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Bouhnik Y, Pineton de Chambrun G, Lambert J, Nachury M, Seksik P, Altwegg R, Vuitton L, Stefanescu C, Nancey S, Aubourg A, Serrero M, Filippi J, Desseaux K, Viennot S, Abitbol V, Boualit M, Bourreille A, Giletta C, Buisson A, Roblin X, Dib N, Malamut G, Amiot A, Fumery M, Louis E, Elgharabawy Y, Peyrin-Biroulet L. Adalimumab in Biologic-naïve Patients With Crohn's Disease After Resolution of an Intra-abdominal Abscess: A Prospective Study From the GETAID. Clin Gastroenterol Hepatol 2023; 21:3365-3378.e5. [PMID: 36731588 DOI: 10.1016/j.cgh.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS The management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging, and surgery with delayed intestinal resection is often recommended. The aims of this study were to estimate the success rate of adalimumab (ADA) in patients with CD with an intra-abdominal abscess resolved without surgery, and to identify predictive factors for success. METHODS A multicenter, prospective study was conducted in biologic-naïve patients with CD with resolved intra-abdominal abscess treated with ADA with a 2-year follow-up. The primary endpoint was ADA failure at week (W) 24 defined as a need for steroids after W12, intestinal resection, abscess recurrence, and clinical relapse. Secondary post-hoc endpoint was the long-term success defined as the survival without abscess relapse or intestinal resection at W104. The factors associated with ADA failure at W24 and W104 were identified using a logistic and a Cox regression, respectively. RESULTS From April 2013 to December 2017, 190 patients from 27 GETAID centers were screened, and 117 were included in the analysis. Fifty-eight patients (50%) were male, and the median age at baseline was 28 years. At W24, 87 patients (74%; 95% confidence interval [CI], 65.5%-82.0%; n = 117) achieved ADA success. Among the 30 patients with ADA failure, 15 underwent surgery. At W104, the survival rate without abscess recurrence or surgery was 72.9% (95% CI, 62.1%-79.8%; n = 109). Abscess drainage was significantly associated with ADA failure at W24 (odds ratio, 4.18; 95% CI, 1.06-16.5; P =0 .043). Disease duration (hazard ratio [HR], 1.32; 95% CI, 1.09-1.59; P = .008), abscess drainage (HR, 5.59; 95% CI, 2.21-14.15; P = .001), and inflammatory changes in mesenteric fat (HR, 0.4; 95% CI, 0.17-0.94; P = .046) were significantly associated with ADA failure at W104. CONCLUSION Provided that the abscess was carefully managed before initiating medical treatment, this study showed the high efficacy of ADA in the short and long term in biologic-naïve patients with CD complicated by an intra-abdominal abscess. CLINICALTRIALS gov, Number: NCT02856763.
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Affiliation(s)
- Yoram Bouhnik
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France.
| | | | - Jérôme Lambert
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Maria Nachury
- University Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Philippe Seksik
- Département de Gastroentérologie, Hôpital Saint Antoine, Sorbonne Université, Inserm, CRSA, AP-HP, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Éloi, CHU, Montpellier, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Carmen Stefanescu
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Lyon University, Lyon, France
| | - Alexandre Aubourg
- Department of Gastroenterology, Tours University Hospital, Tours, France
| | - Mélanie Serrero
- Department of Gastroenterology, Hôpital Nord, Marseille University, Marseille, France
| | - Jérôme Filippi
- Department of Gastroenterology, Nice University Hospital, Nice, France
| | - Kristell Desseaux
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Stéphanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Vered Abitbol
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Madina Boualit
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | - Arnaud Bourreille
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Department of Gastroenterology, CIC Inserm 1413, Nantes University, Nantes, France
| | - Cyrielle Giletta
- Department of Gastroenterology, Toulouse University Hospital, Hôpital Rangueil, Toulouse, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm U1071, M2iSH, CHU Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Georgia Malamut
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Creteil University, Creteil, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, Liège, Belgium
| | - Yasmine Elgharabawy
- Groupe Etude Thérapeutiques des Affections Inflammatoires Digestives, GETAID, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Brabois Hospital, Nancy University, Nancy les Vandoeuvre-lès-Nancy, France
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Rudler F, Pineton de Chambrun G, Lallemant B, Garrel R, Pouderoux P, Ramdani M, Caillo L, Reynaud C, Valats JC, Blanc P. Management of the Zenker diverticulum: multicenter retrospective comparative study of open surgery and rigid endoscopy versus flexible endoscopy. Surg Endosc 2023; 37:7064-7072. [PMID: 37380740 DOI: 10.1007/s00464-023-10225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND STUDY AIM Zenker's diverticulum is a rare disease that affects quality of life due to dysphagia and regurgitation. This condition can be treated by various surgical or endoscopic methods. PATIENTS AND METHOD Patients treated for Zenker's diverticulum in three centers in the south of France between 2014 and 2019 were included. The primary objective was clinical efficacy. Secondary objectives were technical success, morbidities, recurrences, and need for a new procedure. RESULTS One hundred forty-four patients with a total of one hundred sixty-five procedures performed were included. A significant difference was found between the different groups in terms of clinical success (97% for open surgery versus 79% for rigid endoscopy versus 90% for flexible endoscopy, p = 0.009). Technical failure occurred more frequently in the rigid endoscopy group than in the flexible endoscopy and surgical groups (p = 0.014). Median procedure duration, median time to resumption of feeding, and hospital discharge were statistically shorter for endoscopies than for open surgery. On the other hand, more recurrences occurred in patients treated by endoscopy than those treated by surgery, and more reinterventions were required. CONCLUSION Flexible endoscopy appears to be as effective and safe as open surgery in the treatment of Zenker's diverticulum. Endoscopy allows a shorter hospital stay at the expense of a higher risk of recurrence of symptoms. It could be used as an alternative to open surgery for the treatment of Zenker's diverticulum, especially in frail patients.
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Affiliation(s)
- Franz Rudler
- Gastroenterology Department, CHU Montpellier, Montpellier, France.
| | | | | | - Renaud Garrel
- ORL Department, CHU Montpellier, Montpellier, France
| | | | | | | | | | | | - Pierre Blanc
- Gastroenterology Department, CHU Montpellier, Montpellier, France
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Fumery M, Filippi J, Abitbol V, Biron A, Laharie D, Serrero M, Altwegg R, Bouhnik Y, Peyrin-Biroulet L, Gilletta C, Roblin X, Pineton de Chambrun G, Vuitton L, Bourrier A, Nancey S, Gornet JM, Nahon S, Bouguen G, Viennot S, Nachury M, Amiot A. Effectiveness and safety of ustekinumab maintenance therapy in 103 patients with ulcerative colitis: a GETAID cohort study. Aliment Pharmacol Ther 2021; 54:944-951. [PMID: 34296456 DOI: 10.1111/apt.16544] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/10/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Phase III trials have demonstrated the efficacy and safety of ustekinumab in ulcerative colitis (UC), but few real-life long-term data are currently available. AIMS To assess the real-world effectiveness and safety of ustekinumab in patients with UC. METHODS From January to September 2019, all consecutive patients with active UC treated with ustekinumab in a GETAID centre were included. Patients were evaluated at week 52. Remission was defined as a partial Mayo Clinic score ≤2. RESULTS We included 103 patients with UC (62 men; mean age: 41.2 ± 16.2 years; 52% pancolitis E3) with an insufficient response to immunosuppressants, anti-TNFs and/or vedolizumab. At week 52, 45 (44%) patients had discontinued ustekinumab mainly due to lack of effectiveness (n = 41). The cumulative probabilities of ustekinumab persistence were 96.1%, 81.6%, 71.7% and 58.4% after 3, 6, 9 and 12 months respectively. The overall steroid-free clinical remission rate at week 52 was 32% of whom 71% had subscores of null for rectal bleeding and stool frequency. Ten patients underwent colectomy within a median of 6.7 [4.3-10.6] months. Adverse effects were observed in 15 (16.9%) patients; 4 (4.5%) were severe, including one patient who died from a myocardial infarction. CONCLUSION After 52 weeks, over one-half of patients with refractory UC were still treated by ustekinumab and one-third were in steroid-free clinical remission.
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Wils P, Seksik P, Stefanescu C, Nancey S, Allez M, Pineton de Chambrun G, Altwegg R, Gilletta C, Vuitton L, Viennot S, Serrero M, Fumery M, Savoye G, Collins M, Goutorbe F, Brixi H, Bouguen G, Tavernier N, Boualit M, Amiot A, Abitbol V, Laharie D, Pariente B. Safety of ustekinumab or vedolizumab in pregnant inflammatory bowel disease patients: a multicentre cohort study. Aliment Pharmacol Ther 2021; 53:460-470. [PMID: 33345331 DOI: 10.1111/apt.16192] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/23/2020] [Accepted: 11/14/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND The prevalence of inflammatory bowel diseases (IBD) is high in women of childbearing age. Achieving clinical remission from conception to delivery using current medications is a major issue in IBD. AIMS To assess maternal and neonatal complications and management of vedolizumab or ustekinumab) in pregnant women with IBD receiving these agents. METHODS We performed a retrospective cohort study among GETAID centres including women with IBD who received ustekinumab or vedolizumab during pregnancy or within the 2 months before conception and compared outcomes to women exposed to anti-TNF treatment during pregnancy. RESULTS Seventy-three pregnancies in 68 women with IBD were analysed: 29 on ustekinumab resulting in 26 (90%) live births, two (7%) spontaneous abortions and one (3%) elective termination; 44 on vedolizumab resulting in 38 (86%) live births, five (11%) spontaneous abortions and one (3%) medical interruption. The control group included 88 pregnancies exposed to anti-TNF in 76 women with IBD. The median age at conception, the proportion of women who smoked or in clinical activity at conception was comparable between groups. Only the proportion of patients exposed to >2 anti-TNF agents was significantly increased among the ustekinumab and vedolizumab groups compared to control group (22% and 10% vs 3%, P < 0.005). Rates of prematurity, spontaneous abortion, congenital malformations and maternal complications were comparable between groups. CONCLUSION We report 73 pregnancies in patients receiving vedolizumab or ustekinumab without a negative signal on maternal or neonatal outcomes. Further prospective studies are needed on the outcomes of pregnancies with new biologic drugs.
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Chapuis-Biron C, Kirchgesner J, Pariente B, Bouhnik Y, Amiot A, Viennot S, Serrero M, Fumery M, Allez M, Siproudhis L, Buisson A, Pineton de Chambrun G, Abitbol V, Nancey S, Caillo L, Plastaras L, Savoye G, Chanteloup E, Simon M, Dib N, Rajca S, Amil M, Parmentier AL, Peyrin-Biroulet L, Vuitton L. Ustekinumab for Perianal Crohn's Disease: The BioLAP Multicenter Study From the GETAID. Am J Gastroenterol 2020; 115:1812-1820. [PMID: 33156100 DOI: 10.14309/ajg.0000000000000810] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION New therapeutic options for patients with Crohn's disease (CD) with perianal lesions failing anti-tumor necrosis factor (TNF) agents are needed. We aimed to assess the effectiveness of ustekinumab in perianal CD (pCD) and predictors of clinical success in a real-life multicenter cohort. METHODS We conducted a national multicenter retrospective cohort study in patients with either active or inactive pCD who received ustekinumab. In patients with active pCD at treatment initiation, the success of ustekinumab was defined by clinical success at 6 months assessed by the physician's judgment without additional medical or surgical treatment for pCD. Univariate and multivariable logistic regression analyses were performed to identify predictors of success. In patients with inactive pCD at ustekinumab initiation, the pCD recurrence-free survival was calculated using the Kaplan-Meier method. RESULTS Two hundred seven patients were included, the mean age was 37.7 years, the mean duration of CD was 14.3 years, and the mean number of prior perianal surgeries was 2.8. Two hundred five (99%) patients had previously been exposed to at least 1 anti-TNF and 58 (28%) to vedolizumab. The median follow-up time was 48 weeks; 56/207 (27%) patients discontinued therapy after a median time of 43 weeks. In patients with active pCD, success was reached in 57/148 (38.5%) patients. Among patients with setons at initiation, 29/88 (33%) had a successful removal. The absence of optimization was associated with treatment success (P = 0.044, odds ratio 2.74; 95% confidence interval: 0.96-7.82). In multivariable analysis, the number of prior anti-TNF agents (≥3) was borderline significant (P = 0.056, odds ratio 0.4; 95% confidence interval: 0.15-1.08). In patients with inactive pCD at initiation, the probability of recurrence-free survival was 86.2% and 75.1% at weeks 26 and 52, respectively. DISCUSSION Ustekinumab appears as a potential effective therapeutic option in perianal refractory CD. Further prospective studies are warranted.
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Affiliation(s)
- Constance Chapuis-Biron
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - Julien Kirchgesner
- Department of Gastroenterology, Saint-Antoine Hospital, Assitance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Benjamin Pariente
- Department of Hepatogastroenterology, University Hospital of Lille, Lille, France
| | - Yoram Bouhnik
- Department of Gastroenterology, AP-HP, Hôpital Beaujon, Paris, France
| | - Aurélien Amiot
- Department of Gastroenterology, AP-HP, Hôpital Henri-Mondor, Paris, France
| | - Stéphanie Viennot
- Department of Hepatogastroenterology, University Hospital of Caen, Caen, France
| | - Mélanie Serrero
- Department of Gastroenterology, AP-HM, Hôpital Nord, Marseille, France
| | - Mathurin Fumery
- Department of Hepatogastroenterology, Peritox, University Hospital of Amiens, Amiens, France
| | - Matthieu Allez
- Department of Gastroenterology, AP-HP, Hôpital Saint Louis, Paris, France
| | - Laurent Siproudhis
- Department of Hepatogastroenterology, CHU Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Anthony Buisson
- Department of Hepatogastroenterology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Vered Abitbol
- Department of Gastroenterology, AP-HP, Hôpital Cochin, Paris, France
| | - Stéphane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon, Lyon Sud Hospital, Lyon, France
| | - Ludovic Caillo
- Department of Hepatogastroenterology, University Hospital of Nimes, Nimes, France
| | | | - Guillaume Savoye
- Department of Hepatogastroenterology, University Hospital of Rouen
| | - Elise Chanteloup
- Department of Gastroenterology, Hôpital Paris Saint Joseph, Paris, France
| | - Marion Simon
- Department of Gastroenterology, Institut Mutualiste Montsouris, Paris, France
| | - Nina Dib
- Department of Hepatogastroenterology, University Hospital of Angers, Angers, France
| | - Sylvie Rajca
- Department of Gastroenterology, AP-HP, Hôpital Louis-Mourier, Paris, France
| | - Morgane Amil
- Department of Hepatogastroenterology, Centre hospitalier La Roche-sur-Yon, La Roche-sur-Yon, France
| | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
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Martin A, Nachury M, Peyrin-Biroulet L, Bouhnik Y, Nancey S, Bourrier A, Serrero M, Fumery M, Buisson A, Laharie D, Gilletta C, Filippi J, Allez M, Bouguen G, Roblin X, Altwegg R, Dib N, Pineton de Chambrun G, Savoye G, Carbonnel F, Viennot S, Amiot A, Martin A, Gagnière C, Nachury M, Pariente B, Wils P, Peyrin-Biroulet L, Zallot C, Bouhnik Y, Treton X, Stefanescu C, Nancey S, Boschetti G, Seksik P, Beaugerie L, Kirchgesner J, Bourrier A, Sokol H, Serrero M, Fumery M, Yzet C, Brazier F, Laharie D, Rivière P, Poullenot F, Buisson A, Gilletta C, Filippi J, Hebuterne X, Allez M, Gornet JM, Bouguen G, Siproudhis L, Roblin X, Altwegg R, Pineton de Chambrun G, Dib N, Savoye G, Carbonnel F, Meyer A, Viennot S, Lebaut G. Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. J Crohns Colitis 2020; 14:896-903. [PMID: 31930285 DOI: 10.1093/ecco-jcc/jjaa005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. METHODS This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. RESULTS A total of 95 patients [58 with Crohn's disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6-25.4] months. After a median follow-up period of 11.2 [5.8-17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33-0.95], p = 0.03) and discontinuation due to patients' elective choice (HR = 0.41, 95% CI [0.21-0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4-13.3] months, respectively, without any infusion reactions. CONCLUSIONS In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.
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Affiliation(s)
- Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Anne Bourrier
- Department of Gastroenterology, Sorbonne Univeristé, Centre de Recherche Saint-Antoine, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Peritox UMRI-01, Amiens University Hospital, Amiens, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | | | - Guillaume Savoye
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | | | - Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Charlotte Gagnière
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Pauline Wils
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Camille Zallot
- INSERM U954 and Department of Gastroenterology, Université de Lorraine, Nancy, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Xavier Treton
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Philippe Seksik
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Julien Kirchgesner
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Harry Sokol
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d’investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Franck Brazier
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Pauline Rivière
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Florian Poullenot
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Anthony Buisson
- Department of Gastroenterology, University of Clermont Ferrand, Clermont-Ferrand, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jérôme Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Xavier Hebuterne
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Laurent Siproudhis
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | | | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Antoine Meyer
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Guillaume Lebaut
- Department of Gastroenterology, Caen University Hospital, Caen, France
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7
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Amiot A, Filippi J, Abitbol V, Cadiot G, Laharie D, Serrero M, Altwegg R, Bouhnik Y, Peyrin-Biroulet L, Gilletta C, Roblin X, Pineton de Chambrun G, Vuitton L, Bourrier A, Nancey S, Gornet JM, Nahon S, Bouguen G, Viennot S, Pariente B, Fumery M. Effectiveness and safety of ustekinumab induction therapy for 103 patients with ulcerative colitis: a GETAID multicentre real-world cohort study. Aliment Pharmacol Ther 2020; 51:1039-1046. [PMID: 32291786 DOI: 10.1111/apt.15717] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/04/2020] [Accepted: 03/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Phase III trials have demonstrated the efficacy and safety of ustekinumab in moderate-to-severe ulcerative colitis (UC), but few real-world data are currently available. AIM To assess short-term effectiveness and safety of ustekinumab in patients with UC. METHODS From January to September 2019, all patients with UC treated with ustekinumab in 20 French GETAID centres were retrospectively included. The primary outcome was steroid-free clinical remission (partial Mayo Clinic score ≤2) at weeks 12-16 without a rectal bleeding subscore >1. RESULTS Among the 103 patients included, 70% had been previously exposed to ≥2 anti-TNF agents and 85% to vedolizumab. At weeks 12-16, steroid-free clinical remission and clinical remission rates were 35.0% and 39.8% respectively; the absence of rectal bleeding with normal stool frequency was noted in 19.4% of patients. Two patients discontinued ustekinumab before the week 12-16 visit and underwent surgery. In multivariable analysis, a partial Mayo Clinic score >6 at inclusion (18.6% vs 46.7%, P = 0.003) and a history of both exposure to anti-TNF and vedolizumab therapies (27.3% vs 80.0%, P = 0.001) were negatively associated with steroid-free clinical remission at weeks 12-16. Adverse events occurred in 7.8% of patients and serious adverse events in 3.9% of patients. CONCLUSION In a cohort of highly refractory patients with UC with multiple prior drug failures, ustekinumab provided steroid-free clinical remission in one-third of cases at weeks 12-16. Clinical severity and previous use of anti-TNF and vedolizumab therapies were associated with ustekinumab failure at weeks 12-16.
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8
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Pineton de Chambrun G, Amiot A, Bouguen G, Viennot S, Altwegg R, Louis E, Collins M, Fumery M, Poullenot F, Armengol L, Buisson A, Abitbol V, Laharie D, Seksik P, Nancey S, Blanc P, Bouhnik Y, Pariente B, Peyrin-Biroulet L, Boschetti G, Flourié B, Danion P, Savoye G, brazier F, Loreau J, Beaugerie L, Sokol H, Nion-Larmurier I, Bourrier A, Landman C, Lefèvre J, Chafai N, Bouta N, Funakoshi N. Efficacy of Tumor Necrosis Factor Antagonist Treatment in Patients With Refractory Ulcerative Proctitis. Clin Gastroenterol Hepatol 2020; 18:620-627.e1. [PMID: 31202984 DOI: 10.1016/j.cgh.2019.05.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is a challenge to manage patients with ulcerative proctitis (UP) refractory to standard therapy. We investigated the effectiveness of tumor necrosis factor (TNF) antagonists in a large cohort of patients with refractory UP. METHODS We conducted a nationwide retrospective cohort study of 104 consecutive patients with active UP refractory to conventional therapies, treated at 1 of 15 centers in France or 1 center in Belgium (the GETAID cohort). Patients received at least 1 injection of anti-TNF (infliximab, adalimumab, golimumab) from October 2006 through February 2017. Clinical response was defined as significant improvement in UC-related symptoms, and remission as complete disappearance of UC-related symptoms, each determined by treating physicians. We collected demographic, clinical, and treatment data. The median duration of follow-up was 24 months (interquartile range, 13-51 months). The primary outcome was clinical response of UP to anti-TNF treatment. RESULTS Overall, 80 patients (77%) had a clinical response to anti-TNF therapy and 52 patients (50%) achieved clinical remission. Extra-intestinal manifestations (odds ratio OR, 0.24; 95% CI, 0.08-0.7), ongoing treatment with topical steroids (OR, 0.14; 95% CI, 0.03-0.73), and ongoing treatment with topical 5-aminosalycilates (OR, 0.21; 95% CI, 0.07-0.62) were significantly associated with the absence of clinical remission. Sixty percent (38/63) of the patients who had endoscopic assessment during follow up had mucosal healing. Among the overall population (n = 104), the cumulative probabilities of sustained clinical remission were 87.6% ± 3.4% at 1 year and 74.7% ± 4.8% at 2 years. CONCLUSIONS In a retrospective study of 104 patients with refractory UP, anti-TNF therapy induced clinical remission in 50% and mucosal healing in 60%. About two thirds of the patients were still receiving anti-TNF therapy at 2 years.
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Affiliation(s)
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Creteil University, Creteil, France
| | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
| | - Stéphanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, Liège, Belgium
| | - Michael Collins
- Department of Gastroenterology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Florian Poullenot
- Department of Gastroenterology, Haut-Leveque Hospital, Bordeaux University, Pessac, France
| | - Laura Armengol
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Gastroenterology, Estaing Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, Paris Descartes University, Paris, France
| | - David Laharie
- Department of Gastroenterology, Haut-Leveque Hospital, Bordeaux University, Pessac, France
| | - Philippe Seksik
- Département de Gastroentérologie, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Lyon University, Lyon, France
| | - Pierre Blanc
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Yoram Bouhnik
- Department of Gastroenterology, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Benjamin Pariente
- Department of Gastroenterology, Claude Huriez Hospital, Lille 2 University, Lille, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Brabois Hospital, Nancy University, Nancy les Vandoeuvre-lès-Nancy, France
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9
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Pouillon L, Lamoureux A, Pineton de Chambrun G, Vuitton L, Pariente B, Zallot C, Dufour G, Fumery M, Baumann C, Amiot A, Nancey S, Rousseau H, Peyrin-Biroulet L. Dose de-escalation to adalimumab 40 mg every three weeks in patients with inflammatory bowel disease-A multicenter, retrospective, observational study. Dig Liver Dis 2019; 51:236-241. [PMID: 30502230 DOI: 10.1016/j.dld.2018.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/20/2018] [Accepted: 10/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data about the outcomes after adalimumab dose de-escalation in inflammatory bowel disease (IBD) are scarce. OBJECTIVES To assess the outcomes after adalimumab dose de-escalation, and to identify potential factors associated with failure. METHODS Retrospective, observational study including all IBD patients who had undergone adalimumab dose de-escalation to 40 mg every three weeks across seven GETAID centers, between June 2011 and September 2017. Failure of adalimumab dose de-escalation was defined as the need for treatment re-escalation, discontinuation of adalimumab, or clinical, biochemical and/or morphologic disease relapse. RESULTS Fifty-six patients were identified (n = 46 Crohn's disease, n = 10 ulcerative colitis). Median (IQR) duration of follow-up after adalimumab dose de-escalation was 15.9 (7.9-30.6) months. Adalimumab dose de-escalation was a failure in 21/56 (37.5%) patients and successful in 35/56 (62.5%) patients. Median (IQR) time until failure was 8.9 (4.6-15.6) months. At multivariate analysis, inactive disease at magnetic resonance imaging and/or endoscopy in the year before adalimumab dose de-escalation decreased the risk of failure with a factor five (P = 0.02). CONCLUSIONS Adalimumab dose de-escalation to 40 mg every three weeks is possible in almost two thirds of IBD patients. Objective morphologic signs of active disease should be ruled out before considering a de-escalation strategy with adalimumab.
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Affiliation(s)
- Lieven Pouillon
- INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France; Imelda GI Clinical Research Center, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium
| | - Anne Lamoureux
- INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | | | - Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Benjamin Pariente
- Department of Hepato-Gastroenterology, Claude Huriez Hospital, University of Lille-II, Lille, France
| | - Camille Zallot
- INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Gaspard Dufour
- Department of Gastroenterology and Hepatology, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France
| | - Cédric Baumann
- Clinical Research Support Facility PARC, UMDS, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris-Est Cretain Val-de-Marne University (UPEC), Créteil, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils of Lyon, Pierre Bénite, France; INSERM U1111 and International Center for Research in Infectiology, Lyon, France
| | - Hélène Rousseau
- Clinical Research Support Facility PARC, UMDS, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
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10
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Le Baut G, Peyrin-Biroulet L, Bouguen G, Gornet JM, Stefanescu C, Amiot A, Laharie D, Altwegg R, Fumery M, Trang C, Vuitton L, Simon M, Gilletta de Saint Joseph C, Nahon S, Caillo L, Del Tedesco E, Plastaras L, Aubourg A, Pineton de Chambrun G, Seksik P, Viennot S. Anti-TNF therapy for genital fistulas in female patients with Crohn's disease: a nationwide study from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID). Aliment Pharmacol Ther 2018; 48:831-838. [PMID: 30194687 DOI: 10.1111/apt.14946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/16/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genital fistulas represent a devastating complication of Crohn's disease. Only studies with small sample sizes have evaluated the efficacy of anti-TNF therapy for this complication. AIMS To assess the efficacy of anti-TNF therapy for genital fistulas complicating Crohn's disease and to identify predictive factors associated with clinical response at 1 year. METHODS Consecutive patients treated with anti-TNF therapy for genital fistulas complicating Crohn's disease from 1999 to 2016 in 19 French centres from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif were included in a retrospective cohort study. Outcome was clinical fistula closure at 1 year. RESULTS Among the 204 women with genital fistulas who received anti-TNF therapy, 131 were analysed. The first anti-TNF given was infliximab (79%), adalimumab (20%), or certolizumab (1%). At start of anti-TNF therapy, 56% of patients had seton drainage and 53% had concomitant immunosuppressive treatment. A complementary surgery was performed during the first year in 10 patients (8%). At 1 year, 37% of patients had complete clinical fistula closure, 22% had a partial response, and 41% had no response. Among patients without complementary surgery, 34% (41/121) had complete clinical fistula closure. Only complementary surgery was associated with better response on multivariate analysis (adjusted relative risk: 2.02, 95% CI: 1.25-3.26, P = 0.0043). CONCLUSIONS In the anti-TNF era, approximately one-third of patients with genital fistula in Crohn's disease had complete fistula closure at 1 year. Collaboration between surgeons and gastroenterologists appears to be very important to improve the rate of fistula closure.
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de Chambrun GP, Nachury M, Funakoshi N, Gerard R, Bismuth M, Valats JC, Panaro F, Navarro F, Desreumaux P, Pariente B, Blanc P. Oral vancomycin induces sustained deep remission in adult patients with ulcerative colitis and primary sclerosing cholangitis. Eur J Gastroenterol Hepatol 2018; 30:1247-1252. [PMID: 30052539 DOI: 10.1097/meg.0000000000001223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology. The treatment of UC is challenging, especially when it is associated with primary sclerosing cholangitis (PSC), a chronic inflammatory disease of the bile ducts that affects around 5% of patients with UC, and leads to an increased risk of cholangiocarcinoma and colorectal cancer. Microbiota is considered to play an important role in the pathogenesis of UC, although the efficacy of antibiotics in this context is only limited and transient. Several studies have investigated the use of antibiotics for the treatment of PSC in adult and pediatric populations, with conflicting results. In this brief report, we describe the effect of oral vancomycin treatment in three patients with UC and PSC refractory to conventional and biologic therapies. All three patients achieved clinical remission and mucosal healing with vancomycin 500 mg twice a day administered orally. Maintenance treatment with oral vancomycin was well tolerated and led to sustained clinical and endoscopic remission in all three patients. Oral vancomycin also improved liver function tests in two patients who did not have pre-existing cirrhosis.
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Affiliation(s)
| | - Maria Nachury
- Gastroenterology and Hepatology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Natalie Funakoshi
- Department of Gastroenterology, Mersey Community Hospital, Tasmanian Health Service North West Region, Latrobe, Tasmania, Australia
| | - Romain Gerard
- Gastroenterology and Hepatology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | | | | | - Fabrizio Panaro
- Digestive Surgery and Transplantation Department, Montpellier University Hospital, Montpellier
| | - Francis Navarro
- Digestive Surgery and Transplantation Department, Montpellier University Hospital, Montpellier
| | - Pierre Desreumaux
- Gastroenterology and Hepatology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Benjamin Pariente
- Gastroenterology and Hepatology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
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12
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Pineton de Chambrun G, Dufour G, Tassy B, Rivière B, Bouta N, Bismuth M, Panaro F, Funakoshi N, Ramos J, Valats JC, Blanc P. Diagnosis, Natural History and Treatment of Eosinophilic Enteritis: a Review. Curr Gastroenterol Rep 2018; 20:37. [PMID: 29968127 DOI: 10.1007/s11894-018-0645-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW To review recent findings regarding eosinophilic enteritis, including epidemiology, pathogenesis, natural history, and treatment. RECENT FINDINGS A 2017 population-based study using a US healthcare system database identified 1820 patients with a diagnosis of eosinophilic enteritis among 35,826,830 individuals. The majority of patients with eosinophilic enteritis in this study were women (57.7%), Caucasian (77.5%), and adults (> 18 years of age) (83.5%). The overall prevalence of eosinophilic enteritis was estimated at 5.1/100,000 persons. Eosinophilic enteritis, also known as eosinophilic gastroenteritis, is a rare primary eosinophilic gastrointestinal disorder (EGID) of unknown etiology characterized by the presence of an intense eosinophilic infiltrate on histopathological examination of the intestinal mucosa. The etiology of eosinophilic enteritis remains unknown. However, there is evidence to support the role of allergens in the pathogenesis of this disorder, as children and adults with EGIDs often have positive skin testing to food allergens and a family history of allergic diseases. Recent studies unraveling the role of IgE-mediated but also delayed Th2-type responses have provided insight into the pathogenesis of this disease. Eosinophilic enteritis causes a wide array of gastrointestinal symptoms such as abdominal pain, diarrhea, nausea, vomiting, bloating, or ascites, and its diagnosis requires a high degree of clinical likelihood, given the nonspecific clinical presentation and physical examination findings. Oral corticosteroids are considered to be the mainstay of treatment and are generally used for a short period with good response rates. Antihistamine drugs and sodium cromoglycate have also been used to treat patients with eosinophilic enteritis. Preliminary studies have demonstrated the potential benefit of biological therapies targeting the eosinophilic pathway such as mepolizumab, an anti-IL5 antibody, or omalizumab, an anti-IgE monoclonal antibody. Eosinophilic enteritis is generally considered to be a benign disease without relapse, but up to 50% of patients may present a more complex natural history characterized by unpredictable relapses and a chronic course.
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Affiliation(s)
- Guillaume Pineton de Chambrun
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France.
- School of Medicine, Montpellier University, Montpellier, France.
| | - Gaspard Dufour
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
- School of Medicine, Montpellier University, Montpellier, France
| | - Barbara Tassy
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
- School of Medicine, Montpellier University, Montpellier, France
| | - Benjamin Rivière
- School of Medicine, Montpellier University, Montpellier, France
- Pathology Department, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Najima Bouta
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
- School of Medicine, Montpellier University, Montpellier, France
| | - Michael Bismuth
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
- School of Medicine, Montpellier University, Montpellier, France
| | - Fabrizio Panaro
- School of Medicine, Montpellier University, Montpellier, France
- Digestive Surgery and Transplantation Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Natalie Funakoshi
- Department of Gastroenterology, Mersey Community Hospital, Tasmanian Health Service North West Region, Latrobe, TAS, Australia
| | - Jeanne Ramos
- School of Medicine, Montpellier University, Montpellier, France
- Pathology Department, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Jean-Christophe Valats
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
- School of Medicine, Montpellier University, Montpellier, France
| | - Pierre Blanc
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
- School of Medicine, Montpellier University, Montpellier, France
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13
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Panaro F, Benedetti E, Pineton de Chambrun G, Habibeh H, Leon P, Bouyabrine H, Herrero A, Navarro F. Indocyanine green fluorescence angiography during liver and pancreas transplantation: a tool to integrate perfusion statement's evaluation. Hepatobiliary Surg Nutr 2018; 7:161-166. [PMID: 30046566 DOI: 10.21037/hbsn.2017.07.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Indocyanine green (ICG) fluorescence imaging is a promising tool for intraoperative decision-making during surgical procedures, in particular to assess organs perfusion. Methods We used the ICG fluorescence during liver transplantations in six cirrhotic patients to help assessing the graft biliary duct perfusion in order to identify the appropriate level to perform the anastomosis. We also used ICG fluorescence also in five patients receiving kidney-pancreas transplantation to evaluate the perfusion levels of the duodenal stump of the pancreas graft. Results Follow-up period for the patients was 12 months. The perioperative period was uneventful, no biliary complications such as leaks or stenosis were reported after liver transplantation, no complications of the entero-enteric anastomoses occurred after pancreatic transplantation. Conclusions ICG fluorescence seems to safely provide important objectifiable perfusion information during organ transplantation procedures that can integrate surgeon's expertise. In fact, detecting intra-operatively perfusion defects, it allows real time modifications on technical strategies potentially useful to reduce the feared risk of anastomotic leakage and consequent severe complications.
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Affiliation(s)
- Fabrizio Panaro
- Department of General Surgery, Division of Transplantation, University of Montpellier-College of Medicine, Saint Eloi Hospital, Montpellier-Cedex 5, France
| | - Enrico Benedetti
- Division of Transplantation, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Guillaume Pineton de Chambrun
- Department of Medicine, Division of Gastroenterology, Hospital St. Eloi, Montpellier University Hospital, Augustin Fliche, 34295-Montpellier, France
| | - Hussein Habibeh
- Department of General Surgery, Division of Transplantation, University of Montpellier-College of Medicine, Saint Eloi Hospital, Montpellier-Cedex 5, France
| | - Piera Leon
- Department of General Surgery, Division of Transplantation, University of Montpellier-College of Medicine, Saint Eloi Hospital, Montpellier-Cedex 5, France
| | - Hassan Bouyabrine
- Department of General Surgery, Division of Transplantation, University of Montpellier-College of Medicine, Saint Eloi Hospital, Montpellier-Cedex 5, France
| | - Astrid Herrero
- Department of General Surgery, Division of Transplantation, University of Montpellier-College of Medicine, Saint Eloi Hospital, Montpellier-Cedex 5, France
| | - Francis Navarro
- Department of General Surgery, Division of Transplantation, University of Montpellier-College of Medicine, Saint Eloi Hospital, Montpellier-Cedex 5, France
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14
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Lorenzo D, Maire F, Stefanescu C, Gornet JM, Seksik P, Serrero M, Bournet B, Marteau P, Amiot A, Laharie D, Trang C, Coffin B, Bellaiche G, Cadiot G, Reenaers C, Racine A, Viennot S, Pauwels A, Bouguen G, Savoye G, Pelletier AL, Pineton de Chambrun G, Lahmek P, Nahon S, Abitbol V. Features of Autoimmune Pancreatitis Associated With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2018; 16:59-67. [PMID: 28782667 DOI: 10.1016/j.cgh.2017.07.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/11/2017] [Accepted: 07/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Few people know of autoimmune pancreatitis (AIP), a rare disorder associated with inflammatory bowel diseases (IBD). We aimed to describe phenotype and outcomes of IBD and AIP when associated. METHODS We performed a retrospective study of cases of AIP in IBD identified from the multicenter Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif in Belgium and France from July 2012 through July 2015. Patients were diagnosed with AIP based on the International Consensus Diagnostic Criteria for AIP. A definitive AIP diagnosis was based on histological analysis of pancreatic resection specimens or samples collected by fine-needle aspiration during endoscopic ultrasound. Patients with probable type 1 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, level of serum immunoglobulin G4, and involvement of other organs. Patients with probable type 2 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, and association with IBD. The primary objective was to collect information on the characteristics of AIP in patients with IBD. We also compared features of patients with IBD with and without AIP in a case-control analysis, using multivariate analysis. RESULTS We analyzed data from 91 individuals with AIP and IBD (47 women) seen at 23 centers (58 had ulcerative colitis [UC] and 33 Crohn's disease [CD]). Eighty-nine patients had type 2 AIP, and 2 patients had type 1 AIP. The mean age at diagnosis of AIP was 35 ± 12 years, and for IBD it was 32 ± 12 years. AIP preceded IBD in 19 patients (21%). Over a mean follow-up period of 5.7 ± 4.9 years, 31 patients (34%) relapsed, 11 patients (12%) developed diabetes, and 17 patients (19%) developed exocrine pancreatic insufficiency. In patients with UC, factors independently associated with AIP included proctitis (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.3; P = .007) and colectomy (OR, 7.1; 95% CI, 2.5-20; P = .0003). In patients with CD, AIP was significantly associated with fewer perianal lesions (OR, 0.16; 95% CI, 0.03-0.77; P = .023), non-stricturing non-penetrating CD (OR, 6.7; 95% CI, 1.25-33.3; P = .0029), and higher rate of colectomy (OR, 27.8; 95% CI, 3.6-217; P = .0029). CONCLUSIONS In a multicenter retrospective analysis of patients with AIP and IBD, followed for an average of 5.7 ± 4.9 years, we found most to have type 2 AIP. Two-thirds of patients have UC, often with proctitis. One-third of patients have CD, often with inflammatory features. Patients with IBD and AIP have higher rates of colectomy than patients with just IBD.
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Affiliation(s)
- Diane Lorenzo
- Departement of Hepato-Gastroenterology, Hôpital Cochin, AP-HP, Paris, France.
| | - Frédérique Maire
- Departement of Hepato-Gastroenterology, Hôpital Beaujon, AP-HP, Clichy La Garenne, France
| | - Carmen Stefanescu
- Departement of Hepato-Gastroenterology, Hôpital Beaujon, AP-HP, Clichy La Garenne, France
| | - Jean-Marc Gornet
- Departement of Hepato-Gastroenterology, Hôpital Saint Louis, AP-HP, Paris, France
| | - Philippe Seksik
- Departement of Hepato-Gastroenterology, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Mélanie Serrero
- Departement of Hepato-Gastroenterology, Hôpital Nord, AP-HM, Marseille, France
| | - Barbara Bournet
- Departement of Hepato-Gastroenterology, Hôpital Rangueil, Toulouse, France
| | - Philippe Marteau
- Departement of Hepato-Gastroenterology, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Aurelien Amiot
- Departement of Hepato-Gastroenterology, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - David Laharie
- Departement of Hepato-Gastroenterology, Hôpital Haut-Lévêque, Pessac, France
| | - Caroline Trang
- Departement of Hepato-Gastroenterology, CHU Nantes, Nantes, France
| | - Benoit Coffin
- Departement of Hepato-Gastroenterology, Hôpital Louis Mourier, AP-HP, Colombes, France
| | - Guy Bellaiche
- Departement of Hepato-Gastroenterology, CH d'Aulnay, Aulnay sous-bois, France
| | - Guillaume Cadiot
- Departement of Hepato-Gastroenterology, CHU Reims, Reims, France
| | | | - Antoine Racine
- Departement of Hepato-Gastroenterology, CHU du Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France
| | | | - Arnaud Pauwels
- Departement of Hepato-Gastroenterology, CH Gonesse, Gonesse, France
| | | | - Guillaume Savoye
- Departement of Hepato-Gastroenterology, CHU Rouen, Rouen, France
| | | | | | - Pierre Lahmek
- Departement of Hepato-Gastroenterology, CH Montfermeil, Montfermeil, France
| | - Stéphane Nahon
- Departement of Hepato-Gastroenterology, CH Montfermeil, Montfermeil, France
| | - Vered Abitbol
- Departement of Hepato-Gastroenterology, Hôpital Cochin, AP-HP, Paris, France
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15
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Bozon A, Jeantet G, Rivière B, Funakoshi N, Dufour G, Combes R, Valats JC, Delmas S, Serre JE, Bismuth M, Ramos J, Le Quintrec M, Blanc P, Pineton de Chambrun G. Stricturing Crohn’s disease-like colitis in a patient treated with belatacept. World J Gastroenterol 2017; 23:8660-8665. [PMID: 29358873 PMCID: PMC5752725 DOI: 10.3748/wjg.v23.i48.8660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/15/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) modifying agents have been involved in the development of intestinal inflammation, especially therapeutic monoclonal antibodies directed against CTLA-4. Here we report the appearance of a severe stricturing Crohn’s disease-like colitis in a patient with a kidney allograft who was treated with belatacept, a recombinant CTLA-4-Ig fusion protein.
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Affiliation(s)
- Anne Bozon
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Guillaume Jeantet
- Nephrology Department, Lapeyronie Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Benjamin Rivière
- Pathology Department, Guy de Chauliac Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Natalie Funakoshi
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Gaspard Dufour
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Roman Combes
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Jean-Christophe Valats
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Sylvie Delmas
- Nephrology Department, Lapeyronie Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Jean Emmanuel Serre
- Nephrology Department, Lapeyronie Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Michael Bismuth
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Jeanne Ramos
- Pathology Department, Guy de Chauliac Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Moglie Le Quintrec
- Nephrology Department, Lapeyronie Hospital, Montpellier University Hospital, Montpellier 34000, France
| | - Pierre Blanc
- Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier 34000, France
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16
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Collins M, Sarter H, Gower-Rousseau C, Koriche D, Libier L, Nachury M, Cortot A, Zerbib P, Blanc P, Desreumaux P, Colombel JF, Peyrin-Biroulet L, Pineton de Chambrun G. Previous Exposure to Multiple Anti-TNF Is Associated with Decreased Efficiency in Preventing Postoperative Crohn's Disease Recurrence. J Crohns Colitis 2017; 11:281-288. [PMID: 27578800 DOI: 10.1093/ecco-jcc/jjw151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Infliximab and adalimumab are increasingly used to prevent postoperative recurrence in Crohn's disease patients. The impact of previous exposure to one or more anti-tumour necrosis factor [TNF] agents before surgery on the efficacy of anti-TNF therapy on postoperative recurrence is unknown. METHODS We performed a retrospective analysis of Crohn's disease patients who underwent surgical bowel resection with anastomosis and prophylactic treatment with anti-TNF therapy between January 2005 and June 2013. RESULTS A total of 57 consecutive Crohn's disease patients with bowel resection and anastomosis followed by prophylactic treatment with anti-TNF were included; 21 [37%] and 24 [42%] patients had a previous exposure to one and more than one anti-TNF agents, respectively; 39 patients [68%] had a surveillance colonoscopy. Cumulative rates of postoperative endoscopic recurrence at 2 years were 45.5% [26.6-69.6%] in patients exposed to two or more anti-TNFα as compared with 29.1% [11.5-48.1%] in patients exposed to one or to zero anti-TNFα before surgery [p = 0.07]. Cumulative rates of clinical recurrence at 1 year were 21.6% [9.6-44.4%] in patients exposed to two or more anti-TNFα as compared with 6.9% [1.8-25.1%] in patients exposed to zero or one anti-TNFα before surgery [p = 0.02]. Multivariable analysis identified smoking and previous exposure to two or more anti-TNFα as risk factors for Crohn's disease clinical or endoscopic postoperative recurrence (hazard ratio [HR] = 3.17; 95% confidence interval [CI]: 1.3-7.8, p = 0.01 and HR = 4.2; 95% CI: 1.8-10.2, p = 0.001, respectively). CONCLUSIONS Previous exposure to two or more anti-TNF agents was associated with a higher risk of postoperative recurrence in Crohn's disease patients.
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Affiliation(s)
- Michael Collins
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.,Gastroenterology Department, Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Hélène Sarter
- Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France
| | - Corinne Gower-Rousseau
- Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France
| | - Dine Koriche
- Colorectal Surgery Department, Lille University Hospital, Lille, France
| | - Louise Libier
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France
| | - Maria Nachury
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France
| | - Antoine Cortot
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France
| | - Philippe Zerbib
- Colorectal Surgery Department, Lille University Hospital, Lille, France
| | - Pierre Blanc
- Gastroenterology and Hepatology Department, Montpellier University Hospital, Montpellier, France
| | - Pierre Desreumaux
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.,Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France
| | - Jean-Frédéric Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurent Peyrin-Biroulet
- Gastroenterology Department, Nancy University Hospital, Lorraine University, Vandoeuvre, France
| | - Guillaume Pineton de Chambrun
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.,Gastroenterology and Hepatology Department, Montpellier University Hospital, Montpellier, France
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17
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Pineton de Chambrun G, Blanc P, Peyrin-Biroulet L. Current evidence supporting mucosal healing and deep remission as important treatment goals for inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2016; 10:915-27. [PMID: 27043489 DOI: 10.1586/17474124.2016.1174064] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Mucosal healing (MH) is now considered as a major treatment goal in clinical trials and clinical practice for patients with inflammatory bowel disease (IBD). MH is associated with sustained clinical remission, steroid-free remission, and reduced rates of hospitalization and surgery. There is a well-known disconnect between clinical symptoms and mucosal lesions that is more pronounced in CD. More stringent therapeutic goals have been discussed recently such as deep remission defined as clinical remission associated with MH. Recent international guidelines from the IOIBD recommended deep remission as a treatment goal in clinical practice. However there is no validated definition of deep remission in IBD. Also, the efficacy of available drugs to induce and maintain deep remission in IBD is poorly known. Finally, whether deep remission is the best way to modify the course of IBD and whether it should be achieved before considering drug de-escalation have to be formally evaluated in upcoming disease-modification trials.
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Affiliation(s)
- Guillaume Pineton de Chambrun
- a Department of Gastroenterology and Hepatology , Saint-Eloi Hospital, Montpellier University , Montpellier , France
| | - Pierre Blanc
- a Department of Gastroenterology and Hepatology , Saint-Eloi Hospital, Montpellier University , Montpellier , France
| | - Laurent Peyrin-Biroulet
- b Inserm U954 and Department of Gastroenterology , Université de Lorraine , Vandoeuvre-les-Nancy , France
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18
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Fumery M, Pineton de Chambrun G, Stefanescu C, Buisson A, Bressenot A, Beaugerie L, Amiot A, Altwegg R, Savoye G, Abitbol V, Bouguen G, Simon M, Duffas JP, Hébuterne X, Nancey S, Roblin X, Leteurtre E, Bommelaer G, Lefevre JH, Brunetti F, Guillon F, Bouhnik Y, Peyrin-Biroulet L. Detection of Dysplasia or Cancer in 3.5% of Patients With Inflammatory Bowel Disease and Colonic Strictures. Clin Gastroenterol Hepatol 2015; 13:1770-5. [PMID: 26001338 DOI: 10.1016/j.cgh.2015.04.185] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Colonic strictures complicate inflammatory bowel disease (IBD) and often lead to surgical resection to prevent dysplasia or cancer. We assessed the frequency of dysplasia and cancer among IBD patients undergoing resection of a colorectal stricture. METHODS We analyzed data from the Groupe d'études et thérapeutiques des affections inflammatoires du tube digestif study. This was a nationwide retrospective study of 12,013 patients with IBD in France who underwent surgery for strictures at 16 centers from August 1992 through January 2014 (293 patients for a colonic stricture, 248 patients with Crohn's disease, 51% male, median age at stricture diagnosis of 38 years). Participants had no preoperative evidence of dysplasia or cancer. We collected clinical, endoscopic, surgical, and pathology data and information on outcomes. RESULTS When patients were diagnosed with strictures, they had IBD for a median time of 8 years (3-14). The strictures were a median length of 6 cm (4-10) and caused symptoms in 70% of patients. Of patients with Crohn's disease, 3 (1%) were found to have low-grade dysplasia, 1 (0.4%) was found to have high-grade dysplasia, and 2 (0.8%) were found to have cancer. Of patients with ulcerative colitis, 1 (2%) had low-grade dysplasia, 1 (2%) had high-grade dysplasia, and 2 (5%) had cancer. All patients with dysplasia or cancer received curative surgery, except 1 who died of colorectal cancer during the follow-up period. No active disease at time of surgery was the only factor associated with dysplasia or cancer at the stricture site (odds ratio, 4.86; 95% confidence interval, 1.11-21.27; P = .036). CONCLUSIONS In a retrospective study of patients with IBD undergoing surgery for colonic strictures, 3.5% were found to have dysplasia or cancer. These findings can be used to guide management of patients with IBD and colonic strictures.
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Affiliation(s)
- Mathurin Fumery
- Department of Gastroenterology, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France; Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | | | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Aude Bressenot
- Department of Pathology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Laurent Beaugerie
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine F-75012, ERL 1057 Inserm/UMRS 7203 and GRC-UPMC 03, UPMC Université Paris 06 F-75005, Paris, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University and Hospital, Rouen, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Marion Simon
- Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Jean-Pierre Duffas
- Department of Digestive Surgery, Rangueil University Hospital, University of Toulouse, Toulouse, France
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Stéphane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | | | - Gilles Bommelaer
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Jeremie H Lefevre
- Department of Digestive Surgery, Saint-Antoine Hospital, University Paris 6 Pierre and Marie Curie, Paris, France
| | - Francesco Brunetti
- Digestive Surgery and Liver Transplant Unit, Henri Mondor Hospital, UPEC, Creteil, France
| | - Françoise Guillon
- Department of Digestive Surgery, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
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Abstract
BACKGROUND Eosinophilic enteritis, also known as eosinophilic gastroenteritis, is a rare primary eosinophilic gastrointestinal disorder (EGID) of unknown etiology characterized by the presence of an intense eosinophilic infiltrate on histopathology of the intestinal mucosa. KEY MESSAGES The etiology of eosinophilic enteritis remains obscure. There is growing evidence to support the role of aeroallergens and food allergens in the pathogenesis of this disorder as children and adults with EGIDs often have positive skin testing for food allergens and a familial history of allergic diseases. Moreover, significant progress has been made in elucidating that EGIDs involve mechanisms that fall between pure IgE-mediated and delayed Th2 type responses. Preclinical studies have identified a contributory role for the cytokine IL-5 and eotaxin chemokines, providing a rationale for specific disease therapy. Eosinophilic enteritis causes a wide array of gastrointestinal symptoms such as abdominal pain, diarrhea, nausea, vomiting, bloating or ascites, and its diagnosis requires a high degree of clinical likelihood given the nonspecific presentation and physical examination findings. The Klein classification arbitrarily divided patients with eosinophilic enteritis into those with predominantly mucosal, muscle layer or subserosal disease relying on the concept that clinical presentation is dependent on the predominant involved layer of the gastrointestinal tract. Main therapeutic options are represented by oral corticosteroids for a short period with good efficacy. Antihistaminic drugs and sodium cromoglycate have also been used to treat patients with eosinophilic enteritis. CONCLUSION Eosinophilic enteritis is generally considered as a benign disease with no relapse, but half of the patients may present a more complex natural history characterized by unpredictable relapses and a chronic course.
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20
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McAllister CS, Lakhdari O, Pineton de Chambrun G, Gareau MG, Broquet A, Lee GH, Shenouda S, Eckmann L, Kagnoff MF. TLR3, TRIF, and caspase 8 determine double-stranded RNA-induced epithelial cell death and survival in vivo. J Immunol 2012; 190:418-27. [PMID: 23209324 DOI: 10.4049/jimmunol.1202756] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
TLR3 signaling is activated by dsRNA, a virus-associated molecular pattern. Injection of dsRNA into mice induced a rapid, dramatic, and reversible remodeling of the small intestinal mucosa with significant villus shortening. Villus shortening was preceded by increased caspase 3 and 8 activation and apoptosis of intestinal epithelial cells (IECs) located in the mid to upper villus with ensuing luminal fluid accumulation and diarrhea because of an increased secretory state. Mice lacking TLR3 or the adaptor molelcule TRIF mice were completely protected from dsRNA-induced IEC apoptosis, villus shortening, and diarrhea. dsRNA-induced apoptosis was independent of TNF signaling. Notably, NF-κB signaling through IκB kinase β protected crypt IECs but did not protect villus IECs from dsRNA-induced or TNF-induced apoptosis. dsRNA did not induce early caspase 3 activation with subsequent villus shortening in mice lacking caspase 8 in IECs but instead caused villus destruction with a loss of small intestinal surface epithelium and death. Consistent with direct activation of the TLR3-TRIF-caspase 8 signaling pathway by dsRNA in IECs, dsRNA-induced signaling of apoptosis was independent of non-TLR3 dsRNA signaling pathways, IL-15, TNF, IL-1, IL-6, IFN regulatory factor 3, type I IFN receptor, adaptive immunity, as well as dendritic cells, NK cells, and other hematopoietic cells. We conclude that dsRNA activation of the TLR3-TRIF-caspase 8 signaling pathway in IECs has a significant impact on the structure and function of the small intestinal mucosa and suggest signaling through this pathway has a host protective role during infection with viral pathogens.
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21
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Pariente B, Pineton de Chambrun G, Krzysiek R, Desroches M, Louis G, De Cassan C, Baudry C, Gornet JM, Desreumaux P, Emilie D, Colombel JF, Allez M. Trough levels and antibodies to infliximab may not predict response to intensification of infliximab therapy in patients with inflammatory bowel disease. Inflamm Bowel Dis 2012; 18:1199-206. [PMID: 22127789 DOI: 10.1002/ibd.21839] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/06/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Infliximab is effective for the treatment of refractory inflammatory bowel disease (IBD). Nevertheless, up to 40% of patients lose response to infliximab over time. The aim was to assess the clinical value of measuring infliximab trough levels and antibodies to infliximab (ATI) concentrations in IBD patients who lost response to infliximab therapy. METHODS We retrospectively studied records of IBD patients who lost response to infliximab therapy. We first assessed clinical responses of different therapeutic strategies that were applied when patients lost response to infliximab and then we looked at the correlation between clinical response and infliximab trough levels and ATI concentrations. RESULTS Seventy-six IBD patients were included. 31/76 patients (41%) continued infliximab therapy without any modification, 39 patients (51%) had an intensification of infliximab therapy, five patients (7%) had switched to adalimumab therapy, and one patient (1%) underwent surgery. Clinical response was observed in 27 patients (69%) with an intensification of infliximab therapy. There was no significant difference in mean infliximab trough level at inclusion in patients who responded to intensification of infliximab therapy (3.3 ± 4.1 μg/mL) as compared with patients who did not respond (2.3 ± 2.2 μg/mL, P = 0.85). In all, 16/76 patients (22.4%) presented detectable ATI in the serum. Ten ATI-positive patients had an intensification of infliximab therapy and six (60%) demonstrated a clinical response. After intensification of infliximab therapy the ATI concentration decreased in five patients. CONCLUSIONS In patients with IBD who lose response to infliximab, clinical improvement may occur upon intensification of infliximab therapy, irrespective of infliximab serum concentration or presence of ATI.
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Affiliation(s)
- Benjamin Pariente
- Hepato-Gastroenterology Department, Saint-Louis Hospital, Université Paris VII, Paris, France
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22
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Armuzzi A, Van Assche G, Reinisch W, Pineton de Chambrun G, Griffiths A, Sladek M, Preiss JC, Lukas M, D'Haens G. Results of the 2nd scientific workshop of the ECCO (IV): therapeutic strategies to enhance intestinal healing in inflammatory bowel disease. J Crohns Colitis 2012; 6:492-502. [PMID: 22406343 DOI: 10.1016/j.crohns.2011.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 02/08/2023]
Abstract
Evidence supporting the importance of assessment of mucosal healing in inflammatory bowel disease has increased in the last years. Mucosal healing has been integrated in the assessment of treatment efficacy in ulcerative colitis, but in Crohn's disease this thought has arised after biological agents have been evaluated in clinical trials. Although a validated definition of mucosal healing still does not exist, its use is also assuming an increasingly important role in the follow-up of individual patients in clinical practice. Corticosteroids induce mucosal healing in a small proportion of patients with Crohn's disease and are of no benefit to maintain it. By contrast, mucosal healing in Crohn's disease can be achieved and maintained, with varying degrees of evidence and success, with thiopurines and biological agents. In ulcerative colitis, the ability of corticosteroids to induce mucosal healing is well recognized. 5-aminosalicylates, thiopurines and biological agents are also able to induce mucosal healing and, additionally, to maintain it. Mucosal healing assessment should be considered in clinical practice when symptoms persist despite therapy or when treatment discontinuation is being considered. Conversely, in patients whose clinical remission is not associated with mucosal healing, intensification of treatment is not currently recommended because of lack of evidence.
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Affiliation(s)
- Alessandro Armuzzi
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
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Pineton de Chambrun G, Gonzalez F, Canva JY, Gonzalez S, Houssin L, Desreumaux P, Cortot A, Colombel JF. Natural history of eosinophilic gastroenteritis. Clin Gastroenterol Hepatol 2011; 9:950-956.e1. [PMID: 21806952 DOI: 10.1016/j.cgh.2011.07.017] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 07/13/2011] [Accepted: 07/19/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Eosinophilic gastroenteritis (EGE) is a rare gastrointestinal disorder; little is known about its natural history. We determined the clinical features and long-term outcomes of patients with EGE. METHODS We reviewed files from 43 patients diagnosed with EGE who were followed from January 1988 to April 2009. The diagnosis was made according to standard criteria after other eosinophilic gastrointestinal disorders were excluded. We analyzed data on initial clinical presentation and long-term outcomes. RESULTS EGE was classified as mucosal, subserosal, or muscular in 44%, 39%, and 12% of cases, respectively. Disease location was mostly duodenal (62%), ileal (72%), or colonic (88%); it was less frequently esophageal (30%) or gastric (38%). Blood eosinophilia (numbers >500/mm(3)) was observed in 74% of cases. Spontaneous remission occurred in 40% of patients; the majority of treated patients (74%) received oral corticosteroids, which were effective in most cases. After a median follow-up period of 13 years (0.8-29 years), we identified 3 different courses of disease progression: 18 patients (42%; 9 with subserosal disease) had an initial flare of the disease without relapse, 16 (37%) had multiple flares that were separated by periods of full remission (recurring disease), and 9 (21%) had chronic disease. CONCLUSIONS The clinical presentation of EGE is heterogeneous and varies in histologic pattern; about 40% of patients resolve the disease spontaneously, without relapse. Approximately 50% have a more complex disease, which is characterized by unpredictable relapses and a chronic course.
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Tremblay L, Pineton de Chambrun G, De Vroey B, Lavogiez C, Delaporte E, Colombel JF, Cortot A. Stevens-Johnson syndrome with sulfasalazine treatment: report of two cases. J Crohns Colitis 2011; 5:457-60. [PMID: 21939920 DOI: 10.1016/j.crohns.2011.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/25/2011] [Accepted: 03/26/2011] [Indexed: 02/08/2023]
Abstract
We report two cases of Stevens-Johnson syndrome (SJS) associated with the use of sulfasalazine in two ulcerative colitis patients previously tolerant to mesalamine. SJS and toxic epidermal necrolysis (TEN) are very rare adverse cutaneous reactions that can be associated with the use of sulfasalazine. The most severe cases can result in death, and for the others, permanent skin, mucosal or ocular sequelae, which can impair the quality of life in our young IBD patients. Clinicians and patients need to be aware of the signs and symptoms that often precede the appearance of the mucocutaneous lesions in a SJS or TEN, such as fever, influenza-like symptoms, sore throat or burning eyes. For patients with SJS or TEN, immediate withdrawal of the offending medication should be done when blisters or erosions appear in the course of a drug eruption, as this may improve the prognosis.
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Affiliation(s)
- Lydjie Tremblay
- Pharmacy Department, Centre hospitalier de l'Université de Montréal, Montréal, Canada.
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Abstract
Mucosal healing (MH) has emerged as an important treatment goal for patients with IBD. Historically, the therapeutic goals of induction and maintenance of clinical remission seemed insufficient to change the natural history of IBD. Evidence has now accumulated to show that MH can alter the course of IBD, as it is associated with sustained clinical remission, and reduced rates of hospitalization and surgical resection. In patients with ulcerative colitis, MH may represent the ultimate therapeutic goal because inflammation is limited to the mucosa. In patients with Crohn's disease, which is a transmural disease, MH could be considered as a minimum therapeutic goal. This Review focuses on the definition of MH and discusses the ability of each available IBD medication to induce and maintain MH. The importance of achieving MH is also discussed and literature that demonstrates improvement of disease course with MH is reviewed. Finally, we discuss how best to integrate the treatment end point of MH into clinical practice for the management of patients with IBD.
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Affiliation(s)
- Guillaume Pineton de Chambrun
- Clinique des maladies de l'appareil digestif et de la nutrition, Hôpital Claude Huriez, Rue Michel Polonovski, 59037 Lille Cedex, France
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