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By Jeff Bank Internal Medicine R2 at the University of Utah
Uma Mahadevan, Ryan A McConnell, Christina Chambers
The management of the pregnant patient with inflammatory bowel disease (IBD) is complicated by multiple providers, misinformation and a disease entity that, particularly when active, can adversely affect pregnancy outcomes. This paper seeks to frame the debate on medication safety in pregnancy and lactation using the Food and Drug Administration's new Pregnancy and Lactation Labeling Rule (PLLR) and the most up to date safety information to discuss the risks and benefits of using each class of IBD medication...
October 18, 2016: Gastroenterology
Adam S Cheifetz, Robert Gianotti, Raphael Luber, Peter R Gibson
Patients and physicians often have many questions regarding the role of complementary and alternative medicines (CAMs), or non-allopathic therapies, for inflammatory bowel diseases (IBD). CAMs of various forms are used by more than half of patients with IBD during some point in their disease course. We summarize the available evidence for the most commonly used and discussed CAMs. We discuss evidence for the effects of herbs (such as cannabis and curcumin), probiotics, acupuncture, exercise, and mind-body therapy...
October 12, 2016: Gastroenterology
Julian Panes, Vipul Jairath, Barrett G Levesque
Crohn's disease and ulcerative colitis are heterogeneous inflammatory bowel disease (IBD), and therapeutic requirements vary among patients. We have a limited capacity to predict disease progression for individual patients, so it is important that they are evaluated for presence of active disease when symptoms are mild or even absent, when patients are more likely to respond to new treatment interventions. It is then important to monitor responses to treatment, to quickly identify those therapies that are ineffective, modify or change therapy, and avoid disease complications...
October 14, 2016: Gastroenterology
Thaddeus S Stappenbeck, Dermot P B McGovern
Pathogenesis of Crohn's disease (CD) involves immune and microbial dysregulation, induced by environmental factors in genetically susceptible individuals. There are believed to be multiple subtypes of CD, which contributes to its observed clinical heterogeneity. This concept has been reinforced by recognition of the complexity of the genetic, microbial, immune, and environmental factors that affect risk for CD. Paneth cells mediate immunity in and maintain the small intestinal epithelium; defects in activities of these cells have been observed in high proportions of patients with CD, and associated with more aggressive CD phenotype...
October 8, 2016: Gastroenterology
Jean-Frederic Colombel, Neeraj Narula, Laurent Peyrin-Biroulet
Strategies for management of inflammatory bowel diseases (IBD) are shifting from simple control of symptoms toward full control of these diseases (clinical and endoscopic remission), with the final aim of blocking their progression and preventing bowel damage and disability. New goals have been proposed for treatment, such as treat to target and tight control based on therapeutic monitoring and early intervention. For patients who achieve clinical remission, there is often interest in discontinuation of therapy due to safety and/or economic concerns...
October 5, 2016: Gastroenterology
Ray K Boyapati, Rahul Kalla, Jack Satsangi, Gwo-Tzer Ho
The completion of the human genome project in 2003 represented a major scientific landmark, ushering in a new era with hopes and expectations of fresh insights into disease mechanisms and treatments. In inflammatory bowel disease (IBD), many important discoveries soon followed, notably the identification of >200 genetic susceptibility loci and characterization of the gut microbiome. As "big data", driven by advances in technology, becomes increasingly available and affordable, individuals with IBD and clinicians alike yearn for tangible outcomes from the promise of "precision medicine"-precise diagnosis, monitoring, and treatment...
September 27, 2016: American Journal of Gastroenterology
Sabela Carballal, Sandra Maisterra, Antonio López-Serrano, Antonio Z Gimeno-García, María Isabel Vera, José Carlos Marín-Garbriel, José Díaz-Tasende, Lucía Márquez, Marco Antonio Álvarez, Luis Hernández, Luisa De Castro, Jordi Gordillo, Ignasi Puig, Pablo Vega, Marco Bustamante-Balén, Juan Acevedo, Beatriz Peñas, María López-Cerón, Elena Ricart, Miriam Cuatrecasas, Mireya Jimeno, María Pellisé
OBJECTIVE: Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life. DESIGN: From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded...
September 9, 2016: Gut
Clifford J Rosen, Julie R Ingelfinger
No abstract text is available yet for this article.
September 18, 2016: New England Journal of Medicine
Rahul Kalla, Nicholas A Kennedy, Nicholas T Ventham, Ray K Boyapati, Alex T Adams, Elaine R Nimmo, Micaela R Visconti, Hazel Drummond, Gwo-Tzer Ho, Rebecca J Pattenden, David C Wilson, Jack Satsangi
OBJECTIVES: There is an unmet need for novel blood-based biomarkers that offer timely and accurate diagnostic and prognostic testing in inflammatory bowel diseases (IBD). We aimed to investigate the diagnostic and prognostic utility of serum calprotectin (SC) in IBD. METHODS: A total of 171 patients (n=96 IBD, n=75 non-IBD) were prospectively recruited. A multi-biomarker model was derived using multivariable logistic regression analysis. Cox proportional hazards model was derived to assess the contribution of each variable to disease outcomes...
September 6, 2016: American Journal of Gastroenterology
Michael Due Larsen, Sonia Friedman, Bjarne Magnussen, Bente Mertz Nørgård
OBJECTIVES: The safety of paternal use of anti-tumor necrosis factor-α (TNF-α) agents immediately prior to conception is practically unknown. On the basis of nationwide data from Danish health registries, we examined the association between paternal use of anti-TNF-α agents within 3 months before conception and adverse birth outcomes. METHODS: This nationwide cohort study is based on data from all women who had a live born singleton child in Denmark from 1 January 2007 through 2013...
September 13, 2016: American Journal of Gastroenterology
Tsunetaka Arai, Ken Takeuchi, Miyuki Miyamura, Rumiko Ishikawa, Akihiro Yamada, Masao Katsumata, Yoshinori Igarashi, Yasuo Suzuki
BACKGROUND & AIMS: Previous studies have not found a correlation between fecal level of calprotectin and small bowel Crohn's disease (CD). However, these studies evaluated patients mainly by ileocolonoscopy, which views up to only the terminal ileum rather than entire small intestine. We investigated whether level of fecal calprotectin (FC) is a marker of active CD of the small bowel, identified by balloon-assisted enteroscopy and computed tomography enterography (CTE). METHODS: We performed a prospective study of 123 patients with CD (35 with ileitis, 72 with ileocolitis, and 16 with colitis) evaluated by balloon-assisted enteroscopy from May 2012 through July 2015 at Toho University Sakura Medical Centre in Japan...
August 23, 2016: Clinical Gastroenterology and Hepatology
Grant E Barber, Vijay Yajnik, Hamed Khalili, Cosmas Giallourakis, John Garber, Ramnik Xavier, Ashwin N Ananthakrishnan
OBJECTIVES: One-fifth of patients with Crohn's disease (CD) are primary non-responders to anti-tumor necrosis factor (anti-TNF) therapy, and an estimated 10-15% will fail therapy annually. Little is known about the genetics of response to anti-TNF therapy. The aim of our study was to identify genetic factors associated with primary non-response (PNR) and loss of response to anti-TNFs in CD. METHODS: From a prospective registry, we characterized the response of 427 CD patients to their first anti-TNF therapy...
September 6, 2016: American Journal of Gastroenterology
T Billiet, I Cleynen, V Ballet, M Ferrante, G Van Assche, A Gils, S Vermeire
BACKGROUND: The long-term efficacy of infliximab in patients with Crohn's disease is suboptimal. AIM: To study prognostic factors for real-life long-term effcacy of infliximab in Crohn's disease. METHODS: All consecutive Crohn's disease patients treated with infliximab at a tertiary centre were retrospectively analysed. Only patients who received scheduled infliximab maintenance treatment were considered. Patient- and disease-related factors were used to identify independent predictors of infliximab failure-free survival using Cox proportional hazards regression...
October 2016: Alimentary Pharmacology & Therapeutics
Dalin Li, Jean-Paul Achkar, Talin Haritunians, Jonathan P Jacobs, Ken Y Hui, Mauro D'Amato, Stephan Brand, Graham Radford-Smith, Jonas Halfvarson, Jan-Hendrik Niess, Subra Kugathasan, Carsten Büning, L Philip Schumm, Lambertus Klei, Ashwin Ananthakrishnan, Guy Aumais, Leonard Baidoo, Marla Dubinsky, Claudio Fiocchi, Jürgen Glas, Raquel Milgrom, Deborah D Proctor, Miguel Regueiro, Lisa A Simms, Joanne M Stempak, Stephan R Targan, Leif Törkvist, Yashoda Sharma, Bernie Devlin, James Borneman, Hakon Hakonarson, Ramnik J Xavier, Mark Daly, Steven R Brant, John D Rioux, Mark S Silverberg, Judy H Cho, Jonathan Braun, Dermot P B McGovern, Richard H Duerr
BACKGROUND & AIMS: Genome-wide association studies have identified 200 inflammatory bowel disease (IBD) loci, but the genetic architecture of Crohn's disease (CD) and ulcerative colitis remain incompletely defined. Here, we aimed to identify novel associations between IBD and functional genetic variants using the Illumina ExomeChip (San Diego, CA). METHODS: Genotyping was performed in 10,523 IBD cases and 5726 non-IBD controls. There were 91,713 functional single-nucleotide polymorphism loci in coding regions analyzed...
October 2016: Gastroenterology
Laurent Peyrin-Biroulet, Gert Van Assche, David Gómez-Ulloa, Laura García-Álvarez, Núria Lara, Chris M Black, Sumesh Kachroo
BACKGROUND & AIMS: This systematic review investigated the efficacy and the effectiveness of biologic drugs in extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD). METHODS: Literature search was conducted in PubMed, Embase, and Cochrane until October 2015. Main inclusion criteria were adults with IBD, use of a biologic drug, evolution of EIMs, interventional study, or non-interventional study. RESULTS: Nine interventional studies (2 randomized controlled trials [N = 797], 7 open label trials [N = 1143], and 13 non-interventional studies [N = 914]) were included...
July 5, 2016: Clinical Gastroenterology and Hepatology
Tim Wyant, Eric Fedyk, Brihad Abhyankar
Vedolizumab is a novel therapeutic monoclonal antibody recently approved for the treatment of moderately to severely active ulcerative colitis and Crohn's disease in adults who have failed at least one conventional therapy. An integrin antagonist, vedolizumab binds to the α4β7 integrin which is expressed specifically by a subset of gastrointestinal-homing T lymphocytes. The binding of α4β7 integrin to mucosal addressin cell adhesion molecule-1 expressed on the surface of mucosal endothelial cells is a crucial component of the gut-selective homing mechanism for lymphocytes...
June 1, 2016: Journal of Crohn's & Colitis
Ling-Shiang Chuang, Nicole Villaverde, Ken Y Hui, Arthur Mortha, Adeeb Rahman, Adam P Levine, Talin Haritunians, Sok Meng Evelyn Ng, Wei Zhang, Nai-Yun Hsu, Jody-Ann Facey, Tramy Luong, Heriberto Fernandez-Hernandez, Dalin Li, Manuel Rivas, Elena R Schiff, Alexander Gusev, L Phillip Schumm, Beatrice M Bowen, Yashoda Sharma, Kaida Ning, Romain Remark, Sacha Gnjatic, Peter Legnani, James George, Bruce E Sands, Joanne M Stempak, Lisa W Datta, Seth Lipka, Seymour Katz, Adam S Cheifetz, Nir Barzilai, Nikolas Pontikos, Clara Abraham, Marla J Dubinsky, Stephan Targan, Kent Taylor, Jerome I Rotter, Ellen J Scherl, Robert J Desnick, Maria T Abreu, Hongyu Zhao, Gil Atzmon, Itsik Pe'er, Subra Kugathasan, Hakon Hakonarson, Jacob L McCauley, Todd Lencz, Ariel Darvasi, Vincent Plagnol, Mark S Silverberg, Aleixo M Muise, Steven R Brant, Mark J Daly, Anthony W Segal, Richard H Duerr, Miriam Merad, Dermot P B McGovern, Inga Peter, Judy H Cho
BACKGROUND & AIMS: Crohn's disease (CD) has the highest prevalence in Ashkenazi Jewish populations. We sought to identify rare, CD-associated frameshift variants of high functional and statistical effects. METHODS: We performed exome sequencing and array-based genotype analyses of 1477 Ashkenazi Jewish individuals with CD and 2614 Ashkenazi Jewish individuals without CD (controls). To validate our findings, we performed genotype analyses of an additional 1515 CD cases and 7052 controls for frameshift mutations in the colony-stimulating factor 2-receptor β common subunit gene (CSF2RB)...
October 2016: Gastroenterology
Alison de Lima-Karagiannis, Zuzana Zelinkova-Detkova, Christien Janneke van der Woude
OBJECTIVES: Previous data on inflammatory bowel disease (IBD) relapse during pregnancy mainly originate from retrospective studies. The aim of this study was therefore (i) to evaluate the effect of active disease at conception and IBD disease type on disease relapse during pregnancy and (ii) to study the effects of disease relapse during pregnancy on birth outcomes in a prospective cohort with adequate representation of current treatments. METHODS: From 2008 to 2014, IBD women were recruited from an ongoing prospective clinical cohort...
September 2016: American Journal of Gastroenterology
Li-Hui Wang, Yao-Jong Yang, Wei-Chun Cheng, Wei-Ming Wang, Sheng-Hsiang Lin, Chi-Chang Shieh
OBJECTIVES: The relationship between inflammatory bowel disease (IBD) and cancer remains unclear especially in Asian populations. Therefore, we conducted a nationwide population-based study in Taiwan to reveal the cancer risk in patients with IBD. METHODS: Using the national health database of Taiwan, we identified 3,348 IBD patients without previous cancer, including 685 with Crohn's disease (CD) and 2,663 with ulcerative colitis (UC), as a cohort from 1998 to 2012 and followed them up until 2013...
September 2016: American Journal of Gastroenterology
Sean Ahrens
Editor's Note: This article discusses the experience, ingenuity, and determination of Sean Ahrens, a young patient with Crohn's disease who took it upon himself to treat his longstanding, symptomatic Crohn's disease with pig whipworm eggs. Reading this story will make some of you uncomfortable. You might question whether this work belongs in a medical journal or sends the wrong message to readers. However, we recognize that this topic is controversial and that N=1 reports cannot and should not change practice...
July 2016: American Journal of Gastroenterology
2016-06-03 15:10:48
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