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Crohn Disease: HELP
Articles from McGill University
Based on 111 articles published since 2010
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These are the 111 published articles about Crohn Disease that originated from McGill University during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial Ver(s)ifying the Efficacy of Vedolizumab Therapy on Mucosal Healing in Patients With Crohn's Disease. 2019

Gonczi, Lorant / Bessissow, Talat / Lakatos, Peter L. ·First Department of Medicine, Semmelweis University, Budapest, Hungary. · Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada. · First Department of Medicine, Semmelweis University, Budapest, Hungary and Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: kislakpet99@gmail.com. ·Gastroenterology · Pubmed #31356804.

ABSTRACT: -- No abstract --

2 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 --

3 Review Disease monitoring strategies in inflammatory bowel diseases: What do we mean by "tight control"? 2019

Gonczi, Lorant / Bessissow, Talat / Lakatos, Peter Laszlo. ·First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary. · Division of Gastroenterology, McGill University Health Centre, Montreal H3G 1A4, Quebec, Canada. · First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary. peter.lakatos@mcgill.ca. ·World J Gastroenterol · Pubmed #31749591.

ABSTRACT: In recent years, there has been a critical change in treatment paradigms in inflammatory bowel diseases (IBD) triggered by the arrival of new effective treatments aiming to prevent disease progression, bowel damage and disability. The insufficiency of symptomatic disease control and the well-known discordance between symptoms and objective measures of disease activity lead to the need of reviewing conventional treatment algorithms and developing new concepts of optimal therapeutic strategy. The treat-to-target strategies, defined by the selecting therapeutic targets in inflammatory bowel disease consensus recommendation, move away from only symptomatic disease control and support targeting composite therapeutic endpoints (clinical and endoscopical remission) and timely assessment. Emerging data suggest that early therapy using a treat-to-target approach and an algorithmic therapy escalation using regular disease monitoring by clinical and biochemical markers (fecal calprotectin and C-reactive protein) leads to improved outcomes. This review aims to present the emerging strategies and supporting evidence in the current therapeutic paradigm of IBD including the concepts of "early intervention", "treat-to-target" and "tight control" strategies. We also discuss the real-word experience and applicability of these new strategies and give an overview on the future perspectives and areas in need of further research and potential improvement regarding treatment targets and ("tight") disease monitoring strategies.

4 Review Endoscopic scoring systems for the evaluation and monitoring of disease activity in Crohn's disease. 2019

Hart, Lara / Bessissow, Talat. ·Division of Pediatric Gastroenterology, Department of Pediatrics, McMaster University Medical Center (MUMC), McMaster Children's Hospital, 1200 Main St. W, 3A, Hamilton, ON, Canada; Division of Gastroenterology, Department of Medicine, McGill University Health Center (MUHC), Montreal General Hospital, 1650 Cedar Ave, C7-200, Montreal, QC, H3G 1A4, Canada. Electronic address: lara.hart@medportal.ca. · Division of Gastroenterology, Department of Medicine, McGill University Health Center (MUHC), Montreal General Hospital, 1650 Cedar Ave, C7-200, Montreal, QC, H3G 1A4, Canada. Electronic address: talat.bessissow@mcgill.ca. ·Best Pract Res Clin Gastroenterol · Pubmed #31327405.

ABSTRACT: Crohn's disease is a chronic relapsing idiopathic condition that can affect any part of the gastrointestinal tract. It has been shown that mucosal healing is associated with improved clinical outcomes such as reduced risk of surgery, hospitalization and complications. Nowadays mucosal healing is considered the optimal target of medical therapy. To evaluate the mucosa in an objective and standardized manner, it is important to rely on accurate and validated endoscopic scores. The Crohn's disease endoscopic index of severity, the simple endoscopic score for Crohn's disease as well as the Rutgeerts score will be reviewed. Their clinical implications and limitations will be discussed.

5 Review Strictures in Crohn's Disease and Ulcerative Colitis: Is There a Role for the Gastroenterologist or Do We Always Need a Surgeon? 2019

Reinglas, Jason / Bessissow, Talat. ·Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada. · Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada. Electronic address: talat.bessissow@mcgill.ca. ·Gastrointest Endosc Clin N Am · Pubmed #31078252.

ABSTRACT: Symptomatic strictures occur more often in Crohn disease than in ulcerative colitis. The mainstay of endoscopic therapy for strictures in inflammatory bowel disease is endoscopic balloon dilation. Serious complications are rare, and risk factors for perforation include active inflammation, use of steroids, and dilation of ileorectal or ileosigmoid anastomotic strictures. This article presents current literature on strictures in inflammatory bowel disease. Focus is placed on the short- and long-term outcomes, complications, and safety of endoscopic balloon dilation for Crohn disease strictures. Adjuvant techniques, such as intralesional injection of steroids and anti-tumor necrosis factor, stricturotomy, and stent insertion, are briefly discussed.

6 Review [The role of fecal calprotectin in the diagnosis and treatment of gastrointestinal diseases]. 2019

Iliás, Ákos / Rózsa, Fióna Petra / Gönczi, Lóránt / Lovász, Barbara Dorottya / Kürti, Zsuzsanna / Lakatos, Péter László. ·I. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Korányi Sándor u. 2/a, 1083. · Egészségfejlesztési és Klinikai Módszertani Intézet, Egészségtudományi Klinikai Tanszék, Semmelweis Egyetem, Egészségtudományi Kar Budapest. · MUHC, Montreal General Hospital, McGill University Montreal, Kanada. ·Orv Hetil · Pubmed #30798622.

ABSTRACT: The diagnostics of gastrointestinal diseases have evolved significantly in the past few decades. Besides endoscopy and conventional imaging modalities, there is a growing interest for rapid point-of-care laboratory tests to help discriminate between diseases with similar clinical symptoms and/or help the follow-up of chronic conditions, predicting relapses. The fecal calprotectin testing is a routine diagnostic tool in many countries. It is also more and more accessible in Hungary as well. We aim to present a short review on the role and performance of fecal calprotectin test in the diagnosis and follow-up of gastrointestinal diseases, especially inflammatory bowel diseases, gastrointestinal infections, irritable bowel syndrome and pediatric conditions. By presenting the different cut-off values, sensitivity and specificity rates representative for each disease, we hope to further aid clinicians in decision-making regarding these conditions. Orv Hetil. 2019; 160(9): 322-328.

7 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.

8 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.

9 Review Progress with infliximab biosimilars for inflammatory bowel disease. 2018

Kurti, Zsuzsanna / Gonczi, Lorant / Lakatos, Peter L. ·a First Department of Medicine , Semmelweis University , Budapest , Hungary. · b Division of Gastroenterology , McGill University Health Center , Montreal , QC , Canada. ·Expert Opin Biol Ther · Pubmed #29688797.

ABSTRACT: INTRODUCTION: Biological therapies have revolutionized the treatment of inflammatory bowel diseases (IBD) in the last two decades. Though biological drugs are effective, their use is associated with high costs and access to biological agents varies among countries. As the patent for the reference products expired, the advent of biosimilar monoclonal antibodies has been expected. Biosimilars represent less expensive alternatives compared to the reference product. AREAS COVERED: In this review, authors will review the literature on the clinical efficacy, safety and immunogenicity of current and future biosimilar infliximabs. Short- and medium-term data from real-life cohorts and from randomized-clinical trials in IBD demonstrated similar outcomes in terms of efficacy, safety and immunogenicity as the reference product for CT-P13. Switch data from the reference to the biosimilar product are also accumulating (including the NOR-SWITCH and the CT-P13 3.4 study). EXPERT OPINION: The use of biosimilar infliximab in IBD is increasing worldwide. Its use may be associated with budget savings leading to better access to biological therapies and consequently improved health outcomes. Switching from the originator to a biosimilar in patients with IBD is acceptable, although scientific and clinical evidence is lacking regarding reverse switching, multiple switching, and cross-switching among biosimilars in IBD patients.

10 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.

11 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.

12 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.

13 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.

14 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.

15 Review Co-existence of non-alcoholic fatty liver disease and inflammatory bowel disease: A review article. 2016

Chao, Che-Yung / Battat, Robert / Al Khoury, Alex / Restellini, Sophie / Sebastiani, Giada / Bessissow, Talat. ·Che-Yung Chao, Robert Battat, Alex Al Khoury, Giada Sebastiani, Talat Bessissow, Division of Gastroenterology, McGill University Health Center, Montreal, QC H3G 1A4, Canada. ·World J Gastroenterol · Pubmed #27678354.

ABSTRACT: Emerging data have highlighted the co-existence of non-alcoholic fatty liver disease (NAFLD) and inflammatory bowel disease; both of which are increasingly prevalent disorders with significant complications and impact on future health burden. Cross-section observational studies have shown widely variable prevalence rates of co-existing disease, largely due to differences in disease definition and diagnostic tools utilised in the studies. Age, obesity, insulin resistance and other metabolic conditions are common risks factors in observational studies. However, other studies have also suggested a more dominant role of inflammatory bowel disease related factors such as disease activity, duration, steroid use and prior surgical intervention, in the development of NAFLD. This suggests a potentially more complex pathogenesis and relationship between the two diseases which may be contributed by factors including altered intestinal permeability, gut dysbiosis and chronic inflammatory response. Commonly used immunomodulation agents pose potential hepatic toxicity, however no definitive evidence exist linking them to the development of hepatic steatosis, nor are there any data on the impact of therapy and prognosis in patient with co-existent diseases. Further studies are required to assess the impact and establish appropriate screening and management strategies in order to allow early identification, intervention and improve patient outcomes.

16 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.

17 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.

18 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.

19 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.

20 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.

21 Review Therapeutic drug monitoring in inflammatory bowel disease. 2014

Kopylov, Uri / Ben-Horin, Shomron / Seidman, Ernest. ·Division of Gastroenterology, McGill University Health Center, Montreal, Canada (Uri Kopylov, Ernest Seidman) ; Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Israel (Shomron Ben-Horin). · Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Israel (Shomron Ben-Horin). · Division of Gastroenterology, McGill University Health Center, Montreal, Canada (Uri Kopylov, Ernest Seidman). ·Ann Gastroenterol · Pubmed #25331715.

ABSTRACT: Tumor necrosis factor (TNF)-α inhibitors and thiopurines are among the most important classes of medications utilized in the clinical management of Crohn's disease and ulcerative colitis. A significant proportion of patients loses response to these agents or develops adverse effects during the course of the treatment. Monitoring of drug levels and anti-drug antibodies (for TNF-α inhibitors) and metabolite levels (for thiopurines) can provide valuable insight into the possible etiology of unfavorable outcomes and allow for an appropriate management strategy for these patients. This review summarizes the current knowledge on the clinical implications of therapeutic drug monitoring in inflammatory bowel disease patients treated with TNF-α inhibitors and thiopurines.

22 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.

23 Review Inflammatory bowel disease: clinical aspects and treatments. 2014

Fakhoury, Marc / Negrulj, Rebecca / Mooranian, Armin / Al-Salami, Hani. ·Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical engineering and Artificial Cells and Organs Research Center, Faculty of Medicine, McGill University, Montreal, QC, Canada. · Biotechnology and Drug Development Research Laboratory, Curtin Health Innovation Research Institute, Biosciences Research Precinct, School of Pharmacy, Curtin University, Perth, WA, Australia. ·J Inflamm Res · Pubmed #25075198.

ABSTRACT: Inflammatory bowel disease (IBD) is defined as a chronic intestinal inflammation that results from host-microbial interactions in a genetically susceptible individual. IBDs are a group of autoimmune diseases that are characterized by inflammation of both the small and large intestine, in which elements of the digestive system are attacked by the body's own immune system. This inflammatory condition encompasses two major forms, known as Crohn's disease and ulcerative colitis. Patients affected by these diseases experience abdominal symptoms, including diarrhea, abdominal pain, bloody stools, and vomiting. Moreover, defects in intestinal epithelial barrier function have been observed in a number of patients affected by IBD. In this review, we first describe the types and symptoms of IBD and investigate the role that the epithelial barrier plays in the pathophysiology of IBD as well as the major cytokines involved. We then discuss steps used to diagnose this disease and the treatment options available, and finally provide an overview of the recent research that aims to develop new therapies for such chronic disorders.

24 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.

25 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.

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