1
|
Mañosa M, Rivière P, de Greef I, Oller B, Roig C, Calafat M, Garcia-Planella E, Laharie D, Ferrante M, Domènech E. Long-term risk of delayed postoperative Crohn's disease recurrence in patients with no or mild endoscopic recurrence at first assessment. Eur J Clin Invest 2024:e14219. [PMID: 38647188 DOI: 10.1111/eci.14219] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Early endoscopic evaluation is recommended for assessment of postoperative recurrence (POR) of Crohn's disease (CD) but no further monitoring recommendations are available. AIM To evaluate the long-term outcome of patients without endoscopic POR at first endoscopic assessment. METHODS Retrospective four-centre study including consecutive CD patients with ileocolonic resection (ICR) without endoscopic POR (Rutgeerts score i0-i1) at first endoscopic assessment performed within 18 months from ICR. All patients had a clinical follow-up ≥24 months and at least one further endoscopic assessment. Main outcomes were endoscopic, clinical and surgical POR, need for rescue therapy and "delayed POR" (any need for rescue therapy or clinical or surgical POR) during follow-up. RESULTS Overall, 183 patients were included (79% with risk factors for POR, 44% without postoperative prophylaxis). Endoscopic POR was observed in 42% of patients. Clinical POR-free survival was 89.4% and 81.5% at 3 and 5 years, and delayed POR-free survival was 76.9% and 63.4% at 5 and 10 years, respectively. In multivariate analysis, postoperative prophylaxis (HR .55; 95% CI .325-.942) and active smoking (HR 1.72; 95%CI 1.003-2.962) were independent risk factors for clinical POR, whereas presence of mild endoscopic lesions at index ileocolonoscopy (i1) was the only risk factor for delayed POR (HR 1.824; 95% CI 1.108-3.002). CONCLUSIONS Long-term risk of POR among patients with no or mild endoscopic lesions at first ileocolonoscopy after surgery is steadily low, being higher among smokers, in the absence of postoperative prophylaxis and when mild endoscopic lesions are observed in the first endoscopic assessment.
Collapse
Affiliation(s)
- Míriam Mañosa
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Pauline Rivière
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, CHU de Bordeaux, Bordeaux, France
- INSERM CIC 1401, Bordeaux, France
| | - Ine de Greef
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Blanca Oller
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Cristina Roig
- Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Margalida Calafat
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - David Laharie
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, CHU de Bordeaux, Bordeaux, France
- INSERM CIC 1401, Bordeaux, France
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Eugeni Domènech
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|
2
|
Vauquelin B, Quénéhervé L, Pioche M, Barret M, Wallenhorst T, Chabrun E, Coron E, Roman S, Mion F, Chaussade S, Ponchon T, Olivier R, Rivière P, Zerbib F, Berger A. Factors associated with early failure of peroral endoscopic myotomy in achalasia. Gastrointest Endosc 2024; 99:349-357.e3. [PMID: 37806398 DOI: 10.1016/j.gie.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/01/2023] [Revised: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND AIMS Achalasia can be treated very effectively with peroral endoscopic myotomy (POEM), but factors associated with early failure remain to be determined, especially in European cohorts. METHODS All consecutive adult patients who underwent a first POEM to treat primary achalasia were included in this multicenter retrospective study. Early failure was defined by an Eckardt score (ES) >3 at 3 months after POEM. When evaluating factors predictive of early failure, 2 cohorts were considered: one consisted of the total population, for whom only basic variables were collected, and the other a cohort built for a case-control study that included matched early-failure and early-success patients (ratio, 1:2). RESULTS Among 746 patients, the early failure rate was 9.4%. Predictive factors were age ≤45 years (P = .019), achalasia types I and III (P < .001), and the development of a severe adverse event during the procedure (P = .023). In the case-control study, the only additional independent risk factor for early failure was a high pre-POEM ES (P = .001). Only the retrosternal pain subscore was significantly associated with the early failure rate. CONCLUSION The early failure rate of POEM used to treat primary achalasia is <10%. Younger age, type I/III achalasia, and a high pre-POEM ES were significantly associated with failure.
Collapse
Affiliation(s)
- Blandine Vauquelin
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Lucille Quénéhervé
- Gastroenterology Department, University Hospital of Brest, Brest, France
| | - Mathieu Pioche
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University, Inserm U1032, LabTAU, Lyon, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin University Hospital, AP-HP, Paris, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | - Edouard Chabrun
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Sabine Roman
- Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University Hospital, Inserm U1032, LabTAU, Lyon, France
| | - François Mion
- Digestive Physiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University Hospital, Inserm U1032, LabTAU, Lyon, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin University Hospital, AP-HP, Paris, France
| | - Thierry Ponchon
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon University, Inserm U1032, LabTAU, Lyon, France
| | - Raphael Olivier
- Department of Gastroenterology, Nantes University Hospital, Nantes, France
| | - Pauline Rivière
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Frank Zerbib
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France
| | - Arthur Berger
- Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France.
| |
Collapse
|
3
|
Rivière P, Li Wai Suen C, Chaparro M, De Cruz P, Spinelli A, Laharie D. Acute severe ulcerative colitis management: unanswered questions and latest insights. Lancet Gastroenterol Hepatol 2024; 9:251-262. [PMID: 38340753 DOI: 10.1016/s2468-1253(23)00313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/13/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 02/12/2024]
Abstract
Acute severe ulcerative colitis (ASUC) is a distinctive ulcerative colitis flare presentation characterised by the presence of systemic inflammation as well as bloody diarrhoea, and occurs at least once in 25% of patients with ulcerative colitis during their disease course. Each episode carries a risk of complications, need for colectomy, and mortality. Little is known about ASUC pathogenesis, although impaired host-microbiota crosstalk involving pathobionts is suspected. In this Review, we discuss unanswered questions and results from the latest research on the medical-first-line, second-line, and potential third-line therapies-and surgical management of ASUC. We detail promising options for management, such as the use of enteral nutrition in combination with intravenous steroids, the ability to predict early failure of first-line or second-line therapies, and the emerging role of JAK inhibitors. An optimal framework to personalise therapy on the basis of multiomics tools is yet to be developed.
Collapse
Affiliation(s)
- Pauline Rivière
- CHU de Bordeaux, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Christopher Li Wai Suen
- Department of Gastroenterology, Austin Health and Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - María Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autonoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health and Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan Italy; Colon and Rectal Surgery Division, IRCCS Humanitas Research Hospital, Milan, Italy
| | - David Laharie
- CHU de Bordeaux, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France.
| |
Collapse
|
4
|
ten Bokkel Huinink S, Thomassen D, Steyerberg EW, Pauwels RWM, Casanova MJ, Bouguen G, Mak JWY, Molnár T, Lobo AJ, Seidelin JB, Amiot A, D’Haens G, Rivière P, Guidi L, Bor R, Lin WC, Peyrin-Biroulet L, Gisbert JP, Janneke van der Woude C, de Vries AC. Discontinuation of Anti-Tumour Necrosis Factor Therapy in Patients with Perianal Fistulizing Crohn's Disease: Individual Participant Data Meta-Analysis of 309 Patients from 12 Studies. J Crohns Colitis 2024; 18:134-143. [PMID: 37437094 PMCID: PMC10821706 DOI: 10.1093/ecco-jcc/jjad118] [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: 02/13/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The risk of relapse after anti-tumour necrosis factor [TNF] therapy discontinuation in Crohn's disease patients with perianal fistulas [pCD] is unclear. We aimed to assess this risk. METHODS A systematic literature search was conducted to identify cohort studies on the incidence of relapse following anti-TNF discontinuation in pCD patients. Individual participant data were requested from the original study cohorts. Inclusion criteria were age ≥16 years, pCD as a (co)indication for start of anti-TNF therapy, more than three doses, and remission of luminal and pCD at anti-TNF discontinuation. The primary outcome was the cumulative incidence of CD relapse using Kaplan-Meier estimates. Secondary outcomes included response to re-treatment and risk factors associated with relapse as assessed by Cox regression analysis. RESULTS In total, 309 patients from 12 studies in ten countries were included. The median duration of anti-TNF treatment was 14 months [interquartile range 5.8-32.5]. Most patients were treated for pCD without active luminal disease [89%], received first-line anti-TNF therapy [87%], and continued immunomodulatory therapy following anti-TNF discontinuation [78%]. The overall cumulative incidence of relapse was 36% (95% confidence interval [CI] 25-48%) and 42% [95% CI 32-53%] at 1 and 2 years after anti-TNF discontinuation, respectively. Risk factors for relapse included smoking (hazard ratio [HR] 1.5 [1.0, 2.1]) and history of proctitis (HR 1.7 [1.1, 2.5]). The overall re-treatment response rate was 82%. CONCLUSIONS This individual participant data meta-analysis, on predominantly patients with pCD without active luminal disease and first-line anti-TNF therapy, shows that over half of patients remain in remission 2 years after anti-TNF discontinuation. Therefore, anti-TNF discontinuation may be considered in this subgroup.
Collapse
Affiliation(s)
| | - Doranne Thomassen
- Leiden UMC, Department of Biomedical Data Sciences, Leiden, The Netherlands
| | - Ewout W Steyerberg
- Leiden UMC, Department of Biomedical Data Sciences, Leiden, The Netherlands
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
| | - Renske W M Pauwels
- Erasmus MC, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - Maria J Casanova
- Hospital Universitario de La Princesa, Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Guillaume Bouguen
- University Hospital of Pontchaillou, Department of Gastroenterology and Hepatology, Rennes, France
| | - Joyce W Y Mak
- Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Tamas Molnár
- University of Szeged, First Department of Medicine, Szeged, Hungary
| | - Alan J Lobo
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Department of Gastroenterology and Hepatology, Sheffield, UK
| | - Jacob B Seidelin
- Herlev Hospital, Department of Gastroenterology, University of Copenhagen, Denmark
| | - Aurelien Amiot
- Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Department of Gastroenterology, Creteil, France
| | - Geert D’Haens
- Amsterdam UMC, Academic Medical Centre, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Pauline Rivière
- Hospitalier Universitaire, Department of Gastroenterology and Hepatology, Bordeaux, France
| | - Luisa Guidi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Department of Gastroenterology, Rome, Italy
| | - Renata Bor
- University of Szeged, First Department of Medicine, Szeged, Hungary
| | - Wei-Chen Lin
- Mackay Memorial Hospital, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei, Taiwan
| | - Laurent Peyrin-Biroulet
- University Hospital of Nancy, Department of Hepato-Gastroenterology, Vandoeuvre-les-Nancy, France
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Annemarie C de Vries
- Erasmus MC, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
| |
Collapse
|
5
|
Geldof J, Truyens M, Hanssens M, Van Gucht E, Holvoet T, Elorza A, Bouillon V, Barros S, Martins V, Argyriou K, Potamianos S, Diculescu M, Stroie T, Bossuyt P, Moens A, Theodoraki E, Koutroubakis IE, Pedro J, Fernandes S, Nikolaou P, Karmiris K, Baert FJ, Ferreiro-Iglesias R, Peeters H, Claeys S, Casanova MJ, Eder P, Porter RJ, Arnott I, Karakan T, Mesonero F, Revés J, Van Dyck E, Jauregui-Amezaga A, Mañosa M, Rivière P, Marquez Mosquera L, Portela F, Pimentel R, Lobaton T. Prophylactic versus endoscopy-driven treatment of Crohn's postoperative recurrence: A retrospective, multicentric European study (PORCSE study). J Crohns Colitis 2024:jjae011. [PMID: 38243807 DOI: 10.1093/ecco-jcc/jjae011] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND AIMS No consensus exists on optimal strategy to prevent postoperative recurrence (POR) after ileocecal resection (ICR) for Crohn's disease (CD).We compared early medical prophylaxis versus expectant management with treatment driven by findings at elective endoscopy 6-12 months after ICR. METHODS A retrospective, multicentric, observational study was performed. CD-patients undergoing first ICR were assigned to cohort1 if a biologic or immunomodulator was (re)started prophylactically after ICR, or to cohort2 if no postoperative prophylaxis was given and treatment was started as reaction to elective endoscopic findings. Primary endpoint was rate of endoscopic POR (Rutgeerts>i1). Secondary endpoints were severe endoscopic POR (Rutgeerts i3/i4), clinical POR, surgical POR and treatment burden during follow-up. RESULTS Of 346 included patients, 47.4% received prophylactic postoperative treatment (proactive/cohort1) and 52.6% did not (reactive/cohort2).Endoscopic POR (Rutgeerts>i1) rate was significantly higher in cohort2 (41.5% vs 53.8%, OR1.81, P=0.039) at endoscopy 6-12 months after surgery. No significant difference in severe endoscopic POR was found (OR1.29, P=0.517). Cohort2 had significantly higher clinical POR rates (17.7% vs 35.7%, OR3.05, P=0.002) and numerically higher surgical recurrence rates (6.7% vs 13.2%, OR2.59, P=0.051). Cox proportional hazards regression analysis showed no significant difference in time to surgical POR of proactive versus expectant/reactive approach (HR2.50, P=0.057). Quasi-Poisson regression revealed a significantly lower treatment burden for immunomodulator use in cohort2 (mean ratio 0.53, P=0.002), but no difference in burden of biologics or combination treatment. CONCLUSIONS The PORCSE study showed lower rates of endoscopic POR with early postoperative medical treatment compared to expectant management after first ileocecal resection for Crohn's disease.
Collapse
Affiliation(s)
- Jeroen Geldof
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| | - Marie Truyens
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| | - Michiel Hanssens
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| | - Emily Van Gucht
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| | - Tom Holvoet
- Department of Gastroenterology and Hepatology, VITAZ, Sint-Niklaas, Belgium
| | - Ainara Elorza
- Department of Gastroenterology, Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - Vincent Bouillon
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Sónia Barros
- Department of Gastroenterology - Algarve Universitary Medical Center, Portugal
| | - Viviana Martins
- Department of Gastroenterology - Algarve Universitary Medical Center, Portugal
| | - Konstantinos Argyriou
- University Hospital of Larisa - IBD unit, Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Spyridon Potamianos
- University Hospital of Larisa - IBD unit, Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Mircea Diculescu
- Gastroenterology and Hepatology Center Fundeni Clinical Institute, Carol Davila University of Medicine Bucharest, Bucharest, Romania
| | - Tudor Stroie
- Gastroenterology and Hepatology Center Fundeni Clinical Institute, Carol Davila University of Medicine Bucharest, Bucharest, Romania
| | - Peter Bossuyt
- Imelda GI clinical research center, Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Annick Moens
- Imelda GI clinical research center, Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Eirini Theodoraki
- Department of Gastroenterology, University Hospital Heraklion, Heraklion, Greece
| | | | - Juliana Pedro
- Department of Gastroenterology and Hepatology, Hospital Santa Maria, Centro Hospital Universitario de Liboa Norte, Lisbon, Portugal
| | - Samuel Fernandes
- Department of Gastroenterology and Hepatology, Hospital Santa Maria, Centro Hospital Universitario de Liboa Norte, Lisbon, Portugal
| | | | | | - Filip J Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Rocio Ferreiro-Iglesias
- Inflammatory Bowel Diseases Unit, Department of Gastroenterology, Hospital Clinico Universitario de Santiago, Fundación Instituto de investigación Sanitaria de Santiago de Compostela, Galicia, Spain
| | - Harald Peeters
- Department of Gastroenterology, AZ Sint-Lucas, Ghent, Belgium
| | - Sophie Claeys
- Department of Gastroenterology, AZ Sint-Lucas, Ghent, Belgium
| | - Mariá José Casanova
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ross J Porter
- Edinburgh IBD unit, Western General Hospital, NHS Lothian - Edinburgh, Edinburgh, Scotland
| | - Ian Arnott
- Edinburgh IBD unit, Western General Hospital, NHS Lothian - Edinburgh, Edinburgh, Scotland
| | | | - Francisco Mesonero
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramon y Cajal, Spain
| | - Joana Revés
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Evi Van Dyck
- Department of Gastroenterology, AZ Klina, Brasschaat, Belgium
| | - Aranzazu Jauregui-Amezaga
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Belgium. Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Gastroenterology-Hepatology, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Míriam Mañosa
- Centro de Investigacion Biomédica en Red de Enfermedades Hepaticas y Digestivas CIBERehd. Hospital Department of Gastroenterology and Hepatology, Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Pauline Rivière
- Department of Hepato-Gastroenterology and digestive oncology, CHU Bordeaux, Hôpital Haut Levêque, Bordeaux, France
| | | | - Francisco Portela
- Department of Gastroenterology, Hospital and University of Coimbra, Portugal
| | - Raquel Pimentel
- Department of Gastroenterology, Hospital and University of Coimbra, Portugal
| | - Triana Lobaton
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
6
|
Ferrante M, Pouillon L, Mañosa M, Savarino E, Allez M, Kapizioni C, Arebi N, Carvello M, Myrelid P, De Vries AC, Rivière P, Panis Y, Domènech E. Results of the Eighth Scientific Workshop of ECCO: Prevention and Treatment of Postoperative Recurrence in Patients With Crohn's Disease Undergoing an Ileocolonic Resection With Ileocolonic Anastomosis. J Crohns Colitis 2023; 17:1707-1722. [PMID: 37070324 DOI: 10.1093/ecco-jcc/jjad053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/16/2023] [Indexed: 04/19/2023]
Abstract
Despite the introduction of biological therapies, an ileocolonic resection is often required in patients with Crohn's disease [CD]. Unfortunately, surgery is not curative, as many patients will develop postoperative recurrence [POR], eventually leading to further bowel damage and a decreased quality of life. The 8th Scientific Workshop of ECCO reviewed the available scientific data on both prevention and treatment of POR in patients with CD undergoing an ileocolonic resection, dealing with conventional and biological therapies, as well as non-medical interventions, including endoscopic and surgical approaches in case of POR. Based on the available data, an algorithm for the postoperative management in daily clinical practice was developed.
Collapse
Affiliation(s)
- Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Lieven Pouillon
- Imelda GI Clinical Research Center, Imelda General Hospital, Bonheiden, Belgium
| | - Míriam Mañosa
- Department of Gastroenterology and Hepatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Matthieu Allez
- Gastroenterology Department, Hôpital Saint-Louis - APHP, Université Paris Cité, INSERM U1160, Paris, France
| | - Christina Kapizioni
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Harrow, London, UK
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annemarie C De Vries
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Yves Panis
- Paris IBD Center, Groupe Hospitalier Privé Ambroise-Paré Hartmann, Neuily/Seine, France
| | - Eugeni Domènech
- Department of Gastroenterology and Hepatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| |
Collapse
|
7
|
Rivière P, Bislenghi G, Hammoudi N, Verstockt B, Brown S, Oliveira-Cunha M, Bemelman W, Pellino G, Kotze PG, Ferrante M, Panis Y. Results of the Eighth Scientific Workshop of ECCO: Pathophysiology and Risk Factors of Postoperative Crohn's Disease Recurrence after an Ileocolonic Resection. J Crohns Colitis 2023; 17:1557-1568. [PMID: 37070326 DOI: 10.1093/ecco-jcc/jjad054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/16/2023] [Indexed: 04/19/2023]
Abstract
Postoperative recurrence [POR] after an ileocolonic resection with ileocolonic anastomosis is frequently encountered in patients with Crohn's disease. The 8th Scientific Workshop of ECCO reviewed the available evidence on the pathophysiology and risk factors for POR. In this paper, we discuss published data on the role of the microbiome, the mesentery, the immune system and the genetic background. In addition to investigating the causative mechanisms of POR, identification of risk factors is essential to tailor preventive strategies. Potential clinical, surgical and histological risk factors are presented along with their limitations. Emphasis is placed on unanswered research questions, guiding prevention of POR based on individual patient profiles.
Collapse
Affiliation(s)
- Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Nassim Hammoudi
- Department of Gastroenteology, Hôpital Saint-Louis, APHP, INSERM U1160, Université Paris Cité, Paris, France
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Steven Brown
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Melissa Oliveira-Cunha
- Department of Colorectal Surgery, University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Willem Bemelman
- Department of Surgery, Amsterdam University Medical Centers, location Meibergdreef, Amsterdam, the Netherlands
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Science, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Paulo Gustavo Kotze
- IBD Outpatient Clinics, Colorectal Surgery Unit, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Yves Panis
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| |
Collapse
|
8
|
Dragoni G, Allocca M, Myrelid P, Noor NM, Hammoudi N, Rivière P, Panis Y, Ferrante M. Results of the Eighth Scientific Workshop of ECCO: Diagnosing Postoperative Recurrence of Crohn's Disease After an Ileocolonic Resection With Ileocolonic Anastomosis. J Crohns Colitis 2023; 17:1373-1386. [PMID: 37070339 DOI: 10.1093/ecco-jcc/jjad055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/16/2023] [Indexed: 04/19/2023]
Abstract
Despite the introduction of potent biologic therapies, many patients with Crohn's disease [CD] still require an ileocolonic resection [ICR] during the course of their disease. Furthermore, the need of redo ICR has not decreased over the past few decades, highlighting the need for better strategies to prevent and treat postoperative recurrence [POR]. The first step to develop such a strategy would be to define and standardise the description of POR with adequate diagnostic instruments. In this article, we will describe the different methodologies used to report POR [endoscopic, histological, radiological, biochemical, clinical, and surgical], and review their potential benefits and limitations, as well as the optimal timing of evaluation.
Collapse
Affiliation(s)
- Gabriele Dragoni
- IBD Referral Center, Department of Gastroenterology, Careggi University Hospital, Florence, Italy
- Gastroenterology Research Unit, Department of Experimental and Clinical Biochemical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nurulamin M Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nassim Hammoudi
- Gastroenterology Department, Hôpital Saint-Louis - APHP, Université Paris Cité, INSERM U1160, Paris, France
| | - Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Yves Panis
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders [TARGID], Department of Chronic Diseases and Metabolism [CHROMETA], KU Leuven, Leuven, Belgium
| |
Collapse
|
9
|
Vauquelin B, Rivière P. [Celiac disease]. Rev Med Interne 2023; 44:539-545. [PMID: 37558601 DOI: 10.1016/j.revmed.2023.07.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/12/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
Celiac disease is a frequent auto-immune disease characterized by villous atrophy related to gluten intake in patients with genetic susceptiblity. Patients do not present symptoms in the majority of cases. Presence of the disease must be investigated in case of digestive symptoms or presence of auto-immune disease. Diagnosis is based on anti-transglutaminase antibody and dudodenal biospies. The only available treatment is gluten-free diet. Associated auto-immune diseases must be investigated, especially thyroiditis. Complications related to nutritional deficiency must be accounted for also.
Collapse
Affiliation(s)
- B Vauquelin
- Service d'hépato-gastroentérologie et oncologie digestive, centre médico-chirurgical Magellan, CHU de Bordeaux, Bordeaux, France
| | - P Rivière
- Service d'hépato-gastroentérologie et oncologie digestive, centre médico-chirurgical Magellan, CHU de Bordeaux, Bordeaux, France.
| |
Collapse
|
10
|
Le Cosquer G, Capirchio L, Rivière P, Denis MA, Poullenot F, Remue C, Zerbib F, Leonard D, Célérier B, Kartheuser A, Laharie D, Dewit O. Time trend in surgical indications and outcomes in ulcerative colitis-A two decades in-depth retrospective analysis. Dig Liver Dis 2023; 55:1338-1344. [PMID: 37029063 DOI: 10.1016/j.dld.2023.03.003] [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: 12/21/2022] [Revised: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Recent data regarding the impact of biologics and new surgical techniques on the indications and outcomes of colectomy for ulcerative colitis (UC) are limited. AIMS The present study aimed at determining the trend of colectomy in UC by comparing colectomy indications and outcomes between 2000 and 2010 and 2011-2020. METHODS This observational retrospective study was conducted in two tertiary hospitals, including consecutive patients who underwent colectomy between 2000 and 2020. All data concerning UC history, treatment and surgeries were collected. RESULTS Among the 286 patients included, 87 underwent colectomy in 2001-2010 and 199 in 2011-2020. Patients' characteristics were similar between groups, except for prior biologic exposure (50.6 % vs. 74.9%; p<0.001). The indications of colectomy significantly decreased for refractory UC (50.6 % vs. 37.7%; p = 0.042), but were similar for acute severe UC (36.8 % vs. 42.2%; p = 0.390) and (pre)neoplastic lesions (12.6 % vs. 20.1%; p = 0.130). A widespread use of laparoscopy (47.7 % vs. 81.4%; p<0.001) was associated with fewer early complications (12.6 % vs. 5.5%; p = 0.038). CONCLUSION Over the last two decades, the proportion of surgery for refractory UC significantly decreased compared to other surgical indications while surgical outcomes improved despite larger exposure to biologics.
Collapse
Affiliation(s)
- Guillaume Le Cosquer
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Lena Capirchio
- Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pauline Rivière
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Marie Armelle Denis
- Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Florian Poullenot
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Christophe Remue
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Frank Zerbib
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Daniel Leonard
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bertrand Célérier
- Department of Digestive and Endocrine Surgery, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Alex Kartheuser
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - David Laharie
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Olivier Dewit
- Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| |
Collapse
|
11
|
Rivière P, Le Chevillier A, Rullier A, Marty M, Schurr E, Lapuyade B, Célerier B, Fernandez B, Bessissow T, Treton X, Uzzan M, Poullenot F, Berger A, Zerbib F, Laharie D. Deep ulcers are associated with increased C-reactive protein in active ulcerative colitis. Dig Liver Dis 2023; 55:1194-1200. [PMID: 37244790 DOI: 10.1016/j.dld.2023.05.004] [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: 03/10/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Increased C-reactive protein (CRP) is used to diagnose and predict response to treatment in acute severe ulcerative colitis (UC). AIMS To investigate the connection between CRP elevation and deep ulcers in UC. METHODS Patients with active UC were enrolled in a multicenter prospective cohort and a retrospective cohort of consecutive patients undergoing colectomy from 2012 to 2019. RESULTS Forty-one (9 (22%) with deep ulcers) patients were included in the prospective cohort: 4/5 (80%) patients with CRP > 100 mg/L, 2/10 (20%) patients with CRP between 30 and 100 mg/L and 3/26 (12%) patients with CRP < 30 mg/L had deep ulcers (p = 0.006). In the retrospective cohort [46 patients (31 (67%) with deep ulcers)], 14/14 (100%) patients with CRP > 100 mg/L, 11/17 (65%) patients with CRP between 30 and 100 mg/l and 6/15 (40%) patients with CRP < 30 mg/L had deep ulcers (p = 0.001). Positive predictive value of CRP > 100 mg/l for presence of deep ulcers was 80% and 100% in both cohorts, respectively. CONCLUSIONS CRP elevation is a robust surrogate marker for presence of deep ulcers in UC. Elevated CRP or presence of deep ulcers could influence the choice of medical therapy in acute severe UC.
Collapse
Affiliation(s)
- P Rivière
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France; Program in Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - A Le Chevillier
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - A Rullier
- CHU de Bordeaux, Hôpital Pellegrin, Pathology department - Université de Bordeaux, Bordeaux F-33000, France
| | - M Marty
- CHU de Bordeaux, Hôpital Haut-Lévêque, Pathology department - Université de Bordeaux, Bordeaux F-33000, France
| | - E Schurr
- Program in Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - B Lapuyade
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Radiology department - Université de Bordeaux, Bordeaux F-33000, France
| | - B Célerier
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Abdominal surgery department - Université de Bordeaux, Bordeaux F-33000, France
| | - B Fernandez
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Abdominal surgery department - Université de Bordeaux, Bordeaux F-33000, France
| | - T Bessissow
- Division of Gastroenterology and hepatology, McGill University Health Centre, Montreal, Canada
| | - X Treton
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, 25 bd Victor Hugo, Neuilly/Seine 92200, France
| | - M Uzzan
- Paris Est Créteil University UPEC, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Gastroenterology department, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Créteil F-94010, France
| | - F Poullenot
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - A Berger
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - F Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France.
| |
Collapse
|
12
|
Chappe C, Salut C, Amiot A, Gaye D, Frulio N, Lapuyade B, Vuitton L, Altwegg R, Gilletta C, Fumery M, Bouguen G, Serrero M, Nachury M, de Suray N, Caillo L, Simon M, Laharie D, Rivière P, Poullenot F. Preoperative Predictors of Neoplasia in Patients Undergoing Small Bowel Resection for Complicated Crohn’s Disease: A Multicentre Case-Control Study. Cancers (Basel) 2023; 15:cancers15072004. [PMID: 37046666 PMCID: PMC10093720 DOI: 10.3390/cancers15072004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Crohn’s disease (CD) is associated with an increased risk of small bowel neoplasia (SBN). We aimed to assess preoperative predictors of SBN in CD patients. We conducted a retrospective case-control study including CD patients who underwent surgery: cases were diagnosed with SBN on histopathological analysis and controls had no neoplasia. Preoperative cross-sectional imaging was reviewed by a panel of blinded expert radiologists. Fifty cases were matched to one hundred and fifty consecutive controls. In multivariable analysis, predictors of SBN were age ≥ 50 years (OR = 28, 95% CI = 5.05–206), median CD duration ≥ 17.5 years (OR = 4.25, 95% CI = 1.33–14.3), and surgery for stricture (OR = 5.84, 95% CI = 1.27–35.4). The predictors of small bowel adenocarcinoma were age ≥ 50 years (OR = 5.14, 95% CI = 2.12–12.7), CD duration ≥ 15 years (OR = 5.65, 95% CI = 2.33–14.3), and digestive wall thickening > 8 mm (OR = 3.79, 95% CI = 1.45–11.3). A predictive score based on the aforementioned factors was constructed. Almost 73.7% of patients with a high score had SBA. Old age, long small bowel CD duration, and stricture predicted the presence of SBN, particularly adenocarcinoma when patients have digestive wall thickening > 8 mm on preoperative imaging.
Collapse
|
13
|
Rivière P, Pekow J, Hammoudi N, Wils P, De Cruz P, Wang CP, Mañosa M, Ollech J, Allez M, Nachury M, Kamm MA, Ahanori M, Ferrante M, Buisson A, Singh S, Laharie D, Diouf M, Fumery M. Comparison of the Risk of Crohn's Disease Postoperative Recurrence Between Modified Rutgeerts Score i2a and i2b Categories: An Individual Patient Data Meta-analysis. J Crohns Colitis 2023; 17:269-276. [PMID: 36124813 DOI: 10.1093/ecco-jcc/jjac137] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The modified Rutgeerts' score [RS] differentiates i2a-lesions confined to the anastomosis-and i2b-more than five aphthous ulcers in the neoterminal ileum with normal intervening mucosa, with or without anastomotic lesions-categories. Its relevance for the therapeutic management of Crohn's disease [CD] patients after ileocolic resection is still debated. Our objective was to compare the postoperative recurrence risk in patients with an i2a or i2b score, using an individual patient data meta-analysis. METHODS We conducted a systematic literature search until July 2020, to identify all relevant studies reporting the i2a/i2b status in the year following ileocolic resection and clinical and/or surgical postoperative CD recurrence in their follow-up. Individual patient-level data were obtained from the corresponding authors. The association between the modified RS and time-to-event was evaluated using a mixed Cox model with the centre as the random effect. RESULTS Seven studies published between 2008 and 2019 were included, corresponding to 400 patients: 189 [47%] i2a and 211 [53%] i2b. Median [interquartile range, IQR] time from ileocolic resection to ileocolonoscopy was 6.2 [5.5, 7.9] months and median [IQR] follow-up time after ileocolonoscopy was 4.5 [2.9, 7.3] years. The risk of clinical postoperative recurrence at 1 and 3 years was 11% [6-15%], and 25% [18-32%] in the i2a group versus 9% [5-13%] and 33% [26-41%] in the i2b group [p = 0.63 and p = 0.12, respectively]. No significant difference was observed in terms of time to clinical postoperative recurrence [p = 0.16] or surgical postoperative recurrence [p = 0.87]. Results did not change after excluding patients having initiated an immunosuppressant or a biologic in the 3 months after endoscopy [remaining cohort, n = 361]. CONCLUSIONS In this individual patient data meta-analysis, no difference was observed between i2a and i2b subcategories with regards to clinical or surgical postoperative recurrence. As we wait for prospective trials, the same treatment strategy could be applied to all patients classified as i2 on the Rutgeerts score.
Collapse
Affiliation(s)
- Pauline Rivière
- Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, Bordeaux, France
| | - Joel Pekow
- Gastroenterology Department, University of Chicago, Chicago, IL, USA
| | - Nassim Hammoudi
- Service d'Hépato-gastroentérologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Pauline Wils
- Univ. Lille, Institute for Translational Research in Inflammation, Lille, France
| | - Peter De Cruz
- Gastroenterology Department, Austin Health, Heidelberg, VIC, Australia
| | - Christina Pu Wang
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Míriam Mañosa
- Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Jacob Ollech
- Gastroenterology Department, University of Chicago, Chicago, IL, USA
| | - Matthieu Allez
- Service d'Hépato-gastroentérologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Maria Nachury
- Univ. Lille, Institute for Translational Research in Inflammation, Lille, France
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Maya Ahanori
- Gastroenterology Department, University of Chicago, Chicago, IL, USA
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Anthony Buisson
- Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Siddarth Singh
- Division of Gastroenterology and Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - David Laharie
- Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, Bordeaux, France
| | - Momar Diouf
- Direction de la recherche clinique, Centre Hospitalier Universitaire Amiens-Picardie Site Sud, Amiens, France
| | - Mathurin Fumery
- Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Amiens-Picardie Site Sud, Amiens, France
| |
Collapse
|
14
|
Torres J, Chaparro M, Julsgaard M, Katsanos K, Zelinkova Z, Agrawal M, Ardizzone S, Campmans-Kuijpers M, Dragoni G, Ferrante M, Fiorino G, Flanagan E, Gomes CF, Hart A, Hedin CR, Juillerat P, Mulders A, Myrelid P, O'Toole A, Rivière P, Scharl M, Selinger CP, Sonnenberg E, Toruner M, Wieringa J, Van der Woude CJ. European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation. J Crohns Colitis 2023; 17:1-27. [PMID: 36005814 DOI: 10.1093/ecco-jcc/jjac115] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Joana Torres
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal.,Division of Gastroenterology, Hospital da Luz, Lisboa, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, IIS-Princesa, UAM, CIBEREHD, Madrid, Spain
| | - Mette Julsgaard
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Zuzana Zelinkova
- Department of Internal Medicine, Svet zdravia, Nemocnica Dunajska Streda, Slovakia.,Firstst Department of Internal Medicine of University Hospital and Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Manasi Agrawal
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Sandro Ardizzone
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences. University of Milan, Milan, Italy
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.,Gastroenterology Department, Careggi University Hospital, Florence, Italy
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | | | - Ailsa Hart
- Inflammatory Bowel Diseases Unit, St Mark's Hospital, Harrow, UK
| | - Charlotte Rose Hedin
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden.,Karolinska University Hospital, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.,Crohn's and Colitis Center, Gastroenterology Beaulieu SA, Lausanne, Switzerland
| | - Annemarie Mulders
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Aoibhlinn O'Toole
- Beaumont Hospital, Department of Gastroenterology, Royal College of Surgeons, Dublin, Ireland
| | - Pauline Rivière
- Gastroenterology Unit, Bordeaux University Hospital, Pessac, France
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Elena Sonnenberg
- Charité-Universitätsmedizin Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology, Germany
| | - Murat Toruner
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Jantien Wieringa
- Department of Paediatrics, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Paediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Janneke Van der Woude
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Poullenot F, Amiot A, Nachury M, Viennot S, Altwegg R, Bouhnik Y, Abitbol V, Nancey S, Vuitton L, Peyrin-Biroulet L, Biron A, Fumery M, Picon L, Vidon M, Reenaers C, Serrero M, Savoye G, Beaugerie L, Rivière P, Laharie D. Comparative Risk of Incident Cancer in Patients with Inflammatory Bowel Disease with Prior Non-digestive Malignancy According to Immunomodulator: a Multicentre Cohort Study. J Crohns Colitis 2022; 16:1523-1530. [PMID: 35512337 DOI: 10.1093/ecco-jcc/jjac061] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/04/2021] [Revised: 03/27/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Knowledge about the cancer risk when initiating a biologic in inflammatory bowel disease [IBD] patients with prior malignancy remains scarce, especially for vedolizumab. Our aim was to evaluate the rate of incident cancer in a cohort of IBD patients with prior non-digestive malignancy, according to the subsequent treatment given. METHODS A multicentre retrospective study included consecutive IBD patients with prior non-digestive malignancy. Inclusion date corresponded to the diagnosis of index malignancy. Patients were categorized into different cohorts according to the first treatment [none, conventional immunosuppressant, anti-TNF, or vedolizumab] to which they were exposed after inclusion and before incident cancer [recurrent or new cancer]. RESULTS Among the 538 patients {58% female; mean (standard deviation [SD]) age inclusion: 52 [15] years} analyzed, the most frequent malignancy was breast cancer [25%]. The first immunomodulator given after inclusion was a conventional immunosuppressant in 27% of patients, anti-TNF in 21%, or vedolizumab in 9%. With a median (interquartile range [IQR]) follow-up duration of 55 [23-100] months, 100 incident cancers were observed. Crude cancer incidence rates per 1000 person-years were 47.0 for patients receiving no immunomodulator, 36.6 in the anti-TNF cohort, and 33.6 in the vedolizumab cohort [p = 0.23]. Incident-cancer free survival rates were not different between patients receiving anti-TNF and those receiving vedolizumab [p = 0.56]. After adjustment, incidence rates were not different between patients receiving no immunomodulator, anti-TNF, or vedolizumab. CONCLUSIONS In this large multicentre cohort study, there was no difference of cancer incidence in those IBD patients with prior non-digestive malignancy, treated with vedolizumab or anti-TNF.
Collapse
Affiliation(s)
- F Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - A Amiot
- Département de Gastroentérologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
| | - M Nachury
- Univ. Lille, Institute for Translational Research in Inflammation, France
| | - S Viennot
- Hepato-gastroenterology Department, CHU Caen, Caen, France
| | - R Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier, France
| | - Y Bouhnik
- Gastroenterology and Nutrition Support Department, Department of Gastroenterology, Beaujon Hospital, Clichy, France
| | - V Abitbol
- Hôpital Cochin AP-HP Gastro-entérologie, and Université de Paris, Paris, France
| | - S Nancey
- Department of Gastroenterology, CHU, Lyon, France
| | - L Vuitton
- Department of Gastroenterology, CHRU, Besançon, France
| | - L Peyrin-Biroulet
- Gastroenterology Department, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - A Biron
- CHU Reims, Hôpital Robert Debré. Service Hépato-gastroentérologie et cancérologie digestive, Reims, France
| | - M Fumery
- Department of Gastroenterology, CHU, Amiens, France
| | - L Picon
- Hepato-gastroenterology Department, CHRU Tours-TROUSSEAU Hospital, Tours, France
| | - M Vidon
- Departement of Gastroenterology, Hôpital Intercommunal de Créteil, Créteil, France
| | - C Reenaers
- Hepato-gastroenterology Department, CHU Sart Tilman, Liège University, Liège, Belgium
| | - M Serrero
- Hepato-gastroenterology Department, APHM Hôpital Nord, Marseille, France
| | - G Savoye
- Department of Gastroenterology, Normandie University, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - L Beaugerie
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - P Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | | |
Collapse
|
16
|
Le Cosquer G, Altwegg R, Rivière P, Bournet B, Boivineau L, Poullenot F, Bozon A, Buscail L, Laharie D, Gilletta C. Prevention of post-operative recurrence of Crohn's disease among patients with prior anti-TNFα failure: A retrospective multicenter study. Dig Liver Dis 2022; 55:727-734. [PMID: 36192340 DOI: 10.1016/j.dld.2022.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/27/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-TNFα are recommended for preventing Crohn's disease (CD) postoperative recurrence (POR) in patients with risk factors. However, few data exploring anti-TNFα efficacy in patients with preoperative anti-TNFα failure are available so far. AIMS The aim of the present study was to compare the efficacy of anti-TNFα with other biologics and immunosuppressants to prevent POR in this setting. METHODS Consecutive CD patients who underwent bowel resection between January 2010 and December 2019 after failure of at least one anti-TNFα were retrospectively included among three tertiary centers if they started a postoperative medical prophylaxis within the three months after index surgery. The main outcome was to compare rates of objective recurrence (endoscopic or radiological recurrence in absence of colonoscopy) between patients treated with an anti-TNFα agent or another treatment as prevention of POR. RESULTS Among the 119 patients included, 71 patients received an anti-TNFα (26 infliximab, 45 adalimumab) and 48 another treatment (18 ustekinumab, 7 vedolizumab, 20 azathioprine and 3 methotrexate) to prevent POR. Rates of objective recurrence at two years were 23.9% in patients treated with anti-TNFα and 44.9% in the others (p = 0.011). CONCLUSION Anti-TNFα remained an effective option to prevent POR for patients operated upon with previous anti-TNFα failure.
Collapse
Affiliation(s)
- Guillaume Le Cosquer
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France.
| | - Romain Altwegg
- Department of Hepato-gastroenterology, Hôpital Saint-Eloi, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Barbara Bournet
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France
| | - Lucile Boivineau
- Department of Hepato-gastroenterology, Hôpital Saint-Eloi, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Florian Poullenot
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Anne Bozon
- Department of Hepato-gastroenterology, Hôpital Saint-Eloi, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Louis Buscail
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France
| | - David Laharie
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Cyrielle Gilletta
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France
| |
Collapse
|
17
|
Chaparro M, Kunovský L, Aguas M, Livne M, Rivière P, Bar-Gil Shitrit A, Myrelid P, Arroyo M, Barreiro-de Acosta M, Bautista M, Biancone L, Biron IA, Boysen T, Carpio D, Castro B, Dragoni G, Ellul P, Holubar SD, de Jorge MÁ, Leo E, Manceñido N, Moens A, Molnár T, Ramírez de la Piscina P, Ricanek P, Sebkova L, Sempere L, Teich N, Gisbert JP, Julsgaard M. Surgery due to Inflammatory Bowel Disease During Pregnancy: Mothers and Offspring Outcomes From an ECCO Confer Multicentre Case Series [Scar Study]. J Crohns Colitis 2022; 16:1428-1435. [PMID: 35380641 DOI: 10.1093/ecco-jcc/jjac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/28/2023]
Abstract
AIMS i] To evaluate the evolution of pregnancies and offspring after inflammatory bowel disease [IBD] surgery during pregnancy; and ii] to describe the indications, the surgical techniques, and the frequency of caesarean section concomitant with surgery. METHODS Patients operated on due to IBD during pregnancy after 1998 were included. Participating clinicians were asked to review their databases to identify cases. Data on patients' demographics, IBD characteristics, medical treatments, IBD activity, pregnancy outcomes, surgery, delivery, and foetal and maternal outcomes, were recorded. RESULTS In all, 44 IBD patients were included, of whom 75% had Crohn's disease; 18% of the surgeries were performed in the first trimester, 55% in the second, and 27% in the third trimester. One patient had complications during surgery, and 27% had postsurgical complications. No patient died. Of deliveries, 70% were carried out by caesarean section. There were 40 newborns alive. There were four miscarriages/stillbirths [one in the first, two in the second, and one in the third trimester]; two occurred during surgery, and another two occurred 2 weeks after surgery; 14% of the surgeries during the second trimester and 64% of those in the third trimester ended up with a simultaneous caesarean section or vaginal delivery. Of the 40 newborns, 61% were premature and 47% had low birth weight; 42% of newborns needed hospitalisation [25% in the intensive care unit]. CONCLUSIONS IBD surgery during pregnancy remains an extremely serious situation. Therefore, surgical management should be performed in a multidisciplinary team, involving gastroenterologists, colorectal surgeons, obstetricians, and neonatal specialists.
Collapse
Affiliation(s)
- María Chaparro
- Hospital Universitario de La Princesa, [IIS-IP], UAM, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - Lumír Kunovský
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mariam Aguas
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | | | | | | | - Pär Myrelid
- Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | - Maite Arroyo
- Hospital Clínico Universitario Lozano Blesa and CIBERehd, IIS Aragón, Zaragoza, Spain
| | | | | | | | | | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, Pontevedra, Spain
| | - Beatriz Castro
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | | | | | - Eduardo Leo
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Noemí Manceñido
- Hospital Universitario Infanta Sofía. San Sebastián de los Reyes, Spain
| | | | - Tamás Molnár
- University of Szeged, Albert Szent-Györgyi Medical School, Department of Internal Medicine, Szeged, Hungary
| | | | | | | | - Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Niels Teich
- Practice for Internal Medicine, Leipzig, Germany
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, [IIS-IP], UAM, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | | | | |
Collapse
|
18
|
Cottron C, Treton X, Altwegg R, Reenaers C, Amiot A, Fumery M, Vuitton L, Peyrin-Biroulet L, Bouguen G, Dewit O, Nancey S, Caillo L, Roblin X, Beylot-Barry M, Rivière P, Laharie D. How to Manage Inflammatory Bowel Disease Patients When They Withdraw Anti-Tumour Necrosis Factor [Anti-TNF] Due to Severe Anti-TNF-Induced Skin Lesions? A Multicentre Cohort Study. J Crohns Colitis 2022; 16:1202-1210. [PMID: 35218189 DOI: 10.1093/ecco-jcc/jjac035] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Optimal management of patients with inflammatory bowel disease [IBD] after anti-tumour necrosis factor [TNF] discontinuation due to severe induced skin lesions is unclear. Our study aimed to describe dermatological and IBD evolution after anti-TNF discontinuation for this side effect. METHODS We conducted a multicentre retrospective study including consecutive IBD patients who discontinued anti-TNF due to severe induced skin lesions. Our objectives were to determine factors associated with dermatological remission [complete disappearance of skin lesions] and with IBD relapse in patients with inactive disease at inclusion, notably the impact of an early switch to another biological agent within 3 months of anti-TNF discontinuation. RESULTS Among the 181 patients [134 women, 160 Crohn's disease] included in the 13 participating centres, dermatological remission occurred in 110 [62%] patients with a median [interquartile range, IQR] interval of 8.0 [6.8-11.0] months. Scalp location was independently associated with less remission of skin lesions (hazard ratio [HR] = 0.64 [95% CI 0.43-0.94], p = 0.02) while early switch was independently associated with a higher probability of remission of skin lesions (HR = 1.64 [95% CI 1.1-2.5], p = 0.02). Among the 148 patients with inactive IBD at inclusion, disease relapse occurred in 75 [51%] patients with a median [IQR] interval of 26.0 [23.0-39.1] months. Survival rates without IBD relapse at 1 year were 85.8% [95% CI 77.5-94.9] in the early switch group and 59.3% [95% CI 48.9-71.9] in the other group [p < 0.01]. CONCLUSIONS Early switch to a new biological is associated with a higher probability of healing of anti-TNF-induced skin lesions and significantly reduces the risk of IBD relapse.
Collapse
Affiliation(s)
- C Cottron
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - X Treton
- Department of Gastroenterology, IBD and Nutrition, Beaujon Hospital, APHP, Paris, France
| | - R Altwegg
- Department of Hepatogastroenterology, Saint Eloi Hospital, CHU de Montpellier, Montpellier, France
| | - C Reenaers
- Department of Gastroenterology, CHU Sart Tilman, Liège, Belgium
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - M Fumery
- Department of Gastroenterology, CHU de Amiens, and Peritox, UMR I-01, France
| | - L Vuitton
- Department of Hepatogastroenterology, CHRU de Besançon, Besançon, France
| | - L Peyrin-Biroulet
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - G Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
| | - O Dewit
- Department of Gastroenterology, Université Catholique de Louvain Saint Luc, Brussels, Belgium
| | - S Nancey
- Department of Gastroenterology, CHU de Lyon, Lyon Sud Hospital, University Claude Bernard Lyon 1, INSERM U1111, Lyon, France
| | - L Caillo
- Department of Hepatogastroenterology, CHU de Nîmes, Nîmes, France
| | - X Roblin
- Department of Hepatogastroenterology, CHU de Saint-Etienne, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France
| | - M Beylot-Barry
- Department of Dermatology, Saint-André Hospital, CHU de Bordeaux, France
| | - P Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| |
Collapse
|
19
|
Rivière P, Kanters C, Pellet G, Ni A, Hupé M, Aboulhamid N, Poullenot F, Bitton A, Zerbib F, Lakatos PL, Afif W, Laharie D, Bessissow T. Comparative Effectiveness of Ustekinumab and Anti-TNF Agent as First-Line Biological Therapy in Luminal Crohn's Disease: A Retrospective Study From 2 Referral Centers. Inflamm Bowel Dis 2022:6653347. [PMID: 35917111 DOI: 10.1093/ibd/izac167] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Real-life data on the efficacy of ustekinumab as first-line therapy for the treatment of luminal Crohn's disease (CD) compared with anti-tumor necrosis factor (anti-TNF) agents are lacking. We compared the clinical response rates at 3 months in 2 cohorts of biologic-naïve patients treated by ustekinumab and anti-TNF agents. METHODS Biologic-naïve patients starting either ustekinumab or an anti-TNF agent for luminal CD between 2016 and 2019 in 2 tertiary centers were retrospectively included. The primary endpoint was clinical response at 3 months, defined as a Harvey-Bradshaw Index <4 or a 3-point drop in the score without steroids, need for CD-related surgery, or treatment discontinuation owing to failure or intolerance. Patients treated with ustekinumab were matched to patients receiving anti-TNF agents by a propensity score algorithm. RESULTS We included 156 patients starting anti-TNF agents (95 adalimumab and 61 infliximab) and 50 ustekinumab. After matching, clinical response rates at 3 months were 64% and 86% in the ustekinumab and anti-TNF groups, respectively (P = .01). At 12 months, in multivariate analysis adjusted for disease duration, location, concomitant immunosuppressant and steroids, and symptoms, clinical remission was independently associated with the biological therapy received (odds ratio, 2.6 for anti-TNF agent vs ustekinumab; P = .02). With a median follow-up duration of 40 (interquartile range, 23-52) months, no difference was observed in terms of time to drug withdrawal (P = .29) or safety. CONCLUSIONS This retrospective real-world data suggest that an anti-TNF agent as a first-line biological therapy is associated with higher rates of response at 3 months than ustekinumab in patients with CD.
Collapse
Affiliation(s)
- Pauline Rivière
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Caitlyn Kanters
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gauthier Pellet
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Alexander Ni
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marianne Hupé
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nesrine Aboulhamid
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Florian Poullenot
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Frank Zerbib
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Waqqas Afif
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Laharie
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
20
|
Buisson A, Serrero M, Orsat L, Nancey S, Rivière P, Altwegg R, Peyrin-Biroulet L, Nachury M, Hébuterne X, Gilletta C, Flamant M, Viennot S, Bouguen G, Amiot A, Mathieu S, Vuitton L, Plastaras L, Bourreille A, Caillo L, Goutorbe F, Pineton De Chambrun G, Attar A, Roblin X, Pereira B, Fumery M. Comparative Acceptability of Therapeutic Maintenance Regimens in Patients With Inflammatory Bowel Disease: Results From the Nationwide ACCEPT2 Study. Inflamm Bowel Dis 2022; 29:579-588. [PMID: 35815744 DOI: 10.1093/ibd/izac119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Owing to growing number of therapeutic options with similar efficacy and safety, we compared the acceptability of therapeutic maintenance regimens in inflammatory bowel disease (IBD). METHODS From a nationwide study (24 public or private centers), IBD patients were consecutively included for 6 weeks. A dedicated questionnaire including acceptability numerical scales (ANS) ranging from 0 to 10 (highest acceptability) was administered to both patients and related physicians. RESULTS Among 1850 included patients (65.9% with Crohn's disease), the ANS were 8.68 ± 2.52 for oral route (first choice in 65.8%), 7.67 ± 2.94 for subcutaneous injections (first choice in 21.4%), and 6.79 ± 3.31 for intravenous infusions (first choice in 12.8%; P < .001 for each comparison). In biologic-naïve patients (n = 315), the most accepted maintenance regimens were oral intake once (ANS = 8.8 ± 2.2) or twice (ANS = 6.9 ± 3.4) daily and subcutaneous injections every 12 or 8 weeks (ANS = 7.9 ± 3.0 and ANS = 7.2 ± 3.2, respectively). Among 342 patients with prior exposure to subcutaneous biologics, the preferred regimens were subcutaneous injections (≥2 week-intervals; ANS between 9.1 ± 2.3 and 8.1 ± 2.7) and oral intake once daily (ANS = 7.7 ± 3.2); although it was subcutaneous injections every 12 or 8 weeks (ANS = 8.4 ± 3.0 and ANS = 8.1 ± 3.0, respectively) and oral intake once daily (ANS = 7.6 ± 3.1) in case of prior exposure to intravenous biologics (n = 1181). The impact of usual therapeutic escalation or de-escalation was mild (effect size <0.5). From patients' acceptability perspective, superiority and noninferiority cutoff values should be 15% and 5%, respectively. CONCLUSIONS Although oral intake is overall preferred, acceptability is highly impacted by the rhythm of administration and prior medication exposures. However, SC treatment with long intervals between 2 injections (≥8 weeks) and oral intake once daily seems to be the most accepted modalities.
Collapse
Affiliation(s)
- Anthony Buisson
- Université Clermont Auvergne, Inserm, Centre Hospitalier Universitaire Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, Inserm, M2iSH, USC-INRA, Clermont-Ferrand, France
| | - Mélanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - Laurie Orsat
- Université Clermont Auvergne, Inserm, Centre Hospitalier Universitaire Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - Stéphane Nancey
- French Institute of Health and Medical Research U1111-CIRI, Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Pauline Rivière
- Service d'Hépato-gastroentérologie et oncologie digestive, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Romain Altwegg
- Department of Hepatogastroenterology, Centre Hospitalier Universitaire St Eloi Montpellier, Montpellier, France
| | - Laurent Peyrin-Biroulet
- French Institute of Health and Medical Research Nutrition-Genetics and Exposure to Environmental Risks U1256, Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Maria Nachury
- Université Lille, Inserm, Centre Hospitalier Universitaire Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Xavier Hébuterne
- Gastroenterology and Clinical Nutrition, Centre Hospitalier Universitaire Nice and University Côte d'Azur, Nice, France
| | | | | | | | - Guillaume Bouguen
- Centre Hospitalier Universitaire Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Aurélien Amiot
- EC2M3-EA7375, Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, Assistance Publique-Hôpitaux de Paris, University of Paris Est Créteil, Créteil, France
| | | | - Lucine Vuitton
- Centre Hospitalier Universitaire Besançon, Besançon, France
| | | | | | - Ludovic Caillo
- Service d'hépato-gastro-entérologie, Centre Hospitalier Universitaire Nimes, Univ Montpellier, Nimes, France
| | - Félix Goutorbe
- Department of Gastroenterology, Hospital of Bayonne, Bayonne, France
| | | | - Alain Attar
- Private practice, Clinique Monceau, Paris, France
| | - Xavier Roblin
- Centre Hospitalier Universitaire Saint-Etienne, Saint-Etienne, France
| | - Bruno Pereira
- Université Clermont Auvergne, Centre Hospitalier Universitaire Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - Mathurin Fumery
- Centre Hospitalier Universitaire Amiens, Université de Picardie Jules Verne, Unité Peritox, Amiens, France
| |
Collapse
|
21
|
Le Cosquer G, Grangeon L, Rivière P, Berger A, Zerbib F, Laharie D, Poullenot F. A single dedicated vaccination visit improves vaccination coverage of patients with inflammatory bowel disease. Therap Adv Gastroenterol 2022; 15:17562848221082879. [PMID: 35493617 PMCID: PMC9039447 DOI: 10.1177/17562848221082879] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Patients treated with biologics for inflammatory bowel disease (IBD) have an increased risk of severe infections. Real-life vaccination coverage in this population remains low despite international vaccination guidelines. The aim of this study was to evaluate the impact of a dedicated vaccination visit on vaccination coverage. METHODS A dedicated vaccination visit was offered to all patients admitted for an infusion of a biologic in a tertiary IBD center during a 4-week period. At baseline, vaccination status was collected. Patients received specific information on recommended vaccinations. Perceived utility of both vaccination and the dedicated visit were assessed by visual analogue scale (VAS). Vaccination coverage was reassessed 6 months later by phone call. RESULTS Among the 207 patients analyzed (1 patient declined), rates of vaccination at baseline and 6 months later against diphtheria were 52.7% and 68.6% (p < 0.001), tetanus 55.1% and 70% (p < 0.001), poliomyelitis 51.7% and 68.6% (p < 0.001), pertussis 33.3% and 51.2% (p < 0.001), hepatitis B virus (HBV) 61.4% and 66.7% (p < 0.01), pneumococcus 15.5% and 42.0% (p < 0.001), influenza 29.5% and 36.2% (p < 0.01), and meningococcus C 11.6% and 13.0% (p = 0.083), respectively. A quarter of the patients declined at least one recommended vaccination after the visit. The main reason for this refusal was distrust toward one or more vaccines. CONCLUSION A single visit dedicated to vaccination significantly increases rates of vaccination in patients with IBD treated with biologics.
Collapse
Affiliation(s)
- Guillaume Le Cosquer
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Lionel Grangeon
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Pauline Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Arthur Berger
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Frank Zerbib
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | | |
Collapse
|
22
|
Enaud R, Tetard C, Dupuis R, Laharie D, Lamireau T, Zerbib F, Rivière P, Shili-Mismoudi S, Poullenot F. Compliance with Gluten Free Diet Is Associated with Better Quality of Life in Celiac Disease. Nutrients 2022; 14:nu14061210. [PMID: 35334866 PMCID: PMC8951042 DOI: 10.3390/nu14061210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
The quality of life (QOL) of patients with celiac disease (CD) can be altered by both symptoms of the disease and by the restrictions of the gluten-free diet (GFD). The objective was to determine the factors associated with better QOL in a large cohort of CD patients. A link to an online survey was sent to the members of the French Association of Gluten Intolerant People (AFDIAG). The French-Celiac Disease Questionnaire (F-CDQ), scoring from 0 to 100, was used to measure the QOL. Other data collected were sociodemographic characteristics, information on CD, purchasing and consumption habits of gluten-free products, and a self-assessment scale (ranging from 0 to 10) to determine the compliance with the GFD. Among the 907 CD patients who returned the questionnaire, 787 were analyzed (638 women (81%); median age: 49 years; 71% with self-assessed GFD compliance > 8). Their median F-CDQ was 73 (range: 59−82). In multivariate analysis, the main factors associated with a better quality of life were the long duration of the GFD, good compliance with the GFD, and the number of follow-up visits. Compliance with and duration of the GFD are associated with a better quality of life in patients with CD. Taking this into consideration would offset its restrictive aspect and improve its adherence.
Collapse
Affiliation(s)
- Raphaël Enaud
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Candice Tetard
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Raphaël Dupuis
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - David Laharie
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Thierry Lamireau
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Frank Zerbib
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Pauline Rivière
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Sarah Shili-Mismoudi
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Florian Poullenot
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
- Correspondence:
| |
Collapse
|
23
|
Castinel J, Pellet G, Laharie D, Zerbib F, Silvain C, Wilsius E, Kerlogot L, Rivière P, Poullenot F. MALE GENDER IS ASSOCIATED WITH INFORMAL CAREGIVER BURDEN IN CHRONIC INTESTINAL FAILURE PATIENTS TREATED WITH HOME PARENTERAL NUTRITION. JPEN J Parenter Enteral Nutr 2022; 46:1593-1601. [DOI: 10.1002/jpen.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jean Castinel
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
- CHU de Poitiers, Hepato‐Gastroenterology Department; Université de Poitiers Poitiers France
| | - Gauthier Pellet
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - David Laharie
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Christine Silvain
- CHU de Poitiers, Hepato‐Gastroenterology Department; Université de Poitiers Poitiers France
| | - Eva Wilsius
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Laurianne Kerlogot
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Pauline Rivière
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Florian Poullenot
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| |
Collapse
|
24
|
Laharie D, Rivière P. Editorial: don't forget basic performance measures in the endoscopic assessment of ulcerative colitis. Aliment Pharmacol Ther 2022; 55:129-130. [PMID: 34907554 DOI: 10.1111/apt.16679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- David Laharie
- Service d'Hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Pauline Rivière
- Service d'Hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| |
Collapse
|
25
|
Rivière P, Vauquelin B, Rolland E, Melchior C, Roman S, Bruley des Varannes S, Mion F, Gourcerol G, Sacher-Huvelin S, Zerbib F. Low FODMAPs diet or usual dietary advice for the treatment of refractory gastroesophageal reflux disease: An open-labeled randomized trial. Neurogastroenterol Motil 2021; 33:e14181. [PMID: 34051134 DOI: 10.1111/nmo.14181] [Citation(s) in RCA: 6] [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: 10/27/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The low FODMAPs (fermentable oligo-, di-, monosaccharides, and polyols) diet improves lower gastrointestinal symptoms. Patients suffering from proton pump inhibitor (PPI) refractory gastroesophageal reflux disease (GERD) have limited treatment options. We investigated the efficacy of a low FODMAPs diet in patients with PPI refractory GERD. METHODS This multicenter, randomized, open-label study compared the efficacy of a 4-week low FODMAPs diet and usual dietary advice (ie, low-fat diet and head of bed elevation) in patients with symptomatic PPI refractory GERD, defined by a Reflux Disease Questionnaire (RDQ) score >3 and abnormal pH-impedance monitoring on PPIs. The primary endpoint was the percentage of responders (RDQ ≤3) at the end of the diet. RESULTS Thirty-one patients (55% women, median age 45 years) were included, 16 randomized in the low FODMAPs diet group and 15 in the usual dietary advice group. Adherence to the assigned diet was good, with a significant difference in the FODMAPs intake per day between the low FODMAPs diet (2.5 g) and the usual dietary advice group (13 g) (p < 0.001). There was no difference in response rates (RDQ score ≤3) between the low FODMAPs diet (6/16, 37.5%) and usual dietary advice (3/15, 20%) groups (p = 0.43). Total RDQ score and dyspepsia subscore decreased significantly over time in both groups (p = 0.002), with no difference according to the assigned diet group (p = 0.85). CONCLUSION Low FODMAPs diet and usual dietary advice have similar but limited beneficial effects on symptoms in patients with PPI refractory GERD.
Collapse
Affiliation(s)
- Pauline Rivière
- Centre Médico-Chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.,INSERM CIC 1401, Université de Bordeaux, Bordeaux, France
| | - Blandine Vauquelin
- Centre Médico-Chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.,INSERM CIC 1401, Université de Bordeaux, Bordeaux, France
| | - Emiliane Rolland
- Centre Médico-Chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.,INSERM CIC 1401, Université de Bordeaux, Bordeaux, France
| | - Chloé Melchior
- Gastroenterology Department and INSERM CIC-CRB 1404, Rouen University Hospital, Rouen Cedex, France.,INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Sabine Roman
- Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,Inserm U1032, LabTAU, Université de Lyon, Lyon, France
| | - Stanislas Bruley des Varannes
- Gastroenterology Department, CHU de Nantes, Institut des Maladies de l'Appareil Digestif, IMAD CIC 1413, Université de Nantes, Nantes, France
| | - François Mion
- Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,Inserm U1032, LabTAU, Université de Lyon, Lyon, France
| | - Guillaume Gourcerol
- INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Physiology Department and INSERM CIC-CRB 1404, Rouen University Hospital, Rouen Cedex, France
| | - Sylvie Sacher-Huvelin
- Gastroenterology Department, CHU de Nantes, Institut des Maladies de l'Appareil Digestif, IMAD CIC 1413, Université de Nantes, Nantes, France
| | - Frank Zerbib
- Centre Médico-Chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.,INSERM CIC 1401, Université de Bordeaux, Bordeaux, France
| |
Collapse
|
26
|
Burri E, Maillard MH, Schoepfer AM, Seibold F, Van Assche G, Rivière P, Laharie D, Manz M. Treatment Algorithm for Mild and Moderate-to-Severe Ulcerative Colitis: An Update. Digestion 2021; 101 Suppl 1:2-15. [PMID: 31945767 DOI: 10.1159/000504092] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 05/21/2019] [Accepted: 10/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patient care in ulcerative colitis (UC) remains challenging despite an array of established treatment options and emerging new therapies. The management of UC therapy should be guided by the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome. Complete remission, defined as durable symptomatic and endoscopic remission without corticosteroid therapy, is the desired treatment goal. SUMMARY This review focuses on treatment recommendations for different clinical scenarios in moderate-to-severe UC: Active UC of any extent not responding to aminosalicylates, steroid-dependent UC, steroid-refractory UC, immunomodulator-refractory UC, and acute severe UC. Comprehensive treatment algorithms for daily clinical practice were developed based on published guidelines and current literature. Key Messages: While current treatment options including a number of biologicals and small molecules have evolved UC treatment to achieve sustained remission in a majority of patients, upcoming treatment options with different molecular pathways and different modes of actions will further increase the need for personalized medicine.
Collapse
Affiliation(s)
- Emanuel Burri
- Department of Gastroenterology and Hepatology, Cantonal Hospital Baselland, Liestal, Switzerland,
| | - Michel H Maillard
- Crohn and Colitis Center, Gastroentérologie Beaulieu SA, Lausanne, Switzerland
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Frank Seibold
- Crohn-Colitis Zentrum, Hochhaus Lindenhofspital, Bern, Switzerland
| | - Gert Van Assche
- Department of Gastroenterology, University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Pauline Rivière
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - David Laharie
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Michael Manz
- Department of Gastroenterology and Hepatology, Clarunis, Basel, Switzerland
| | | |
Collapse
|
27
|
Malian A, Rivière P, Bouchard D, Pigot F, Eléouet-Kaplan M, Favreau-Weltzer C, Poullenot F, Laharie D. Erratum to: Predictors of Perianal Fistula Relapse in Crohn's Disease. Inflamm Bowel Dis 2021; 27:1365. [PMID: 33277906 DOI: 10.1093/ibd/izaa272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
28
|
Broussard D, Rivière P, Bonnet J, Fotsing G, Amiot A, Peyrin-Biroulet L, Rajca S, Buisson A, Gilleta C, Pelletier AL, Serrero M, Bouguen G, Altwegg R, Hebuterne X, Nancey S, Fumery M, Cadiot G, Nahon S, Rahier JF, Gornet JM, Vendrely V, Laharie D. Impact of abdominal or pelvic radiotherapy on disease activity in inflammatory bowel disease: a multicentre cohort study from the GETAID. Aliment Pharmacol Ther 2021; 53:400-409. [PMID: 33241906 DOI: 10.1111/apt.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/16/2020] [Accepted: 11/04/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Abdominal or pelvic radiotherapy in inflammatory bowel disease (IBD) patients raises concerns regarding the risk of worsening of underlying disease. AIM To assess the impact of radiotherapy on IBD course. METHODS A retrospective multicentre study including IBD patients exposed to abdominal or pelvic irradiation was conducted, retrieving IBD activity by semester (6-month periods) before (from S-4 to S-1) and after (from S + 1 to S + 6) radiotherapy and IBD flare during follow-up. RESULTS Sixty-one patients (32 women, mean age 59 years), with 467 patient semesters of follow-up, treated for digestive (n = 31), urinary tract (n = 23) and gynaecological cancers (n = 7) were included. Rates of IBD activity per semester were, respectively, 21% (95% CI: 16-27) from S-4 to S-1; 12% (7-19) from S + 1 to S + 3 (P = 0.15 vs S-4 to S-1) and 16% (10-25) from S + 4 to S + 6 (P = 0.45 vs S-4 to S-1). With a median follow-up of 156 weeks (interquartile range: 82-365), rates of survival without IBD flare at 1 and 3 years after radiotherapy were 82.5% (73.2-93.0) and 70.6% (58.8-84.7). Moderate-to-severe acute radiotherapy-induced gut toxicity and the absence of concomitant chemotherapy were independently associated with an increased risk of flare. CONCLUSION Most patients with non-active IBD can be safely treated with abdominal or pelvic radiotherapy. Patients having acute gut toxicity and those without concomitant chemotherapy should be more closely monitored in the post-radiotherapy period.
Collapse
|
29
|
Boudiaf R, Bouchard D, Rivière P, Brochard C, Laharie D, Abramowitz L, Pigot F. Assessment of sexual dysfunction in patients with perianal Crohn's disease. Colorectal Dis 2021; 23:114-122. [PMID: 32961618 DOI: 10.1111/codi.15375] [Citation(s) in RCA: 6] [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: 11/13/2019] [Revised: 08/02/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022]
Abstract
AIM Over the past 10 years, several studies have focused on sexuality in patients with Crohn's disease. Very few of them specifically focused on perianal disease (PD). This study aimed to compare the prevalence of sexual dysfunction (SD) in Crohn's disease patients with active PD versus controls without active PD. METHOD Patients from 14 French centres with active PD, defined by the presence of symptomatic ulceration, fistula or stenosis, were arbitrarily included. They were compared with controls from the existing SEXIA cohort. Men completed the International Index of Erectile Function (IIEF) and women the Female Sexual Function Index (FSFI). The primary end-point was SD defined by FSFI < 26.55 in women and IIEF < 42.9 in men. RESULTS Ninety-seven patients (64 women, 33 men) and 238 controls (131 women, 107 men) were included. SD was found in 66% of the female patients versus 50% of the controls (P = 0.04). In the male population, SD was found in 30% of the cases versus 16% of the controls (P = 0.06). Erectile dysfunction affected 46% of the male patients and 43% of the controls (P = 0.8). On multivariate analysis, the predictive factor most strongly associated with SD in women was severely active anal PD defined by a perineal disease activity index > 4 [OR = 13.05 (2.32-73.44)]. CONCLUSION Women with active PD had an increased prevalence of SD compared with controls without active PD. In the male population, the study was unable to determine whether there was a difference as it was underpowered.
Collapse
Affiliation(s)
- R Boudiaf
- Department of Gastroenterology, CHU de Bordeaux, Pessac, France.,Department of Proctology, Maison de Santé Bagatelle, Talence, France
| | - D Bouchard
- Department of Proctology, Maison de Santé Bagatelle, Talence, France
| | - P Rivière
- Department of Gastroenterology, CHU de Bordeaux, Pessac, France
| | - C Brochard
- Department of Gastroenterology, CHU de Rennes, Rennes, France
| | - D Laharie
- Department of Gastroenterology, CHU de Bordeaux, Pessac, France
| | - L Abramowitz
- Ramsay Santé, Clinique Blomet, Paris, France.,Department of Proctology, Hôpital Bichat, Paris, France
| | - F Pigot
- Department of Proctology, Maison de Santé Bagatelle, Talence, France
| | -
- Department of Proctology, Hôpital Bichat, Paris, France
| |
Collapse
|
30
|
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.
Collapse
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
| | | |
Collapse
|
31
|
Rivière P, Zerbib F. Les colites microscopiques. Rev Med Interne 2020; 41:523-528. [PMID: 32674898 DOI: 10.1016/j.revmed.2020.05.022] [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: 12/17/2019] [Revised: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022]
Abstract
Microscopic colitis is frequently found as a cause of chronic watery diarrhea in women after menopause. The disease can be associated with a medication side effect in half of the patients (non-steroidal anti-inflammatory drugs or proton pump inhibitors for instance). Colonic biopsies are mandatory for the diagnosis of microscopic colitis and should be performed in several locations of the colon. Management of microscopic colitis is first based on avoiding iatrogenic factors and smoking together with symptomatic treatment of diarrhea (loperamide, cholestyramine). In case of failure or severe symptoms, budesonide is the key treatment. The aim of the treatment is to achieve clinical remission, defined as less than 3 liquid stools per day, to improve quality of life. After a first course of budesonide, recurrence of diarrhea is frequent and a maintenance therapy can be prescribed for several months. In case of intolerance or refractoriness, second-line therapy (immunosuppressants, biological therapy, surgery) should be discussed in multidisciplinary team meeting.
Collapse
Affiliation(s)
- P Rivière
- Service d'Hépato-gastroentérologie et Oncologie digestive, Centre Médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France.
| | - F Zerbib
- Service d'Hépato-gastroentérologie et Oncologie digestive, Centre Médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France
| |
Collapse
|
32
|
Malian A, Rivière P, Bouchard D, Pigot F, Eléouet-Kaplan M, Favreau-Weltzer C, Poullenot F, Laharie D. Pedictors of Perianal Fistula Relapse in Crohn's Disease. Inflamm Bowel Dis 2020; 26:926-931. [PMID: 31504542 DOI: 10.1093/ibd/izz200] [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] [Received: 05/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite an optimal medico-surgical management of perineal Crohn's disease (PCD), fistula relapse still occurs in 30% of patients. Our aim was to determine predictors of fistula relapse in patients in remission after treatment of a PCD lesion. METHODS Consecutive patients treated for fistulizing PCD have been included in a retrospective study when they achieved fistula remission within 3 months after the surgery. Remission was defined as the absence of any draining fistula at clinical examination. Primary outcome was the occurrence of a fistula relapse, defined as a subsequent perianal draining fistula or an abscess confirmed clinically and/or by pelvic MRI. RESULTS One hundred and thirty-seven patients (57% female, median age: 35 years) corresponding to 157 abscess events, including 120 (76.4%) treated by anti-TNF after drainage, achieved fistula remission after surgery. During the follow-up period (median duration: 43 months [interquartile range 26 to 64]), 34 (22%) patients experienced a fistula relapse within a median time of 1.8 years. Survival without fistula was 96.7% at 1 year, 78.4% at 3 years, and 74.4% at 5 years. Fistula relapse rates were not different in patients receiving infliximab or adalimumab (P = 0.66). In patients treated by anti-TNF at inclusion, discontinuation of anti-TNF therapy (odds ratio 3.49, P = 0.04), colonic location (OR 6.25, P = 0.01), and stricturing phenotype (odds ratio 4.39, P = 0.01) were independently associated with fistula relapse in multivariate analysis. CONCLUSION In patients achieving fistula remission of PCD, relapse rates are low and are not different between infliximab and adalimumab. Discontinuation of anti-TNF therapy is associated with increased relapse rate.
Collapse
Affiliation(s)
- Audrey Malian
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Pauline Rivière
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Dominique Bouchard
- Proctologie, Maison de Santé Protestante Bordeaux-Bagatelle, Talence, France
| | - François Pigot
- Proctologie, Maison de Santé Protestante Bordeaux-Bagatelle, Talence, France
| | | | | | - Florian Poullenot
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - David Laharie
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| |
Collapse
|
33
|
Hupé M, Rivière P, Nancey S, Roblin X, Altwegg R, Filippi J, Fumery M, Bouguen G, Peyrin-Biroulet L, Bourreille A, Caillo L, Simon M, Goutorbe F, Laharie D. Comparative efficacy and safety of vedolizumab and infliximab in ulcerative colitis after failure of a first subcutaneous anti-TNF agent: a multicentre cohort study. Aliment Pharmacol Ther 2020; 51:852-860. [PMID: 32201971 DOI: 10.1111/apt.15680] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 12/05/2019] [Revised: 12/30/2019] [Accepted: 02/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few data exist to help select a second biologic agent in patients with refractory ulcerative colitis (UC). AIM To compare the efficacy of infliximab (IFX) and vedolizumab (VDZ) in UC patients who failed a first subcutaneous anti-tumor necrosing factor (TNF) agent. METHODS Consecutive UC patients from 12 French centres starting IFX or VDZ after at least one injection of adalimumab or golimumab have been included in a retrospective study. Outcomes were clinical remission at week 14, survival without treatment discontinuation and survival without UC-related event. RESULTS Among the 225 patients included, clinical remission at week 14 was achieved in 40/154 (26%) patients treated with IFX and in 35/71 (49%) treated with VDZ (P = 0.001). After a propensity score matching analysis, this difference remained significant (odds ratio: 1.67; 95% confidence interval: 1.08-2.56; P = 0.02). With a median follow-up of 117 weeks, survival rates without treatment discontinuation at years 1 and 3 were 50% and 29% with IFX, and 80% and 55% with VDZ, respectively (P < 0.001). Regarding survival without UC-related event, they were 49% and 27% with IFX, and 74% and 52% with VDZ (P < 0.01). CONCLUSION After failure of a first subcutaneous anti-TNF agent, UC patients were more likely to achieve clinical remission with VDZ than those treated with IFX. Although due to prescription habits patients in the IFX group had a significantly more severe disease, these differences remained after adjustments and subgroup analyses. Such results have to be confirmed prospectively and warrant dedicated head-to-head trials.
Collapse
|
34
|
Poullenot F, Ollivier J, Rivière P, Sauvaget L, Berroneau A, Djabarouti S, Xuereb F, Zerbib F, Breilh D, Laharie D. Implementation of infliximab standardized doses after pharmacokinetic modelization in a cohort of patients with Crohn's disease. Dig Liver Dis 2020; 52:408-413. [PMID: 31874834 DOI: 10.1016/j.dld.2019.11.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND According to infliximab (IFX) license in Crohn's disease (CD), infusion doses are based on patient's body-weight. Dose banding providing standardized doses (SD) has been implemented in parenteral chemotherapy in order to optimize aseptic unit capacity and reduce drug expenditure, duration of hospital stay and costs without decreasing efficacy. MATERIAL AND METHOD The first part was a single-center retrospective analysis of consecutive CD patients receiving IFX maintenance therapy to determine standardized doses covering more than 50% of infusions. The second part was a prospective cohort study assessing the impact of SD compared to body-weight doses (BWD) on admission duration and costs. RESULTS Six IFX SD covering more than 90% of infusion doses were implemented for dose banding. According to the Monte-Carlo simulation, there was no significant difference between IFX SD and BWD maintenance regimens. When assessed prospectively in 116 patients (75 patients treated with SD and 41 with BWD) corresponding to 128 infusions, hospitalization duration was shortened by 70 min per patient (p < 0.001). CONCLUSION According to a pharmacokinetic model, IFX SD has a pharmacokinetic profile close to BWD and is associated with reduced length of hospitalization in a cohort of patients with CD. IFX SD implementation could optimize infusion units functioning and, save time and costs without decreasing efficacy.
Collapse
Affiliation(s)
- Florian Poullenot
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France.
| | - Julien Ollivier
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France
| | - Pauline Rivière
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Lucie Sauvaget
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France
| | - Aude Berroneau
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Sarah Djabarouti
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Fabien Xuereb
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Frank Zerbib
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Dominique Breilh
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - David Laharie
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| |
Collapse
|
35
|
Rivière P, Laharie D, Marteau P. Concise Commentary: Second Line Is Not Second Best-Continuing Validity of the Oxford Criteria in the Management of Acute Severe Ulcerative Colitis. Dig Dis Sci 2020; 65:581-582. [PMID: 31489565 DOI: 10.1007/s10620-019-05788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Pauline Rivière
- Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - David Laharie
- Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Philippe Marteau
- Sorbonne Université - INSERM-ERL 1157, CHU Saint-Antoine 27 - UMR7203 - Saint Antoine IBD Network, APHP, Hôpital Saint Antoine, Paris, France. .,Hepatology and Gastroenterology, Hôpital Saint Antoine, 184 Faubourg St Antoine, 75012, Paris, France.
| |
Collapse
|
36
|
Kamphuis JBJ, Guiard B, Leveque M, Olier M, Jouanin I, Yvon S, Tondereau V, Rivière P, Guéraud F, Chevolleau S, Noguer-Meireles MH, Martin JF, Debrauwer L, Eutamène H, Theodorou V. Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa. Gastroenterology 2020; 158:652-663.e6. [PMID: 31711923 DOI: 10.1053/j.gastro.2019.10.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 04/15/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is characterized by abdominal pain, bloating, and erratic bowel habits. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) can reduce symptoms of IBS, possibly by reducing microbial fermentation products. We investigated whether ingestion of FODMAPs can induce IBS-like visceral hypersensitivity mediated by fermentation products of intestinal microbes in mice. METHODS C57Bl/6 mice were gavaged with lactose, with or without the antiglycation agent pyridoxamine, or saline (controls) daily for 3 weeks. A separate group of mice were fed a diet containing fructo-oligosaccharides, with or without pyridoxamine in drinking water, or a normal chow diet (controls) for 6 weeks. Feces were collected and analyzed by 16S ribosomal RNA gene sequencing and bacterial community analyses. Abdominal sensitivity was measured by electromyography and mechanical von Frey filament assays. Colon tissues were collected from some mice and analyzed by histology and immunofluorescence to quantify mast cells and expression of advanced glycosylation end-product specific receptor (AGER). RESULTS Mice gavaged with lactose or fed fructo-oligosaccharides had increased abdominal sensitivity compared with controls, associated with increased numbers of mast cells in colon and expression of the receptor for AGER in proximal colon epithelium. These effects were prevented by administration of pyridoxamine. Lactose and/or pyridoxamine did not induce significant alterations in the composition of the fecal microbiota. Mass spectrometric analysis of carbonyl compounds in fecal samples identified signatures associated with mice given lactose or fructo-oligosaccharides vs controls. CONCLUSIONS We found that oral administration of lactose or fructo-oligosaccharides to mice increases abdominal sensitivity, associated with increased numbers of mast cells in colon and expression of AGER; these can be prevented with an antiglycation agent. Lactose and/or pyridoxamine did not produce alterations in fecal microbiota of mice. Our findings indicate that preventing glycation reactions might reduce abdominal pain in patients with IBS with sensitivity to FODMAPs.
Collapse
Affiliation(s)
- Jasper B J Kamphuis
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse
| | - Bruno Guiard
- Centre de Recherches sur la Cognition Animale, Centre de Biologie Intégrative, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Mathilde Leveque
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse
| | - Maiwenn Olier
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse
| | - Isabelle Jouanin
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; AXIOM Platform, MetaToul MetaboHUB, National Infrastructure for Metabolomics and Fluxomics, Toulouse, France
| | - Sophie Yvon
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse
| | - Valerie Tondereau
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse
| | - Pauline Rivière
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse
| | - Françoise Guéraud
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Prevention and Promotion of Carcinogenesis by Food team, Toxalim, Toulouse, France
| | - Sylvie Chevolleau
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; AXIOM Platform, MetaToul MetaboHUB, National Infrastructure for Metabolomics and Fluxomics, Toulouse, France
| | - Maria-Helena Noguer-Meireles
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; AXIOM Platform, MetaToul MetaboHUB, National Infrastructure for Metabolomics and Fluxomics, Toulouse, France
| | - Jean-François Martin
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; AXIOM Platform, MetaToul MetaboHUB, National Infrastructure for Metabolomics and Fluxomics, Toulouse, France
| | - Laurent Debrauwer
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; AXIOM Platform, MetaToul MetaboHUB, National Infrastructure for Metabolomics and Fluxomics, Toulouse, France
| | - Helene Eutamène
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse.
| | - Vassilia Theodorou
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Toxalim, UMR1331, INRAE/INP/UPS, Toulouse, France; Neurogastroenterology and Nutrition, Toxalim, Toulouse
| |
Collapse
|
37
|
Affiliation(s)
- David Laharie
- Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Pauline Rivière
- Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| |
Collapse
|
38
|
Leenhardt R, Rivière P, Papazian P, Nion-Larmurier I, Girard G, Laharie D, Marteau P. Sexual health and fertility for individuals with inflammatory bowel disease. World J Gastroenterol 2019; 25:5423-5433. [PMID: 31576090 PMCID: PMC6767981 DOI: 10.3748/wjg.v25.i36.5423] [Citation(s) in RCA: 25] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
The impact of a chronic disease such as inflammatory bowel disease (IBD) on sexual functioning and body image can significantly impair the quality of life of patients. This review considers the sexual and fertility aspects of IBD patients and their daily management. Modern IBD healthcare management should include appropriate communication on sexuality and consider psychological, physiological, and biological issues. Patients with IBD have less children than the general population, and voluntary childlessness is frequent. The most influential factors reported by IBD patients who experience fertility alteration are psychological and surgery-related problems. Pregnancy is a major concern for patients, and any pregnancy for IBD patients should be closely followed-up to keep the chronic disease in a quiescent state. Preconceptional consultation is of great help.
Collapse
Affiliation(s)
- Romain Leenhardt
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| | - Pauline Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux 33604, Pessac, France
| | - Patrick Papazian
- Hôpital Bichat, Service des maladies infectieuses et tropicales, APHP, Paris 75018, France
| | - Isabelle Nion-Larmurier
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| | - Guillaume Girard
- Service de gynécologie obstétrique, Hôpital Armand Trousseau, Paris 75012, Ile-de-France, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux 33604, Pessac, France
| | - Philippe Marteau
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| |
Collapse
|
39
|
Rivière P, Vermeire S, Irles-Depe M, Van Assche G, Rutgeerts P, de Buck van Overstraeten A, Denost Q, Wolthuis A, D'Hoore A, Laharie D, Ferrante M. No Change in Determining Crohn's Disease Recurrence or Need for Endoscopic or Surgical Intervention With Modification of the Rutgeerts' Scoring System. Clin Gastroenterol Hepatol 2019; 17:1643-1645. [PMID: 30291910 DOI: 10.1016/j.cgh.2018.09.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 02/07/2023]
Abstract
The postoperative endoscopic recurrence score, commonly referred to as the Rutgeerts score, was designed to predict clinical recurrence risk in Crohn's disease (CD) patients undergoing ileocolonic resection based on early endoscopic findings at the anastomosis and in the neoterminal ileum.1 In the pivotal publication, the i2 category, including aphthous lesions in the terminal ileum as well as ileocolonic anastomosis lesions, had a heterogeneous recurrence risk. Because anastomotic ulcers were suspected to be postsurgical ischemic lesions and less predictive of progressive disease,2 a modified Rutgeerts score (mRS) was proposed: i2a, lesions confined to the anastomosis ±<5 isolated aphthous ulcers in the ileum; i2b, more than 5 aphthous ulcers in the ileum with normal mucosa in between, ± anastomotic lesions.3,4.
Collapse
Affiliation(s)
- Pauline Rivière
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Séverine Vermeire
- Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Marie Irles-Depe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gert Van Assche
- Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Paul Rutgeerts
- Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | | | - Quentin Denost
- Department of Abdominal Surgery, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Andre D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - David Laharie
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France.
| |
Collapse
|
40
|
Rivière P, Münch A, Michetti P, Chande N, de Hertogh G, Schoeters P, Ferrante M, Vermeire S, Van Assche G. Vedolizumab in Refractory Microscopic Colitis: An International Case Series. J Crohns Colitis 2019; 13:337-340. [PMID: 30329034 DOI: 10.1093/ecco-jcc/jjy169] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Evidence for second-line therapy in patients with microscopic colitis [MC] failing budesonide is scarce, although anti-tumour necrosis factors [anti-TNFs], methotrexate and azathioprine have been reported to be effective in small cohort studies. Vedolizumab, a monoclonal antibody targeting α4β7-integrin, prevents homing of T-cells to the gut. We evaluated clinical remission with vedolizumab in budesonide-refractory MC patients. METHODS We solicited gastroenterologists in Europe and Canada for cases of MC treated with vedolizumab. Vedolizumab 300 mg IV was administered at weeks 0, 2 and 6, and then every 8 weeks. Clinical remission and histological remission were defined as less than three stools per day and normalization of histology, respectively, after induction treatment. RESULTS Eleven cases were retrieved (nine females, lymphocytic colitis [LC] n = 5, collagenous colitis [CC] n = 6). Median [interquartile range] disease duration at vedolizumab initiation was 51 [29-70] months. Nine of 11 patients had failed one immunosuppressant and ten of 11 at least one anti-TNF agent. After three infusions of vedolizumab, clinical remission was observed in 5/11 patients [two LC and three CC] of whom three remained well with maintenance therapy [median duration of 13 months]. Biopsies were obtained from 9/11 patients. Histological remission was observed in 3/4 patients with clinical remission [2/3 CC, 1/1 LC] and 0/5 patients without clinical improvement. CONCLUSION In a series of highly refractory MC patients, vedolizumab induced clinical remission in 5/11 subjects, of whom 75% showed normalized histology. Larger randomized trials are needed to assess the efficacy of vedolizumab in patients with MC.
Collapse
Affiliation(s)
- Pauline Rivière
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat, Leuven, Belgium
| | - Andreas Münch
- Division of Gastroenterology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Pierre Michetti
- Gastro-entérologie La Source-Beaulieu, Lausanne, Switzerland
| | - Nilesh Chande
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Gert de Hertogh
- Department of Pathology, University Hospitals Leuven, KU Leuven, Herestraat, Leuven, Belgium
| | | | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat, Leuven, Belgium
| | - Gert Van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat, Leuven, Belgium
| |
Collapse
|
41
|
Julien C, Laroche J, Deledalle FX, Brocq FX, Fournier R, Rivière P, Lechevallier E, Savoie PH. [Result of treatment of urinary lithiasis for professional aptitude]. Prog Urol 2018; 28:329-335. [PMID: 29705059 DOI: 10.1016/j.purol.2018.03.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/11/2018] [Accepted: 03/15/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Military people are inapt for presence of urinary stones. In this specific population, the treatment of stones is even more aggressive than for the general population without recommendation. The final decision about aptitude is the responsibility of the military doctor. Whereas, ureteroscopy has its place there and must done by any urologist. METHODS The purpose of this study was to estimate the results of treatments by ureteroscopy in this population. Success was defined by the complete absence of fragment visualized in the imaging of control operating comment and so the end of the inaptitude time. RESULTS Between 2009 and 2016, forty-two were treated for ureteral or renal calculi. The population comprises of 93% men, 35 years old on average. The stones were mainly multiple (more 2) and the medium size is 5mm; sixteen (42.9%) was at the left and eight (19%) was bilateral. In 78.8% (78) of the cases there was a stone in renal position whose 50% (39) still at the lower calyx. In total, 5% of the patients were stone-free in 2 sessions on average. The average deadline of inaptitude of the initial consultation in the resumption of work was of 6 months. In 4% of the cases there was a complication operating rank 4. CONCLUSION This study confirms the feasibility, the weak harmlessness of ureteroscopy and the lesser deadline of inaptitude. Every urologist can treat this specific population. The patient must be informed and accept the treatment because of excluding referential. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- C Julien
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - J Laroche
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - F-X Deledalle
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - F-X Brocq
- Centre d'expertise médicale du personnel naviguant (CEMPN) de Toulon, H.I.A Ste-Anne, CEMPN, BP 600, 83800 Toulon cedex 9, France
| | - R Fournier
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - P Rivière
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - E Lechevallier
- Service d'urologie, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - P-H Savoie
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| |
Collapse
|
42
|
Rivière P, Zerbib F. [Dysphagia]. Rev Prat 2018; 68:e99-e102. [PMID: 30869307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Pauline Rivière
- Service d'hépato-gastro-entérologie, centre médico-chirurgical Magellan, hôpital Haut-Lévêque, 33600 Pessac, France
| | - Frank Zerbib
- Service d'hépato-gastro-entérologie, centre médico-chirurgical Magellan, hôpital Haut-Lévêque, 33600 Pessac, France
| |
Collapse
|
43
|
Rivière P, Zallot C, Desobry P, Sabaté JM, Vergniol J, Zerbib F, Peyrin-Biroulet L, Laharie D, Poullenot F. Frequency of and Factors Associated With Sexual Dysfunction in Patients With Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:1347-1352. [PMID: 28981625 DOI: 10.1093/ecco-jcc/jjx100] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 04/03/2017] [Accepted: 07/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Improvement of quality of life is a main objective in inflammatory bowel disease [IBD] management. Data on sexual dysfunction [SD] in IBD are scarce. This study compared rates of SD between IBD patients and healthy controls [HC], and searched for predictors of SD. METHODS All consecutive IBD patients seen in two tertiary centres during 2 months were invited to fill an anonymous validated questionnaire on their sexual function [Female Sexual Index Function and International Index of Erectile Function]. The same questionnaires were filled by HC and by patients with irritable bowel syndrome [IBS] enrolled as a second comparative group. RESULTS In all, 358 IBD patients filled the questionnaire [192 women]-including 238 with Crohn's disease and 120 with ulcerative colitis-and 110 HC [54 women] and 107 IBS patients [54 women]. In women, SD rates were 53.6% in IBD vs 28% in HC [p < 0.01] and 77.5% in IBS [p = 0.10] patients; in men, figures were 16.9% in IBD, 7.4% in HC [p = 0.64], and 26.4% in IBS [p = 0.60]. An erectile dysfunction [ED] was reported by 43% of IBD patients, 13% of HC [p < 0.01] and 55% of IBS patients [p = 0.60 vs IBD]. Predictors of SD and ED were social and emotional functioning, anxiety in women and depression in men. IBD activity was not associated with SD. CONCLUSIONS In IBD, 54% of women have an SD and 43% of men an ED. These rates are significantly higher than in HC, mostly driven by psychological factors, and independent from disease severity.
Collapse
Affiliation(s)
- P Rivière
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - C Zallot
- Hépato-gastro-entérologie and Inserm U954, Lorraine University, Nancy, France
| | - P Desobry
- Médecine du travail ERDF-GRDF, Lille, France
| | - J M Sabaté
- Hépato-gastro-entérologie, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Vergniol
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - F Zerbib
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - L Peyrin-Biroulet
- Hépato-gastro-entérologie and Inserm U954, Lorraine University, Nancy, France
| | - D Laharie
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - F Poullenot
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| |
Collapse
|
44
|
Rivière P, Ferrante M. Management of Postoperative Crohn's Disease: Missing Pieces of the Puzzle. J Crohns Colitis 2017; 11:1291-1292. [PMID: 28961940 DOI: 10.1093/ecco-jcc/jjx114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/09/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Pauline Rivière
- Department of Hepatogastroenterology and Digestive Oncology, Haut-Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| |
Collapse
|
45
|
Rivière P, Zerbib F. [Gastroesophageal reflux in infants, children and adults. Hiatal hernia]. Rev Prat 2017; 67:e367-e374. [PMID: 30512832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Pauline Rivière
- Service d'hépato-gastro-entérologie, hôpital Saint-André, 33075 Bordeaux Cedex, France
| | - Frank Zerbib
- Service d'hépato-gastro-entérologie, hôpital Saint-André, 33075 Bordeaux Cedex, France
| |
Collapse
|
46
|
Lara-Astiaso M, Silva REF, Gubaydullin A, Rivière P, Meier C, Martín F. Enhancing High-Order Harmonic Generation in Light Molecules by Using Chirped Pulses. Phys Rev Lett 2016; 117:093003. [PMID: 27610851 DOI: 10.1103/physrevlett.117.093003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 06/06/2023]
Abstract
One of the current challenges in high-harmonic generation is to extend the harmonic cutoff to increasingly high energies while maintaining or even increasing the efficiency of the high-harmonic emission. Here we show that the combined effect of down-chirped pulses and nuclear dynamics in light molecules allows one to achieve this goal, provided that long enough IR pulses are used to allow the nuclei to move well outside the Franck-Condon region. We also show that, by varying the duration of the chirped pulse or by performing isotopic substitution while keeping the pulse duration constant, one can control the extension of the harmonic plateau.
Collapse
Affiliation(s)
- M Lara-Astiaso
- Departamento de Química, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - R E F Silva
- Departamento de Química, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - A Gubaydullin
- Departamento de Química, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - P Rivière
- Departamento de Química, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - C Meier
- Laboratoire de Collisions Agrégats Réactivité, IRSAMC, UMR CNRS 5589, Université Paul Sabatier, 31062 Toulouse, France
| | - F Martín
- Departamento de Química, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Instituto Madrileño de Estudios Avanzados en Nanociencia, 28049 Madrid, Spain
- Condensed Matter Physics Center (IFIMAC), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| |
Collapse
|
47
|
Raffray L, Rivière P, Bonnet H, Duffau P, Longy-Boursier M. Hépatite granulomateuse révélant une infection disséminée à Mycobacterium bovis après BCG-thérapie intravésicale. Rev Med Interne 2015; 36:626-30. [DOI: 10.1016/j.revmed.2014.10.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/21/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
|
48
|
Coupaye M, Rivière P, Breuil MC, Castel B, Bogard C, Dupré T, Flamant M, Msika S, Ledoux S. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg 2014; 24:276-83. [PMID: 24122661 DOI: 10.1007/s11695-013-1089-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sleeve gastrectomy (SG) is supposed to induce fewer nutritional deficiencies than gastric bypass (GBP). However, few studies have compared nutritional status after these two procedures, and the difference in weight loss (WL) between procedures may alter the results. Thus, our aim was to compare nutritional status after SG and GBP in subjects matched for postoperative weight. Forty-three subjects who underwent SG were matched for age, gender, and 6-month postoperative weight with 43 subjects who underwent GBP. Dietary intakes (DI), metabolic (MP), and nutritional parameters (NP) were recorded before and at 6 and 12 months after both procedures. Multivitamin supplements were systematically prescribed after surgery. Before surgery, BMI, DI, MP, and NP were similar between both groups. After surgery, LDL cholesterol, serum prealbumin, vitamin B12, urinary calcium, and vitamin D concentrations were lower after GBP than after SG, whereas WL and DI were similar after both procedures. However, the total number of deficiencies did not increase after surgery regardless of the procedure. In addition, we found a significant increase in liver enzymes and a greater decrease in C-reactive protein after GBP. In conclusion, during the first year after surgery, in patients with the same WL and following the same strategy of vitamin supplementation, global nutritional status was only slightly impaired after SG and GBP. However, some nutritional parameters were specifically altered after GBP, which could be related to malabsorption or other mechanisms, such as alterations in liver metabolism.
Collapse
|
49
|
Deberdt P, Guyot J, Coranson-Beaudu R, Launay J, Noreskal M, Rivière P, Vigné F, Laplace D, Lebreton L, Wicker E. Diversity of Ralstonia solanacearum in French Guiana expands knowledge of the "emerging ecotype". Phytopathology 2014; 104:586-596. [PMID: 24283538 DOI: 10.1094/phyto-09-13-0264-r] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although bacterial wilt remains a major plant disease throughout South America and the Caribbean, the diversity of prevalent Ralstonia solanacearum populations is largely unknown. The genetic and phenotypic diversity of R. solanacearum strains in French Guiana was assessed using diagnostic polymerase chain reactions and sequence-based (egl and mutS) genotyping on a 239-strain collection sampled on the families Solanaceae and Cucurbitaceae, revealing an unexpectedly high diversity. Strains were distributed within phylotypes I (46.9%), IIA (26.8%), and IIB (26.3%), with one new endoglucanase sequence type (egl ST) found within each group. Phylotype IIB strains consisted mostly (97%) of strains with the emerging ecotype (IIB/sequevar 4NPB). Host range of IIB/4NPB strains from French Guiana matched the original emerging reference strain from Martinique. They were virulent on cucumber; virulent and highly aggressive on tomato, including the resistant reference Hawaii 7996; and only controlled by eggplant SM6 and Surya accessions. The emerging ecotype IIB/4NPB is fully established in French Guiana in both cultivated fields and uncultivated forest, rendering the hypothesis of introduction via ornamental or banana cuttings unlikely. Thus, this ecotype may have originated from the Amazonian region and spread throughout the Caribbean region.
Collapse
|
50
|
Coupaye M, Breuil MC, Rivière P, Castel B, Bogard C, Dupré T, Msika S, Ledoux S. Serum vitamin D increases with weight loss in obese subjects 6 months after Roux-en-Y gastric bypass. Obes Surg 2013; 23:486-93. [PMID: 23150206 DOI: 10.1007/s11695-012-0813-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Malabsorptive surgical procedures lead to deficiencies in fat-soluble vitamins. However, results concerning serum vitamin D (25OHD) after gastric bypass (GBP) are controversial. The aim of the study was to assess the influence of GBP on 25OHD and calcium metabolism. METHODS Parameters of calcium metabolism were evaluated in 202 obese subjects before and 6 months after GBP. Thirty of them were matched for age, gender, weight, skin color, and season with 30 subjects who underwent sleeve gastrectomy (SG). A multivitamin preparation that provides 200 to 500 IU vitamin D3 per day was systematically prescribed after surgery. RESULTS In the 202 patients after GBP, serum 25OHD significantly increased from 13.4 ± 9.1 to 22.8 ± 11.3 ng/ml (p < 0.0001), whereas parathyroid hormone (PTH) did not change. Despite a decrease in calcium intake (p < 0.0001) and urinary calcium/creatinine ratio (p = 0.015), serum calcium increased after GBP (p < 0.0001). Preoperatively, 91 % of patients had 25OHD insufficiency (< 30 ng/ml), 80% deficiency (< 20 ng/ml), and 19% secondary hyperparathyroidism (> 65 pg/ml) vs. 76, 44, and 17%, respectively, following GBP. Serum 25OHD was negatively correlated with BMI at 6 months after GBP (R = -0.299, p < 0.0001). In the two groups of 30 subjects, serum 25OHD and PTH did not differ at 6 months after GBP or SG. CONCLUSIONS At 6 months after GBP, serum 25OHD significantly increased in subjects supplemented with multivitamins containing low doses of vitamin D. These data suggest that weight loss at 6 months after surgery has a greater influence on vitamin D status than malabsorption induced by GBP.
Collapse
Affiliation(s)
- Muriel Coupaye
- Service des Explorations Fonctionnelles, Hôpital Louis Mourier (AP-HP), Centre de référence de prise en charge de l'obésité, Université Paris 7 Denis Diderot, 178 rue des Renouillers, 92701, Colombes Cedex,
| | | | | | | | | | | | | | | |
Collapse
|