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Crohn Disease HELP
Based on 13,777 articles published since 2008

These are the 13777 published articles about Crohn Disease that originated from Worldwide during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
451 Review [Evolving Therapeutic Strategies in the Inflammatory Bowel Disease]. 2018

Na, Soo Young / Moon, Won. ·Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea. · Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. ·Korean J Gastroenterol · Pubmed #29471602.

ABSTRACT: It is important to have effective therapeutic strategies and goals in clinical practice and research of inflammatory bowel disease. Conventional end points for clinical trials in Crohn's disease and ulcerative colitis have been based on composite indices, such as the Crohn's Disease Activity Index and the Mayo Clinic Score. Although these indices have been shown to reduce the intestinal injury to some extent, satisfactory results have not been obtained in improving the quality of life of patients. Recently, alternative measures of outcome and definitions of response are being developed beyond symptoms. Mucosal healing as a clinical response and treatment goal has showed better long-term outcomes. Patient-reported outcomes (PROs) are emerging instrument directly created by patient to quantify symptoms. Coprimary realistic treatment 'target', comprising mucosal healing and PROs, can offer a clinically valid endpoint and can be readily applied in practice compare to existing composite indices. 'Treat-to-target' algorithm based on mucosal healing and PROs, in which therapy is progressively intensified until a specific personal treatment goal is reached, could improve quality of life of patient by reducing disease-related disability. Furthermore, histologic remission is an area of increased research focus and has the potential to guide treatment decisions in the future.

452 Review Fungal infections in patients with inflammatory bowel disease: A systematic review. 2018

Stamatiades, George A / Ioannou, Petros / Petrikkos, George / Tsioutis, Constantinos. ·Infectious Diseases Working Group, Society of Junior Doctors, Athens, Greece. · Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. · Internal Medicine & Infectious Diseases Department, University Hospital of Heraklion, Heraklion, Greece. · School of Medicine, European University of Cyprus, Nicosia, Cyprus. ·Mycoses · Pubmed #29453860.

ABSTRACT: BACKGROUND: Despite reports of fungal infections in patients with inflammatory bowel disease (IBD), their clinical and microbiological characteristics remain unknown. OBJECTIVES: The aim of this systematic review was to examine all available evidence regarding fungal infections in patients with IBD. METHODS: Systematic search of PubMed (through 27 May 2017) for studies providing data on clinical, microbiological, treatment and outcome data of fungal infections in patients with IBD. The primary study outcome was to record the most common fungal species in patients with IBD. Secondary outcomes were classified into 3 categories: (i) characteristics of fungal infections; (ii) data on IBD and (iii) treatment and outcomes of fungal infections in patients with IBD. RESULTS: Fourteen studies with data on 1524 patients were included in final analysis. The most common fungal infections in patients with IBD were caused by Candida species (903 infections); the most commonly reported site of Candida infection was the gastrointestinal tract. Available evidence shows that most fungal infections occur within 12 months of IBD treatment and within 6 months when anti-TNFa agents are used. CONCLUSIONS: This systematic review thoroughly describes fungal infections in patients with IBD and provides important information for the early detection and management of these infections.

453 Review [Towards new therapeutic paradigms beyond symptom control in the management of inflammatory bowel diseases.] 2018

Festa, Stefano / Zerboni, Giulia / Aratari, Annalisa / Ballanti, Riccardo / Papi, Claudio. ·UOC Gastroenterologia, UOS Malattie Infiammatorie Croniche dell'Intestino, Ospedale San Filippo Neri, Roma. ·Recenti Prog Med · Pubmed #29451523.

ABSTRACT: Inflammatory bowel diseases, Crohn's disease and ulcerative colitis are chronic relapsing conditions that may result in progressive bowel damage, high risk of complications, surgery and permanent disability. The conventional therapeutic approach for inflammatory bowel diseases is based mainly on symptom control. Unfortunately, a symptom-based therapeutic approach has little impact on major long-term disease outcomes. In other chronic disabling conditions such as diabetes, hypertension and rheumatoid arthritis, the development of new therapeutic approaches has led to better outcomes. In this context a "treat to target" strategy has been developed. This strategy is based on identification of high-risk patients, regular assessment of disease activity by means of objective measures, adjustment of treatment to reach the pre-defined target. A treat to target approach has recently been proposed for inflammatory bowel disease with the aim at modifying the natural history of the disease. In this review, the evidence and the limitations of the treat to target paradigm in inflammatory bowel disease are analyzed and discussed.

454 Review Filgotinib for the treatment of Crohn's disease. 2018

Labetoulle, Remi / Paul, Stephane / Roblin, Xavier. ·a Department of Immunology , CIC 1408, GIMAP EA3064 University Hospital of Saint Etienne , Saint-Etienne , France. · b Department of Gastroenterology , University Hospital of Saint Etienne , Saint-Etienne , France. ·Expert Opin Investig Drugs · Pubmed #29448862.

ABSTRACT: INTRODUCTION: Inflammatory bowel diseases, such as Crohn's disease (CD) and ulcerative colitis (UC), are widespread diseases (with an estimated 2.2 million Europeans affected), and even populations previously considered 'low risk' (such as Japan and India) are witnessing an increasing incidence. CD is a chronic, progressive immunologically driven disease, with an evolution characterized by succession of periods of progression and remission. New physiopathological pathways are continuously being discovered, the more we understand about how the disease appears and progresses, the more targets become available for the development of novel therapies. Areas covered: Filgotinib is one of these promising new therapies; this article discusses the currently available data. We used an exhaustive search of the PubMed database to corroborate information regarding its chemical characteristics, and the studies evaluating clinical efficacy and safety. Expert opinion: Up to now, the phase-II study evaluating Filgotinib yielded very promising results in moderate to severe CD patients, with good clinical response, mucosal healing, while having few and moderate adverse effects, both in anti-TNF naïve and resistant patients. Phase-III studies are still ongoing and will help decide whether Filgotinib will be a worthwhile drug in the treatment of CD and the best way to use it.

455 Review Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy. 2018

Shaikhkhalil, Ala K / Crandall, Wallace. ·Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA. ·Nutr Clin Pract · Pubmed #29446858.

ABSTRACT: Enteral nutrition (EN) for the treatment of Crohn's disease (CD) involves administration of a liquid nutrition product, administered orally or through tube feeding, while excluding typical dietary components. It is a safe and effective, but largely underused, therapy in the United States as a treatment for CD. EN is a particularly attractive option for pediatric CD as it avoids side effects of corticosteroids, improves growth, and may have a higher likelihood of achieving mucosal healing than some traditional medications. However, there are multiple real and perceived barriers to its use among providers. A comprehensive approach to addressing these barriers to EN may result in its increased use. This paper reviews the literature on the efficacy of EN, methods of utilization, and potential barriers and solutions to those barriers.

456 Review Immunomodulatory Effects of Flavonoids in the Prophylaxis and Treatment of Inflammatory Bowel Diseases: A Comprehensive Review. 2018

Ribeiro, Daniela / Proenca, Carina / Rocha, Silvia / Lima, Jose L F C / Carvalho, Felix / Fernandes, Eduarda / Freitas, Marisa. ·LAQV, REQUIMTE, Laboratory of Applied Chemistry, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal. · UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal. ·Curr Med Chem · Pubmed #29446723.

ABSTRACT: Inflammatory Bowel Diseases (IBD) comprised of two disorders of idiopathic chronic intestinal inflammation that affect about three million people worldwide: Crohn's disease and ulcerative colitis. Nowadays, the first-line of treatment for patients with mild to moderate symptoms of IBD is comprised of corticosteroids, immunosuppressants, antibiotics, and biological agents. Unfortunately, none of these drugs are curative, and their long-term use may cause severe side effects and complications. Almost 40% of IBD patients use alternative therapies to complement the conventional one, and flavonoids are gaining attention for this purpose. The biological properties of flavonoids are well documented and their antioxidant and anti-inflammatory activities have been arousing attention in the scientific community. Flavonoids are the most widely distributed polyphenols in plants and fruits, making part of the human diet. Taking into account that all ingested flavonoids are expected to exert biological actions at the gastrointestinal level, research on the modulatory effect of these compounds in IBD is of paramount importance. This review intends to summarize, in an integrated and comprehensive form, the effect of flavonoids, both in vitro and in vivo, in the different phases of the characteristic IBD inflammatory network.

457 Review Crohn's disease associated strictures. 2018

Chan, Webber Pak Wo / Mourad, Fadi / Leong, Rupert Wl. ·Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, New South Wales, Australia. · Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore. ·J Gastroenterol Hepatol · Pubmed #29427364.

ABSTRACT: Crohn's disease (CD) is a chronic relapsing and remitting disease that can affect any segments of the gastrointestinal tract. More than 50% of patients with CD develop stricturing or penetrating complications within the first 10 years after diagnosis. Strictures can lead to intestinal obstruction, which is a common indication for surgery. Despite significant advances in the understanding of the pathogenesis of intestinal fibrostenosis, imaging and therapeutic armamentarium of CD, the risk of intestinal surgery remained significantly high. Endoscopic balloon dilation is a promising first-line alternative to surgery as it is less invasive and could preserve intestinal length. In this review, we will evaluate the literature on the mechanism of intestinal fibrosis, emerging imaging techniques, and management strategies for CD associated strictures.

458 Review IgG4-Related Disease Mimicking Crohn's Disease: A Case Report and Review of Literature. 2018

Ciccone, Fabiana / Ciccone, Antonio / Di Ruscio, Mirko / Vernia, Filippo / Cipolloni, Gianluca / Coletti, Gino / Calvisi, Giuseppe / Frieri, Giuseppe / Latella, Giovanni. ·Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy. · Pathology Unit, San Salvatore Hospital, Via Lorenzo Natali, 1, Coppito, 67100, L'Aquila, Italy. · Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy. giolatel@tin.it. ·Dig Dis Sci · Pubmed #29417330.

ABSTRACT: -- No abstract --

459 Review Nutritional Interventions in the Patient with Inflammatory Bowel Disease. 2018

Limketkai, Berkeley N / Wolf, Andrea / Parian, Alyssa M. ·Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Alway M211, Stanford, CA 94305, USA. Electronic address: berkeley.limketkai@gmail.com. · Department of Clinical Nutrition, Stanford Health Care, Stanford, 300 Pasteur Drive, Palo Alto, CA 94305, USA. · Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA. ·Gastroenterol Clin North Am · Pubmed #29413010.

ABSTRACT: Nutritional strategies have been explored as primary or adjunct therapies for inflammatory bowel disease (IBD). Exclusive enteral nutrition is effective for the induction of remission in Crohn disease and is recommended as a first-line therapy for children. Dietary strategies focus on adjusting the ratio of consumed nutrients that are proinflammatory or antiinflammatory. Treatments with dietary supplements focus on the antiinflammatory effects of the individual supplements (eg, curcumin, omega-3 fatty acids, vitamin D) or their positive effects on the intestinal microbiome (eg, prebiotics, probiotics). This article discusses the role of diets and dietary supplements in the treatment of IBD.

460 Review Vedolizumab for the treatment of Crohn's disease. 2018

Argollo, Marjorie / Fiorino, Gionata / Peyrin-Biroulet, Laurent / Danese, Silvio. ·a Department of Gastroenterology , Universidade Federal de São Paulo - UNIFESP , São Paulo , Brazil. · b IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Milan , Italy. · c Department of Gastroenterology and Inserm U954 , Nancy University Hospital, Lorraine University , Vandoeuvre , France. · d Department of Biomedical Sciences , Humanitas University , Milan , Italy. ·Expert Rev Clin Immunol · Pubmed #29406811.

ABSTRACT: INTRODUCTION: Crohn's disease (CD) is an immune-mediated condition characterized by inflammation of the gut tissue, associated with progressive damage of the affected intestinal tract and possible complications. A treat-to-target approach is strongly advocated, consisting of early and aggressive inflammatory control. However, a great proportion of affected subjects lack response or are intolerant to conventional therapy. Even though the first-line biologic therapy targeting tumor necrosis factor-alfa (TNF-α) is associated with improvement of inflammation in some patients, others do not respond at first or lose response over time. These findings brought about the possibility of different mechanisms being involved in perpetuating the chronic inflammatory state. Novel drugs targeting different inflammatory pathways have been studied in CD, specifically addressed to leucocyte trafficking. Areas covered: We aim to review the relevant data available in the literature and briefly summarize the efficacy and safety profile of vedolizumab in the treatment of CD. Expert commentary: Vedolizumab has shown, from pivotal and real-life data, significant clinical benefit among CD patients, in addition to a singular safety profile. Future studies will provide helpful data concerning its use in special situations.

461 Review [Oral manifestations of Crohn's disease]. 2018

Tan, C X W / de Boer, N K H / Brand, H S. · ·Ned Tijdschr Tandheelkd · Pubmed #29377966.

ABSTRACT: Gastrointestinal symptoms are predominant in Crohn's disease. Oral manifestations may also occur. The prevalence of oral manifestations varies between 0.5% and 37%. The manifestations may coincide with or precede gastrointestinal symptoms, and can be subdivided into specific and non-specific lesions. In most patients, lesions are asymptomatic but some patients experience serious discomfort. Oral manifestations can be classified as specific lesions, such as diffuse lip and buccal swelling and cobblestones, and non-specific lesions, such as aphthous ulcers, pyostomatitis vegetans, caries, gingivitis and periodontitis. In many patients, these oral symptoms do not cause pain or discomfort and do not require treatment. For patients who do experience discomfort, pain caused by aphthous ulcers, for example, can be relieved with a lidocaine solution or a 0.1% dexamethasone gel, and corticosteroids can be used to treat pain caused by ulceration or cobblestoning. It is advisable in complex cases to consult the patient's gastroenterologist.

462 Review The Safety and Efficacy of Low-Dose Naltrexone in the Management of Chronic Pain and Inflammation in Multiple Sclerosis, Fibromyalgia, Crohn's Disease, and Other Chronic Pain Disorders. 2018

Patten, Denise K / Schultz, Bob G / Berlau, Daniel J. ·Regis University School of Pharmacy, Denver, Colorado. ·Pharmacotherapy · Pubmed #29377216.

ABSTRACT: Chronic inflammatory diseases are complex to treat and have an impact on a large number of patients. Due to the difficulty of treating these diseases and the great impact on quality of life, patients often seek off-label, complimentary, or alternative medicines to gain relief from symptoms. Low-dose naltrexone has been used off-label for treatment of pain and inflammation in multiple sclerosis, Crohn's disease, fibromyalgia, and other diseases. Naltrexone is a mu-opioid receptor antagonist indicated by the U.S. Food and Drug Administration for opioid and alcohol dependence. It is hypothesized that lower than standard doses of naltrexone inhibit cellular proliferation of T and B cells and block Toll-like receptor 4, resulting in an analgesic and antiinflammatory effect. It is the purpose of this review to examine the evidence of the safety, tolerability, and efficacy of low-dose naltrexone for use in chronic pain and inflammatory conditions. Currently, evidence supports the safety and tolerability of low-dose naltrexone in multiple sclerosis, fibromyalgia, and Crohn's disease. Fewer studies support the efficacy of low-dose naltrexone, with most of these focusing on subjective measures such as quality of life or self-reported pain. These studies do demonstrate that low-dose naltrexone has subjective benefits over placebo, but evidence for more objective measures is limited. However, further randomized controlled trials are needed to determine the efficacy of low-dose naltrexone due to insufficient evidence supporting its use in these disease states. This review provides practitioners with the extent of low-dose naltrexone evidence so that they can be cognizant of situations where it may not be the most appropriate therapy.

463 Review Primary Non-Response to Tumor Necrosis Factor Antagonists is Associated with Inferior Response to Second-line Biologics in Patients with Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis. 2018

Singh, Siddharth / George, John / Boland, Brigid S / Vande Casteele, Niels / Sandborn, William J. ·Division of Gastroenterology, University of California San Diego, La Jolla, California. · Division of Biomedical Informatics, University of California San Diego, La Jolla, California. · Department of Internal Medicine, Bridgeport Hospital-Yale New Haven Health, Bridgeport, Connecticut. ·J Crohns Colitis · Pubmed #29370397.

ABSTRACT: Background and Aims: We sought to analyze whether response to a second-line biologic varies depending on the reason for discontinuation of the primary anti-TNF agent (primary non-response [PNR], secondary loss of response [LOR] after initial response, or intolerance), through a systematic review and meta-analysis. Methods: Through a systematic search through May 31, 2017, we identified eight randomized controlled trials [RCTs] of biologics in patients with IBD with prior exposure to anti-TNF agents, that stratified response to second-line therapy by reason for discontinuing primary anti-TNF therapy [PNR vs. LOR vs. intolerance]. We estimated relative risk [RR] (and 95% confidence interval [CI]) of achieving clinical remission in patients with PNR as compared with patients with LOR, and intolerance, through random effects meta-analysis. Results: As compared with patients who discontinued prior anti-TNF due to intolerance, patients with prior PNR were 24% less likely to achieve remission with second-line biologics (RR,0.76 [0.61-0.96]). As compared with patients who discontinued prior anti-TNF due to LOR, patients with prior PNR were 27% less likely to achieve remission with induction therapy with second-line biologics (RR,0.73 [0.56-0.97]), particularly to ustekinumab (RR,0.64 [0.52-0.80]). There was no difference in response to vedolizumab in patients with prior PNR or LOR to anti-TNF agents (RR,1.16 [0.85-1.58]). Conclusion: Patients with PNR to anti-TNF agents are less likely to respond to second-line non-TNF biologics, as compared with patients who discontinued therapy due to secondary LOR or intolerance. This may be attributed to underlying pharmacokinetics and pharmacodynamics of anti-TNF agents in patients with PNR.

464 Review Advanced endoscopic imaging for diagnosis of inflammatory bowel diseases: Present and future perspectives. 2018

Sivanathan, Visvakanth / Tontini, Gian Eugenio / Möhler, Markus / Galle, Peter R / Neumann, Helmut. ·Department of Interdisciplinary Endoscopy, I. Medizinische Klinik und Poliklinik, University Hospital, Mainz, Germany. · Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, Milan, Italy. ·Dig Endosc · Pubmed #29360261.

ABSTRACT: Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) causing severe damage of the luminal gastrointestinal tract. Differential diagnosis between both disease entities is sometimes awkward requiring a multifactorial pathway, including clinical and laboratory data, radiological findings, histopathology and endoscopy. Apart from disease diagnosis, endoscopy in IBD plays a major role in prediction of disease severity and extent (i.e. mucosal healing) for tailored patient management and for screening of colitis-associated cancer and its precursor lesions. In this state-of-the-art review, we focus on current applications of endoscopy for diagnosis and surveillance of IBD. Moreover, we will discuss the latest guidelines on surveillance and provide an overview of the most recent developments in the field of endoscopic imaging and IBD.

465 Review Updated review on immune factors in pathogenesis of Crohn's disease. 2018

Li, Na / Shi, Rui-Hua. ·Department of Gastroenterology, Zhongda Hospital, Affiliated Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China. ·World J Gastroenterol · Pubmed #29358878.

ABSTRACT: Although the incidence of Crohn's disease (CD) in China is not as high as that in European and American countries, there has been a clear increasing trend in recent years. Little is known about its pathogenesis, cause of deferment, and the range of complications associated with the disease. Local and international scholars have presented many hypotheses about CD pathogenesis based on experimental and clinical studies, including genetic susceptibility, immune function defects, intestinal microflora disorders, delayed hypersensitivity, and food antigen stimulation. However, the specific mechanism leading to this immune imbalance, which causes persistent intestinal mucosal damage, and the source of the inflammatory cascade reaction are still unclear. So far, the results of research studies differ locally and internationally. This paper presents the most current research on immune factors in the pathogenesis of CD.

466 Review Epithelial-mesenchymal transition in Crohn's disease. 2018

Jiang, H / Shen, J / Ran, Z. ·Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China. ·Mucosal Immunol · Pubmed #29346350.

ABSTRACT: Crohn's disease (CD) is often accompanied by the complications of intestinal strictures and fistulas. These complications remain obstacles in CD treatment. In recent years, the importance of epithelial-mesenchymal transition in the pathogenesis of CD-associated fistulas and intestinal fibrosis has become apparent. Epithelial-mesenchymal transition refers to a dynamic change, wherein epithelial cells lose their polarity and adherence and acquire migratory function and fibroblast features. During formation of CD-associated fistulas, intestinal epithelial cells dislocate from the basement membrane and migrate to the lining of the fistula tracts, where they convert into transitional cells as a compensatory response under the insufficient wound healing condition. In CD-associated intestinal fibrosis, epithelial-mesenchymal transition may serve as a source of new fibroblasts and consequently lead to overproduction of extracellular matrix. In this review, we present current knowledge of epithelial-mesenchymal transition and its role in the pathogenesis of CD in order to highlight new therapy targets for the associated complications.

467 Review [X-linked inhibitor of apoptosis deficiency manifested as Crohn's disease: a case report and literature review]. 2018

Xu, L J / Luo, Y Y / Yu, J D / Lou, J G / Fang, Y H / Chen, J. ·Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China. ·Zhonghua Er Ke Za Zhi · Pubmed #29342997.


468 Review Therapeutic role of methotrexate in pediatric Crohn's disease. 2018

Djurić, Zlatko / Šaranac, Ljiljana / Budić, Ivana / Pavlović, Voja / Djordjević, Jelena. ·Division of Gastroenterology, Children's Hospital, Faculty of Medicine, University of Niš, Niš, Serbia. zldjuric@yahoo.com. ·Bosn J Basic Med Sci · Pubmed #29338679.

ABSTRACT: The main role of therapy in Crohn's disease (CD) is to achieve long-term clinical remission, and to allow for normal growth and development of children. The immunomodulatory drugs used for the maintenance of remission in CD include thiopurines (azathioprine and 6-mercaptopurine) and methotrexate (MTX). Development of hepatosplenic T-cell lymphoma in some patients with inflammatory bowel disease, treated with thiopurines only or in combination with anti-tumor necrosis factor agents, resulted in a growing interest in the therapeutic application of MTX in children suffering from CD. This review summarizes the literature on the therapeutic role of MTX in children with CD. MTX is often administered as a second-line immunomodulator, and 1-year clinical remission was reported in 25-69% of children with CD after excluding for the use of thiopurines. Initial data on MTX effectiveness in mucosal healing, and as a first-line immunomodulator in pediatric patients with CD, are promising. A definite conclusion, however, may only be made on the basis of additional research with a larger number of subjects.

469 Review Modern management of perianal fistulas in Crohn's disease: future directions. 2018

Kotze, Paulo Gustavo / Shen, Bo / Lightner, Amy / Yamamoto, Takayuki / Spinelli, Antonino / Ghosh, Subrata / Panaccione, Remo. ·Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada. · Interventional IBD Unit, Cleveland Clinic Foundation, Cleveland, Ohio, USA. · Division of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. · IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan. · Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Italy. · Institute of Translational Medicine, University of Birmingham, Birmingham, UK. ·Gut · Pubmed #29331943.

ABSTRACT: Perianal fistulae in patients with Crohn's disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%. More recently, newer biologics, cell-based therapies as well as novel endoscopic and surgical techniques have been introduced raising new hopes that outcomes can be improved upon. In this review, we describe the modern management and the most recent advances in the management of complex perianal fistulising CD, which will likely impact clinical practice. We will explore optimal use of both older and newer biological agents, as well as new data on cell-based therapies. In addition, new techniques in endoscopic and surgical approaches will be discussed.

470 Review Autologous Haematopoietic Stem Cell Transplantation (AHSCT) in Severe Crohn's Disease: A Review on Behalf of ECCO and EBMT. 2018

Snowden, John A / Panés, Julián / Alexander, Tobias / Allez, Matthieu / Ardizzone, Sandro / Dierickx, Daan / Finke, Jürgen / Hasselblatt, Peter / Hawkey, Chris / Kazmi, Majid / Lindsay, James O / Onida, Francesco / Salas, Azucena / Saccardi, Riccardo / Vermeire, Severine / Rovira, Montserrat / Ricart, Elena / Anonymous1300933 / Anonymous1310933 / Anonymous1320933 / Anonymous1330933. ·Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK. · Department of Gastroenterology, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain. · Department of Rheumatology and Clinical Immunology, Charité - University Medicine, Berlin, Germany. · Department of Gastroenterology, Hôpital Saint Louis, APHP, INSERM U1160, Paris Diderot, Sorbonne Paris-Cité University, Paris, France. · DIBIC - ASST Fatebenefratelli Sacco - University of Milan, Italy. · Department of Haematology, University Hospitals, Leuven, Belgium. · Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK. · Department of Haematology, Guys & St Thomas' NHS Foundation Trust, London, UK. · The Royal London Hospital, Barts Health NHS Trust, London UK & Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Italy. · Department of Haematology, Careggi University Hospital, Firenze, Italy. · Department of Gastroenterology - University Hospitals, Leuven, Belgium. · BMT Unit, Hematology Department, IDIBAPS, Hospital Clinic. Josep Carreras Leukaemia Research Institute (IJC), Barcelona, Spain. ·J Crohns Colitis · Pubmed #29325112.

ABSTRACT: Despite the major recent progress in the treatment of Crohn's disease [CD], there is a subset of patients in whom the disease runs an aggressive course with progressive tissue damage requiring early and repeated surgical management. Increasing evidence supports sustained and profound improvement in gastrointestinal parameters and quality of life following high-dose immunosuppressive therapy and autologous haematopoietic stem cell transplantation [AHSCT] compared to standard therapy in this context. In addition, international transplant registry data reflect the use of AHSCT in CD outside of trials in selected patients. However, AHSCT may be associated with significant treatment-related complications with risk of transplant-related mortality. In a joint initiative, the European Crohn's and Colitis Organisation [ECCO] and the European Society for Blood and Marrow Transplantation [EBMT] have produced a state-of-the-art review of the rationale, evaluation, patient selection, stem cell mobilization and transplant procedures and long-term follow up. Given the unique spectrum of issues, we recommend that AHSCT should only be performed in experienced centres with expertise in both haematological and gastroenterological aspects of the procedure. Where possible, patients should be enrolled on clinical trials and data registered centrally. Future development should be coordinated at both national and international levels.

471 Review Enteral Nutrition in the Management of Crohn's Disease: Reviewing Mechanisms of Actions and Highlighting Potential Venues for Enhancing the Efficacy. 2018

Alhagamhmad, Moftah H. ·Faculty of Medicine, University of Benghazi (Al-Arab Medical University), Benghazi, Libya. ·Nutr Clin Pract · Pubmed #29323428.

ABSTRACT: Crohn's disease (CD) is a chronic condition that affects the gut and has adverse effects on growth and development. There is a global increase in the incidence and prevalence rates, and several factors are believed to contribute to this rise, including dietary habits. In contrast, the use of enteral nutrition (EN) as an exclusive source of nutrition is increasingly becoming the preferred induction treatment of pediatric CD patients in part to address the nutrition complications. However, EN therapy is considered less effective in adults with CD. A better understanding of the molecular mechanisms of enteral therapy will help improve the clinical management of CD. It is increasingly becoming evident that the therapeutic utility of EN is in part due to the reversal of the microbial changes and the direct immunomodulatory effects. Moreover, there is a potential tendency for enhancing the efficacy of EN therapy by improving the palatability of the given formulas and, more important, by magnifying the anti-inflammatory properties. Recent observations have shown that the immunomodulatory effects of EN are mediated at least in part by blocking nuclear factor-κB. Furthermore, it is likely that several ingredients of EN contribute to this activity, in particular glutamine and arginine amino acids. In addition, manipulating the composition of EN therapy by altering concentrations of the key ingredients is found to have the potential for more efficient therapy. In this review, the underlying mechanisms of EN actions will be discussed further with a focus on the potential methods for enhancing the efficacy.

472 Review Old and New Lymphocyte Players in Inflammatory Bowel Disease. 2018

Giuffrida, Paolo / Corazza, Gino Roberto / Di Sabatino, Antonio. ·First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy. · First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy. a.disabatino@smatteo.pv.it. ·Dig Dis Sci · Pubmed #29275447.

ABSTRACT: Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic intestinal inflammatory disorder characterized by diffuse accumulation of lymphocytes in the gut mucosa as a consequence of over-expression of endothelial adhesion molecules. The infiltrating lymphocytes have been identified as subsets of T cells, including T helper (Th)1 cells, Th17 cells, and regulatory T cells. The function of these lymphocyte subpopulations in the development of IBD is well-known, since they produce a number of pro-inflammatory cytokines, such as interferon-γ and interleukin-17A, which in turn activate mucosal proteases, thus leading to the development of intestinal lesions, i.e., ulcers, fistulas, abscesses, and strictures. However, the immune mechanisms underlying IBD are not yet fully understood, and knowledge about the function of newly discovered lymphocytes, including Th9 cells, innate lymphoid cells, mucosal-associated invariant T cells, and natural killer T cells, might add new pieces to the complex puzzle of IBD pathogenesis. This review summarizes the recent advances in the understanding of the role of mucosal lymphocytes in chronic intestinal inflammation and deals with the therapeutic potential of lymphocyte-targeting drugs in IBD patients.

473 Review Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. 2018

de Jonge, C S / Smout, A J P M / Nederveen, A J / Stoker, J. ·Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands. · Department of Gastroenterology & Hepatology, Academic Medical Center (AMC), Amsterdam, the Netherlands. ·Neurogastroenterol Motil · Pubmed #29265641.

ABSTRACT: Dynamic magnetic resonance imaging (MRI) of gastrointestinal motility has developed rapidly over the past few years. The non-invasive and non-ionizing character of MRI is an important advantage together with the fact that it is fast and can visualize the entire gastrointestinal tract. Advances in imaging and quantification techniques have facilitated assessment of gastric, small intestinal, and colonic motility in a clinical setting. Automated quantitative motility assessment using dynamic MRI meets the need for non-invasive techniques. Recently, studies have begun to examine this technique in patients, including those with IBD, pseudo-obstruction and functional bowel disorders. Remaining challenges for clinical implementation are processing the large amount of data, standardization and validation of the numerous MRI metrics and subsequently assessment of the potential role of dynamic MRI. This review examines the methods, advances, and remaining challenges of evaluation of gastrointestinal motility with MRI. It accompanies an article by Khalaf et al. in this journal that describes a new protocol for assessment of pan-intestinal motility in fasted and fed state in a single MRI session.

474 Review Autophagy limits activation of the inflammasomes. 2018

Takahama, Michihiro / Akira, Shizuo / Saitoh, Tatsuya. ·Division of Inflammation Biology, Institute for Enzyme Research, Tokushima University, Tokushima, Japan. · Laboratory of Host Defense, World Premier International Research Center Immunology Frontier Research Center, Osaka University, Osaka, Japan. · Department of Host Defense, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan. ·Immunol Rev · Pubmed #29248000.

ABSTRACT: Inflammasomes are multiprotein complexes that control the maturation and production of interleukin-1 family members and play crucial roles in host defense against pathogens. However, dysregulated activation of inflammasomes is associated with intense inflammation, leading to the development of inflammatory diseases. Therefore, inflammasomes must be activated at a proper strength to protect against infection and avoid tissue damage. Recent studies have highlighted the cross-talk between inflammasome activation and autophagy, the cellular machinery associated with the degradation of intracellular components and maintenance of cellular homeostasis. Notably, deficiencies in autophagy-related proteins induce the aberrant activation of inflammasomes, causing severe tissue damage. In contrast, autophagy inducers ameliorate symptoms of inflammasome-related diseases. In this review, we discuss recent advances in the involvement of autophagy in regulating inflammasomes activation and in the development of inflammatory diseases.

475 Review Bowel Sonoelastography in Patients with Crohn's Disease: A Systematic Review. 2018

Pescatori, Lorenzo Carlo / Mauri, Giovanni / Savarino, Edoardo / Pastorelli, Luca / Vecchi, Maurizio / Sconfienza, Luca Maria. ·Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy. Electronic address: lorenzo.carlo.pescatori@gmail.com. · Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Milan, Italy. · Divisione di Gastroenterologia, Dipartimenti di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padua, Italy. · Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy. · Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. ·Ultrasound Med Biol · Pubmed #29195757.

ABSTRACT: Sonoelastography is an ultrasound-based method for evaluating the biological properties of a target tissue. It is commonly used in the diagnosis of liver and thyroid disease, but recently its use for monitoring the characteristics of bowel wall in patients affected by Crohn's disease (CD) has been proposed. Our aim was a systematic review of the use of sonoelastography in patients with CD. An initial database search retrieved 32 possible articles. On initial screening, 7 articles, concerning a total of 129 patients and 154 lesions of the small and large bowel, were finally included in the review. The age range varied between 6 and 53 y, and disease duration ranged between 1 and 623 mo. We collected data on the examinations performed (type and time), bowel area considered and parameters evaluated. All authors found that elastography correlates well with the degree of fibrosis, as wall strain significantly decreases in segments affected by fibrotic stenosis. Even though the endpoints proposed in the various articles are relatively inhomogeneous and scarcely comparable, we found that sonoelastography is a promising tool in the evaluation of patients with CD as it can differentiate inflammatory and fibrotic strictures in small case series.

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