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Crohn Disease: HELP
Articles by Shannon Chang
Based on 5 articles published since 2010
(Why 5 articles?)
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Between 2010 and 2020, Shannon Chang wrote the following 5 articles about Crohn Disease.
 
+ Citations + Abstracts
1 Review Optimizing pharmacologic management of inflammatory bowel disease. 2017

Chang, Shannon / Hanauer, Stephen. ·a Division of Gastroenterology , New York University Langone Medical Center , New York , NY , USA. · b Division of Gastroenterology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA. ·Expert Rev Clin Pharmacol · Pubmed #28475384.

ABSTRACT: INTRODUCTION: As our medical armamentarium for IBD continues to expand, it is essential that clinicians understand both optimizing and sequencing of individual and combination therapeutic approaches with available medications. Areas covered: This review summarizes dosing strategies and therapeutic drug monitoring for pharmacologic optimization in IBD. Aminosalicylates remain first-line therapies for mild-to-moderate UC but have limited evidence of efficacy in CD. Budesonide provides an alternative to aminosalicylates when targeted to appropriate sites in the distal small bowel and colon, as do conventional corticosteroids when applied rectally. Systemic steroids are highly efficacious but burdened by toxicity. Thiopurines or methotrexate can be utilized as steroid-sparing agents. Biologic agents targeting TNF remain important for steroid-sparing therapy in moderate-to-severe UC and CD. Newer biologics targeting lymphocyte trafficking and lymphocyte activation are also efficacious for moderate-to-severe IBD. Near future conventional drug options include oral agents such as tofacitinib and mongersen. Expert commentary: Positioning therapies according to the location, phenotypes, and severity, as well as the use of therapeutic and clinical targets, will improve outcomes and minimize toxicities and therapeutic futilities. Future IBD treatment should focus on personalized therapy plans based on genetic determinants, targeted mechanisms of action, and pharmacologic optimization.

2 Review Disease monitoring in inflammatory bowel disease. 2015

Chang, Shannon / Malter, Lisa / Hudesman, David. ·Shannon Chang, Lisa Malter, David Hudesman, Division of Gastroenterology, New York University, New York City, NY 10016, United States. ·World J Gastroenterol · Pubmed #26523100.

ABSTRACT: The optimal method for monitoring quiescent disease in patients with Crohn's disease (CD) and ulcerative colitis is yet to be determined. Endoscopic evaluation with ileocolonoscopy is the gold standard but is invasive, costly, and time-consuming. There are many commercially available biomarkers that may be used in clinical practice to evaluate disease status in patients with inflammatory bowel disease (IBD), but the most widely adopted biomarkers are C-reactive protein (CRP) and fecal calprotectin (FC). This review summarizes the evidence for utilizing CRP and FC for monitoring IBD during clinical remission and after surgical resection. Endoscopic correlation with CRP and FC is evaluated in each disease state. Advantages and drawbacks of each biomarker are discussed with special consideration of isolated ileal CD. Fecal immunochemical testing, traditionally used for colorectal cancer screening, is mentioned as a potential new alternative assay in the evaluation of IBD. Based on a mixture of information gleaned from biomarkers, clinical status, and endoscopic evaluation, the best treatment decisions can be made for the patient with IBD.

3 Article Alvimopan for the Prevention of Postoperative Ileus in Inflammatory Bowel Disease Patients. 2020

Jang, Janice / Kwok, Benjamin / Zhong, Hua / Xia, Yuhe / Grucela, Alexis / Bernstein, Mitchell / Remzi, Feza / Hudesman, David / Chen, Jingjing / Axelrad, Jordan / Chang, Shannon. ·Division of Gastroenterology and Hepatology, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA. · Department of Internal Medicine, New York University Langone Health, New York, NY, USA. · Department of Population Health, New York University Langone Health, New York, NY, USA. · Department of Surgery, New York University Langone Health, New York, NY, USA. · Department of Internal Medicine, Stanford University Medical Center, Stanford, CA, USA. · Division of Gastroenterology and Hepatology, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA. Shannon.Chang@nyulangone.org. ·Dig Dis Sci · Pubmed #31522323.

ABSTRACT: BACKGROUND: Postoperative ileus (POI) is a temporary delay of coordinated intestinal peristalsis. Alvimopan, an oral peripherally acting mu-opioid receptor antagonist approved for accelerating gastrointestinal recovery, has never been studied specifically in patients with inflammatory bowel disease (IBD). AIM: To investigate the efficacy of alvimopan in preventing POI among IBD patients. METHODS: A retrospective chart review was conducted on 246 IBD patients undergoing bowel surgery between 2012 and 2017. Data collected included demographics, IBD subtype, length of stay (LOS), postoperative gastrointestinal symptoms, and administration of alvimopan. The primary outcome was POI; secondary gastrointestinal recovery outcomes were: time to first flatus, time to first bowel movement, time to tolerating a liquid diet, time to tolerating solid food, and LOS. RESULTS: When compared with the control group, patients in the alvimopan group had shorter times to tolerating liquids and solids, first flatus, and first bowel movements (p < 0.01). LOS was shorter in the alvimopan group when compared with controls (p < 0.01). The overall incidence of POI was higher in controls than in the alvimopan group (p = 0.07). For laparoscopic surgeries, the incidence of POI was also higher in controls than in the alvimopan group (p < 0.01). On multivariable analysis, alvimopan significantly decreased time to all gastrointestinal recovery endpoints when compared to controls (p < 0.01). CONCLUSIONS: Alvimopan is effective in accelerating time to gastrointestinal recovery and reducing POI in IBD patients. While the benefits of alvimopan have been demonstrated previously, this is the first study of the efficacy of alvimopan in IBD patients.

4 Article Predictors and Management of Loss of Response to Vedolizumab in Inflammatory Bowel Disease. 2018

Shmidt, Eugenia / Kochhar, Gursimran / Hartke, Justin / Chilukuri, Prianka / Meserve, Joseph / Chaudrey, Khadija / Koliani-Pace, Jenna L / Hirten, Robert / Faleck, David / Barocas, Morris / Luo, Michelle / Lasch, Karen / Boland, Brigid S / Singh, Siddharth / Vande Casteele, Niels / Sagi, Sashidhar Varma / Fischer, Monika / Chang, Shannon / Bohm, Matthew / Lukin, Dana / Sultan, Keith / Swaminath, Arun / Hudesman, David / Gupta, Nitin / Kane, Sunanda / Loftus, Edward V / Sandborn, William J / Siegel, Corey A / Sands, Bruce E / Colombel, Jean-Frederic / Shen, Bo / Dulai, Parambir S. ·Icahn School of Medicine at Mount Sinai, New York, NY, USA. · University of Minnesota, Minneapolis, MN, USA. · Cleveland Clinic Foundation, Cleveland, OH, USA. · Indiana University, Indianapolis, IN, USA. · University of California, San Diego, La Jolla, CA, USA. · Mayo Clinic, Rochester, MN, USA. · Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. · Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA. · New York University (NYU), New York, NY, USA. · Montefiore Medical Center, New York, NY, USA. · North Shore University Hospital, Manhasset, NY, USA. · Lenox Hill Hospital, New York, NY, USA. · University of Mississippi, Jackson, MS, USA. ·Inflamm Bowel Dis · Pubmed #29788240.

ABSTRACT: Background: We quantified loss of response (LOR) to vedolizumab (VDZ) in clinical practice and assessed the effectiveness of VDZ dose intensification for managing LOR. Methods: Retrospective review (May 2014-December 2016) of a prospectively maintained inflammatory bowel disease (IBD) registry. Kaplan-Meier estimates were used to determine rates of LOR to VDZ . Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Success of recapturing response (>50% reduction in symptoms from baseline) and remission (complete resolution of symptoms) after dose intensification was quantified. Results: Cumulative rates for VDZ LOR were 20% at 6 months and 35% at 12 months, with slightly lower rates in Crohn's disease than in ulcerative colitis (6 months 15% vs 18% and 12 months 30% vs 39%, P = 0.03). On multivariable analysis, LOR to a tumor necrosis factor (TNF) antagonist before VDZ use was associated with an increased risk for LOR to VDZ [hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.25-2.97] in all patients. For Crohn's disease patients specifically, higher baseline C-reactive protein concentration was associated with increased risk for LOR to VDZ (HR 1.01 per mg/dL increase, 95% CI 1.01-1.02). Shortening of VDZ infusion interval from 8 to every 4 or 6 weeks recaptured response in 49% and remission in 18% of patients. Conclusions: LOR to a TNF antagonist before VDZ use and higher baseline C-reactive protein are important predictors of VDZ LOR. Treatment response can be recaptured in almost half of these patients with VDZ infusion interval shortening.

5 Article When Not to Pouch: Important Considerations for Patient Selection for Ileal Pouch-Anal Anastomosis. 2017

Chang, Shannon / Shen, Bo / Remzi, Feza. ·Dr Chang is an assistant professor of medicine at the Inflammatory Bowel Disease Center at New York University Langone Medical Center in New York, New York. Dr Shen is a professor of medicine at the Center for Inflammatory Bowel Diseases at the Digestive Disease and Surgery Institute at The Cleveland Clinic Foundation in Cleveland, Ohio. Dr Remzi is a professor of surgery and director of the Inflammatory Bowel Disease Center at New York University Langone Medical Center. ·Gastroenterol Hepatol (N Y) · Pubmed #28867978.

ABSTRACT: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients who undergo colectomy and wish to avoid a permanent ileostomy. The overall outcomes are positive, with an improved quality of life and stable long-term pouch retention. However, certain conditions or disease states may be at a higher risk of pouch dysfunction or failure. For example, obese patients have an increased risk for postoperative complications. In addition, women with a history of obstetric complications and elderly patients with a history of sphincter damage or dysfunction may be at an increased risk for postoperative incontinence, although quality-of-life indices do not necessarily correlate with incontinence scores. Advanced age itself is not a contraindication to pouch surgery, and elderly patients can be considered for IPAA based on individual functionality and comorbidities. Pelvic radiation may lead to pouch dysfunction. Finally, patients with Crohn's disease and indeterminate colitis may have increased complications with IPAA, but highly specific patient selection leads to good rates of pouch retention. This article examines several clinical scenarios that require careful thought prior to considering IPAA.