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Crohn fistula

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https://www.readbyqxmd.com/read/29760785/monitoring-crohn-s-disease-activity-endoscopy-fecal-markers-and-computed-tomography-enterography
#1
Susana Lopes, Patrícia Andrade, Joana Afonso, Rui Cunha, Eduardo Rodrigues Pinto, Isabel Ramos, Guilherme Macedo, Fernando Magro
Background: The treatment goal of Crohn's disease (CD) has moved towards achieving mucosal healing, resolution of transmural inflammation, and normalization of biomarkers. The purpose of this study was to evaluate how well computed tomography enterography (CTE) and fecal calprotectin (FC) correlated with endoscopic activity in newly diagnosed patients with CD and after 1 year of therapy. Methods: Consecutive patients with newly diagnosed CD were evaluated by endoscopy, CTE, and FC at diagnosis and 12 months after beginning immunosuppression...
2018: Therapeutic Advances in Gastroenterology
https://www.readbyqxmd.com/read/29759924/resources-used-in-the-treatment-of-perianal-crohn-s-disease-and-the-results-in-a-real-life-cohort
#2
Cristina Rubín de Célix Vargas, Alicia Algaba, Iván Guerra, Ángel Serrano, Estíbaliz Pérez-Viejo, Carolina Aulló, Fernando Bermejo
OBJECTIVE: To study the multidisciplinary management of patients with Crohn's disease (CD) and perianal disease (perianal Crohn's disease, PCD), as well as to analyse a possible relationship between the recurrence of perianal symptoms, the type of fistula and the treatment used. PATIENTS AND METHODS: Descriptive, retrospective study of patients with PCD who were treated in the Inflammatory Bowel Disease Unit. Epidemiological, clinical, diagnostic and therapeutic variables were collected, as well as clinical outcome and response to treatment...
May 11, 2018: Gastroenterología y Hepatología
https://www.readbyqxmd.com/read/29756637/withdrawal-of-immunosuppressant-or-biologic-therapy-for-patients-with-quiescent-crohn-s-disease
#3
REVIEW
Ray K Boyapati, Joana Torres, Carolina Palmela, Claire E Parker, Orli M Silverberg, Sonam D Upadhyaya, Tran M Nguyen, Jean-Frédéric Colombel
BACKGROUND: Crohn's disease (CD) is a chronic, relapsing and remitting disease of the gastrointestinal tract that can cause significant morbidity and disability. Current treatment guidelines recommend early intervention with immunosuppressant or biological therapy in high-risk patients with a severe disease phenotype at presentation. The feasibility of therapeutic de-escalation once remission is achieved is a commonly encountered question in clinical practice, driven by patient and clinician concerns regarding safety, adverse events, cost and national regulations...
May 12, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29743841/intraoperative-inspection-alone-is-a-reliable-guide-to-the-choice-of-surgical-procedure-for-enteroenteric-fistulas-in-crohn-s-disease
#4
Zhen Guo, Xingchen Cai, Ruiqing Liu, Jianfeng Gong, Yi Li, Lei Cao, Weiming Zhu
Background/Aims: Resection of the diseased segment and suture of the victim segment is recommended for enteroenteric fistula in Crohn's disease (CD). The main difficulty in this procedure remains reliable diagnosis of the victim segment, especially for fistulas found intraoperatively and inaccessible on endoscopic examination. We aimed to explore whether intraoperative inspection alone is reliable. Methods: Patients undergoing conservative surgery between 2011 and 2016 for enteroenteric fistulas complicating CD were identified from a prospectively maintained database...
April 2018: Intestinal Research
https://www.readbyqxmd.com/read/29742985/laparoscopic-redo-ileocolic-resection-for-crohn-s-disease-in-patients-with-previous-multiple-laparotomies
#5
V Celentano, F Sagias, K G Flashman, J Conti, J Khan
PURPOSES: Over 80% of patients with primary ileocolic Crohn's disease have a surgical resection within 10 years of diagnosis, and 40%-50% of them need further surgery within 15 years. Laparoscopic surgery can be challenging due to a thickened mesentery and the potential for fistulas, abscesses, and phlegmons. Aim of this study is to analyze the short-term outcomes of laparoscopic redo ileocolic resections for Crohn's disease in patients with previous multiple laparotomies. METHODS: All patients undergoing laparoscopic surgery for ileocolic Crohn's disease from March 2006 to February 2017 were prospectively evaluated...
May 1, 2018: Scandinavian Journal of Surgery: SJS
https://www.readbyqxmd.com/read/29736773/risk-factors-for-early-postoperative-complications-and-length-of-hospital-stay-in-ileocecal-resection-and-right-hemicolectomy-for-crohn-s-disease-a-single-center-experience
#6
Christian Galata, Christel Weiss, Julia Hardt, Steffen Seyfried, Stefan Post, Peter Kienle, Karoline Horisberger
PURPOSE: To determine risk factors for early postoperative complications and longer hospital stay after ileocecal resection and right hemicolectomy in a single-center cohort of patients with Crohn's disease (CD). METHODS: A retrospective analysis of the prospectively maintained surgical database for patients with CD at our institution was performed. All consecutive patients operated on between January 2010 and December 2016 were included. RESULTS: A total of 305 patients were included...
May 7, 2018: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/29733370/outcomes-of-perianal-fistulising-crohn-s-disease-following-anti-tnf%C3%AE-treatment-discontinuation
#7
Clémence Legué, Charlène Brochard, Grégoire Bessi, Timothée Wallenhorst, Marie Dewitte, Laurent Siproudhis, Guillaume Bouguen
Background: Discontinuation of antitumour necrosis factor (TNF)α therapy with perianal fistulising Crohn's disease remains controversial due to the risk of severe relapse without any clear evidence. Aim: The aim of this study was to assess the rate and type of perianal and luminal relapses following anti-TNFα discontinuation. Methods: All patients treated with anti-TNFα for perianal fistulising Crohn's disease with subsequent discontinuation of therapy were retrospectively reviewed from a prospective database (1998-2016)...
May 4, 2018: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/29719998/biologics-and-immunomodulators-for-treating-crohn-s-disease-developing-after-surgery-for-an-initial-diagnosis-of-ulcerative-colitis-a-review-of-current-literature
#8
Abhijeet Yadav, Joshua Foromera, Kenneth R Falchuk, Joseph D Feuerstein
Crohn's Disease (CD) or CD-like (CDL) conditions of the pouch are rare long-term inflammatory complications of patients who were initially diagnosed with ulcerative colitis (UC) who undergo total proctocolectomy with ileo-anal anastomosis (IPAA). There are no societal guidelines nor a consensus on their treatment, resulting in significant challenges for clinicians for their diagnosis and management. It is important to differentiate them from other more common pouch-related complications like pouchitis, cuffitis, irritable pouch syndrome, surgery associated stricture, and fistula...
May 2, 2018: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/29718450/real-time-interobserver-agreement-in-bowel-ultrasonography-for-diagnostic-assessment-in-patients-with-crohn-s-disease-an-international-multicenter-study
#9
Emma Calabrese, Torsten Kucharzik, Christian Maaser, Giovanni Maconi, Deike Strobel, Stephanie R Wilson, Francesca Zorzi, Kerri L Novak, David H Bruining, Marietta Iacucci, Mamoru Watanabe, Elisabetta Lolli, Carlo Chiaramonte, Stephen B Hanauer, Remo Panaccione, Francesco Pallone, Subrata Ghosh, Giovanni Monteleone
Background: The unavailability of standardized parameters in bowel ultrasonography (US) commonly used in Crohn's disease (CD) and the shortage of skilled ultrasonographers are 2 limiting factors in the use of this imaging modality around the world. The aim of this study is to evaluate interobserver agreement among experienced sonographers in the evaluation of bowel US parameters in order to improve standardization in imaging reporting and interpretation. Methods: Fifteen patients with an established diagnosis of CD underwent blinded bowel US performed by 6 experienced sonographers...
April 28, 2018: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/29697818/clinical-benefit-of-long-term-adalimumab-treatment-in-patients-with-crohn-s-disease-following-loss-of-response-or-intolerance-to-infliximab-96-week-efficacy-data-from-gain-adhere-trials
#10
Remo Panaccione, William J Sandborn, Geert D'Haens, Douglas C Wolf, Sofie Berg, Jen-Fue Maa, Joel Petersson, Anne M Robinson
Background and Aims: In the 4-week GAIN clinical trial, adalimumab was efficacious in inducing remission in patients with moderate to severe Crohn's disease (CD) who had prior loss of response/intolerance to infliximab. The efficacy and safety of adalimumab in these patients are reported here up to 96 weeks or for 3 years, respectively, in ADHERE open-label extension study. Methods: Patients who completed GAIN could enrol in ADHERE and receive open-label adalimumab 40 mg every other week...
April 25, 2018: Journal of Crohn's & Colitis
https://www.readbyqxmd.com/read/29697797/efficacy-and-safety-of-endoscopic-balloon-dilatation-of-ileoanal-pouch-strictures
#11
Mathurin Fumery, Niraj S Patel, Brigid S Boland, Parambir S Dulai, Siddharth Singh, William J Sandborn
Background and aims: Colectomy with ileoanal pouch is the standard of care for most patients with ulcerative colitis (UC) who require surgery. However, 5%-38% of patients with ileoanal pouch develop pouch strictures that can severely impact the functional results. We retrospectively evaluated the efficacy and safety of endoscopic balloon dilation of ileoanal pouch strictures in patients with inflammatory bowel disease (IBD). Methods: All consecutive patients with IBD that underwent endoscopic balloon dilatation of a pouch stricture at our institution between January 1, 2011, and April 31, 2016, were included...
April 25, 2018: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/29688401/anal-fistulas-in-severe-perineal-crohn-s-disease-mri-assessment-in-the-determination-of-long-term-healing-rates
#12
Charlène Brochard, Amandine Landemaine, Alexandre Merlini L'Heritier, Marie Provost Dewitte, Belinda Tchoundjeu, Tanguy Rohou, Aurélien Garros, Guillaume Bouguen, Laurent Siproudhis
Background & Aims: The European Crohn's and Colitis Organization recommends magnetic resonance imaging (MRI) of anal fistulas to decide on the drug/surgery strategy. No evidence is available on the long-term impact of MRI features on fistula healing. The aim of this study was to evaluate the benefit of combined drug/surgery strategies for the treatment of perianal Crohn's fistulas based on MRI factors at referral. Methods: The clinical event (anal abscess, new fistula tract, cellulitis), therapeutic intervention (introduction/optimization of immunosuppressant/biologics, anal surgery, intestinal resection, stoma), and MRI data were prospectively recorded for patients with Crohn's disease (CD) and anal fistulas...
April 20, 2018: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/29624551/three-dimensional-modeling-for-crohn-s-fistula-in-ano-a-novel-interactive-approach
#13
David Lam, Eric Yong, Basil D'Souza, Rodney Woods
BACKGROUND: Pelvic MRI allows for clear delineation of anatomy in Crohn's fistula-in-ano, although its interpretation is often difficult for nonradiologists. OBJECTIVE: The aim was to develop a 3-dimensional model where fistula tracts and their relationship to the sphincter complex can be accurately defined, which can then be rotated in multiple axes by the surgeon. DESIGN: A 3-dimensional model was created based on MRI images. An additional 3-dimensional T2-weighted sequence was added to the existing MRI protocol to obtain high-resolution images...
May 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29611841/significance-of-diffusion-weighted-imaging-dwi-as-an-improving-factor-in-contrast-enhanced-magnetic-resonance-imaging-mri-enterography-in-evaluation-of-patients-with-crohn-s-disease
#14
Bilal Imširović, Enver Zerem, Alma Efendić, Alma Mekić Abazović, Omar Zerem, Muhamed Djedović
Aim To determine capabilities and potential of contrast enhanced magnetic resonance imaging (MRI) enterography in order to establish the diagnosis and to evaluate severity and activity of intestinal inflammation. Methods Fifty-five patients with suspicion for presence of Crohn's disease were evaluated. All patients underwent contrast enhanced MRI enterography and diffusion weighted imaging (DWI), and subsequently endoscopic examination or surgical treatment. Four parameters were analysed: thickening of the bowel wall, and presence of abscess, fistula and lymphadenopathy...
August 1, 2018: Medicinski Glasnik
https://www.readbyqxmd.com/read/29578916/a-systematic-review-and-meta-analysis-of-mesenchymal-stem-cell-injections-for-the-treatment-of-perianal-crohn-s-disease-progress-made-and-future-directions
#15
REVIEW
Amy L Lightner, Zhen Wang, Abba C Zubair, Eric J Dozois
BACKGROUND: There has been a surge in clinical trials studying the safety and efficacy of mesenchymal stem cells for the treatment of perianal Crohn's disease. OBJECTIVE: The purpose of this work was to systematically review the literature to determine safety and efficacy of mesenchymal stem cells for the treatment of refractory perianal Crohn's disease. DATA SOURCES: Sources included PubMed, Cochrane Library Central Register of Controlled Trials, and Embase...
May 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29572889/risk-factors-for-diagnostic-delay-in-crohn-s-disease-and-their-impact-on-long-term-complications-how-do-they-differ-in-a-tuberculosis-endemic-region
#16
R Banerjee, P Pal, B G Girish, D N Reddy
BACKGROUND: The diagnosis of Crohn's disease (CD) can be delayed in clinical practice. In tuberculosis endemic areas, empirical anti-tubercular therapy further delays treatment. AIM(S): To assess risk factors for diagnostic delay and its impact on the long-term complications of Crohn's disease in India where tuberculosis is endemic. METHODS: Data from a large prospectively established inflammatory bowel disease registry were analysed retrospectively...
March 24, 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29569419/patients-with-perianal-crohn-s-fistulae-experience-delays-in-accessing-anti-tnf-therapy-due-to-slow-recognition-diagnosis-and-integration-of-specialist-services-lessons-learned-from-three-referral-centres
#17
Matthew J Lee, Clare Freer, Sam Adegbola, Soad Elkady, Miles Parkes, Ailsa Hart, Nicola S Fearnhead, Alan J Lobo, Steven R Brown
BACKGROUND: Crohn's anal fistula should be managed with a multidisciplinary team. There is no clearly defined 'patient pathway' from presentation to treatment. The aim of this study was to describe the patient route from presentation with symptomatic Crohn's anal fistula to starting anti-TNF therapy. METHOD: Case note review was undertaken at three hospitals with established IBD services. Patients with Crohn's anal fistula presenting between 2010 and 2015 were identified through clinical coding and local databases...
March 22, 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/29556726/new-treatment-options-for-inflammatory-bowel-diseases
#18
REVIEW
Bram Verstockt, Marc Ferrante, Séverine Vermeire, Gert Van Assche
The advent of anti-TNF agents has dramatically changed the treatment algorithms for IBD in the last 15 years, but primarily and more importantly secondary loss of response is often observed. Fortunately , new treatment options have been actively explored and some have already entered our clinical practice. In the class of anti-cytokine agents, the anti-IL12/IL23 monoclonal antibodies (mAbs) have entered clinical practice with the anti-p40 mAb ustekinumab in Crohn's disease (CD). Also, more selective anti-IL23 agents (anti-p19) have shown efficacy and are being further developed, in contrast to agents inhibiting IL-17 downstream which have failed in clinical trials despite their clear efficacy in psoriasis (Verstockt et al...
March 19, 2018: Journal of Gastroenterology
https://www.readbyqxmd.com/read/29549474/contributions-of-magnetic-resonance-imaging-to-gastroenterological-practice-mris-for-gis
#19
REVIEW
Christopher G Roth, Dina Halegoua-De Marzio, Flavius F Guglielmo
MRI has transformed from the theoretical, investigative realm to mainstream clinical medicine over the past four decades and has become a core component of the diagnostic toolbox in the practice of gastroenterology (GI). Its success is attributable to exquisite contrast and the ability to isolate specific proton species through the use of different pulse sequences (i.e., T1-weighted, T2-weighted, diffusion-weighted) and exploiting extracellular and hepatobiliary contrast agents. Consequently, MRI has gained preeminence in various GI clinical applications: liver and pancreatic lesion evaluation and detection, liver transplantation evaluation, pancreatitis evaluation, Crohn's disease evaluation (using MR enterography) rectal cancer staging and perianal fistula evaluation...
March 16, 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29529206/mechanical-bowel-preparation-mbp-prior-to-elective-colorectal-resections-in-crohn-s-disease-patients
#20
Igors Iesalnieks, Melanie Hoene, Theresa Bittermann, Hans J Schlitt, Christina Hackl
Background: Studies addressing the role of mechanical bowel preparation (MBP) in Crohn's disease (CD) patients are lacking. Methods: Consecutive elective colorectal resections for CD have been included in the present analysis. Exclusion criteria were small bowel resections not including colon, urgent surgeries, surgeries for cancer, and abdominoperineal resections for perianal disease. MBP was performed routinely between 1992 and 2004, omitted between 2005 and 2015, and reintroduced in 2016...
March 19, 2018: Inflammatory Bowel Diseases
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