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Crohn Disease: HELP
Articles from McGill University
Based on 73 articles published since 2008
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These are the 73 published articles about Crohn Disease that originated from McGill University during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial Endoscopic Balloon Dilation vs Surgery for Crohn's Disease-related Strictures. 2017

Bessissow, Talat / Van Assche, Gert. ·Division of Gastroenterology, McGill University Health Center, Montreal, Canada. · Division of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium, University of Leuven, Leuven, Belgium. ·Clin Gastroenterol Hepatol · Pubmed #28442316.

ABSTRACT: -- No abstract --

2 Review Positioning of old and new biologicals and small molecules in the treatment of inflammatory bowel diseases. 2018

Reinglas, Jason / Gonczi, Lorant / Kurt, Zsuzsanna / Bessissow, Talat / Lakatos, Peter L. ·Department of Gastroenterology, McGill University Health Center, Montreal, Québec H4A 3J1, Canada. · First Department of Medicine, Semmelweis University, H-1083, Budapest, Koranyi S. 2A, Hungary. ·World J Gastroenterol · Pubmed #30166855.

ABSTRACT: The past decade has brought substantial advances in the management of inflammatory bowel diseases (IBD). The introduction of tumor necrosis factor (TNF) antagonists, evidence for the value of combination therapy, the recognition of targeting lymphocyte trafficking and activation as a viable treatment, and the need for early treatment of high-risk patients are all fundamental concepts for current modern IBD treatment algorithms. In this article, authors review the existing data on approved biologicals and small molecules as well as provide insight on the current positioning of approved therapies. Patient stratification for the selection of specific therapies, therapeutic targets and patient monitoring will be discussed as well. The therapeutic armamentarium for IBD is expanding as novel and more targeted therapies become available. In the absence of comparative trials, positioning these agents is becoming difficult. Emerging concepts for the future will include an emphasis on the development of algorithms which will facilitate a greater understanding of the positioning of novel biological drugs and small molecules in order to best tailor therapy to the patient. In the interim, anti-TNF therapy remains an important component of IBD therapy with the most real-life evidence and should be considered as first-line therapy in patients with complicated Crohn's disease and in acute-severe ulcerative colitis. The safety and efficacy of these 'older' anti-TNF therapies can be optimized by adhering to therapeutic algorithms which combine clinical and objective markers of disease severity and response to therapy.

3 Review Endoscopic management of Crohn's strictures. 2018

Bessissow, Talat / Reinglas, Jason / Aruljothy, Achuthan / Lakatos, Peter L / Van Assche, Gert. ·Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, QC H3G1A4, Canada. talat.bessissow@mcgill.ca. · Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, QC H3G1A4, Canada. · Division of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium and University of Leuven, Leuven 3000, Belgium. ·World J Gastroenterol · Pubmed #29740201.

ABSTRACT: Symptomatic intestinal strictures develop in more than one third of patients with Crohn's disease (CD) within 10 years of disease onset. Strictures can be inflammatory, fibrotic or mixed and result in a significant decline in quality of life, frequently requiring surgery for palliation of symptoms. Patients under the age of 40 with perianal disease are more likely to suffer from disabling ileocolonic disease thus may have a greater risk for fibrostenotic strictures. Treatment options for fibrostenotic strictures are limited to endoscopic and surgical therapy. Endoscopic balloon dilatation (EBD) appears to be a safe, less invasive and effective alternative modality to replace or defer surgery. Serious complications are rare and occur in less than 3% of procedures. For non-complex strictures without adjacent fistulizaation or perforation that are less than 5 cm in length, EBD should be considered as first-line therapy. The aim of this review is to present the current literature on the endoscopic management of small bowel and colonic strictures in CD, which includes balloon dilatation, adjuvant techniques of intralesional injection of steroids and anti-tumor necrosis factor, and metal stent insertion. Short and long-term outcomes, complications and safety of EBD will be discussed.

4 Review Vitamin D deficiency and the pathogenesis of Crohn's disease. 2018

White, John H. ·Departments of Physiology and Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: john.white@mcgill.ca. ·J Steroid Biochem Mol Biol · Pubmed #28025175.

ABSTRACT: Vitamin D has emerged as a key regulator of innate immune responses to pathogen threat. The hormonal form of vitamin D signals through a nuclear receptor transcription factor and regulates gene transcription. Several papers have shown that vitamin D signaling is active both upstream and downstream of pattern recognition receptors, vanguards of innate immune responses. Crohn's disease (CD) is a relapsing-recurring inflammatory bowel disease (IBD) that arises from dysregulated intestinal innate immunity. Indeed, genetic studies have identified several CD susceptibility markers linked to mechanisms of innate immune responses to infection. Interest in links between vitamin D deficiency and CD has grown substantially, particularly in the last five years. While a number of studies have consistently revealed an association between CD and vitamin D deficiency, recent experimental work has uncovered a compelling mechanistic basis for the contribution of vitamin D deficiency to the pathogenesis of the disease. Moreover, a number of intervention trials have provided generally solid evidence that robust vitamin D supplementation may be of therapeutic benefit to patients with CD. This review summarizes these laboratory and clinical findings.

5 Review Update on Therapeutic Drug Monitoring in Crohn's Disease. 2017

Heron, Valérie / Afif, Waqqas. ·Division of Gastroenterology, McGill University Health Center, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. · Division of Gastroenterology, McGill University Health Center, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. Electronic address: waqqas.afif@mcgill.ca. ·Gastroenterol Clin North Am · Pubmed #28838420.

ABSTRACT: In patients with Crohn's disease on biologic medications, the use of therapeutic drug monitoring leads to a personalized approach to optimize treatment. Using an algorithmic approach, measurement of drug concentrations and anti-drug antibodies can be used to improve treatment outcomes. Therapeutic drug concentrations and absence of antibodies are associated with improved clinical and endoscopic outcomes. In clinical practice, therapeutic drug monitoring has been shown to be clinically useful and cost-effective in patients experiencing a loss of response to treatment. This review highlights the available data on therapeutic drug monitoring in the treatment of patients with Crohn's disease on biologic medications.

6 Review The NOD2-Smoking Interaction in Crohn's Disease is likely Specific to the 1007fs Mutation and may be Explained by Age at Diagnosis: A Meta-Analysis and Case-Only Study. 2017

Kuenzig, M Ellen / Yim, Jeff / Coward, Stephanie / Eksteen, Bertus / Seow, Cynthia H / Barnabe, Cheryl / Barkema, Herman W / Silverberg, Mark S / Lakatos, Peter L / Beck, Paul L / Fedorak, Richard / Dieleman, Levinus A / Madsen, Karen / Panaccione, Remo / Ghosh, Subrata / Kaplan, Gilaad G. ·Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Department of Medicine, University of Calgary, Calgary, Alberta, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · McGill University, Montreal General Hospital, Montreal, Quebec, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Department of Medicine, Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. · Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada; (i)Alberta Inflammatory Bowel Disease Consortium, University of Calgary, Calgary, Alberta, Canada. Electronic address: ggkaplan@ucalgary.ca. ·EBioMedicine · Pubmed #28668336.

ABSTRACT: BACKGROUND: NOD2 and smoking are risk factors for Crohn's disease. We meta-analyzed NOD2-smoking interactions in Crohn's disease (Phase 1), then explored the effect of age at diagnosis on NOD2-smoking interactions (Phase 2). METHODS: Phase 1: MEDLINE and EMBASE were searched for studies (n=18) providing data on NOD2 and smoking in Crohn's disease. NOD2-smoking interactions were estimated using odds ratios (ORs) and 95% confidence intervals (CIs) calculated using random effects models. Phase 2: A case-only study compared the proportion of smokers and carriers of the 1007fs variant across ages at diagnosis (≤16, 17-40, >40years). FINDINGS: Phase 1: Having ever smoked was less common among carriers of the 1007fs variant of NOD2 (OR 0.74, 95%CI:0.66-0.83). There was no interaction between smoking and the G908R (OR 0.96, 95%CI:0.82-1.13) or the R702W variant (OR 0.89, 95%CI:0.76-1.05). Phase 2: The proportion of patients (n=627) carrying the 1007fs variant decreased with age at diagnosis (≤16years: 15%; 17-40: 12%; >40: 3%; p=0.003). Smoking was more common in older patients (≤16years: 4%; 17-40: 48%; >40: 71%; p<0.001). INTERPRETATION: The negative NOD2-smoking interaction in Crohn's disease is specific to the 1007fs variant. However, opposing rates of this variant and smoking across age at diagnosis may explain this negative interaction.

7 Review Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn's disease: Systematic review and meta-analysis. 2017

Kopylov, Uri / Yung, Diana E / Engel, Tal / Vijayan, Sanju / Har-Noy, Ofir / Katz, Lior / Oliva, Salvatore / Avni, Tomer / Battat, Robert / Eliakim, Rami / Ben-Horin, Shomron / Koulaouzidis, Anastasios. ·Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel. Electronic address: ukopylov@gmail.com. · Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. · Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel. · Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy. · Department of Medicine E, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and Sackler School of Medicine, Tel-Aviv University, Israel. · McGill University Health Center, McGill University, Montreal, QC, Canada. ·Dig Liver Dis · Pubmed #28512034.

ABSTRACT: BACKGROUND AND AIMS: Capsule endoscopy (CE), magnetic resonance enterography (MRE) and small bowel (SB) intestinal contrast ultrasound (SICUS) are the modalities of choice for SB evaluation. This study aimed to compare the diagnostic yield (DY) of CE to MRE and SICUS in detection and monitoring of SB CD through meta-analysis of the available literature. METHODS: We performed a systematic literature search for trials comparing the accuracy of CE, MRE and SICUS for detection of active SB inflammation in patients with suspected and/or established CD. Only prospective studies comparing CE with another additional diagnostic modality were included in the final analysis. Pooled odds ratios (ORs) for the DY of the three modalities were calculated. RESULTS: A total of 112 studies were retrieved; following selection, 13 studies were eligible for analysis. The DY of CE for detection of active SB CD was similar to that of MRE (10 studies, 400 patients, OR 1.17; 95% CI 0.83-1.67) and SICUS (5 studies, 142 patients, OR 0.88; 95% CI 0.51-1.53). The outcomes were similar for the subgroups of suspected versus established CD and adult versus pediatric patients. CE was superior to MRE for proximal SB CD (7 studies, 251 patients, OR 2.79; 95% CI 1.2-6.48); the difference vs SICUS was not significant. CONCLUSION: CE, MRE and SICUS have similar DY for detection of SB CD in both suspected and established CD. CE is superior to MRE for detection of proximal SB disease, however the risk of capsule retention should be considered.

8 Review Inflammatory bowel disease and airway diseases. 2016

Vutcovici, Maria / Brassard, Paul / Bitton, Alain. ·Maria Vutcovici, Alain Bitton, Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, Montreal, Québec H3G 1A4, Canada. ·World J Gastroenterol · Pubmed #27678355.

ABSTRACT: Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact.

9 Review Fecal calprotectin for the prediction of small-bowel Crohn's disease by capsule endoscopy: a systematic review and meta-analysis. 2016

Kopylov, Uri / Yung, Diana E / Engel, Tal / Avni, Tomer / Battat, Robert / Ben-Horin, Shomron / Plevris, John N / Eliakim, Rami / Koulaouzidis, Anastasios. ·aDepartment of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler Medical School bDepartment of Medicine E, Rabin Medical Center, Petach Tikva and Sackler Medical School, Tel Aviv 52960, Israel cCentre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK dDepartment of Gastroenterology, McGill University Health Center, Montreal, Québec, Canada. ·Eur J Gastroenterol Hepatol · Pubmed #27415156.

ABSTRACT: BACKGROUND AND AIMS: Fecal calprotectin is a well-established marker of mucosal inflammation. Although the correlation of elevated calprotectin levels with colonic inflammation has been confirmed repeatedly, it is less established for the small bowel. The aim of the current study was to assess the diagnostic accuracy of calprotectin for the prediction of active small-bowel disease on capsule endoscopy by performing a diagnostic test meta-analysis. MATERIALS AND METHODS: A comprehensive search was performed using PubMed/Embase. Studies addressing patients with suspected/established Crohn's disease (CD) evaluated with calprotectin and videocapsule were included. A diagnostic meta-analysis was carried out; pooled diagnostic sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each cut-off. RESULTS: Seven studies (463 patients) were entered into the final analysis. The DOR was significant for all the evaluated FC cut-offs (50 μg/g: sensitivity 0.83, specificity 0.53, DOR-5.64; 100 μg/g: sensitivity 0.68, specificity 0.71, DOR-5.01; 200 μg/g: sensitivity 0.42, specificity 0.94, DOR-13.64). On sensitivity analyses, when only studies addressing suspected Crohn's or retrospective studies were included, the results did not change significantly. For studies including patients with suspected CD only, the overall accuracy for FC cut-off 50 μg/g was further increased (sensitivity 0.89, specificity 0.55, DOR-10.3), with a negative predictive value of 91.8%. SUMMARY AND CONCLUSION: Fecal calprotectin has a significant diagnostic accuracy for the detection of small-bowel CD. Our results suggest that in patients with suspected CD with calprotectin <50 μg/g, the likelihood of positive diagnosis is very low.

10 Review Diffusion-weighted MRI in Crohn's disease: Current status and recommendations. 2016

Dohan, Anthony / Taylor, Stuart / Hoeffel, Christine / Barret, Maximilien / Allez, Matthieu / Dautry, Raphael / Zappa, Magaly / Savoye-Collet, Céline / Dray, Xavier / Boudiaf, Mourad / Reinhold, Caroline / Soyer, Philippe. ·McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada. · Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France. · Université Paris-Diderot, Sorbonne Paris Cité, Paris, France. · INSERM UMR 965, Paris, France. · Centre for Medical Imaging, University College London, Podium Level 2, University College Hospital, London, UK. · Department of Radiology, Hôpital Robert-Debré, Reims, France. · Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France. · Department of Gastroenterology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France. · Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France. · Department of Radiology, CHU Charles Nicolle, Rouen, France. · Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. ·J Magn Reson Imaging · Pubmed #27249184.

ABSTRACT: Over the past years, technological improvements and refinements in magnetic resonance imaging (MRI) hardware have made high-quality diffusion-weighted imaging (DWI) routinely possible for the bowel. DWI is promising for the detection and characterization of lesions in Crohn's disease (CD) and has been advocated as an alternative to intravenous gadolinium-based contrast agents. Furthermore, quantification using the apparent diffusion coefficient may have value as a biomarker of CD activity and has shown promise. In this article we critically review the literature pertaining to the value of DWI in CD for detection, characterization, and quantification of disease activity and complications. Although the body of supportive evidence is growing, it is clear that well-designed, multicenter studies are required before the role of DWI in clinical practice can be fully established. J. Magn. Reson. Imaging 2016;44:1381-1396.

11 Review Video Capsule Endoscopy of the Small Bowel for Monitoring of Crohn's Disease. 2015

Kopylov, Uri / Ben-Horin, Shomron / Seidman, Ernest G / Eliakim, Rami. ·*Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; and †Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada. ·Inflamm Bowel Dis · Pubmed #26193349.

ABSTRACT: Video capsule endoscopy has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of suspected small bowel Crohn's disease, and it is increasingly used for the monitoring of disease activity in patients with established small bowel Crohn's. The purpose of the current article was to review the literature pertaining to the utilization of capsule endoscopy in established Crohn's disease, for monitoring of mucosal healing, postoperative recurrence, disease classification, and other indications.

12 Review Cytokines as therapeutic targets in rheumatoid arthritis and other inflammatory diseases. 2015

Siebert, Stefan / Tsoukas, Alexander / Robertson, Jamie / McInnes, Iain. ·Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom (S.S., J.R., I.M.); and Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada (A.T.) stefan.siebert@glasgow.ac.uk. · Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom (S.S., J.R., I.M.); and Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada (A.T.). ·Pharmacol Rev · Pubmed #25697599.

ABSTRACT: The human immune system involves highly complex and coordinated processes in which small proteins named cytokines play a key role. Cytokines have been implicated in the pathogenesis of a number of inflammatory and autoimmune diseases. Cytokines are therefore attractive therapeutic targets in these conditions. Anticytokine therapy for inflammatory diseases became a clinical reality with the introduction of tumor necrosis factor (TNF) inhibitors for the treatment of severe rheumatoid arthritis. Although these therapies have transformed the treatment of patients with severe inflammatory arthritis, there remain significant limiting factors: treatment failure is commonly seen in the clinic; safety concerns remain; there is uncertainty regarding the relevance of immunogenicity; the absence of biomarkers to direct therapy decisions and high drug costs limit availability in some healthcare systems. In this article, we provide an overview of the key efficacy and safety trials for currently approved treatments in rheumatoid arthritis and review the major lessons learned from a decade of use in clinical practice, focusing mainly on anti-TNF and anti-interleukin (IL)-6 agents. We also describe the clinical application of anticytokine therapies for other inflammatory diseases, particularly within the spondyloarthritis spectrum, and highlight differential responses across diseases. Finally, we report on the current state of trials for newer therapeutic targets, focusing mainly on the IL-17 and IL-23 pathways.

13 Review Diagnostic modalities for the evaluation of small bowel disorders. 2015

Kopylov, Uri / Seidman, Ernest G. ·aDivision of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel bDivision of Gastroenterology, McGill University Health Center, McGill Faculty of Medicine, Montreal, Quebec, Canada. ·Curr Opin Gastroenterol · Pubmed #25635667.

ABSTRACT: PURPOSE OF REVIEW: This review summarizes the recent developments in the evaluation of small bowel disorders using videocapsule endoscopy (VCE) and serological and breath-test biomarkers. RECENT FINDINGS: The ability to visualize the small bowel was revolutionized with the introduction of VCE technology. VCE allows for accurate, noninvasive visualization of the small bowel mucosa. This device is invaluable in the investigation of obscure gastrointestinal bleeding (OGIB), occult bleeding with iron deficiency anaemia, small bowel Crohn's disease (CD), small bowel neoplasms and other mucosal disorders. Recent studies underscored the utility of VCE for documenting the extent and severity of small bowel CD as well as monitoring activity after therapy. The accuracy of the discrimination between small bowel tumours and benign bulges has been improved by a novel endoscopic algorithm. The accuracy of VCE was also evaluated as a potential noninvasive alternative to small bowel biopsies in suspected celiac disease. New findings have been made using breath tests and other biomarkers for the diagnosis of celiac disease, irritable bowel syndrome and bacterial overgrowth. SUMMARY: VCE as well as breath-test biomarkers play a major and expanding role in the diagnosis and monitoring of various small bowel disorders.

14 Review Small bowel adenocarcinoma and Crohn's disease: any further ahead than 50 years ago? 2014

Cahill, Caitlin / Gordon, Philip H / Petrucci, Andrea / Boutros, Marylise. ·Caitlin Cahill, Philip H Gordon, Andrea Petrucci, Marylise Boutros, McGill University Department of Surgery; Sir Mortimer B. Davis Jewish General Hospital Colorectal Surgery, Montreal PQ H3T 1E2, Canada. ·World J Gastroenterol · Pubmed #25206256.

ABSTRACT: This review of the literature on small bowel carcinoma associated with Crohn's disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn's disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn's disease.

15 Review Adalimumab monotherapy versus combination therapy with immunomodulators in patients with Crohn's disease: a systematic review and meta-analysis. 2014

Kopylov, Uri / Al-Taweel, Talal / Yaghoobi, Mohammad / Nauche, Benedicte / Bitton, Alain / Lakatos, Peter L / Ben-Horin, Shomron / Afif, Waqqas / Seidman, Ernest G. ·Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: ukopylov@gmail.com. · Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada. · Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada; Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston SC, United States. · Medical Library, McGill University Health Centre, Montreal, Quebec, Canada. · 1st Department of Medicine, Summelweis University, Budapest, Hungary. · Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel. ·J Crohns Colitis · Pubmed #25067824.

ABSTRACT: BACKGROUND AND AIMS: Combination therapy with infliximab and azathioprine has been shown to be superior to either treatment alone in Crohn's disease (CD). However, the benefit of combining adalimumab with an immunomodulator remains controversial. The aim of this study was to compare the efficacy of adalimumab monotherapy with combination therapy for induction and maintenance of response and remission in CD using a meta-analysis of the current literature. METHODS: We performed a systematic literature search using Medline, Embase, Cochrane and several other databases. Prospective randomized controlled trials, retrospective cohort and case-controlled studies were included. The primary outcomes included induction of response and remission (up to week 12), maintenance of clinical response and remission (1 year) and the need for dose escalation. Several subgroup and sensitivity analyses were performed. RESULTS: Eighteen out of 2743 retrieved studies were included. A meta-analysis of 7 studies assessing induction of remission (n=1984) showed that ADA monotherapy was inferior to combination therapy [OR=0.78 (0.64-0.96), p=0.02]. A meta-analysis of 4 studies revealed that combination therapy was not statistically different from ADA for maintenance of remission [OR=1.08 (0.79-1.48), p=0.48]. Combination therapy was also not different from ADA monotherapy in terms of requirement for dose escalation [OR=1.13 (0.69-1.85), p=0.62]. CONCLUSIONS: Combination therapy with ADA and immunomodulator was mildly superior to ADA monotherapy for induction of remission in CD. The rate of remission at 1 year and the need for dose escalation were similar in both groups. These findings should be interpreted with caution in view of possible confounders and should be further validated by randomized controlled trials.

16 Review Gracilis muscle transposition for complex perineal fistulas and sinuses: a systematic literature review of surgical outcomes. 2014

Takano, Shota / Boutros, Marylise / Wexner, Steven D. ·Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. · Department of Surgery, Division of Colorectal Surgery, McGill University, Montreal, QC, Canada. · Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. Electronic address: wexners@ccf.org. ·J Am Coll Surg · Pubmed #25038961.

ABSTRACT: -- No abstract --

17 Review Vitamin B12 deficiency in inflammatory bowel disease: prevalence, risk factors, evaluation, and management. 2014

Battat, Robert / Kopylov, Uri / Szilagyi, Andrew / Saxena, Anjali / Rosenblatt, David S / Warner, Margaret / Bessissow, Talat / Seidman, Ernest / Bitton, Alain. ·*Department of Medicine, McGill University, Montreal, Quebec, Canada; †Department of Internal Medicine, Jewish General Hospital, Montreal, Quebec, Canada; ‡Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada; §Division of Gastroenterology, Jewish General Hospital, Montreal, Quebec, Canada; ‖Departments of Human Genetics, Pediatrics, and Biology, McGill University, Montreal, Quebec, Canada; and ¶Division of Hematology, McGill University Health Center, Montreal, Quebec, Canada. ·Inflamm Bowel Dis · Pubmed #24739632.

ABSTRACT: BACKGROUND: Management of vitamin B(12) (cobalamin, Cbl) deficiency in inflammatory bowel disease (IBD) is often not evidenced-based because of uncertainty on whether it causes enough malabsorption to result in clinical disease. This systematic review examines whether IBD predisposes to Cbl deficiency. We provide an approach to the management of abnormal Cbl values in IBD based on current literature and consensus-based guidelines. METHODS: An extensive search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 42 articles with a total of 3732 patients evaluating Cbl deficiency in IBD. RESULTS: Crohn's disease without ileal resection, regardless of disease location in the ileum, did not increase the risk for Cbl deficiency. Ileal resections greater than 30 cm were associated with Cbl deficiency in Crohn's disease, whereas those less than 20 cm were not. The effects of 20 to 30 cm resections were inconsistent. Ulcerative colitis did not predispose to deficiency. All studies failed to use confirmatory biomarker testing as stipulated by diagnostic guidelines for Cbl deficiency. CONCLUSIONS: This literature does not support an association of Crohn's disease in general, regardless of ileal involvement, with Cbl deficiency. Only ileal resections greater than 20 cm in Crohn's disease predispose to deficiency and warrant treatment. Based on these findings, we suggest a diagnostic and therapeutic algorithm. All findings and recommendations require verification in further studies using confirmatory biomarkers as per diagnostic guidelines for Cbl deficiency. Serum Cbl levels alone are likely insufficient to diagnose deficiency in asymptomatic patients.

18 Review Role of capsule endoscopy in inflammatory bowel disease. 2014

Kopylov, Uri / Seidman, Ernest G. ·Uri Kopylov, Ernest G Seidman, Division of Gastroenterology, McGill University Health Center, Montreal, Quebec H3G A14, Canada. ·World J Gastroenterol · Pubmed #24574792.

ABSTRACT: Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn's disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease.

19 Review Clinical utility of fecal biomarkers for the diagnosis and management of inflammatory bowel disease. 2014

Kopylov, Uri / Rosenfeld, Greg / Bressler, Brian / Seidman, Ernest. ·*Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada; †Department of Medicine, McGill University, Montreal, Quebec, Canada; and ‡Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. ·Inflamm Bowel Dis · Pubmed #24562174.

ABSTRACT: Diagnosis and monitoring of inflammatory bowel diseases rely on clinical, endoscopic, and radiologic parameters. Inflammatory biomarkers have been investigated as a surrogate marker for endoscopic diagnosis of inflammatory activity. Fecal inflammatory biomarkers such as calprotectin and lactoferrin are direct products of bowel inflammation and provide an accurate and noninvasive diagnostic and monitoring modality for Crohn's disease and ulcerative colitis. This report contains an overview of the currently existing literature pertaining to clinical implications of fecal biomarkers for diagnosis, monitoring, and prediction of outcomes of inflammatory bowel disease.

20 Review Crohn's as an immune deficiency: from apparent paradox to evolving paradigm. 2013

Vinh, Donald C / Behr, Marcel A. ·Department of Medicine, McGill University Health Centre, Montreal, QC, H3G 1A4, Canada. ·Expert Rev Clin Immunol · Pubmed #23256761.

ABSTRACT: Crohn's disease is often considered an autoimmune condition, based on the observations of a histopathological inflammatory process in the absence of identifiable causal microorganism(s) and that immune-modulating therapeutics result in diminished host-directed inflammatory pathology. However, the evidence for a self-targeted immune response is unproven; thus, the instigating and perpetuating forces that drive this chronic inflammation remain unknown. In recent years, a convergence of findings from different fields of investigation has led to a new paradigm, where Crohn's disease appears to be the consequence of an intrinsic innate immune deficiency. While genomic/postgenomic studies and functional immunologic investigations offer a common perspective, critical details of the processes involved require further elaboration. In this review, we place this new model in the context of the emerging literature on non-HIV immune deficiencies, to compare and contrast what is known about proven intrinsic (primary) immune deficiencies to the nascent understanding of Crohn's disease. We then re-evaluate postgenomic research, looking at the functional importance of Crohn's disease-associated mutations and polymorphisms, to delineate points of consensus and issues requiring further study. We ask whether the immunologic profile can guide predictions as to which microbial triggers could exploit these defects and thereby initiate and/or perpetuate chronic enteritis. Finally, we outline potential clinical implications of this model, from immunologic assessment of patients to the selection of therapeutic interventions.

21 Review Mycobacteria in Crohn's disease: how innate immune deficiency may result in chronic inflammation. 2010

Lalande, Jean-Daniel / Behr, Marcel A. ·Department of Medicine, McGill University Health Centre, A5.156, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. ·Expert Rev Clin Immunol · Pubmed #20594136.

ABSTRACT: Crohn's disease (CD) is often considered to be an autoimmune condition or, alternatively, an autoinflammatory condition, based on the observation of host-directed inflammatory processes. However, the underlying basis of this deleterious inflammatory response remains elusive. Recent findings from genetic and genomic studies have altered the perspective on the pathogenesis of CD, hinting at defects in innate immune sensing of intracellular bacteria and the handling of these organisms through autophagy. These findings are consistent with emerging data from immunological studies that point to a systemic immune deficiency in CD patients. Both sets of data (genetic predisposition and immunodeficiency) are consistent with the longstanding hypothesis that mycobacteria might be involved in the etiology of CD. In this article, we discuss the convergence of these three lines of investigation and highlight important knowledge gaps required in order to address the mycobacterial hypothesis with greater clarity. In the coming years, clinical immunological investigations should focus on defining the specificity of functional immune defects with regards to microbes and their associated ligands. Should CD result from a dysfunctional host-pathogen interaction, elucidation of the microbes that can exploit such defects to induce a chronic inflammatory disease is critical for the development of subsequent diagnostic assays and clinical interventions.

22 Review The path to Crohn's disease: is mucosal pathology a secondary event? 2010

Behr, Marcel A. ·Department of Medicine, McGill University Health Centre, Montreal, QC, Canada. marcel.behr@mcgill.ca ·Inflamm Bowel Dis · Pubmed #19924803.

ABSTRACT: Current models of Crohn's disease (CD) invoke an initial disturbance of the epithelial interface between the gut mucosa and intestinal microbiota. This "outside-in" paradigm, mirroring the pathophysiology of acute gastroenteritis, suggests that mucosal damage by luminal bacteria is an early, initiating factor in the etiopathogenesis of disease. However, a number of features of CD argue against a primary mucosal process, including phenotypic studies of CD patients that point to a macrophage defect and genetic studies that predict impaired innate immunity to intracellular bacteria. Intracellular pathogens, such as Listeria, Salmonella, and Mycobacteria, invade via the gastrointestinal tract with minimal or no acute mucosal pathology. These organisms then infect and persist in lymphatic tissues before inducing pathology, in the gut or elsewhere, as a secondary process. In a disease resulting from impaired macrophage responses to intracellular pathogens, mucosal damage could instead represent a terminal event in the pathogenesis of disease. Such an "inside-out" model is also compatible with observations on postoperative disease relapses where subepithelial pathology precedes ulceration. This alternative disease paradigm suggests that clinical and experimental research efforts should be directed at deeper processes in the gut wall and attached mesentery to understand how intracellular bacteria could initiate or exacerbate this chronic inflammatory disease.

23 Review Differentiating intestinal tuberculosis from Crohn's disease: a diagnostic challenge. 2009

Almadi, Majid Abdulrahman / Ghosh, Subrata / Aljebreen, Abdulrahman Mohamed. ·Gastroenterology Division, McGill University Health Center, McGill University, Montreal, Canada. ·Am J Gastroenterol · Pubmed #19240705.

ABSTRACT: With the changing epidemiology of Crohn's disease (CD) and intestinal tuberculosis (ITB), we are in an era where the difficulty facing physicians in discriminating between the two diseases has increased, and the morbidity and mortality resulting from a delayed diagnosis or misdiagnosis is considerably high. In this article, we examine the changing trends in the epidemiology of CD and ITB, in addition to clinical features that aid in the differentiation of both diseases. The value of various laboratory, serological, and the tuberculin skin tests are reviewed as well. The use of an interferon-gamma-release assay, QuantiFERON-TB Gold, in the workup of these patients and its value in populations where the bacillus Calmette-Guérin vaccine is still administered is discussed. Different radiological, endoscopic, and pathological similarities and features that can aid the clinician in reaching a rapid diagnosis are reviewed as well. The association between mycobacteria and CD, the concerns with the practice of antituberculosis medication trials in areas where tuberculosis (TB) is endemic, as well as extrapulmonary TB induced by the use of antitumor necrosis factor-alpha agents are delineated in this article. Furthermore, we propose an algorithm for the investigation of patients in whom the differential diagnosis encompasses CD and ITB.

24 Article Validity of the EQ-5D-5L and EQ-5D-3L in patients with Crohn's disease. 2019

Rencz, Fanni / Lakatos, Peter L / Gulácsi, László / Brodszky, Valentin / Kürti, Zsuzsanna / Lovas, Szilvia / Banai, János / Herszényi, László / Cserni, Tamás / Molnár, Tamás / Péntek, Márta / Palatka, Károly. ·Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary. fanni.rencz@uni-corvinus.hu. · Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, Budapest, 1051, Hungary. fanni.rencz@uni-corvinus.hu. · 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, Budapest, 1083, Hungary. · Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada. · Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary. · Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98., Debrecen, 4032, Hungary. · Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, Budapest, 1062, Hungary. · Faculty of Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary. · 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, Szeged, 6720, Hungary. ·Qual Life Res · Pubmed #30225788.

ABSTRACT: PURPOSE: The EuroQol five-dimension questionnaire (EQ-5D) is the most commonly used instrument to obtain utility values for cost-effectiveness analyses of treatments for Crohn's disease (CD). We aimed to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with CD. METHODS: Between 2016 and 2017, a multicentre cross-sectional survey was carried out. Consecutive outpatients with CD completed the 3L, 5L and EQ visual analogue scale (VAS). Disease severity was graded by the Crohn's Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI). The 3L and 5L were compared in terms of feasibility, agreement, ceiling effect, redistribution properties, discriminatory power, convergent and known-groups validity. RESULTS: Two-hundred and six patients (54.9% male, mean age 35 ± 11 years) participated in the survey. For 3L, 25 unique health states were observed versus 59 for the 5L. The overall ceiling effect decreased from 29.6% (3L) to 25.5% (5L). Absolute discriminatory power improved (mean Shannon index 0.84 vs. 1.18). The 3L correlated stronger with EQ VAS and CDAI scores, whereas the 5L with PDAI. The 5L demonstrated a better known-groups validity on the basis of age, perianal fistulas, extraintestinal manifestations and disability. CONCLUSIONS: This is the first study to report the impact of CD on quality of life using the EQ-5D-5L questionnaire. The 5L seems to perform better than 3L in terms of feasibility, ceiling effect, discriminatory power and known-groups validity. Understanding the differences in psychometrics between the 3L and 5L is essential as they have substantial implications for financial decision-making about CD treatments.

25 Article Sex-Based Differences in Incidence of Inflammatory Bowel Diseases-Pooled Analysis of Population-Based Studies From Western Countries. 2018

Shah, Shailja C / Khalili, Hamed / Gower-Rousseau, Corinne / Olen, Ola / Benchimol, Eric I / Lynge, Elsebeth / Nielsen, Kári R / Brassard, Paul / Vutcovici, Maria / Bitton, Alain / Bernstein, Charles N / Leddin, Desmond / Tamim, Hala / Stefansson, Tryggvi / Loftus, Edward V / Moum, Bjørn / Tang, Whitney / Ng, Siew C / Gearry, Richard / Sincic, Brankica / Bell, Sally / Sands, Bruce E / Lakatos, Peter L / Végh, Zsuzsanna / Ott, Claudia / Kaplan, Gilaad G / Burisch, Johan / Colombel, Jean-Frederic. ·Division of Gastroenterology, Mount Sinai Hospital, New York, New York; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: shailja.c.shah@vanderbilt.edu. · Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Public Health Unit, Epimad Registre, Lille University Hospital, France; INSERM LIRIC, UMR 995, Lille University, France. · Department of Medicine, Karolinska Institutet, Stockholm, Sweden. · CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. · Division of Gastroenterology, University of Copenhagen, Copenhagen, Denmark. · Division of Gastroenterology, National Hospital, Tórshavn, Faroe Islands. · Department of Medicine, McGill University, Montreal, Quebec, Canada. · Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada. · Division of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada. · Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada. · Division of Gastroenterology, National University Hospital of Iceland, Reykjavík, Iceland. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, New York. · Department of Gastroenterology, Oslo University Hospital and University of Oslo, Oslo, Norway. · Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. · Division of Gastroenterology, University of Otago, Christchurch, New Zealand. · Division of Gastroenterology, University of Rijeka, Rijeka, Croatia. · Division of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia. · Division of Gastroenterology, Mount Sinai Hospital, New York, New York. · Division of Gastroenterology, Semmelweis University, Budapest, Hungary. · Division of Gastroenterology, University of Regensburg, Regensburg, Germany. · Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. · Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark. ·Gastroenterology · Pubmed #29958857.

ABSTRACT: BACKGROUND & AIMS: Although the incidence of inflammatory bowel diseases (IBDs) varies with age, few studies have examined variations between the sexes. We therefore used population data from established cohorts to analyze sex differences in IBD incidence according to age at diagnosis. METHODS: We identified population-based cohorts of patients with IBD for which incidence and age data were available (17 distinct cohorts from 16 regions of Europe, North America, Australia, and New Zealand). We collected data through December 2016 on 95,605 incident cases of Crohn's disease (CD) (42,831 male and 52,774 female) and 112,004 incident cases of ulcerative colitis (UC) (61,672 male and 50,332 female). We pooled incidence rate ratios of CD and UC for the combined cohort and compared differences according to sex using random effects meta-analysis. RESULTS: Female patients had a lower risk of CD during childhood, until the age range of 10-14 years (incidence rate ratio, 0.70; 95% CI, 0.53-0.93), but they had a higher risk of CD thereafter, which was statistically significant for the age groups of 25-29 years and older than 35 years. The incidence of UC did not differ significantly for female vs male patients (except for the age group of 5-9 years) until age 45 years; thereafter, men had a significantly higher incidence of ulcerative colitis than women. CONCLUSIONS: In a pooled analysis of population-based studies, we found age at IBD onset to vary with sex. Further studies are needed to investigate mechanisms of sex differences in IBD incidence.

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