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Computed tomography enterography-based radiomics for assessing mucosal healing in patients with small bowel Crohn's disease

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World Journal of Gastroenterology 2025年第3期31卷 62-72页

作者： Hao Ding Yuan-Yuan Fang Wen-Jie Fan Chen-Yu Zhang Shao-Fei Wang Jing Hu Wei Han Qiao Mei Department of Gastroenterology The First Affiliated Hospital of Anhui Medical UniversityHefei 230022Anhui ProvinceChina Department of Radiation Oncology The First Affiliated Hospital of Anhui Medical UniversityHefei 230022Anhui ProvinceChina Department of Gastroenterology Suzhou First People's HospitalSuzhou 234099Anhui ProvinceChina

BACKGROUND mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD ***,it poses a significant challenge due to its limited accessibility through conventional endoscopic *** To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD *** Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic *** demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic *** diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),*** Of the 73 patients enrolled,25 patients achieved *** radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by *** These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.

关键词： Crohn’s disease Computed tomography enterography mucosal healing Nomogram Radiomics

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Effect of Modulen vs budesonide on clinical response and mucosal healing in Crohn’s patients

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World Journal of Gastroenterology 2025年第5期31卷 84-93页

作者： Baruch Ovadia Eva Niv Sara Stern Katie Elisabeth Mahajna Oren Gal Yael Kopelman Department of Gastroenterology Hillel Yaffe Medical CenterHadera 38100HaifaIsrael Faculty of Medicine Technion-Israel Institute of TechnologyHadera 38100HaifaIsrael Department of Gastroenterology Meuhedet Health ServicesHadera 38100HaifaIsrael

BACKGROUND mucosal healing has become an important goal of Crohn’s disease(CD)***,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate ***,their effects on the small bowel(SB)mucosa remain *** To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule *** Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of ***,laboratory,and endoscopic responses were *** mucosal changes were assessed through SB capsule *** Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory ***,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide *** Both interventions have a role in CD ***,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.

关键词： Crohn’s disease Modulen oral polymeric diet Transforming growth factor-beta 2 Budesonide mucosal healing Clinical response Capsule endoscopy Small bowel capsule

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mucosal healing and inflammatory bowel disease:Therapeutic implications and new targets

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World Journal of Gastroenterology 2023年第7期29卷 1157-1172页

作者： Megan Lynn Otte Raju Lama Tamang Julia Papapanagiotou Rizwan Ahmad Punita Dhawan Amar B Singh Department of Pathology and Microbiology University of Nebraska Medical CenterOmahaNE 68198United States Department of Biochemistry and Molecular Biology University of Nebraska Medical CenterOmahaNE 68198United States

mucosal healing(MH)is vital in maintaining homeostasis within the gut and protecting against injury and *** factors and signaling pathways contribute in a dynamic and coordinated manner to maintain intestinal homeostasis and mucosal regeneration/***,when intestinal homeostasis becomes chronically disturbed and an inflammatory immune response is constitutively active due to impairment of the intestinal epithelial barrier autoimmune disease results,particularly inflammatory bowel disease(IBD).Many proteins and signaling pathways become dysregulated or impaired during these pathological conditions,with the mechanisms of regulation just beginning to be ***,there remains a relative lack of broadly effective therapeutics that can restore MH due to the complexity of both the disease and healing processes,so tissue damage in the gastrointestinal tract of patients,even those in clinical remission,*** increased understanding of the molecular mechanisms of IBD and MH,tissue damage from autoimmune disease may in the future be ameliorated by developing therapeutics that enhance the body’s own healing *** this review,we introduce the concept of mucosal healing and its relevance in IBD as well as discuss the mechanisms of IBD and potential strategies for altering these processes and inducing MH.

关键词： Inflammation Injury/repair mucosal healing mucosal barrier Therapeutics Colitis

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Mechanism of Acupuncture and Moxibustion on Promoting mucosal healing in Ulcerative Colitis

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Chinese Journal of Integrative Medicine 2023年第9期29卷 847-856页

作者： LI Han YE Xiao-feng SU Yang-shuai HE Wei ZHANG Jian-bin ZHANG Qi ZHAN Li-bin JING Xiang-hong Department of Acupuncture and Moxibustion Changzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese MedicineChangzhouJiangsu Province213002China Nanjing University of Chinese Medicine Nanjing210023China Research Center of Meridians Institute of Acupuncture and MoxibustionChina Academy of Chinese Medical SciencesBeijing100700China Department of Acupuncture and Moxibustion the Second Affiliated Hospital of Nanjing University of Chinese MedicineNanjing211005China Liaoning University of Chinese Medicine Shenyang116600China

The latest guideline about ulcerative colitis(UC) clinical practice stresses that mucosal healing, rather than anti-inflammation, is the main target in UC clinical management. Current mucosal dysfunction mainly closely relates to the endoscopic intestinal wall(mechanical barrier) injury with the imbalance between intestinal epithelial cells(IECs) regeneration and death, as well as tight junction(TJ) dysfunction. It is suggested that biological barrier(gut microbiota), chemical barrier(mucus protein layer, MUC) and immune barrier(immune cells) all take part in the imbalance, leading to mechanical barrier injury. Lots of experimental studies reported that acupuncture and moxibustion on UC recovery by adjusting the gut microbiota, MUC and immune cells on multiple targets and pathways, which contributes to the balance of IEC regeneration and death, as well as TJ structure recovery in animals. Moreover, the validity and superiority of acupuncture and moxibustion were also demonstrated in clinic. This paper aims to review the achievements of acupuncture and moxibustion on mucosal healing and analyse the underlying mechanisms.

关键词： acupuncture and moxibustion ulcerative colitis mucosal healing intestinal epithelial cells regeneration and death tight junction function gut microbiota review

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Ulcerative colitis patients in clinical remission demonstrate correlations between fecal immunochemical test results, mucosal healing, and risk of relapse

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World Journal of Gastroenterology 2016年第21期22卷 5079-5087页

作者： Asuka Nakarai Jun Kato Sakiko Hiraoka Shiho Takashima Daisuke Takei Toshihiro Inokuchi Yuusaku Sugihara Masahiro Takahara Keita Harada Hiroyuki Okada Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Second Department of Internal Medicine Wakayama Medical University Department of Endoscopy Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences

AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) ***: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores (MESs) and FIT ***: Patients with an MES of 0 (n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3 (n = 100, 52%) (HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result (fecal hemoglobin concentrations ≤ 100 ng/mL) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score (HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse (HR = 0.11, 95%CI: 0.04-0.23).CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing (MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.

关键词： Ulcerative colitis Clinical remission mucosal healing Mayo endoscopic subscore Quantitative fecal immunochemical test

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Thalidomide induces mucosal healing in Crohn's disease: Case report

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World Journal of Gastroenterology 2011年第45期17卷 5028-5031页

作者： Márcio Rios Leite Sandra Sousa Santos André Castro Lyra Jaciane Mota Genoile Oliveira Santana Department of Gastroenterology Prof. Edgard Santos University Hospital Federal University of Bahia Salvador Department of Gastrohepatology So Rafael Hospital Monte Tabor Foundation So Marcos Avenue

Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract that is defi ned by relapsing and remitting episodes. Tumor necrosis factor alpha (TNF-α) appears to play a central role in the pathophysiology of the disease. Standard therapies for inflammatory bowel disease fail to induce remission in about 30% of patients. Biological therapies have been associated with an increased incidence of infections, especially infection by Mycobacterium tuberculosis (Mtb). Thalidomide is an oral immunomodulatory agent with anti-TNF-α properties. Recent studies have suggested that thalidomide is effective in refractory luminal and fistulizing Crohn's disease. Thalidomide costimulates T lymphocytes, with greater effect on CD8+ than on CD4+ T cells, which contributes to the protective immune response to Mtb infection. We present a case of Crohn's disease with gastric, ileal, colon and rectum involvement as well as steroid dependency, which progressed with loss of response to infliximabafter three years of therapy. The thorax computed tomography scan demonstrated a pulmonary nodule suspected to be Mtb infection. The patient was started on thalidomide therapy and exhibited an excellent response.

关键词： Anti-tumor necrosis factor alpha Crohn’s disease mucosal healing Mycobacterium tuberculosis Thalidomide

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Systemic interleukin-9 in inflammatory bowel disease: Association with mucosal healing in ulcerative colitis

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World Journal of Gastroenterology 2017年第22期23卷 4039-4046页

作者： Malgorzata Matusiewicz Katarzyna Neubauer Iwona Bednarz-Misa Sabina Gorska Malgorzata Krzystek-Korpacka Department of Medical Biochemistry Wroclaw Medical University Department of Gastroenterology and Hepatology Wroclaw Medical University Laboratory of Medical Microbiology Ludwik Hirszfeld Institute of Immunology and Experimental TherapyPolish Academy of Sciences

To evaluate circulating IL9 in inflammatory bowel disease and disease-associated anemia/cachexia and assess its potential as a mucosal healing *** IL9 as well as other cytokines (IL1β, IL6, IL13, IFNγ, TNFα, and VEGF-A) were determined in 293 individuals: 97 patients with Crohn’s disease (CD) and 74 with ulcerative colitis (UC) and in 122 apparently healthy controls. The clinical activity of CD and UC was expressed in terms of the Crohn’s Disease Activity Index (CDAI) and the Mayo Scoring System (MDAI), respectively, and the severity of bowel inflammation in UC patients was assessed using Mayo endoscopic score. Cytokine concentrations were measured by a flow cytometry-based method using Luminex xMAP® technology. High-sensitive C-reactive protein concentrations (hsCRP) were determined in CD and UC patients using the enhanced immunoturbidimetric *** IL9 was significantly lower in healthy individuals [9 pg/mL (95%CI: 8.2-10)] than in patients with inflammatory bowel disease (IBD): both inactive [14.3 pg/mL (11.9-19.9)] and active [27.6 pg/mL (24.5-32), P mucosal healing (MH), IL9 had an accuracy superior to hsCRP and IL6 [97% (P < 0.0001), 67% (P = 0.071), and 55% (P = 0.525), respectively]. IL9 was significantly higher in cachectic IBD patients [30.25 pg/mL (24.4-37.5) vs 21.88 pg/mL (18-26.5), P = 0.026] and negatively correlated with hemoglobin concentrations (ρ = -0.27, P < 0.001). Multiple regression showed IL1β and IL13 to be the independent predictors of circulating IL9 in healthy individuals, IFNγ

关键词： Interleukin 9 mucosal healing Biomarker Inflammatory bowel disease Crohn’s disease Ulcerative colitis Cachexia Anemia

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Surrogate markers of mucosal healing in inflammatory bowel disease:A systematic review

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World Journal of Gastroenterology 2021年第16期27卷 1828-1840页

作者： Monica State Lucian Negreanu Theodor Voiosu Andrei Voiosu Paul Balanescu Radu Bogdan Mateescu Department of Gastroenterology Colentina Clinical HospitalBucharest 020125Romania Department of Gastroenterology Emergency University HospitalBucharest 050098Romania Carol Davila University of Medicine and Pharmacy Bucharest 020021Romania Department of Internal Medicine and Research Methodology Colentina Clinical HospitalBucharest 020125Romania

mucosal healing(MH)has emerged as a key therapeutic target in inflammatory bowel disease(IBD),and achievement of this goal is documented by endoscopy with ***,colonoscopy is burdensome and invasive,and substitution with an accurate noninvasive biomarker is *** To summarize published data regarding the performance of noninvasive biomarkers in assessing MH in IBD *** We conducted a systematic review of studies that reported the performance of biomarkers in diagnosing MH in patients with *** main outcome measure was to review the diagnostic accuracy of serum and fecal markers that showed promising utility in assessing *** We screened 1301 articles,retrieved 46 manuscripts and included 23 articles for full-text *** majority of the included manuscripts referred to fecal markers(12/23),followed by circulatory markers(8/23);only 3/23 of the included manuscripts investigated combined markers(serum and/or fecal markers).Fecal calprotectin(FC)was the most investigated fecal marker for assessing *** ulcerative colitis,for cutoff levels ranging between 58 mcg/g and 490 mcg/g,the sensitivity was 89.7%-100%and the specificity was 62%-93.3%.For Crohn’s disease,the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g(sensitivity 50%-95.9%and specificity 52.3%-100%).The best performance for a serum marker was observed for the endoscopic healing index,which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive *** Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization assessing *** ulcerative colitis,for cutoff levels ranging between 58 mcg/g and 490 mcg/g,the sensitivity was 89.7%-100%and the specificity was 62%-93.3%.For Crohn’s disease,the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g(sensitivity 50%-95.9%and specificity 52.3%-100%).The bes

关键词： Inflammatory bowel disease Ulcerative colitis Crohn’s disease Biomarkers Serum Fecal mucosal healing

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Fecal calprotectin and endoscopic scores: The cornerstones in clinical practice for evaluating mucosal healing in inflammatory bowel disease

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World Journal of Gastroenterology 2024年第24期30卷 3022-3035页

作者： Marcia Henriques de Magalhães Costa Ligia Yukie Sassaki Júlio Maria Fonseca Chebli Department of Clinical Medicine Fluminense Federal UniversityRio de Janeiro 24210-200Brazil Department of Internal Medicine Medical SchoolSão Paulo State University(Unesp)Botucatu 18618-686São PauloBrazil Division of Gastroenterology Department of MedicineUniversity Hospital of The Federal University of Juiz de ForaUniversity of Juiz de Fora School of MedicineJuiz de Fora 36036-247Minas GeraisBrazil

Managing inflammatory bowel disease(IBD)is becoming increasingly complex and personalized,considering the advent of new advanced therapies with distinct mechanisms of *** mucosal healing(MH)is a pivotal therapeutic goal in IBD management and can prevent IBD progression and reduce flares,hospitalization,surgery,intestinal damage,and colorectal *** proactive disease and therapy assessment is essential to achieve better control of intestinal inflammation,even if subclinical,to alter the natural course of *** monitoring of fecal calprotectin(FC)levels and interval endoscopic evaluations are cornerstones for evaluating response/remission to advanced therapies targeting IBD,assessing MH,and detecting subclinical ***,we comment on the article by Ishida et al Moreover,this editorial aimed to review the role of FC and endoscopic scores in predicting MH in patients with ***,we intend to present some evidence on the role of these markers in future targets,such as histological and transmural *** prospective multicenter studies with a stricter MH criterion,standardized endoscopic and histopathological analyses,and virtual chromoscopy,potentially including artificial intelligence and other biomarkers,are desired.

关键词： Fecal calprotectin Endoscopic scores mucosal healing Histological healing Ulcerative colitis Inflammatory bowel diseases

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Fecal calprotectin measurement is a marker of shortterm clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2017年第41期23卷 7387-7396页

作者： Athanasios Kostas Spyros I Siakavellas Charalambos Kosmidis Anna Takou Joanna Nikou Georgios Maropoulos John Vlachogiannakos George V Papatheodoridis Ioannis Papaconstantinou Giorgos Bamias Department of Gastroenterology University of Athens Medical School Laiko General Hospital Bioche-mistry Department Laiko General Hospital 2nd Department of Surgery University of Athens Medical School Areteion General Hospital

AIM To evaluate the utility of fecal calprotectin(FC) in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease(IBD) *** All FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified. Data regarding the short-term(6 mo) course of the disease were extracted from the medical files. Exclusion criteria were defined as:(1) An established flare of the disease at the time of FC measurement,(2) Loss to follow up within 6 mo from baseline FC measurement, and,(3) Insufficient data on file. Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short term clinical relapse and/or the presence of mucosal *** We included 149 [Crohn's disease(CD) = 113, Ulcerative colitis(UC) = 36, male = 77] IBD patients in our study. Within the determined 6-month period post-FC measurement, 47(31.5%) had a disease flare. Among 76 patients who underwent endoscopy, 39(51.3%) had mucosal healing. Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up(481.0 μg/g, 286.0-600.0 vs 89.0, 36.0-180.8, P mucosal healing in endoscopy(69.0 μg/g, 30.0-128.0 vs 481.0, 278.0-600.0, in those with mucosal inflammation, median with IQR, P mucosal healing(174 μg/g with AUC = 0.956, sensitivity 91.9%, specificity 87.2%, P < 0.001). FC was better than CRP in

关键词： Fecal calprotectin Biomarker Inflammatory bowel disease mucosal healing Clinical outcome Relapse Ulcerative colitis Crohn’s disease

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