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Crohn Disease: HELP
Articles by David H. Bruining
Based on 37 articles published since 2008
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Between 2008 and 2019, D. Bruining wrote the following 37 articles about Crohn Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. 2018

Bruining, David H / Zimmermann, Ellen M / Loftus, Edward V / Sandborn, William J / Sauer, Cary G / Strong, Scott A / Anonymous2630933. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. · Department of Gastroenterology, University of Florida, Gainesville, Florida. · Division of Gastroenterology, University of California San Diego, San Diego, California. · Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia. · Division of GI Surgery, Northwestern Medicine, Chicago, Illinois. ·Gastroenterology · Pubmed #29329905.

ABSTRACT: Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented.

2 Review Interdisciplinary Updates in Crohn's Disease Reporting Nomenclature, and Cross-Sectional Disease Monitoring. 2018

Baker, Mark E / Fletcher, Joel G / Al-Hawary, Mahmoud / Bruining, David. ·Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue - L10, Cleveland, OH 44195, USA. Electronic address: bakerm@ccf.org. · Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. · Department of Radiology, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 489109, USA. · Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. ·Radiol Clin North Am · Pubmed #30119768.

ABSTRACT: Computed tomography enterography and magnetic resonance enterography are essential in the evaluation and treatment of patients with Crohn's disease. As such, examination reporting must use standardized nomenclature for effective communication. This report documents an interdisciplinary consensus of the Society of Abdominal Radiology, the Society of Pediatric Radiology, and the American Gastroenterology Association on the computed tomography enterography/magnetic resonance enterography imaging findings and imaging-based morphologic phenotypes.

3 Review Diffusion-weighted MRI in inflammatory bowel disease. 2018

Pouillon, Lieven / Laurent, Valérie / Pouillon, Marc / Bossuyt, Peter / Bonifacio, Christiana / Danese, Silvio / Deepak, Parakkal / Loftus, Edward V / Bruining, David H / Peyrin-Biroulet, Laurent. ·Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France; Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium. · Department of Radiology, Nancy University Hospital, Université de Lorraine, Nancy, France. · Department of Radiology, GZA Ziekenhuizen, Antwerp, Belgium. · Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium. · Department of Radiology, Humanitas Research Hospital, Milan, Italy. · Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy. · Division of Gastroenterology, Washington University in St Louis School of Medicine, St Louis, MO, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA. · Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France. Electronic address: peyrinbiroulet@gmail.com. ·Lancet Gastroenterol Hepatol · Pubmed #29739674.

ABSTRACT: Cross-sectional MRI is an attractive alternative to endoscopy for the objective assessment of patients with inflammatory bowel disease (IBD). Diffusion-weighted imaging is a specialised technique that maps the diffusion of water molecules in biological tissues and can be done without intravenous gadolinium contrast injection. Diffusion-weighted imaging further expands the capability of traditional MRI sequences in IBD. However, the use of quantitative parameters, such as the apparent diffusion coefficient, is limited by low reproducibility. The Nancy score is a luminal disease activity index applied in diffusion-weighted imaging, and comprises only qualitative parameters. The score is accurate in Crohn's disease and ulcerative colitis, and requires no fasting or bowel preparation for assessment of colonic disease. However, deficiency of anatomic detail limits the use of diffusion-weighted imaging for assessment of intra-abdominal Crohn's disease complications. The contribution of such imaging in the prediction of disease course and treatment response in patients with IBD remains to be determined.

4 Review Endoscopic and Radiographic Assessment of Crohn's Disease. 2017

Al-Bawardy, Badr / Hansel, Stephanie L / Fidler, Jeff L / Barlow, John M / Bruining, David H. ·Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: albawardy.badr@mayo.edu. · Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. · Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. ·Gastroenterol Clin North Am · Pubmed #28838411.

ABSTRACT: Crohn's disease is a chronic inflammatory disorder that can progress to obstructive and penetrating complications. Although clinical symptoms are an important component of therapy, they correlate poorly with objective measures of inflammation. The treatment targets have evolved from clinical improvement only to the addition of more objective measures, such as endoscopic mucosal healing and radiologic response, which have been associated with favorable long-term outcomes, including reduced hospitalizations, surgeries, and need for corticosteroids. There are multiple endoscopic and radiologic scoring systems that can aid in quantifying disease activity and response to therapy. These modalities and scoring tools are discussed in this article.

5 Review MR Imaging of Perianal Crohn Disease. 2017

Sheedy, Shannon P / Bruining, David H / Dozois, Eric J / Faubion, William A / Fletcher, Joel G. ·From the Departments of Radiology (S.P.S., J.G.F.), Internal Medicine (D.H.B., W.A.F.), and Surgery (E.J.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905. ·Radiology · Pubmed #28218881.

ABSTRACT: Pelvic magnetic resonance (MR) imaging is currently the standard for imaging perianal Crohn disease. Perianal fistulas are a leading cause of patient morbidity because closure often requires multimodality treatments over a prolonged period of time. This review summarizes clinically relevant anal sphincter anatomy, imaging methods, classification systems, and treatment objectives. In addition, the MR appearance of healing perianal fistulas and fistula complications is described. Difficult imaging tasks including the assessment of rectovaginal fistulas and ileoanal anastomoses are highlighted, along with illustrative cases. Emerging innovative treatments for perianal Crohn disease are now available and have the promise to better control sepsis and maintain fecal continence. Different treatment modalities are selected based on fistula anatomy, patient factors, and management goals (closure versus sepsis control). Radiologists can help maximize patient care by being familiar with MR imaging features of perianal Crohn disease and knowledgeable about what features may influence therapy decisions.

6 Review Crohn's disease diagnosis, treatment approach, and management paradigm: what the radiologist needs to know. 2017

Deepak, Parakkal / Park, Sang Hyoung / Ehman, Eric C / Hansel, Stephanie L / Fidler, Jeff L / Bruining, David H / Fletcher, Joel G. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Department of Gastroenterology, Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. · Division of Abdominal Imaging, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA. · Division of Abdominal Imaging, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA. fletcher.joel@mayo.edu. ·Abdom Radiol (NY) · Pubmed #28210767.

ABSTRACT: Crohn's disease is one of the major subtypes of idiopathic inflammatory bowel disease and is characterized by chronic transmural intestinal inflammation of the gastrointestinal tract anywhere from mouth to the anus, with a predilection for the small bowel. Cross-sectional imaging with computed tomography and magnetic resonance enterography plays a key role in confirming diagnosis, identifying and managing complications, assessing disease severity, and identifying response to medical therapy. This review will focus on the role of radiologists in the diagnosis and assessment of Crohn's disease. Additionally, a review of current medical therapy approaches, available medications, and side effects will be discussed. The review will also highlight key complications of medical therapy and associated diseases that should be evaluated by the radiologist with cross-sectional imaging.

7 Review Computed Tomography and Magnetic Resonance Enterography in Crohn's Disease: Assessment of Radiologic Criteria and Endpoints for Clinical Practice and Trials. 2016

Deepak, Parakkal / Fletcher, Joel G / Fidler, Jeff L / Bruining, David H. ·*Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota; †Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota; and ‡Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #27508513.

ABSTRACT: Early recognition of Crohn's disease with initiation of disease-modifying therapy has emerged as a prominent inflammatory bowel disease management strategy. Clinical practice and trials have often focused on patient symptoms, and more recently, serologic tests, stool inflammatory markers, and/or endoscopic inflammatory features for study entry criteria, treatment targets, disease activity monitoring, and to assess therapeutic response. Unfortunately, patient symptoms do not correlate well with biological disease activity, and endoscopy potentially misses or underestimates disease extent and severity in small bowel Crohn's disease. Computed tomography enterography and magnetic resonance enterography (MRE) are potential tools to identify and quantify transmural structural damage and disease activity in the small bowel. In this review, we discuss the role of computed tomography enterography and MRE in disease management algorithms in clinical practice. We also compare the currently developed MRE-based scoring systems, their strengths and pitfalls, as well as the role for MRE in clinical trials for Crohn's disease.

8 Review Bowel Ultrasonography in the Management of Crohn's Disease. A Review with Recommendations of an International Panel of Experts. 2016

Calabrese, Emma / Maaser, Christian / Zorzi, Francesca / Kannengiesser, Klaus / Hanauer, Stephen B / Bruining, David H / Iacucci, Marietta / Maconi, Giovanni / Novak, Kerri L / Panaccione, Remo / Strobel, Deike / Wilson, Stephanie R / Watanabe, Mamoru / Pallone, Francesco / Ghosh, Subrata. ·*Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; †Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany; ‡Klinik für Allgemeine Innere Medizin und Gastroenterologie, Lüneburg, Germany; §Digestive Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ‖Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota; ¶Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada; **Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy; ††University Hospital Erlangen, Erlangen, Germany; and ‡‡Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University Hospital, Tokyo, Japan. ·Inflamm Bowel Dis · Pubmed #26958988.

ABSTRACT: BACKGROUND: Bowel ultrasonography (US) is considered a useful technique for assessing mural inflammation and complications in Crohn's disease (CD). The aim of this review is to appraise the evidence on the accuracy of bowel US for CD. In addition, we aim to provide recommendations for its optimal use. METHODS: Publications were identified by literature search from 1992 to 2014 and selected based on predefined criteria: 15 or more patients; bowel US for diagnosing CD, complications, postoperative recurrence, activity; adequate reference standards; prospective study design; data reported to allow calculation of sensitivity, specificity, agreement, or correlation values; articles published in English. RESULTS: The search yielded 655 articles, of which 63 were found to be eligible and retrieved as full-text articles for analysis. Bowel US showed 79.7% sensitivity and 96.7% specificity for the diagnosis of suspected CD, and 89% sensitivity and 94.3% specificity for initial assessment in established patients with CD. Bowel US identified ileal CD with 92.7% sensitivity, 88.2% specificity, and colon CD with 81.8% sensitivity, 95.3% specificity, with lower accuracy for detecting proximal lesions. The oral contrast agent improves the sensitivity and specificity in determining CD lesions and in assessing sites and extent. CONCLUSIONS: Bowel US is a tool for evaluation of CD lesions in terms of complications, postoperative recurrence, and monitoring response to medical therapy; it reliably detects postoperative recurrence and complications, as well as offers the possibility of monitoring disease progression.

9 Review Update on the Medical Management of Crohn's Disease. 2015

Deepak, Parakkal / Bruining, David H. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. deepak.parakkal@mayo.edu. · Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. bruining.david@mayo.edu. ·Curr Gastroenterol Rep · Pubmed #26363802.

ABSTRACT: The medical management of Crohn's disease is a rapidly evolving field with expanding therapeutic drug options and treatment strategies. In addition to corticosteroids, immunomodulators, and anti-tumor necrosis (anti-TNF) agents, a new anti-adhesion medication (vedolizumab) has been approved. Individualized patient-based dosing of immunomodulators and biologic agents is now possible with therapeutic drug monitoring (TDM). There is a changing paradigm in treatment goals to achieve deeper remission identified by composite clinical and endoscopic endpoints. More aggressive treatment strategies in the postoperative setting have been proposed due to emerging data on medication efficacy in this setting. Management algorithms that stratify CD patients into risk groups to balance treatment benefit against adverse events and costs are being developed to translate research into clinical practice. This review provides an update on these new developments for practicing gastroenterologists.

10 Review CT and MR enterography in Crohn's disease: current and future applications. 2015

Bruining, David H / Bhatnagar, Gauraang / Rimola, Jordi / Taylor, Stuart / Zimmermann, Ellen M / Fletcher, Joel G. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA, bruining.david@mayo.edu. ·Abdom Imaging · Pubmed #25637127.

ABSTRACT: -- No abstract --

11 Review Do not assume symptoms indicate failure of anti-tumor necrosis factor therapy in Crohn's disease. 2011

Bruining, David H / Sandborn, William J. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. ·Clin Gastroenterol Hepatol · Pubmed #21277392.

ABSTRACT: It is a challenge to monitor patients with Crohn's disease who remain symptomatic despite anti-tumor necrosis factor therapy. Clinicians must use a systematic approach for each patient and obtain objective evidence about disease activity and response to therapy. Alternate etiologies for symptoms should be sought and treated, if found. Active Crohn's disease despite therapy requires reassessment and adjustments to management plans.

12 Review Crohn's disease clinical issues and treatment: what the radiologist needs to know and what the gastroenterologist wants to know. 2009

Bruining, David H / Loftus, Edward V. ·Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA ·Abdom Imaging · Pubmed #18493815.

ABSTRACT: Crohn's disease is an idiopathic chronic intestinal illness that requires specialized medical care for prompt disease diagnosis and appropriate management. Clinicians must accurately interpret and integrate findings from multitude of sources in order to achieve diagnostic certainty. Ileocolonoscopy remains the most relied modality, allowing for a direct mucosal visualization and biopsies for histologic assessments. Serologic markers currently serve an adjunctive role, often utilized in attempts to further subtype patients with indeterminate colitis. Radiologic imaging, such as computed tomography enterography can evaluate the far reaches of the small intestine, while also providing information about penetrating complications and extraintestinal disease manifestations. Treatment options and strategies continue to evolve with new biologic agents and ongoing testing of aggressive "top-down" approaches. In addition, identification of increased colorectal cancer risks in individuals with Crohn's colitis has led to formal surveillance guidelines. The clinical diagnosis and management of Crohn's disease continues to be an area of rapid change and exciting developments.

13 Clinical Trial Tacrolimus salvage in anti-tumor necrosis factor antibody treatment-refractory Crohn's disease. 2013

Gerich, Mark E / Pardi, Darrell S / Bruining, David H / Kammer, Patricia P / Becker, Brenda D / Tremaine, William T. ·Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, Colorado 80045, USA. mark.gerich@ucdenver.edu ·Inflamm Bowel Dis · Pubmed #23518805.

ABSTRACT: BACKGROUND: Several small retrospective studies have reported encouraging response rates in patients with Crohn's disease (CD) treated with tacrolimus. METHODS: We conducted a retrospective study of the use of oral tacrolimus for severe CD refractory to anti-tumor necrosis factor agents. Response was defined as a clinician's assessment of improvement after at least 7 days of treatment of one or more of the following: bowel movement frequency, fistula output, rectal bleeding, abdominal pain, extraintestinal manifestations, or well-being. Remission required all of the following: <3 stools per day, no bleeding, abdominal pain or extraintestinal manifestations, and increased well-being. RESULTS: Twenty-four eligible patients were treated with tacrolimus for a median of 4 months. Approximately 37% were steroid dependent or steroid refractory. Response and steroid-free remission rates were 67% and 21%, respectively, and lasted for a median of 4 months. Approximately 42% of patients were able to stop steroids and 54% of patients ultimately required surgery within a median of 10 months after starting tacrolimus. Patients with mean tacrolimus trough levels of 10 to 15 ng/mL had the highest rates of response (86%) and remission (57%). Surgery seemed to be postponed in this group compared with others. An adverse event occurred in 75% of patients. Eight of these events (33%) required dose reduction and 6 (25%) led to treatment discontinuation. There were no irreversible side effects or deaths attributable to tacrolimus over a median follow-up of 56 months. CONCLUSIONS: Oral tacrolimus seems to be safe and effective in some patients with severe CD refractory to anti-tumor necrosis factor therapy, particularly at a mean trough level of 10 to 15 ng/mL.

14 Clinical Trial Natalizumab for moderate to severe Crohn's disease in clinical practice: the Mayo Clinic Rochester experience. 2012

Kane, S V / Horst, S / Sandborn, W J / Becker, B / Neis, B / Moscandrew, M / Hanson, K A / Tremaine, W J / Bruining, D H / Faubion, W A / Pardi, D S / Harmsen, W S / Zinsmeister, A R / Loftus, E V. ·Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. kane.sunanda@mayo.edu ·Inflamm Bowel Dis · Pubmed #22419661.

ABSTRACT: BACKGROUND: Not all patients with Crohn's disease (CD) respond or maintain response to anti-tumor necrosis factor (TNF) agents and alternative treatment is necessary. Natalizumab, a monoclonal antibody to alpha-4 integrin approved for CD, has demonstrated efficacy in randomized clinical trials. We describe our experience with natalizumab in clinical practice at Mayo Clinic Rochester. METHODS: Consecutive patients prescribed natalizumab for active CD were invited to participate and were followed prospectively. Incidence of infection, hospitalization, neoplasm, or other adverse events were recorded. Clinical activity was assessed using the Harvey-Bradshaw Index at each 30-day infusion visit. RESULTS: Between April 2008 and September 2010, 36 patients were prescribed natalizumab and 30 (83.3%) agreed to participate. Median disease duration was 9 years (range, 3-43). Twenty-three patients had prior exposure to two anti-TNF agents, seven to one agent. All patients experienced at least one adverse event; none of the 13 patients in whom natalizumab was stopped (43%) discontinued due to adverse events. Five patients had infusions held for infection. No patient developed progressive multifocal leukoencephalopathy (PML). Fourteen patients (46%) had clinical response. The cumulative probability of achieving complete response within 1 year was 56% (28%-73%). Four of seven patients were weaned off corticosteroids. CONCLUSIONS: In our experience with natalizumab in clinical practice, adverse events were manageable and did not result in treatment cessation. No PML cases were seen and clinical response was similar to that in clinical trials. Natalizumab results in clinical benefit in patients who have active disease and have failed anti-TNF therapy.

15 Article Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. 2018

Bruining, David H / Zimmermann, Ellen M / Loftus, Edward V / Sandborn, William J / Sauer, Cary G / Strong, Scott A / Anonymous6840932. ·From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L) · Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.) · Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S) · Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S) · and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S). ·Radiology · Pubmed #29319414.

ABSTRACT: Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented.

16 Article De-novo Inflammatory Bowel Disease After Bariatric Surgery: A Large Case Series. 2018

Braga Neto, Manuel B / Gregory, Martin / Ramos, Guilherme P / Loftus, Edward V / Ciorba, Matthew A / Bruining, David H / Bazerbachi, Fateh / Abu Dayyeh, Barham K / Kushnir, Vladimir M / Shah, Meera / Collazo-Clavell, Maria L / Raffals, Laura E / Deepak, Parakkal. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. · Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA. · Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA. ·J Crohns Colitis · Pubmed #29272375.

ABSTRACT: Background: Case reports of inflammatory bowel diseases [IBD] have been reported in patients with a history of bariatric surgery. Our aim was to characterize patients who were diagnosed with IBD after having undergone bariatric surgery. Methods: Electronic medical records were reviewed at two institutions to identify patients who developed de-novo Crohn's disease or ulcerative colitis [UC] after bariatric surgery. Data on demographics, type of bariatric surgical procedure, IBD subtype, phenotype and medication usage were obtained. The incidence rate of de-novo IBD after bariatric surgery [per 100000 person-years] and standardized incidence ratio [SIR] were estimated from a prospective bariatric surgery database. Results: A total of 44 patients with de-novo IBD after bariatric surgery were identified [31 Crohn's disease, 12 UC, one IBD unclassified]. Most patients were female [88.6%], with median age at IBD onset of 44 years [IQR, 37-52] and median time to IBD diagnosis after bariatric surgery of 7 years [IQR, 3-10]. Sixty-eight per cent underwent Roux-en-Y gastric bypass. In the prospective database, the incidence of IBD in patients who underwent bariatric surgery was 26.7 per 100000 person-years [4.5 for UC and 22.3 for Crohn's disease]. The age-adjusted SIR ranged from 3.56 in the 40-49 year age group to 4.73 in the 30-39 year age group. Conclusion: We described a case series of patients developing de-novo IBD after bariatric surgery. There appears to be a numerically higher incidence of Crohn's disease in this population. Confirmation of causality is required in larger patient cohorts.

17 Article Endoscopic Skipping of the Terminal Ileum in Pediatric Crohn Disease. 2017

Mansuri, Ishrat / Fletcher, Joel G / Bruining, David H / Kolbe, Amy B / Fidler, Jeff L / Samuel, Sunil / Tung, Jeanne. ·1 Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. · 2 Present address: Boston Children's Hospital, Boston, MA. · 3 Department of Radiology, Mayo Clinic, Rochester, MN. · 4 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. · 5 Division of Gastroenterology and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK. ·AJR Am J Roentgenol · Pubmed #28379745.

ABSTRACT: OBJECTIVE: Pediatric small-bowel (SB) Crohn disease (CD) may be missed if the terminal ileum (TI) appears normal at endoscopy and SB imaging is not performed. We sought to estimate the prevalence and clinical characteristics of pediatric patients with CD and endoscopic skipping of the TI-that is, pediatric patients with active SB or upper gut inflammation and an endoscopically normal TI. MATERIALS AND METHODS: This retrospective study included pediatric patients with CD who underwent both CT enterography (CTE) or MR enterography (MRE) and ileocolonoscopy within a 30-day period between July 2004 and April 2014. The physician global assessment was used as the reference standard for SB CD activity. Radiologists reviewed the CTE and MRE studies for inflammatory parameters; severity, length, and multifocality of SB inflammation; and the presence of penetrating complications. RESULTS: Of 170 patients who underwent ileal intubation, the TI was macroscopically normal or showed nonspecific inflammation in 73 patients (43%). Nearly half (36/73, 49%) of the patients with normal or nonspecific findings at ileocolonoscopy had radiologically active disease with a median length of SB involvement of 20 cm (range, 1 to > 100 cm). Seventeen (47%) of these patients had multifocal SB involvement and five (14%) had penetrating complications. Overall, endoscopic TI skipping was present in 43 (59%) patients with normal or nonspecific ileocolonoscopic findings: 20 with histologic inflammation (17 with positive imaging findings), 14 with inflammation at imaging only, and nine with proximal disease (upper gut, jejunum, or proximal ileum). There were no significant differences in the clinical parameters of the patients with and those without endoscopic TI skipping. CONCLUSION: Ileocolonoscopy may miss SB CD in pediatric patients that is due to isolated histologic, intramural, or proximal inflammation. Enterography is complementary to ileocolonoscopy in the evaluation of pediatric CD.

18 Article Radiological Response Is Associated With Better Long-Term Outcomes and Is a Potential Treatment Target in Patients With Small Bowel Crohn's Disease. 2016

Deepak, Parakkal / Fletcher, Joel G / Fidler, Jeff L / Barlow, John M / Sheedy, Shannon P / Kolbe, Amy B / Harmsen, William S / Loftus, Edward V / Hansel, Stephanie L / Becker, Brenda D / Bruining, David H. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Division of Pediatric Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. ·Am J Gastroenterol · Pubmed #27166131.

ABSTRACT: OBJECTIVES: Crohn's disease (CD) management targets mucosal healing on ileocolonoscopy as a treatment goal. We hypothesized that radiologic response is also associated with better long-term outcomes. METHODS: Small bowel CD patients between 1 January 2002 and 31 October 2014 were identified. All patients had pre-therapy computed tomography enterography (CTE)/magnetic resonance enterography (MRE) with follow-up CTE or MRE after 6 months, or 2 CTE/MREs≥6 months apart while on maintenance therapy. Radiologists characterized inflammation in up to five small bowel lesions per patient. At second CTE/MRE, complete responders had all improved lesions, non-responders had worsening or new lesions, and partial responders had other scenarios. CD-related outcomes of corticosteroid usage, hospitalization, and surgery were assessed using Kaplan-Meier survival analysis and multivariable Cox models. RESULTS: CD patients (n=150), with a median disease duration of 9 years, had 223 inflamed small bowel segments (76 with strictures and 62 with penetrating, non-perianal disease), 49% having ileal distribution. Fifty-five patients (37%) were complete radiologic responders, 39 partial (26%), and 56 non-responders (37%). In multivariable Cox models, complete and partial response decreased risk for steroid usage by over 50% (hazard ratio (HR)s: 0.37 (95% confidence interval (CI), 0.21-0.64); 0.45 (95% CI, 0.26-0.79)), and complete response decreased the risk of subsequent hospitalizations and surgery by over two-thirds (HRs: HR, 0.28 (95% CI, 0.15-0.50); HR, 0.34 (95% CI, 0.18-0.63)). CONCLUSIONS: Radiological response to medical therapy is associated with significant reductions in long-term risk of hospitalization, surgery, or corticosteroid usage among small bowel CD patients. These findings suggest the significance of radiological response as a treatment target.

19 Article Magnetic resonance enterography is feasible and reliable in multicenter clinical trials in patients with Crohn's disease, and may help select subjects with active inflammation. 2016

Coimbra, A J F / Rimola, J / O'Byrne, S / Lu, T T / Bengtsson, T / de Crespigny, A / Luca, D / Rutgeerts, P / Bruining, D H / Fidler, J L / Sandborn, W J / Santillan, C S / Higgins, P D R / Al-Hawary, M M / Vermeire, S / Vanbeckevoort, D / Vanslembrouck, R / Peyrin-Biroulet, L / Laurent, V / Herrmann, K A / Panes, J. ·Genentech, Inc., South San Francisco, CA, USA. · Hospital Clínic de Barcelona, Catalonia, Spain. · University Hospitals Leuven, Leuven, Belgium. · Mayo Clinic, Rochester, MN, USA. · University of California San Diego, La Jolla, CA, USA. · University of Michigan, Ann Arbor, MI, USA. · TARGID, KU Leuven, Leuven, Belgium. · University Hospital Leuven, Leuven, Belgium. · University Hospital of Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France. · Adults University, Nancy University, Vandoeuvre-lès-Nancy, France. · University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA. · Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. ·Aliment Pharmacol Ther · Pubmed #26548868.

ABSTRACT: BACKGROUND: Reliable tools for patient selection are critical for clinical drug trials. AIM: To evaluate a consensus-based, standardised magnetic resonance enterography (MRE) protocol for selecting patients for inclusion in Crohn's disease (CD) multicenter clinical trials. METHODS: This study recruited 20 patients [Crohn's Disease Activity Index (CDAI) scores: <150 (n = 8); 150-220 (n = 4); 220-450 (n = 8)], to undergo ileocolonoscopy and two MREs (with and without colonic contrast) within a 14-day period. Procedures were scored centrally using, Magnetic Resonance Index of Activity (MaRIA), and both Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic Score (SES-CD). RESULTS: 37 MREs were acquired. Both MREs were evaluable in 16 patients for calculation of test-retest and inter-reader reliability scores. The MaRIA scores for the terminal ileum had excellent test-retest and inter-reader reliability, with correlations >0.9. The proximal ileum showed strong within-reader agreement (0.90-0.96), and fair between-reader agreement (0.59-0.72). MRE procedures were tolerable. MaRIA scores correlated with CDEIS and SES-CD (0.63 and 0.71), but not with CDAI (0.34). MRE identified 3 patients with intra-abdominal complications, who would otherwise have been included in clinical trials. Furthermore, both MRE and ileocolonoscopy identified active bowel wall inflammation in 2 patients with CDAI <150, and none in 1 patient with CDAI > 220. Data quality was good/excellent in 85% of scans, and fair or better in 96%. CONCLUSIONS: Magnetic resonance enterography of high-quality and reproducibility was feasible in a global multi- centre setting, with evidence for improved selectivity over CDAI and ileocolonoscopy in identifying appropriate CD patients for inclusion in therapeutic intervention trials.

20 Article Incremental diagnostic yield of chromoendoscopy and outcomes in inflammatory bowel disease patients with a history of colorectal dysplasia on white-light endoscopy. 2016

Deepak, Parakkal / Hanson, Gregory J / Fletcher, Joel G / Tremaine, William J / Pardi, Darrell S / Kisiel, John B / Schroeder, Kenneth W / Wong Kee Song, Louis M / Harmsen, William S / Loftus, Edward V / Bruining, David H. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Mayo Medical School, Rochester, Minnesota, USA. · Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. ·Gastrointest Endosc · Pubmed #26408903.

ABSTRACT: BACKGROUND AND AIMS: Chromoendoscopy (CE) identifies dysplastic lesions with a higher sensitivity than white-light endoscopy (WLE). The role of CE in the management of dysplasia on surveillance WLE in inflammatory bowel disease (IBD) remains unclear. METHODS: A retrospective cohort of IBD patients with colorectal dysplasia on WLE who subsequently underwent CE between January 1, 2006 and August 31, 2013 was identified. Endoscopic and histologic findings were compared among the index WLE, first CE, and subsequent CE. Outcomes assessed included endoscopic lesion removal, surgery or repeat CE, and diagnosis of colorectal cancer. RESULTS: Ninety-five index cases were identified. The median duration of IBD was 18 years (interquartile range 9.3-29.8); 78 patients had ulcerative colitis. Dysplasia was identified in 55 patients during the index WLE with targeted biopsies of 72 lesions. The first CE visualized dysplastic lesions in 50 patients, including 34 new lesions (not visualized on the index examination). Endoscopic resection was performed successfully of 43 lesions, most in the cecum/ascending colon (n = 20) with sessile morphology (n = 33). After the first CE, 14 patients underwent surgery that revealed 2 cases of colorectal cancer and 3 cases of high-grade dysplasia. Multiple CEs were performed in 44 patients. Of these, 20 patients had 34 visualized lesions, 26 of which were new findings. CONCLUSION: Initial and subsequent CE performed in IBD patients with a history of colorectal dysplasia on WLE frequently identified new lesions, most of which were amenable to endoscopic treatment. These data support the use of serial CEs in this high-risk population.

21 Article Detection of Cytomegalovirus in Patients with Inflammatory Bowel Disease: Where to Biopsy and How Many Biopsies? 2015

McCurdy, Jeffrey D / Enders, Felicity T / Jones, Andrea / Killian, Jill M / Loftus, Edward V / Bruining, David H / Smyrk, Thomas C. ·*Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; †Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; and ‡Department of Pathology, Mayo Clinic, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #26273816.

ABSTRACT: BACKGROUND: The potential negative impact of cytomegalovirus (CMV) in ulcerative colitis (UC) and Crohn's disease (CD) warrants efforts to improve the yield of diagnostic techniques. METHODS: We retrospectively determined the optimal biopsy location and number from sixty-eight patients with inflammatory bowel disease (66% UC, 31% CD, and 3% inflammatory bowel disease-unclassified) with CMV disease between 2005 and 2011. Biopsies with endoscopic and histologic inflammation were analyzed by immunohistochemistry and/or in situ hybridization. The proportion of positive biopsies was determined, and using data from the 25th percentile, we assessed the number of biopsies required to achieve an 80% probability of a single positive biopsy. RESULTS: Of the patients with a diagnosis by immunohistochemistry and/or in situ hybridization, 27 of 61 (44%; 95% confidence interval, 32-57) were positive by hematoxylin and eosin, and 11 of 36 (31%; 95% confidence interval, 16-46) had systemic CMV by polymerase chain reaction. Of the patients with biopsies proximal and distal to the splenic flexure, 1 of 11 with UC and 4 of 8 with CD had a diagnosis limited to the right colon. Twenty percent of biopsies were positive by immunohistochemistry or in situ hybridization (20% in UC and 17% in CD). Eleven biopsies in UC and 16 in CD were required to achieve an 80% probability of a positive biopsy. CONCLUSIONS: Biopsy location and number are important considerations when assessing for CMV. We recommend a flexible sigmoidoscopy with 11 biopsies in UC and a colonoscopy with 16 biopsies in CD.

22 Article Efficacy and safety of certolizumab pegol for Crohn's disease in clinical practice. 2015

Moon, W / Pestana, L / Becker, B / Loftus, E V / Hanson, K A / Bruining, D H / Tremaine, W J / Kane, S V. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. · Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. ·Aliment Pharmacol Ther · Pubmed #26081839.

ABSTRACT: BACKGROUND: Certolizumab pegol (CZP) is Food and Drug Administration (FDA)-approved to treat Crohn's disease (CD). However, the efficacy and safety of CZP outside clinical trials are not well established. AIM: To report the efficacy, safety and predictors of response to CZP in CD patients treated during a 6-year period since FDA-approval at a tertiary care centre. METHODS: All CD patients who received CZP at our institution between 2008 and 2013 were evaluated through retrospective medical record-based review of steroid-free complete response (SCR), loss of response and safety. RESULTS: A total of 358 patients were included. One hundred twelve patients (31.3%) and 189 (52.8%) received CZP as their second and third biological agent, respectively. The probability of SCR at 26 week was 19.9% (95% CI, 15.9-24.5). The probability of survival free of loss of response at 2 year was 45.7% (95% CI, 32.5-59.5). A predictor of SCR was age at CD diagnosis of >40 years old (hazard ratio, HR relative to those <17, 4.69; 95% CI, 1.75-12.61). Negative predictors included present perianal fistula (HR, 0.39; 95% CI, 0.16-0.98) and prior primary nonresponse to adalimumab (ADA; HR relative to secondary loss of response, 0.18; 95% CI, 0.04-0.76). Twenty-three patients (6.4%) experienced serious adverse events and 19 patients (5.3%) discontinued CZP due to adverse events. CONCLUSIONS: Certolizumab pegol was both effective and well tolerated for the treatment of Crohn's disease in this large tertiary care centre enriched with biologics-exposed patients. It may be more effective in patients without early-aged Crohn's disease diagnosis, prior primary nonresponse to adalimumab and present perianal fistula.

23 Article Development of the Lémann index to assess digestive tract damage in patients with Crohn's disease. 2015

Pariente, Benjamin / Mary, Jean-Yves / Danese, Silvio / Chowers, Yehuda / De Cruz, Peter / D'Haens, Geert / Loftus, Edward V / Louis, Edouard / Panés, Julian / Schölmerich, Jürgen / Schreiber, Stefan / Vecchi, Maurizio / Branche, Julien / Bruining, David / Fiorino, Gionata / Herzog, Matthias / Kamm, Michael A / Klein, Amir / Lewin, Maïté / Meunier, Paul / Ordas, Ingrid / Strauch, Ulrike / Tontini, Gian-Eugenio / Zagdanski, Anne-Marie / Bonifacio, Cristiana / Rimola, Jordi / Nachury, Maria / Leroy, Christophe / Sandborn, William / Colombel, Jean-Frédéric / Cosnes, Jacques. ·Department of Hepatogastroenterology, Hôpital Saint-Louis, Paris, France; Department of Hepatogastroenterology, University of Lille, Hôpital Claude Huriez, Lille, France. · INSERM U717, Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Paris, France. · BD Center, Department of Gastroenterology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. · Department of Gastroenterology, Rambam Health Care Campus, Haifa, Bat Galim, Israel. · St Vincent's Hospital & University of Melbourne, Melbourne, Australia. · Academic Medical Center, Amsterdam, The Netherlands; Imelda GI Clinical Research Center, Bonheiden, Belgium. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. · Department of Hepatogastroenterology, Centre Hospitalier Universitaire de Liège, Liège University, Liège, Belgium. · Gastroenterology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. · Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. · Institute of Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany. · Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato and University of Milan, Milan, Italy. · Department of Hepatogastroenterology, University of Lille, Hôpital Claude Huriez, Lille, France. · St Vincent's Hospital & University of Melbourne, Melbourne, Australia; Imperial College, London, UK. · Radiology Department, Hôpital Saint-Antoine, Paris, France. · Department of Medical Imaging, Centre Hospitalier Universitaire de Liège, Liège University, Liège, Belgium. · Radiology Department, Hôpital Saint-Louis, Paris, France. · Department of Radiology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. · Radiology Department, CDI-Hospital Clinic, Barcelona, Spain. · Radiology Department, University Hospital, Lille, France. · Division of Gastroenterology, UC San Diego Health System, La Jolla, California. · Department of Gastroenterology, Icahn Medical School at Mount Sinai, New York, New York. · Gastroenterology and Nutrition Department, Hôpital Saint-Antoine, Paris, France. Electronic address: jacques.cosnes@sat.ap-hop-paris.fr. ·Gastroenterology · Pubmed #25241327.

ABSTRACT: BACKGROUND & AIMS: There is a need for a scoring system that provides a comprehensive assessment of structural bowel damage, including stricturing lesions, penetrating lesions, and surgical resection, for measuring disease progression. We developed the Lémann Index and assessed its ability to measure cumulative structural bowel damage in patients with Crohn's disease (CD). METHODS: We performed a prospective, multicenter, international, cross-sectional study of patients with CD evaluated at 24 centers in 15 countries. Inclusions were stratified based on CD location and duration. All patients underwent clinical examination and abdominal magnetic resonance imaging analyses. Upper endoscopy, colonoscopy, and pelvic magnetic resonance imaging analyses were performed according to suspected disease locations. The digestive tract was divided into 4 organs and subsequently into segments. For each segment, investigators collected information on previous operations, predefined strictures, and/or penetrating lesions of maximal severity (grades 1-3), and then provided damage evaluations ranging from 0.0 (no lesion) to 10.0 (complete resection). Overall level of organ damage was calculated from the average of segmental damage. Investigators provided a global damage evaluation (from 0.0 to 10.0) using calculated organ damage evaluations. Predicted organ indexes and Lémann Index were constructed using a multiple linear mixed model, showing the best fit with investigator organ and global damage evaluations, respectively. An internal cross-validation was performed using bootstrap methods. RESULTS: Data from 138 patients (24, 115, 92, and 59 with upper tract, small bowel, colon/rectum, and anus CD location, respectively) were analyzed. According to validation, the unbiased correlation coefficients between predicted indexes and investigator damage evaluations were 0.85, 0.98, 0.90, 0.82 for upper tract, small bowel, colon/rectum, anus, respectively, and 0.84 overall. CONCLUSIONS: In a cross-sectional study, we assessed the ability of the Lémann Index to measure cumulative structural bowel damage in patients with CD. Provided further successful validation and good sensitivity to change, the index should be used to evaluate progression of CD and efficacy of treatment.

24 Article Clinical characteristics and imaging features of small bowel adenocarcinomas in Crohn's disease. 2015

Weber, Nicholas K / Fletcher, Joel G / Fidler, Jeff L / Barlow, John M / Pruthi, Shiv / Loftus, Edward V / Pardi, Darrell S / Smyrk, Thomas C / Becker, Brenda D / Pasha, Shabana F / Bruining, David H. ·Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA. ·Abdom Imaging · Pubmed #24760323.

ABSTRACT: PURPOSE: Small bowel adenocarcinoma is uncommon in patients with Crohn's disease but has an extremely poor prognosis. There is a paucity of data on the clinical characteristics and radiologic features of this entity. We sought to update our institutional experience with small bowel adenocarcinoma occurring in the setting of Crohn's disease and to systematically re-examine pre-operative imaging findings. METHODS: Medical records were abstracted to identify all patients with Crohn's disease and small bowel adenocarcinoma who were evaluated at Mayo Clinic, Rochester, Minnesota and Mayo Clinic, Scottsdale, Arizona between 1976 and 2012. Clinical, demographic, and outcomes data were obtained for each patient. Pre-diagnosis radiologic imaging was re-evaluated by two gastrointestinal radiologists. RESULTS: Thirty-four patients (21 males) were identified. Median ages at Crohn's disease and cancer diagnoses were 22.4 and 52.9 years, respectively. Median follow-up after cancer diagnosis was 272.0 days; 22 patients (64.7%) had persistent or recurrent adenocarcinoma at last follow-up. 1- and 2-year mortality rates were 29.6% and 48.0%. Pre-operative imaging studies were available for re-review in 14 cases. Features concerning for malignancy included annular mass, nodularity at the extraluminal margins of the mass, and perforation. Nearly all tumors arose in regions of chronic inflammation and caused luminal narrowing with pre-stenotic dilatation. CONCLUSIONS: Small bowel adenocarcinoma is rare in patients with Crohn's disease but results in significant mortality. CT or MR imaging findings can be suggestive of the pre-operative diagnosis, but it is usually diagnosed at an advanced stage with laparotomy.

25 Article Comparative outcomes of younger and older hospitalized patients with inflammatory bowel disease treated with corticosteroids. 2013

Weber, Nicholas K / Bruining, David H / Loftus, Edward V / Tremaine, William J / Augustin, Jessica J / Becker, Brenda D / Kammer, Patricia P / Harmsen, William Scott / Zinsmeister, Alan R / Pardi, Darrell S. ·*Division of Gastroenterology and Hepatology and †Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #24105393.

ABSTRACT: BACKGROUND: Data on the differences in inpatient treatment approaches and outcomes between younger and older patients with inflammatory bowel disease (IBD) are limited. Therefore, we used a parallel cohort study design to compare outcomes between younger and older patients with IBD. METHODS: All anti-tumor necrosis factor (TNF)-naive patients aged 60 years and older hospitalized at our institution between 2003 and 2011 and treated with corticosteroids for an IBD flare were matched 1:1 to younger patients aged 18 to 50 years. Rates of corticosteroid response, colectomy, and initiation of anti-TNF therapy were compared. RESULTS: Sixty-five patients were identified in each cohort. Median ages were 70 years (range, 60-94) and 30 years (range, 18-50) for the older and younger groups, respectively. Twenty-three percent of older patients were refractory to corticosteroids compared with 38% of the younger cohort (odds ratio, 0.5; 95% confidence intervals, 0.2-1.1). Older corticosteroid-refractory patients had surgery (80% versus 72%) and were started on anti-TNF therapy (20% versus 12%; P = 0.71), at a similar frequency as younger patients. Older steroid-responsive patients were less likely to start an anti-TNF agent during the first year of follow-up than younger patients (7% versus 31%, P = 0.006), but there was no difference in 1-year colectomy rates (27% versus 28%, P = 0.63). CONCLUSIONS: Corticosteroid response was similar in older and younger patients hospitalized for IBD. Inpatient treatment for corticosteroid-refractory patients was similar between cohorts. Older corticosteroid-responsive patients were less likely to be treated with an anti-TNF than younger patients.

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