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Smoking increases the risk of extraintestinal manifestations in Crohn's disease

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World Journal of Gastroenterology 2014年第34期20卷 12269-12276页

作者： Claudia Ott Angela Takses Florian Obermeier Elisabeth Schnoy Martina Müller Department of Internal Medicine I University of Regensburg93042 RegensburgGermany

AIM:To demonstrate a high prevalence of extraintestinal manifestations(EIMs)in a prospective populationbased cohort of inflammatory bowel disease(IBD)patients at first diagnosis as well as during the early course of the disease.METHODS:EIMs are common in patients with IBD.Data on the frequency of EIMs have mostly been assessed in patients from tertiary centers;however,data about the prevalence of EIMs at first diagnosis as well as factors influencing their incidence during the early course of disease from prospective population-based cohorts are scarce.We present data of patients of our population-based"Oberpfalz cohort"(Bavaria,Germany)from first diagnosis(up to 3 mo after first diagnosis)as well as during the early course of the disease.Possible risk factors were assessed by calculating the relative risk(RR)as well as using logistic regression analysis.RESULTS:In total,data of 257 newly diagnosed patients with IBD were evaluated[161 Crohn’s disease(CD),96 ulcerative colitis(UC)].Median duration of follow-up was 50 mo after first diagnosis.In 63.4%of all patients(n=163),an EIM was diagnosed at any point during the observation period.At first diagnosis,patients with CD had a significantly increased risk of an EIM[n=69(42.9%)]compared with UC patients[n=21(21.9%);P<0.001;RR=1.96;95%CI:1.30-2.98].Active smoking increased the risk of CD patients developing an EIM during the early course of the disease,but notably not of UC patients(P=0.046;RR=1.96;95%CI:1.01-3.79).In addition,using logistic regression analysis,the need for IBD-related surgery and a young age at first diagnosis were identified as risk factors for the development of an EIM in CD patients.No association with EIMs was found for the factors sex,localization of the disease and positive family history of IBD.In contrast,no key factors which increased the risk of development of an EIM could be identified in UC patients.CONCLUSION:We found a high prevalence of EIM in this cohort at first diagnosis and during the early course of the disease.In patients with C

关键词： extraintestinal manifestations Crohn’s disease Ulc

Inflammatory bowel disease: An increased risk factor for neurologic complications

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World Journal of Gastroenterology 2014年第5期20卷 1228-1237页

作者： Germán Morís Neurology Department Hospital Universitario Central Asturias

Only a very few systematic studies have investigated the frequency of neurologic disorders in patients with Crohn's disease(CD) and ulcerative colitis(UC), which are the two main types of inflammatory bowel disease(IBD). Results have been inconsistent and variable, owing to differences in case-finding methods and evaluated outcomes in different studies. The most frequent neurologic manifestations reported in CD and UC populations are cerebrovascular disease(with either arterial or venous events), demyelinating central nervous system disease, and peripheral neuropathy(whether axonal or demyelinating); however, the literature describes numerous nervous system disorders as being associated with IBD. The pathogenesis of nervous system tissue involvement in IBD has yet to be elucidated, although it seems to be related to immune mechanisms or prothrombotic states. The recently-introduced tumor necrosis factor(TNF) inhibitors have proven successful in controlling moderate to severe IBD activity. However, severe neurologic disorders associated with TNF inhibitors have been reported, which therefore raises concerns regarding the effect of anti-TNF-α antibodies on the nervous system. Although neurological involvement associated with IBD is rarely reported, gastroenterologists should be aware of the neurologic manifestations of IBD in order to provide early treatment, which is crucial for preventing major neurologic morbidity.

关键词： extraintestinal manifestations Inflamma-tory bowel

Extra-intestinal and long term consequences of Giardia duodenalis infections

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World Journal of Gastroenterology 2013年第47期19卷 8974-8985页

作者： Marie CM Halliez André G Buret Department of Biological Sciences Inflammation Research NetworkUniversity of CalgaryCalgaryAlbertaAB T2N 1N4Canada Parasitology Department Rouen University Hospital & EA 3800 Institute for Biomedical & Research University of RouenRouen76183France

Giardiasis is the most common waterborne parasitic infection of the human intestine worldwide.The etiological agent,Giardia duodenalis(syn.G.intestinalis,G.lamblia),is a flagellated,binucleated protozoan parasite which infects a wide array of mammalian hosts.Human giardiasis is a true cosmopolitan pathogen,with highest prevalence in developing countries.Giardiasis can present with a broad range of clinical manifestations from asymptomatic,to acute or chronic diarrheal disease associated with abdominal pain and nausea.Most infections are self-limiting,although re-infection and chronic infection can occur.Recent evidence indicating that Giardia may cause chronic post-infectious gastrointestinal complications have made it a topic of intense research.The causes of the post-infectious clinical manifestations due to Giardia,even after complete elimination of the parasite,remain obscure.This review offers a state-of-the-art discussion on the long-term consequences of Giardia infections,from extra-intestinal manifestations,growth and cognitive deficiencies,to post-infectious irritable bowel syndrome.The discussion also sheds light on some of the novel mechanisms recently implicated in the production of these postinfectious manifestations.

关键词： Giardiasis Inflammatory disorders extraintestinal manifestations of enteritis Failure to thrive Post-infectious irritable bowel syndrome

Hepatobiliary manifestations in inflammatory bowel disease: The gut,the drugs and the liver

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World Journal of Gastroenterology 2013年第42期19卷 7327-7340页

作者： María Rojas-Feria Manuel Castro Emilio Suárez Javier Ampuero Manuel Romero-Gómez Unit for Medical and Surgical Management of Digestive Diseases and CIBERehd Valme University HospitalUniversity of SevilleE-41014 SevillaSpain

Abnormal liver biochemical tests are present in up to30%of patients with inflammatory bowel disease(IBD),and therefore become a diagnostic challenge.Liver and biliary tract diseases are common extraintestinal manifestations for both Crohn’s disease and ulcerative colitis(UC),and typically do not correlate with intestinal activity.Primary sclerosing cholangitis(PSC)is the most common hepatobiliary manifestation of IBD,and is more prevalent in UC.Approximately 5%of patients with UC develop PSC,with the prevalence reaching up to 90%.Cholangiocarcinoma and colon cancer risks are increased in these patients.Less common disorders include autoimmune hepatitis/PSC overlap syndrome,IgG4-associated cholangiopathy,primary biliary cirrhosis,hepatic amyloidosis,granulomatous hepatitis,cholelithiasis,portal vein thrombosis,liver abscess,and non-alcoholic fatty liver disease.Hepatitis B reactivation during immunosuppressive therapy is a major concern,with screening and vaccination being recommended in serologically negative cases for patients with IBD.Reactivation prophylaxis with entecavir or tenofovir for 6to 12 mo after the end of immunosuppressive therapy is mandatory in patients showing as hepatitis B surface antigen(HBsAg)positive,independently from viral load.HBsAg negative and anti-HBc positive patients,with or without anti-HBs,should be closely monitored,measuring alanine aminotransferase and hepatitis B virus DNA within 12 mo after the end of therapy,and should be treated if the viral load increases.On the other hand,immunosuppressive therapy does not seem to promote reactivation of hepatitis C,and hepatitis C antiviral treatment does not influence IBD natural history either.Most of the drugs used for IBD treatment may induce hepatotoxicity,although the incidence of serious adverse events is low.Abnormalities in liver biochemical tests associated with aminosalicylates are uncommon and are usually not clinically relevant.Methotrexaterelated hepatotoxicity has been described in 14%of patients with IBD,in a dose-dependen

关键词： Inflammatory bowel disease Hepatobiliary disorders extraintestinal manifestations Primary sclerosing cholangitis Drug-induced liver injury Hepatotoxicity Hepatitis B Hepatitis C

Pancreatic disorders in inflammatory bowel disease

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World Journal of Gastrointestinal Pathophysiology 2016年第3期7卷 276-282页

作者： Filippo Antonini Raffaele Pezzilli Lucia Angelelli Giampiero Macarri Department of Gastroenterology A.Murri HospitalPolytechnic University of Marche Department of Digestive Diseases and Internal Medicine Sant’Orsola-Malpighi Hospital Medical Oncology Mazzoni Hospital

An increased incidence of pancreatic disorders either acute pancreatitis or chronic pancreatitis has been rec-orded in patients with inflammatory bowel disease(IBD) compared to the general population.Although most of the pancreatitis in patients with IBD seem to be related to biliary lithiasis or drug induced,in some cases pancreatitis were defined as idiopathic,suggesting a direct pancreatic damage in IBD.Pancreatitis and IBD may have similar presentation therefore a pancreatic disease could not be recognized in patients with Crohn's disease and ulcerative colitis.This review will discuss the most common pancreatic diseases seen in patients with IBD.

关键词： Pancreas Pancreatitis extraintestinal mani- festations Exocrine pancreatic insufficiency Ulcerative colitis Crohn’s disease Inflammatory bowel disease