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Crohn Disease: HELP
Articles by Robert P. Hirten
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, Robert Hirten wrote the following 11 articles about Crohn Disease.
 
+ Citations + Abstracts
1 Review Clinical updates on perianal fistulas in Crohn's disease. 2018

Rackovsky, Ori / Hirten, Robert / Ungaro, Ryan / Colombel, Jean-Frederic. ·a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA. ·Expert Rev Gastroenterol Hepatol · Pubmed #29792734.

ABSTRACT: INTRODUCTION: Perianal fistulizing disease is an aggressive and debilitating phenotype of Crohn's disease (CD), representing a significant therapeutic challenge. New work has led to advancement in epidemiology and long-term outcomes of perianal disease. The range of therapeutic options continues to expand, including new biologic agents, biosimilars, and stem cell therapy. Areas covered: We discuss updates to all aspects of management of perianal disease, with a focus on the last 3 years of published data. Areas considered include new data on epidemiology and prognostication, medical and surgical therapy, and stem cell therapy. Expert commentary: The presence of perianal disease at CD diagnosis portends a significantly worse disease course. Patients with perianal disease require close monitoring to identify those who are at risk for worsening disease, suboptimal biologic drug levels, and signs of developing neoplasm. With the impending availability of local mesenchymal stem cell therapy, this becomes increasingly important as this therapy, although extremely promising, is thus far only effective in patients without proctitis.

2 Review The Management of Intestinal Penetrating Crohn's Disease. 2018

Hirten, Robert P / Shah, Shailja / Sachar, David B / Colombel, Jean-Frederic. ·The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. ·Inflamm Bowel Dis · Pubmed #29528400.

ABSTRACT: Crohn's disease (CD) leads to the development of complications through progressive uncontrolled inflammation and the transmural involvement of the bowel wall. Most of the available literature on penetrating CD focuses on the perianal phenotype. The management of nonperianal penetrating complications poses its own set of challenges and can result in significant morbidity and an increased risk of mortality. Few controlled trials have been published evaluating this subgroup of patients for clinicians to use for guidance. Utilizing the available evidence, we review the epidemiology, presentation, and modalities used to diagnosis and assess intestinal fistulas, phlegmons, and abscesses. The literature regarding the medical, endoscopic, and surgical management options are reviewed providing physicians with a therapeutic framework to comprehensively treat these nonperianal penetrating complications. Through a multidisciplinary evidence-based approach to the complex sequela of CD outcomes can be improved and patient's quality of life enhanced.10.1093/ibd/izx108_video1izx108_Video5754037501001.

3 Review Combining Biologics in Inflammatory Bowel Disease and Other Immune Mediated Inflammatory Disorders. 2018

Hirten, Robert P / Iacucci, Marietta / Shah, Shailja / Ghosh, Subrata / Colombel, Jean-Frederic. ·The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: robert.hirten@mountsinai.org. · Institute of Immunology & Immunotherapy, NIHR Biomedical Research Centre IBD Theme, Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom. · Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee. · The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. ·Clin Gastroenterol Hepatol · Pubmed #29481970.

ABSTRACT: Current therapies used in the treatment of inflammatory bowel disease (IBD) are not effective in all patients. Biologic agents result in approximately 40% remission rates at 1 year in selected populations, prompting a growing interest in combining biologic therapy to improve outcomes. There are limited published data regarding the efficacy and safety of combination targeted therapy in IBD specifically, which include only 1 exploratory randomized control trial and 3 case reports or series. This review evaluates the published literature regarding this therapeutic paradigm in IBD and its extensive utilization in the treatment of other immune-mediated inflammatory disorders. The combination of biologic therapies demonstrates variable degrees of efficacy and highlights some safety concerns, depending upon the agents used and the disease state treated. A trial (Clinical Trials.gov Identifier: NCT02764762) combining vedolizumab and adalimumab is currently underway evaluating the effectiveness and safety of this approach in patients with Crohn's disease, which should provide further insight into this treatment concept. While combination biologic therapy is an attractive strategy, the lack of consistent superior efficacy as well as safety concerns militates the need for further trials prior to its general application in IBD.

4 Review Adherent-invasive 2018

Palmela, Carolina / Chevarin, Caroline / Xu, Zhilu / Torres, Joana / Sevrin, Gwladys / Hirten, Robert / Barnich, Nicolas / Ng, Siew C / Colombel, Jean-Frederic. ·Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA. · Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal. · Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, F-63000 Clermont-Ferrand, France. · Department of Medicine and Therapeutics, Institute of Digestive Diseases, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. ·Gut · Pubmed #29141957.

ABSTRACT: Intestinal microbiome dysbiosis has been consistently described in patients with IBD. In the last decades,

5 Review Hepatic manifestations of non-steroidal inflammatory bowel disease therapy. 2015

Hirten, Robert / Sultan, Keith / Thomas, Ashby / Bernstein, David E. ·Robert Hirten, Keith Sultan, Ashby Thomas, David E Bernstein, Division of Gastroenterology, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY 11030, United States. ·World J Hepatol · Pubmed #26644815.

ABSTRACT: Inflammatory bowel disease (IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.

6 Article Anastomotic Ulcers After Ileocolic Resection for Crohn's Disease Are Common and Predict Recurrence. 2019

Hirten, Robert P / Ungaro, Ryan C / Castaneda, Daniel / Lopatin, Sarah / Sands, Bruce E / Colombel, Jean Frederic / Cohen, Benjamin L. ·Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL, USA. · Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. ·Inflamm Bowel Dis · Pubmed #31639193.

ABSTRACT: BACKGROUND: Crohn's disease recurrence after ileocolic resection is common and graded with the Rutgeerts score. There is controversy whether anastomotic ulcers represent disease recurrence and should be included in the grading system. The aim of this study was to determine the impact of anastomotic ulcers on Crohn's disease recurrence in patients with prior ileocolic resections. Secondary aims included defining the prevalence of anastomotic ulcers, risk factors for development, and their natural history. METHODS: We conducted a retrospective cohort study of patients undergoing an ileocolic resection between 2008 and 2017 at a large academic center, with a postoperative colonoscopy assessing the neoterminal ileum and ileocolic anastomosis. The primary outcome was disease recurrence defined as endoscopic recurrence (>5 ulcers in the neoterminal ileum) or need for another ileocolic resection among patients with or without an anastomotic ulcer in endoscopic remission. RESULTS: One hundred eighty-two subjects with Crohn's disease and an ileocolic resection were included. Anastomotic ulcers were present in 95 (52.2%) subjects. No factors were associated with anastomotic ulcer development. One hundred eleven patients were in endoscopic remission on the first postoperative colonoscopy. On multivariable analysis, anastomotic ulcers were associated with disease recurrence (adjusted hazard ratio [aHR] 3.64; 95% CI, 1.21-10.95; P = 0.02). Sixty-six subjects with anastomotic ulcers underwent a second colonoscopy, with 31 patients (79.5%) having persistent ulcers independent of medication escalation. CONCLUSION: Anastomotic ulcers occur in over half of Crohn's disease patients after ileocolic resection. No factors are associated with their development. They are associated with Crohn's disease recurrence and are persistent.

7 Article Diffusion and perfusion MRI quantification in ileal Crohn's disease. 2019

Hectors, Stefanie J / Gordic, Sonja / Semaan, Sahar / Bane, Octavia / Hirten, Robert / Jia, Xiaoyu / Colombel, Jean-Frederic / Taouli, Bachir. ·Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland. · IBD Center, Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. bachir.taouli@mountsinai.org. · Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. bachir.taouli@mountsinai.org. ·Eur Radiol · Pubmed #30019143.

ABSTRACT: OBJECTIVES: To quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments in Crohn's disease (CD) patients and to assess the association of these parameters with clinical and MRI-based measurements of CD activity. METHODS: In this prospective study, 27 CD patients (M/F 18/9, mean age 42 years) underwent MR enterography, including IVIM-DWI and DCE-MRI. IVIM-DWI and DCE-MRI parameters were quantified in normal and abnormal small bowel segments, the latter identified by the presence of inflammatory changes. MRI parameter differences between normal and abnormal bowel were tested using Wilcoxon signed-rank tests. IVIM-DWI and DCE-MRI parameters were correlated with clinical data (C-reactive protein, Harvey-Bradshaw Index), conventional MRI parameters (wall thickness, length of involvement) and MRI activity scores (MaRIA, Clermont). Diagnostic performance of (combined) parameters for differentiation between normal and abnormal bowel was determined using ROC analysis. RESULTS: The DCE-MRI parameters peak concentration C CONCLUSIONS: DCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD. KEY POINTS: • IVIM-DWI and DCE-MRI parameters were significantly different between normal and abnormal bowel segments in CD patients. • DCE-MRI parameters showed a significant association with wall thickness and MRI activity scores. • Combination of IVIM-DWI and DCE-MRI parameters led to the highest diagnostic performance for differentiation between normal and abnormal bowel segments, while ADC showed the highest diagnostic performance of individual parameters.

8 Article Development and Validation of a Scoring System to Predict Outcomes of Vedolizumab Treatment in Patients With Crohn's Disease. 2018

Dulai, Parambir S / Boland, Brigid S / Singh, Siddharth / Chaudrey, Khadija / Koliani-Pace, Jenna L / Kochhar, Gursimran / Parikh, Malav P / Shmidt, Eugenia / Hartke, Justin / Chilukuri, Prianka / Meserve, Joseph / Whitehead, Diana / Hirten, Robert / Winters, Adam C / Katta, Leah G / Peerani, Farhad / Narula, Neeraj / Sultan, Keith / Swaminath, Arun / Bohm, Matthew / Lukin, Dana / Hudesman, David / Chang, John T / Rivera-Nieves, Jesus / Jairath, Vipul / Zou, G Y / Feagan, Brian G / Shen, Bo / Siegel, Corey A / Loftus, Edward V / Kane, Sunanda / Sands, Bruce E / Colombel, Jean-Frederic / Sandborn, William J / Lasch, Karen / Cao, Charlie. ·University of California-San Diego, La Jolla, California. Electronic address: pdulai@ucsd.edu. · University of California-San Diego, La Jolla, California. · Mayo Clinic, Rochester, Minnesota. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. · Cleveland Clinic Foundation, Cleveland, Ohio. · Icahn School of Medicine at Mount Sinai, New York, New York. · Indiana University, Indianapolis, Indiana. · North Shore University Hospital, Manhasset, New York. · Icahn School of Medicine at Mount Sinai, New York, New York; University of Alberta, Edmonton, Alberta, Canada. · Icahn School of Medicine at Mount Sinai, New York, New York; McMaster University Medical Centre, Hamilton, Ontario, Canada. · Lenox Hill Hospital, New York, New York. · Montefiore Medical Center, New York, New York. · New York University (NYU), New York, New York. · University of Western Ontario, London, Ontario, Canada. · Takeda Pharmaceuticals USA Inc., Deerfield, Illinois. ·Gastroenterology · Pubmed #29857091.

ABSTRACT: BACKGROUND & AIMS: As more treatment options for inflammatory bowel diseases become available, it is important to identify patients most likely to respond to different therapies. We created and validated a scoring system to identify patients with Crohn's disease (CD) who respond to vedolizumab. METHODS: We collected data from the GEMINI 2 phase 3 trial of patients with active CD treated with vedolizumab for 26 weeks (n = 814) and performed logistic regression analysis to identify factors associated with clinical, steroid-free, and durable remission (derivation set). We used these data to develop a clinical decision support tool, which we validated using data from 366 participants in a separate clinical practice observational cohort of patients with active CD treated with vedolizumab for 26 weeks (the VICTORY cohort). We evaluated the ability of this tool to identify patients in clinical remission or corticosteroid-free remission, or those with mucosal healing (MH), clinical remission with MH, or corticosteroid-free remission with MH after vedolizumab therapy using receiver operating characteristic area under the curve (AUC) analyses. The primary outcome was to develop and validate a list of factors associated with achieving remission by vedolizumab in patients with active CD. RESULTS: In the derivation analysis, we identified absence of previous treatment with a tumor necrosis factor antagonist (+3 points), absence of prior bowel surgery (+2 points), absence of prior fistulizing disease (+2 points), baseline level of albumin (+0.4 points per g/L), and baseline concentration of C-reactive protein (reduction of 0.5 points for values between 3.0 and 10.0 mg/L and 3.0 points for values >10.0 mg/L) as factors associated with remission. In the validation set, our model identified patients in clinical remission with an AUC of 0.67, patients in corticosteroid-free remission with an AUC of 0.66, patients with MH with an AUC of 0.72, patients in clinical remission with MH with an AUC of 0.73, and patients in corticosteroid-free clinical remission with MH with an AUC of 0.75. A cutoff value of 13 points identified patients in clinical remission after vedolizumab therapy with 92% sensitivity, patients in corticosteroid-free remission with 94% sensitivity, patients with MH with 98% sensitivity, patients with clinical remission and MH with 100% sensitivity, and patients with corticosteroid-free clinical remission with MH with 100% sensitivity. CONCLUSIONS: We developed and validated a scoring system to identify patients with CD most likely to respond to 26 weeks of vedolizumab therapy. Further studies are needed to optimize its accuracy in select populations and determine its cost-effectiveness.

9 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.

10 Minor Vedolizumab and Infliximab Combination Therapy in the Treatment of Crohn's Disease. 2015

Hirten, Robert / Longman, Randy S / Bosworth, Brian P / Steinlauf, Adam / Scherl, Ellen. ·Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA. · Division of Gastroenterology and Hepatology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA. ·Am J Gastroenterol · Pubmed #26673509.

ABSTRACT: -- No abstract --

11 Minor The Uncertain Role of Immunomodulator Maintenance After Cessation of Anti-Tumor Necrosis Factor α Therapy. 2015

Sultan, Keith / Inamdar, Sumant / Hirten, Robert. ·Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York. ·Clin Gastroenterol Hepatol · Pubmed #25599656.

ABSTRACT: -- No abstract --