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Shakibfar S, Allin KH, Jess T, Barbieri MA, Battini V, Simoncic E, Kirchgesner J, Ulven T, Sessa M. Drug Repurposing in Crohn's Disease Using Danish Real-World Data. Pragmat Obs Res 2024; 15:17-29. [PMID: 38404739 PMCID: PMC10894518 DOI: 10.2147/por.s444569] [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: 12/08/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Aim Drug repurposing, utilizing electronic healthcare records (EHRs), offers a promising alternative by repurposing existing drugs for new therapeutic indications, especially for patients lacking effective therapies. Intestinal fibrosis, a severe complication of Crohn's disease (CD), poses significant challenges, increasing morbidity and mortality without available pharmacological treatments. This article focuses on identifying medications associated with an elevated or reduced risk of fibrosis in CD patients through a population-wide real-world data and artificial intelligence (AI) approach. Methods Patients aged 65 or older with a diagnosis of CD from 1996 to 2019 in the Danish EHRs were followed for up to 24 years. The primary outcome was the need of specific surgical procedures, namely proctocolectomy with ileostomy and ileocecal resection as proxies of intestinal fibrosis. The study explored drugs linked to an increased or reduced risk of the study outcome through machine-learning driven survival analysis. Results Among the 9179 CD patients, 1029 (11.2%) underwent surgery, primarily men (58.5%), with a mean age of 76 years, 10 drugs were linked to an elevated risk of surgery for proctocolectomy with ileostomy and ileocecal resection. In contrast, 10 drugs were associated with a reduced risk of undergoing surgery for these conditions. Conclusion This study focuses on repurposing existing drugs to prevent surgery related to intestinal fibrosis in CD patients, using Danish EHRs and advanced statistical methods. The findings offer valuable insights into potential treatments for this condition, addressing a critical unmet medical need. Further research and clinical trials are warranted to validate the effectiveness of these repurposed drugs in preventing surgery related to intestinal fibrosis in CD patients.
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Affiliation(s)
- Saeed Shakibfar
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Kristine H Allin
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Maria Antonietta Barbieri
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vera Battini
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università Degli Studi Di Milano, Milan, Italy
| | - Eva Simoncic
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Julien Kirchgesner
- Department of Gastroenterology, INSERM, Institut Pierre Louis d’Epidémiologie Et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Trond Ulven
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Amo‐Tachie S, Ocansey FK, Yeboah AD. Crohn's disease: An enigmatic variant with gastritis and ileal obstruction. Clin Case Rep 2024; 12:e8371. [PMID: 38161629 PMCID: PMC10753134 DOI: 10.1002/ccr3.8371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/22/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
There are multiple atypical manifestations of Crohn's disease, which sometimes delay diagnosis or even more often result in complete misdiagnosis, especially in poorly equipped facilities. This is the case of an elderly woman with Crohn's disease who presented with gastritis and bowel obstruction. She had hitherto been wrongly managed for peptic ulcer disease and functional constipation based mainly on her symptoms. Her diagnosis was made only after years of failed symptomatic management. This case aims to highlight the uncommon and easily misdiagnosed gastroduodenal presentation of Crohn's disease, as well as clinical clues to correctly diagnosing the condition.
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Affiliation(s)
- Samuel Amo‐Tachie
- Department of Medicine and TherapeuticsUniversity of Ghana Medical School, University of GhanaAccraGhana
- Department of Internal MedicineCape Coast Teaching HospitalCape CoastGhana
| | | | - Abena Durowaa Yeboah
- Department of Medicine and TherapeuticsUniversity of Ghana Medical School, University of GhanaAccraGhana
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Kim ES, Park JH, Choe YH, Kim MJ. Pediatric Crohn's disease with severe morbidity manifested by gastric outlet obstruction: two cases report and review of the literature. Intest Res 2020; 19:472-477. [PMID: 33108856 PMCID: PMC8566835 DOI: 10.5217/ir.2020.00072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
Crohn’s disease (CD) presenting as gastric outlet obstruction is rare but serious clinical presentation of CD causing severe morbidity. However, there have been few case reports concerning this disorder in East Asian children and adolescents. The current case report describes 2 pediatric patients with CD who had had gastric outlet obstruction as an initial symptom of CD. Two pediatric patients developed postprandial vomiting, bloating, and unintentional weight loss. The upper endoscopy result indicated that there was pyloric obstruction with mucosal edema, inflammation and ulcers. The serologic test and colonoscopy results suggested CD. These patients were treated with infliximab, and endoscopic balloon dilation without surgery and showed remarkable improvement in obstructing symptoms with maintaining clinical and biochemical remission. This case report elucidates the benefits of early intervention using infliximab and endoscopic balloon dilation to improve gastric outlet obstruction and achieve baseline recovery in patients with upper gastrointestinal B2 phenotype of CD.
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Affiliation(s)
- Eun Sil Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyung Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yon Ho Choe
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Balendran K, Udumalagala S, Nawaraththne NMM. Pyloric stenosis as a manifestation of isolated gastric Crohn's disease responding to intralesional steroid injection and balloon dilation: a case report. J Med Case Rep 2019; 13:331. [PMID: 31718712 PMCID: PMC6852991 DOI: 10.1186/s13256-019-2272-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Crohn's disease is a chronic inflammatory condition that can affect the gut from mouth to anus. Gastroduodenal involvement is seen in less than 5% of all patients with Crohn's disease. Among those cases, isolated gastric Crohn's disease is even rarer. Although most patients with isolated gastric involvement have nonspecific complaints, very few of them do develop features of pyloric obstruction. There is a paucity of data on specific management of gastric Crohn's disease owing to its rarity and its frequent coexistence with colonic or ileal disease. We report a case of a patient who had pyloric stenosis as a manifestation of isolated gastric Crohn's disease responding to intralesional steroid injection and balloon dilation. CASE PRESENTATION A previously healthy woman presented with recurrent postprandial vomiting, epigastric discomfort, and unintentional weight loss over 6 months. She had no diarrhea or extraintestinal manifestations. Clinically, she was pale and dehydrated. Examination of systems was unremarkable except for mild epigastric tenderness. Her initial laboratory findings were normocytic normochromic anemia, high inflammatory markers, and hypokalemia. Esophagogastroduodenoscopy revealed an inflamed pyloric mucosa with features of pyloric obstruction. Furthermore, magnetic resonance enterography confirmed the pyloric stenosis. Histopathological examination of a biopsy from the pylorus revealed noncaseating granuloma with superficial ulceration. Tuberculosis and sarcoidosis were excluded by appropriate investigations, and a diagnosis of gastric Crohn's disease was made. Following the initial resuscitation, intralesional steroid injection and controlled radial expansion balloon dilation of the pylorus were carried out. The patient was commenced on azathioprine as a maintenance treatment, which led to a successful dilation and remarkable symptom improvement. CONCLUSION Symptoms of pyloric obstruction as a manifestation of isolated gastric Crohn's disease are extremely unusual in clinical practice, awareness of which would facilitate early appropriate investigations and treatment.
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Affiliation(s)
- K Balendran
- Gastroenterology & Hepatology unit, National Hospital of Sri Lanka, Colombo, 10, Sri Lanka.
| | - S Udumalagala
- Gastroenterology & Hepatology unit, National Hospital of Sri Lanka, Colombo, 10, Sri Lanka
| | - N M M Nawaraththne
- Gastroenterology & Hepatology unit, National Hospital of Sri Lanka, Colombo, 10, Sri Lanka
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Lone YA, Hushain D, Chana RS, Khan RA, Sachdeva S, Mushtaq E. Primary acquired gastric outlet obstruction in children: A retrospective single center study. J Pediatr Surg 2019; 54:2285-2290. [PMID: 30922687 DOI: 10.1016/j.jpedsurg.2019.02.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/10/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND/ PURPOSE Idiopathic hypertrophic pyloric stenosis is by far the most common cause of gastric outlet obstruction (GOO) in young infants, with more than 90% of cases presenting between 3 and 10 weeks after birth. While cases of late onset pyloric stenosis beyond infancy have been reported, the etiology is poorly understood. We report our experience of 5 cases, describing the similarities and differences in management of our patient population which happens to be the second largest reported in literature. METHODS From July 2014 to June 2018 (4 years) a total of five patients of primary acquired GOO were encountered at our center. RESULTS The age range was 3 to 6 years and only one of them was a female. All presented with characteristic nonbilious vomiting that was recurrent and episodic. Upper GI (gastrointestinal) contrast study series revealed a dilated stomach and delayed gastric emptying. Upper GI endoscopy also demonstrated a dilated stomach without any intraluminal polyp, ulcer or any other pathology. Intraoperatively the pylorus had no evidence of scarring, inflammation, external compression or any mass in and around the pylorus. A retrocolic gastrojejunostomy was curative in all patients. CONCLUSION Though rare, one must maintain a high index of suspicion for primary acquired GOO in the differential diagnosis of older children with nonbilious vomiting and failure to thrive. Following appropriate diagnostic workup, surgical interventions should be performed expeditiously because adequate nutrition is key to proper physical and mental development of the child. Further research will hopefully elucidate the underlying pathophysiology in order to guide clinical options for both prevention and treatment. TYPE OF STUDY Retrospective single center study. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Yasir Ahmad Lone
- Dept. of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India.
| | - Danish Hushain
- Dept. of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
| | - Rajendra Singh Chana
- Dept. of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
| | - Rizwan Ahmad Khan
- Dept. of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
| | - Sandeep Sachdeva
- Dept. of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
| | - Enas Mushtaq
- Dept. of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Aligarh Muslim University, UP, India
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Bartlett E, Carlisle E, Mak G. Gastric outlet obstruction in a 12 year old male. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Zhi XT, Hong JG, Li T, Sun D, Yu DX, Chen ZQ, Li T. Gastric Crohn's Disease: A Rare Cause of Intermittent Abdominal Pain and Vomiting. Am J Med 2017; 130:e181-e185. [PMID: 28161347 DOI: 10.1016/j.amjmed.2016.12.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Xu-Ting Zhi
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, PR China
| | - Jian-Guo Hong
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, PR China
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, PR China
| | - Dong Sun
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, PR China
| | - De-Xin Yu
- Department of Radiology, Qilu Hospital, Shandong University, Jinan 250012, PR China
| | - Zhi-Qiang Chen
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, PR China
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, PR China.
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Inayat F, Ullah W, Hussain Q, Shafique K. Crohn's disease presenting as gastric outlet obstruction: a therapeutic challenge? BMJ Case Rep 2017; 2017:bcr-2016-218181. [PMID: 28455456 DOI: 10.1136/bcr-2016-218181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Isolated gastric Crohn's disease with initial presentation related to gastric outlet obstruction is an unusual clinicopathological entity. We undertake here a literature review of this rare initial presentation of isolated gastric Crohn's disease and discuss the formidable diagnostic and therapeutic challenges encountered in such patients.
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Affiliation(s)
- Faisal Inayat
- New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, New York, USA
| | | | | | - Khurram Shafique
- Department of Pathology, SUNY Downstate Medical Center, New York, USA
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Gaggar S, Scott J, Thompson N. Pyloric stenosis associated Crohn's disease responding to adalimumab therapy. World J Gastrointest Pharmacol Ther 2012; 3:97-9. [PMID: 23494865 PMCID: PMC3596519 DOI: 10.4292/wjgpt.v3.i6.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 10/08/2012] [Accepted: 11/20/2012] [Indexed: 02/06/2023] Open
Abstract
Gastroduodenal Crohn’s disease (CD) is rare and the response to standard medical therapy is often poor. Anti-tumor necrosis factor therapy has revolutionised the treatment of CD. We present a patient with pyloric stenosis associated with CD which improved with Adalimumab therapy. We recommend considering anti-tumor necrosis factor therapy in symptomatic gastroduodenal CD.
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Affiliation(s)
- Sameer Gaggar
- Sameer Gaggar, Nicholas Thompson, Department of Gastroenterology, Freeman Hospital, NE7 7DN Newcastle, United Kingdom
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