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Interventional inflammatory bowel disease:endoscopic therapy of complications of Crohn’s disease

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Gastroenterology Report 2022年第1期10卷 145-154页

作者： Bo Shen center for inflammatory bowel disease Columbia University Irving Medical Center/New York-Presbyterian HospitalNew YorkNYUSA

Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical ***,the main applications of interventional IBD are(i)strictures;(ii)fistulas and abscesses;(iii)bleeding lesions,bezoars,foreign bodies,and polyps;(iv)post-operative complications such as acute and chronic anastomotic leaks;and(v)colitis-associated *** endoscopic treatment modalities include balloon dilation,stricturotomy,strictureplasty,fistulotomy,incision and drainage(of fistula and abscess),sinusotomy,septectomy,banding ligation,clipping,polypectomy,endoscopic mucosal resection,and endoscopic submucosal *** field of interventional IBD is evolving with a better understanding of the underlying disease process,advances in endoscopic technology,and interest and proper training of next-generation IBD interventionalists.

关键词： Crohn’s disease complication balloon dilation endoscopy fistula fistulotomy sinusotomy stricture strictureplasty stricturotomy therapy

Acute duodenal Crohn's disease successfully managed with low-speed elemental diet infusion via nasogastric tube:A case report

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World Journal of Gastroenterology 2006年第4期12卷 649-651页

作者： TakayukiYamamoto MakiNakahigashi SatoruUmegae TatsushiKitagawa KoichiMatsumoto inflammatory bowel disease center Yokkaichi Social Insurance Hospital10-8 HazuyamachoYokkaichiMie 510-0016Japan

Duodenal Crohn＇s disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn＇s disease was successfully managed with low-speed elemental diet infusion through a nasogastric tube. A 28-year-old female developed acute duodenal Crohn＇s disease. Upper GI radiologic and endoscopic examinations showed a stricture in the duodenal bulb. Using the duodenal biopsy specimens, mucosal cytokine levels were measured; interleukin （IL）-1β, IL-6, IL-8, and tumor necrosis factor-α levels were remarkably elevated. For initial 2 wk, powdered mesalazine was orally given but it was not effective. For the next 2 wk, she was treated with low-speed elemental diet therapy using a commercially available ElentalTM, which was infused continuously through a nasogastric tube using an infusion pump. The tip of the nasogastric tube was placed at an immediate oral side of the pylorus. The infusion speed was 10 mL/h （usual speed, 100 mL/h）. After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment. Although our experience was limited, lowspeed elemental diet infusion through a nasogastric tube may be a useful treatment for acute duodenal Crohn＇s disease.

关键词： Cytokine Duodenal Crohn's disease Elemental diet Inflammation Stricture

Evolving role of endoscopy in inflammatory bowel disease:Going beyond diagnosis

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World Journal of Gastroenterology 2021年第20期27卷 2521-2530页

作者： Paulina Núñez F Noa Krugliak Cleveland Rodrigo Quera David T Rubin Department of Gastroenterology Inflammatory Bowel Disease ProgramClinica Universidad de los AndesSantiago 7620157RMChile Department of Gastroenterology Hospital San Juan de DiosSantiago 8350488RMChile University of Chicago medicine inflammatory bowel disease center ChicagoIL 60637United States

inflammatory bowel disease,encompassing Crohn’s disease(CD)and ulcerative colitis,are chronic immune-mediated inflammatory bowel diseases(IBD)that primarily affect the gastrointestinal tract with periods of activity and *** body of evidence exist to strengthen the prognostic role of endoscopic evaluation for both disease activity and severity and it remains the gold standard for the assessment of mucosal *** healing has been associated with improved clinical outcomes with prolonged remission,decreased hospitalization,IBD-related surgeries and colorectal cancer ***,endoscopic objectives in IBD have been incorporated as part of standard *** the known increased risk of colorectal cancer in IBD,although prevention strategies continue to develop,regular surveillance for early detection of neoplasia continue to be paramount in IBD patients’*** is thanks to evolving technology and visualization techniques that surveillance strategies are continuously *** endoscopic options in IBD have also been expanding,from surgery sparing therapies such as balloon dilation of fibrostenotic strictures in CD to endoscopic mucosal resection of neoplastic *** this review article,we discuss the current evidence on the use of endoscopy as part of standard of care of IBD,its role in surveillance of neoplasia,and the role of interventional endoscopic therapies.

关键词： inflammatory bowel disease Endoscopy Crohn’s disease Ulcerative colitis Therapeutic endoscopy Surveillance

Machine learning models and over-fitting considerations

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World Journal of Gastroenterology 2022年第5期28卷 605-607页

作者： Paris Charilaou Robert Battat Jill Roberts center for inflammatory bowel disease-Division of Gastroenterology&Hepatology Weill Cornell MedicineNew YorkNY 10021United States

Machine learning models may outperform traditional statistical regression algorithms for predicting clinical *** validation of building such models and tuning their underlying algorithms is necessary to avoid over-fitting and poor generalizability,which smaller datasets can be more prone *** an effort to educate readers interested in artificial intelligence and model-building based on machine-learning algorithms,we outline important details on crossvalidation techniques that can enhance the performance and generalizability of such models.

关键词： Machine learning Over-fitting Cross-validation Hyper-parameter tuning

Safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis therapy for ulcerative colitis

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World Journal of Gastroenterology 2006年第4期12卷 520-525页

作者： TakayukiYamamoto SatoruUmegae KoichiMatsumoto inflammatory bowel disease center Yokkaichi Social Insurance Hospital10-8 HazuyamachoYokkaichiMie 510-0016Japan

Active ulcerative colitis （UC） is frequently associated with infiltration of a large number of leukocytes into the bowel mucosa. Therefore, removal of activated circulating leukocytes by apheresis has the potential for improving UC. In Japan, since April 2000, leukocytapheresis using Adacolumn has been approved as the treatment for active UC by the Ministry of Health and Welfare. The Adacolumn is an extracorporeal leukocyte apheresis device filled with cellulose acetate beads, and selectively adsorbs granulocytes and monocytes/macrophages. To assess the safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis （GMCAP） for UC, we reviewed 10 open trials of the use of GMCAP to treat UC. One apheresis session （session time, 60 min） per week for five consecutive weeks （a total of five apheresis sessions） has been a standard protocol. Several studies used modified protocols with two sessions per week, with 90-min session, or with a total of 10 apheresis sessions. Typical adverse reactions were dizziness, nausea, headache, flushing, and fever. No serious adverse effects were reported during and after GMCAP therapy, and almost all the patients could complete the treatment course. GMCAP is safe and well-tolerated. In the majority of patients, GMCAP therapy achieved clinical remission or improvement. GMCAP is a useful alternative therapy for patients with steroid-refractory or -dependent UC. GMCAP should have the potential to allow tapering the dose of steroids, and is useful for shortening the time to remission and avoiding re-administration of steroids at the time of relapse. Furthermore, GMCAP may have efficacy as the first-line therapy for steroid-naive patients or patients who have the first attack of UC. However, most of the previous studies were uncontrolled trials. To assess a definite efficacy of GMCAP, randomized, doubleblind, sham-controlled trials are necessary. A serious problem with GMCAP is cost; a single session costs ￥145 000 （$1 300）. Ho

关键词： Clinical efficacy Granulocyte and monocyte adsorptive apheresis Leukocytapheresis Safety Ulcerative colitis

Endoscopic band ligation with hypertonic glucose cushion in the treatment of ileal pouch prolapse

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Gastroenterology Report 2021年第5期9卷 480-482,I0003页

作者： Bo Shen center for inflammatory bowel disease Columbia University Irving Medical Center-New York Presbyterian HospitalNew YorkNYUSA

Introduction Restorative proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical treatment of choice of patients with ulcerative colitis(UC)or familial adenomatous polyposis who require the removal of the *** this reconstructive surgery significantly improves patients’quality of life,post-operative structural,inflammatory,and functional complications are *** our Pouch center,we have noticed a growing number of patients presenting with dyschezia,feeling of incomplete evacuation,and frequent bowel movements.

关键词：高渗葡萄糖内镜套扎术 operative

Pouchitis and pre-pouch ileitis developed after restorative proctocolectomy for ulcerative colitis:A case report

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World Journal of Gastroenterology 2007年第4期13卷 643-646页

作者： Takashi Iwata Takayuki Yamamoto Satoru Umegae Koichi Matsumoto inflammatory bowel disease center and Department of Surgery Yokkaichi Social Insurance Hospital 10-8 Hazuyamacho Yokkaichi Mie 510-0016 Japan

We report a case of pouchitis and pre-pouch ileitis, and inflammation in the neo-terminal ileum proximal to the pouch, developed after restorative proctocolectomy for ulcerative colitis. A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. Computed tomography showed collection of feces in the pouch and proximal ileum. A drainage tube was placed in the pouch perianally, and purulent feces were discharged. With antibiotic treatment, her symptoms disappeared, but two weeks later, she repeatedly developed fever and abdominal pain along with anal bleeding. Pouchscopy showed mucosal inflammation in both the pouch and the pre-pouch ileum. The mucosal cytokine production was elevated in the pouch and pre-pouch ileum. With antibiotic and corticosteroid therapy, her symptoms were improved along with improvement of endoscopic inflammation and decrease of mucosal cytokine production. The fecal stasis with bacterial overgrowth is the major pathogenesis of pouchitis and pre-pouch ileitis in our case.

关键词： Mucosal cytokines Pouchitis Pre-pouchileitis Restorative proctocolectomy Ulcerative colitis

Oral vancomycin in the treatment of primary sclerosing cholangitis-associated pouchitis

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Gastroenterology Report 2021年第3期9卷 274-275,I0003页

作者： Bo Shen center for inflammatory bowel disease Columbia University Irving Medical CenterNew York Presbyterian HospitalNew YorkNYUSA

Introduction Pouchitis is a common complication in those with restorative proctocolectomy with ileal pouch–anal anastomosis(IPAA).Some patients may develop chronic antibiotic-refractory pouchitis and its management can be *** sclerosing cholangitis(PSC)has consistently been reported to be a risk factor for chronic *** with PSC-associated pouchitis and enteritis may represent a unique phenotype[1]that usually does not respond to conventional antibiotics,such as metronidazole and ***-associated pouchitis has been treated with budesonide[2].

关键词： pouchitis primary sclerosing cholangitis vancomycin

Crohn’s disease:Innate immunodeficiency?

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World Journal of Gastroenterology 2006年第42期12卷 6751-6755页

作者： Jesus K Yamamoto-Furusho Joshua R Korzenik Gastro-intestinal Unit and center for the Study of inflammatory bowel disease Massachusetts General Hospital and Harvard Medical School Boston MA 02114 United States

In the past, Crohn’s disease (CD) has been understood primarily as an immunologic disorder characterized by an abnormal T-cell response. Recent in vitro and in vivo data suggests that CD may instead be precipitated by innate immune dysfunction resulting from a combination of genetic and environmental factors. Some reports have demonstrated a defective immune response in a variety of other cellular components, including neutrophils, monocytes and dendritic cells. Recent studies of granulocyte-macrophage colony-stimulating factor (GM- CSF) in CD, aiming to stimulate the innate immune system with the conception that an innate immune defect underlies the development of the disease, have been demonstrated a clinical benefit and reinforce this evolving understanding of the disease.

关键词： Crohn's disease Innate immunity Immunodeficiency NOD2