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Zeng W, Chen Y, Yin B, Wen X, Xiao J, Luo L, Tang H, Zheng H. Analysis of the risk of future gastrointestinal surgery in Crohn's disease with stricture. Saudi J Gastroenterol 2024; 30:108-113. [PMID: 38011407 PMCID: PMC10980300 DOI: 10.4103/sjg.sjg_256_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Stricture in patients with Crohn's disease (CD) carries a high risk of CD-related surgery in the course of the disease. The aim of this study was to assess the rate of occurrence of CD-related surgery and to determine baseline risk factors predicting subsequent surgery in this patient group. METHODS Patients registered with stricturing CD were included. All baseline and follow-up data were collected retrospectively. Patients attended the clinic for follow-up at week 14 to assess their response to infliximab (IFX). CD-related surgery was the observational endpoint. Univariate and multivariate Cox regression analyses were used. RESULTS A total of 123 patients with stricturing CD were included in this study. The cumulative risk of CD-related surgery for years 1-5 after diagnosis was 18.0%, 26.7%, 32.6%, 40.7%, and 46.4%, respectively. Prior gastrointestinal (GI) surgery, low body mass index (BMI), and high platelet count might be risk factors for future CD-related surgery. With 97 participants treated by IFX, prior GI surgery and primary non-response (PNR) to IFX correlated with future CD-related surgery. CONCLUSION Prior GI surgery, BMI, and platelet counts were related to future CD-related surgery. Patients who were PNR to IFX had a higher risk of CD-related surgery in the future.
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Affiliation(s)
- Wen Zeng
- Department of Scientific Research and Teaching, Central Hospital of Shaoyang, Shaoyan, China
| | - Yong Chen
- Department of Oncology, Central Hospital of Shaoyang, Shaoyan, China
| | - Bolong Yin
- Department of Scientific Research and Teaching, Central Hospital of Shaoyang, Shaoyan, China
| | - Xue Wen
- Department of Scientific Research and Teaching, Central Hospital of Shaoyang, Shaoyan, China
- Graduate School, University of South China, China
| | - Jian Xiao
- Graduate School, University of South China, China
- Department of Hepatobiliary Surgery, Central Hospital of Shaoyang, Shaoyan, China
| | - Lian Luo
- Department of Oncology, Central Hospital of Shaoyang, Shaoyan, China
- Graduate School, University of South China, China
| | - Haiyuan Tang
- Department of Neurology and Stroke Center, Central Hospital of Shaoyang, Shaoyan, China
| | - He Zheng
- Department of Hepatobiliary Surgery, Central Hospital of Shaoyang, Shaoyan, China
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Liu C, Zhan S, Li N, Tu T, Lin J, Li M, Chen M, Zeng Z, Zhuang X. Bile acid alterations associated with indolent course of inflammatory bowel disease. Scand J Gastroenterol 2023; 58:988-997. [PMID: 37070769 DOI: 10.1080/00365521.2023.2200518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The indolent course of treatment-naive patients with inflammatory bowel disease (IBD) is confirmed predictable based on clinical characteristics. Current evidences supported that bile acids (BAs) alteration might be promising biomarkers in the field of IBD. We aimed to analyze the alterations of BAs as the disease progresses and explore their predictive value for indolent course of IBD. METHODS The indolent course of IBD was defined as a disease course without need for strict interventions throughout the entire follow-up. A targeted metabolomics method was used to detect the concentration of 27 BAs from serum sample in treatment-naive patients with IBD (Crohn's disease [CD], n = 27; ulcerative colitis [UC], n = 50). Patients with CD and UC were individually divided into two groups for further study according to the median time of indolent course. The overall BAs profile and the clinical value of BAs in predicting indolent course of IBD were identified between different groups. RESULTS For CD, the levels of deoxycholic acid, glycodeoxycholic acid, taurodeoxycholic acid, glycolithocholic acid-3-sulfate disodium salt and iso-lithocholic acid were significantly increased in patients with indolent course > 18 M (p < 0.05). These five BAs owned 83.5% accuracy for predicting indolent course over 18 months in CD. For UC, the concentration of deoxycholic acid and glycodeoxycholic acid were significantly higher, while dehydrocholic acid were lower in patients with indolent course > 48 M (p < 0.05). These three BAs predicted indolent course over 48 months of 69.8% accuracy in UC. CONCLUSION The specific BAs alterations might be potential biomarkers in predicting disease course of IBD patients.
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Affiliation(s)
- Caiguang Liu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shukai Zhan
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Na Li
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tong Tu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianming Lin
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Manying Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zeng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Zhuang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Kumar S, Plumb A, Mallett S, Bhatnagar G, Bloom S, Clarke CS, Hamlin J, Hart AL, Jacobs I, Travis S, Vega R, Halligan S, Taylor SA. METRIC-EF: magnetic resonance enterography to predict disabling disease in newly diagnosed Crohn's disease-protocol for a multicentre, non-randomised, single-arm, prospective study. BMJ Open 2022; 12:e067265. [PMID: 36192092 PMCID: PMC9535152 DOI: 10.1136/bmjopen-2022-067265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Crohn's disease (CD) is characterised by discontinuous, relapsing enteric inflammation. Instituting advanced therapies at an early stage to suppress inflammation aims to prevent future complications such as stricturing or penetrating disease, and subsequent surgical resection. Therapeutics are effective but associated with certain side-effects and relatively expensive. There is therefore an urgent need for robust methods to predict which newly diagnosed patients will develop disabling disease, to identify patients who are most likely to benefit from early, advanced therapies. We aim to determine if magnetic resonance enterography (MRE) features at diagnosis improve prediction of disabling CD within 5 years of diagnosis. METHODS AND ANALYSIS We describe the protocol for a multicentre, non-randomised, single-arm, prospective study of adult patients with newly diagnosed CD. We will use patients already recruited to the METRIC study and extend their clinical follow-up, as well as a separate group of newly diagnosed patients who were not part of the METRIC trial (MRE within 3 months of diagnosis), to ensure an adequate sample size. Follow-up will extend for at least 4 years. The primary outcome is to evaluate the comparative predictive ability of prognostic models incorporating MRE severity scores (Magnetic resonance Enterography Global Score (MEGS), simplified MAgnetic Resonance Index of Activity (sMaRIA) and Lémann Index) versus models using standard characteristics alone to predict disabling CD (modified Beaugerie definition) within 5 years of new diagnosis. ETHICS AND DISSEMINATION This study protocol achieved National Health Service Research Ethics Committee (NHS REC), London-Hampstead Research Ethics Committee approval (IRAS 217422). Our findings will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN76899103.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | | | - Stuart Bloom
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - John Hamlin
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital and Academic Institute, London, UK
| | | | - Simon Travis
- Kennedy Institute and Translational Gastroenterology Unit, University of Oxford and Biomedical Research Centre, Oxford, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
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Puri BK, Monro JA. Detection of 41-kDa bacterial flagellin protein by the lymphocyte transformation test-memory lymphocyte immunostimulation assay. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2022; 11:72-77. [PMID: 36187894 PMCID: PMC9520187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND/OBJECTIVES Diagnosis of human infection by various species of the bacterial genus Borrelia is mainly reliant on serological testing, polymerase chain reaction (PCR) or culture but such serological tests have been reported to have heterogeneous sensitivities, while Borrelia PCR and culture have been reported as being of modest diagnostic value. It has been suggested that the adjunctive use of the lymphocyte transformation test-memory lymphocyte immunostimulation assay (LTT-MELISA) may be helpful in this regard; however, the clinical usefulness of this assay has been questioned. The Borrelia immunodominant 41-kDa flagellin protein almost always gives rise to a marked human antibody response following infection. It was therefore decided to determine whether the LTT-MELISA detects the human antibody response to this antigen. METHODS Blood samples from consecutive patients with possible borreliosis attending a clinic were independently tested by both Western blots and LTT-MELISA. RESULTS After omitting cases with indeterminate Western blot results and equivocal LTT-MELISA results, multiple linear regression modelling demonstrated that the 41-kDa flagellin immunoglobulin (Ig) M level was predictable from two LTT-MELISA variables (F 2,51 = 5.981, P = 0.005). Similarly, the corresponding 41-kDa IgG model also contained two LTT-MELISA variables (F 2,57 = 3.700, P = 0.031). CONCLUSION It is concluded that the LTT-MELISA appears to be able to detect the response to this antigen.
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Affiliation(s)
| | - Jean A Monro
- Breakspear Medical GroupHemel Hempstead, Hertfordshire, UK
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Ferraro S, Biganzoli EM, Castaldi S, Plebani M. Health Technology Assessment to assess value of biomarkers in the decision-making process. Clin Chem Lab Med 2022; 60:647-654. [PMID: 35245972 DOI: 10.1515/cclm-2021-1291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
Clinical practice guidelines (CPGs) on screening, surveillance, and treatment of several diseases recommend the selective use of biomarkers with central role in clinical decision-making and move towards including patients in this process. To this aim we will clarify the multidisciplinary interactions required to properly measure the cost-effectiveness of biomarkers with regard to the risk-benefit of the patients and how Health Technology Assessment (HTA) approach may assess value of biomarkers integrated within the decision-making process. HTA through the interaction of different skills provides high-quality research information on the effectiveness, costs, and impact of health technologies, including biomarkers. The biostatistical methodology is relevant to HTA but only meta-analysis is covered in depth, whereas proper approaches are needed to estimate the benefit-risk balance ratio. Several biomarkers underwent HTA evaluation and the final reports have pragmatically addressed: 1) a redesign of the screening based on biomarker; 2) a de-implementation/replacement of the test in clinical practice; 3) a selection of biomarkers with potential predictive ability and prognostic value; and 4) a stronger monitoring of the appropriateness of test request. The COVID-19 pandemic has disclosed the need to create a robust and sustainable system to urgently deal with global health concerns and the HTA methodology enables rapid cost-effective implementation of diagnostic tests allowing healthcare providers to make critical patient-management decisions.
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Affiliation(s)
- Simona Ferraro
- Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Silvana Castaldi
- Fondazione Ca' Granda Ospedale Maggiore Policlinico Research Institute of Milano, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padua, Italy
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