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Are we giving biologics too late? The case for early versus late use

World Journal of Gastroenterology 2008年第36期14卷 5523-5527页

作者： Elena Ricart Orlando García-Bosch ingrid ordás Julián Panés Gastroenterology Department Hospital Clinic CIBER- EHD C/Villarroel 170 Barcelona 08036 Spain

Corticosteroids and immunomodulators have been the mainstay therapies for Crohn’s disease. Corticosteroids are highly effective to control symptoms in the short- term, but they are not effective in maintaining remission, they heal the mucosa in a reduced proportion of cases, and long-time exposure is associated with an increased risk of infections and mortality. Immunomodulators, azathioprine and methotrexate, heal the mucosa in a higher proportion of patients that corticosteroids but their onset of action is slow and they benefit less than half of patients with Crohn’s disease. In the last decade, medical therapy for Crohn’s disease has experienced a remarkable change due to the introduction of biologic therapy, and particularly the use of anti-tumour necrosis factor-alpha agents. Infliximab, adalimumab, and certolizumab pegol have demonstrated efficacy for induction and maintenance of remission in active Crohn’s disease. These agents have raised the bar for what is a suitable symptomatic response in Crohn’s disease and modification of the natural history of the disease has become a major goal in the treatment of Crohn’s disease. There are several data in the literature that suggest that early use of biologic therapy and achievement of mucosal healing contribute to disease course modification. However, many questions on early biological therapy for Crohn’s disease remain still unanswered.

关键词： Biologic therapy Crohn's disease Corticosteroids Immunomodulators

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Predictors of bowel damage in the long-term progression of Crohn’s disease

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World Journal of Clinical Cases 2022年第33期10卷 12208-12220页

作者： Agnes Fernández-Clotet Julian Panés Elena Ricart Jesús Castro-Poceiro Maria Carme Masamunt sonia Rodríguez Berta Caballol ingrid ordás Jordi Rimola Department of Gastroenterology Hospital ClinicBarcelona 08036Spain Universitat de Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS)Barcelona 08036Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHDMadrid 28029Spain Department of Radiology Hospital ClinicBarcelona 08036Spain

BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disorder that progresses to bowel damage(BD)over *** image-based index,the Lémann index(LI),has been developed to measure cumulative *** To characterize the long-term progression of BD in CD based on changes in the LI and to determine risk factors for long-term *** This was a single-center longitudinal cohort *** who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as a gold standard and who had a follow-up of at least 5 years were reevaluated after 5-12 *** seventy-two patients were *** increased in 38 patients(52.8%),remained unchanged in 9 patients(12.5%),and decreased in 25 patients(34.7%).The small bowel score and surgery subscale significantly increased(P=0.002 and P=0.001,respectively),whereas the fistulizing subscale significantly decreased(P=0.001).Baseline parameters associated with BD progression were ileal location(P=0.026),CD phenotype[stricturing,fistulizing,or both(P=0.007,P=0.006,and P=0.035,respectively)],disease duration>10 years(P=0.019),and baseline LI stricturing score(P=0.049).No correlation was observed between BD progression and baseline clinical activity,biological markers,or severity of endoscopic *** BD,as assessed by the LI,progressed in half of the patients with CD over a period of 5-12 *** main determinants of BD progression were ileal location,stricturing/fistulizing phenotype,and disease duration.

关键词： Crohn’s disease Lémann index Bowel damage Inflammatory bowel disease Magnetic resonance imaging

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Impact of mass screening for gluten-sensitive enteropathy in working population

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World Journal of Gastroenterology 2009年第11期15卷 1331-1338页

作者： Meritxell Mariné Fernando Fernández-Baares Montserrat Alsina Carme Farré Montserrat Cortijo Rebeca santaolalla Antonio salas Margarita Tomàs Elias Abugattas Carme Loras ingrid ordás Josep M Viver Maria Esteve Department of Gastroenterology University Hospital of Mútua de TerrassaResearch Foundation Mútua de TerrassaUniversity of Barcelona08221 TerrassaCataloniaSpain Department of Immunology(Catlab) University Hospital of Mútua de TerrassaResearch Foundation Mútua de TerrassaUniversity of Barcelona08221 TerrassaCataloniaSpain Department of Biochemistry Sant Joan de DéuHospitalEsplugues08950 CataloniaSpain Occupational Health Department Egarsat(Prevention Society)Sant Cugat del Vallès08173 CataloniaSpain Department of Pathology University Hospital of Mútua de TerrassaResearch Foundation Mútua de TerrassaUniversity of Barcelona08221 TerrassaCataloniaSpain

AIM:To assess:(1)frequency and clinical relevanceof gluten sensitive enteropathy(GsE)detected by serology in a mass screening program;(2)sensitivity of antitransglutaminase(tTGA)and antiendomysium antibodies(EmA);and(3)adherence to gluten-free diet(GFD)and follow-up. METHODs:One thousand,eight hundred and sixtyeight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive,duodenal biopsy,DQ2/DQ8 genotyping, clinical feature recording,blood tests,and densitometry were ***>98%of individuals had tTGA s value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same *** to a GFD and follow up were registered. REsULTs:Twenty-six(1.39%)subjects had positive tTGA and/or EmA,and 21 underwent biopsy:six Marsh Ⅲ(oneⅢa,fourⅢb,oneⅢc),nine MarshⅠand six Marsh 0(frequency of GsE 1:125).The sensitivity of EmA for GsE was 46.6%(11.1%for MarshⅠ,100% for MarshⅢ),while for tTGA,it was 93.3%(88.8% for MarshⅠ,100%for MarshⅢ).All 15 patients with abnormal histology had clinical features related to ***ⅠandⅢsubjects had more abdominal pain than Marsh 0(P=0.029),and a similar trend was observed for distension and *** differences in the percentage of osteopenia were found between MarshⅠandⅢ(P=0.608).Adherence to follow-up was 69.2%.Of 15 GsE patients,66.7%followed a GFD with 80%responding to it. CONCLUsION:GsE in the general population is frequent and clinically relevant,irrespective of histological *** is the marker of *** screening programs are useful in identifying patients who can benefit from GFD and follow-up.

关键词： Antitransglutaminase and antiendomysiumantibodies Celiac disease Lymphocytic enteritis Massscreening

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Endoscopic response to tumor necrosis factor inhibitors predicts long term benefits in Crohn's disease

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World Journal of Gastroenterology 2019年第14期25卷 1764-1774页

作者： Ignacio Alfaro Maria Carme Masamunt Nuria Planell Alicia López-García Jesús Castro Marta Gallego Rebeca Barastegui Angel Giner Alejandro Vara Azucena salas Elena Ricart Julián Panés ingrid ordás Gastroenterology Department Hospital Clínic de Barcelona Institut d'Investigacions Biomèdiques August Pi i sunyer (IDIBAPs) University of Barcelona

BACKGROUND Identifying predictors of therapeutic response is the cornerstone of personalized *** To identify predictors of long-term mucosal healing(MH) in patients with Crohn's disease(CD) treated with tumor necrosis factor α(TNF-α) *** Prospective single center study. Consecutive patients with clinically active CD requiring treatment with a TNF-α inhibitor were included. A baseline segmental CD Endoscopic Index of severity(CDEIs) ≥ 10 in at least one segment or the presence of ulcerations were required for inclusion. Clinical, biological and endoscopic data were obtained at baseline, weeks 14 and 46. Endoscopic response(ER) was defined as a decrease ≥ 50% from baseline CDEIs and MH as partial CDEIs ≤ 5 in all *** Of 62 patients were included. At baseline, median CD Activity Index and CDEIs were 201 and 6.7, respectively with a significant reduction after one year of treatment(53 and 3.0 respectively, P s achieved ER and 34% MH. At week 46, the corresponding percentages were 52%and 44%. Baseline disease characteristics or biomarkers did not predict MH. A decrease from baseline CDEIs at week 14 of at least 80% was the best predictor of MH at week 46(59% sensitivity and 91% specificity; area under the curve =0.778).CONCLUsION Clinical and biomarker data are not useful predictors of response to TNF-αinhibitors in CD, whereas ER to induction therapy, defined as 80% reduction in global CDEIs, is a robust predictor of long-term MH. Achievement of this endoscopic endpoint may be considered as a therapeutic target for anti-TNF-αtherapy.

关键词： Crohn’s disease Endoscopy Mucosal healing Crohn’s Disease Endoscopic Index of severity Tumor necrosis factor

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