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Xu AA, Vincent S, Ma S, Catania V, Zarrin-Khameh N. Crohn's Disease-Associated Granulomatous Pancreatitis With Exocrine Pancreatic Insufficiency. ACG Case Rep J 2024; 11:e01428. [PMID: 39081299 PMCID: PMC11286247 DOI: 10.14309/crj.0000000000001428] [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: 03/22/2024] [Accepted: 06/03/2024] [Indexed: 08/02/2024] Open
Abstract
Extraintestinal manifestations of inflammatory bowel disease occur commonly and can lead to considerable morbidity. Pancreatic manifestations of inflammatory bowel disease have been reported to be more common in Crohn's disease (CD) than ulcerative colitis. We report a case of granulomatous inflammation in the body of the pancreas with exocrine pancreatic insufficiency, which prompted a diagnosis switch from ulcerative colitis to CD. This is of interest to readers to remind them that pancreatic manifestations can occur and are more common in CD.
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Affiliation(s)
- Anthony A. Xu
- Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sara Vincent
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Samuel Ma
- School of Medicine, Baylor College of Medicine, Houston, TX
| | | | - Neda Zarrin-Khameh
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX
- Ben Taub Hospital, Houston, TX
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Hong SM, Baek DH. Diagnostic Procedures for Inflammatory Bowel Disease: Laboratory, Endoscopy, Pathology, Imaging, and Beyond. Diagnostics (Basel) 2024; 14:1384. [PMID: 39001273 PMCID: PMC11241288 DOI: 10.3390/diagnostics14131384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Diagnosing inflammatory bowel disease (IBD) can often be challenging, and differentiating between Crohn's disease and ulcerative colitis can be particularly difficult. Diagnostic procedures for IBD include laboratory tests, endoscopy, pathological tests, and imaging tests. Serological and stool tests can be easily performed in an outpatient setting and provide critical diagnostic clues. Although endoscopy is an invasive procedure, it offers essential diagnostic information and allows for tissue biopsy and therapeutic procedures. Video capsule endoscopy and device-assisted enteroscopy are endoscopic procedures used to evaluate the small bowel. In addition to endoscopy, magnetic resonance imaging, computed tomography, and ultrasound (US) are valuable tools for small bowel assessment. Among these, US is noninvasive and easily utilized, making its use highly practical in daily clinical practice. Endoscopic biopsy aids in the diagnosis of IBD and is crucial for assessing the histological activity of the disease, facilitating a thorough evaluation of disease remission, and aiding in the development of treatment strategies. Recent advances in artificial intelligence hold promise for enhancing various aspects of IBD management, including diagnosis, monitoring, and precision medicine. This review compiles current procedures and promising future tools for the diagnosis of IBD, providing comprehensive insights.
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Affiliation(s)
- Seung Min Hong
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
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Alves Martins BA, Shamsiddinova A, Alquaimi MM, Worley G, Tozer P, Sahnan K, Perry-Woodford Z, Hart A, Arebi N, Matharoo M, Warusavitarne J, Faiz O. Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery. Frontline Gastroenterol 2024; 15:203-213. [PMID: 38665796 PMCID: PMC11042438 DOI: 10.1136/flgastro-2023-102503] [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: 07/08/2023] [Accepted: 11/26/2023] [Indexed: 04/28/2024] Open
Abstract
Background Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support clinical risk assessment and patient selection in those considering IPAA. Methods A literature review was performed to identify the risk factors associated with surgical complications, decreased functional outcomes/quality of life, and pouch failure after IPAA. Based on this, a preliminary checklist was devised and modified through an iterative process. This was then evaluated by a consensus group comprising the pouch multidisciplinary team (MDT) core members. Results The final preoperative checklist includes assessment for risk factors such as gender, advanced age, obesity, comorbidities, sphincteric impairment, Crohn's disease and pelvic radiation therapy. In addition, essential steps in the decision-making process, such as pouch nurse counselling and discussion regarding surgical alternatives, are also included. The last step of the checklist is discussion at a dedicated pouch-MDT. Discussion A preoperative checklist may support clinicians with the selection of patients that are suitable for pouch surgery. It also serves as a useful tool to inform the discussion of cases at the MDT meeting.
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Affiliation(s)
- Bruno Augusto Alves Martins
- Department of Colorectal Surgery, Hospital Universitário de Brasília, Brasilia, Brazil
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
| | - Amira Shamsiddinova
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Manal Mubarak Alquaimi
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Department of General Surgery, King Faisal University, Al-Hasa, Saudi Arabia
| | - Guy Worley
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
| | - Phil Tozer
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kapil Sahnan
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zarah Perry-Woodford
- Pouch and Stoma Care, St Mark's the National Bowel Hospital and Academic Institute, London, UK
| | - Ailsa Hart
- IBD Unit, St Mark's the National Bowel Hospital and Academic Institute, London, UK
| | - Naila Arebi
- IBD Unit, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Manmeet Matharoo
- Wolfson Endoscopy Unit, St Mark's the National Bowel Hospital and Academic Institute, London, UK
| | - Janindra Warusavitarne
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Omar Faiz
- Department of Colorectal Surgery, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Alotaibi A, Alhubayshi A, Allehibi A, Almtawa A, Alotaibi N, Alghamdi A, Alrajhi S, Alqutub A, Aleid A, Alamr A, Ibrahim B, Alahmari M, Alhamidi H, Ahmad S, AlBayyat H, Alshaya O, Altannir Y, Alghamdi A. Prevalence of Classical Extraintestinal Manifestations among Inflammatory Bowel Disease Patients in Saudi Arabia: A Single Tertiary Center Experience. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:169-174. [PMID: 38764558 PMCID: PMC11098265 DOI: 10.4103/sjmms.sjmms_139_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/26/2023] [Accepted: 02/07/2024] [Indexed: 05/21/2024]
Abstract
Background Patients with inflammatory bowel disease (IBD) may also experience extraintestinal manifestations (EIMs), which can affect various organ systems, and their occurrence is based on disease activity. Objectives To determine the prevalence of EIMs and their most common types among IBD patients from Saudi Arabia. Materials and Methods This retrospective study included all IBD patients aged 14-80 years who visited the Gastroenterology and Hepatology clinics at King Fahad Medical City, Riyadh, between February 2017 and December 2022. The collected data included demographic characteristics, disease characteristics, EIMs, and treatment. Results The study included 578 IBD patients, of which 65 (11.2%) had at least one EIM, with primary sclerosing cholangitis (46.2%) and sacroiliitis (16.9%) being the most common. Patients with ulcerative colitis were more likely to have EIMs than those with Crohn's disease (15.1% vs. 9%; P = 0.026). Patients with ileocolonic (L3) Crohn's disease reported a higher prevalence of EIMs (7.5%) than those with other disease locations (P = 0.012), while in patients with ulcerative colitis, those with extensive colitis (E3) reported higher prevalence of EIMs (19.2%) (P = 0.001). Patients receiving 6 MP had a significantly high prevalence of EIMs (P = 0.014). Conclusion The prevalence of extraintestinal manifestations among IBD patients in Saudi Arabia is 11.2%. These findings suggest the need for clinicians to screen for EIMs and manage them early. Further research is needed to understand the mechanisms underlying EIMs for the development of more effective treatments.
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Affiliation(s)
| | - Abrar Alhubayshi
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abed Allehibi
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Abdullah Almtawa
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Nawaf Alotaibi
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Adel Alghamdi
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Saad Alrajhi
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Adel Alqutub
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Ahmad Aleid
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Abdulrhman Alamr
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Bashaar Ibrahim
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | | | - Hussam Alhamidi
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Shameem Ahmad
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
| | - Hadeel AlBayyat
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Osama Alshaya
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed Alghamdi
- Department of Gastroenterology and Hepatology, Riyadh, Saudi Arabia
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Yu H, Guo H. Effects of hospital-family holistic care mode on psychological state and nutritional status of patients with inflammatory bowel disease. Am J Transl Res 2023; 15:6760-6770. [PMID: 38186974 PMCID: PMC10767536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/13/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE This study was designed to determine the effects of hospital-family holistic care mode on psychological state and nutritional status of patients with inflammatory bowel disease (IBD). METHODS A retrospective analysis was conducted on the data of 80 patients with IBD treated in The Second Affiliated Hospital of Jiaxing University from May 2021 to November 2022. Among the patients, 37 patients who received conventional care were assigned to a control group and the remaining 43 patients who received hospital-family holistic care were assigned to an intervention group. The changes of psychological state and nutritional status were compared between the two groups before and after intervention. The two groups were also compared in terms of clinical data, serum preprotein (PA) and albumin (ALB) levels, quality of life (QoL), disease cognition level, self-management of patients, and nursing satisfaction. RESULTS After 6 months of intervention, the intervention group exhibited significantly lower anxiety and depression scores (P<0.001), and significantly higher Crohn's and Colitis knowledge scale and McMaster inflammatory bowel disease questionnaire scores than the control group (P<0.001). The scores of IBD-self-efficacy scale, mini nutritional assessment, and subjective global assessment in the intervention group were all significantly higher than those in the control group after intervention (P<0.001). Also, the intervention group showed significantly higher PA and ALB levels, as well as higher nursing satisfaction than the control group (P<0.001). CONCLUSION The hospital-family holistic care mode can substantially improve the management and nursing of patients with IBD through improving self-management ability, maintaining nutritional status, alleviating negative emotions, and elevating QoL.
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Affiliation(s)
- Huichuang Yu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Jiaxing University Jiaxing 314000, Zhejiang, China
| | - Hongmei Guo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Jiaxing University Jiaxing 314000, Zhejiang, China
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Bao W, Wang L, Liu X, Li M. Predicting diagnostic biomarkers associated with immune infiltration in Crohn's disease based on machine learning and bioinformatics. Eur J Med Res 2023; 28:255. [PMID: 37496049 PMCID: PMC10369716 DOI: 10.1186/s40001-023-01200-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate potential biomarkers of Crohn's disease (CD) and the pathological importance of infiltration of associated immune cells in disease development using machine learning. METHODS Three publicly accessible CD gene expression profiles were obtained from the GEO database. Inflammatory tissue samples were selected and differentiated between colonic and ileal tissues. To determine the differentially expressed genes (DEGs) between CD and healthy controls, the larger sample size was merged as a training unit. The function of DEGs was comprehended through disease enrichment (DO) and gene set enrichment analysis (GSEA) on DEGs. Promising biomarkers were identified using the support vector machine-recursive feature elimination and lasso regression models. To further clarify the efficacy of potential biomarkers as diagnostic genes, the area under the ROC curve was observed in the validation group. Additionally, using the CIBERSORT approach, immune cell fractions from CD patients were examined and linked with potential biomarkers. RESULTS Thirty-four DEGs were identified in colon tissue, of which 26 were up-regulated and 8 were down-regulated. In ileal tissues, 50 up-regulated and 50 down-regulated DEGs were observed. Disease enrichment of colon and ileal DEGs primarily focused on immunity, inflammatory bowel disease, and related pathways. CXCL1, S100A8, REG3A, and DEFA6 in colon tissue and LCN2 and NAT8 in ileum tissue demonstrated excellent diagnostic value and could be employed as CD gene biomarkers using machine learning methods in conjunction with external dataset validation. In comparison to controls, antigen processing and presentation, chemokine signaling pathway, cytokine-cytokine receptor interactions, and natural killer cell-mediated cytotoxicity were activated in colonic tissues. Cytokine-cytokine receptor interactions, NOD-like receptor signaling pathways, and toll-like receptor signaling pathways were activated in ileal tissues. NAT8 was found to be associated with CD8 T cells, while CXCL1, S100A8, REG3A, LCN2, and DEFA6 were associated with neutrophils, indicating that immune cell infiltration in CD is closely connected. CONCLUSION CXCL1, S100A8, REG3A, and DEFA6 in colonic tissue and LCN2 and NAT8 in ileal tissue can be employed as CD biomarkers. Additionally, immune cell infiltration is crucial for CD development.
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Affiliation(s)
- Wenhui Bao
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Spleen and Gastroenterology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, No.354 Beima Road, Hongqiao District, Tianjin, China
| | - Lin Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Nephrology Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaoxiao Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Comprehensive Rehabilitation, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ming Li
- Spleen and Gastroenterology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, No.354 Beima Road, Hongqiao District, Tianjin, China.
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Lu S, Yao J, Zhi M. Therapeutic effect of ustekinumab on patients with extra-intestinal manifestations of Crohn's disease. Expert Rev Gastroenterol Hepatol 2023; 17:379-384. [PMID: 36896662 DOI: 10.1080/17474124.2023.2189096] [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] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Ustekinumab serves as an important alternative option for patients with various extraintestinal manifestations (EIMs), which leads to poor quality of life and heavy burden of care. Therefore, a comprehensive review summarizing the efficacy and safety of ustekinumab in patients with CDassociated EIMs is needed to provide reference for clinical medication and help with the appliance of precision medicine. AREAS COVERED In this review, we collected and summarized the efficacy and paradoxical side effects of ustekinumab in patients with CDassociated EIMs including musculoskeletal, cutaneous, ocular, and hepatobiliary manifestations. This literature review was performed using PubMed to identify and collect relevant studies published in English. EXPERT OPINION The effectiveness of ustekinumab on patients with CDassociated EIMs is mainly reflected in musculoskeletal and cutaneous manifestations compared to ocular or hepatobiliary manifestations. Relevant data from large scale cohort studies and prospective randomized trials are needed to further demonstrate the efficacy and safety of ustekinumab in patients with multiple EIMs.
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Affiliation(s)
- Shilin Lu
- Sun Yat-sen University Zhongshan School of Medicine, Guangzhou, Guangdong Province, China
| | - Jiayin Yao
- Department of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Department of gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Min Zhi
- Department of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Department of gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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