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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.
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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
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2
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Holvoet T, Truyens M, De Galan C, Peeters H, Gismero FM, Elorza A, Torres P, Vandermeulen L, Jauregui-Amezaga A, Ferreiro-Iglesias R, Zabana Y, Reverter LP, Geldof J, Lobatón T. Safety and Effectiveness of Vedolizumab and Ustekinumab in Elderly Patients with Inflammatory Bowel Disease: A Real-Life Multicentric Cohort Study. J Clin Med 2024; 13:365. [PMID: 38256499 PMCID: PMC10816258 DOI: 10.3390/jcm13020365] [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: 11/25/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Data on ustekinumab and vedolizumab in the elderly inflammatory bowel disease (IBD) population are limited. The aim of the current study was to assess the safety and effectiveness of both in an elderly real-life population. METHODS A multicentric retrospective study was performed on IBD patients who started vedolizumab or ustekinumab between 2010 and 2020. Clinical and endoscopic remission rates and (serious) adverse events (AE) were assessed. RESULTS A total of 911 IBD patients were included, with 171 (19%) aged above 60 (111 VDZ, 60 UST). Elderly patients treated with vedolizumab or ustekinumab had an increased risk for non-IBD hospitalization (10.5% vs. 5.7%, p = 0.021) and malignancy (2.3% vs. 0.5%, p = 0.045) compared to the younger population. Corticosteroid-free clinical (50% vs. 44%; p = 0.201) and endoscopic remission rates (47.9% vs. 31%, p = 0.07) at 1 year were similar. Comparing vedolizumab to ustekinumab in the elderly population, corticosteroid-free (47.9% vs. 31%, p = 0.061) and endoscopic remission rates (66.7% vs. 64.4%, p = 0.981) were similar. Vedolizumab- and ustekinumab-treated patients had comparable infection rates (13.5% vs. 10.0%, p = 0.504), IBD flare-ups (4.5% vs. 5%, p = 1.000), the occurrence of new EIMs (13.5% vs. 10%, p = 0.504), a risk of intestinal surgery (5.4% vs. 6.7%, p = 0.742), malignancy (1.8% vs. 3.3%, p = 0.613), hospitalization (9.9% vs. 11.7%, p = 0.721), and mortality (0.9% vs. 1.7%, p = 1.000). AE risk was associated only with corticosteroid use. CONCLUSIONS Ustekinumab and vedolizumab show comparable effectiveness and safety in the elderly IBD population. Elderly IBD patients have an increased risk for non-IBD hospitalizations and malignancy compared to the younger IBD population, with corticosteroid use as the main risk factor.
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Affiliation(s)
- Tom Holvoet
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Ghent Gut Inflammation Group (GGIG), Ghent University, 9000 Ghent, Belgium
- Department of Gastroenterology, VITAZ, 9100 Sint-Niklaas, Belgium
- Department of Gastroenterology, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Marie Truyens
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Ghent Gut Inflammation Group (GGIG), Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research (IRC), Ghent University, 9000 Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, 9000 Ghent, Belgium
| | - Cara De Galan
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Ghent Gut Inflammation Group (GGIG), Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research (IRC), Ghent University, 9000 Ghent, Belgium
| | - Harald Peeters
- Department of Gastroenterology, AZ Sint Lucas, 9000 Ghent, Belgium;
| | - Francisco Mesonero Gismero
- Department of Gastroenterology, Hospital Ramon y Cajal, 28034 Madrid, Spain;
- Department of Internal Medicine, Universidad de Alcalá de Henares, 28805 Madrid, Spain
| | - Ainara Elorza
- Department of Gastroenterology, Hospital de Galdakao, 48960 Bilbao, Spain;
| | - Paola Torres
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, 08916 Barcelona, Spain;
| | - Liv Vandermeulen
- Department of Gastroenterology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium
| | - Aranzazu Jauregui-Amezaga
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, 2650 Antwerp, Belgium;
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Gastroenterology and Hepatology, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Rocio Ferreiro-Iglesias
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - Yamile Zabana
- Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Laia Peries Reverter
- Department of Gastroenterology, Hospital Universitari de Girona, 17007 Girona, Spain;
| | - Jeroen Geldof
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Department of Gastroenterology, University Hospital Ghent, 9000 Ghent, Belgium
| | - Triana Lobatón
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Department of Gastroenterology, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, 9000 Ghent, Belgium
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Boeykens K, Holvoet T, Duysburgh I. Nasogastric tube insertion length measurement and tip verification in adults: a narrative review. Crit Care 2023; 27:317. [PMID: 37596615 PMCID: PMC10439641 DOI: 10.1186/s13054-023-04611-6] [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: 05/29/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023] Open
Abstract
Nasogastric feeding tube insertion is a common but invasive procedure most often blindly placed by nurses in acute and chronic care settings. Although usually not harmful, serious and fatal complications with misplacement still occur and variation in practice still exists. These tubes can be used for drainage or administration of fluids, drugs and/or enteral feeding. During blind insertion, it is important to achieve correct tip position of the tube ideally reaching the body of the stomach. If the insertion length is too short, the tip and/or distal side-openings at the end of the tube can be located in the esophagus increasing the risk of aspiration (pneumonia). Conversely, when the insertion length is too long, the tube might kink in the stomach, curl upwards into the esophagus or enter the duodenum. Studies have demonstrated that the most frequently used technique to determine insertion length (the nose-earlobe-xiphoid method) is too short a distance; new safer methods should be used and further more robust evidence is needed. After blind placement, verifying correct gastric tip positioning is of major importance to avoid serious and sometimes lethal complications.
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Affiliation(s)
- Kurt Boeykens
- Nutrition Support Team, VITAZ Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium.
| | - Tom Holvoet
- Nutrition Support Team, VITAZ Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
| | - Ivo Duysburgh
- Nutrition Support Team, VITAZ Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
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4
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Halkjær SI, Lo B, Cold F, Højer Christensen A, Holster S, König J, Brummer RJ, Aroniadis OC, Lahtinen P, Holvoet T, Gluud LL, Petersen AM. Fecal microbiota transplantation for the treatment of irritable bowel syndrome: A systematic review and meta-analysis. World J Gastroenterol 2023; 29:3185-3202. [PMID: 37346153 PMCID: PMC10280798 DOI: 10.3748/wjg.v29.i20.3185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is the most prevalent gastrointestinal disorder in developed countries and reduces patients’ quality of life, hinders their ability to work, and increases health care costs. A growing number of trials have demonstrated an aberrant gut microbiota composition in IBS, also known as ‘gut dysbiosis’. Fecal microbiota transplantation (FMT) has been suggested as a treatment for IBS.
AIM To assess the efficacy and safety of FMT for the treatment of IBS.
METHODS We searched Cochrane Central, MEDLINE, EMBASE and Web of Science up to 24 October 2022 for randomised controlled trials (RCTs) investigating the effectiveness of FMT compared to placebo (including autologous FMT) in treating IBS. The primary outcome was the number of patients with improvements of symptoms measured using a validated, global IBS symptoms score. Secondary outcomes were changes in quality-of-life scores, non-serious and serious adverse events. Risk ratios (RR) and corresponding 95%CI were calculated for dichotomous outcomes, as were the mean differences (MD) and 95%CI for continuous outcomes. The Cochrane risk of bias tool was used to assess the quality of the trials. GRADE criteria were used to assess the overall quality of the evidence.
RESULTS Eight RCTs (484 participants) were included in the review. FMT resulted in no significant benefit in IBS symptoms three months after treatment compared to placebo (RR 1.19, 95%CI: 0.68-2.10). Adverse events were reported in 97 participants in the FMT group and in 45 participants in the placebo group (RR 1.17, 95%CI: 0.63-2.15). One serious adverse event occurred in the FMT group and two in the placebo group (RR 0.42, 95%CI: 0.07-2.60). Endoscopic FMT delivery resulted in a significant improvement in symptoms, while capsules did not. FMT did not improve the quality of life of IBS patients but, instead, appeared to reduce it, albeit non significantly (MD -6.30, 95%CI: -13.39-0.79). The overall quality of the evidence was low due to moderate-high inconsistency, the small number of patients in the studies, and imprecision.
CONCLUSION We found insufficient evidence to support or refute the use of FMT for IBS. Larger trials are needed.
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Affiliation(s)
- Sofie Ingdam Halkjær
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
- Copenhagen IBD Center, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Bobby Lo
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
- Copenhagen IBD Center, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Frederik Cold
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
- Copenhagen IBD Center, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | | | - Savanne Holster
- Nutrition-Gut-Brain Interactions Research Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro 70362, Sweden
| | - Julia König
- Nutrition-Gut-Brain Interactions Research Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro 70362, Sweden
| | - Robert Jan Brummer
- Nutrition-Gut-Brain Interactions Research Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro 70362, Sweden
| | - Olga C Aroniadis
- Department of Internal Medicine, Division of Gastroenterology, Renaissance School of Medicine, Stony Brook University Hospital, New York, NY 11794-8434, United States
| | - Perttu Lahtinen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti 15850, Finland
- Department of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Tom Holvoet
- Department of Gastroenterology, University Hospital Ghent, Ghent 9000, Belgium
| | - Lise Lotte Gluud
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Andreas Munk Petersen
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
- Copenhagen IBD Center, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
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5
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Lommaert E, Verlinden W, Duysburgh I, Holvoet T, Schouten J. Hyperferritinemia and non-HFE hemochromatosis: differential diagnosis and workup. Acta Gastroenterol Belg 2023; 86:356-359. [PMID: 37428170 DOI: 10.51821/86.2.11249] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Hyperferritinemia is a common reason for referral to a hepatogastroenterologist. The most frequent causes are not associated with iron overload (e.g. inflammatory diseases, alcohol abuse, metabolic syndrome, etc.). However, hyperferritinemia can also be caused by a genetic variant in one of the iron regulatory genes, called hereditary hemochromatosis, often but not always associated with iron overload. A variation in the human Hemostatic Iron Regulator protein (HFE) gene is the most common genotype, but many other variants have been described. In this paper we discuss two cases of rare hyperferritinemia associated disorders, ferroportin disease and hyperferritinemia-cataract syndrome. We also propose an algorithm for evaluating hyperferritinemia, facilitating a correct diagnosis and preventing potentially unnecessary examinations and therapeutic actions.
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Affiliation(s)
- E Lommaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - W Verlinden
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
- Department of Hepato-Gastroenterology, Vitaz, Belgium
| | - I Duysburgh
- Department of Hepato-Gastroenterology, Vitaz, Belgium
| | - T Holvoet
- Department of Hepato-Gastroenterology, Vitaz, Belgium
| | - J Schouten
- Department of Hepato-Gastroenterology, Vitaz, Belgium
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6
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De Galan C, Truyens M, Peeters H, Mesonero Gismero F, Elorza A, Torres P, Vandermeulen L, Amezaga AJ, Ferreiro-Iglesias R, Holvoet T, Zabana Y, Reverter LP, Gonzales GB, Geldof J, Varkas G, De Vos M, Lobatón T. The Impact of Vedolizumab and Ustekinumab on Articular Extra-Intestinal Manifestations in Inflammatory Bowel Disease Patients: A Real-Life Multicentre Cohort Study. J Crohns Colitis 2022; 16:1676-1686. [PMID: 35442433 DOI: 10.1093/ecco-jcc/jjac058] [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: 01/26/2023]
Abstract
BACKGROUND AND AIMS Extra-intestinal manifestations are frequently reported in inflammatory bowel diseases. However, data comparing the effect of vedolizumab and ustekinumab on articular extra-intestinal manifestations are limited. The aim here was to evaluate differences in new-onset and the evolution of pre-existing joint extra-intestinal manifestations during both treatments. METHODS An international multicentre retrospective study was performed on inflammatory bowel disease patients who started vedolizumab or ustekinumab between May 2010 and December 2020. Extra-intestinal manifestations were assessed at baseline and joint extra-intestinal manifestations were evaluated throughout the 2-year follow-up. Arthropathy was defined by joint inflammation [arthritis/sacroiliitis], diagnosed by a rheumatologist, and arthralgia as articular pain without confirmed inflammation. Additionally, skin, ocular and hepatic extra-intestinal manifestations were assessed at baseline. Uni- and multivariate analyses were performed. RESULTS In total, 911 patients [vedolizumab: 584; ustekinumab: 327] were included. Deterioration of pre-existing arthropathy and rate of new-onset arthropathy were not significantly associated with vedolizumab over ustekinumab. Arthropathy was used as reason to stop treatment in six vedolizumab and two ustekinumab patients. The odds of developing new arthralgia within 6 months was higher in patients who took vedolizumab compared to ustekinumab (adjusted odds ratio [aOR]: 2.28 [1.01-5.15], p = 0.047). However, this effect was not sustained during the 2-year follow-up (aOR: 1.35 [0.80-2.29], p = 0.259). Deterioration of pre-existing arthralgia was comparable between ustekinumab and vedolizumab-treated patients. In two vedolizumab-treated patients arthralgia was given as the reason to stop treatment. CONCLUSIONS Vedolizumab and ustekinumab can be used safely in patients with articular extra-intestinal manifestations. Only a temporary increased risk for developing arthralgia has been observed under vedolizumab.
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Affiliation(s)
- Cara De Galan
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,VIB Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium.,Ghent Gut Inflammation Group (GGIG), Ghent University, Ghent, Belgium
| | - Marie Truyens
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,VIB Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium.,Ghent Gut Inflammation Group (GGIG), Ghent University, Ghent, Belgium.,Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Harald Peeters
- Department of Gastroenterology, AZ Sint Lucas, Ghent, Belgium
| | | | - Ainara Elorza
- Department of Gastroenterology, Hospital de Galdakao, Bilbao, Spain
| | - Paola Torres
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Liv Vandermeulen
- Department of Gastroenterology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Rocio Ferreiro-Iglesias
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tom Holvoet
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.,Department of Gastroenterology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Yamile Zabana
- Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Barcelona, Spain
| | - Laia Peries Reverter
- Department of Gastroenterology, Hospital Universitari de Girona Doctor Joseph Trueta, Girona, Spain
| | - Gerard Bryan Gonzales
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,VIB Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium.,Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Jeroen Geldof
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Gaëlle Varkas
- VIB Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium.,Department of Rheumatology, University Hospital Ghent, Ghent, Belgium
| | - Martine De Vos
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,Ghent Gut Inflammation Group (GGIG), Ghent University, Ghent, Belgium
| | - Triana Lobatón
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
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7
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Truyens M, Lobatón T, Ferrante M, Bossuyt P, Vermeire S, Pouillon L, Dewint P, Cremer A, Peeters H, Lambrecht G, Louis E, Rahier JF, Dewit O, Muls V, Holvoet T, Vandermeulen L, Peeters A, Gonzales GB, Bos S, Laukens D, De Vos M. Effect of 5-Hydroxytryptophan on Fatigue in Quiescent Inflammatory Bowel Disease: A Randomized Controlled Trial. Gastroenterology 2022; 163:1294-1305.e3. [PMID: 35940251 DOI: 10.1053/j.gastro.2022.07.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/27/2022] [Revised: 06/22/2022] [Accepted: 07/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Fatigue is highly prevalent among patients with inflammatory bowel disease (IBD), and only limited treatment options are available. Based on the hypothetical link between low serum tryptophan concentrations and fatigue, we determined the effect of 5-hydroxytryptophan supplementation on fatigue in patients with inactive IBD. METHODS A multicenter randomized controlled trial was performed at 13 Belgian hospitals, including 166 patients with IBD in remission but experiencing fatigue, defined by a fatigue visual analog scale (fVAS) score of ≥5. Patients were treated in a crossover manner with 100 mg oral 5-hydroxytryptophan or placebo twice daily for 2 consecutive periods of 8 weeks. The primary end point was the proportion of patients reaching a ≥20% reduction in fVAS after 8 weeks of intervention. Secondary outcomes included changes in serum tryptophan metabolites, Functional Assessment of Chronic Illness Therapy Fatigue scale, and scores for depression, anxiety, and stress. The effect of the intervention on the outcomes was evaluated by linear mixed modeling. RESULTS During 5-hydroxytryptophan treatment, a significant increase in serum 5-hydroxytryptophan (estimated mean difference, 52.66 ng/mL; 95% confidence interval [CI], 39.34-65.98 ng/mL; P < .001) and serotonin (3.0 ng/mL; 95 CI, 1.97-4.03 ng/mL; P < .001) levels was observed compared with placebo. The proportion of patients reaching ≥20% reduction in fVAS was similar in placebo- (37.6%) and 5-hydroxytryptophan (35.6%)-treated patients (P = .830). The fVAS reduction (-0.18; 95% CI, -0.81 to 0.46; P = .581) and Functional Assessment of Chronic Illness Therapy Fatigue scale increase (0.68; 95% CI, -2.37 to 3.73; P = .660) were both comparable between 5-hydroxytryptophan and placebo treatment as well as changes in depression, anxiety, and stress scores. CONCLUSIONS Despite a significant increase in serum 5-hydroxytryptophan and serotonin levels, oral 5-hydroxytryptophan did not modulate IBD-related fatigue better than placebo. (Trial Registration: Belgian Federal Agency for Medication and Health Products, EudraCT number: 2017-005059-10 and ClinicalTrials.gov: NCT03574948, https://clinicaltrials.gov/ct2/show/NCT03574948.).
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Affiliation(s)
- Marie Truyens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium; Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium
| | - Triana Lobatón
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Marc Ferrante
- Department of Chronic Diseases & Metabolism (CHROMETA), Translational Research Center for Gastrointestinal Disorders (TARGID), Katholieke Universiteit (KU) Leuven, Leuven, Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Bossuyt
- Imelda Gastrointestinal (GI) Clinical Research Center, Imelda General Hospital, Bonheiden, Belgium
| | - Séverine Vermeire
- Department of Chronic Diseases & Metabolism (CHROMETA), Translational Research Center for Gastrointestinal Disorders (TARGID), Katholieke Universiteit (KU) Leuven, Leuven, Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Lieven Pouillon
- Imelda Gastrointestinal (GI) Clinical Research Center, Imelda General Hospital, Bonheiden, Belgium
| | - Pieter Dewint
- Department of Gastroenterology, Algemeen Ziekenhuis (AZ) Maria Middelares, Ghent, Belgium; Department of Gastroenterology, University Hospital Antwerp, Antwerp, Belgium
| | - Anneline Cremer
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Harald Peeters
- Department of Gastroenterology, Algemeen Ziekenhuis (AZ) St-Lucas, Ghent, Belgium
| | - Guy Lambrecht
- Department of Gastroenterology, Algemeen Ziekenhuis (AZ) Damiaan, Ostend, Belgium
| | - Edouard Louis
- Department of Gastroenterology, Centre Hospitalier Universitaire Liège (CHU) University Hospital, Liège, Belgium
| | - Jean-François Rahier
- Department of Gastroenterology, Centre Hospitalier Universitaire (CHU) Université catholique de Louvain (UCL) Namur, Yvoir, Belgium
| | - Olivier Dewit
- Université catholique (UC) Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Vinciane Muls
- Department of Gastroenterology and Endoscopy, Saint-Pierre University Hospital Center, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Tom Holvoet
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium; Department of Gastroenterology, Algemeen Ziekenhuis (AZ) Nikolaas General Hospital, Sint-Niklaas, Belgium
| | - Liv Vandermeulen
- Department of Gastroenterology-Hepatology, University Hospital Brussels/Free University of Brussels (VUB), Brussels, Belgium
| | - Anneleen Peeters
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Gerard Bryan Gonzales
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Simon Bos
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium
| | - Debby Laukens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium.
| | - Martine De Vos
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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8
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Kindt S, Louis H, De Schepper H, Arts J, Caenepeel P, De Looze D, Gerkens A, Holvoet T, Latour P, Mahler T, Mokaddem F, Nullens S, Piessevaux H, Poortmans P, Rasschaert G, Surmont M, Vafa H, Van Malderen K, Vanuytsel T, Wuestenberghs F, Tack J. Belgian consensus on irritable bowel syndrome. Acta Gastroenterol Belg 2022; 85:360-382. [PMID: 35709780 DOI: 10.51821/85.2.10100] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain related to defaecation or associated with altered stool frequency or consistency. Despite its prevalence, major uncertainties in the diagnostic and therapeutic management persist in clinical practice. METHODS A Delphi consensus was conducted by 20 experts from Belgium, and consisted of literature review and voting process on 78 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement. RESULTS Consensus was reached for 50 statements. The Belgian consensus agreed as to the multifactorial aetiology of IBS. According to the consensus abdominal discomfort also represents a cardinal symptom, while bloating and abdominal distension often coexist. IBS needs subtyping based on stool pattern. The importance of a positive diagnosis, relying on history and clinical examination is underlined, while additional testing should remain limited, except when alarm features are present. Explanation of IBS represents a crucial part of patient management. Lifestyle modification, spasmolytics and water-solube fibres are considered first-line agents. The low FODMAP diet, selected probiotics, cognitive behavioural therapy and specific treatments targeting diarrhoea and constipation are considered appropriate. There is a consensus to restrict faecal microbiota transplantation and gluten-free diet, while other treatments are strongly discouraged. CONCLUSIONS A panel of Belgian gastroenterologists summarised the current evidence on the aetiology, symptoms, diagnosis and treatment of IBS with attention for the specificities of the Belgian healthcare system.
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Affiliation(s)
- S Kindt
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - H Louis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - H De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - J Arts
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology, AZ Sint-Lucas, Brugge, Belgium
| | - P Caenepeel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Genk, Belgium
- UHasselt, Hasselt, Belgium
| | - D De Looze
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Gent, Belgium
| | - A Gerkens
- Boitsfort Medical Center, Brussels, Belgium
| | - T Holvoet
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Gent, Belgium
- Department of Gastroenterology, AZ Nikolaas, Sint Niklaas, Belgium
| | - P Latour
- Department of Gastroenterology, Hepatology and Digestive Oncology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - T Mahler
- Department of Pediatrics, Universitair Ziekenuis Brussel, Brussel, Belgium
| | - F Mokaddem
- Department of Gastroenterology and Hepatology, Vivalia-Centre Sud Luxembourg, Arlon, Belgium
| | - S Nullens
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - H Piessevaux
- Department of Hepato-gastroenterology, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - P Poortmans
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - G Rasschaert
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - M Surmont
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - H Vafa
- Department of Gastroenterology and Hepatology, Chirec-Site Delta, Brussels, Belgium
| | - K Van Malderen
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - T Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - F Wuestenberghs
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - J Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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9
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Waked B, Holvoet T, Geldof J, Baert F, Pattyn P, Lobatón T, Hindryckx P. Conservative management of spontaneous intra-abdominal abscess in Crohn's disease: Outcome and prognostic factors. J Dig Dis 2021; 22:263-270. [PMID: 33742782 DOI: 10.1111/1751-2980.12984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/04/2020] [Revised: 02/07/2021] [Accepted: 03/15/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the outcomes of different treatments for spontaneous intra-abdominal abscesses (IAA) in active Crohn's disease (CD). METHODS A retrospective analysis of patients with CD between January 2007 and December 2018 was performed in two Belgian inflammatory bowel disease centers. Successful conservative management was defined as complete resolution of abscesses without the need for bowel resection. The primary outcome was suboptimal evolution, defined as a composite outcome of recurrence of abscess, postoperative complications or the need for a non-elective resection. RESULTS Forty CD patients presenting with 43 independent episodes of spontaneous IAA development were included. One underwent immediate bowel resection. In all other 42 cases a conservative approach was taken, which led to a complete abscess resolution rate of 28.6% (12/42). The remaining abscesses required bowel resection. Anti-tumor necrosis factor (TNF) agent use was associated with successful conservative management (odds ratio [OR] 13.36, 95% confidence interval [CI] 11.19-15.52, P = 0.006), while the opposite trend was found for corticosteroids (OR 0.14, 95% CI 0.02-1.26, P = 0.055). There was a trend towards suboptimal evolution in case of previous bowel resection (OR 4.77, 95% CI 0.77-29.66, P = 0.094) or in patients aged above 50 years (OR 5.17, 95% CI 0.86-30.91, P = 0.072). CONCLUSIONS Bowel resection appears to be inevitable in most CD patients presenting with IAA. An attempt at conservative treatment may be particularly successful with anti-TNF agents in younger patients who have not undergone previous bowel resection. Large-scale prospective studies are needed to confirm these findings.
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Affiliation(s)
- Bruno Waked
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Tom Holvoet
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium.,Department of Gastroenterology, AZ Nikolaas General Hospital, Sint-Niklaas, Belgium
| | - Jeroen Geldof
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta General Hospital, Roeselare, Belgium
| | - Piet Pattyn
- Department of Abdominal Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Triana Lobatón
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
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10
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Holvoet T, Lobaton T, Hindryckx P. Optimal Management of Acute Severe Ulcerative Colitis (ASUC): Challenges and Solutions. Clin Exp Gastroenterol 2021; 14:71-81. [PMID: 33727846 PMCID: PMC7955027 DOI: 10.2147/ceg.s197719] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/25/2020] [Accepted: 12/14/2020] [Indexed: 12/25/2022] Open
Abstract
Acute severe colitis is a severe complication of ulcerative colitis, affecting approximately 20% of patients. For physicians, it remains a challenging condition to treat. Current treatment algorithms have diminished the mortality associated with acute severe ulcerative colitis (ASUC), but colectomy rates remain high (approximately 30%) despite advances in therapy. Colectomy in ASUC is particularly associated with important postoperative complications and morbidity. In this review, reasons for the inability to improve care and avoid evolution to colectomy for ASUC are explored and solutions that might lead to a better management of the disease are investigated.
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Affiliation(s)
- Tom Holvoet
- Department of Gastroenterology, AZ Nikolaas, Sint-Niklaas, Belgium.,Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Triana Lobaton
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
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11
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Holvoet T, Joossens M, Vázquez-Castellanos JF, Christiaens E, Heyerick L, Boelens J, Verhasselt B, van Vlierberghe H, De Vos M, Raes J, De Looze D. Fecal Microbiota Transplantation Reduces Symptoms in Some Patients With Irritable Bowel Syndrome With Predominant Abdominal Bloating: Short- and Long-term Results From a Placebo-Controlled Randomized Trial. Gastroenterology 2021; 160:145-157.e8. [PMID: 32681922 DOI: 10.1053/j.gastro.2020.07.013] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with intestinal dysbiosis. Given the reported promising results of open-label fecal microbiota transplantation (FMT) therapy in patients with predominant abdominal bloating, we studied efficacy of this treatment in a randomized, placebo-controlled trial. METHODS Patients with refractory IBS, defined as failure of ≥3 conventional therapies, were randomly assigned to single-dose nasojejunal administration of donor stools (n = 43) or autologous stools (n = 19) in a double-blind study, performed from December 2015 through October 2017, and were followed up for 1 year. IBS-related symptoms were assessed by using a daily symptom diary to determine general abdominal discomfort, abdominal bloating, abdominal pain, and flatulence on a scale of 1-6. Number of daily bowel movements, consistency of the stools, and abdominal circumference were also recorded. Patients completed the IBS-specific quality of life questionnaire. Primary endpoints were improvement of IBS symptoms and bloating at 12 weeks (response). Secondary endpoints were changes in IBS symptom scores and quality of life. Stool samples were collected for microbiota amplicon sequencing. Open-label retransplantation was offered after the trial. RESULTS At week 12, 56% of patients given donor stool reported improvement in both primary endpoints compared with 26% of patients given placebo (P = .03). Patients given donor stool had significant improvements in level of discomfort (mean reduction, 19%; median score before FMT, 3.98; range, 2.13-6.00; median score after FMT, 3.1; range, 951.29-5.90), stool frequency (mean reduction, 13%; median score before FMT, 2.10; range, 0.57-14.29; median score after FMT 1.7; range, 0.71-4.29), urgency (mean reduction, 38%; median score before FMT, 0.61; range, 0.00-1.00; median score after FMT, 0.37; range, 0.00-1.00), abdominal pain (mean reduction, 26%; median score before FMT, 3.88; range, 1.57-5.17; median score after FMT, 2.80; range, 1.14-4.94), flatulence (mean reduction, 10%; median score before FMT, 3.42; range, 0.71-6.00; median score after FMT, 3.07; range, 0.79-4.23), and quality of life (mean increase, 16%; median score before FMT 32.6; range, 11-119; median score after FMT, 43.1; range, 32.25-99). A significantly higher proportion of women given donor stool (69%) had a response than men (29%) (P = .01). Fecal samples from responders had higher diversity of microbiomes before administration of donor material than fecal samples from nonresponders (P = .04) and distinct baseline composition (P = .04), but no specific marker taxa were associated with response. After single FMT, 21% of patients given donor stool reported effects that lasted for longer than 1 year compared with 5% of patients given placebo stool. A second FMT reduced symptoms in 67% of patients with an initial response to donor stool but not in patients with a prior nonresponse. CONCLUSIONS In a randomized trial of patients with treatment-refractory IBS with predominant bloating, FMT relieved symptoms compared with placebo (autologous transplant), although the effects decreased over 1 year. A second FMT restored the response patients with a prior response. Response was associated with composition of the fecal microbiomes before FMT; this might be used to as a biomarker to select patients for this treatment. ClinicalTrials.gov, Number: NCT02299973.
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Affiliation(s)
- Tom Holvoet
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium; Faculty of Health Sciences, Ghent University, Ghent, Belgium.
| | - Marie Joossens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Leuven, Belgium; VIB, Center for Microbiology, Leuven, Belgium
| | - Jorge F Vázquez-Castellanos
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Leuven, Belgium; VIB, Center for Microbiology, Leuven, Belgium
| | | | - Lander Heyerick
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Jerina Boelens
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | | | - Martine De Vos
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Jeroen Raes
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Leuven, Belgium; VIB, Center for Microbiology, Leuven, Belgium
| | - Danny De Looze
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium; Faculty of Health Sciences, Ghent University, Ghent, Belgium
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12
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Deroo R, Trépo E, Holvoet T, De Pauw M, Geerts A, Verhelst X, Colle I, Van Vlierberghe H, Fallon MB, Raevens S. Vasomodulators and Liver Transplantation for Portopulmonary Hypertension: Evidence From a Systematic Review and Meta-Analysis. Hepatology 2020; 72:1701-1716. [PMID: 32017176 DOI: 10.1002/hep.31164] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Untreated portopulmonary hypertension (PoPH) carries a poor prognosis. Previous reports have described vasomodulator (VM) therapy and liver transplantation (LT) as treatment options. We aimed to provide summary estimates on the endpoints of pulmonary hemodynamics and survival in patients with PoPH, treated with different modalities. APPROACH AND RESULTS We performed a systematic review with meta-analysis of mainly observational and case-control studies describing no treatment, VM, LT, or VM + LT in patients with PoPH. Twenty-six studies (1,019 patients) were included. Both VM and VM + LT improve pulmonary hemodynamics. A substantial proportion of patients treated with VM become eligible for LT (44%; 95% confidence interval [CI], 31-58). Pooled estimates for 1-, and 3-year postdiagnosis survival in patients treated with VM were 86% (95% CI, 81-90) and 69% (95% CI, 50-84) versus 82% (95% CI, 52-95) and 67% (95% CI, 53-78) in patients treated with VM + LT. Of note, studies reporting on the effect of VM mainly included Child-Pugh A/B patients, whereas studies reporting on VM + LT mainly included Child-Pugh B/C. Seven studies (238 patients) included both patients who received VM only and patients who received VM + LT. Risk of death in VM-only-treated patients was significantly higher than in patients who could be transplanted as well (odds ratio, 3.5; 95% CI, 1.4-8.8); however, importantly, patients who proceeded to transplant had been selected very strictly. In 50% of patients, VM can be discontinued post-LT (95% CI, 38-62). CONCLUSIONS VM and VM + LT both improve pulmonary hemodynamics and prognosis in PoPH. In a strictly selected subpopulation of cases where LT is indicated based on severe liver disease and where LT is considered safe and feasible, treatment with VM + LT confers a better prognosis. Considering successful VM, 44% can proceed to LT, with half being able to postoperatively stop medication.
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Affiliation(s)
- Rebecca Deroo
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Eric Trépo
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.,Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Tom Holvoet
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Anja Geerts
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Xavier Verhelst
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Isabelle Colle
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Hans Van Vlierberghe
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
| | - Michael B Fallon
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, AZ
| | - Sarah Raevens
- Department of Gastroenterology and Hepatology, Ghent University-Ghent University Hospital, Ghent, Belgium
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13
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Hindryckx P, Levesque BG, Holvoet T, Durand S, Tang CM, Parker C, Khanna R, Shackelton LM, D'Haens G, Sandborn WJ, Feagan BG, Lebwohl B, Leffler DA, Jairath V. Disease activity indices in coeliac disease: systematic review and recommendations for clinical trials. Gut 2018; 67:61-69. [PMID: 27799282 DOI: 10.1136/gutjnl-2016-312762] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Although several pharmacological agents have emerged as potential adjunctive therapies to a gluten-free diet for coeliac disease, there is currently no widely accepted measure of disease activity used in clinical trials. We conducted a systematic review of coeliac disease activity indices to evaluate their operating properties and potential as outcome measures in registration trials. DESIGN MEDLINE, EMBASE and the Cochrane central library were searched from 1966 to 2015 for eligible studies in adult and/or paediatric patients with coeliac disease that included coeliac disease activity markers in their outcome measures. The operating characteristics of histological indices, patient-reported outcomes (PROs) and endoscopic indices were evaluated for content and construct validity, reliability, responsiveness and feasibility using guidelines proposed by the US Food and Drug Administration (FDA). RESULTS Of 19 123 citations, 286 studies were eligible, including 24 randomised-controlled trials. Three of five PROs identified met most key evaluative criteria but only the Celiac Disease Symptom Diary (CDSD) and the Celiac Disease Patient-Reported Outcome (CeD PRO) have been approved by the FDA. All histological and endoscopic scores identified lacked content validity. Quantitative morphometric histological analysis had better reliability and responsiveness compared with qualitative scales. Endoscopic indices were infrequently used, and only one index demonstrated responsiveness to effective therapy. CONCLUSIONS Current best evidence suggests that the CDSD and the CeD PRO are appropriate for use in the definition of primary end points in coeliac disease registration trials. Morphometric histology should be included as a key secondary or co-primary end point. Further work is needed to optimise end point configuration to inform efficient drug development.
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Affiliation(s)
- Pieter Hindryckx
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada.,Department of Gastroenterology, University of Ghent, Ghent, Belgium
| | - Barrett G Levesque
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada.,Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Tom Holvoet
- Department of Gastroenterology, University of Ghent, Ghent, Belgium
| | - Serina Durand
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Ceen-Ming Tang
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK.,Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Claire Parker
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada
| | - Reena Khanna
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Lisa M Shackelton
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada
| | - Geert D'Haens
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada.,Inflammatory Bowel Disease Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - William J Sandborn
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada.,Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Brian G Feagan
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Benjamin Lebwohl
- Celiac Disease Center, Columbia University, New York, New York, USA
| | - Daniel A Leffler
- The Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vipul Jairath
- Robarts Clinical Trials Inc., University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
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14
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Holvoet T, Devriese S, Castermans K, Boland S, Leysen D, Vandewynckel YP, Devisscher L, Van den Bossche L, Van Welden S, Dullaers M, Vandenbroucke RE, De Rycke R, Geboes K, Bourin A, Defert O, Hindryckx P, De Vos M, Laukens D. Treatment of Intestinal Fibrosis in Experimental Inflammatory Bowel Disease by the Pleiotropic Actions of a Local Rho Kinase Inhibitor. Gastroenterology 2017. [PMID: 28642198 DOI: 10.1053/j.gastro.2017.06.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [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: 01/13/2023]
Abstract
BACKGROUND Intestinal fibrosis resulting in (sub)obstruction is a common complication of Crohn's disease (CD). Rho kinases (ROCKs) play multiple roles in TGFβ-induced myofibroblast activation that could be therapeutic targets. Because systemic ROCK inhibition causes cardiovascular side effects, we evaluated the effects of a locally acting ROCK inhibitor (AMA0825) on intestinal fibrosis. METHODS Fibrosis was assessed in mouse models using dextran sulfate sodium (DSS) and adoptive T-cell transfer. The in vitro and ex vivo effects of AMA0825 were studied in different cell types and in CD biopsy cultures. RESULTS ROCK is expressed in fibroblastic, epithelial, endothelial, and muscle cells of the human intestinal tract and is activated in inflamed and fibrotic tissue. Prophylactic treatment with AMA0825 inhibited myofibroblast accumulation, expression of pro-fibrotic factors, and accumulation of fibrotic tissue without affecting clinical disease activity and histologic inflammation in 2 models of fibrosis. ROCK inhibition reversed established fibrosis in a chronic DSS model and impeded ex vivo pro-fibrotic protein secretion from stenotic CD biopsies. AMA0825 reduced TGFβ1-induced activation of myocardin-related transcription factor (MRTF) and p38 mitogen-activated protein kinase (MAPK), down-regulating matrix metalloproteinases, collagen, and IL6 secretion from fibroblasts. In these cells, ROCK inhibition potentiated autophagy, which was required for the observed reduction in collagen and IL6 production. AMA0825 did not affect pro-inflammatory cytokine secretion from other ROCK-positive cell types, corroborating the selective in vivo effect on fibrosis. CONCLUSIONS Local ROCK inhibition prevents and reverses intestinal fibrosis by diminishing MRTF and p38 MAPK activation and increasing autophagy in fibroblasts. Overall, our results show that local ROCK inhibition is promising for counteracting fibrosis as an add-on therapy for CD.
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Affiliation(s)
- Tom Holvoet
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | - Sarah Devriese
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | | | | | | | | | | | | | | | - Melissa Dullaers
- Inflammation Research Center, VIB, Ghent, Belgium; Department of Pulmonary Medicine, Ghent University, Ghent, Belgium
| | - Roosmarijn E Vandenbroucke
- Inflammation Research Center, VIB, Ghent, Belgium; Department of Molecular Biomedical Research, Ghent University, Ghent, Belgium
| | - Riet De Rycke
- Inflammation Research Center, VIB, Ghent, Belgium; Department of Molecular Biomedical Research, Ghent University, Ghent, Belgium
| | - Karel Geboes
- Department of Pathology, Ghent University, Ghent, Belgium
| | | | | | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | - Martine De Vos
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | - Debby Laukens
- Department of Gastroenterology, Ghent University, Ghent, Belgium.
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15
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De Vos M, Dhooghe B, Vermeire S, Louis E, Mana F, Elewaut A, Bossuyt P, Baert F, Reenaers C, Van Gossum M, Macken E, Ferrante M, Hindryckx P, Dewit O, Holvoet T, Franchimont D. Efficacy of vedolizumab for induction of clinical response and remission in patients with moderate to severe inflammatory bowel disease who failed at least two TNF antagonists. United European Gastroenterol J 2017; 6:439-445. [PMID: 29774158 DOI: 10.1177/2050640617722310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/26/2017] [Indexed: 12/12/2022] Open
Abstract
Background Vedolizumab is a recently available monoclonal antibody targeting α4β7 integrin for the treatment of ulcerative colitis (UC) and Crohn's disease (CD). Objective The objective of this article is to evaluate the efficacy of vedolizumab induction therapy in anti-TNF-refractory/intolerant UC and CD patients in real life. Methods A cohort of 149 moderately to severely active UC and CD patients who failed or showed intolerance to at least two TNF antagonists participated in a medical need program and received vedolizumab in 37 Belgian centers (April-September 2015). Rates of clinical response and remission were retrospectively evaluated at Week 10 for UC and Week 14 for CD using the physician's global assessment (PGA), Mayo score and Harvey Bradshaw index (HBI) or Crohn's disease activity score (CDAI) scores. Results Eighty-four patients (29 UC, 55 CD) had sufficient data for analysis. For UC patients, clinical response was observed in 76% based on PGA and 59% based on the Mayo score. The corresponding percentages for CD patients were 80% for PGA and 65% for HBI/CDAI. Clinical remission rates were 10% and 40% for UC and CD, respectively. Steroid-free remission was observed in respectively 10% and 35%. Globally, corticosteroids were stopped in 14 out of 48 patients (29%). No new safety signals were reported. Conclusion Up to 70% TNF-refractory/intolerant UC and CD patients achieved a clinical response after 10 to 14 weeks of vedolizumab treatment in this real-life cohort.
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Affiliation(s)
- Martine De Vos
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Belgium
| | - Barbara Dhooghe
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Belgium
| | - Severine Vermeire
- Departments of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Edouard Louis
- Department of Gastroenterology, University Hospital of Liège, Belgium
| | - Fazia Mana
- Department of Gastroenterology, University Hospital Brussels (Jette), Belgium
| | - Ann Elewaut
- Department of Gastroenterology, AZ Groeninge, Kortrijk, Belgium
| | - Peter Bossuyt
- Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | | | - Marc Van Gossum
- Department of Gastroenterology, ULB Erasme, Brussels, Belgium
| | - Elisabeth Macken
- Department of Gastroenterology, University Hospital Antwerp, Belgium
| | - Marc Ferrante
- Departments of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Belgium
| | - Olivier Dewit
- Department of Hepato-Gastro-Enterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Tom Holvoet
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Belgium
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16
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Van den Bossche L, Borsboom D, Devriese S, Van Welden S, Holvoet T, Devisscher L, Hindryckx P, De Vos M, Laukens D. Tauroursodeoxycholic acid protects bile acid homeostasis under inflammatory conditions and dampens Crohn's disease-like ileitis. J Transl Med 2017; 97:519-529. [PMID: 28165466 DOI: 10.1038/labinvest.2017.6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/06/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023] Open
Abstract
Bile acids regulate the expression of intestinal bile acid transporters and are natural ligands for nuclear receptors controlling inflammation. Accumulating evidence suggests that signaling through these receptors is impaired in inflammatory bowel disease. We investigated whether tauroursodeoxycholic acid (TUDCA), a secondary bile acid with cytoprotective properties, regulates ileal nuclear receptor and bile acid transporter expression and assessed its therapeutic potential in an experimental model of Crohn's disease (CD). Gene expression of the nuclear receptors farnesoid X receptor, pregnane X receptor and vitamin D receptor and the bile acid transporters apical sodium-dependent bile acid transporter and organic solute transporter α and β was analyzed in Caco-2 cell monolayers exposed to tumor necrosis factor (TNF)α, in ileal tissue of TNFΔARE/WT mice and in inflamed ileal biopsies from CD patients by quantitative real-time polymerase chain reaction. TNFΔARE/WT mice and wild-type littermates were treated with TUDCA or placebo for 11 weeks and ileal histopathology and expression of the aforementioned genes were determined. Exposing Caco-2 cell monolayers to TNFα impaired the mRNA expression of nuclear receptors and bile acid transporters, whereas co-incubation with TUDCA antagonized their downregulation. TNFΔARE/WT mice displayed altered ileal bile acid homeostasis that mimicked the situation in human CD ileitis. Administration of TUDCA attenuated ileitis and alleviated the downregulation of nuclear receptors and bile acid transporters in these mice. These results show that TUDCA protects bile acid homeostasis under inflammatory conditions and suppresses CD-like ileitis. Together with previous observations showing similar efficacy in experimental colitis, we conclude that TUDCA could be a promising therapeutic agent for inflammatory bowel disease, warranting a clinical trial.
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Affiliation(s)
| | - Daniel Borsboom
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Sarah Devriese
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Sophie Van Welden
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Tom Holvoet
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Lindsey Devisscher
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Martine De Vos
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Debby Laukens
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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17
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Holvoet T, Joossens M, Wang J, Boelens J, Verhasselt B, Laukens D, van Vlierberghe H, Hindryckx P, De Vos M, De Looze D, Raes J. Assessment of faecal microbial transfer in irritable bowel syndrome with severe bloating. Gut 2017; 66:980-982. [PMID: 27511198 PMCID: PMC5531219 DOI: 10.1136/gutjnl-2016-312513] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/13/2016] [Indexed: 12/08/2022]
Affiliation(s)
- Tom Holvoet
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Marie Joossens
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute, B-3000 Leuven, Belgium,VIB, Center for the Biology of Disease, Leuven, Belgium,Faculty of Sciences and Bioengineering Sciences, Microbiology Unit, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jun Wang
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute, B-3000 Leuven, Belgium,VIB, Center for the Biology of Disease, Leuven, Belgium
| | - Jerina Boelens
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Debby Laukens
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | | | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Martine De Vos
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Danny De Looze
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Jeroen Raes
- KU Leuven - University of Leuven, Department of Microbiology and Immunology, Rega Institute, B-3000 Leuven, Belgium,VIB, Center for the Biology of Disease, Leuven, Belgium
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18
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Devriese S, Van den Bossche L, Van Welden S, Holvoet T, Pinheiro I, Hindryckx P, De Vos M, Laukens D. T84 monolayers are superior to Caco-2 as a model system of colonocytes. Histochem Cell Biol 2017; 148:85-93. [PMID: 28265783 DOI: 10.1007/s00418-017-1539-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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] [Accepted: 01/09/2017] [Indexed: 01/21/2023]
Abstract
Colonic adenocarcinoma-derived Caco-2 and T84 epithelial cell lines are frequently used as in vitro model systems of functional epithelial barriers. Both are utilised interchangeably despite evidence that differentiated Caco-2 cells are more reminiscent of small intestinal enterocytes than of colonocytes, whereas differentiated T84 cells are less well characterised. The aim of this study was, therefore, to further characterise and compare differentiated Caco-2 and T84 cells. The objectives were to (1) compare the brush border morphology, (2) measure the expression of enterocyte- and colonocyte-specific genes and (3) compare their response to butyrate, which is dependent on the monocarboxylate transporter 1 (MCT1), an apical protein expressed primarily in colonocytes. T84 microvilli were significantly shorter than those of Caco-2 cells, which is a characteristic difference between small intestinal enterocytes and colonocytes. Also, enterocyte-associated brush border enzymes expressed in differentiated Caco-2 cells were not increased during T84 maturation, whereas colonic markers such as MCT1 were more abundant in differentiated T84 cells compared to differentiated Caco-2 cells. Consequently, T84 cells displayed a dose-responsive improvement of barrier function towards butyrate, which was absent in Caco-2 cells. On the other hand, differences in epithelial toll-like receptor expression between Caco-2 and T84 monolayers did not result in a corresponding differential functional response. We conclude that differentiated Caco-2 and T84 cells have distinct morphological, biochemical and functional characteristics, suggesting that T84 cells do not acquire the biochemical signature of mature small intestinal enterocytes like Caco-2 cells, but retain much of their original colonic characteristics throughout differentiation. These findings can help investigators select the appropriate intestinal epithelial cell line for specific in vitro research purposes.
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Affiliation(s)
- Sarah Devriese
- Department of Gastroenterology, Ghent University, De Pintelaan 185, 0MRB2, 9000, Ghent, Belgium
| | - Lien Van den Bossche
- Department of Gastroenterology, Ghent University, De Pintelaan 185, 0MRB2, 9000, Ghent, Belgium
| | - Sophie Van Welden
- Department of Gastroenterology, Ghent University, De Pintelaan 185, 0MRB2, 9000, Ghent, Belgium
| | - Tom Holvoet
- Department of Gastroenterology, Ghent University, De Pintelaan 185, 0MRB2, 9000, Ghent, Belgium
| | - Iris Pinheiro
- ProDigest BVBA, Technologiepark 3, 9052, Ghent, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University, De Pintelaan 185, 0MRB2, 9000, Ghent, Belgium
| | - Martine De Vos
- Department of Gastroenterology, Ghent University, De Pintelaan 185, 0MRB2, 9000, Ghent, Belgium
| | - Debby Laukens
- Department of Gastroenterology, Ghent University, De Pintelaan 185, 0MRB2, 9000, Ghent, Belgium.
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19
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Van Welden S, De Vos M, Wielockx B, Tavernier SJ, Dullaers M, Neyt S, Descamps B, Devisscher L, Devriese S, Van den Bossche L, Holvoet T, Baeyens A, Correale C, D'Alessio S, Vanhove C, De Vos F, Verhasselt B, Breier G, Lambrecht BN, Janssens S, Carmeliet P, Danese S, Elewaut D, Laukens D, Hindryckx P. Haematopoietic prolyl hydroxylase-1 deficiency promotes M2 macrophage polarization and is both necessary and sufficient to protect against experimental colitis. J Pathol 2017; 241:547-558. [PMID: 27981571 DOI: 10.1002/path.4861] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 08/20/2016] [Revised: 11/21/2016] [Accepted: 12/06/2016] [Indexed: 12/17/2022]
Abstract
Prolyl hydroxylase domain-containing proteins (PHDs) regulate the adaptation of cells to hypoxia. Pan-hydroxylase inhibition is protective in experimental colitis, in which PHD1 plays a prominent role. However, it is currently unknown how PHD1 targeting regulates this protection and which cell type(s) are involved. Here, we demonstrated that Phd1 deletion in endothelial and haematopoietic cells (Phd1f/f Tie2:cre) protected mice from dextran sulphate sodium (DSS)-induced colitis, with reduced epithelial erosions, immune cell infiltration, and colonic microvascular dysfunction, whereas the response of Phd2f/+ Tie2:cre and Phd3f/f Tie2:cre mice to DSS was similar to that of their littermate controls. Using bone marrow chimeras and cell-specific cre mice, we demonstrated that ablation of Phd1 in haematopoietic cells but not in endothelial cells was both necessary and sufficient to inhibit experimental colitis. This effect relied, at least in part, on skewing of Phd1-deficient bone marrow-derived macrophages towards an anti-inflammatory M2 phenotype. These cells showed an attenuated nuclear factor-κB-dependent response to lipopolysaccharide (LPS), which in turn diminished endothelial chemokine expression. In addition, Phd1 deficiency in dendritic cells significantly reduced interleukin-1β production in response to LPS. Taken together, our results further support the development of selective PHD1 inhibitors for ulcerative colitis, and identify haematopoietic cells as their primary target. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Martine De Vos
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | - Ben Wielockx
- Heisenberg Research Group, Department of Clinical Pathobiochemistry, Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Simon J Tavernier
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Inflammation Research Centre VIB, Zwijnaarde, Belgium
| | - Melissa Dullaers
- Inflammation Research Centre VIB, Zwijnaarde, Belgium.,Department of Pulmonary Medicine, Ghent University, Ghent, Belgium
| | - Sara Neyt
- Laboratory of Radiopharmacy, Ghent University, Ghent, Belgium
| | - Benedicte Descamps
- Infinity Imaging Laboratory (iMinds Medical IT-IBiTech-MEDISIP), Ghent University, Ghent, Belgium
| | | | - Sarah Devriese
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | | | - Tom Holvoet
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | - Ann Baeyens
- Department of Clinical Chemistry, Microbiology, and Immunology, Ghent University, Ghent, Belgium
| | - Carmen Correale
- IBD Centre, Department of Gastroenterology, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Silvia D'Alessio
- IBD Centre, Department of Gastroenterology, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Christian Vanhove
- Infinity Imaging Laboratory (iMinds Medical IT-IBiTech-MEDISIP), Ghent University, Ghent, Belgium
| | - Filip De Vos
- Laboratory of Radiopharmacy, Ghent University, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Clinical Chemistry, Microbiology, and Immunology, Ghent University, Ghent, Belgium
| | - Georg Breier
- Division of Medical Biology, Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Bart N Lambrecht
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Inflammation Research Centre VIB, Zwijnaarde, Belgium
| | - Sophie Janssens
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Inflammation Research Centre VIB, Zwijnaarde, Belgium
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular metabolism, Vesalius Research Centre, KU Leuven, VIB, Leuven, Belgium
| | - Silvio Danese
- IBD Centre, Department of Gastroenterology, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Dirk Elewaut
- Inflammation Research Centre VIB, Zwijnaarde, Belgium.,Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Debby Laukens
- Department of Gastroenterology, Ghent University, Ghent, Belgium
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University, Ghent, Belgium
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20
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Holvoet T, Raevens S, Vandewynckel YP, Van Biesen W, Geboes K, Van Vlierberghe H. Systematic review of guidelines for management of intermediate hepatocellular carcinoma using the Appraisal of Guidelines Research and Evaluation II instrument. Dig Liver Dis 2015; 47:877-83. [PMID: 26250948 DOI: 10.1016/j.dld.2015.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 03/17/2015] [Revised: 07/04/2015] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma is the second leading cause of cancer-related mortality worldwide. Multiple guidelines have been developed to assist clinicians in its management. We aimed to explore methodological quality of these guidelines focusing on treatment of intermediate hepatocellular carcinoma by transarterial chemoembolization. METHODS A systematic search was performed for Clinical Practice Guidelines and Consensus statements for hepatocellular carcinoma management. Guideline quality was appraised using the Appraisal of Guidelines Research and Evaluation II instrument, which rates guideline development processes across 6 domains: 'Scope and purpose', 'Stakeholder involvement', 'Rigour of development', 'Clarity of presentation', 'Applicability' and 'Editorial independence'. Thematic analysis of guidelines was performed to map differences in recommendations. RESULTS Quality of 21 included guidelines varied widely, but was overall poor with only one guideline passing the 50% mark on all domains. Key recommendations as (contra)indications and technical aspects were inconsistent between guidelines. Aspects on side effects and health economics were mainly neglected. CONCLUSIONS Methodological quality of guidelines on transarterial chemoembolization in hepatocellular carcinoma management is poor. This results in important discrepancies between guideline recommendations, creating confusion in clinical practice. Incorporation of the Appraisal of Guidelines Research and Evaluation II instrument in guideline development may improve quality of future guidelines by increasing focus on methodological aspects.
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Affiliation(s)
- Tom Holvoet
- Department of Hepatology and Gastroenterology, Ghent University, Ghent, Belgium
| | - Sarah Raevens
- Department of Hepatology and Gastroenterology, Ghent University, Ghent, Belgium
| | | | - Wim Van Biesen
- ERBP, Ghent University Hospital, Ghent, Belgium; Renal Division, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Karen Geboes
- Department of Hepatology and Gastroenterology, Ghent University, Ghent, Belgium
| | - Hans Van Vlierberghe
- Department of Hepatology and Gastroenterology, Ghent University, Ghent, Belgium.
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21
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Weyns D, Schelfthout K, Holvoet T. Exploiting a Virtual Environment in a Real-World Application. Environments for Multi-Agent Systems II 2006. [DOI: 10.1007/11678809_13] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Weyns D, Van Dyke Parunak H, Michel F, Holvoet T, Ferber J. Environments for Multiagent Systems State-of-the-Art and Research Challenges. Environments for Multi-Agent Systems 2005. [DOI: 10.1007/978-3-540-32259-7_1] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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23
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De Wolf T, Holvoet T. Emergence Versus Self-Organisation: Different Concepts but Promising When Combined. Engineering Self-Organising Systems 2005. [DOI: 10.1007/11494676_1] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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