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Best Practice & Research. Clinical Gastroenterology

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https://www.readbyqxmd.com/read/30060945/can-il-23-be-a-good-target-for-ulcerative-colitis
#1
REVIEW
Mariangela Allocca, Federica Furfaro, Gionata Fiorino, Daniela Gilardi, Silvia D'Alessio, Silvio Danese
A considerable percentage of patients with ulcerative colitis (UC) do not respond to therapies, including anti-tumor necrosis factor (TNF) drugs and vedolizumab, or lose response over time. Hence the continuing need to find new therapeutic strategies and novel drugs to control this chronic debilitating disease. Increased levels of interleukin (IL)-23 and T helper (Th) 17 cell cytokines have been found in intestinal mucosa, plasma, and serum of patients with inflammatory bowel disease (IBD). IL23-blocking has been shown to reduce the severity of inflammation in experimental colitis...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060944/can-we-move-directly-from-5-asa-to-a-biologic-agent-in-ulcerative-colitis
#2
REVIEW
Pieter Hindryckx, Gregor Novak
European consensus guidelines and reimbursement policies position biologic drugs for ulcerative colitis (UC) as a third-line treatment, after failure of 5-aminosalicylic acid (5-ASA) and corticosteroids/thiopurines. While 5-ASA have a very favorable safety profile, (prolonged) use of corticosteroids and thiopurines is associated with potentially serious adverse events. The therapeutic landscape of UC is rapidly evolving and selective biologic drugs with improved safety are being introduced. The first biosimilars have entered the market, leading to improved cost-effectiveness of older biologic drugs...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060943/jak-inhibitors-novel-developments-in-management-of-ulcerative-colitis
#3
REVIEW
Gionata Fiorino, Ferdinando D'Amico, Angelo Italia, Daniela Gilardi, Federica Furfaro, Silvio Danese
Janus kinase inhibitors are small molecules, orally administered, under development for the treatment of ulcerative colitis. These molecules reduce the immune response, blocking the signal transduction of multiple cytokines implicated in the activation of inflammation. Currently multiple JAK inhibitors are being evaluated in clinical trials. The aim of this review is to examine the efficacy and the safety of the JAK inhibitors being tested and to discuss the available data on the use of these drugs in moderate-to-severe ulcerative colitis, in order to understand how these new molecules can fit into the therapeutic algorithm of patients with ulcerative colitis...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060942/the-impact-of-biologics-in-surgical-outcomes-in-ulcerative-colitis
#4
REVIEW
Marjorie C Argollo, Paulo Gustavo Kotze, Antonino Spinelli, Tarcia N F Gomes, Silvio Danese
Ulcerative Colitis (UC) is an immune mediated condition characterized by inflammation of colonic mucosa, associated with progressive damage of the colon and possible complications, such as hemorrhage, perforation and cancer. It is strongly advocated a treat to target approach in patients with UC consisting in an early and aggressive inflammatory control. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. Even though the first line biologic therapy targeting the tumor necrosis factor-alfa (TNF-α) is associated with improvement of the inflammation in some patients, others do not respond at first or lose response over time...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060941/surgery-in-ulcerative-colitis-when-how
#5
REVIEW
Gaetano Gallo, Paulo Gustavo Kotze, Antonino Spinelli
Ulcerative Colitis (UC) is an idiopathic chronically-remitting inflammatory bowel disorder characterized by a contiguous inflammation of the colonic mucosa affecting the rectum that generally extends proximally in a continuous manner through the entire colon. Patients typically experience intermittent exacerbations, with symptoms characterized by bloody diarrhea associated with urgency and tenesmus. The anatomical extent of mucosal involvement is the most important factor determining disease course and is an important predictor of colectomy...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060940/acute-severe-ulcerative-colitis-state-of-the-art-treatment
#6
REVIEW
Javier P Gisbert, María Chaparro
Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition. In the present review, we give a broad overview of the state of the art in the management of this condition. A systematic bibliographic search was performed in PubMed. Patient with ASUC should be hospitalized and managed by a multidisciplinary team (gastroenterologist plus surgeon). Intravenous corticosteroids remain the cornerstone of medical therapy. However, about 30% of patients do not respond. After failing 3-5 days of corticosteroids, patients should be considered for either rescue medical therapy or for colectomy...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060939/the-treatment-of-refractory-ulcerative-colitis
#7
REVIEW
Guillaume Pineton de Chambrun, Barbara Tassy, Laura Kollen, Gaspard Dufour, Jean-Christophe Valats, Michael Bismuth, Natalie Funakoshi, Fabrizio Panaro, Pierre Blanc
Ulcerative proctitis is defined as a mucosal inflammation limited to the rectum. Ulcerative proctitis is responsible for distressing symptoms and alteration of patient quality of life. Effective treatment is important to prevent or delay proximal extension of the disease and to improve quality of life. Refractory ulcerative proctitis is defined as the failure of topical and oral 5-aminosalicylic acid and corticosteroids. Medical management of refractory ulcerative proctitis may be challenging as there is little evidence regarding drug efficacy in this clinical situation...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060938/safety-of-biological-therapies-in-ulcerative-colitis-an-umbrella-review-of-meta-analyses
#8
REVIEW
Stefanos Bonovas, Katerina Pantavou, Despo Evripidou, Anan Judina Bastiampillai, Georgios K Nikolopoulos, Laurent Peyrin-Biroulet, Silvio Danese
Biological agents have proven clinical efficacy in the treatment of ulcerative colitis (UC). Their adverse effects have also been studied in a substantial number of primary studies and meta-analyses. Given the large volume of information that has been published, the aim of this umbrella review was to effectively summarize the accumulated evidence from randomized controlled trials (RCTs) on the safety of biological therapies for UC into one accessible and usable document. Pubmed and Scopus databases were systematically searched through November 2017 to identify meta-analyses of RCTs that have investigated potential harms of biological agents (adalimumab, golimumab, infliximab, and vedolizumab) in patients with UC...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060937/biosimilars-in-ulcerative-colitis-when-and-for-who
#9
REVIEW
Akos Ilias, Lorant Gonczi, Zuszsanna Kurti, Peter L Lakatos
The introduction of biological agents has revolutionized the management of ulcerative colitis (UC). Biosimilars are considered to be equivalent to the reference biologic products in terms of pharmacokinetic properties, clinical effectiveness and safety and have now been approved in inflammatory bowel diseases (IBD). CT-P13 was the first biosimilar to infliximab that obtained regulatory approval by the EMA and US FDA. Accumulating data on biosimilars led to an increased acceptance amongst practicing gastroenterologists and their use can be associated with a potential reduction in healthcare costs...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060936/which-evidence-for-a-treat-to-target-strategy-in-ulcerative-colitis
#10
REVIEW
Aude Marchal Bressenot
The main therapeutic goal of in ulcerative colitis is to maintain disease remission. The new concept of deep remission implies also a complete mucosal healing. Histological assessment of disease in UC seems to be an important prognostic factor to predict disease outcome. In this article we review current definitions of mucosal healing, histological healing, histological remission and available histological scores assessing histological activity of disease in ulcerative colitis. Comparison between mucosal healing and histological remission shows that histological remission is a better prognostic factor than mucosal healing to predict outcome in ulcerative colitis and could be a new therapeutic goal in ulcerative colitis but actually histology is not a target due to lack of evidence of clinical utility...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060935/should-we-use-vedolizumab-as-mono-or-combo-therapy-in-ulcerative-colitis
#11
REVIEW
Charlotte Hedin, Jonas Halfvarson
Randomized controlled trials comparing the efficacy of vedolizumab monotherapy with combination therapy of vedolizumab and an immunomodulator in patients with ulcerative colitis (UC) are lacking. Emerging pharmacokinetic data indicate that vedolizumab concentrations correlate with clinical outcomes, although the correlation may be less strong for vedolizumab compared with an anti-TNF agents. Associations between concomitant use of immunomodulators and decreased immunogenicity of vedolizumab have been reported, but this does not appear to translate into enhanced therapeutic effect of combination therapy, at least not based on present data...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060934/should-we-use-anti-tumor-necrosis-factor-agents-or-vedolizumab-as-first-line-biological-therapy-in-ulcerative-colitis
#12
REVIEW
Lieven Pouillon, Johan Van Stappen, Peter Bossuyt, Silvio Danese, Laurent Peyrin-Biroulet
Randomized controlled trials with direct comparisons between the different available biological agents in ulcerative colitis are lacking. The comparative efficacy, safety and tolerability, patient profile, patient preference and costs should be taken into account when choosing an appropriate first-line biological. Tumor necrosis factor antagonists have a systemic mode of action, while vedolizumab is mainly gut-selective, and this influences the clinical profile of both treatment options. Tofacitinib will further expand the therapeutic armamentarium in ulcerative colitis...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060933/colorectal-cancer-prevention-in-patients-with-ulcerative-colitis
#13
REVIEW
Anthony Lopez, Lieven Pouillon, Laurent Beaugerie, Silvio Danese, Laurent Peyrin-Biroulet
Ulcerative colitis is characterized by chronic inflammation, which may lead to the accumulation of high levels of pro-inflammatory cytokines within the colonic mucosa, and thus to dysplastic lesions and cancer. Although the trend is decreasing, ulcerative colitis patients still have a 2.4 fold higher risk of colorectal cancer compared to the general population. The key task is to control colonic inflammation, and a rapid step-up approach while closely monitoring intestinal inflammation are recommented. Surveillance colonoscopy program demonstrated its efficacy for reducing the incidence of colorectal cancer in ulcerative colitis...
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30060932/evolving-strategies-and-goals-of-treatment-in-ulcerative-colitis
#14
EDITORIAL
Mariangela Allocca, Laurent Peyrin-Biroulet, Silvio Danese
No abstract text is available yet for this article.
February 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/29566913/intervening-in-disease-through-genetically-modified-bacteria
#15
REVIEW
Adilson K Ferreira, Lisley I Mambelli, Saravanan Y Pillai
The comprehension of the molecular basis of different diseases is rapidly being dissected as a consequence of advancing technology. Consequently, proteins with potential therapeutic usefulness, including cytokines and signaling molecules have been identified in the last decades. However, their clinical use is hampered by disadvantageous functional and economic considerations. One of the most important of these considerations is targeted topical delivery and also the synthesis of such proteins, which for intravenous use requires rigorous purification whereas proteins often do not withstand digestive degradation and thus cannot be applied per os...
December 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/29566912/microbiome-pattern-recognition-receptor-function-in-health-and-inflammation
#16
REVIEW
David Fawkner-Corbett, Alison Simmons, Kaushal Parikh
The innate immune system plays an important role in shaping the microbiota into configurations that are tolerated and beneficial to the host, thereby playing a crucial role in human health. Innate immunity is based on the fundamental principle that Pattern Recognition Receptors (PRRs) recognise pathogen associated molecular patterns as non-self-entities and trigger intracellular signalling pathways that lead to the induction of numerous cytokines and chemokines that help maintain host resistance to infections...
December 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/29566911/diet-microbiome-and-colorectal-cancer
#17
REVIEW
Sergey R Konstantinov
The scientific interests in the colorectal cancer (CRC) associated microbiome have increased significantly in the past decade. Mechanistically, several members of the human microbiome and products thereof have been implicated as inductors of the pathogenic inflammation related to CRC. Conversely, the activities of the human intestinal microbial community influenced by specific diet might confer a protective effect against the CRC risks and progression. As the microbiome is both a key contributor and one of the tools to prevent CRC, the current review gives a summary of the CRC-associated microbiome and the dietary strategies relevant to CRC...
December 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/29566910/intestinal-microbiome-and-permeability-in-patients-with-autoimmune-hepatitis
#18
REVIEW
Wangfeng Cai, Ying Ran, Yanni Li, Bangmao Wang, Lu Zhou
Autoimmune hepatitis (AIH) is a severe inflammatory liver disease. The underlying mechanisms remain unclear, but recent studies provided new perspectives on altered intestinal microbiome and permeability in AIH animal models and patients, highlighting gut-liver crosstalk in the pathogenesis of AIH. Transgenic AIH mice carrying HLA-DR3 showed reduced diversity and total load of gut microbiota. Germ-free mice are resistant to concanavalin A-induced liver injury, whereas enterogenouss antigens induce the activation of natural killer T cells participating in concanavalin A-induced liver injury, supporting the close relationship between microbiota and AIH...
December 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/29566909/nafld-helicobacter-species-and-the-intestinal-microbiome
#19
REVIEW
Natalia Castaño-Rodríguez, Hazel M Mitchell, Nadeem O Kaakoush
Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide. It is well-accepted that gut dysbiosis is associated with NAFLD, however, there is some conflicting evidence regarding the nature of these alterations. Infection with Helicobacter species, mainly H. pylori, has also been associated with increased NAFLD risk, however, some studies have failed to reproduce this finding. Further studies including large study samples and standardised procedures for microbiota analyses, H...
December 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/29566908/action-and-function-of-chromobacterium-violaceum-in-health-and-disease-violacein-as-a-promising-metabolite-to-counteract-gastroenterological-diseases
#20
REVIEW
Giselle Zenker Justo, Nelson Durán
Chromobacterium violaceum is a Gram negative, β-proteobacterium found in the microbiota of tropical and subtropical environments. Although considered an opportunistic pathogen, infection rapidly progress to fatal sepsis, with metastatic abscesses. It is noteworthy the multidrug resistant phenotype of C. violaceum and the possibility of relapse. Recently, an influence of global climate in the incidence of cases beyond the previous areas has been observed. Furthermore, chronic granulomatous disease has been considered a risk factor to infection...
December 2017: Best Practice & Research. Clinical Gastroenterology
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