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Anemia in inflammatory bowel disease: A neglected issue with relevant effects

World Journal of Gastroenterology 2014年第13期20卷 3542-3551页

作者： danila guagnozzi Alfredo J Lucendo Department of Gastroenterology Hospital General de Tomelloso 13700 TomellosoCiudad RealSpain

Anemia, a common complication associated with inflammatory bowel disease (IBD), is frequently overlooked in the management of IBD patients. Unfortunately, it represents one of the major causes of both decreased quality of life and increased hospital admissions among this population. Anemia in IBD is pathogenically complex, with several factors contributing to its development. While iron deficiency is the most common cause, vitamin B12 and folic acid deficiencies, along with the effects of pro-inflammatory cytokines, hemolysis, drug therapies, and myelosuppression, have also been identified as the underlying etiology in a number of patients. Each of these etiological factors thus needs to be identified and corrected in order to effectively manage anemia in IBD. Because the diagnosis of anemia in IBD often presents a challenge, combinations of several hematimetric and biochemical parameters should be used. Recent studies underscore the importance of determining the ferritin index and hepcidin levels in order to distinguish between iron deficiency anemia, anemia due to chronic disease, or mixed anemia in IBD patients. With regard to treatment, the newly introduced intravenous iron formulations have several advantages over orally-administered iron compounds in treating iron deficiency in IBD. In special situations, erythropoietin supplementation and biological therapies should be considered. In conclusion, the management of anemia is a complex aspect of treating IBD patients, one that significantly influences the prognosis of the disease. As a consequence, its correction should be considered a specific, first-line therapeutic goal in the management of these patients.

关键词： Anemia Inflammatory bowel disease Iron deficiency Anemia of chronic disease Erythropoietin

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Towards a new paradigm of microscopic colitis: Incomplete and variant forms

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World Journal of Gastroenterology 2016年第38期22卷 8459-8471页

作者： danila guagnozzi Stefania Landolfi Maria Vicario Department of Gastroenterology Hospital Universitario Vall d’Hebron08035 BarcelonaSpain Department of Pathology Hospital Universitario Vall d’Hebron08035 BarcelonaSpain Translational Mucosal Immunology Lab Digestive Diseases Research UnitVall d’Hebron Institut de RecercaDepartment of Gastroenterology.Hospital Universitario Vall d’HebronUniversitat Autónoma de Barcelona08035 BarcelonaSpain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas(CIBERehd) 08035 BarcelonaSpain

Microscopic colitis(MC) is a chronic inflammatory bowel disease that has emerged in the last three decades as a leading cause of chronic watery diarrhoea. MC classically includes two main subtypes: lymphocytic colitis(LC) and collagenous colitis(CC). Other types of histopathological changes in the colonic mucosa have been described in patients with chronic diarrhoea, without fulfilling the conventional histopathological criteria for MC diagnosis. Whereas those unclassified alterations remained orphan for a long time, the use of the term incomplete MC(MCi) is nowadays universally accepted. However, it is still unresolved whether CC, LC and MCi should be considered as one clinical entity or if they represent three related conditions. In contrast to classical MC, the real epidemiological impact of MCi remains unknown, because only few epidemiological studies and case reports have been described. MCi presents clinical characteristics indistinguishable from complete MC with a good response to budesonide and cholestiramine. Although a number of medical treatments have been assayed in MC patients, currently, there is no causal treatment approach for MC and MCi, and only empirical strategies have been performed. Further studies are needed in order to identify their etiopathogenic mechanisms, and to better classify and treat MC.

关键词： Microscopic colitis Incomplete microscopic colitis Collagenous colitis Lymphocytic colitis

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Effect of infliximab on small bowel stenoses in patients with Crohn's disease

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World Journal of Gastroenterology 2008年第12期14卷 1885-1890页

作者： Nadia Pallotta Fausto Barberani Naima Abdulkadir Hassan danila guagnozzi Giuseppina Vincoli Enrico Corazziari Department of Clinical Science University of Rome Sapienza Rome COU Gastroenterology S. Camillo De Lellis Hospital Rieti Rome 00168 Italy

AIM: To assess prospectively small bowel stenoses in Crohn's disease (CD) patients treated with infliximab using Small Intestine Contrast Ultrasonography (SICUS). METHODS: Twenty patients (M 12, age, 42.7 ± 11.8 years), 15 of whom showed obstructive symptoms indicating the presence of small bowel stenosis, and 5 without stenosis, were treated with infliximab (5 mg/kg at wk 0, 2, 6 and 5 mg/kg every 8 wk thereafter) for steroid refractoriness, fistulizing disease, or to avoid high-risk surgery. SICUS was performed at the induction phase and at regular time intervals during the follow-up period of 34.7 ± 16.1 mo (range 7-58). Small bowel stenoses were detected by SICUS, endoscopy and MRI. RESULTS: In no case was progression of stenoses or the appearance of new ones seen. Of the 15 patients with stenosis, 5 stopped treatment after the induction phase (2 for no response, 3 for drug intolerance, one of whom showed complete regression of one stenosis). Among the remaining 10 patients, a complete regression of 8 stenoses (1 stenosis in 5 patients and 3 stenoses in one patient) was observed after 6-22 infliximab infusions. CONCLUSION: In patients with CD treated with infliximab we observed: (a) No progression of small bowel stenosis and no appearance of new ones, (b) Complete regression of 1/22 stenosis after the induction phase and of 8/15 (53.3%) stenosis after 6-22 infusionsduring maintenance therapy.

关键词： Crohn's disease Infliximab Intestinalstenosis

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Colorectal cancer surveillance in patients with inflammatory bowel disease: What's new?

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World Journal of Gastrointestinal Endoscopy 2012年第4期4卷 108-116页

作者： danila guagnozzi Alfredo J Lucendo Department of Gastroenterology Hospital General de Tomelloso 13700 Tomelloso Ciudad Real Spain

Several studies assessing the incidence of colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients have found an increased risk globally estimated to be 2 to 5 times higher than for the general population of the same age group. The real magnitude of this risk, however, is still open to debate. Research is currently being carried out on several risk and protective factors for CRC that have recently been identified in IBD patients. A deeper understanding of these factors could help stratify patient risk and aid specialists in choosing which surveillance program is most efficient. There are several guidelines for choosing the correct surveillance program for IBD patients; many present common characteristics with various distinctions. Current recommendations are far from perfect and have important limitations such as the fact that their efficiency has not been demonstrated through randomized controlled trials, the limited number of biopsies performed in daily endoscopic practice, and the difficulty in establishing the correct time to begin a given surveillance program and maintain a schedule of surveillance. That being said, new endoscopic technologies should help by replacing random biopsy protocols with targeted biopsies in IBD patients, thereby improving the efficiency of surveillance ***, further studies are needed to evaluate the cost-effectiveness of introducing these techniques into daily endoscopic practice.

关键词： Colonoscopy Colorectal cancer Crohn’s disease Dysplasia Inflammatory bowel disease Ulcerative colitis

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Small bowel video capsule endoscopy in Crohn’s disease: What have we learned in the last ten years?

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World Journal of Gastrointestinal Endoscopy 2011年第2期3卷 23-29页

作者： Alfredo J Lucendo danila guagnozzi Department of Gastroenterology Hospital General de Tomelloso Tomelloso 13700 Ciudad Real Spain

Since its introduction in 2001, capsule endoscopy (CE) has become the most important advance in the study of small bowel disease, including Crohn's disease (CD). This technique has been demonstrated to be superior to all other current forms of radiological investigation in detecting mucosal abnormalities of small bowel nonstricturing CD. CE has proven to be extremely useful in diagnosing CD in patients with inconclusive findings from ileocolonoscopy and x-ray-based studies. Almost half of all patients with CD involving the ileum also present lesions in proximal intestinal segments, with the small bowel being exclusively involved in up to 30% of all CD cases. Despite the widespread use of CE, several questions concerning the utility of this technique remain unanswered. The lack of commonly agreed diagnostic criteria for defining CD lesions with the aid of CE may have had an influence on the variation in diagnostic re sults for CE reported in the literature. The utility of CE in monitoring CD and in guiding therapy has also been proposed. Furthermore, CE could be a useful second-line technique for patients with an established diagn osis of CD and unexplained symptoms. Finally, as no thres hold for CD diagnosis has been agreed upon, a se verity scale of mucosal disease activity has notbeen universally followed. None of the available activity indexes based on CE findings has been independently validated. This article discusses several cutting-edge aspects of the usefulness of CE in CD 10 years after its introduction as a sensible method to study the small intestine.

关键词： Capsule endoscopy Crohn’s disease Inflammatory bowel disease

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