1
|
Sumida K, Shrestha P, Mallisetty Y, Thomas F, Gyamlani G, Streja E, Kalantar-Zadeh K, Kovesdy CP. Anti-Tumor Necrosis Factor Therapy and Risk of Kidney Function Decline and Mortality in Inflammatory Bowel Disease. JAMA Netw Open 2024; 7:e246822. [PMID: 38625700 PMCID: PMC11022116 DOI: 10.1001/jamanetworkopen.2024.6822] [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: 09/13/2023] [Accepted: 02/16/2024] [Indexed: 04/17/2024] Open
Abstract
Importance Inflammatory bowel disease (IBD) is associated with adverse clinical outcomes, including chronic kidney disease and mortality, due in part to chronic inflammation. Little is known about the effects of anti-tumor necrosis factor (TNF) therapy on kidney disease progression and mortality among patients with new-onset IBD. Objective To examine the association of incident use of TNF inhibitors with subsequent decline in kidney function and risk of all-cause mortality. Design, Setting, and Participants This retrospective cohort study used data from the US Department of Veterans Affairs health care system. Participants were US veterans with new-onset IBD enrolled from October 1, 2004, through September 30, 2019. Data were analyzed from December 2022 to February 2024. Exposures Incident use of TNF inhibitors. Main Outcomes and Measures The main outcomes were at least 30% decline in estimated glomerular filtration rate (eGFR) and all-cause mortality. Results Among 10 689 patients (mean [SD] age, 67.4 [12.3] years; 9999 [93.5%] male) with incident IBD, 3353 (31.4%) had diabetes, the mean (SD) baseline eGFR was 77.2 (19.2) mL/min/1.73 m2, and 1515 (14.2%) were newly initiated on anti-TNF therapy. During a median (IQR) follow-up of 4.1 (1.9-7.0) years, 3367 patients experienced at least 30% decline in eGFR, and over a median (IQR) follow-up of 5.0 (2.5-8.0) years, 2502 patients died. After multivariable adjustments, incident use (vs nonuse) of TNF inhibitors was significantly associated with higher risk of decline in eGFR (adjusted hazard ratio [HR], 1.34 [95% CI, 1.18-1.52]) but was not associated with risk of all-cause mortality (adjusted HR, 1.02 [95% CI, 0.86-1.21]). Similar results were observed in sensitivity analyses. Conclusions and Relevance In this cohort study of US veterans with incident IBD, incident use (vs nonuse) of TNF inhibitors was independently associated with higher risk of progressive eGFR decline but was not associated with risk of all-cause mortality. Further studies are needed to elucidate potentially distinct pathophysiologic contributions of TNF inhibitor use to kidney and nonkidney outcomes in patients with IBD.
Collapse
Affiliation(s)
- Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Prabin Shrestha
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Yamini Mallisetty
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Fridtjof Thomas
- Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis
| | - Geeta Gyamlani
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
| | - Elani Streja
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
| |
Collapse
|
2
|
Kilic Y, Kamal S, Jaffar F, Sriranganathan D, Quraishi MN, Segal JP. Prevalence of Extraintestinal Manifestations in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2024; 30:230-239. [PMID: 37042969 DOI: 10.1093/ibd/izad061] [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: 09/15/2022] [Indexed: 04/13/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a multisystem disease impacting various body systems including musculoskeletal, ocular, skin, hepatobiliary, pulmonary, cardiac, and haematological systems. The extraintestinal manifestations of IBD are frequent, common in both ulcerative colitis (UC) and Crohn's disease (CD), and impact the morbidity and mortality of patients. METHODS The Embase, Embase classic, and PubMed databases were searched between January 1979 and December 2021. A random effects model was performed to find the pooled prevalence of joint, ocular, and skin extraintestinal manifestations of UC and CD. RESULTS Fifty-two studies were included that reported on 352 454 patients. The prevalence of at least 1 joint, ocular, or skin extraintestinal manifestation in all IBD, UC, and CD was 24%, 27%, and 35% respectively. The prevalence between UC and CD were similar for pyoderma gangrenosum and axial joint manifestations. Ocular manifestations were found to be more common in CD than in UC. Peripheral joint manifestations and erythema nodosum were found to be more common in CD than UC. DISCUSSION To our knowledge, this is the first meta-analysis that reports on the prevalence of at least 1 joint, ocular, or skin extraintestinal manifestation in IBD. Our results are largely consistent with figures and statements quoted in the literature. However, our findings are based on significantly larger cohort sizes. Thus, our results have the potential to better power studies and more accurately counsel patients.
Collapse
Affiliation(s)
- Yakup Kilic
- Department of Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Shahed Kamal
- Department of Gastroenterology, Northern Hospital, Epping, Melbourne, Australia
| | - Farah Jaffar
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Uxbridge, UB9 6JH, United Kingdom
| | - Danujan Sriranganathan
- Department of Gastroenterology, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, London E11 1NR, United Kingdom
| | - Mohammed Nabil Quraishi
- Department of Gastroenterology, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS, United Kingdom
| | - Jonathan P Segal
- Department of Gastroenterology, Northern Hospital, Epping, Melbourne, Australia
- Department of Medicine, University of Melbourne, Parkville, Melbourne, Australia
| |
Collapse
|
3
|
Nakamura A, Towheed T. Pathogenesis, assessment, and management of bone loss in axial spondyloarthritis. Semin Arthritis Rheum 2024; 64:152345. [PMID: 38103486 DOI: 10.1016/j.semarthrit.2023.152345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Axial spondyloarthritis (axSpA) presents a complex scenario where both new bone formation in entheseal tissues and significant trabecular bone loss coexist, emphasizing the intricate nature of bone dynamics in this context. METHODS A search of the literature was conducted to compose a narrative review exploring the pathogenesis, possible assessment methods, and potential management options for axSpA. RESULTS While chronic systemic and local inflammation contribute to bone loss, the mechanisms behind axSpA-associated bone loss exhibit distinct characteristics influenced by factors like mechanical stress and the gut microbiome. These factors directly or indirectly stimulate osteoclast differentiation and activation through the RANK-RANKL axis, while simultaneously impeding osteoblast differentiation via negative regulation of bone anabolic pathways, including the Wnt signaling pathway. This disruption in the balance between bone-resorbing osteoclasts and bone-forming osteoblasts contributes to overall bone loss in axSpA. Early evaluation at diagnosis is prudent for detecting bone changes. While traditional dual x-ray absorptiometry (DXA) has limitations due to potential overestimation from spinal new bone formation, alternative methods like trabecular bone score (TBS), quantitative CT (QCT), and quantitative ultrasound (QUS) show promise. However, their integration into routine clinical practice remains limited. In addition to approved anti-inflammatory drugs, lifestyle adjustments like regular exercise play a key role in preserving bone health. Tailoring interventions based on individual risk profiles holds potential for mitigating bone loss progression. CONCLUSION Recognizing the pivotal role of bone loss in axSpA underscores the importance of integrating regular assessments and effective management strategies into clinical practice. Given the multifaceted contributors to bone loss in axSpA, a multidisciplinary approach is essential.
Collapse
Affiliation(s)
- Akihiro Nakamura
- Department of Medicine, Division of Rheumatology, Queen's University, Kingston, Ontario, Canada; Translational Institute of Medicine, School of Medicine, Queen's University, Ontario, Canada; Kingston Health Science Centre, Kingston, Ontario, Canada.
| | - Tanveer Towheed
- Department of Medicine, Division of Rheumatology, Queen's University, Kingston, Ontario, Canada; Translational Institute of Medicine, School of Medicine, Queen's University, Ontario, Canada; Kingston Health Science Centre, Kingston, Ontario, Canada.
| |
Collapse
|
4
|
Migliorisi G, Vella G, Dal Buono A, Gabbiadini R, Busacca A, Loy L, Bezzio C, Vinciguerra P, Armuzzi A. Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It. Cells 2024; 13:142. [PMID: 38247834 PMCID: PMC10814681 DOI: 10.3390/cells13020142] [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: 12/15/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn's disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. METHODS PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. RESULTS The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs' pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs.
Collapse
Affiliation(s)
- Giulia Migliorisi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| | - Giovanna Vella
- Department of Ophtalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Arianna Dal Buono
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Roberto Gabbiadini
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Anita Busacca
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Laura Loy
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
- Department of Ophtalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| |
Collapse
|
5
|
Clinton JW, Cross RK. Personalized Treatment for Crohn's Disease: Current Approaches and Future Directions. Clin Exp Gastroenterol 2023; 16:249-276. [PMID: 38111516 PMCID: PMC10726957 DOI: 10.2147/ceg.s360248] [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: 06/30/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
Crohn's disease is a complex, relapsing and remitting inflammatory disorder of the gastrointestinal tract with a variable disease course. While the treatment options for Crohn's disease have dramatically increased over the past two decades, predicting individual patient response to treatment remains a challenge. As a result, patients often cycle through multiple different therapies before finding an effective treatment which can lead to disease complications, increased costs, and decreased quality of life. Recently, there has been increased emphasis on personalized medicine in Crohn's disease to identify individual patients who require early advanced therapy to prevent complications of their disease. In this review, we summarize our current approach to management of Crohn's disease by identifying risk factors for severe or disabling disease and tailoring individual treatments to patient-specific goals. Lastly, we outline our knowledge gaps in implementing personalized Crohn's disease treatment and describe the future directions in precision medicine.
Collapse
Affiliation(s)
- Joseph William Clinton
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond Keith Cross
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Tie Y, Huang Y, Chen R, Li L, Chen M, Zhang S. Current insights on the roles of gut microbiota in inflammatory bowel disease-associated extra-intestinal manifestations: pathophysiology and therapeutic targets. Gut Microbes 2023; 15:2265028. [PMID: 37822139 PMCID: PMC10572083 DOI: 10.1080/19490976.2023.2265028] [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: 03/15/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic, recurrent inflammatory disease of the gastrointestinal tract. In addition to digestive symptoms, patients with IBD may also develop extra-intestinal manifestations (EIMs), the etiology of which remains undefined. The gut microbiota has been reported to exert a critical role in the pathogenesis of IBD, with a similar pattern of gut dysbiosis observed between patients with IBD and those with EIMs. Therefore, it is hypothesized that the gut microbiota is also involved in the pathogenesis of EIMs. The potential mechanisms are presented in this review, including: 1) impaired gut barrier: dysbiosis induces pore formation in the intestinal epithelium, and activates pattern recognition receptors to promote local inflammation; 2) microbial translocation: intestinal pathogens, antigens, and toxins translocate via the impaired gut barrier into extra-intestinal sites; 3) molecular mimicry: certain microbial antigens share similar epitopes with self-antigens, inducing inflammatory responses targeting extra-intestinal tissues; 4) microbiota-related metabolites: dysbiosis results in the dysregulation of microbiota-related metabolites, which could modulate the differentiation of lymphocytes and cytokine production; 5) immunocytes and cytokines: immunocytes are over-activated and pro-inflammatory cytokines are excessively released. Additionally, we summarize microbiota-related therapies, including probiotics, prebiotics, postbiotics, antibiotics, and fecal microbiota transplantation, to promote better clinical management of IBD-associated EIMs.
Collapse
Affiliation(s)
- Yizhe Tie
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongle Huang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Rirong Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shenghong Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
7
|
Alizadeh M, Ali O, Cross RK. Extraintestinal Manifestations of Inflammatory Bowel Disease Are Associated With Increased Biologic Cycling. CROHN'S & COLITIS 360 2023; 5:otad058. [PMID: 37901191 PMCID: PMC10601919 DOI: 10.1093/crocol/otad058] [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: 07/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) are a common, frequently debilitating complication of the disease. Biologics are indicated and often required in patients with EIMs to control disease; however, little is known about whether patients with EIMs cycle through more therapies than their counterparts without EIMs. Methods To address this question, we performed a retrospective analysis of patients enrolled in the Study of Prospective Adult Research Cohort with IBD registry seen at our University Medical Center, on data from December 2016 to January 2021. Four hundred fifty-six participants with information on EIMs and biologic use available were included, and demographic and clinical characteristics were analyzed. Results Three hundred thirty-eight and 118 participants without and with EIMs were identified, respectively. Those with EIMs were likelier to have biologic exposure, and cycle through more biologics, both in univariate and multivariate analyses controlling for age, disease duration, sex, corticosteroid use, and IBD type (P-value = .006). In a subanalysis of patients with Crohn's disease (CD), EIMs were associated with increased biologic cycling in ileocolonic disease (P-value = .050). Conclusions To our knowledge, this is the first study assessing biologic cycling in patients with EIMs. Our findings that patients with EIMs are likelier to cycle through biologics, particularly CD patients with ileocolonic disease, highlights the need for more research on which biologics may be most effective for specific subsets of IBD patients, including those with concurrent EIMs. The presence of EIMs is a marker of harder-to-treat IBD and may indicate earlier initiation of advanced therapies.
Collapse
Affiliation(s)
- Madeline Alizadeh
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Osman Ali
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
8
|
Palandurkar GS, Kumar S. Biofilm's Impact on Inflammatory Bowel Diseases. Cureus 2023; 15:e45510. [PMID: 37868553 PMCID: PMC10585119 DOI: 10.7759/cureus.45510] [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: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
The colon has a large surface area covered with a thick mucus coating. Colon's biomass consists of about 1,012 colony-forming units per gram of feces and 500-1,000 distinct bacterial species. The term inflammatory bowel disease (IBD) indicates the collection of intestinal illnesses in which the digestive system (esophagus, large intestine, mouth, stomach, and small intestine) experiences persistent inflammation. IBD development is influenced by environmental (infections, stress, and nutrition) and genetic factors. The microbes present in gut microbiota help maintain intestinal homeostasis and support immune and epithelial cell growth, differentiation, as well as proliferation. It has been discovered that a variety of variables and microorganisms are crucial for the development of biofilms and mucosal colonization during IBD. An extracellular matrix formed by bacteria supports biofilm production in our digestive system and harms the host's immunological response. Irritable bowel syndrome (IBS) and IBD considerably affect human socioeconomic well-being and the standard of living. IBD is a serious public health issue, affecting millions of people across the globe. The gut microbiome may significantly influence IBS pathogenesis, even though few diagnostic and treatment options are available. As a result, current research focuses more on disrupting biofilm in IBD patients and stresses primarily on drugs that help improve the quality of life for human well-being. We evaluate studies on IBD and bacterial biofilm to add fresh insights into the existing state of knowledge of biofilm formation in IBD, incidence of IBD patients, molecular level of investigations, bacteria that are involved in the formation of biofilm, and present and down the line regimens and probiotics. Planning advanced ways to control and eradicate bacteria in biofilms should be the primary goal to add fresh insights into generating innovative diagnostic and alternative therapy options for IBD.
Collapse
Affiliation(s)
- Gopal S Palandurkar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
9
|
Licona Vera E, Betancur Vasquez C, Peinado Acevedo JS, Rivera Bustamante T, Martinez Redondo JM. Ocular Manifestations of Inflammatory Bowel Disease. Cureus 2023; 15:e40299. [PMID: 37448411 PMCID: PMC10337643 DOI: 10.7759/cureus.40299] [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: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease connected to the immune system, with a predilection for the gastrointestinal tract. However, a large proportion of the patients have extraintestinal manifestations (EIM), and the ocular system is affected in some patients. The clinical presentation of ocular pathology is broad, ranging from asymptomatic cases to blindness, leading to high morbidity. Ocular complications can be primary and, in general, are associated with episodes of acute flare-ups that subside with immunological management of the digestive disease. Secondary complications arise from the primary ones and as adverse effects of immunological treatment. In addition, on many occasions, the ocular manifestation may appear prior to the presentation of digestive symptoms. The presence of a multidisciplinary team that includes a gastroenterologist and an ophthalmologist is important in order to achieve early diagnosis of ocular complications, thereby preventing, treating, and avoiding unfavorable and irreversible long-term ocular sequelae.
Collapse
|
10
|
Jayasundara JMHD, Samarawickrama VT, Peiris R, Aponso T, Abeynayake D. Concomitant Guillain-Barré Syndrome in a young Sri Lankan male with severe ulcerative colitis. BMC Gastroenterol 2022; 22:411. [PMID: 36064313 PMCID: PMC9444105 DOI: 10.1186/s12876-022-02455-y] [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: 08/21/2021] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Guillain–Barré Syndrome is an immune mediated polyneuropathy. Ulcerative Colitis is an immune mediated chronic inflammatory condition mainly of the large intestine. Guillain–Barré Syndrome can present as a rare extraintestinal manifestation of Ulcerative Colitis when in remission or in a relapse. However, the concomitant presentation of Guillain–Barré Syndrome during a relapse of Ulcerative Colitis is very rare and only a few cases are reported to date. Case presentation A 24 year old young male diagnosed of Ulcerative Colitis presented with bloody diarrhea of frequency more than six times a day. He had been in clinical remission even after defaulting treatment for more than a year. He had also noted difficulty in walking prior to admission to the hospital. He was managed as for a severe relapse of Ulcerative Colitis and Guillain–Barré Syndrome. Appropriate management of both the illnesses helped him to recover. Conclusion Immune mediated diseases can have rare coexisting presentations. We report a case of Ulcerative Colitis with concomitant Guillain–Barré Syndrome. It is essential to be open minded and timely, appropriate treatment led to successful management of both the illnesses.
Collapse
Affiliation(s)
| | | | | | - Tilan Aponso
- National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | |
Collapse
|
11
|
van Hoeve K, Hoffman I. Renal manifestations in inflammatory bowel disease: a systematic review. J Gastroenterol 2022; 57:619-629. [PMID: 35834005 DOI: 10.1007/s00535-022-01903-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023]
Abstract
As extra-intestinal manifestations (EIMs) are frequent in inflammatory bowel disease (IBD) and affect morbidity and sometimes even mortality, vigilance in the surveillance of EIMs and installing the appropriate treatment are essential. Data on renal manifestations in patients with IBD are however rare. Nevertheless, up to 5-15% of adult patients with IBD will develop chronic kidney disease over time. The pathophysiology of renal involvement in patients with IBD is complex and poorly understood, with a wide range of renal disorders affecting the glomeruli and/or the tubular structure. Furthermore, medication used to treat IBD can be potentially nephrotoxic and metabolic complication due to the disease itself can furthermore cause renal damage. The aim of this systematic review is to provide an overview of the existing data in literature on these renal manifestations and complications in patients with IBD.
Collapse
Affiliation(s)
- Karen van Hoeve
- Department of Paediatric Gastroenterology and Hepatology and Nutrition, University Hospitals Leuven, Herestraat 49. 3000 KU, Louvain, Belgium.
| | - Ilse Hoffman
- Department of Paediatric Gastroenterology and Hepatology and Nutrition, University Hospitals Leuven, Herestraat 49. 3000 KU, Louvain, Belgium
| |
Collapse
|
12
|
Tao S, Wang X, Yang X, Liu Y, Fu Z, Zhang L, Wang Z, Ni J, Shuai Z, Pan H. COVID-19 and inflammatory bowel disease crosstalk: From emerging association to clinical proposal. J Med Virol 2022; 94:5640-5652. [PMID: 35971954 PMCID: PMC9538900 DOI: 10.1002/jmv.28067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause coronavirus disease 2019 (COVID-19), an acute respiratory inflammation that has emerged worldwide since December 2019, and it quickly became a global epidemic. Inflammatory bowel disease (IBD) is a group of chronic nonspecific intestinal inflammatory diseases whose etiology has not been elucidated. The two have many overlapping symptoms in clinical presentation, such as abdominal pain, diarrhea, pneumonia, etc. Imbalance of the autoimmune system in IBD patients and long-term use of immunosuppressive drugs may increase the risk of infection; and systemic symptoms caused by COVID-19 may also induce or exacerbate intestinal inflammation. It has been found that the SARS-CoV-2 receptor angiotensin converting enzyme 2, which is highly expressed in the lung and intestine, is an inflammatory protective factor, and is downregulated and upregulated in COVID-19 and IBD, respectively, suggesting that there may be a coregulatory pathway. In addition, the immune activation pattern of COVID-19 and the cytokine storm in the inflammatory response have similar roles in IBD, indicating that the two diseases may influence each other. Therefore, this review aimed to address the following research questions: whether SARS-CoV-2 infection leads to the progression of IBD; whether IBD increases the risk of COVID-19 infection and poor prognosis; possible common mechanisms and genetic cross-linking between the two diseases; new treatment and care strategies for IBD patients, and the feasibility and risk of vaccination in the context of the COVID-19 epidemic.
Collapse
Affiliation(s)
- Sha‐Sha Tao
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Xin‐Yi Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, First Clinical Medical CollegeAnhui Medical UniversityHefeiAnhuiChina
| | - Xiao‐Ke Yang
- Department of Rheumatology and ImmunologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Yu‐Chen Liu
- Department of Otolaryngology, Head, and Neck SurgeryThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Zi‐Yue Fu
- Department of Clinical Medicine, The Second School of Clinical MedicineAnhui Medical UniversityHefeiAnhuiChina
| | - Li‐Zhi Zhang
- Department of Clinical Medicine, The First School of Clinical MedicineAnhui Medical UniversityHefeiAnhuiChina
| | - Zhi‐Xin Wang
- Department of Rheumatology and ImmunologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jing Ni
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Zong‐Wen Shuai
- Department of Rheumatology and ImmunologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Hai‐Feng Pan
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| |
Collapse
|
13
|
King D, Chandan JS, Thomas T, Nirantharakumar K, Reulen RC, Adderley NJ, Trudgill N. The Risk of Later Diagnosis of Inflammatory Bowel Disease in Patients With Dermatological Disorders Associated With Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1731-1739. [PMID: 34669933 DOI: 10.1093/ibd/izaa344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dermatological conditions such as erythema nodosum (EN), pyoderma gangrenosum, Sweet's syndrome, and aphthous stomatitis can occur with inflammatory bowel disease (IBD) and are considered dermatological extraintestinal manifestations (D-EIMs). Rarely, they may precede IBD. Other common conditions such as psoriasis have also been associated with IBD. This study examined the risk of a subsequent IBD diagnosis in patients presenting with a D-EIM. METHODS A retrospective cohort study compared patients with D-EIMs and age-/sex-matched patients without D-EIMs. Hazard ratios (HRs) were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, loperamide use, anemia, and lower gastrointestinal symptoms. Logistic regression was used to produce a prediction model for the diagnosis of IBD within 3 years of EN diagnosis. RESULTS We matched 7447 patients with D-EIMs (74% female; median age 38 years (interquartile ratio [IQR], 24-65 years) to 29,297 patients without D-EIMs. We observed 131 (1.8%) subsequent IBD diagnoses in patients with D-EIMs compared with 65 (0.2%) in those without D-EIMs. Median time to IBD diagnosis was 205 days (IQR, 44-661 days) in those with D-EIMs and 1594 days (IQR, 693-2841 days) in those without D-EIMs. The adjusted HR for a later diagnosis of IBD was 6.16 (95% confidence interval [CI], 4.53-8.37; P < 0.001), for ulcerative colitis the HR was 3.30 (95% CI, 1.98-5.53; P < 0.001), and for Crohn's disease the HR was 8.54 (95% CI, 5.74-12.70; P < 0.001). Patients with psoriasis had a 34% increased risk of a subsequent IBD diagnosis compared with the matched control patients (HR, 1.34; 95% CI, 1.20-1.51; P < 0.001). We included 4043 patients with an incident EN diagnosis in the prediction model cohort, with 87 patients (2.2%) diagnosed with IBD within 3 years. The model had a bias-corrected c-statistic of 0.82 (95% CI, 0.78-0.86). CONCLUSIONS Patients with D-EIMs have a 6-fold increased risk of a later diagnosis of IBD. Younger age, smoking, low body mass index, anemia, and lower gastrointestinal symptoms were associated with an increased risk of diagnosis of IBD within 3 years in patients with EN.
Collapse
Affiliation(s)
- Dominic King
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Tom Thomas
- Translational Gastroenterology Unit and Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | | | - Raoul C Reulen
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nigel Trudgill
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom
| |
Collapse
|
14
|
Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management. Gastroenterology 2021; 161:1118-1132. [PMID: 34358489 PMCID: PMC8564770 DOI: 10.1053/j.gastro.2021.07.042] [Citation(s) in RCA: 264] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel diseases (IBDs) are systemic diseases that manifest not only in the gut and gastrointestinal tract, but also in the extraintestinal organs in many patients. The quality of life for patients with IBD can be substantially affected by these extraintestinal manifestations (EIMs). It is important to have knowledge of the prevalence, pathophysiology, and clinical presentation of EIMs in order to adapt therapeutic options to cover all aspects of IBD. EIMs can occur in up to 24% of patients with IBD before the onset of intestinal symptoms, and need to be recognized to initiate appropriate diagnostic procedures. EIMs most frequently affect joints, skin, or eyes, but can also affect other organs, such as the liver, lung, and pancreas. It is a frequent misconception that a successful therapy of the intestinal inflammation will be sufficient to treat EIMs satisfactorily in most patients with IBD. In general, peripheral arthritis, oral aphthous ulcers, episcleritis, or erythema nodosum can be associated with active intestinal inflammation and can improve on standard treatment of the intestinal inflammation. However, anterior uveitis, ankylosing spondylitis, and primary sclerosing cholangitis usually occur independent of disease flares. This review provides a comprehensive overview of epidemiology, pathophysiology, clinical presentation, and treatment of EIMs in IBD.
Collapse
Affiliation(s)
- Gerhard Rogler
- Department of Gastroenterology & Hepatology, Department of Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Abha Singh
- University of California, San Diego, La Jolla, CA, USA
| | | | - David T. Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| |
Collapse
|
15
|
Sange AH, Srinivas N, Sarnaik MK, Modi S, Pisipati Y, Vaidya S, Syed Gaggatur N, Sange I. Extra-Intestinal Manifestations of Inflammatory Bowel Disease. Cureus 2021; 13:e17187. [PMID: 34548984 PMCID: PMC8438649 DOI: 10.7759/cureus.17187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is associated with extra-intestinal manifestations (EIMs) that tend to parallel intestinal activity and have a debilitating effect on the quality of life. EIMs primarily affect the joints, skin, and eyes with less frequent involvement of the liver, kidney, and pancreas. This article reviews the prevalence of musculoskeletal, dermatological, ocular, and other manifestations in IBD and their coalition with underlying intestinal inflammation. EIMs occurring independently of intestinal activity are managed by targeted therapies, categorical regimens, and specific treatments. On the other hand, EIMs paralleling the bowel activity are carefully monitored while the IBD is brought under control. Since the etiology of the disease is responsible for the development of the EIMs, the research scrutinizes the identified pathogenic mechanisms that tend to involve genetic susceptibility, aberrant self-recognition, and autoantibodies directed against organ-specific antigens shared by intestinal and extra-intestinal organs. This article also provides an overview of the epidemiology, clinical features, diagnostic modalities, and management of the EIMs associated with IBD.
Collapse
Affiliation(s)
| | - Natasha Srinivas
- Research, BGS Global Institute of Medical Sciences, Bangalore, IND
| | | | - Srimy Modi
- Research, K.J. Somaiya Medical College, Mumbai, IND
| | | | - Sarayoo Vaidya
- Internal Medicine, M.S. Ramaiah Medical College, Bangalore, IND
| | | | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, K.J. Somaiya Medical College, Mumbai, IND
| |
Collapse
|
16
|
Buchbender M, Fehlhofer J, Proff P, Möst T, Ries J, Hannig M, Neurath MF, Gund M, Atreya R, Kesting M. Expression of inflammatory mediators in biofilm samples and clinical association in inflammatory bowel disease patients-a preliminary study. Clin Oral Investig 2021; 26:1217-1228. [PMID: 34383142 PMCID: PMC8816497 DOI: 10.1007/s00784-021-04093-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/19/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Inflammatory bowel disease (IBD) has multiple impacts on soft and hard tissues in the oral cavity. The aim of this study was to analyze the expression of cytokines in biofilm samples from patients suffering from IBD and compare them to healthy patients. It was hypothesized that different cytokine expression levels and clinical associations might be drawn. MATERIAL AND METHODS A total of 56 biofilm samples from three different patient cohorts (group 0 = healthy, HC n = 30; group 1 = Crohn's disease, CD, n = 19; group 2 = ulcerative colitis, UC, n = 7) were examined for the expression levels of the cytokine interleukins IL-2, -6, and -10; matrix metalloproteinases 7 and 9; and surface antigens CD90/CD11a by quantitative real-time PCR and according to clinical parameters (plaque index, BOP, PD, DMFT, CAL). Relative gene expression was determined using the ∆∆CT method. RESULTS The mean BOP values (p = 0.001) and PD (p = 0.000) were significantly higher in the CD group compared to controls. Expression of IL-10 was significantly higher in the CD (p = 0.004) and UC groups (p = 0.022). Expression of MMP-7 was significantly higher in the CD group (p = 0.032). IBD patients treated with TNF inhibitors (p = 0.007) or other immunosuppressants (p = 0.014) showed significant overexpression of IL-10 compared to controls. CONCLUSION Different expression levels of IL-10 and MMP-7 were detected in plaque samples from IBD patients. As only BOP was significantly increased, we conclude that no clinical impairment of periodontal tissue occurred in IBD patients. CLINICAL RELEVANCE With the worldwide increasing incidence of IBD, it is important to obtain insights into the effects of the disease on the oral cavity. The study was registered (01.09.2020) at the German clinical trial registry (DRKS00022956). CLINICAL TRIAL REGISTRATION The study is registered at the German clinical trial registry (DRKS00022956).
Collapse
Affiliation(s)
- Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany.
| | - Jakob Fehlhofer
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Peter Proff
- Head of the Department of Orthodontics, University of Regensburg, Regensburg, Germany
| | - Tobias Möst
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Jutta Ries
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Matthias Hannig
- Head of Department of Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Markus F Neurath
- Department of Medicine, University of Erlangen-Nuremberg, Erlangen, Germany.,Deutsches Zentrum Immuntherapie DZI, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Madline Gund
- Department of Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Raja Atreya
- Department of Medicine, University of Erlangen-Nuremberg, Erlangen, Germany.,Deutsches Zentrum Immuntherapie DZI, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany
| |
Collapse
|
17
|
Kröner PT, Lee A, Farraye FA. Respiratory Tract Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:563-574. [PMID: 32448912 DOI: 10.1093/ibd/izaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease can manifest in many extraintestinal organ systems. The most frequently involved extraintestinal locations include the mucocutaneous, hepatobiliary, and ocular organ systems. The respiratory tract is less commonly involved and is therefore frequently overlooked. Consequently, it is believed that involvement of the respiratory tract in patients with inflammatory bowel disease is underreported. The pathogenesis is thought to be multifactorial, involving the common embryologic origin shared by the respiratory and luminal digestive tract, molecular mimicry, and immunologic interactions leading to immune-complex deposition in affected tissue. The spectrum of manifestations of the respiratory tract related to inflammatory bowel disease is broad. It not only includes direct involvement of the respiratory tract (ie, airways, interstitium, and pleura) but also can result as a consequence of systemic involvement such as in thromboembolic events. In addition, it may also be related to other conditions that affect the respiratory tract such as sarcoidosis and alpha-1 antitrypsin deficiency. Though some conditions related to respiratory tract involvement might be subclinical, others may have life-threatening consequences. It is critical to approach patients with suspected inflammatory bowel disease-related respiratory tract involvement in concert with pulmonology, infectious diseases, and any other pertinent experts, as treatments may require a multidisciplinary overlap of measures. Therefore, it is of paramount importance for the clinician to be aware of the array of respiratory tract manifestations of patients with inflammatory bowel disease, in addition to the possible spectrum of therapeutic measures.
Collapse
Affiliation(s)
- Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Augustine Lee
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
18
|
Di Ruscio M, Tinazzi I, Variola A, Geccherle A, Marchetta A, McGonagle D. Prevalence and Real-World Management of Vedolizumab Associated Enthesitis in Successfully Treated IBD Patients. Rheumatology (Oxford) 2021; 60:5809-5813. [PMID: 33580246 DOI: 10.1093/rheumatology/keab135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies have reported the development of moderate and severe de novo spondyloarthritis (SpA) associated disease under vedolizumab (VDZ) treatment for inflammatory bowel disease (IBD). Herein, we report a case series that developed severe enthesitis under VDZ therapy from a cohort of 90 treated cases. METHODS In a single Italian IBD Unit, where 90 cases were on VDZ therapy, we identified 11 cases that developed severe enthesitis. The onset of disease in relationship to VDZ initiation, clinical and sonographic imaging features, outcomes including therapy switches were described. RESULTS 11 cases, including 8 prior anti-TNF failures, with new onset entheseal pathology were identified (Multifocal (n = 4), unifocal (n = 6), enthesitis/synovitis/dactylitis (n = 1). The mean duration to symptoms was 46 weeks (range 6-119), mean CRP was 5.1 mg/dl and the majority were HLA-B27 negative and showed good clinical response for gut disease. Clinical features and Ultrasound showed severe enthesitis including PD change in 7 patients.All patients were initially treated with NSAIDs, 5 patients underwent local steroid injections. At 12 months 5/7 cases continued VDZ and 2 were switched to Ustekinumab. At 12 months follow-up of 7 cases, 5 patients were in clinical remission and 2 patients had mild enthesitis with minimal increase of PD signal. Also 4/7 severe patients developed marked post-inflammatory entheseal calcifications. CONCLUSIONS A predominant isolated severe enthesitis pattern of SpA may develop under VDZ therapy with severe disease in 8% of cases. Most cases continued VDZ therapy.
Collapse
Affiliation(s)
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | | | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust & The University of Leeds, Leeds, United Kingdom
| |
Collapse
|
19
|
Yamamoto-Furusho JK, Sánchez-Morales GE. Factors Associated with the Presence of Extraintestinal Manifestations in Patients with Ulcerative Colitis in a Latin American Country. Inflamm Intest Dis 2020; 5:200-204. [PMID: 33313072 DOI: 10.1159/000510070] [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: 04/14/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Aim Ulcerative colitis (UC) is a subtype of inflammatory bowel disease that can develop extraintestinal manifestations (EIMs) in a subgroup of patients. The aim of this work was to study the frequency and clinical factors associated with the development of EIMs. Methods We evaluated a total of 260 Mexican patients with confirmed UC who were followed retrospectively in order to identify the factors associated with the presence of EIMs. Results The frequency of EIM was 55.8%. The factors associated with the development of EIM were pancolitis (p = 0.003, OR = 2.44, 95% CI = 1.34-4.56) and previous colectomy (p = 0.024, OR = 7.54, 95% CI = 1.20-60.44). A clinical course of initial activity and then long remission for >5 years was found to be a protective factor (p = 0.002, OR = 0.31, 95% CI = 0.14-0.67). Conclusion The frequency of EIM was 55.8% in our population, and the factors associated with their development were pancolitis and colectomy; meanwhile, a clinical course of initial activity and then long remission was a protector feature.
Collapse
Affiliation(s)
- Jesús K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Germán E Sánchez-Morales
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| |
Collapse
|
20
|
Falling C, Stebbings S, Baxter GD, Siegel CA, Gearry RB, Nijs J, Mani R. Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors. Scand J Pain 2020; 21:283-295. [PMID: 34387957 DOI: 10.1515/sjpain-2020-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Musculoskeletal (MSK) pain is a common complaint in patients with inflammatory bowel diseases (IBD). MSK pain in IBD has previously demonstrated association with symptoms of central sensitization; however it is uncertain whether these symptoms are influenced simply by the presence of MSK pain and/or IBD. Primary aim of this study was to investigate whether symptoms of central sensitization differed across three groups: IBD patients with and without MSK pain and healthy controls. Secondary aim was to investigate between-group differences for measures of somatosensory functioning. METHODS Cross-sectional study was performed on adults with IBD. Assessments included: central sensitization inventory (CSI), pressure pain threshold, temporal summation, conditioned pain modulation, perceived stress, affect style, anxiety, depression, and pain catastrophizing. One-way analyses of variance and covariance were used to investigate between-group differences for measures of central sensitization and potential confounding by psychological factors. RESULTS Study participants (n=66) were age/gender matched across three study groups. Between-group differences were solely demonstrated for CSI scores [F(2,63)=19.835, p<0.001, r=0.62], with IBD patients with MSK pain demonstrating the highest CSI scores and healthy controls the lowest. After controlling for individual psychological features, post hoc comparisons indicated that CSI scores were significantly different between-groups (p≤0.025) after controlling for most psychological variables, with the exception of perceived stress (p=0.063) and pain catastrophizing (p=0.593). CONCLUSIONS IBD patients as a whole demonstrated significantly greater symptoms of central sensitization compared to healthy controls. However, IBD patients with persistent MSK pain demonstrated the greatest symptoms of central sensitization compared to patients without MSK pain and healthy controls. Between-group differences for CSI in IBD patients with MSK were not confounded by psychological features. IMPLICATIONS Study results indicate that persistent MSK pain in IBD represents patients with greater central sensitization symptomology. This increased symptomology is suggestive of underlying mechanisms related to central sensitization, highlighting patient potentially at risk for worse pain experiences.
Collapse
Affiliation(s)
- Carrie Falling
- School of Physiotherapy, University of Otago, Dunedin, 9010, New Zealand
| | - Simon Stebbings
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - G David Baxter
- School of Physiotherapy, University of Otago, Dunedin, 9010, New Zealand
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, USA
| | - Richard B Gearry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ramakrishnan Mani
- School of Physiotherapy, University of Otago, Dunedin, 9010, New Zealand
| |
Collapse
|
21
|
Vannala V, Palaian S, Shankar PR. Therapeutic Dimensions of Bisphosphonates: A Clinical Update. Int J Prev Med 2020; 11:166. [PMID: 33312475 PMCID: PMC7716604 DOI: 10.4103/ijpvm.ijpvm_33_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022] Open
Abstract
Bisphosphonates (BPs) are a commonly used class of drugs for the treatment of bone disorders. An extensive review of BPs with their clinical efficacy and safety profile is unavailable. This study aimed to review the available literature on BPs, summarize their role in clinical therapy, and emphasize their safety profile. Authors reviewed the existing literature using the Google Scholar, PubMed, and Micromedex databases and analyzed the collected articles. BPs are the preferred medication for osteoporosis and other similar conditions owing to their efficient antiosteoclastic activity. Few of them are available in oral dosage forms; hence, they are patient-friendly. The mechanism of action, common adverse effects and their clinical applications, precautions and warnings pertaining to the route of administration, and safety profiles have been discussed in this manuscript. The common adverse effects are majorly related to the gastrointestinal, cardiovascular, and endocrine system. Upon chronic usage, patients may experience serious problems like osteonecrosis of the jaw and atypical bone fractures. Although BPs are effective and safe, they may cause GI adverse effects and rare cases of osteonecrosis. Patient counseling could prove beneficial in early identification and prevention of the adverse effects associated with BPs.
Collapse
Affiliation(s)
- Venkataramana Vannala
- Department of Orthodontics, College of Dentistry, Gulf Medical University, Ajman, UAE
| | - Subish Palaian
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | | |
Collapse
|
22
|
Diaconescu S, Strat S, Balan GG, Anton C, Stefanescu G, Ioniuc I, Stanescu AMA. Dermatological Manifestations in Pediatric Inflammatory Bowel Disease. Medicina (B Aires) 2020; 56:medicina56090425. [PMID: 32842528 PMCID: PMC7559248 DOI: 10.3390/medicina56090425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in IBD are either specific, related to the disease activity or treatment-associated, or non-specific. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime. Materials and Methods: A systemic literature review was performed, investigating articles and case reports on dermatological manifestations in children with IBD starting from 2005. A total of 159 potentially suitable articles were identified and after the exclusion process, 75 articles were selected. Results: The most common dermatological manifestations reported in pediatric IBD are erythema nodosum and pyoderma gangrenosum. More rare cases of metastatic Crohn’s disease, epidermolysis bullosa acquisita, small-vessel vasculitis, necrotizing vasculitis, leukocytoclastic vasculitis, cutaneous polyarteritis nodosa, and Sweet’s syndrome have been reported. Oral manifestations of IBD are divided into specific (tag-like lesions, mucogingivitis, lip swelling with vertical fissures, aphthous stomatitis, and pyostomatitis vegetans) and non-specific. IBD treatment may present with side effects involving the skin and mucosa. Anti-tumor necrosis factor agents have been linked to opportunistic skin infections, psoriasiform lesions, and a potentially increased risk for skin cancer. Cutaneous manifestations such as acrodermatitis enteropathica, purpuric lesions, and angular cheilitis may appear secondary to malnutrition and/or malabsorption. Conclusions: The correct diagnosis of dermatological manifestations in pediatric IBD is of paramount importance because of their impact on disease activity, treatment options, and a patient’s psychological status.
Collapse
Affiliation(s)
- Smaranda Diaconescu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.D.); (I.I.)
- Clinical Department of Pediatric Gastroenterology, “St. Mary” Emergency Children’s Hospital, 700309 Iasi, Romania
| | - Silvia Strat
- Clinical Department of Pediatric Gastroenterology, “St. Mary” Emergency Children’s Hospital, 700309 Iasi, Romania
- Correspondence: ; Tel.: +40-768-035-458
| | - Gheorghe G. Balan
- Gastroenterology and Hepatology Clinic, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (G.G.B.); (C.A.); (G.S.)
- Department of Gastroenterology and Hepatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Carmen Anton
- Gastroenterology and Hepatology Clinic, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (G.G.B.); (C.A.); (G.S.)
- Department of Gastroenterology and Hepatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Stefanescu
- Gastroenterology and Hepatology Clinic, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania; (G.G.B.); (C.A.); (G.S.)
- Department of Gastroenterology and Hepatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ileana Ioniuc
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.D.); (I.I.)
- Department of Pediatrics, “St. Mary” Emergency Children’s Hospital, 700309 Iasi, Romania
| | | |
Collapse
|
23
|
Li X, Lu C, Yang Y, Yu C, Rao Y. Site-specific targeted drug delivery systems for the treatment of inflammatory bowel disease. Biomed Pharmacother 2020; 129:110486. [PMID: 32768972 DOI: 10.1016/j.biopha.2020.110486] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis and manifests as a complex and dysregulated immune response. To date, there is no cure for IBD; thus, lifelong administration of maintenance drugs is often necessary. Since conventional IBD treatment strategies do not target the sites of inflammation, only limited efficacy is observed with their use. Moreover, the possibility of severe side effects resulting from systemic drug redistribution is high when conventional drug treatments are used. Therefore, a straightforward disease-targeted drug delivery system is desirable. Based on the pathophysiological changes associated with IBD, novel site-specific targeted drug delivery strategies that deliver drugs directly to the inflammation sites can enhance drug accumulation and decrease side effects. This review summarizes novel inflammation targeted delivery systems in the management of IBD. It also discusses the challenges and new perspectives in this field.
Collapse
Affiliation(s)
- Xin Li
- Department of Pharmacology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chao Lu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yanyan Yang
- Department of Pharmacology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chaohui Yu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
| | - Yuefeng Rao
- Department of Pharmacology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
| |
Collapse
|
24
|
Ribaldone DG, Brigo S, Mangia M, Saracco GM, Astegiano M, Pellicano R. Oral Manifestations of Inflammatory Bowel Disease and the Role of Non-Invasive Surrogate Markers of Disease Activity. MEDICINES (BASEL, SWITZERLAND) 2020; 7:E33. [PMID: 32560118 PMCID: PMC7345678 DOI: 10.3390/medicines7060033] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), can be associated with several extra-intestinal manifestations requiring a multidisciplinary management both in terms of work-up and therapy. Oral lesions are common in patients with IBD, with a prevalence ranging from 5% to 50%. These can represent an oral location of IBD as well as a side-effect of drugs used to treat the intestinal disease. Oral manifestations, occurring in patients with IBD, can be divided in nonmalignant, specific, and non-specific ones, and malignant lesions. While there is undoubtedly a need to search for an IBD in patients with oral lesions associated with intestinal symptoms, the work-up of those with an exclusive oral lesion should be personalized. Fecal calprotectin is a non-invasive marker of intestinal inflammation and may be used to select which patients need to undergo endoscopic examination, thereby avoiding unnecessary investigations. The pharmacological armamentarium to treat oral lesions associated with IBD includes topical or systemic corticosteroids, immunosuppressive agents, and biologic drugs.
Collapse
Affiliation(s)
| | - Selvaggia Brigo
- Bow Lane Dental Group, St George’s Hospital, Bupa Dental Care, London SW17 0QT, UK;
| | - Michela Mangia
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (M.M.); (G.M.S.)
| | - Giorgio Maria Saracco
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (M.M.); (G.M.S.)
| | - Marco Astegiano
- Unit of Gastroenterology, Molinette Hospital, 10126 Turin, Italy; (M.A.); (R.P.)
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, 10126 Turin, Italy; (M.A.); (R.P.)
| |
Collapse
|
25
|
Noble A, Durant L, Hoyles L, Mccartney AL, Man R, Segal J, Costello SP, Hendy P, Reddi D, Bouri S, Lim DNF, Pring T, O’Connor MJ, Datt P, Wilson A, Arebi N, Akbar A, Hart AL, Carding SR, Knight SC. Deficient Resident Memory T Cell and CD8 T Cell Response to Commensals in Inflammatory Bowel Disease. J Crohns Colitis 2020; 14:525-537. [PMID: 31665283 PMCID: PMC7242004 DOI: 10.1093/ecco-jcc/jjz175] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The intestinal microbiota is closely associated with resident memory lymphocytes in mucosal tissue. We sought to understand how acquired cellular and humoral immunity to the microbiota differ in health versus inflammatory bowel disease [IBD]. METHODS Resident memory T cells [Trm] in colonic biopsies and local antibody responses to intraepithelial microbes were analysed. Systemic antigen-specific immune T and B cell memory to a panel of commensal microbes was assessed. RESULTS Systemically, healthy blood showed CD4 and occasional CD8 memory T cell responses to selected intestinal bacteria, but few memory B cell responses. In IBD, CD8 memory T cell responses decreased although B cell responses and circulating plasmablasts increased. Possibly secondary to loss of systemic CD8 T cell responses in IBD, dramatically reduced numbers of mucosal CD8+ Trm and γδ T cells were observed. IgA responses to intraepithelial bacteria were increased. Colonic Trm expressed CD39 and CD73 ectonucleotidases, characteristic of regulatory T cells. Cytokines/factors required for Trm differentiation were identified, and in vitro-generated Trm expressed regulatory T cell function via CD39. Cognate interaction between T cells and dendritic cells induced T-bet expression in dendritic cells, a key mechanism in regulating cell-mediated mucosal responses. CONCLUSIONS A previously unrecognised imbalance exists between cellular and humoral immunity to the microbiota in IBD, with loss of mucosal T cell-mediated barrier immunity and uncontrolled antibody responses. Regulatory function of Trm may explain their association with intestinal health. Promoting Trm and their interaction with dendritic cells, rather than immunosuppression, may reinforce tissue immunity, improve barrier function, and prevent B cell dysfunction in microbiota-associated disease and IBD aetiology.
Collapse
Affiliation(s)
- Alistair Noble
- Gut Microbes and Health Programme, Quadram Institute Bioscience, Norwich, UK,Antigen Presentation Research Group, Imperial College London, Northwick Park and St Mark’s Campus, Harrow, London, UK,Corresponding author: Alistair Noble, PhD, Antigen Presentation Research Group, Northwick Park and St Mark’s Hospital, Level 7W, Watford Road, Harrow HA1 3UJ, UK. Tel.: [44] 20 8869 3255;
| | - Lydia Durant
- Antigen Presentation Research Group, Imperial College London, Northwick Park and St Mark’s Campus, Harrow, London, UK
| | - Lesley Hoyles
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK,Department of Bioscience, Nottingham Trent University, Nottingham, UK
| | - Anne L Mccartney
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Ripple Man
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Jonathan Segal
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK,St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Samuel P Costello
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK,Department of Gastroenterology, Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Philip Hendy
- Antigen Presentation Research Group, Imperial College London, Northwick Park and St Mark’s Campus, Harrow, London, UK,St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Durga Reddi
- Antigen Presentation Research Group, Imperial College London, Northwick Park and St Mark’s Campus, Harrow, London, UK
| | - Sonia Bouri
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Dennis N F Lim
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Toby Pring
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Matthew J O’Connor
- Antigen Presentation Research Group, Imperial College London, Northwick Park and St Mark’s Campus, Harrow, London, UK
| | - Pooja Datt
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Ana Wilson
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Naila Arebi
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Ayesha Akbar
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Ailsa L Hart
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK,St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Simon R Carding
- Gut Microbes and Health Programme, Quadram Institute Bioscience, Norwich, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Stella C Knight
- Antigen Presentation Research Group, Imperial College London, Northwick Park and St Mark’s Campus, Harrow, London, UK,St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| |
Collapse
|
26
|
Musculoskeletal Pain in Individuals With Inflammatory Bowel Disease Reflects Three Distinct Profiles. Clin J Pain 2019; 35:559-568. [DOI: 10.1097/ajp.0000000000000698] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
27
|
Xu W, Ou W, Guo Y, Gu Y, Cui L, Zhong J, Du P. Clinical outcomes and risk factors of secondary extraintestinal manifestation in ulcerative colitis: results of a multicenter and long-term follow-up retrospective study. PeerJ 2019; 7:e7194. [PMID: 31304061 PMCID: PMC6609875 DOI: 10.7717/peerj.7194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/25/2019] [Indexed: 12/20/2022] Open
Abstract
Background Extraintestinal manifestations (EIM) are common in ulcerative colitis (UC). In Shanghai, China, data on the incidence rate and risk factors of EIM in UC patients remain scarce. Methods The study population consisted of UC patients who were identified from a prospectively maintained, institutional review board-approved database at our institutes from June 1986 to December 2018. The demographic and clinical characteristics of the study participants were analyzed. The study included secondary EIM in UC patients and follow-up, while primary EIM was excluded. The diagnosis of EIM was based on clinical, radiological, endoscopic, and immunologic examination and histological findings. Results In total, 271 eligible patients were included in the current study, with a median follow-up time of 13.0 years (interquartile range, 9.0–17.0), and including 31 cases (11.4%) that developed EIM. EIM was associated with clinical outcomes in UC patients and the following factors were identified as contributing factors for the development of EIM: a disease duration of >5 years (odds ratio (OR), 3.721; 95% confidence interval (CI) [1.209–11.456]), age at diagnosis >40 years (OR, 2.924, 95% CI [1.165–7.340]), refractory clinical symptoms (OR, 4.119; 95% CI [1.758–9.650]), and moderate or severe anemia (OR, 2.592; 95% CI [1.047–6.413]). Conclusion In this study, approximately 11.4% UC patients go on to develop at least one EIM. Clinicians should prioritize early control of the disease and treatment of anemia in UC in order to prevent the development of EIM and improve disease prognosis.
Collapse
Affiliation(s)
- Weimin Xu
- Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weijun Ou
- Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuegui Guo
- Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yubei Gu
- Department of Gastroenterology, Rui Jin Hospital, affiliate to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Long Cui
- Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Zhong
- Department of Gastroenterology, Rui Jin Hospital, affiliate to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Peng Du
- Department of Colorectal Surgery, Xin-Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
28
|
Falling C, Stebbings S, Baxter GD, Mani R. Central hypersensitivity - A model for persistent musculoskeletal pain in inflammatory bowel diseases. Med Hypotheses 2019; 129:109243. [PMID: 31371091 DOI: 10.1016/j.mehy.2019.109243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/28/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022]
Abstract
Pain is reported to affect over 70% of individuals with inflammatory bowel diseases (IBD), with abdominal and musculoskeletal (MSK) pain representing the most common complaints. MSK pain is typically considered within the narrow framework of inflammatory extraintestinal manifestations of IBD, resulting in a limited scope for the nature and underlying mechanisms participating in MSK pain experiences in this population. Symptoms related to central sensitization have recently demonstrated association with active IBD and worse MSK pain experiences, suggesting a potential roll for central mechanisms in MSK-related pain. Current literature exploring persistent pain in chronic inflammatory and MSK populations propose complex pain models comprised of dynamic nervous system relationships influenced by primary disease features and concomitant pain states, as well as affective and cognitive components. Nervous system contributions in the development and maintenance of persistent pain are postulated to include mechanisms of peripheral and central sensitization, changes in descending central modulation, as well as structural brain changes. These models go beyond current MSK pain models described in IBD literature, highlighting the need for new frameworks for considering MSK-related pain in IBD. Consequently, this paper proposes a broader theoretical model whereby central mechanisms, such as central sensitization and grey matter changes, as well as psychological and disease factors are suggested to modulate pain experiences in this population. Exploration of relationships within the proposed framework may provide not only a deeper understanding of the generation and maintenance of persistent MSK pain in IBD, but also highlight the need for new targeted management pathways in this population. This paper hypothesizes that exploration of central sensitization in IBD patients will demonstrate altered somatosensory functioning in patients with MSK pain, and that IBD activity and psychological factors will be associated with altered somatosensory functioning and worse pain experiences.
Collapse
Affiliation(s)
- Carrie Falling
- University of Otago, School of Physiotherapy, New Zealand.
| | | | - G David Baxter
- University of Otago, School of Physiotherapy, New Zealand
| | | |
Collapse
|
29
|
Garber A, Regueiro M. Extraintestinal Manifestations of Inflammatory Bowel Disease: Epidemiology, Etiopathogenesis, and Management. Curr Gastroenterol Rep 2019; 21:31. [PMID: 31098819 DOI: 10.1007/s11894-019-0698-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE OF REVIEW Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) represent a complex array of disease processes with variable epidemiologic penetrance, genetic antecedents, and phenotypic presentations. The purpose of this review is to provide an overview of primary and secondary EIMs as well as salient treatment strategies utilized. RECENT FINDINGS While the genetic antecedents remain incompletely understood, the treatment armamentarium for EIMs has expanded with new pharmaceutical drug classes that effectively treat IBD. EIMs are an increasingly recognized complication of IBD that require prompt recognition, multidisciplinary management, and a multifaceted therapeutic approach. This review highlights the complexities and ramifications of EIM management and offers therapeutic guidance.
Collapse
Affiliation(s)
- Ari Garber
- Departments of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Miguel Regueiro
- Departments of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| |
Collapse
|
30
|
Núñez F P, Quera P R, Gomollón F. Primary sclerosing cholangitis and inflammatory bowel disease: Intestine-liver interrelation. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:316-325. [PMID: 30948141 DOI: 10.1016/j.gastrohep.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 02/08/2023]
Abstract
The association between inflammatory bowel disease (IBD) and primary sclerosing cholangitis should be considered a distinct clinical entity. This association involves genetic abnormalities, epidemiological factors (more common in men, with no a geographical pattern) and, commonly, subclinical inflammation, predominance of the right colon (endoscopic and histological), backwash ileitis and rectal sparing. Furthermore, there is an increased risk of colorectal cancer and cholangiocarcinoma. The aim of this review is to show how IBD influences the progression of this entity, transplantation requirements and recurrence. We also discuss the current evidence on the use of biological therapy in this group of patients.
Collapse
Affiliation(s)
- Paulina Núñez F
- Fellow Programa Enfermedad Inflamatoria Universidad de Chile-Clínica Las Condes. Servicio de Gastroenterología, Hospital San Juan de Dios, Santiago, Chile.
| | - Rodrigo Quera P
- Programa Enfermedad Inflamatoria; Servicio de Gastroenterología, Clínica Las Condes, Santiago, Chile
| | - Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Ciberehd, Zaragoza, España
| |
Collapse
|
31
|
Greuter T, Vavricka SR. Extraintestinal manifestations in inflammatory bowel disease - epidemiology, genetics, and pathogenesis. Expert Rev Gastroenterol Hepatol 2019; 13:307-317. [PMID: 30791773 DOI: 10.1080/17474124.2019.1574569] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder, primarily of, but not restricted to the gut. Extraintestinal manifestations (EIMs) are frequently observed and involve the joints, eyes, hepatobiliary tract, and skin. Areas covered: In this review, we discuss classical EIM focusing on epidemiology, genetics, and pathogenesis, highlighting recent advances in the understanding of EIM. We further discuss treatment-induced immunological phenomena, which are increasingly recognized and might challenge IBD-treating physicians in the era of biological treatment. Expert opinion: EIM considerably contributes to morbidity and mortality. Genetic studies have revealed a common genetic background between EIM and IBD and among specific EIM. Identified protein interactions have been shown to cluster in shared biological pathways. However - despite these recent advances - pathogenesis of EIM is at best partially understood. Several pathogenic mechanisms have been proposed such as upregulation of tumor necrosis factor, aberrant lymphocyte homing, and cross-reactive antigen presentation. It still remains unclear whether EIM is a direct result of the inflammatory process in the gut or rather a consequence of a shared genetic background leading to dysfunctional immune responses to environmental stimuli. Exploration and understanding of EIM genetics and pathophysiology will pave the road for better and more efficacious treatment options in the future.
Collapse
Affiliation(s)
- Thomas Greuter
- a Department of Gastroenterology and Hepatology , University Hospital Zurich , Zurich , Switzerland
| | - Stephan R Vavricka
- a Department of Gastroenterology and Hepatology , University Hospital Zurich , Zurich , Switzerland.,b Center for Gastroenterology and Hepatology , Zurich , Switzerland
| |
Collapse
|
32
|
Roth N, Biedermann L, Fournier N, Butter M, Vavricka SR, Navarini AA, Rogler G, Scharl M. Occurrence of skin manifestations in patients of the Swiss Inflammatory Bowel Disease Cohort Study. PLoS One 2019; 14:e0210436. [PMID: 30682031 PMCID: PMC6347222 DOI: 10.1371/journal.pone.0210436] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS Extraintestinal cutaneous manifestations of IBD represent a severe disease complication and an early and accurate treatment might positively influence the disease course. Using the patient collective of the Swiss IBD Cohort Study (SIBDCS), we analysed epidemiological as well as clinical factors being associated with the onset of pyoderma gangrenosum, erythema nodosum and aphthous ulcers in IBD patients. METHODS We included 3266 SIBDCs patients, 1840 with Crohn's disease (CD) and 1426 with ulcerative colitis (UC) or IBD unclassified (IBDU) and analysed the association of cutaneous manifestations with age, age at diagnosis time, type of disease, gender, family history, HLA-allotype, smoking, intestinal disease activity, therapy and other extraintestinal manifestations (EIM). RESULTS 354 CD patients and 136 UC/IBDU patients presented with skin manifestations at any time during their disease course. In both, CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations. For CD, we also detected a positive family history as associated factor. As an indicator of more intensive intestinal disease activity, patients with cutaneous manifestations of IBD needed more frequently therapy with antibiotics, steroids, immunomodulators and anti-TNF. Multivariate analysis revealed female gender, younger age at diagnosis and presence of other extraintestinal manifestations as factors being associated with skin EIM in IBD patients and anti-TNF as well as immunomodulatory treatment in CD patients. CONCLUSION Our results suggest that young females with a positive family history of IBD might be at increased risk for the onset of skin manifestations and require a careful screening for such complications.
Collapse
Affiliation(s)
- Nina Roth
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Internal Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Fournier
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Butter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephan R. Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- * E-mail:
| | | |
Collapse
|
33
|
Chams S, Badran R, Sayegh SE, Chams N, Shams A, Hajj Hussein I. Inflammatory bowel disease: Looking beyond the tract. Int J Immunopathol Pharmacol 2019; 33:2058738419866567. [PMID: 31382828 PMCID: PMC6685113 DOI: 10.1177/2058738419866567] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/05/2019] [Indexed: 12/31/2022] Open
Abstract
Inflammatory bowel disease is a chronic inflammatory condition that encompasses Crohn's disease and ulcerative colitis. Inflammatory bowel disease is not exclusive to the gastrointestinal system, as it has been identified to be associated with extraintestinal manifestations that encompass every other organ system in the human body. This review article will comprehensively review the current knowledge on extraintestinal manifestations of inflammatory bowel disease. In addition, it will discuss the recommendations for screening and surveillance for extraintestinal manifestations in these patients since early appropriate diagnosis is imperative in preventing morbidity and cancer development.
Collapse
Affiliation(s)
- Sana Chams
- Division of Geriatric Medicine, Beaumont Health, Royal Oak, MI, USA
| | - Reina Badran
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Skye El Sayegh
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nour Chams
- Division of Geriatric Medicine, Beaumont Health, Royal Oak, MI, USA
| | - Ali Shams
- Department of Emergency Medicine, Beaumont Health, Royal Oak, MI, USA
| | - Inaya Hajj Hussein
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| |
Collapse
|
34
|
Jang HJ, Kang B, Choe BH. The difference in extraintestinal manifestations of inflammatory bowel disease for children and adults. Transl Pediatr 2019; 8:4-15. [PMID: 30881893 PMCID: PMC6382501 DOI: 10.21037/tp.2019.01.06] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Extraintestinal manifestations (EIMs) are frequently observed in adult and pediatric patients with inflammatory bowel disease (IBD). The most common EIMs involve the joints, skin, and eyes, but they can affect various organs and result in significant morbidity. Since EIMs can appear years before the diagnosis of IBD is made, clinicians should be aware of their various manifestations to help decrease diagnostic delay of IBD and establish appropriate treatment plans.
Collapse
Affiliation(s)
- Hyo-Jeong Jang
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, South Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea
| |
Collapse
|
35
|
Bijelić B, Matić IZ, Besu I, Janković L, Juranić Z, Marušić S, Andrejević S. Celiac disease-specific and inflammatory bowel disease-related antibodies in patients with recurrent aphthous stomatitis. Immunobiology 2019; 224:75-79. [DOI: 10.1016/j.imbio.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
|
36
|
Anderson A, Ferris LK, Click B, Ramos-Rivers C, Koutroubakis IE, Hashash JG, Dunn M, Barrie A, Schwartz M, Regueiro M, Binion DG. Low Rates of Dermatologic Care and Skin Cancer Screening Among Inflammatory Bowel Disease Patients. Dig Dis Sci 2018; 63:2729-2739. [PMID: 29713987 DOI: 10.1007/s10620-018-5056-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dermatologic manifestations of inflammatory bowel disease (IBD) are common, and certain IBD medications increase the risk of skin cancer. AIMS To define the rates of care and factors associated with dermatologic utilization with a focus on skin cancer screening. METHODS We utilized a prospective, natural history IBD research registry to evaluate all outpatient healthcare encounters from 2010 to 2016. Gastrointestinal, dermatologic and primary care visits per individual were identified. We calculated the proportion of patients obtaining care, categorized primary indications for dermatologic visits, determined the incidence of melanoma and non-melanoma skin cancers, and used logistic regression to determine factors associated with dermatology utilization. RESULTS Of the 2127 IBD patients included, 452 (21.3%) utilized dermatology over the study period, and 55 (2.6%) had a total body skin examination at least once. The 452 patients incurred 1633 dermatology clinic visits, 278 dermatologic procedures, and 1108 dermatology telephone encounters. The most frequent indication was contact dermatitis or dermatitis. Factors associated with dermatology use were family history of skin cancer, employment, systemic steroids, longer disease duration, emergency room use, and the number of IBD-related clinic visits. Between 8.3 and 11% of IBD patients recommended for skin cancer screening visited dermatology each year, and the resulting incidence of non-melanoma skin cancer was 35.4/10,000 [95% CI 23.3-51.5] and melanoma was 6.56/10,000 [95% CI 2.1-15.3]. CONCLUSIONS Less than one in ten IBD patients obtain dermatologic care. Given the increased risk of skin cancers among IBD patients, an emphasis on education, prevention, and screening merits attention.
Collapse
Affiliation(s)
- Alyce Anderson
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Benjamin Click
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Claudia Ramos-Rivers
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Ioannis E Koutroubakis
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jana G Hashash
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Michael Dunn
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Arthur Barrie
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marc Schwartz
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Miguel Regueiro
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - David G Binion
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
37
|
Falling C, Stebbings S, Baxter GD, Gearry RB, Mani R. Profile of musculoskeletal pain in patients with inflammatory bowel disease: a study protocol for assessing the multidimensional experience of self-reported pain. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1500149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Carrie Falling
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Simon Stebbings
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - G. David Baxter
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Richard B. Gearry
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
38
|
Dubinsky MC, Cross RK, Sandborn WJ, Long M, Song X, Shi N, Ding Y, Eichner S, Pappalardo B, Ganguli A, Wang A. Extraintestinal Manifestations in Vedolizumab and Anti-TNF-Treated Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:1876-1882. [PMID: 29668916 DOI: 10.1093/ibd/izy065] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extra-intestinal manifestations (EIMs) can impact morbidity in patients with inflammatory bowel diseases (IBD; Crohn's disease [CD] and ulcerative colitis [UC]). This study compared incidence rates of EIMs in patients with moderate to severe IBD receiving gut-selective vedolizumab (VDZ) vs those receiving systemic anti-tumor necrosis factor (anti-TNF) therapies. METHODS Adult IBD patients receiving VDZ or anti-TNFs were identified from the MarketScan claims database from September 28, 2012, through September 30, 2016. Incidence rates of EIMs were compared between the 2 cohorts. Descriptive analyses were performed for all courses of treatment. Generalized linear models estimated the impact of treatment on the likelihood of developing EIMs. RESULTS Compared with patients receiving anti-TNF therapy, VDZ-treated CD patients were 28% more likely to develop "any EIMs" (adjusted incident rate ratio [IRR], 1.28; 95% confidence interval [CI], 1.02-1.62). Specifically, CD patients treated with VDZ were more likely to develop erythema nodosum (IRR, 4.29; 95% CI, 1.73-10.64), aphthous stomatitis (IRR, 3.73; 95% CI, 1.51-9.23), episcleritis/scleritis (IRR, 2.51; 95% CI, 1.02-6.14), arthropathy (IRR, 1.45; 95% CI, 1.15-1.84), primary sclerosing cholangitis (PSC) (IRR, 7.79; 95% CI, 3.32-18.27), and uveitis/iritis (IRR, 2.89; 95% CI, 1.35-6.18). UC patients receiving VDZ did not have a statistically significant increase in "any EIMs" vs patients receiving anti-TNFs, but were more likely to develop specific EIMs (aphthous stomatitis: IRR, 3.67; 95% CI, 1.30-10.34; pyoderma gangrenosum: IRR, 4.42; 95% CI, 1.00-19.45; and PSC: IRR, 3.44; 95% CI, 1.23-9.68). CONCLUSIONS IBD patients receiving VDZ may be more likely to develop EIMs vs patients receiving anti-TNF therapies. The gut-selective inflammatory control of VDZ may potentially limit its clinical effect on EIM prevention.
Collapse
Affiliation(s)
| | - Raymond K Cross
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Millie Long
- Universtiy of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Xue Song
- Truven Health Analytics, Cambridge, Massachusetts
| | - Nianwen Shi
- Truven Health Analytics, Cambridge, Massachusetts
| | - Yao Ding
- Truven Health Analytics, Cambridge, Massachusetts
| | | | | | | | | |
Collapse
|
39
|
Wang X, Shen B. Management of Crohn's Disease and Complications in Patients With Ostomies. Inflamm Bowel Dis 2018; 24:1167-1184. [PMID: 29722891 DOI: 10.1093/ibd/izy025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Indexed: 12/13/2022]
Abstract
Fecal diversion with ostomy construction can be a temporary or definitive surgical measure for the treatment of refractory inflammatory bowel disease (IBD). However, the fecal diversion surgery is associated with various stoma, peristomal complications, and recurrence or occurrence of de novo small bowel Crohn's disease (CD). Stoma complications often need enterostomal therapy or surgical revision. Peristomal cutaneous lesions, such as pyoderma gangrenosum, usually require immunomodulator or biological therapy. Routine monitoring for occurrence or recurrence of CD with endoscopy or imaging should be performed, and prophylaxis with mesalamines, antibiotics, immunomodulators, or anti-TNFα or anti-integrin agents is needed for patients at risk. Those agents, along with corticosteroids, may also be used for the treatment of CD of the neo-small intestine, particularly inflammatory and fistulizing phenotypes. Endoscopic balloon dilation or endoscopic stricturotomy via stoma is safe and feasible to treat short (<4-5 cm), straight strictures in the neo-small intestine. Medically or endoscopically refractory fibrostenotic disease usually requires surgical intervention, with bowel-sparing stricturoplasty being the surgical treatment of choice.
Collapse
Affiliation(s)
- Xinying Wang
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bo Shen
- Center for Inflammatory Bowel Diseases, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
40
|
Nir O, Rinawi F, Amarilyo G, Harel L, Shamir R, Assa A. Phenotypic Features and Longterm Outcomes of Pediatric Inflammatory Bowel Disease Patients with Arthritis and Arthralgia. J Rheumatol 2017; 44:1636-1643. [PMID: 28864649 DOI: 10.3899/jrheum.170168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The natural history of pediatric inflammatory bowel disease (IBD) patients with joint involvement has not been clearly described. Thus, we aimed to investigate phenotypic features and clinical outcomes of this distinct association. METHODS The medical records of patients with pediatric IBD diagnosed from 2000 to 2016 were reviewed retrospectively. Main outcome measures included time to first flare, hospitalization, surgery, and biologic therapy. RESULTS Of 301 patients with Crohn disease (median age 14.2 yrs), 37 (12.3%) had arthritis while 44 (14.6%) had arthralgia at diagnosis. Arthritis and arthralgia were more common in women (p = 0.028). Patients with arthritis and arthralgia demonstrated lower rates of perianal disease (2.7% and 4.5% vs 16.9%, p = 0.013), whereas patients with arthritis were more likely to be treated with biologic therapy (HR 2.05, 95% CI 1.27-3.33, p = 0.009). Of 129 patients with ulcerative colitis (UC; median age 13.7 yrs), 3 (2.3%) had arthritis and 16 (12.4%) had arthralgia at diagnosis. Patients with arthralgia were treated more often with corticosteroids (p = 0.03) or immunomodulator therapies (p = 0.003) compared with those without joint involvement. The likelihood to undergo colectomy was significantly higher in patients with arthralgia (HR 2.9, 95% CI 1.1-7.4, p = 0.04). During followup (median 9.0 yrs), 13 patients developed arthritis (3.3%). Arthralgia at diagnosis was a significant predictor for the development of arthritis during followup (HR 9.0, 95% CI 2.86-28.5, p < 0.001). CONCLUSION Pediatric IBD patients with arthritis have distinct phenotypic features. Arthralgia at diagnosis is a predictor for colectomy in UC and a risk factor for the development of arthritis during followup.
Collapse
Affiliation(s)
- Osnat Nir
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University
| | - Firas Rinawi
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University
| | - Gil Amarilyo
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University
| | - Liora Harel
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University
| | - Raanan Shamir
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University
| | - Amit Assa
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel. .,O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.
| |
Collapse
|
41
|
Greuter T, Navarini A, Vavricka SR. Skin Manifestations of Inflammatory Bowel Disease. Clin Rev Allergy Immunol 2017. [DOI: 10.1007/s12016-017-8617-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
42
|
Sánchez-Martínez M, Garcia-Planella E, Laiz A, Puig L. Enfermedad inflamatoria intestinal: abordaje conjunto digestivo-dermatológico. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:184-191. [DOI: 10.1016/j.ad.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 07/01/2016] [Accepted: 07/10/2016] [Indexed: 01/05/2023] Open
|
43
|
Inflammatory Bowel Disease: Joint Management in Gastroenterology and Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
44
|
Crosstalk between the gut and the liver via susceptibility loci: Novel advances in inflammatory bowel disease and autoimmune liver disease. Clin Immunol 2017; 175:115-123. [DOI: 10.1016/j.clim.2016.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/08/2016] [Accepted: 10/18/2016] [Indexed: 02/07/2023]
|
45
|
Vasovic M, Gajovic N, Brajkovic D, Jovanovic M, Zdravkovaic N, Kanjevac T. The relationship between the immune system and oral manifestations of inflammatory bowel disease: a review. Cent Eur J Immunol 2016; 41:302-310. [PMID: 27833449 PMCID: PMC5099388 DOI: 10.5114/ceji.2016.63131] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/28/2015] [Indexed: 12/15/2022] Open
Abstract
Inflammatory bowel diseases (IBDs) are chronic, relapsing inflammatory diseases characterized by exacerbations and remissions of the gastrointestinal tract, clinically manifested as Crohn's disease and ulcerative colitis. The etiology of IBDs is considered to be multi factorial, comprising environmental, immune, microbial and genetic factors. Clinical signs may include abdominal pain, frequent bloody diarrheas, mucorrhea, vomiting, fever, fatigue or weight loss. Changes in the oral cavity often precede intestinal symptoms. Inflammatory bowel disease leads to a significant deterioration of oral health, which indicates that cooperation between the dentist and the gastroenterologist is necessary when considering patients' welfare. Patients with IBD have an altered immune response, but microorganisms of the oral cavity may also be responsible for its modification. This review paper discusses the correlation between the immune system and inflammatory bowel disease manifestations in the oral cavity.
Collapse
Affiliation(s)
- Miroslav Vasovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Nevena Gajovic
- Center for Molecular Medicine and Stem Cells Research, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Denis Brajkovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Natasa Zdravkovaic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Tatjana Kanjevac
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Serbia
| |
Collapse
|
46
|
Zhao H, Zhao L, Shi W, Luo H, Duan L, You Y, Li Y, Zuo X. Is it bowel-associated dermatosis-arthritis syndrome induced by small intestinal bacteria overgrowth? SPRINGERPLUS 2016; 5:1551. [PMID: 27652124 PMCID: PMC5021650 DOI: 10.1186/s40064-016-3236-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/06/2016] [Indexed: 01/22/2023]
Abstract
Introduction Bowel-associated dermatosis-arthritis syndrome is rare systemic diseases characterized by a prodrome of fever, chills, and influenza-like symptoms with subsequent skin eruptions, myalgias, and polyarthralgias. It is reported to be occurred in Intestinal bypass surgery and inflammatory bowel disease. Case description Herein, we described a 29-years-old man with Bowel-associated dermatosis-arthritis syndrome. He had no history of gastrointestinal surgery and inflammatory bowel disease. Distribution of the gut bacterial flora showed small intestinal bacterial overgrowth. Discussion and Evaluation It is rarely form as Non-intestinal bypass road and non-inflammatory bowel disease was induced by small intestinal bacteria overgrowth. Conclusions We concluded that Immuno-inflammatory response to overgrowth of intestinal bacterial antigen induce the clinical symptoms of bowel-associated dermatosis-arthritis syndrome.
Collapse
Affiliation(s)
- Hongjun Zhao
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province 410008 People's Republic of China
| | - Lijuan Zhao
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province 410008 People's Republic of China
| | - Wei Shi
- Departments of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008 People's Republic of China
| | - Hui Luo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province 410008 People's Republic of China
| | - Liping Duan
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province 410008 People's Republic of China
| | - Yunhui You
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province 410008 People's Republic of China
| | - Yisha Li
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province 410008 People's Republic of China
| | - Xiaoxia Zuo
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan Province 410008 People's Republic of China
| |
Collapse
|
47
|
Park KS. Lung injury as an extra-intestinal manifestation of inflammatory bowel disease. Korean J Intern Med 2016; 31:851-2. [PMID: 27604797 PMCID: PMC5016295 DOI: 10.3904/kjim.2016.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/23/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kyung Sik Park
- Correspondence to Kyung Sik Park, M.D. Department of Internal Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: +82-53-250-7088 Fax: +82-53-250-7442 E-mail:
| |
Collapse
|
48
|
Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID. Psoriasis and inflammatory bowel disease: links and risks. PSORIASIS-TARGETS AND THERAPY 2016; 6:73-92. [PMID: 29387596 PMCID: PMC5683131 DOI: 10.2147/ptt.s85194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Psoriasis and the spectrum of inflammatory bowel diseases (IBD) are chronic, inflammatory, organotropic conditions. The epidemiologic coexistence of these diseases is corroborated by findings at the level of disease, biogeography, and intrafamilial and intrapatient coincidence. The identification of shared susceptibility loci and DNA polymorphisms has confirmed this correlation at a genetic level. The pathogenesis of both diseases implicates the innate and adaptive segments of the immune system. Increased permeability of the epidermal barrier in skin and intestine underlies the augmented interaction of allergens and pathogens with inflammatory receptors of immune cells. The immune response between psoriasis and IBD is similar and comprises phagocytic, dendritic, and natural killer cell, along with a milieu of cytokines and antimicrobial peptides that stimulate T-cells. The interplay between dendritic cells and Th17 cells appears to be the core dysregulated immune pathway in all these conditions. The distinct similarities in the pathogenesis are also reflected in the wide overlapping of their therapeutic approaches. Small-molecule pharmacologic immunomodulators have been applied, and more recently, biologic treatments that target proinflammatory interleukins have been introduced or are currently being evaluated. However, the fact that some treatments are quite selective for either skin or gut conditions also highlights their crucial pathophysiologic differences. In the present review, a comprehensive comparison of risk factors, pathogenesis links, and therapeutic strategies for psoriasis and IBD is presented. Specific emphasis is placed on the role of the immune cell species and inflammatory mediators participating in the pathogenesis of these diseases.
Collapse
Affiliation(s)
| | | | - Konstantinos H Katsanos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Epameinondas Tsianos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | |
Collapse
|
49
|
Abstract
Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.
Collapse
Affiliation(s)
- Joshua W Hagen
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA
| | - Jason M Swoger
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop street, C-Wing, Mezzanine, Pittsburgh, PA 15213, USA
| | - Lisa M Grandinetti
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA.
| |
Collapse
|
50
|
Brown SR, Coviello LC. Extraintestinal Manifestations Associated with Inflammatory Bowel Disease. Surg Clin North Am 2016; 95:1245-59, vii. [PMID: 26596925 DOI: 10.1016/j.suc.2015.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) affects multiple organ systems outside of the gastrointestinal tract. The clinician treating patients with IBD should be acutely aware of the diagnosis and treatment of extraintestinal manifestations in order to decrease morbidity. The management can be difficult and often times requires a multidisciplinary approach. Future research investigating the pathophysiology, diagnosis, and treatment is needed to further the care of these patients.
Collapse
Affiliation(s)
- Shaun R Brown
- Department of Colorectal Surgery, Oschner Clinic Foundation, New Orleans, LA, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Lisa C Coviello
- Department of Surgery, National Capital Region Medical Directorate, Fort Belvoir, VA 22060, USA; Department of Surgery of the Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
| |
Collapse
|