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Gastroenteric tube feeding: Techniques, problems and solutions

World Journal of Gastroenterology 2014年第26期20卷 8505-8524页

作者： Irina Blumenstein Yogesh M Shastri Jürgen Stein Department of Gastroenterology and clinical Nutrition Johann Wolfgang Goethe University Clinic Gastroenterology and clinical Nutrition Hospital Sachsenhausen crohn colitis clinical research center rheinmain

Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ***,despite the benefits and widespread use of enteral tube feeding,some patients experience *** review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding,together with associated complications and special *** conducted an extensive literature search on PubMed,Embase and Medline using index terms relating to enteral access,enteral feeding/nutrition,tube feeding,percutaneous endoscopic gastrostomy/jejunostomy,endoscopic nasoenteric tube,nasogastric tube,and refeeding *** literature showed common routes of enteral access to include nasoenteral tube,gastrostomy and jejunostomy,while complications fall into four major categories:mechanical,e.g.,tube blockage or removal;gastrointestinal,e.g.,diarrhea;infectious e.g.,aspiration pneumonia,tube site infection;and metabolic,e.g.,refeeding syndrome,*** the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route,gastrointestinal complications are without doubt the most *** associated with enteral tube feeding can be reduced by careful observance of guidelines,including those related to food composition,administration rate,portion size,food temperature and patient supervision.

关键词： Enteral tube feeding Percutaneous endoscopic gastrostomy Refeeding syndrome Enteral nutrition Buried bumper syndrome Nasoenteral tubes Colocutaneous fistulae

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Patients'perspectives on smoking and inflammatory bowel disease:An online survey in collaboration with European Federation of crohn's and Ulcerative colitis Associations

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World Journal of Gastroenterology 2020年第29期26卷 4343-4355页

作者： Catherine Le Berre Laura Loy Sanna Lönnfors Luisa Avedano Daniele Piovani Institut des Maladies de l'Appareil Digestif Nantes University HospitalNantes 44000France Department of Gastroenterology Humanitas Clinical and Research InstituteRozzanoMilan 20089Italy European Federation of crohn's and Ulcerative colitis Associations Brussels B-1000Belgium Department of Biomedical Sciences Humanitas UniversityPieve Emanuele MIMilan 20090Italy Humanitas clinical and research center-IRCCS MilanRozzano 20089Italy

BACKGROUNDSmoking has detrimental effects on crohn’s disease (CD) activity while data onulcerative colitis (UC) are conflicting. Little is known about the use and impact ofalternative smoking products in inflammatory bowel diseases (IBD).AIMTo understand the patients’ perceptions of the impact of smoking on their IBDand to assess differences between CD and UC *** questionnaire was developed by Philip Morris Products SA in cooperationwith European Federation of crohn's and Ulcerative colitis Associations. Thefinal survey questionnaire consisted of 41 questions divided in 8 categories: (1)Subject screener;(2) Smoking history;(3) Background information;(4) IBD diseasebackground;(5) Current disease status;(6) Current therapeutics and medications;and (7) Current nicotine/cigarettes use and awareness of the impacts of smokingon IBD. The questionnaire was submitted online from 4th November 2019 to 11th March 2020 through the European Federation of crohn's and Ulcerative colitisAssociations website to IBD patients who were current smokers or had a historyof *** total 1050 IBD patients speaking nine languages participated to the *** them, 807 (76.9%) patients declared to have ever smoked or consumed analternative smoking product, with a higher proportion of current cigarettesmokers among CD patients (CD: 63.1% vs UC: 54.1%, P = 0.012). About twothirdsof the participants declared to have ever stopped cigarette smoking andrestarted (67.0%), with a significantly higher proportion among UC patientscompared to CD patients (73.1% vs 62.0%, P = 0.001). We also found significantdifferences between CD and UC patients in the awareness of the healthconsequences of smoking in their disease and in the perceived impact of smokingon disease activity, for both cigarettes and alternative smoking *** survey found significant differences between CD and UC patients in bothawareness and perception of the impact of smoking on their diseas

关键词： Inflammatory bowel disease Ulcerative colitis crohn's disease Cigarettes Alternative smoking products Tobacco Nicotine Marijuana

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Colorectal cancer and dysplasia in inflammatory bowel disease

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World Journal of Gastroenterology 2008年第17期14卷 2662-2669页

作者： Timothy L Zisman David T Rubin clinical research Fellow in Gastro-enterology the University of Chicago Medical Center The University of Chicago Medical center

Both ulcerative colitis and crohn’s disease carry an increased risk of developing colorectal cancer. Established risk factors for cancer among patients with inflammatory bowel disease (IBD) include the younger age at diagnosis, greater extent and duration of disease, increased severity of inflammation, family history of colorectal cancer and coexisting primary sclerosing cholangitis. Recent evidence suggests that current medical therapies and surgical techniques for inflammatory bowel disease may be reducing the incidence of this complication. Nonetheless heightened vigilance and a careful, comprehensive approach to prevent or minimize the complications of invasive cancer are warranted in this unique cohort of patients. Current guidelines for the prevention and early detection of cancer in this high risk population are grounded in the concept of an inflammation-dysplasia- carcinoma sequence. A thorough understanding of the definition and natural history of dysplasia in IBD, as well as the challenges associated with detection and interpretation of dysplasia are fundamental to developing an effective strategy for surveillance and prevention, and understanding the limitations of the current approach to prevention. This article reviews the current consensus guidelines for screening and surveillance of cancer in IBD, as well as presenting the evidence and rationale for chemoprevention of cancer and a discussion of emerging technologies for the detection of dysplasia.

关键词： Cancer Dysplasia Inflammatory Bowel Disease Ulcerative colitis crohn's Disease Chemoprevention

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Prevalence of-and risk factors for work disability in Dutch patients with inflammatory bowel disease

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World Journal of Gastroenterology 2017年第46期23卷 8182-8192页

作者： Lieke M Spekhorst Bas Oldenburg Ad A van Bodegraven Dirk J de Jong Floris Imhann Andrea E van der Meulen-de Jong Marieke J Pierik Janneke C van der Woude Gerard Dijkstra Geert D'Haens Mark Lowenberg Rinse K Weersma Eleonora AM Festen 无 Department of Gastroenterology and Hepatology University of Groningen and University Medical Centre Groningen Department of Genetics University of Groningen and University Medical Centre Groningen Department of Gastroenterology and Hepatology University Medical Center Utrecht Department of Gastroenterology and Hepatology VU University Medical Center Department of Gastroenterology and Hepatology University Medical Center St. Radboud Department of Gastroenterology and Hepatology Leiden University Medical Center Department of Gastroenterology and Hepatology University Medical Center Maastricht Department of Gastroenterology and Hepatology Erasmus Medical Center Department of Gastroenterology and Hepatology Amsterdam Medical Center Parelsnoer Institute and the Dutch Initiative on crohn and colitis

AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD), and to assess risk factors associated with work *** For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability(sick leave, partial and full disability) and long-term full work disability(> 80% work disability for > 2 years).RESULTS Prevalence of work disability was higher in crohn's disease(CD)(29%) and ulcerative colitis(UC)(19%) patients compared to the general Dutch population(7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years,smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level(OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications(OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work *** The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.

关键词： Inflammatory bowel disease crohn’s disease Ulcerative colitis Work disability Health care costs

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Microscopic features of colorectal neoplasia in inflammatory bowel diseases

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World Journal of Gastroenterology 2014年第12期20卷 3164-3172页

作者： Aude Bressenot Virginie Cahn Silvio Danese Laurent Peyrin-Biroulet Department of pathology University Hospital of Nancy IBD center Division of GastroenterologyHumanitas Clinical and Research Center Inserm U954 and Department of Hepato-Gastroenterology University Hospital of Nancy

The risk of developing dysplasia leading to colorectal cancer (CRC) is increased in both ulcerative colitis and crohn’s disease. The prognosis of CRC may be poorer in patients with inflammatory bowel disease (IBD) than in those without IBD. Most CRCs, in general, develop from a dysplastic precursor lesion. The interpretation by the pathologist of the biopsy will guide decision making in clinical practice: colonoscopic surveillance or surgical management. This review summarizes features of dysplasia (or intraepithelial neoplasia) with macroscopic and microscopic characteristics. From an endoscopic (gross) point of view, dysplasia may be classified as flat or elevated (raised); from a histological point of view, dysplasia is separated into 3 distinct categories: negative for dysplasia, indefinite for dysplasia, and positive for dysplasia with low- or high-grade dysplasia. The morphologic criteria for dysplasia are based on a combination of cytologic (nuclear and cytoplasmic) and architectural aberrations of the crypt epithelium. Immunohistochemical and molecular markers for dysplasia are reviewed and may help with dysplasia diagnosis, although diagnosis is essentially based on morphological criteria. The clinical, epidemiologic, and pathologic characteristics of IBD-related cancers are, in many aspects, different from those that occur sporadically in the general population. Herein, we summarize macroscopic and microscopic features of IBD-related colorectal carcinoma.

关键词： Inflammatory bowel disease Dysplasia Colorectal cancer Microscopic features

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Risk of venous thromboembolism in children and adolescents with inflammatory bowel disease: A systematic review and meta-analysis

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World Journal of Gastroenterology 2022年第16期28卷 1705-1717页

作者： Xin-Yue Zhang Hai-Cheng Dong Wen-Fei Wang Yao Zhang Department of Traditional Chinese Medicine The Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhou 310005Zhejiang ProvinceChina

BACKGROUND A two-to three-fold increased risk of venous thrombotic events(VTE) has been demonstrated in patients with inflammatory bowel disease(IBD) compared to the general population, but less is known about the risk of VTE in child-and pediatric-onset IBD. In recent years, several studies have reported the rising incidence rate of VTE in juvenile patients with IBD, and the related risk factors have been *** To evaluate the risk of VTE in children and adolescents with *** Articles published up to April 2021 were retrieved from Pub Med, Embase, Cochrane Library, Web of Science, Sino Med, CNKI, and WANFANG. Data from observational studies and clinical work were extracted. The outcome was the occurrence of VTE according to the type of IBD. The available odds ratio(OR) and the corresponding 95% confidence interval(CI) were extracted to compare the outcomes. Effect size(P), odds ratio(OR), and 95%CI were used to assess the association between VTE risk and IBD disease. Subgroup analyses stratified by subtypes of VTE and IBD were *** Twelve studies(7450272 IBD patients) were included in the meta-analysis. Child and adolescent IBD patients showed increased VTE risk(P = 0.02, 95%CI: 0.01-0.03). Subgroup analyses stratified by IBD(ulcerative colitis(UC): P = 0.05, 95%CI: 0.03-0.06;crohn’s disease(CD): P = 0.02, 95%CI: 0.00-0.04) and VTE subtypes(portal vein thrombosis: P = 0.04, 95%CI: 0.02-0.06;deep vein thrombosis: P = 0.03, 95%CI: 0.01-0.05;central venous catheter-related thrombosis: P = 0.23, 95%CI: 0.00-0.46;thromboembolic events: P = 0.02, 95%CI: 0.01-0.03) revealed a significant correlation between VTE risk and IBD. Patients with IBD were more susceptible to VTE risk than those without IBD(OR = 2.99, 95%CI: 1.45-6.18). The funnel plot was asymmetric, suggesting the presence of significant publication bias. Pediatric and adolescent IBD patients have an increased VTE risk. UC and CD patients exhibited a high risk of VTE. The risk of VTE s

关键词： Thromboembolism Children Adolescents Ulcerative colitis crohn’s disease Meta-analysis

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Lack of correlation between Treg quantification assays in inflammatory bowel disease patients

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World Journal of Gastroenterology 2015年第11期21卷 3325-3329页

作者： Gunnar Brandhorst Darinka Todorova Petrova Sebastian Weigand Christoph Eberle Nicolas von Ahsen Jessica Schmitz Frank Christian Schultze Dirk Raddatz Michael Karaus Michael Oellerich Philip D Walson Department of clinical Chemistry University Medical Center Department of clinical Pharmacology University Medical Center Chronix Biomedical Clinics of Gastroen-terology and Endocrinology University Medical Center Department of Internal Medicine Evangelisches Krankenhaus G?ttingen--Weende

AIM:To compare the number of regulatory T-cells( Tregs) measured by flow cytometry with those obtained using a real-time quantitative PCR(q PCR) method in patients suffering from inflammatory bowel disease(IBD).METHODS:Tregs percentages obtained by both flow cytometry and q PCR methods in 35 adult IBD patients,18 out of them with crohn′s disease(CD)and 17 with ulcerative colitis(UC)were compared to each other as well as to scores on two IBD activity questionnaires using the Harvey Bradshaw Index(HBI)for CD patients and the Simple colitis clinical Activity Index(SCCAI)for UC *** Treg percentages by flow cytometry were defined as CD4+CD25highCD127lowFOXP3+cells in peripheral blood mononuclear cells,whereas the Treg percentages by q PCR method were determined as FOXP3 promoter demethylation in genomic ***:We found an average of 1.56%±0.78%Tregs by using flow cytometry,compared to 1.07%±0.53%Tregs by using q PCR in adult IBD *** were no significant correlations between either the percentages of Tregs measured by flow cytometry or q PCR and the HBI or SCCAI questionnaire scores in CD or UC patients,*** addition,there was no correlation between Treg percentages measured by q PCR and those measured by flow cytometry(r=-0.06,P=0.73;Spearman Rho).These data suggest that,either Treg-related immune function or the clinical scores in these IBD patients did not accurately reflect actual disease *** the cause(s)for these differences are more clearly defined,the resultssuggest caution in interpreting studies of Tregs in various inflammatory ***:The two methods did not produce equivalent measures of the percentage of total Tregs in the IBD patients studied which is consistent with the conclusion that Tregs subtypes are not equally detected by these two assays.

关键词： Regulatory T-cells Inflammatory bowel disease Croh

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IL-10 and TNF-α promoter haplotypes are associated with childhood crohn’s disease location

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World Journal of Gastroenterology 2009年第30期15卷 3776-3782页

作者： Rocio Sanchez Emile Levy Florin Costea Daniel Sinnett research center Sainte-Justine University health centerMontreal H3T 1C5Canada research center Sainte-Justine University health centerDepartment of NutritionUniversity of MontrealMontreal H3T 1C5Canada research center Sainte-Justine University health centerDepartment of PediatricsUniversity of MontrealMontreal H3T 1C5Canada

AIM： To determine the distribution and frequencies of the genotypes and haplotypes of the genes encoding for the glucocorticoid receptor （GR）, the tumor necrosis factor （TNF）-α and the interleukin （IL）-10 in childhood crohn＇s disease （CD） and to assess the impact of the corresponding DNA variants on clinical and disease phenotypes.METHODS： Ten variants in GR, TNF-a and IL-10 were genotyped in 113 childhood CD cases and 95 healthy subjects, both of French-Canadian origin.RESULTS： For the GR polymorphisms （R23K and N363S） and IL-10 variants in the 5＇flanking region （-1082 G 〉 A, -819 T 〉 C and -592 A 〉 C）, no difference was observed in allele and genotype frequencies between CD patients and controls. At the haplotype level, we found three IL-10 haplotypes previously described in Caucasians （GCC, ACC and ATA） and three novel haplotypes only present in IBD patients. When we analyzed the haplotype distribution with the anatomical location of the disease, the GCC haplotype was associated with the colonic and the ACC haplotype with the terminal ileum location, respectively. The genotyping of five polymorphisms in the promoter region of the TNF-α gene （-1031 T 〉 C, -863 A 〉 C, -857 T 〉 C, -308 A 〉 G and -238 A 〉 G） revealed a significant overrepresentation of homozygous -1031 CC among CD patients （OR = 9.9） and an association with the colonic location. For TNF-α, eleven haplotypes were inferred, including two frequent ones, TCCGG and CACGG, which were significantly observed more frequently in controls and cases, respectively.CONCLUSION： This is one of the first studies investigating the association between haplotype structure and disease location in a CD pediatric cohort. Our results will help to increase our understanding of the genetic determinants of childhood CD.

关键词： Haplotype Polymorphism crohn’s disease Glucocorticoid receptor Interleukin-10 Tumor necrosis factor-α

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Serum bile acid profiling reflects enterohepatic detoxification state and intestinal barrier function in inflammatory bowel disease

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World Journal of Gastroenterology 2009年第25期15卷 3134-3141页

作者： Carsten Gnewuch Gerhard Liebisch Thomas Langmann Benjamin Dieplinger Thomas Mueller Meinhard Haltmayer Hans Dieplinger Alexandra Zahn Wolfgang Stremmel Gerhard Rogler Gerd Schmitz Institute of clinical Chemistry and Laboratory Medicine Regensburg University Medical Center Institute of Human Genetics University of Regensburg Department of Laboratory Medicine Konventhospital Barmherzige Brueder Linz Division of Genetic Epidemiology Department of Medical GeneticsClinical and Molecular PharmacologyInnsbruck Medical University Department of Gastro-enterology University Hospital Heidelberg Department of Internal Medicine I Regensburg University Medical Center

AIM： To determine free and conjugated serum bile acid （BA） levels in inflammatory bowel disease （IBD） subgroups with defined clinical manifestations. METHODS： Comprehensive serum BA profiling was performed in 358 IBD patients and 310 healthy con- trols by liquid chromatography coupled to electrospray ionization tandem mass spectrometry. RESULTS： Serum levels of hyodeoxycholic acid, the CYP3A4-mediated detoxification product of the second- ary BA lithocholic acid （LCA）, was increased significantly in crohn＇s disease （CD） and ulcerative colitis （UC）, while most other serum BA species were decreased signifi- cantly. Total BA, total BA conjugate, and total BA glyco- conjugate levels were decreased only in CD, whereas total unconjugated BA levels were decreased only in UC. In UC patients with hepatobiliary manifestations, the conjugated primary BAs glycocholic acid, taurocholic acid, and glycochenodeoxycholic acid were as signifi- cantly increased as the secondary BAs LCA, ursodeoxy- cholic acid, and tauroursodeoxycholic acid compared to UC patients without hepatobiliary manifestations. Finally, we found that in ileocecal resected CD patients, the unconjugated primary BAs, cholic acid and chenode- oxycholic acid, were increased significantly compared to controls and patients without surgical interventions. CONCLUSION： Serum BA profiling in IBD patients that indicates impaired intestinal barrier function and increased detoxification is suitable for advanced diag- nostic characterization and differentiation of IBD sub- groups with defined clinical manifestations.

关键词： Bile acids Liquid chromatography Tandem mass spectrometry Inflammatory bowel disease crohn's disease Ulcerative colitis

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Positions of selective leukocytapheresis in the medical therapy of ulcerative colitis

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World Journal of Gastroenterology 2006年第47期12卷 7568-7577页

作者： Hiroyuki Hanai center for Gastroenterology and Inflammatory Bowel Disease research Hamamatsu South Hospital Hamamatsu Japan

Ulcerative colitis （UC） and crohn＇s disease （CD） are the major forms of idiopathic inflammatory bowel disease （IBD）. Both UC and CD are debilitating chronic disorders that afflict millions of individuals throughout the world with symptoms which impair function and quality of life. The etiology of IBD is inadequately understood and therefore, drug therapy has been empirical instead of being based on sound understanding of IBD pathogenesis. This is a major factor for poor drug efficacy and drug related side effects that often add to the disease complexity. The development of biologicals notably infliximab to intercept tumor necrosis factor （TNF）-α reflects some progress, albeit major concern about their side effects and lack of long-term safety and efficacy profiles. However, IBD seems to be perpetuated by inflammatory cytokines like TNF-α, interleukin （IL）-Iβ, IL-6 and IL-8 for which activated peripheral granulocytes and monocytes/macrophages （GH） are major sources. Further, in IBD, peripheral GHs are elevated with activation behavior, increased survival time and are found in vast numbers within the inflamed intestinal mucosa; they are suspected to be major factors in the immunopathogenesis of IBD. Hence, peripheral blood GMs should be appropriate targets of therapy. The Adacolumn is a medical device developed for selective depletion of GH by receptor-mediated adsorption （GHA）. clinical data show GMA, in patients with steroid dependent or steroid refractory UC, is associated with up to 85% efficacy and tapering or discontinuation of steroids, while in steroid nai＇ve patients （the best responders）, GHA spares patients from exposure to steroids. Likewise, GMA at appropriate intervals in patients at a high risk of clinical relapse suppresses relapse thus sparing the patients from the morbidity associated with IBD relapse. Further, GHA appears to reduce the number of patients being submitted to colectomy or exposure to unsafe immunosupressants. First UC episode, steroid

关键词： Inflammatory bowel disease Ulcerative colitis crohn's disease Selective leukocytapheresis Aclacolumn Intedeukin 10 Intefleukin-1 receptor antagonist

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