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World Journal of Clinical Pediatrics 2024年第1期13卷 107-117页

作者： Krishanth Manokaran Jonathan Spaan Giulio Cataldo Christopher Lyons Paul D Mitchell Tatyana Sare LoriA Zimmerman Paul A Rufo center for inflammatory bowel disease Boston Children's HospitalBostonMA 02115United States Institutional centers for Clinical and Translational Research Boston Children's HospitalBostonMA 02115United States

BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this *** To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our *** A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron *** Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse *** Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.

关键词： Iron deficiency anemia Pediatric inflammatory bowel disease Intravenous iron therapy inflammatory bowel disease

Emerging treatments for complex perianal fistula in Crohn's disease

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World Journal of Gastroenterology 2009年第34期15卷 4263-4272页

作者： Carlos Taxonera David A Schwartz Damián García-Olmo inflammatory bowel disease Unit Department of GastroenterologyHospital Clínico inflammatory bowel disease center Vanderbilt University Medical Center Department of General Surgery "La Paz"University Hospital

Complex perianal fistulas have a negative impact on the quality of life of sufferers and should be *** diagnosis,characterization and classification of the fistulas are essential to optimize ***, in the case of patients whose fistulas are associated with Crohn's disease,complete closure is particularly difficult to *** medical treatments(antibiotics, thiopurines and other immunomodulatory agents,and, more recently,anti-tumor necrosis factor-αagents such as infliximab)have been tried with varying degrees of *** medical(including infliximab)and less aggressive surgical therapy(drainage and seton placement)offer the best outcomes in complex Crohn's fistulas while more aggressive surgical procedures such as fistulotomy or fistulectomy may increase the risk of *** review will focus on emerging novel treatments for perianal disease in Crohn's patients. These include locally applied infliximab or tacrolimus, fistula plugs,instillation of fibrin glue and the use of adult expanded adipose-derived stem cell *** welldesigned controlled studies are required to confirm the effectiveness of these emerging treatments.

关键词： Crohn's disease Perianal fistula Drug therapy Topical administration Infliximab Adalimumab Adipose tissue Stem cells

Prevention of recurrence after surgery for Crohn's disease: Efficacy of infliximab

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World Journal of Gastroenterology 2010年第43期16卷 5405-5410页

作者： Takayuki Yamamoto inflammatory bowel disease center and Department of Surgery Yokkaichi Social Insurance Hospital

After surgery for Crohn's disease (CD), early endoscopic lesions are frequently observed despite no symptomatic recurrence. The severity of lesions found at postoperative endoscopy is reported to be a strong predictive factor for future clinical recurrence. If endoscopic lesions in the early postoperative period can be reduced with medications, symptomatic recurrence will likely be delayed and decreased. Before the introduction of biologic therapies, various medications were used for the maintenance of clinical remission after surgery; however, few demonstrated consistent efficacy. Infliximab is a recombinant anti-tumor necrosis factor-α antibody. Although infliximab is one of the most effective medications in the management of CD, its efficacy for early endoscopic lesions after surgery has not yet been assessed. The author and colleagues recently conducted a prospective study in order to investigate the impact of infliximab on early endoscopic lesions after resection for CD. We found that infliximab therapy showed clear suppressive effects on clinical and endoscopic disease activity in patients with early endoscopic lesions after resection.

关键词： Crohn’s disease Postoperative recurrence Endoscopic lesion Infliximab

Impact of inflammatory bowel disease activity and thiopurine therapy on birth weight: A meta-analysis

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World Journal of Gastroenterology 2017年第45期23卷 8082-8089页

作者： Begona Gonzalez-Suarez Shreyashee Sengupta Alan C Moss Division of Gastroenterology Inflammatory Bowel Disease CenterBeth Israel Deaconess Medical Center

AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight(LBW) or small for gestational age(SGA) among pregnant women with IBD. Sixtynine abstracts were identified,35 papers were full text reviewed and,only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa *** This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria,and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD,when compared with women in remission: 1.3 for SGA(4 studies,95%CI: 1.0-1.6,P = 0.04) and 2.0 for LBW(4 studies,95%CI: 1.5-2.7,P disease activity there was no significant effect on LBW(RR 1.2,95%CI: 0.6-2.2,P = 0.6). No differences were observed regarding SGA(2 studies; RR 0.9,95%CI: 0.7-1.2,P = 0.5). CONCLUSION Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.

关键词： Pregnancy inflammatory bowel disease Thiopurines disease activity Low birth weight Small for gestational age

Immunopathogenesis of inflammatory bowel disease

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World Journal of Gastroenterology 2008年第3期14卷 390-400页

作者： David Q Shih Stephan R Targan Cedars-Sinai inflammatory bowel disease center Los Angeles CA United States Department of Medicine Division of Digestive Diseases University of California Los Angeles CA United States Cedars-Sinai inflammatory bowel disease center Los Angeles CA United States

Crohn＇s disease and ulcerative colitis are chronic relapsing immune mediated disorders that results from an aberrant response to gut luminal antigen in genetically susceptible host. The adaptive immune response that is then triggered was widely considered to be a T-helper-1 mediated condition in Crohn＇s disease and T-helpero2 mediated condition in ulcerative colitis. Recent studies in animal models, genome wide association, and basic science has provided important insights in in the immunopathogenesis of inflammatory bowel disease, one of which was the characterization of the interleukin-23/Th-17 axis.

关键词： Crohn's disease Ulcerative colitis Innate andadaptive immune system

Vedolizumab in the treatment of Crohn’s disease of the pouch

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Gastroenterology Report 2018年第3期6卷 184-188,I0002页

作者： Freeha Khan Xian-Hua Gao Amandeep Singh Jessica R.Philpott Bo Shen center for inflammatory bowel disease Digestive Disease and Surgery InstituteCleveland ClinicClevelandOHUSA

Background:Our recent study showed the efficacy and safety of vedolizumab in the treatment of chronic antibioticrefractory ***,there are no published studies on its efficacy and safety in Crohn’s disease(CD)of the *** aim of this study was to assess the efficacy and safety of vedolizumab in those ***:This case series included all eligible patients with CD of the pouch from our prospectivelymaintained,IRB-approved Pouchitis Registry from 2015 to *** activity in pouch patients can bemonitored using the modified Pouchitis disease Activity Index(mPDAI).mPDAI is the 18-point pouchitis disease activity index consisting of three principal component scores:symptom(range,0–6 points),endoscopy,(range 0–6 points),and histology(range,2–6 points).Pre-and post-treatment(minimum 6 months)pouchoscopy and clinical visits were used to calculate ***:A total of 12 patients were included in this study,who had restorative proctocolectomy with ileal pouch anal anastomosis for medically refractory ulcerative colitis(UC).The mean age at the time of pre-colectomy diagnosis of UC was 25.0611.5 *** mean current age was 41.0612.1 years,nine(75.0%)were female,three(25.0%)had smoked and eight(66.7%)had used anti-tumor necrosis factor agents prior to vedolizumab *** mean duration of vedolizumab use was 1.066.4 *** was a significant reduction in mPDAI symptom subscores after vedolizumab therapy(3.5061.93 vs 5.0860.79,P=0.015).The pre-and post-treatment mean endoscopy subscores were 1.2561.36 and 0.9161.50 in the afferent limb(P=0.583);2.5861.68 and 2.2762.05(P=0.701)in the pouch body;and 2.6761.93 and 2.0962.12(P=0.511)in the cuff,*** of the patients experienced side effects throughout the vedolizumab ***:The findings of our study suggests that vedolizumab appears to be effective and safe in reducing the symptoms in patients with CD of the pouch.

关键词： Anti-tumor necrosis factor agent Crohn’s disease ileal pouch restorative proctocolectomy vedolizumab

Precision medicine in inflammatory bowel disease

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Precision Clinical medicine 2024年第1期7卷 54-80页

作者： Zhen Zeng Mingshan Jiang Xi Li Jing Yuan Hu Zhang Department of Gastroenterology West China HospitalSichuan UniversityChengdu 610041China Centrefor inflammatory bowel disease West China HospitalSichuan UniversityChengdu 610041China Lab of inflammatory bowel disease Frontiers Science Center for Disease-Related Molecular NetworkWest China HospitalSichuan UniversityChengdu 610041China General Practice Ward/International Medical center Ward General Practice Medical CenterWest China HospitalSichuan UniversityChengdu 610041China

inflammatory bowel disease(IBD)is an incurable disease characterized by remission-relapse cycles throughout its *** Crohn's disease(CD)and ulcerative colitis(UC),the two main forms of IBD,exhibit tendency to develop complications and substantial heterogeneity in terms of frequency and severity of relapse,thus posing great challenges to the clinical management for *** treatment strategies are effective in different ways in induction and maintenance therapies for *** advances in studies of genetics,pharmacogenetics,proteomics and microbiome provide a strong driving force for identifying molecular markers of prognosis and treatment response,which should help clinicians manage IBD patients more effectively,and then,improve clinical outcomes and reduce treatment costs of *** this review,we summarize and discuss precision medicine in IBD,focusing on predictive markers of disease course and treatment response,and monitoring indices during therapeutic drug monitoring.

关键词： disease course inflammatory bowel disease precision treatment precision monitoring treatment response

inflammatory bowel disease:Genetic and epidemiologic considerations

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World Journal of Gastroenterology 2008年第3期14卷 338-347页

作者： Judy H Cho Director Inflammatory Bowel Disease Center Yale University New Haven CT 06519 United States

Genome-wide association studies have firmly established that many genomic loci contribute to inflammatory bowel disease, especially in Crohn’s disease. These studies have newly-established the importance of the interleukin 23 and autophagy pathways in disease pathogenesis. Future challenges include: (1) the establishment of precisely causal alleles, (2) definition of altered functional outcomes of associated and causal alleles and (3) integration of genetic findings with environmental factors.

关键词： Crohn's disease Ulcerative colitis Interleukin 23 Autophagy Complex genetics

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

Natural history of children with mild Crohn’s disease

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World Journal of Gastroenterology 2019年第30期25卷 4235-4245页

作者： Yamini Sharma Athos Bousvaros Enju Liu Julia Bender Stern Department of Gastroenterology and Hepatology Inflammatory Bowel Disease Center Boston Children’s Hospital

BACKGROUND There is a small and poorly studied population of patients with mild and limited Crohn’s disease(CD),who either spontaneously enter remission and can discontinue therapy,or be maintained on milder anti-inflammatory *** To identify a group of children with mild CD who were not escalated to immunomodulators(azathioprine,mercaptopurine,or methotrexate)or biologics(infliximab or adalimumab)within the first two years after their Crohn’s diagnosis and outline the natural history and phenotypic features of these *** In a retrospective chart review of the inflammatory bowel disease database at Boston Children’s Hospital we reviewed all the mild CD patient’s clinic visits,laboratory studies,and procedures for the duration of time they were followed at the *** were included if they had clear diagnosis of Crohn’s disease,and they were not escalated to immunosuppressive therapies for at least 2 years after the date of *** mild CD patients were compared to controls diagnosed at a similar time,that were treated with immunomodulators or *** that was abstracted included:Age at diagnosis,sex,disease location utilizing the Paris classification,medical treatment,surgical treatment,endoscopic findings,histology,and *** also analyzed differences in the phenotypic features between those with mild CD and those with moderate to severe *** Out of 1205 patients with CD diagnosed between 1990 and 2013,we identified 29 patients that met the inclusion criteria,and they were matched with 58 *** were no significant differences between the disease behaviors at presentation,with approximately 90%of patients in each group having inflammatory ***,patients with mild disease were more likely to have disease limited to the colon(31%vs 12%,P=0.03).In contrast,patients with moderate to severe disease(aka control group)were more likely to have ileocolonic disease(70%vs 45%in the mild grou

关键词： Crohn’s disease Colitis Aminosalicylates Antibiotics Immunosuppression inflammatory bowel disease Child Pediatric