorusso A. Current Approaches for Monitoring of Patients with Inflammatory Bowel Diseases: A Narrative Review. J Clin Med 2024; 13:1008. [PMID: 38398321 PMCID: PMC10888591 DOI: 10.3390/jcm13041008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBD) require proactive monitoring both during the active phase to evaluate therapeutic response and during the remission phase to evaluate relapse or colorectal cancer surveillance. However, monitoring may vary between patients with ulcerative colitis (UC) and Crohn's disease (CD), with distinct tools and intervals. METHODS This narrative review aims to focus on modern approaches to IBD monitoring, considering international guidelines and expert consensus. RESULTS The most recent European diagnostic guidelines advocate a combination of clinical, laboratory, endoscopic, and radiological parameters to evaluate the disease course of patients with IBD. Unfortunately, the conventional symptom-based therapeutic approach does not improve long-term outcomes and there is no single ideal biomarker available. Endoscopy plays a key role in evaluating response to therapy as well as monitoring disease activity. Recently, bedside intestinal ultrasound (IUS) has gained increasing interest and diffusion as it appears to offer several advantages including the monitoring of therapeutic response. CONCLUSION In light of growing clinical advances, we present a schematic evidence-based monitoring algorithm that can be easily applied in clinical practice which combines all major monitoring modalities, including noninvasive tools such as IUS and video-capsule endoscopy.
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Affiliation(s)
- Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy
| | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy;
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Mauro Grova
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
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Geem D, Hercules D, Pelia RS, Venkateswaran S, Griffiths A, Noe JD, Dotson JL, Snapper S, Rabizadeh S, Rosh JR, Baldassano RN, Markowitz JF, Walters TD, Ananthakrishnan A, Sharma G, Denson LA, Hyams JS, Kugathasan S. Progression of Pediatric Crohn's Disease Is Associated With Anti-Tumor Necrosis Factor Timing and Body Mass Index Z-Score Normalization. Clin Gastroenterol Hepatol 2024; 22:368-376.e4. [PMID: 37802268 DOI: 10.1016/j.cgh.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND & AIMS The evolution of complicated pediatric Crohn's disease (CD) in the era of anti-tumor necrosis factor (aTNF) therapy continues to be described. Because CD progresses from inflammatory to stricturing (B2) and penetrating (B3) disease behaviors in a subset of patients, we aimed to understand the risk of developing complicated disease behavior or undergoing surgery in relation to aTNF timing and body mass index z-score (BMIz) normalization. METHODS Multicenter, 5-year longitudinal data from 1075 newly diagnosed CD patients were analyzed. Descriptive statistics, univariate and stepwise multivariate Cox proportional hazard regression (CPHR), and log-rank analyses were performed for risk of surgery and complicated disease behaviors. Differential gene expression from ileal bulk RNA sequencing was correlated with outcomes. RESULTS Stricturing complications had the largest increase: from 2.98% to 10.60% over 5 years. Multivariate CPHR showed aTNF exposure within 3 months from diagnosis (hazard ratio [HR], 0.33; 95% CI, 0.15-0.71) and baseline L2 disease (HR, 0.29; 95% CI, 0.09-0.92) to be associated with reduced B1 to B2 progression. For children with a low BMIz at diagnosis (n = 294), multivariate CPHR showed BMIz normalization within 6 months of diagnosis (HR, 0.47; 95% CI, 0.26-0.85) and 5-aminosalicyclic acid exposure (HR, 0.32; 95% CI, 0.13-0.81) were associated with a decreased risk for surgery while B2 (HR, 4.20; 95% CI, 1.66-10.65) and B2+B3 (HR, 8.24; 95% CI, 1.08-62.83) at diagnosis increased surgery risk. Patients without BMIz normalization were enriched for genes in cytokine production and inflammation. CONCLUSIONS aTNF exposure up to 3 months from diagnosis may reduce B2 progression. In addition, lack of BMIz normalization within 6 months of diagnosis is associated with increased surgery risk and a proinflammatory transcriptomic profile.
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Affiliation(s)
- Duke Geem
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - David Hercules
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia
| | - Ranjit S Pelia
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia
| | - Suresh Venkateswaran
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia
| | - Anne Griffiths
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joshua D Noe
- Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer L Dotson
- Department of Pediatric Gastroenterology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Scott Snapper
- Department of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Shervin Rabizadeh
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joel R Rosh
- Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey
| | - Robert N Baldassano
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas D Walters
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ashwin Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Garima Sharma
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia
| | - Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Subra Kugathasan
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, Atlanta, Georgia.
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Pal P, Gala J, Rebala P, Banerjee R, Ramchandani M, Nabi Z, Kanaganti S, Shetty MG, Gupta R, Lakhtakia S, Rao GV, Tandan M, Reddy DN. Re-intervention rates and symptom-free survival at 1 year after endoscopic versus surgical management of strictures in Crohn's disease: A propensity matched analysis of a prospective inflammatory bowel disease cohort. J Gastroenterol Hepatol 2024; 39:353-359. [PMID: 37897304 DOI: 10.1111/jgh.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/02/2023] [Accepted: 10/07/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND AND AIM Resection for Crohn's disease (CD) related strictures is definitive but carries risk of morbidity, recurrence, and short bowel syndrome. On the contrary, the durability of endotherapy (ET) for CD-related strictures is questionable. Prospective comparative studies are limited. We aimed to prospectively compare the outcomes of ET in CD strictures with a case-matched surgical therapy (ST) cohort. METHODS Patients undergoing ET or resection for primary CD strictures (symptomatic, non-traversable, < 5 cm length, n ≤ 3) between January 2021 and March 2022 in a high-volume tertiary center were compared with regard to recurrent symptoms, escalation of therapy, re-intervention, and re-operation based on propensity matched analysis. RESULTS Fifty-nine patients [49% ET, 57.6% male, median (years): 34 (15-74)] had ≥ 12 months of follow up. Before propensity matching, cumulative re-intervention rate was significantly higher with ET [34.5% (10/29) vs 3.3% (1/30) ST, P = 0.002]. Recurrent symptoms (34.5% vs 26.7%, P = 0.42), escalation of medical therapy (27.5% vs 23.3%, P = 0.64), and re-operation (7.4% vs 3.1%, P = 0.55) were comparable. In propensity matched analysis adjusted for demographics, disease, and stricture characteristics [n = 42, 21 each, 62% male, median (years): 32 (15-60)], cumulative probability of re-intervention rates was higher in ET (28.6% vs 4.8%, P = 0.042). The cumulative probability of recurrent symptoms (ET: 33.3% vs surgery 33.3%, P = 0.93), therapy escalation (ET: 23.8% vs surgery 28.6%, P = 0.75), and re-operation (ET: 9.5% vs surgery 4.8%, P = 0.57) was similar. CONCLUSIONS ET for CD strictures require higher re-interventions compared with resection although re-operation could be avoided in the majority with comparable symptom free survival at 1 year.
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Affiliation(s)
- Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jaini Gala
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pradeep Rebala
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Swathi Kanaganti
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mahesh G Shetty
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guduru Venkat Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Elford AT, Ardalan Z, Simkin P, Christensen B. Comprehensive review and update of stricturing Crohn's disease. Indian J Gastroenterol 2024; 43:64-77. [PMID: 38277070 DOI: 10.1007/s12664-023-01508-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024]
Abstract
Up to 50% of patients with Crohn's disease develop a stricture within 10 years of diagnosis. Crohn's strictures can compose of inflammation, fibrosis or smooth muscle expansion and usually a combination of these. There have been numerous new developments in imaging modalities in determining the composition of Crohn's strictures. Magnetic resonance imaging remains the best upfront imaging modality to characterize Crohn's strictures. Gastrointestinal ultrasound (GIUS) has an increasing role in clinical practice, particularly for monitoring stricture response as a treat-to-target tool. Novel imaging techniques to differentiate between fibrosis and inflammatory strictures have been developed including contrast-enhanced GIUS, strain or shear wave elastography with GIUS and multiple new magnetic resonance imaging (MRI) protocols, including diffusion weighted, delayed contrast enhancement and magnetization transfer MR protocols. However, these techniques require further validation and standardization. Regarding therapeutics, anti-tumor necrosis agents with a treat-to-target strategy have the highest quality evidence in treating strictures and can lead to stricture regression in some cases. Endoscopic balloon dilatation remains a mainstay in the treatment algorithm of treating predominantly fibrostenotic Crohn's strictures, particularly those which are symptomatic, < 5 cm in length and not causing prestenotic dilatation. Endoscopic balloon dilatation has greater effectiveness in anastomotic strictures. Surgery remains an important treatment option in Crohn's strictures, with segmental resection and stricturoplasty having their own advantages and disadvantages. Kono-S anastomosis may be superior to conventional anastomosis for endoscopic recurrence; however, further high-quality studies are required to confirm this. Using risk stratification models such as the BACARDI risk model is important to guide management decisions between a medical and surgical approach. Early post-operative medical prophylaxis with an advanced therapy is an important consideration to prevent disease recurrence. This review expands on the above topics, highlights research gaps and provides a suggested investigation and management pathway in stricturing Crohn's disease.
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Affiliation(s)
- Alexander T Elford
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Australia.
- Faculty of Medicine, Melbourne University, Melbourne, Australia.
- Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, UK.
| | - Zaid Ardalan
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Melbourne University, Melbourne, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
| | - Paul Simkin
- Radiology Department, Royal Melbourne Hospital, Melbourne, Australia
| | - Britt Christensen
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Melbourne University, Melbourne, Australia
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Schnitzler F, Tillack-Schreiber C, Szokodi D, Braun I, Tomelden J, Sohn M, Bader F, Waggershauser C, Ochsenkühn T. Safety of perioperative treatment with biologics in patients with inflammatory bowel disease undergoing bowel surgery: Experience from a large urban center. PLoS One 2024; 19:e0290887. [PMID: 38236926 PMCID: PMC10796016 DOI: 10.1371/journal.pone.0290887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/15/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND AND AIMS Risks of peri- and postoperative complications after bowel surgery in patients with inflammatory bowel disease (IBD) receiving biologics are still discussed controversially. We therefore addressed the safety of different biologics that were applied in our IBD center before surgery. METHODS Data of IBD patients who underwent bowel resections between 2012 and 2022 at our hospital were analyzed retrospectively. Exposure to biologics was defined by receiving biologics within 12 weeks before resective abdominal surgery. Safety considerations included minor complications, such as infections and wound healing disorders and major complications, e.g., anastomotic insufficiency or abscess formation. RESULTS A total of 447 IBD patients (334 with Crohn's disease, 113 with ulcerative colitis), 51.9% female, were included and followed for a median follow-up of 45 months [range 0-113]. A total of 73.9% (326/447) were undergoing medical treatment at date of surgery, 61.5% (275/447) were treated with biologics within 3 months and 42.3% (189/447) within 4 weeks before surgery. Most surgeries (97.1%) were planned electively and 67.8% were performed laparoscopically. Major and minor complications occurred in 20.8% (93/447) of patients. Serious complications were rare: Six patients had acute postoperative bleeding, one CD patient developed peritonitis and two CD patients died postoperatively. After adjusting for age, disease duration, disease activity, Montreal classification, and medical treatment at date of surgery, no significant differences were observed regarding complications and exposure to biologics. CONCLUSIONS This retrospective single center study of 447 IBD patients goes to demonstrate that perioperative use of biologics is not associated with a higher risk of complications.
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Affiliation(s)
- Fabian Schnitzler
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Praxisklinik München-Pasing, Munich, Germany
- Synesis IBD Research Center, Munich, Germany
| | - Cornelia Tillack-Schreiber
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- IBD-Center Munich, Munich, Germany
| | | | | | - June Tomelden
- Department of Surgery, Isarklinikum Munich, Munich, Germany
| | | | - Franz Bader
- Department of Surgery, Isarklinikum Munich, Munich, Germany
| | - Constanze Waggershauser
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- IBD-Center Munich, Munich, Germany
| | - Thomas Ochsenkühn
- Department of Medicine II—Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany
- Synesis IBD Research Center, Munich, Germany
- IBD-Center Munich, Munich, Germany
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24
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Srinivasan AR. Treat to target in Crohn's disease: A practical guide for clinicians. World J Gastroenterol 2024; 30:50-69. [PMID: 38293329 PMCID: PMC10823901 DOI: 10.3748/wjg.v30.i1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
A treat-to-target (T2T) approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE)-II guidelines specify short, intermediate, and long-term treatment goals, documenting specific treatment targets to be achieved at each of these timepoints. Scheduled appraisal of Crohn's disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified. Consensus treatment targets in Crohn's disease comprise combination clinical and patient-reported outcome remission, in conjunction with biomarker normalisation and endoscopic healing. Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing, clinicians must consider that this may not always be appropriate, acceptable, or achievable in all patients. This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets. The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques, particularly intestinal ultrasound, holds great promise; as do emerging treatment targets such as transmural healing. Two randomised clinical trials, namely, CALM and STARDUST, have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn's disease. Findings from these studies reflect that patient subgroups and Crohn's disease characteristics likely to benefit most from a T2T approach, remain to be clarified. Moreover, outside of clinical trials, data pertaining to the real-world effectiveness of a T2T approach remains scare, highlighting the need for pragmatic real-world studies. Despite the obvious promise of a T2T approach, a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake. This highlights the need to describe strategies, processes, and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice. Hence, this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn's disease.
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Affiliation(s)
- Ashish R Srinivasan
- Department of Gastroenterology, Austin Health, Victoria, Melbourne 3083, Australia
- Department of Gastroenterology, Eastern Health, Victoria, Melbourne 3128, Australia
- Department of Medicine, University of Melbourne, Victoria, Melbourne 3052, Australia
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Zhu Y, Xu W, Liu Z, Li B, Wu Y, Hua Z, Wang Y, Wang X, Du P, Yang H. Surface-enhanced Raman spectroscopy analysis reveals biochemical difference in urine of patients with perianal fistula. Asian J Surg 2024; 47:140-146. [PMID: 37308382 DOI: 10.1016/j.asjsur.2023.05.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND & AIMS Perianal fistulising Crohn's disease (PFCD) is different from the characteristics and outcomes of traditional non-inflammatory bowel disease (IBD) anal fistulas. The presence of perianal disease was a poor prognostic indicator for Crohn's disease (CD) patients and PFCD patients were more likely to bear an increased risk of recurrence. However, the effective and accurate diagnosis methods to early distinguish PFCD from simple perianal fistula were still scarce. The purpose of this study is to develop a non-invasive detecting approach to predict CD in patients with perianal fistulas. METHODS Data on patients with anal fistulizing disease were collected from July 2020 to September 2020 in two IBD centers. Urine samples from PFCD and simple perianal fistula patients were investigated by surface-enhanced Raman spectroscopy (SERS). Principal component analysis (PCA)-support vector machine (SVM) was utilized to establish classification models to distinguish PFCD from simple perianal fistula. RESULTS After a case-matched 1:1 selection by age and gender, 110 patients were included in the study. By analyzing the average SERS spectra of PFCD and simple perianal fistula patients, it revealed that there were significant differences in intensities at 11 Raman peaks. The established PCA-SVM model distinguished PFCD from simple perianal fistula with a sensitivity of 71.43%, specificity 80.00% and accuracy 75.71% in the leave-one-patient-out cross-validation. The accuracy of the model in validation cohort was 77.5%. CONCLUSIONS Investigation of urine samples by SERS helps clinicians to predict Crohn's disease from perianal fistulas, which make patients achieve benefit from a more individualized treatment strategy.
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Affiliation(s)
- Yilian Zhu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Weimin Xu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Zhiyuan Liu
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China
| | - Bingyan Li
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China
| | - Yaling Wu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Zhebin Hua
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Yaosheng Wang
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China
| | - Xiaolei Wang
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Peng Du
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, China.
| | - Huinan Yang
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, 200093, Shanghai, China.
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Steinwurz F, Machado MB, Veitia G, De Paula JA, Bautista Martinez S, Vergara BI, Capdevielle B, Martinez Silva FA, Ramirez AL. Latin America consensus statement inflammatory bowel disease: importance of timely access to diagnosis and treatment. Therap Adv Gastroenterol 2023; 16:17562848231207312. [PMID: 38144423 PMCID: PMC10748906 DOI: 10.1177/17562848231207312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/26/2023] [Indexed: 12/26/2023] Open
Abstract
Background Inflammatory bowel diseases (IBDs) are chronic conditions that negatively interferes with the quality of life of the patients, on a physical, emotional, and social level. Its symptoms can vary including diarrhea, bleeding, abdominal pain, fever, and weight loss, depending on the type and location and severity of the disease. Despite evolving treatment, they do not always achieve control of the symptoms, so between 23% and 45% of people with idiopathic chronic ulcerative colitis, and up to 75% of those with Crohn's disease, eventually, will need surgery. Objective The increase in its incidence in Latin America has promoted a renewed interest on the part of the medical and scientific community in standardizing and unifying criteria for the proper diagnosis and management of the disease, which is part of the current discussions of various events; however, this interest has not yet been reflected in policies and initiatives by governments to address the disease. We decided to develop a consensus meeting in order to elucidate the actual situation of IBD care in our region. Design The methodology employed to build the consensus document derived from a review of literature, evidence, and policies on IBD, followed by a process of validation and feedback with a group of 10 experts in the field. Methods Nine experts from different countries in Latin America were reunited in web meetings on 2 days and voted on topics derived from the consensus document. A full agreement with 100% approval was needed, so topics were discussed to reach the consensus otherwise were removed. Results There is still a lack of information about IBD in Latin America, therefore IBD continues to be an 'invisible' disease and is little recognized by decision-makers. Conclusion This document describes the current situation of IBDs in the Latin American region, highlighting the main barriers and challenges in timely access to diagnosis and treatment, in order to demonstrate the need to promote the development and implementation of policies, in order to improve the quality of care of patients with IBD.
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Affiliation(s)
- Flavio Steinwurz
- Gastroenterology, Hospital Israelita Albert Einstein, Rua da Consolacao 3741, Sao Paulo 01416-001, Brazil
| | | | - Guillermo Veitia
- Gastroenterology, Hospital Dr José María Vargas de Caracas, Caracas, Venezuela
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Bachour SP, Khan MZ, Shah RS, Joseph A, Syed H, Ali AH, Rieder F, Holubar SD, Barnes EL, Axelrad J, Regueiro M, Cohen BL, Click BH. Anastomotic Configuration and Temporary Diverting Ileostomy Do Not Increase Risk of Anastomotic Stricture in Postoperative Crohn's Disease. Am J Gastroenterol 2023; 118:2212-2219. [PMID: 37410924 PMCID: PMC10921865 DOI: 10.14309/ajg.0000000000002393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Surgical management of Crohn's disease (CD) is common. Postoperative complications include anastomotic stricturing (AS). The natural history and risk factors for AS have not been elucidated. METHODS A retrospective cohort study of patients with CD who underwent ileocolonic resection (ICR) with ≥1 postoperative ileocolonoscopy between 2009 and 2020. Postoperative ileocolonoscopies with corresponding cross-sectional imaging were evaluated for evidence of AS without neoterminal ileal extension. Severity of AS and endoscopic intervention at time of detection were collected. Primary outcome was development of AS. Secondary outcome was time to AS detection. RESULTS A total of 602 adult patients with CD underwent ICR with postoperative ileocolonoscopy. Of these, 426 had primary anastomosis, and 136 had temporary diversion at time of ICR. Anastomotic configuration consisted of 308 side-to-side, 148 end-to-side, and 136 end-to-end. One hundred ten (18.3%) patients developed AS with median time of 3.2 years to AS detection. AS severity at time of detection was associated with need for repeat surgical resection for AS. On multivariable Cox proportional hazard regression, anastomotic configuration and temporary diversion were not associated with risk of or time to AS. Preoperative stricturing disease was associated with decreased time to AS (adjusted hazard ratio 1.8; P = 0.049). Endoscopic ileal recurrence before AS was not associated with subsequent AS detection. DISCUSSION AS is a relatively common postoperative CD complication. Patients with previous stricturing disease behavior are at increased risk of AS. Anastomotic configuration, temporary diversion, and ileal CD recurrence do not increase risk of AS. Early detection and intervention for AS may help prevent progression to repeat ICR.
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Affiliation(s)
- Salam P. Bachour
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Muhammad Z. Khan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ravi S. Shah
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Hareem Syed
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Adel Hajj Ali
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH, USA
| | - Stefan D. Holubar
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Edward L. Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan Axelrad
- Department of Gastroenterology and Hepatology, New York University, New York, NY, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin L. Cohen
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin H. Click
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Yzet C, Riault C, Brazier F, Grados L, Nguyen-Khac E, Chatelain D, Sabbagh C, Buisson A, Diouf M, Fumery M. Positive margins and plexitis increase the risk of recurrence after ileocecal resection: A systematic review and meta-analysis. Dig Liver Dis 2023; 55:1611-1620. [PMID: 36658042 DOI: 10.1016/j.dld.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/23/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION There is debate over the impact of residual microscopic disease after ileocecal resection in Crohn's disease (CD) to predict recurrence. We conducted a meta-analysis to evaluate the impact of positive histological margins and plexitis after ileocecal resection on the risk of postoperative recurrence. METHODS Using a systematic search, we identified. 30 studies evaluating the impact of inflammatory margins on CD recurrence. The primary outcome was the postoperative clinical recurrence and secondary outcomes were surgical, and endoscopic recurrence. We performed random-effects meta-analysis and estimated odds ratio (OR) and 95% CIs. RESULTS Thirty studies were analyzed, seven focused on myenteric plexitis, six on submucosal plexitis and twenty-three on positive margins. Inflammatory margins were associated with a higher rate of clinical and surgical recurrences: respectively 14 studies - OR 2.38; 95% CI, 1.54 - 3.68- I2 = 68.2%, Q test-p = 0.0003 and 8 studies - OR, 1.52; 95% CI, 1.07-2.16 - I2 =0%; Q test-p = 0.43. The presence of myenteric plexitis was associated with a higher rate of clinical recurrence (4 studies- OR, 1.60; 95%CI, 1.12-2.29; I2= 0%, Q-test-p = 0.61), and of endoscopic recurrence (4 studies - OR, 4.25; 95%CI; 2.06-8.76; I2= 0%, Q test-p = 0.97). Submucosal plexitis was not associated with an increased risk of endoscopic recurrence (4 studies - OR, 0.94; 95%CI; 0.58-1.52; I2= 0%, Q test-p = 0.79). CONCLUSION Inflammatory margins and/or plexitis were associated with postoperative recurrence after ileocecal resection for CD. These elements should be taken into account in future algorithm for prevention of postoperative recurrence.
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Affiliation(s)
- Clara Yzet
- Department of gastroenterology, Amiens University hospital, Picardie University, Amiens, France
| | - Clémentine Riault
- Department of gastroenterology, Amiens University hospital, Picardie University, Amiens, France
| | - Franck Brazier
- Department of gastroenterology, Amiens University hospital, Picardie University, Amiens, France
| | - Lucien Grados
- Department of gastroenterology, Amiens University hospital, Picardie University, Amiens, France
| | - Eric Nguyen-Khac
- Department of gastroenterology, Amiens University hospital, Picardie University, Amiens, France
| | | | | | - Anthony Buisson
- Department of gastroenterology, Clermont-Ferrand University hospital, Clermont-Ferrand, France
| | - Momar Diouf
- Department of statistics, Amiens University hospital, Picardie University, Amiens, France
| | - Mathurin Fumery
- Department of gastroenterology, Amiens University hospital, Picardie University, Amiens, France; PériTox Laboratory, Périnatalité & Risques Toxiques, UMR-I 01 INERIS, Picardie Jules Verne University, Amiens, France.
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Bouhnik Y, Pineton de Chambrun G, Lambert J, Nachury M, Seksik P, Altwegg R, Vuitton L, Stefanescu C, Nancey S, Aubourg A, Serrero M, Filippi J, Desseaux K, Viennot S, Abitbol V, Boualit M, Bourreille A, Giletta C, Buisson A, Roblin X, Dib N, Malamut G, Amiot A, Fumery M, Louis E, Elgharabawy Y, Peyrin-Biroulet L. Adalimumab in Biologic-naïve Patients With Crohn's Disease After Resolution of an Intra-abdominal Abscess: A Prospective Study From the GETAID. Clin Gastroenterol Hepatol 2023; 21:3365-3378.e5. [PMID: 36731588 DOI: 10.1016/j.cgh.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS The management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging, and surgery with delayed intestinal resection is often recommended. The aims of this study were to estimate the success rate of adalimumab (ADA) in patients with CD with an intra-abdominal abscess resolved without surgery, and to identify predictive factors for success. METHODS A multicenter, prospective study was conducted in biologic-naïve patients with CD with resolved intra-abdominal abscess treated with ADA with a 2-year follow-up. The primary endpoint was ADA failure at week (W) 24 defined as a need for steroids after W12, intestinal resection, abscess recurrence, and clinical relapse. Secondary post-hoc endpoint was the long-term success defined as the survival without abscess relapse or intestinal resection at W104. The factors associated with ADA failure at W24 and W104 were identified using a logistic and a Cox regression, respectively. RESULTS From April 2013 to December 2017, 190 patients from 27 GETAID centers were screened, and 117 were included in the analysis. Fifty-eight patients (50%) were male, and the median age at baseline was 28 years. At W24, 87 patients (74%; 95% confidence interval [CI], 65.5%-82.0%; n = 117) achieved ADA success. Among the 30 patients with ADA failure, 15 underwent surgery. At W104, the survival rate without abscess recurrence or surgery was 72.9% (95% CI, 62.1%-79.8%; n = 109). Abscess drainage was significantly associated with ADA failure at W24 (odds ratio, 4.18; 95% CI, 1.06-16.5; P =0 .043). Disease duration (hazard ratio [HR], 1.32; 95% CI, 1.09-1.59; P = .008), abscess drainage (HR, 5.59; 95% CI, 2.21-14.15; P = .001), and inflammatory changes in mesenteric fat (HR, 0.4; 95% CI, 0.17-0.94; P = .046) were significantly associated with ADA failure at W104. CONCLUSION Provided that the abscess was carefully managed before initiating medical treatment, this study showed the high efficacy of ADA in the short and long term in biologic-naïve patients with CD complicated by an intra-abdominal abscess. CLINICALTRIALS gov, Number: NCT02856763.
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Affiliation(s)
- Yoram Bouhnik
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France.
| | | | - Jérôme Lambert
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Maria Nachury
- University Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Philippe Seksik
- Département de Gastroentérologie, Hôpital Saint Antoine, Sorbonne Université, Inserm, CRSA, AP-HP, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Éloi, CHU, Montpellier, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Carmen Stefanescu
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Lyon University, Lyon, France
| | - Alexandre Aubourg
- Department of Gastroenterology, Tours University Hospital, Tours, France
| | - Mélanie Serrero
- Department of Gastroenterology, Hôpital Nord, Marseille University, Marseille, France
| | - Jérôme Filippi
- Department of Gastroenterology, Nice University Hospital, Nice, France
| | - Kristell Desseaux
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Stéphanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Vered Abitbol
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Madina Boualit
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | - Arnaud Bourreille
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Department of Gastroenterology, CIC Inserm 1413, Nantes University, Nantes, France
| | - Cyrielle Giletta
- Department of Gastroenterology, Toulouse University Hospital, Hôpital Rangueil, Toulouse, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm U1071, M2iSH, CHU Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Georgia Malamut
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Creteil University, Creteil, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, Liège, Belgium
| | - Yasmine Elgharabawy
- Groupe Etude Thérapeutiques des Affections Inflammatoires Digestives, GETAID, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Brabois Hospital, Nancy University, Nancy les Vandoeuvre-lès-Nancy, France
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Magro F, Protic M, De Hertogh G, Chan LS, Pollack P, Jairath V, Carlier H, Hon E, Feagan BG, Harpaz N, Pai R, Reinisch W. Effects of Mirikizumab on Histologic Resolution of Crohn's Disease in a Randomized Controlled Phase 2 Trial. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00948-5. [PMID: 37993033 DOI: 10.1016/j.cgh.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND & AIMS Histologic evaluation of mucosal healing in Crohn's disease is an evolving treatment target. We evaluated histologic outcomes for mirikizumab efficacy and associations with endoscopic and 1-year outcomes. METHODS Biopsy specimens from 1 ileal and 4 colonic segments were evaluated at weeks 0, 12, and 52 from each of the 170 SERENITY participants. Criteria for the weeks 12 and 52 histologic response were no epithelial neutrophils or epithelial damage, or >50% decrease in either the Robarts Histopathology Index or the active Global Histologic Disease Activity Score, and remission (no mucosal neutrophils and no epithelial damage) had to be met in all biopsy specimens. Agreement was evaluated between histologic and endoscopic end points. Associations between 1-year outcomes and week 12 histologic and endoscopic response were evaluated. RESULTS At week 12, 1000 mg mirikizumab resulted in greater rates of histologic response (66% vs 27%; P < .001) and remission (26% vs 6%; P < .01) than placebo. Rates were numerically similar at 1 year (mirikizumab pooled response, 46%-69%; remission, 13%-31%). Agreement between week 12 histologic and endoscopic response was 69% (Cohen's kappa coefficient [κ] = 0.40) and remission was 83% (κ = 0.38) in all pooled arms, including placebo. At 1 year, the percentage of participants who received any dose of mirikizumab and achieved endoscopic remission differed by their week 12 response: histologic (20%), endoscopic (25%), combined histology-endoscopy (45%), or neither (4%) (P = .003). CONCLUSIONS In a post hoc analysis of phase 2 data, mirikizumab induced and sustained histologic response and remission in Crohn's disease over 52 weeks. Early combined histologic-endoscopic response was associated with endoscopic remission after 1 year of treatment with mirikizumab (ClinicalTrials.gov NCT02891226).
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marijana Protic
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana.
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Lai Shan Chan
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | - Paul Pollack
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | - Vipul Jairath
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Hilde Carlier
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | - Emily Hon
- Medical Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | | | - Noam Harpaz
- Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rish Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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31
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Fernandes SR, Bernardo S, Saraiva S, Rita Gonçalves A, Moura Santos P, Valente A, Araújo Correia L, Cortez-Pinto H, Magro F. Proactive Infliximab Monitoring Improves the Rates of Transmural Remission in Crohn's Disease: A Propensity Score-Matched Analysis. Inflamm Bowel Dis 2023:izad272. [PMID: 37982426 DOI: 10.1093/ibd/izad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Few patients can reach transmural remission in Crohn's disease (CD) with currently available therapies. Proactive optimization of infliximab (IFX) based on trough levels may potentially improve these results. METHODS Retrospective cohort study including consecutive CD patients starting treatment with IFX. Rates of transmural remission were compared between patients with and without therapeutic drug monitoring (target level: 5-7 µg/mL). A propensity score-matched analysis was performed to adjust for potential confounders. RESULTS A total of 195 CD patients were included, 57.9% receiving proactive therapeutic drug monitoring. The rates of transmural remission were higher in patients under proactive therapeutic drug monitoring (37.2% vs 18.3%; P = .004) with similar results in the propensity score-matched analysis (34.2% vs 17.1%; P = .025). In multivariate analysis, proactive therapeutic drug monitoring was independently associated with transmural remission (odds ratio, 2.95; 95% confidence interval, 1.44-6.06; P = .003). CONCLUSIONS Proactive optimization of IFX based on trough levels increases the rates of transmural remission in CD.
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Affiliation(s)
- Samuel Raimundo Fernandes
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Clínica Universitária de Gastrenterologia da Faculdade de Medicina de Lisboa, Lisbon, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal
| | - Sónia Bernardo
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal
| | - Sofia Saraiva
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal
| | - Ana Rita Gonçalves
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal
| | - Paula Moura Santos
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Clínica Universitária de Gastrenterologia da Faculdade de Medicina de Lisboa, Lisbon, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal
| | - Ana Valente
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Luís Araújo Correia
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Clínica Universitária de Gastrenterologia da Faculdade de Medicina de Lisboa, Lisbon, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal
| | - Helena Cortez-Pinto
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Clínica Universitária de Gastrenterologia da Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Fernando Magro
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal
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Furfaro F, D'Amico F, Zilli A, Craviotto V, Aratari A, Bezzio C, Spinelli A, Gilardi D, Radice S, Saibeni S, Papi C, Peyrin-Biroulet L, Danese S, Fiorino G, Allocca M. Noninvasive Assessment of Postoperative Disease Recurrence in Crohn's Disease: A Multicenter, Prospective Cohort Study on Behalf of the Italian Group for Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2023; 21:3143-3151. [PMID: 36521739 DOI: 10.1016/j.cgh.2022.11.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Colonoscopy (CS) is the gold standard to assess postoperative recurrence (POR) in Crohn's disease (CD). However, CS is invasive and may be poorly tolerated by patients. The aim of this study was to prospectively assess the diagnostic accuracy of a noninvasive approach in detecting POR, using the endoscopic Rutgeerts' score (RS) as the reference standard. METHODS Consecutive patients with CD who underwent ileo-cecal resection were prospectively enrolled in 3 referral Italian centers. Patients underwent CS and bowel ultrasound within 1 year of surgery. Uni- and multivariable analyses were used to assess the correlation between noninvasive parameters and endoscopic recurrence, defined by a RS ≥2. RESULTS Ninety-one patients were enrolled. Sixty patients (66%) experienced endoscopic POR. The multivariable analysis identified bowel wall thickness (BWT) per 1-mm increase (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.21-4.89; P = .012), the presence of mesenteric lymph nodes (OR, 15.63; 95% CI, 1.48-164.54; P = .022), and fecal calprotectin (FC) values ≥50 mcg/g (OR, 8.58; 95% CI, 2.45-29.99; P < .001) as independent predictors for endoscopic recurrence. The presence of lymph nodes or the combination of BWT ≥3 mm and FC values ≥50 mcg/g correctly classified 56% and 75% of patients, with less than 5% of patients falsely classified as having endoscopic recurrence. Conversely, the combination of BWT <3 mm and FC <50 mcg/g correctly classified 74% of patients with only 4.5% of patients falsely classified as not having endoscopic recurrence. CONCLUSIONS A noninvasive approach combining bowel ultrasound and FC can be used with confidence for detecting POR in patients with CD without the requirement for CS.
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Affiliation(s)
- Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ferdinando D'Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alessandra Zilli
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | | | | | - Simona Radice
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, Nancy, France; University of Lorraine, Inserm, NGERE, Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Gionata Fiorino
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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Yanai H, Sharar Fischler T, Goren I, Eran-Banai H, Ollech JE, Snir Y, Broitman Y, Barkan R, Pfeffer-Gik T, Godny L, Kutokov Y, Friedeberg A, Pauker MH, Rabinowitz KM, Avni-Biron I, Dotan I. A Real-World Prospective Cohort Study of Patients With Newly Diagnosed Crohn's Disease Treated by a Multidisciplinary Team: 1-Year Outcomes. CROHN'S & COLITIS 360 2023; 5:otad064. [PMID: 37941598 PMCID: PMC10629218 DOI: 10.1093/crocol/otad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Indexed: 11/10/2023] Open
Abstract
Background Real-world data on outcomes of patients with newly diagnosed Crohn's disease (ndCD) is limited. We aimed to assess the achievement of corticosteroid-free clinical remission (CS-free CR) and other therapeutic targets 1 year after diagnosis in a cohort of patients with ndCD treated by a multidisciplinary team (MDT). Methods A prospective observational cohort study was conducted on consecutive treatment-naïve adults with ndCD. Patients received management at the treating physician's discretion, along with a tailored nutritional plan provided by an inflammatory bowel disease (IBD)-oriented dietitian. Patients were guided and educated by an IBD nurse, with flexible communication access to the IBD team. Therapeutic targets were assessed at 1 year. Multivariable logistic regression was used to evaluate predictors of CS-free CR. Results Seventy-six patients (50% female) with a median age of 27 (22-39) years were eligible. Over 75% of patients were assessed by IBD-oriented dietitians and the IBD nurse. Within a median of 4.3 (2.5-6.7) months from diagnosis 60.5% initiated biologics (96% anti- tumor necrosis factor). Dietary intervention was applied to 77.6% of the cohort, either monotherapy (33.9%) or add-on (66.1%). At 1 year, 64.5% of patients achieved sustained CS-free CR, 56.6% biochemical remission, 55.8% endoscopic response, 44.2% endoscopic remission, 30.8% deep remission, and in 39.5% there was an improvement in health-related quality of life (HRQoL). Predictors for CS-free CR were uncomplicated phenotype (B1/P0), lower body mass index, and lower patient-reported outcome 2 scores at diagnosis. Conclusions In a real-world setting at a tertiary medical center, a cohort of ndCD patients treated by an MDT resulted in favorable 1-year outcomes. Over 60% achieved CS-free CR, along with significant improvements in biomarkers and HRQoL.
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Affiliation(s)
- Henit Yanai
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Sharar Fischler
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Goren
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hagar Eran-Banai
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob E Ollech
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Snir
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yelena Broitman
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Barkan
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Pfeffer-Gik
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lihi Godny
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yelena Kutokov
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Friedeberg
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maor H Pauker
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Masha Rabinowitz
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Felsenstein Medical Research Center, Faculty of Medicine, Tel Aviv, Israel
| | - Irit Avni-Biron
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Narula N, Wong ECL, Aruljothy A, Dulai PS, Colombel JF, Marshall JK, Ferrante M, Reinisch W. Baseline Patient-reported Symptoms Less Predictive Than MM-SES-CD for Endoscopic Remission in Crohn's Disease. J Clin Gastroenterol 2023; 57:913-919. [PMID: 36227009 DOI: 10.1097/mcg.0000000000001774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/04/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND This analysis evaluates the association between baseline patient-reported symptom (PRS) severity in Crohn's disease (CD), including abdominal pain, stool frequency, general well-being, and achievement of clinical and endoscopic outcomes. We compared baseline PRS to baseline endoscopic scores for the prediction of endoscopic remission (ER). METHODS This post hoc analysis of 2 clinical trials of infliximab in CD included 601 patients and evaluated baseline PRS variables (abdominal pain, stool frequency, and general well-being) as measured by the Crohn's disease activity index and their association with 6-month clinical remission (CR) (Crohn's Disease Activity Index<150), corticosteroid-free CR, and week 26/54 ER (absence of mucosal ulceration). Logistic regression models assessed the relationships between PRS and outcomes of interest. Receiver operating characteristic curve analyses compared the sensitivity and specificity of the different baseline PRS compared with baseline endoscopic scores for achievement of ER at weeks 26 and 54. RESULTS No difference was found comparing patients with higher baseline PRS to those with lower PRS in achieving 6-month CR, 6-month corticosteroid-free CR, or week 26/54 ER. Modified multiplier of the SES-CD (MM-SES-CD) at baseline demonstrated a significant ability to predict week 54 ER (area under the curve, 0.71; 95% CI 0.65-0.78; P =0.017). CONCLUSIONS Baseline PRS in CD is not prognostic of clinical or endoscopic response. In contrast, active endoscopic disease as measured by the MM-SES-CD, more accurately predicts endoscopic outcomes. Endoscopic scores such as the MM-SES-CD may be considered for selection criteria and as a primary outcome of interest in CD trials, with PRS as a co-primary or secondary endpoint.
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Affiliation(s)
- Neeraj Narula
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Emily C L Wong
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Achuthan Aruljothy
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Parambir S Dulai
- Division of Gastroenterology, Northwestern University, Chicago, IL
| | | | - John K Marshall
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Kamal S, Parkash N, Beattie W, Christensen B, Segal JP. Are We Ready to Reclassify Crohn's Disease Using Molecular Classification? J Clin Med 2023; 12:5786. [PMID: 37762727 PMCID: PMC10532006 DOI: 10.3390/jcm12185786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Crohn's disease (CD) is a type of inflammatory bowel disease. The number of IBD cases worldwide was estimated to be 4.9 million in 2019. CD exhibits heterogeneity in clinical presentation, anatomical involvement, disease behaviour, clinical course and response to treatment. The classical description of CD involves transmural inflammation with skip lesions anywhere along the entire gastrointestinal tract. The complexity and heterogeneity of Crohn's disease is not currently reflected in the conventional classification system. Though the knowledge of Crohn's pathophysiology remains far from understood, the established complex interplay of the omics-genomics, transcriptomics, proteomics, epigenomics, metagenomics, metabolomics, lipidomics and immunophenomics-provides numerous targets for potential molecular markers of disease. Advancing technology has enabled identification of small molecules within these omics, which can be extrapolated to differentiate types of Crohn's disease. The multi-omic future of Crohn's disease is promising, with potential for advancements in understanding of its pathogenesis and implementation of personalised medicine.
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Affiliation(s)
- Shahed Kamal
- Department of Gastroenterology, Northern Hospital, Epping, Melbourne VIC 3076, Australia
| | - Nikita Parkash
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Melbourne VIC 3052, Australia
| | - William Beattie
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Melbourne VIC 3052, Australia
| | - Britt Christensen
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Melbourne VIC 3052, Australia
- Department of Gastroenterology, The University of Melbourne, Parkville, Melbourne VIC 3010, Australia
| | - Jonathan P. Segal
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Melbourne VIC 3052, Australia
- Department of Gastroenterology, The University of Melbourne, Parkville, Melbourne VIC 3010, Australia
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Park EY, Baek DH, Kim GH, Kim C, Kim H, Lee JW, Song GA. Longitudinal trends in direct costs and healthcare utilization ascribable to inflammatory bowel disease in the biologic era: a nationwide, population-based study. J Gastroenterol Hepatol 2023; 38:1485-1495. [PMID: 37129098 DOI: 10.1111/jgh.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/17/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND AIM Biologic-era data regarding the direct cost and healthcare utilization of inflammatory bowel disease at the population level are limited, especially in Asia. Thus, we aimed to investigate the nationwide prevalence, direct cost, and healthcare utilization of inflammatory bowel disease in Korea in a recent 10-year period. METHODS Using the Korean National Health Insurance claim data from 2008 to 2017, we investigated all prescription medications and their associated direct costs, hospitalizations, and outpatient visits. We also estimated the nationwide prevalence of inflammatory bowel disease using population census data. RESULTS The estimated inflammatory bowel disease prevalence significantly increased from 108.8/100 000 in 2008 to 140.4/100 000 in 2017. The overall annual costs for inflammatory bowel disease and the healthcare cost per capita increased from $24.5 million (in US dollars) to $105.1 million and from $458.4 to $1456.6 million, respectively (both P < 0.001). Whereas the ratio of outpatient costs increased from 35.3% to 69.4%, that of outpatient days remained steady. The total annual medication cost and proportion rose from $13.3 million to $76.8 million and from 54.2% to 73.3%, respectively, mainly due to the increasing antitumor necrosis factor cost, from $1.5 million to $49.3 million (from 11.1% to 64.1% of the total annual drug cost and from 6.3% to 46.9% of the total annual cost). CONCLUSIONS We observed increasing trends in the prevalence, direct costs, and healthcare utilization of inflammatory bowel disease in Korea in recent years. The attributable cost was mainly driven by rising expenditures on antitumor necrosis factor medications.
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Affiliation(s)
- Eun Young Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Department of Internal Medicine, Dong-Eui Medical Center, Busan, South Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Choongrak Kim
- Department of Statistics, Pusan National University, Busan, South Korea
| | - Hasung Kim
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, South Korea
| | - Jeong Woo Lee
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, South Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Zhang L, Jin Z, Hao J. Efficacy of early biologic therapy versus late/conventional therapy in children and adolescents with Crohn's disease: A systematic review and meta-analysis. Saudi J Gastroenterol 2023; 29:259-268. [PMID: 37787346 PMCID: PMC10644997 DOI: 10.4103/sjg.sjg_190_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023] Open
Abstract
Background The objective of this study was to estimate the effectiveness of early biologics compared to conventional treatment in the management of Crohn's disease among pediatric and adolescent patients. Methods A comprehensive literature search was conducted in four electronic databases to identify relevant studies published from inception to 2023. The inclusion criteria comprised randomized controlled trials (RCTs) and cohort studies that reported on the efficacy and clinical outcomes of early biologic therapy compared to late/conventional therapy in children with Crohn's disease. The quality of the studies was assessed using the Cochrane Risk of Bias tool and the Newcastle Ottawa scale. Results A total of 13 studies (2 RCTs and 11 cohort studies), involving 861 patients, were included in the meta-analysis. The results demonstrated that early biologic therapy was associated with a significantly higher rate of clinical remission (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.10-1.54), lower relapse rates (RR 0.33, 95% CI 0.21-0.53), and improved mucosal healing (RR 1.47, 95% CI 1.10-1.97) compared to late/conventional therapy. However, it should be noted that there was evidence of publication bias among studies reporting clinical remission. Conclusion In conclusion, early biologic therapy is significantly more effective in achieving clinical remission (within two years of diagnosis), promoting mucosal healing, and reducing relapse rates in pediatric and adolescent patients with Crohn's disease, compared to late/conventional therapy. These findings emphasize the importance of initiating biological therapy early in the treatment of Crohn's disease in this patient population.
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Affiliation(s)
- Lei Zhang
- Department of Pediatric Digestive, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhixiao Jin
- Department of Pediatric Digestive, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia Hao
- Department of Pediatric Digestive, Shengjing Hospital of China Medical University, Shenyang, China
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Vieujean S, Kotze PG, Netter P, Germain A, Louis E, Danese S, Peyrin-Biroulet L. Stemming the tide with ileocecal Crohn's disease: when is pharmacotherapy enough? Expert Opin Pharmacother 2023; 24:1595-1607. [PMID: 37401098 DOI: 10.1080/14656566.2023.2232726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Crohn's disease (CD) mostly affects the terminal ileum and ileocecal region and up to 80% of patients end up requiring surgery. Previously reserved for complicated or refractory forms, surgery is now considered as an alternative to medical treatment in localized ileocecal disease. AREAS COVERED This review examines factors associated with response to medical treatment and those associated with the need for surgery in ileocecal CD to identify the patients' profile for whom pharmacotherapy might be enough. Factors associated with the recurrence and the postoperative complications are also reviewed to help the clinician identify patients for whom medical therapy might be preferred. EXPERT’S OPINION LIR!C study long-term follow-up data show that 38% of infliximab-treated patients were still treated with infliximab at the end of their follow-up, while 14% had switched to another biologic or had received immunomodulator or corticosteroid and 48% had CD-related surgery. Only the combination with an immunomodulator was associated with a greater likelihood of continuing infliximab. Patients with ileocecal CD for whom pharmacotherapy might be sufficient are probably those with no risk factors for CD-related surgery.In addition, patients with high risk of recurrence or of post-operative complications may benefit more from medical treatment than from surgery.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil
| | - Patrick Netter
- Université de Lorraine, CNRS, Laboratoire IMoPa, Nancy, France
| | - Adeline Germain
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-Les-Nancy, France
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University of Lorraine, CHRU-Nancy, Nancy, France
- University of Lorraine, INSERM, NGERE, Nancy, France
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Mortreux P, Leroyer A, Dupont C, Ley D, Bertrand V, Spyckerelle C, Guillon N, Wils P, Gower-Rousseau C, Savoye G, Fumery M, Turck D, Siproudhis L, Sarter H. Natural History of Anal Ulcerations in Pediatric-Onset Crohn's Disease: Long-Term Follow-Up of a Population-Based Study. Am J Gastroenterol 2023; 118:1671-1678. [PMID: 37104674 DOI: 10.14309/ajg.0000000000002301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Anal ulcerations are frequently observed in Crohn's disease (CD). However, their natural history remains poorly known, especially in pediatric-onset CD. METHODS All patients with a diagnosis of CD before the age of 17 years between 1988 and 2011 within the population-based registry EPIMAD were followed retrospectively until 2013. At diagnosis and during follow-up, the clinical and therapeutic features of perianal disease were recorded. An adjusted time-dependent Cox model was used to evaluate the risk of evolution of anal ulcerations toward suppurative lesions. RESULTS Among the 1,005 included patients (females, 450 [44.8%]; median age at diagnosis 14.4 years [interquartile range 12.0-16.1]), 257 (25.6%) had an anal ulceration at diagnosis. Cumulative incidence of anal ulceration at 5 and 10 years from diagnosis was 38.4% (95% confidence interval [CI] 35.2-41.4) and 44.0% (95% CI 40.5-47.2), respectively. In multivariable analysis, the presence of extraintestinal manifestations (hazard ratio [HR] 1.46, 95% CI 1.19-1.80, P = 0.0003) and upper digestive location (HR 1.51, 95% CI 1.23-1.86, P < 0.0001) at diagnosis were associated with the occurrence of anal ulceration. Conversely, ileal location (L1) was associated with a lower risk of anal ulceration (L2 vs L1 HR 1.51, 95% CI 1.11-2.06, P = 0.0087; L3 vs L1 HR 1.42, 95% CI 1.08-1.85, P = 0.0116). The risk of fistulizing perianal CD (pCD) was doubled in patients with a history of anal ulceration (HR 2.00, 95% CI 1.45-2.74, P < 0.0001). Among the 352 patients with at least 1 episode of anal ulceration without history of fistulizing pCD, 82 (23.3%) developed fistulizing pCD after a median follow-up of 5.7 years (interquartile range 2.8-10.6). In these patients with anal ulceration, the diagnostic period (pre vs biologic era), exposure to immunosuppressants, and/or anti-tumor necrosis factor did not influence the risk of secondary anoperineal suppuration. DISCUSSION Anal ulceration is frequent in pediatric-onset CD, with nearly half of patients presenting with at least 1 episode after 10 years of evolution. Fistulizing pCD is twice as frequent in patients with present or past anal ulceration.
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Affiliation(s)
| | - Ariane Leroyer
- Lille University Hospital, Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Claire Dupont
- Department of Pediatrics, Gastroenterology, Caen University Hospital, Caen, France
| | - Delphine Ley
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Department of Pediatrics, Lille University Hospital, Lille, France
| | | | | | - Nathalie Guillon
- Lille University Hospital, Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Pauline Wils
- Lille University Hospital, Gastroenterology, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | | | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Dominique Turck
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Laurent Siproudhis
- Department of Gastroenterology, Rennes University Hospital, Rennes, France
| | - Hélène Sarter
- Lille University Hospital, Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
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Wessling J, Kucharzik T, Bettenworth D, Luegering A, Maaser C, Grenacher L, Juchems MS, Ringe KI, Lauenstein T, Schreyer AG. Intestinal MRI in Inflammatory Bowel Disease - Literature and Survey-Based Recommendations regarding Reporting by the German Radiological Society (DRG) and the German Competence Network for Inflammatory Bowel Diseases. ROFO-FORTSCHR RONTG 2023; 195:675-690. [PMID: 37137321 DOI: 10.1055/a-2036-7190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND MR-enterography/enteroclysis (MRE) is increasingly used for primary diagnosis, detection of complications, and monitoring of patients with inflammatory bowel disease (IBD). Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different faculties. The current manuscript describes the features that are required for optimized reporting of MRE in IBD. METHODS An expert consensus panel of radiologists and gastroenterologists conducted a systematic search of the literature. In a Delphi process, members of the German Radiological Society (DRG) and members of the Competence Network for Inflammatory Bowel Diseases voted on relevant criteria for the reporting of findings in MRE. Based on the voting results, statements were developed by the expert consensus panel. RESULTS Clinically relevant aspects of MRE findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on the description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images. CONCLUSION The current manuscript provides standardized parameters and gives practical recommendations on how to report and how to characterize MRE findings in patients with IBD. KEY POINTS · Systematic overview provides practice-oriented recommendations and names and evaluates the decisive criteria for reporting and interpretation of MRI in inflammatory bowel disease.. · Standardized terminology and reporting criteria for MRI in IBD improves interdisciplinary communication.. · Standardized collection and documentation of MRI findings in IBD helps to further establish the method and to improve care for IBD patients.. CITATION FORMAT · Wessling J, Kucharzik T, Bettenworth D et al. Intestinal MRI in Inflammatory Bowel Disease - Literature and Survey-Based Recommendations regarding Reporting by the German Radiological Society (DRG) and the German Competence Network for Inflammatory Bowel Diseases. Fortschr Röntgenstr 2023; 195: 675 - 690.
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Affiliation(s)
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Municipal Hospital Clinic for General Internal Medicine and Gastroenterology, Lüneburg, Germany
| | - Dominik Bettenworth
- Department for CED, praxis for internal medicine and CED, Himmelreichallee 37-41, Muenster, Germany
| | - Andreas Luegering
- center for gastrointestinal diseases, mvz portal 10 Muenster, Germany
| | - Christian Maaser
- Department of Gastroenterology, Lüneburg Municipal Hospital Clinic for General Internal Medicine and Gastroenterology, Lüneburg, Germany
| | - Lars Grenacher
- Imaging and Prevention Center, Conradia Radiology Munich, Germany
| | - Markus S Juchems
- Department of interventional and diagnostic radiology, Schmieder Hospitals - Hospital Konstanz, Germany
| | | | - Thomas Lauenstein
- Department of Radiology, Evangelical Hospital Düsseldorf Medical Clinic, Düsseldorf, Germany
| | - Andreas G Schreyer
- Institute of diagnostic and interventional radiology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg a. d. Havel, Germany
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Dane B, Li X, Goldberg JD, O'Donnell T, Le L, Megibow A. Crohn's disease phenotype analysis with iodine density from dual-energy CT enterography. Abdom Radiol (NY) 2023; 48:2219-2227. [PMID: 37097450 DOI: 10.1007/s00261-023-03923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To compare dual-source dual-energy CT enterography (dsDECTE) obtained iodine density (I) (mg/mL) and I normalized to the aorta (I%) with Crohn's disease (CD) phenotypes defined by the SAR-AGA small bowel CD consensus statement. METHODS Fifty CD patients (31 male, 19 female; mean [SD] age: 50.4 [15.2] years) who underwent dsDECTE were retrospectively identified. Two abdominal radiologists assigned CD phenotypes: no active inflammation (group-2), active inflammation without (group-3) or with luminal narrowing (group-4), stricture with active inflammation (group-5), stricture without active inflammation (group-1), and penetrating disease (group-6). Semiautomatic prototype software was used to determine the median I and I% of CD-affected small bowel mucosa for each patient. The means of the I and I% medians were compared among 4 groups ("1 + 2", "3 + 4", "5", "6") using one-way ANOVA (significance level 0.05 for each outcome) for each outcome individually followed by Tukey's range test for pairwise comparisons with adjusted p-values (overall alpha = 0.05). RESULTS Mean [SD] I was 2.14 [1.07] mg/mL for groups 1 + 2 (n = 16), 3.54 [1.71] mg/mL for groups 3 + 4 (n = 15), 5.5 [3.27] mg/mL for group- "5" (n = 9), and 3.36 [1.43] mg/mL for group-"6" (n = 10) (ANOVA p = .001; group "1 + 2" versus "5" adj-p = .0005). Mean [SD] I% was 21.2 [6.13]% for groups 1 + 2, 39.47 [9.71]% for groups 3 + 4, 40.98 [11.76]% for group-5, and 35.01 [7.58]% for group-6 (ANOVA p < .0001; groups "1 + 2" versus "3 + 4" adj-p < .0001, group "1 + 2" versus "5" adj-p < .0001, and groups "1 + 2" versus "6" adj-p = .002). CONCLUSION Iodine density obtained from dsDECTE significantly differed among CD phenotypes defined by SAR-AGA, with I (mg/mL) increasing with phenotype severity and decreasing for penetrating disease. I and I% can be used to phenotype CD.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA.
| | - Xiaochun Li
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Judith D Goldberg
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | | | - Linda Le
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA
| | - Alec Megibow
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA
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Ledder O, Viala J, Serban DE, Urlep D, De Ridder L, Martinelli M, Romano C, Church P, Griffiths C, Oliva S, Basude D, Sharma S, Thomson M. Endoscopic Balloon Dilatation in Pediatric Crohn Disease: An IBD Porto Group Study. J Pediatr Gastroenterol Nutr 2023; 77:62-69. [PMID: 36976584 DOI: 10.1097/mpg.0000000000003783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE/BACKGROUND Endoscopic balloon dilatation (EBD) has been shown to be effective and safe in adults with stricturing Crohn disease (CD) yet pediatric data is sparse. We aimed to assess efficacy and safety of EBD in stricturing pediatric CD. METHODS International collaboration included 11 centers from Europe, Canada, and Israel. Recorded data included patient demographics, stricture features, clinical outcomes, procedural adverse events, and need for surgery. Primary outcome was surgery-free over 12 months and secondary outcomes were clinical response and adverse events. RESULTS Eighty-eight dilatations were performed over 64 dilatation series in 53 patients. Mean age at CD diagnosis was 11.1 (±4.0) years, stricture length 4 cm [interquartile range (IQR) 2.8-5], and bowel wall thickness 7 mm (IQR 5.3-8). Twelve of 64 (19%) patients underwent surgery in the year following the dilatation series, at a median of 89 days (IQR 24-120; range 0-264) following EBD. Seven of 64 (11%) had subsequent unplanned EBD over the year, of whom two eventually underwent surgical resection. Two of 88 (2%) perforations were recorded, 1 of whom was managed surgically, and 5 patients had minor adverse events managed conservatively. There was a significant improvement in all clinical measures following EBD with weighted pediatric CD activity index-defined remission increasing from 13% at baseline to 44%, 46%, and 61%, and absence of obstructive symptoms in 55%, 53%, and 64% of patients at week 2, 8, and 24 respectively. CONCLUSIONS In this largest study of EBD in pediatric stricturing CD to date, we demonstrated that EBD is effective in relieving symptoms and avoiding surgery. Adverse events rates were low and consistent with adult data.
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Affiliation(s)
- Oren Ledder
- From the Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jérôme Viala
- Hôpitaux Universitaire Robert-Debré, APHP, Paris, France
| | - Daniela Elena Serban
- 2nd Clinic of Pediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Darja Urlep
- Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Lissy De Ridder
- Erasmus University MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Massimo Martinelli
- the Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Claudio Romano
- the Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Peter Church
- the Division of Gastroenterology, Hepatology, and Nutrition, SickKids Hospital, Department of Paediatrics, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Chris Griffiths
- the Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Salvatore Oliva
- the Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Dharam Basude
- University Hospitals Bristol and Weston, United Kingdom
| | - Shishu Sharma
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Mike Thomson
- Sheffield Children's Hospital, Sheffield, United Kingdom
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Weng MT, Lin KL, Huang YL, Karki C, Hong JL, Bennett D, Arnold Chan K, Wei SC. Epidemiology, Disease Course, and Clinical Outcomes of Perianal Fistulas and Fissures Crohn's Disease: A Nationwide Population-Based Study in Taiwan. CROHN'S & COLITIS 360 2023; 5:otad035. [PMID: 37497019 PMCID: PMC10368329 DOI: 10.1093/crocol/otad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 07/28/2023] Open
Abstract
Background Population-based data on the course of perianal disease in East Asian populations with Crohn's disease (CD) are limited. This study examined the prevalence, clinical course, and compared the outcomes of CD patients with perianal CD (pCD) versus without pCD in Taiwan. Methods A nationwide population-based study was implemented from 2000 to 2017 by using the Taiwan National Health Insurance Research Database. Results Of 2424 patients with CD, 358 (14.8%) patients with pCD were identified. Most patients with CD and pCD were men (79.3%). The mean age at CD diagnosis was lower in patients with pCD (33.7 years) than in those without pCD (44.9 years). Approximately half the patients with pCD received the pCD diagnosis at least 6 months before receiving a CD diagnosis. Approximately one-third (121/358) of patients with pCD had recurrent fistula; the median recurrence interval was 239 days. Compared with patients without pCD, patients with pCD had higher mean incidences of hospitalization (7.0 vs 3.8, P < .01), outpatient visits (13 vs 2.9, P < .01), and emergency room visits (10.3 vs 4.4, P < .01) over a 15-year period. Although patients with pCD had higher rates of healthcare utilization, their 15-year mortality rate was lower than that of those without pCD (6.1% vs 17.3%, P < .01). Conclusions The period prevalence of pCD in Taiwanese patients with CD was 14.8%. Although patients with pCD required more intensive care and had greater healthcare utilization, they did not have inferior survival outcomes compared with those without pCD.
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Affiliation(s)
- Meng-Tzu Weng
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Kuan-Lin Lin
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Ya-Ling Huang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Chitra Karki
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Jin-Liern Hong
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Dimitri Bennett
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Shu-Chen Wei
- Address correspondence to: Shu-Chen Wei, MD, PhD, Division of Hepatology and Gastroenterology, Department of Internal Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan; or, No. 7 Chung-Shan South Road, Taipei, Taiwan ()
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Tavares de Sousa H, Magro F. How to Evaluate Fibrosis in IBD? Diagnostics (Basel) 2023; 13:2188. [PMID: 37443582 DOI: 10.3390/diagnostics13132188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
In this review, we will describe the importance of fibrosis in inflammatory bowel disease (IBD) by discussing its distinct impact on Crohn's disease (CD) and ulcerative colitis (UC) through their translation to histopathology. We will address the existing knowledge on the correlation between inflammation and fibrosis and the still not fully explained inflammation-independent fibrogenesis. Finally, we will compile and discuss the recent advances in the noninvasive assessment of intestinal fibrosis, including imaging and biomarkers. Based on the available data, none of the available cross-sectional imaging (CSI) techniques has proved to be capable of measuring CD fibrosis accurately, with MRE showing the most promising performance along with elastography. Very recent research with radiomics showed encouraging results, but further validation with reliable radiomic biomarkers is warranted. Despite the interesting results with micro-RNAs, further advances on the topic of fibrosis biomarkers depend on the development of robust clinical trials based on solid and validated endpoints. We conclude that it seems very likely that radiomics and AI will participate in the future non-invasive fibrosis assessment by CSI techniques in IBD. However, as of today, surgical pathology remains the gold standard for the diagnosis and quantification of intestinal fibrosis in IBD.
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Affiliation(s)
- Helena Tavares de Sousa
- Gastroenterology Department, Algarve University Hospital Center, 8500-338 Portimão, Portugal
- ABC-Algarve Biomedical Center, University of Algarve, 8005-139 Faro, Portugal
| | - Fernando Magro
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
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Han IS, Baek DH, Hong SM, Lee BE, Lee MW, Kim GH, Song GA. Incidence and adverse clinical events of primary sclerosing cholangitis with ulcerative colitis. Int J Colorectal Dis 2023; 38:175. [PMID: 37349585 DOI: 10.1007/s00384-023-04464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE The aim of this study was to conduct a nationwide population-based study to estimate the incidence of primary sclerosing cholangitis in patients with ulcerative colitis (UC-PSC) and investigate healthcare use, medication use, surgery, cancer, and death as adverse clinical events of UC-PSC. METHODS We identified incident cases of UC with (UC-PSC) or without PSC (UC-alone) between 2008 and 2018 using health insurance claims data in Korea. Univariate (crude hazard ratio (HR)) and multivariate analyses were performed to compare the risk of adverse clinical events between groups. RESULTS A total of 14,406 patients with UC using population-based claims data were detected in the cohort. Overall, 3.38% (487/14,406) of patients developed UC-PSC. During a mean follow-up duration of approximately 5.92 years, the incidence of PSC in patients with UC was 185 per 100,000 person-years. The UC-PSC group showed statistically more frequent healthcare use (hospitalization and emergency department visits: HRs, 5.986 and 9.302, respectively; P < .001), higher immunomodulator and biologic use (azathioprine, infliximab, and adalimumab: HRs, 2.061, 3.457, and 3.170, respectively; P < .001), and higher surgery rate (operation for intestinal obstruction, and colectomy: HRs, 9.728 and 2.940, respectively; P < .001) than did the UC-alone group. The UC-PSC group also showed significantly higher colorectal cancer and biliary tract cancer (HRs, 2.799 and 36.343, respectively; P < .001) and mortality (HR, 4.257) rates than did the UC-alone group. CONCLUSION Patients with UC-PSC have higher risks of colorectal cancer, biliary tract cancer, and death than do patients with UC-alone. Although considered a rare disease, managing this complex and costly disease requires recognition of the impact of increased burden on healthcare services.
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Affiliation(s)
- In Sub Han
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea.
| | - Seung Min Hong
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea
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Ledder O, Homan M, Furlano R, Papadopoulou A, Oliva S, Dias JA, Dall'oglio L, Faraci S, Narula P, Schluckebier D, Hauser B, Nita A, Romano C, Tzivinikos C, Bontems P, Thomson M. Approach to Endoscopic Balloon Dilatation in Pediatric Stricturing Crohn Disease: A Position Paper of the Endoscopy Special Interest Group of ESPGHAN. J Pediatr Gastroenterol Nutr 2023; 76:799-806. [PMID: 36867853 DOI: 10.1097/mpg.0000000000003752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Crohn disease (CD) is often complicated by bowel strictures that can lead to obstructive symptoms, resistant inflammation, and penetrating complications. Endoscopic balloon dilatation of CD strictures has emerged as a safe and effective technique for relieving these strictures, which may obviate the need for surgical intervention in the short and medium term. This technique appears to be underutilized in pediatric CD. This position paper of the Endoscopy Special Interest Group of European Society for Pediatric Gastroenterology, Hepatology and Nutrition describes the potential applications, appropriate evaluation, practical technique, and management of complications of this important procedure. The aim being to better integrate this therapeutic strategy in pediatric CD management.
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Affiliation(s)
- Oren Ledder
- From the Juliet Keidan Institute of Paediatric Gastroenterology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Matjaž Homan
- the Department of Gastroenterology, Hepatology, and Nutrition, Faculty of Medicine, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Raoul Furlano
- the Department of Pediatric Gastroenterology, University Children's Hospital Basel, Basel, Switzerland
| | - Alexandra Papadopoulou
- the First Department of Pediatrics, Athens Children's Hospital "Agia Sofia", University of Athens, Athens, Greece
| | - Salvatore Oliva
- the Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza - University of Rome, Rome, Italy
| | - Jorge Amil Dias
- the Department of Paediatric Gastroenterology, Hospital Lusíadas, Porto, Portugal
| | - Luigi Dall'oglio
- the Digestive Endoscopy Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Simona Faraci
- the Digestive Endoscopy, Gastroenterology, Hepatology, and Nutrition Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Priya Narula
- the Department of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Dominique Schluckebier
- the Department of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Bruno Hauser
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, KidZ Health Castle, Vrije Universiteit Brussel (VUB), UZ Brussel, Brussels, Belgium
| | - Andreia Nita
- the Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, United Kingdom
| | - Claudio Romano
- the Department of Pediatric Gastroenterology, University of Messina, Sicily, Italy
| | - Christos Tzivinikos
- the Department of Pediatric Gastroenterology, Al Jalila Children's Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Patrick Bontems
- the Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, Bruxelles, Belgium
| | - Mike Thomson
- the Department of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
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Burisch J. Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort. APMIS 2023; 131 Suppl 147:1-46. [PMID: 37336790 DOI: 10.1111/apm.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
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Abstract
PURPOSE OF REVIEW Intrabdominal adhesions and intestinal hernias are the commonest cause of small bowel obstruction. Small bowel diseases, which cause small bowel obstruction, are rarer and often poses a challenge to gastroenterologists to diagnose and treat. In this review, small bowel diseases, which predispose to small bowel obstruction, are focused on, and their challenges in diagnosis and treatment. RECENT FINDINGS Diagnosis of causes of partial small bowel obstruction is improved with computed tomography (CT) and magnetic resonance (MR) enterography. In fibrostenotic Crohn's strictures and NSAID diaphragm disease, endoscopic balloon dilatation can delay the need for surgery if the lesion is short and accessible; however, many may still inevitably require surgery. Biologic therapy may reduce the need for surgery in symptomatic small bowel Crohn's disease wherein the strictures are predominantly inflammatory. In chronic radiation enteropathy, only refractory small bowel obstruction and those with nutritional difficulties warrant surgery. SUMMARY Small bowel diseases causing bowel obstruction are often challenging to diagnose and require numerous investigations over a period of time, which often culminate with surgery. Use of biologics and endoscopic balloon dilatation can help to delay and prevent surgery in some instances.
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Affiliation(s)
- Foong Way David Tai
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Reena Sidhu
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Durak MB, Simsek C, İnan B, Yuksel I. Ileocecal valve that cannot be intubated in Crohn's disease: is this a sign of poor prognosis? Int J Colorectal Dis 2023; 38:103. [PMID: 37072530 DOI: 10.1007/s00384-023-04401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND In Crohn's disease (CD), the inability to intubate the ileocecal valve during colonoscopy may be associated with a poor disease prognosis. In this study, we aimed to compare the long-term outcomes of CD patients with and without ileocecal valve intubation during colonoscopy to assess its value as a prognostic parameter. METHODS This retrospective study involved CD patients with isolated ileal involvement who underwent colonoscopy between 1993 and 2022. We compared the basic characteristics and long-term clinical outcomes of two groups of patients: those with intubated and non-intubated ileocecal valves during colonoscopy. RESULTS Of the 155 participants, 97 (62.5%) patients' ileum could be intubated and 58 (37.5%) could not be intubated. The non-intubated group was younger at diagnosis (39 years versus 30.5 years, p = 0.002), but other baseline characteristics such as sex, smoking status, disease duration, perianal disease, and upper gastrointestinal involvements were similar. The non-intubated group had higher rates of steroid dependence (67.2% versus 46.4%; p = 0.012), biologic treatment (89.7% versus 58.8%; p < 0.001), CD-related hospitalization (81% versus 24.7%; p < 0.001), and major abdominal surgery (58.6% versus 15.5%; p < 0.001). In the logistic regression analysis, the positive predictors of successful ileum intubation were inflammatory type CD (OR: 14.821), high serum albumin level (OR: 5.919), and older age (OR: 1.069), while the negative predictors were stenosing (OR: 0.262) and penetrating (OR: 0.247) CD behavior. CONCLUSIONS In Crohn's disease patients with isolated ileal involvement, ileocecal valve cannot be intubated during colonoscopy may indicate the severity of the disease.
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Affiliation(s)
- Muhammed Bahaddin Durak
- Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800, Cankaya, Ankara, Turkey.
| | - Cem Simsek
- Department of Gastroenterology, Health Sciences University, Mehmet, Akif Inan Training and Research Hospital, Sanliurfa, Turkey
- Graduate School of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Bayram İnan
- Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800, Cankaya, Ankara, Turkey
| | - Ilhami Yuksel
- Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800, Cankaya, Ankara, Turkey
- Department of Gastroenterology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
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Moutzoukis M, Argyriou K, Kapsoritakis A, Christodoulou D. Endoscopic luminal stenting: Current applications and future perspectives. World J Gastrointest Endosc 2023; 15:195-215. [PMID: 37138934 PMCID: PMC10150289 DOI: 10.4253/wjge.v15.i4.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/30/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Endoscopic luminal stenting (ELS) represents a minimally invasive option for the management of malignant obstruction along the gastrointestinal tract. Previous studies have shown that ELS can provide rapid relief of symptoms related to esophageal, gastric, small intestinal, colorectal, biliary, and pancreatic neoplastic strictures without compromising cancer patients’ overall safety. As a result, in both palliative and neoadjuvant settings, ELS has largely surpassed radiotherapy and surgery as a first-line treatment modality. Following the abovementioned success, the indications for ELS have gradually expanded. To date, ELS is widely used in clinical practice by well-trained endoscopists in managing a wide variety of diseases and complications, such as relieving non-neoplastic obstructions, sealing iatrogenic and non-iatrogenic perforations, closing fistulae and treating post-sphincterotomy bleeding. The abovementioned development would not have been achieved without corresponding advances and innovations in stent technology. However, the technological landscape changes rapidly, making clinicians’ adaptation to new technologies a real challenge. In our mini-review article, by systematically reviewing the relevant literature, we discuss current developments in ELS with regard to stent design, accessories, techniques, and applications, expanding the research basis that was set by previous studies and highlighting areas that need to be further investigated.
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Affiliation(s)
- Miltiadis Moutzoukis
- Department of Gastroenterology, University Hospital of Ioannina, Ioannina GR45333, Greece
| | - Konstantinos Argyriou
- Department of Gastroenterology, Medical School and University Hospital of Larissa, Larissa GR41334, Greece
| | - Andreas Kapsoritakis
- Department of Gastroenterology, Medical School and University Hospital of Larissa, Larissa GR41334, Greece
| | - Dimitrios Christodoulou
- Department of Gastroenterology, Medical School and University Hospital of Ioannina, Ioannina GR45500, Greece
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