IBD on PubMed

Continent ileostomy [Kock-pouch] formation: a video vignette.

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Continent ileostomy [Kock-pouch] formation: a video vignette.

Colorectal Dis. 2016 Nov 17;:

Authors: Bloemendaal AL, Lovegrove R, Buchs NC, Guy RJ, George BD

Abstract
Chronic inflammatory bowel disease (IBD) refractory to medical therapy and acute severe inflammation (pseudomembranous colitis or IBD-related), or familial adenomatous polyposis coli (FAP) may require surgery in the form of a proctocolectomy, either in one stage or as a multistage procedure. In the latter case, most patients will have an initial colectomy with an end-ileostomy and preservation of the anorectal stump. Subsequently, patient and surgeon are left with the question, whether to leave the situation as it is, or to attempt to restore intestinal continuity. This article is protected by copyright. All rights reserved.

PMID: 27860124 [PubMed - as supplied by publisher]

6-methylmercaptopurine induced leukocytopenia during thiopurine therapy in IBD patients.

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6-methylmercaptopurine induced leukocytopenia during thiopurine therapy in IBD patients.

J Gastroenterol Hepatol. 2016 Nov 16;:

Authors: Meijer B, Kreijne JE, van Moorsel SA, Derijks LJ, Bouma G, Mulder CJ, Wong DR, van der Woude CJ, van Bodegraven AA, de Boer NK

Abstract
BACKGROUND: Thiopurines have a favorable benefit-risk ratio in the treatment of inflammatory bowel disease (IBD). A feared adverse event of thiopurine therapy is myelotoxicity, mostly occurring due to toxic concentrations of the pharmacologically active metabolites 6-thioguaninenucleotides. In oncology, myelosuppression has also been associated with elevated 6-methylmercaptopurine (6-MMP). In this case-series, we provide a detailed overview of 6-MMP-induced myelotoxicity in IBD patients.
METHODS: We retrospectively scrutinized pharmacological laboratory databases of five participating centers over a 5-year period. Patients with leukocytopenia at time of elevated 6-MMP levels (>5,700 pmol/8 x 10(8) red blood cells (RBCs)) were included for detailed chart review.
RESULTS: In this case series, we describe demographic, clinical and pharmacological aspects of 24 cases of 6-MMP induced myelotoxicity on weight-based thiopurine therapy with a median steady-state 6-MMP level of 14,500 pmol/8 x 10(8) RBCs (range 6,600-48,000). All patients developed leukocytopenia (white blood cell count 2.7 ± 0.9 x 10(9) /L) after a median period of 11 weeks after initiation of thiopurine therapy (interquartile range 6-46 weeks). Eighteen patients (75%) developed concurrent anemia (median hemoglobin concentration 6.9 x 10(9) /L) and four patients developed concurrent thrombocytopenia (median platelet count 104 x 10(9) /L). Leukocytopenia resolved in 20 patients (83%) within four weeks upon altered thiopurine treatment regimen and white blood cell count was increasing, but not yet normalized, in the remaining four patients.
CONCLUSION: We observed that thiopurine-induced myelotoxicity also occurs due to (extremely) high 6-MMP concentrations in patients with a skewed thiopurine metabolism. Continued treatment with adapted thiopurine therapy was successful in almost all patients.

PMID: 27859568 [PubMed - as supplied by publisher]

Drug-specific hypophosphatemia and hypersensitivity reactions following different intravenous iron infusions.

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Drug-specific hypophosphatemia and hypersensitivity reactions following different intravenous iron infusions.

Br J Clin Pharmacol. 2016 Nov 17;:

Authors: Bager P, Hvas CL, Dahlerup JF

Abstract
AIMS: Intravenous (IV) iron infusions have been associated with hypophosphatemia (HP) and hypersensitivity reactions (HSRs). No studies have compared the side effects of ferric carboxymaltose (FCM) with those of isomaltoside 1000 (ISM). This study aimed to describe the occurrence of HP and HSRs following the administration of either FCM or ISM.
METHODS: Data on 231outpatients treated with IV iron infusions, between November 2011 and April 2014, were collected. During that period, the department made a switch from FCM to ISM and then back to FCM. Of the 231 patients, 39 received both FCM and ISM during the period. The prevalences of HP and HSRs were compared between the two drugs.
RESULTS: We found more HP events when FCM was given (64 vs. 9; P < 0.01). In contrast, more patients had mild HSRs when ISM was given (2.5% vs. 10.7%; P < 0.01). A comparison of the two drugs in the subpopulation who received both drug types (n = 39) revealed a difference in phosphate decrease (P < 0.01), with the most marked decrease occurring with FCM. Nine patients who had HSRs were exposed to both drugs. No potential HSR crossover between the two drugs was found.
CONCLUSION: We found a higher risk of HP with FCM administration when compared to ISM administration. Conversely, we found a higher risk of mild HSRs with ISM administration when compared to FCM administration. The impacts of the two types of side effects should be considered when choosing an IV iron drug. This article is protected by copyright. All rights reserved.

PMID: 27859495 [PubMed - as supplied by publisher]

Effects of vedolizumab on health-related quality of life in patients with ulcerative colitis: results from the randomised GEMINI 1 trial.

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Effects of vedolizumab on health-related quality of life in patients with ulcerative colitis: results from the randomised GEMINI 1 trial.

Aliment Pharmacol Ther. 2016 Nov 17;:

Authors: Feagan BG, Patel H, Colombel JF, Rubin DT, James A, Mody R, Lasch K

Abstract
BACKGROUND: Health-related quality of life (HRQL) is often diminished in patients with ulcerative colitis.
AIM: To evaluate the effects of vedolizumab on HRQL in patients with ulcerative colitis.
METHODS: Using maintenance phase data from the GEMINI 1 study, an analysis of covariance model was used to calculate mean differences between the vedolizumab and placebo groups in changes from baseline to week 52 for 3 HRQL instruments: The Inflammatory Bowel Disease Questionnaire (IBDQ), 36-Item Short Form Health Survey (SF-36), and EQ-5D. Proportions of patients meeting minimal clinically important difference (MCID) thresholds for changes on these instruments were compared between treatment groups for the overall population and for clinically important subgroups. Concordance between clinical remission and remission defined using IBDQ scores was examined.
RESULTS: Compared with placebo-treated patients, vedolizumab-treated patients had greater improvements (152-201%) in IBDQ, EQ-5D visual analogue scale (VAS), and EQ-5D utility scores. Greater proportions (6.9-19.9%) of vedolizumab-treated patients than placebo-treated patients met MCID thresholds for all the instruments. Vedolizumab-treated patients with lower baseline disease activity and those without prior tumour necrosis factor (TNF) antagonist failure had greater HRQL improvements. Among 127 patients with clinical remission based on complete Mayo Clinic scores, >80% also had IBDQ remission; >70% of the 150 patients with IBDQ remission demonstrated clinical remission.
CONCLUSIONS: Vedolizumab therapy was associated with significant improvements in HRQL measures compared with placebo. Benefits were greater in patients with lower disease activity and no prior TNF antagonist failure.

PMID: 27859410 [PubMed - as supplied by publisher]

Genetics meets Pathology - an increasingly important relationship.

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Genetics meets Pathology - an increasingly important relationship.

J Pathol. 2016 Nov 14;:

Authors: Bonthron DT, Foulkes WD

Abstract
The analytical power of modern methods for DNA analysis has outstripped our capability to interpret and understand the data generated. To make good use of this genomic data in a biomedical setting (whether for research or diagnosis), it is vital that we understand the mechanisms through which mutations affect biochemical pathways and physiological systems. This lies at the centre of what genetics is all about, and it is the reason why genetics and genomics should go hand in hand whenever possible. In this Annual Review Issue of the Journal of Pathology, we have assembled a collection of 16 expert reviews covering a wide range of topics. Through these, we illustrate the power of genetic analysis to improve our understanding of normal physiology and disease pathology, and thereby to think in rational ways about clinical management.

PMID: 27859271 [PubMed - as supplied by publisher]

Medical Cannabis - another piece in the mosaic of autoimmunity?

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Medical Cannabis - another piece in the mosaic of autoimmunity?

Clin Pharmacol Ther. 2016 Nov 10;:

Authors: Katz D, Katz I, Porat-Katz BS, Shoenfeld Y

Abstract
Legalization of cannabis' medicinal use is rapidly increasing worldwide, raising the need to evaluate medical implications of cannabis. Currently evidence supports cannabis and its active ingredients as an immune-modulating agents, affecting T-cells, B-cells, Monocytes and Microglia-cells, causing an overall reduction in pro-inflammatory cytokine expression and an increase in anti-inflammatory cytokines. Due to the supporting evidence of cannabinoids as an immune-modulating agent, research focusing on cannabinoids and autoimmunity has emerged. Several clinical trials in multiple sclerosis, inflammatory bowel disease and fibromyalgia suggest cannabis' effectiveness as an immune-modulator. However, contradicting results and lack of large scale clinical trials obscure these results. Though lacking clinical research, in-vitro and in-vivo experiments in rheumatoid arthritis, diabetes type 1 and systemic sclerosis, demonstrate a correlation between disease activity and cannabinoids. This article is protected by copyright. All rights reserved.

PMID: 27859024 [PubMed - as supplied by publisher]

Long-Term Outcome of Laparoscopic Duhamel Procedure for Extended Hirschsprung's Disease.

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Long-Term Outcome of Laparoscopic Duhamel Procedure for Extended Hirschsprung's Disease.

J Laparoendosc Adv Surg Tech A. 2016 Nov 18;

Authors: Muller CO, Rossignol G, Montalva L, Viala J, Martinez-Vinson C, Mosca A, Berrebi D, Bonnard A

Abstract
BACKGROUND: The aim of our study was to report our experience in extended Hirschsprung's disease (HD) in children operated on by laparoscopy.
PATIENTS AND METHODS: Retrospective data collection from a single center from 1991 to 2013 concerned extended forms of HD operated on by laparoscopic Duhamel procedure and included extension of aganglionosis, comorbidities, short and late postoperative outcome, and results of endoscopy when performed.
RESULTS: Thirty patients presented an extended form of aganglionosis: 5 involving the transverse colon, 10 the right colon, and 15 the ileum (median length = 15 cm, range 1-60). Short-term outcome showed 13% postoperative complications requiring redo-surgery: occlusion (n = 2), wall abscess (n = 1), and anastomotic leak (n = 1). Median follow-up was of 5 years (range: 1-19 years). Satisfying bowel control was reached in 53%, and 46% had a weight-for-age reference curve up to -1 SD. They had four stools per day on average, 13% of soiling, 6% of constipation, and 26% of recurrent abdominal distention. Late enterocolitis occurred in 22% (n = 7): 6 with ileum involvement and 1 extended to the transverse colon. Endoscopy showed Crohn-like ulcerations in 100% of these cases.
CONCLUSION: Laparoscopic Duhamel procedure is a safe and effective surgical technique in the management of extended forms of HD, with a low postoperative morbidity, but the frequent occurrence of late enterocolitis associated with Crohn-like ulcerations impairs the late outcome. Link between HD and Crohn disease still requires to be investigated.

PMID: 27858582 [PubMed - as supplied by publisher]

Different brain responses to electro-acupuncture and moxibustion treatment in patients with Crohn's disease.

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Different brain responses to electro-acupuncture and moxibustion treatment in patients with Crohn's disease.

Sci Rep. 2016 Nov 18;6:36636

Authors: Bao C, Liu P, Liu H, Jin X, Calhoun VD, Wu L, Shi Y, Zhang J, Zeng X, Ma L, Qin W, Zhang J, Liu X, Tian J, Wu H

Abstract
This study aimed to investigate changes in resting state brain activity in remissive Crohn's Disease (CD) patients after electro-acupuncture or moxibustion treatment. Fifty-two CD patients and 36 healthy subjects were enrolled, and 36 patients were equally and randomly assigned to receive either electro-acupuncture or moxibustion treatment for twelve weeks. We used resting state functional magnetic resonance imaging to assess Regional Homogeneity (ReHo) levels, and Crohn's Disease Activity Index (CDAI) and Inflammatory Bowel Disease Questionnaire (IBDQ) scores to evaluate disease severity and quality of life. The results show that (i) The ReHo levels in CD patients were significantly increased in cortical but decreased in subcortical areas, and the coupling between them was declined. (ii) Both treatments decreased CDAI, increased IBDQ scores, and normalized the ReHo values of the cortical and subcortical regions. (iii) ReHo changes in multiple cortical regions were significantly correlated with CDAI score decreases. ReHo changes in several subcortical regions in the electro-acupuncture group, and those of several cortical regions in the moxibustion group, were correlated with reduced CDAI. These findings suggest that both treatments improved cortex-subcortical coupling in remissive CD patients, but electro-acupuncture regulated homeostatic afferent processing network, while moxibustion mainly regulated the default mode network of the brain.

PMID: 27857211 [PubMed - in process]

Effect of IL-17 receptor A blockade with brodalumab in inflammatory diseases.

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Effect of IL-17 receptor A blockade with brodalumab in inflammatory diseases.

Rheumatology (Oxford). 2016 Dec;55(suppl 2):ii43-ii55

Authors: Nirula A, Nilsen J, Klekotka P, Kricorian G, Erondu N, Towne JE, Russell CB, Martin DA, Budelsky AL

Abstract
IL-17 cytokines are expressed by a variety of cells and mediate host defence against extracellular pathogens. IL-17 is upregulated at sites of inflammation and can synergize with other cytokines, such as TNF-α, to amplify the inflammatory response. Activation of these signalling pathways has been hypothesized to contribute to the underlying pathogenesis of several inflammatory diseases, including psoriasis, RA, PsA and asthma. Thus the IL-17 signalling pathway is an attractive target for the development of therapeutic agents to modulate aberrant inflammatory responses. This review of the clinical development of therapeutic agents that target IL-17 signalling pathways in inflammatory diseases focuses on brodalumab, a human anti-IL-17 receptor A mAb. The cumulative findings of early clinical studies with anti-IL-17 agents, including brodalumab, secukinumab and ixekizumab, provide strong evidence for the role of IL-17 signalling in the pathophysiology of certain inflammatory diseases and support the potential use of these agents in treating these diseases.

PMID: 27856660 [PubMed - in process]

Beyond Histological Remission: Intramucosal Calprotectin as a Potential Predictor of Outcomes in Ulcerative Colitis.

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Beyond Histological Remission: Intramucosal Calprotectin as a Potential Predictor of Outcomes in Ulcerative Colitis.

J Crohns Colitis. 2016 Nov 14;:

Authors: Guirgis M, Wendt E, Wang LM, Walsh A, Burger D, Bryant RV, Kent A, Adamson R, Brain O, Travis SP, Keshav S

Abstract
BACKGROUND AND AIMS: Histological remission and low faecal calprotectin are positive prognostic factors in ulcerative colitis [UC]. Intramucosal calprotectin [iMC], which can be readily determined by immunohistochemistry, has not so far been evaluated as a predictor of outcome in UC. We aimed to investigate the relationship between iMC and clinical, endoscopic, and histological measures of remission in UC, and the independent prognostic value of iMC.
METHODS: Ambulant patients with UC were recruited for a study comparing clinical activity indices. Sigmoidoscopy and biopsy were performed at the index visit. Clinical, endoscopic, and histological activity were scored and iMC semi-quantitatively measured using immunohistochemistry for the S100A8/9 heterodimer on colonic biopsies, scored as the mean number of positive cells in five high-power fields [HPF]. At the end of follow-up [6 years], data on steroid use, hospitalisation, and colectomy ['adverse outcomes'] were collected.
RESULTS: iMC was determined in 83 patients and 20 controls, and correlated with clinical, endoscopic, and histological activity [r = 0.51, 0.65, 0.53, p > 0.001, respectively]. iMC was lowest (median 2.4, interquartile range [IQR]: 5.2-5, p < 0.001) in patients with concordance between clinical, endoscopic, and histological remission. Median iMC > 5/HPF was associated with adverse outcome (hazard ratio [HR] 3.36, confidence interval [CI] 1.58, 7.15, p < 0.001). Only 53%, 33%, and 25% of patients in histological remission with iMC > 5 cells/HPF avoided an adverse outcome after 1, 3, and 6 years, respectively.
CONCLUSIONS: iMC was lowest in patients with concordant clinical, endoscopic, and histological remission. Median iMC > 5/HPF was associated with adverse outcomes despite histological remission. Therefore iMC is a potentially useful independent marker of activity.

PMID: 27856523 [PubMed - as supplied by publisher]

Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies.

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Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies.

Clin Microbiol Rev. 2017 Jan;30(1):191-231

Authors: Hudson LE, Anderson SE, Corbett AH, Lamb TJ

Abstract
Beneficial microorganisms hold promise for the treatment of numerous gastrointestinal diseases. The transfer of whole microbiota via fecal transplantation has already been shown to ameliorate the severity of diseases such as Clostridium difficile infection, inflammatory bowel disease, and others. However, the exact mechanisms of fecal microbiota transplant efficacy and the particular strains conferring this benefit are still unclear. Rationally designed combinations of microbial preparations may enable more efficient and effective treatment approaches tailored to particular diseases. Here we use an infectious disease, C. difficile infection, and an inflammatory disorder, the inflammatory bowel disease ulcerative colitis, as examples to facilitate the discussion of how microbial therapy might be rationally designed for specific gastrointestinal diseases. Fecal microbiota transplantation has already shown some efficacy in the treatment of both these disorders; detailed comparisons of studies evaluating commensal and probiotic organisms in the context of these disparate gastrointestinal diseases may shed light on potential protective mechanisms and elucidate how future microbial therapies can be tailored to particular diseases.

PMID: 27856521 [PubMed - in process]

Thrombosis in the setting of obesity or inflammatory bowel disease.

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Thrombosis in the setting of obesity or inflammatory bowel disease.

Blood. 2016 Nov 17;128(20):2388-2394

Authors: Lentz SR

Abstract
Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy. Obesity alters the pharmacokinetics of some anticoagulant drugs, and IBD patients present the added management challenge of having a high risk of gastrointestinal bleeding while taking anticoagulants. An extended duration of anticoagulant therapy is often recommended for obese or IBD patients with unprovoked venous thromboembolism unless there is a high risk of bleeding, although more data and better biomarkers are needed to determine whether anticoagulation can be safely stopped in a subset of IBD patients during remission of active disease. Most patients with obesity or IBD require thromboprophylaxis in conjunction with hospitalization or surgery, with adjustment of anticoagulant dosing in patients with severe obesity.

PMID: 27856470 [PubMed - in process]

Use of Intestinal Ultrasound to Monitor Crohn's Disease Activity.

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Use of Intestinal Ultrasound to Monitor Crohn's Disease Activity.

Clin Gastroenterol Hepatol. 2016 Nov 14;:

Authors: Kucharzik T, Wittig BM, Helwig U, Börner N, Rössler A, Rath S, Maaser C, TRUST study group

Abstract
BACKGROUND & AIMS: We performed a multicenter study to determine whether transabdominal bowel wall ultrasonography, a non-invasive procedure that does not require radiation, can be used to monitor progression of Crohn's disease (CD).
METHODS: We performed a 12-month prospective, non-interventional study at 47 sites in Germany, from December 2010 through September 2014. Our study included 234 adult patients with CD who experienced a flare, defined as Harvey-Bradshaw index score of ≥7. All patients received treatment intensification-most with tumor necrosis factor antagonists. Ultrasound parameters and clinical data were assessed at baseline and then after 3, 6, and 12 months. The primary endpoint was the change in ultrasound parameters within 12 months of study enrollment.
RESULTS: All patients included had bowel wall alterations either within the terminal ileum and/or segments of the colon. After 3 and 12 months, ultrasonographic examination showed significant improvements of nearly all ultrasound parameters, including reductions in bowel-wall thickening or stratification, decreased fibro-fatty proliferation, and increased signals in color Doppler ultrasound (P<.01 for all parameters at months 3 and 12). Median Harvey-Bradshaw index scores decreased from 10 at baseline to 2 after 12 months. Improvement in bowel-wall thickness correlated with reduced levels of c-reactive protein after 3 months (P≤.001).
CONCLUSION: In a multicenter prospective study, we found that ultrasonographic examination can be used to monitor disease activity in patients with active CD. Bowel ultrasonography appears to be an ideal follow-up method to evaluate early transmural changes in disease activity, in response to medical treatment. Clinical trial no: DRKS00010805.

PMID: 27856365 [PubMed - as supplied by publisher]

Incidence and Prevalence of Crohn's Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010.

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Incidence and Prevalence of Crohn's Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010.

Clin Gastroenterol Hepatol. 2016 Nov 14;:

Authors: Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV

Abstract
BACKGROUND & AIMS: The incidence and prevalence of inflammatory bowel diseases (IBD) continue to increase worldwide. We sought to update incidence rates of Crohn's disease (CD) and ulcerative colitis (UC) in a well-defined United States (US) population, calculating values for Olmsted County, Minnesota through 2010. We also calculated prevalence values.
METHODS: The resources of the Rochester Epidemiology Project were used to identify county residents who were diagnosed with IBD (CD or UC), based on previously set criteria. Those with new diagnoses of CD or UC between 1970 and 2010 were identified as incidence cases, and those meeting diagnostic criteria on January 1, 2011 were identified as prevalence cases. Incidence rates were estimated (adjusted for age and sex to the US white population in 2010). Trends in incidence based on age at diagnosis, sex, and year of diagnosis were evaluated by Poisson regression.
RESULTS: The incidence cohort included 410 CD patients (51% female) and 483 individuals with UC (56% male). Median age of diagnosis was 29.5 years for persons with CD (range, 4-93 years) and 34.9 years for UC (range, 1-91 years). From 2000 through 2010, the adjusted annual incidence rate for CD was 10.7 cases per 100,000 person-years (95% CI, 9.1-12.3 person-years) and for UC was 12.2 per 100,000 (95% CI, 10.5-14.0 person-years). On January 1, 2011, there were 380 residents with CD, with an adjusted prevalence of 246.7 cases per 100,000 persons (95% CI, 221.7-271.8 cases per 100,000 persons), and 435 residents with UC, with an adjusted prevalence of 286.3 (95% CI, 259.1-313.5 cases per 100,000 persons). Male sex was significantly associated with a higher incidence rate of UC, and younger age was significantly associated with a higher incidence rate of CD.
CONCLUSION: Estimated incidence rates for UC and CD in Olmsted County are among the highest in the US. Extrapolating the adjusted prevalence to the most recent US Census, there could be approximately 1.6 million persons in the US with IBD.

PMID: 27856364 [PubMed - as supplied by publisher]

Novel MicroRNA Signature to Differentiate Ulcerative Colitis from Crohn Disease: A Genome-Wide Study Using Next Generation Sequencing.

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Novel MicroRNA Signature to Differentiate Ulcerative Colitis from Crohn Disease: A Genome-Wide Study Using Next Generation Sequencing.

Microrna. 2016 Nov 17;

Authors: Lin J, Zhang X, Zhao Z, Welker N, Li Y, Liu Y, Bronner M

Abstract
BACKGROUND: The diagnosis of ulcerative colitis (UC) or Crohn disease (CD) can be challenging given the overlapping features. Knowledge of microRNAs in IBD has expanded recently and supports that microRNAs play an important role. This study aimed to identify novel microRNA biomarkers through comprehensive genome-wide sequencing to distinguish UC from CD.
DESIGN: Illumina next generation sequencing was performed on nondysplastic fresh-frozen colonic mucosa of the distal-most colectomy from 19 patients (10 UC and 9 CD) and 18 patients with diverticular disease serving as controls.
RESULTS: USeq software package identified 44 microRNAs with altered expression (fold change ≥2 and false discovery rate ≤0.10) compared to controls. Among them, a panel of 11 microRNAs was aberrantly expressed between UC and CD. qRT-PCR validation assays performed on frozen tissue from additional samples of UC (n=20) and CD (n=10) confirmed specific differential expression of miR-147b, miR-194-2, miR-383, miR-615 and miR-1826 (P<0.05). In addition, pathway analysis identified target genes of epithelial adhesion junction, integrin, glycolysis and cell cycle that involve in signaling pathways of TGF-β, STAT3, IL-8 and PI3L/AKT/mTOR.
CONCLUSION: Identification of differentially expressed microRNAs in UC and CD supports the hypothesis that UC and CD are regulated by distinct pathophysiologic mechanisms. MicroRNA panels show promise as diagnostic biomarkers for the subtyping of inflammatory bowel disease.

PMID: 27855604 [PubMed - as supplied by publisher]

The role of a defunctioning stoma for colonic and perianal Crohn's disease in the biological era.

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The role of a defunctioning stoma for colonic and perianal Crohn's disease in the biological era.

Scand J Gastroenterol. 2016 Nov 18;:1-6

Authors: Martí-Gallostra M, Myrelid P, Mortensen N, Keshav S, Travis SP, George B

Abstract
OBJECTIVE: A defunctioning stoma is a therapeutic option for colonic or perianal Crohn's disease. In the pre-biologic era the response rate to defunctioning in our unit was high (86%), but intestinal continuity was only restored in 11-20%. Few data exist on the outcome of defunctioning since the widespread introduction of biologicals.
MATERIAL AND METHODS: All patients undergoing a defunctioning stoma for colonic/perianal Crohn's disease since 2003-2011 were identified from a prospective database. Indications for surgery, medical therapy, response to defunctioning and long-term clinical outcome were recorded. Successful restoration of continuity was defined as no stoma at last follow up.
RESULTS: Seventy-six patients were defunctioned (57 with biologicals) and at last follow up, 20 (27%) had continuity restored. Early clinical response rate (<3 months) was 15/76 (20%) and overall response 31/76 (41%). Complex anal fistulae/stenosis were associated with a very low chance of restoring continuity (10% and 0%, respectively), while colitis was associated with a higher chance of restoring continuity (48%). Endoscopic or histological improvement in colitis after defunctioning was associated with a higher rate of restoring continuity (10/16, 63%) compared to no such improvement (4/15, 27%, p = 0.05). Those failing biologics had similar chance of restoration as those not receiving biologics, 15/57 (26%) and 5/19 (26%), respectively.
CONCLUSION: Overall response to colonic defunctioning was 41%. Successful restoration of continuity occurred in 27%, but 48% in the absence of perianal disease. Response is appreciably less in the pre-biologic era, so patient and physician expectations need to be managed appropriately.

PMID: 27855530 [PubMed - as supplied by publisher]

[Cholestatic liver disease].

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[Cholestatic liver disease].

Dtsch Med Wochenschr. 2016 Nov;141(23):1683-1687

Authors: Pichler C, Boettler T, Thimme R

Abstract
Common cholestatic liver diseases are primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Both diseases are considered autoimmune disorders; however, the precise pathogenesis remains elusive. Patients usually show no symptoms or present with pruritus and fatigue. High alkaline phosphatase and the presence of antimitochondrial antibodies are sufficient to diagnose PBC. Ursodeoxycholic acid is approved and recommended for the treatment of PBC. The diagnosis of PSC is established by elevated alkaline phosphatase-levels and typical cholangiographic findings. Liver biopsy is not generally necessary for the diagnosis. The prevalence of inflammatory bowel disease in PSC is up to 80 %. There is no established pharmacological therapy, although Ursodeoxycholic acid is often prescribed. Endoscopic management of biliary obstructions offers clinical benefit. Liver transplantation is the definitive treatment for patients with advanced or decompensated cirrhosis.

PMID: 27855457 [PubMed - in process]

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