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Estimation of quality of life in Cypriot patients with inflammatory bowel disease

World Journal of Gastroenterology 2017年第1期23卷 121-126页

作者： Maria Tsoukka Eleni Jelastopulu Giagkos Lavranos George Charalambous Postgraduate Program Health Management Frederick UniversityNicosiaCyprus University General Hospital of Larnaca Department of Public Health School of MedicineUniversity of Patras Department of Health sciences School of SciencesEuropean University General Hospital of Athens“Hippocratio”

AIM To investigate the health-related quality of life(HRQoL)of patients suffering with idiopathic inflammatory bowel disease(IBD).METHODs The Greek validated version of the short Inflammatory Bowel Disease Questionnaire was used for evaluating the quality of life of IBD patients.The questionnaire was distributed to 100 consecutive patients suffering from IBD and presenting for a clinic appointment at the endoscopy unit of Larnaca General Hospital during the period from October to November 2012.The criteria for participating in this study were constituted by the documented diagnosis of either ulcerative colitis(UC)or Crohn’s disease(CD)after endoscopy and histologic examination at least 6 months before the study,adult patients(18 years old or older),the capability of verbal communication and the patient’s written consent for attending this study.The majority of the questionnaires were completed by a nurse practitioner who specializesin IBD patient care.REsULTs Regarding the physical dimension in patients with UC,males scored significantly higher than females(4.2 vs3.4,P=0.023).Higher scores were also observed in UC patients younger than 35 or older than 50 years(4.0 and 4.2 vs 3.2,respectively,P=0.021).The psychological dimension revealed similar results in patients with UC,with males,and older ages scoring higher(5.0 vs 3.0,P=0.01 and 4.7 vs 2.7,Pspectively),whereas regarding CD higher scores were observed in married compared to unmarried(3.83vs 2.33,P=0.042).No statistical differences in any parameters in the social dimension were observed.Regarding the treatment of,patients with CD,overall higher scores were observed when treated with biological factors compared to standard therapy in all dimensions but with statistical significant difference in the social dimension(5.00 vs 3.25,P=0.045).CONCLUsION The study reveals a negative impact of IBD on HRQo L.Increased risks are age and gender in patients with UC and family status in patients with CD.

关键词： Crohn’ s 疾病生活的健康相关质量生活的质量短煽动性的肠疾病问询表 Ulcerative 大肠炎

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Fecal microbial transplant for the treatment of pediatric inflammatory bowel disease

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World Journal of Gastroenterology 2016年第47期22卷 10304-10315页

作者： Alice Yuxin Wang Jelena Popov Nikhil Pai Michael G DeG roote school of Medicine McM aster University Department of Pediatrics Division of Pediatric Gastroenterology Mc Master Children’s Hospital McM aster University Mc Master Integrative Neuroscience Discovery and study Graduate Program Mc Master University

The role of fecal microbial transplant(FMT) in the treatment of pediatric gastrointestinal disease has become increasingly popular among pediatric practitioners, patients, and parents. The success of FMT for the treatment of recurrent Clostridium difficile infection(RCDI) has bolstered interest in its potential application to other disease states, such as inflammatory bowel disease(IBD). FMT has particular interest in pediatrics, given the concerns of patients and parents about rates of adverse events with existing therapeutic options, and the greater cumulative medication burden associated with childhoodonset disease. Published literature on the use of FMT in pediatrics is sparse. Only 45 pediatric patients treated for RCDI have been reported, and only 27 pediatric patients with pediatric IBD. The pediatric microbiome may uniquely respond to microbial-based therapies. This review will provide a comprehensive overview of fecal microbial transplant and its potential role in the treatment of pediatric inflammatory bowel disease. We will discuss the microbiome in pediatric inflammatory bowel disease, existing adult and pediatric literature on the use of FMT in IBD treatment, and pediatric FMT trials that are currently recruiting patients. This review will also discuss features of the microbiome that may be associated with host response in fecal transplant, and potential challenges and opportunities for the future of FMT in pediatric IBD treatment.

关键词：煽动性的肠疾病 Microbiome Microbiota 烘便微生物引起移植小儿科 Crohn’ s 疾病 Ulcerative 大肠炎

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Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

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World Journal of Gastroenterology 2016年第40期22卷 8892-8904页

作者： James WT Toh Peter stewart Matthew JFX Rickard Rupert Leong Nelson Wang Christopher J Young Department of Colorectal surgery Concord Repatriation General Hospital south Western sydney Clinical school University of New South Wales Liverpool Hospital school of Medicine Western Sydney University Liverpool Hospital Ingham Institute of Applied Research Liverpool Hospital Discipline of surgery Sydney Medical School the University of Sydney Department of Gastroenterology Concord Repatriation General Hospital Department of Colorectal surgery Royal Prince Alfred Hospital

Despite advancements in medical therapy of Crohn's disease(CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD(and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

关键词：外科 Crohn’ s 疾病主要腹的外科 Perianal 煽动性的肠疾病结肠癌

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Reoperation in an adult female with "right-sided" Hirschsprung's disease complicated by refractory hypertension and cough

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World Journal of Gastroenterology 2016年第41期22卷 9235-9241页

作者： Zhi-Jian Wei Lei Huang A-Man Xu Department of Gastrointestinal surgery The First Affiliated Hospital of Anhui Medical University Hefei 230022 Anhui Province China German Cancer Research Center 69120 Heidelberg Germany Department of General surgery The Fourth Affiliated Hospital of Anhui Medical University Hefei 230000 Anhui Province China

Hirschsprung's disease(HD) is an intestinal malformation caused by the innate absence of ganglion cells in the neural plexus of the colorectal wall, and is most common in male infants. It is rare in adult, and is usually left-sided. Herein we reported based on the CARE guidelines a case of a 47-year-old adult female suffering from "right-sided" HD complicated by refractory hypertension and cough. The patient with a history of cesarean section and with digestive unfitness(abdominal pain, distention, and constipation) only since 20 years old had recurrence of HD after initial surgery due to the incomplete removal of the HD-affected bowel based on a diagnosis of "chronic ileus", leading to the relapse of the digestive symptoms and the emergence of some intractable circulatory and respiratory complications which could be hardly controlled by conservative treatment. During the long interval before coming to our department for help, she had been re-hospitalized for several times with various misdiagnoses and supplied merely with symptomatic treatment which could only achieve temporary symptomatic relief. At her admission to our department, the imaging examinations strongly indicated recurrent HD which was further supportedb y p a t h o l o g i c a l e x a m i n a t i o n s, a n d r i g h t h e m i-colectomy was performed to remove the remnant aganglionic intestinal segment. Intraoperative and postoperative pathology supported the completeness of the definitive resection. Post-operation, the patient's bowel motility significantly improved, and interestingly, the complications disappeared. For adult patients with long-term constipation combined with cough and hypertension, rare diseases like HD which requires definite surgery and which could be "right-sided" should not be overlooked. It is vital to diagnose and cure HD patients in childhood. Through the comparison of the two surgeries, it is noteworthy that for diagnosed HD, sufficient removal of the non-functional intestine confirmed by intraoperative pathology is essen

关键词：成年 Hirschsprung’ s 疾病操作肠塞痛长期的便秘高血压咳嗽关心

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sPECT-computed tomography in rats with TNBs-induced colitis: A first step toward functional imaging

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World Journal of Gastroenterology 2017年第2期23卷 216-223页

作者： Rachel Marion-Letellier Pierre Bohn Romain Modzelewski Pierre Vera Moutaz Aziz Charlène Guérin Guillaume savoye Céline savoye-Collet INsERM Unit UMR1073 Rouen University and Rouen University Hospital QUANTIF LITIs EA 4108 Rouen University and Rouen University Hospital service d’Anatomo-pathologie Rouen University Hospital Gastroenterology department Rouen University Hospital Radiology department Rouen University Hospital

AIM To assess the feasibility of sPECT-computed tomography(CT) in rats with trinitrobenzene sulfonic acid(TNBs)-induced acute colitis and confront it with model inflammatory characteristics.METHODs Colitis was induced in sprague-Dawley rats by intrarectal injection of TNBs(n = 10) while controls received vehicle(n = 10). sPECT-CT with intravenous injection of 10 MBq of 67Ga-Citrate was performed at day 2. sPECT-CT criteria were colon wall thickness andmaximal wall signal intensity. Laboratory parameters were assessed: colon weight:length ratio, colon cyclooxygenase-2 expression by western blot and histological inflammatory score.REsULTs Colon weight/length ratio, colon COX-2 expression and histological inflammatory score were significantly higher in the TNBs group than in the control group(P = 0.0296, P spectively). Pixel max tend to be higher in the TNBs group than in the control group but did not reach statistical significance(P = 0.0662). Maximal thickness is significantly increased in the TNBs group compared to the control group(P = 0.0016) while colon diameter is not(P = 0.1904). Maximal thickness and colon diameter were correlated to colon COX-2 expression(P = 0.0093, P = 0.009 respectively) while pixel max was not(P = 0.22). Maximal thickness was significantly increased when inflammation was histologically observed(P = 0.0043) while pixel max and colon diameter did not(P = 0.2452, P = 0.3541, respectively).CONCLUsION sPECT-CT is feasible and easily distinguished control from colitic rats.

关键词： Crohn’ s 疾病大肠炎大肠炎成像 Cyclooxygenase-2 计算 sPECT 的断层摄影术

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Factors associated with surgery in patients with intra-abdominal fistulizing Crohn's disease

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World Journal of Gastroenterology 2016年第47期22卷 10380-10387页

作者： shaul Yaari Ariel Benson Eyal Aviran Naama Lev Cohain Ran Oren Jacob sosna Eran Israeli IBD Unit Institute of Gastroenterology and Liver Diseases Hadassah-Hebrew University Medical Center Department of Radiology and Medical Imaging Hadassah-Hebrew University Medical Center

AIM To characterize radiological and clinical factors associated with subsequent surgical intervention in Crohn's disease(CD) patients with intra-abdominal fistulae.METHODs From a cohort of 1244 CD patients seen over an eight year period(2006 to 2014), 126 patients were identified as having intra-abdominal fistulae, and included in the study. Baseline patient information was collected from the medical records. Imaging studies were assessed for: anatomic type and number of fistulae; diameter of the inflammatory conglomerate; length of diseased bowel; presence of a stricture with pre-stenotic dilatation; presence of an abscess; lymphadenopathy; and the degree of bowel enhancement. Multivariate analysis for the prediction of abdominal surgery was calculated via Generalized Linear Models.REsULTs In total, there were 193 fistulae in 132 patients, the majority(52%) being entero-enteric. Fifty-nine(47%) patients underwent surgery within one year of the imaging study, of which 36(29%) underwent surgery within one month. Radiologic features that were associated with subsequent surgery included: multiple fistulae(P = 0.009), presence of stricture(P = 0.02), and an entero-vesical fistula(P = 0.01). Evidence of an abscess, lymphadenopathy, or intense bowel enhancement as well as C-reactive protein levels was not associated with an increased rate of surgery. Patients who were treated after the imaging study with combination immunomodulatory and anti-TNF therapy had significantly lower rates of surgery(P = 0.01). In the multivariate analysis, presence of a stricture [RR 4.5(1.23-16.3), P = 0.02] was the only factor that increased surgery rate.CONCLUsION A bowel stricture is the only factor predicting an increased rate of surgery. Radiological parameters may guide in selecting treatment options in patients with fistulizing CD.

关键词： Crohn’ s 疾病管代表性的成像 Intra 腹的外科磁性的回声成像计算断层摄影术扫描

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Molecular mechanism of action of anti-tumor necrosis factor antibodies in inflammatory bowel diseases

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World Journal of Gastroenterology 2016年第42期22卷 9300-9313页

作者： Ulrike Billmeier Walburga Dieterich Markus F Neurath Raja Atreya Medical Clinic 1 Friedrich-Alexander-Universit?t Erlangen-Nürnberg

Anti-tumor necrosis factor(TNF) antibodies are successfully used in the therapy of inflammatory bowel diseases(IBD). However, the molecular mechanism of action of these agents is still a matter of debate. Apart from neutralization of TNF, influence on the intestinal barrier function, induction of apoptosis in mucosal immune cells, formation of regulatory macrophages as well as other immune modulating properties have been discussed as central features. Nevertheless, clinically effective anti-TNF antibodies were shown to differ in their mode-of-action in vivo and in vitro. Furthermore, the anti-TNF agent etanercept is effective in the treatment of rheumatoid arthritis but failed to induce clinical response in Crohn's disease patients, suggesting different contributions of TNF in the pathogenesis of these inflammatory diseases. In the following, we will review different aspects regarding the mechanism of action of anti-TNF agents in general and analyze comparatively different effects of each antiTNF agent such as TNF neutralization, modulation of the immune system, reverse signaling and induction of apoptosis. We discuss the relevance of the membranebound form of TNF compared to the soluble form for the immunopathogenesis of IBD. Furthermore, we review reports that could lead to personalized medicine approaches regarding treatment with antiTNF antibodies in chronic intestinal inflammation, by predicting response to therapy.

关键词： Mucosal 免疫学薄板 propria mononuclear 房间 Crohn’ s 疾病 Ulcerative 大肠炎 Transmembrane 肿瘤坏死因素 Apoptosis

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Inter- and intraobserver agreement in computed tomography enterography in inflammatory bowel disease

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World Journal of Gastroenterology 2016年第45期22卷 10002-10008页

作者： Natally Horvat Camila Carlos Tavares Adriana Ribas Andrade Julia Campos sim?es Cabral Hilton Muniz Le?o Filho Angela Hissae Motoyama Caiado serli Kiyomi Nakao Ueda André Zonetti de Arruda Leite Aytan Miranda sipahi Manoel de souza Rocha Radiology Department Hospital das Clínicas da Faculdade de Medicina da Universidade de S?o Paulo Gastroenterology Department Lim 07 Hospital da Clínicas da Faculdade de Medicina da Universidade de S?o Paulo

AIM To evaluate intra- and interobserver agreement in imaging features in inflammatory bowel disease and comparison with fecal calprotectin(FC) levels.METHODs Our institutional computed tomography enterography(CTE) database was retrospectively queried to identify patients who underwent CTE from January 2014 to June 2015. Patient inclusion criteria were confirmed inflammatory bowel disease(IBD) and FC collected surgical treatment during this interval. The exclusion criterion was poor image quality. Two blinded abdominal radiologists, with 12 and 3 years of experience analyzed the CTE regarding localization(small bowel, colonic, both, or no disease detected);type of IBD(inflammatory, stenosing, fistulizing, > 1 pattern, or normal); and signs of active disease(present or absent). In 42 of 44 patients evaluated, routine CTE reports were made by one of the readers who reevaluated the CTEs ≥ 6 mo later, to determine the intraobserver agreement. FC was considered a sign of disease activity when it was higher than 250 μg/g.REsULTs Forty-four patients with IBD(38 with Crohn's disease and 6 with ulcerative colitis) were included. There was a moderate interobserver agreement regarding localization of IBD(k = 0.540), type of disease(k = 0.410) and the presence of active signs in CTE(k = 0.419). There was almost perfect intraobserver agreement regarding localization, type and signs of active disease in IBD. The k values were 0.902, 0.937 and 0.830, respectively. After a consensus between both radiologists regarding inflammatory activity in CTE, we found that 24(85.7%) of 28 patients who were classified with active disease had elevated FC, and six(37.5%) of 16 patients without inflammatory activity in CTE had elevated FC(P = 0.003). The correlation between elevated FC and the presence of active disease in CTE was significant(k = 0.495, P = 0.001).CONCLUsION We found almost perfect intraobserver and moderate interobserver agreement in the signs of active disease in CT

关键词： Crohn’ s 疾病 Ulcerative 大肠炎计算断层摄影术烘便的 calprotectin 煽动性的肠疾病活动

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systematic review: safety of balloon assisted enteroscopy in Crohn's disease

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World Journal of Gastroenterology 2016年第40期22卷 8999-9011页

作者： Ahilan Arulanandan Parambir s Dulai siddharth singh William J sandborn Denise Kalmaz Division of Gastro-enterology University of California San Diego

AIM To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy(BAE) in Crohn's disease(CD). METHODs systematic review(PROsPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy(DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease activity.REsULTs Per procedure perforation rate of diagnostic BAE in CD was 0.15%(95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications(0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12%(95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications(0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74%(95%CI: 0.85-3.55). Eighty-six percentof therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients. CONCLUsION Diagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

关键词： Crohn’ s 疾病汽球 Enteroscopy 安全穿孔苛评

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Potential model for differential diagnosis between Crohn's disease and primary intestinal lymphoma

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World Journal of Gastroenterology 2016年第42期22卷 9411-9418页

作者： Tian-Yu Zhang Yun Lin Rong Fan shu-Rong Hu Meng-Meng Cheng Mao-Chen Zhang Li-Wen Hong Xiao-Lin Zhou Zheng-Ting Wang Jie Zhong Department of Gastroenterology Ruijin Hospital Shanghai Jiaotong University School of Medicine

AIM To evaluate the usefulness of different parameters to differentiate Crohn's disease(CD) from primary intestinal lymphoma(PIL).METHODs The medical records of 85 patients with CD and 56 patients with PIL were reviewed retrospectively. Demographic, clinical, laboratory, endoscopic, and computed tomographic enterography(CTE) parameters were collected. The univariate value of each parameter was analyzed. A differentiation model was established by pooling all the valuable parameters. Diagnostic efficacy was analyzed, and a receiver operating characteristic(ROC) curve was plotted.REsULTs The demographic and clinical parameters that showed significant values for differentiating CD from PIL included age of onset, symptom duration, presence of diarrhea, abdominal mass, and perianal lesions(P se and serum β2-microglobulin levels suggested a PIL diagnosis(P scopic parameters that showed significant values for differentiating CD from PIL included multiple-site lesions, longitudinal ulcer, irregular ulcer,and intraluminal proliferative mass(P s that were useful in the identification of the two conditions included involvement of ≤ 3 segments, circular thickening of the bowel wall, wall thickness > 8 mm, aneurysmal dilation, stricture with proximal dilation, "comb sign", mass showing the "sandwich sign", and intussusceptions(P sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the differentiation model were 91.8%, 96.4%, 93.6%, 97.5%, and 88.5%, respectively. The cutoff value was 0.5. The area under the ROC curve was 0.989.CONCLUsION The differentiation model that integrated the various parameters together may yield a high diagnostic efficacy in the differential diagnosis between CD and PIL.

关键词：主要肠的淋巴瘤 Crohn’ s 疾病微分诊断内视镜检查法 CT enterography

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