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Crohn Disease: HELP
Articles from Maryland
Based on 270 articles published since 2009
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These are the 270 published articles about Crohn Disease that originated from Maryland during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11
1 Guideline Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. 2015

Pennazio, Marco / Spada, Cristiano / Eliakim, Rami / Keuchel, Martin / May, Andrea / Mulder, Chris J / Rondonotti, Emanuele / Adler, Samuel N / Albert, Joerg / Baltes, Peter / Barbaro, Federico / Cellier, Christophe / Charton, Jean Pierre / Delvaux, Michel / Despott, Edward J / Domagk, Dirk / Klein, Amir / McAlindon, Mark / Rosa, Bruno / Rowse, Georgina / Sanders, David S / Saurin, Jean Christophe / Sidhu, Reena / Dumonceau, Jean-Marc / Hassan, Cesare / Gralnek, Ian M. ·Division of Gastroenterology, San Giovanni Battista University Teaching Hospital, Turin, Italy. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University Tel-Hashomer, Israel. · Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany. · Department of Medicine II, Sana Klinikum, Offenbach, Germany. · Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands. · Gastroenterology Unit, Ospedale Valduce, Como, Italy. · Division of Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel. · Department of Medicine I, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany. · Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'Hépato-gastro-entérologie, Paris, France. · Medizinische Klinik, Evangelisches Krankenhaus, Düsseldorf, Germany. · Department of Hepato-Gastroenterology, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France. · Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London, London, UK. · Department of Medicine B, University of Münster, Münster, Germany. · Institute of Gastroenterology and Liver Diseases, Ha'emek Medical Center Afula, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel. · Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. · Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal. · Clinical Psychology Unit, Department of Psychology, University of Sheffield. · Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France. · Gedyt Endoscopy Center, Buenos Aires, Argentina. ·Endoscopy · Pubmed #25826168.

ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence). In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence). 6 In patients with established Crohn's disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn's disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence). In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence). When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence). 7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence).

2 Guideline Guidelines for imaging of Crohn's perianal fistulizing disease. 2015

Ong, Eugene M W / Ghazi, Leyla J / Schwartz, David A / Mortelé, Koenraad J / Anonymous470823. ·*Department of Radiology, Division of Clinical MRI, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; †Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland; and ‡Department of Gastroenterology and Hepatology, Vanderbilt University, Nashville, Tennessee. ·Inflamm Bowel Dis · Pubmed #25751067.

ABSTRACT: -- No abstract --

3 Guideline Guidelines for the multidisciplinary management of Crohn's perianal fistulas: summary statement. 2015

Schwartz, David A / Ghazi, Leyla J / Regueiro, Miguel / Fichera, Alessandro / Zoccali, Marco / Ong, Eugene M W / Mortelé, Koenraad J / Anonymous460823. ·*Department of Gastroenterology and Hepatology, Vanderbilt University, Nashville, Tennessee; †Department of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland; ‡University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; §Division of General Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington; ‖Department of Surgery, Weill Medical College of Cornell University, New York, New York; and ¶Division of Clinical MRI, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. ·Inflamm Bowel Dis · Pubmed #25751066.

ABSTRACT: -- No abstract --

4 Editorial Circulating Endothelial Progenitor Cells in Crohn's Disease: An EPiC in the Making? 2017

Dietrich, Catharine / Singh, Shree Ram. ·Stem Cell Regulation and Animal Aging Section, Basic Research Laboratory, National Cancer Institute, NIH, Frederick, MD, 21702, USA. · Stem Cell Regulation and Animal Aging Section, Basic Research Laboratory, National Cancer Institute, NIH, Frederick, MD, 21702, USA. singhshr@mail.nih.gov. ·Dig Dis Sci · Pubmed #28078527.

ABSTRACT: -- No abstract --

5 Editorial Editorial: serologic microbial associated markers to predict Crohn's disease behaviour - authors' reply. 2016

Colombel, J-F / Riddle, M S / Murray, J A. ·Icahn School of Medicine at Mount Sinai, New York, NY, USA. jean-frederic.colombel@mssm.edu. · Naval Medical Research Center, Silver Spring, MD, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. ·Aliment Pharmacol Ther · Pubmed #27375094.

ABSTRACT: -- No abstract --

6 Editorial Shifting Away From Estrogen-Containing Oral Contraceptives in Crohn's Disease. 2016

Long, Millie D / Hutfless, Susan. ·Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: millie_long@med.unc.edu. · Gastrointestinal Epidemiology Research Center, Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. ·Gastroenterology · Pubmed #27138980.

ABSTRACT: -- No abstract --

7 Editorial Editorial: UV exposure and IBD--should more be done to demonstrate an association before trying to find its mechanism? Authors' reply. 2014

Limketkai, B N / Hutfless, S M. ·Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center, Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, CA, USA. berkeley.limketkai@gmail.com. ·Aliment Pharmacol Ther · Pubmed #25123386.

ABSTRACT: -- No abstract --

8 Editorial Radiating disparity in IBD. 2014

Flasar, Mark / Patil, Seema. ·Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 100 North Greene Street, Lower Level, Baltimore, MD, 21201, USA, mflasar@medicine.umaryland.edu. ·Dig Dis Sci · Pubmed #24318801.

ABSTRACT: -- No abstract --

9 Editorial Editorial: Can stenosis in ileal Crohn's disease be prevented by current therapy? 2013

Limketkai, Berkeley N / Bayless, Theodore M. ·Harvey M. and Lyn P. Meyerhoff IBD Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Am J Gastroenterol · Pubmed #24192948.

ABSTRACT: Diagnostic delay is common with Crohn's disease (CD), especially with ileitis. Recent data show that diagnostic delay is associated with an increased risk of bowel stenosis and intestinal surgery. It is nonetheless unclear whether early diagnosis and treatment can truly prevent CD stenosis. Available cohort studies suggest that CD stricture formation occurs over a fixed time course. Current therapies have also not been shown to reduce the risk of ileal stenosis or rates of surgery, and there are no available therapies to reverse existing fibrosis. Development of medications that target fibrosis is an important area of research.

10 Review Performance measures for small-bowel endoscopy: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. 2019

Spada, Cristiano / McNamara, Deirdre / Despott, Edward J / Adler, Samuel / Cash, Brooks D / Fernández-Urién, Ignacio / Ivekovic, Hrvoje / Keuchel, Martin / McAlindon, Mark / Saurin, Jean-Christophe / Panter, Simon / Bellisario, Cristina / Minozzi, Silvia / Senore, Carlo / Bennett, Cathy / Bretthauer, Michael / Dinis-Ribeiro, Mario / Domagk, Dirk / Hassan, Cesare / Kaminski, Michal F / Rees, Colin J / Valori, Roland / Bisschops, Raf / Rutter, Matthew D. ·Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy. · Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy. · TAGG Research Centre, Department of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Ireland. · Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK. · Division of Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel. · Department of Gastroenterology, Hepatology, and Nutrition, UT Health Science Center at Houston/Memorial Hermann, Houston, TX, USA. · McGovern Medical School, Department of Internal Medicine, Houston, TX, USA. · Department of Gastroenterology, Navarra Hospital Complex, Pamplona, Spain. · Department of Gastroenterology and Hepatology, University Hospital Centre, Zagreb, Croatia. · Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany. · Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. · Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France. · Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK. · CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy. · Office of Research and Innovation, Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland. · Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway. · Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal. · Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany. · Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. · Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland. · Department of Gastroenterological Oncology and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland. · Department of Health Management and Health Economics, University of Oslo, Oslo, Norway. · Northern Institute for Cancer Research, Newcastle University, Newcastle, UK. · Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK. · Department of Gastroenterology and Hepatology. University Hospital Leuven, Leuven, Belgium. · Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK. ·United European Gastroenterol J · Pubmed #31210941.

ABSTRACT: The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, for which performance measures had already been identified, this is the first time small-bowel endoscopy quality measures have been proposed.

11 Review Expert opinion on interleukin-12/23 and interleukin-23 antagonists as potential therapeutic options for the treatment of inflammatory bowel disease. 2019

Wong, Uni / Cross, Raymond K. ·a Department of Medicine, Division of Gastroenterology and Hepatology , University of Maryland School of Medicine , Baltimore , MD , USA. · b Veterans Affairs , Maryland Healthcare System , Baltimore , MD , USA. ·Expert Opin Investig Drugs · Pubmed #30884245.

ABSTRACT: INTRODUCTION: Blockade of interleukin (IL)-12 and IL-23 is a novel therapeutic target for inflammatory bowel disease (IBD). The monoclonal antibody targeting the shared p40 subunit of IL-12 and IL23, namely ustekinumab, has been approved for Crohn's disease (CD) and has demonstrated promising results in the treatment of ulcerative colitis. Several agents targeting the IL-23-specific p19 subunit are currently in various stages of development. These newer agents have the potential to provide safety benefits. AREAS COVERED: This review discusses the current state of IL-12/23 and IL-23 antagonists for the treatment of IBD. With multiple biologic classes available, we make recommendations for positioning of these agents in clinical practice. EXPERT OPINION: While tumor necrosis factor (TNF) antagonists remain the biologic of choice for majority of patients with moderate-to-severe IBD, IL-12/23, and IL-23 antagonists should be considered for first- or second-line therapy because of their efficacy in biologic-naïve and experienced patients. Additionally, IL-12/23 and IL-23 antagonists may be preferred over anti-TNF therapy in older patients who are at increased risk for infections and malignancy. The safety compared to anti-TNF may be even greater when one considers that concurrent immunosuppression is probably not necessary when using this class of drug, owing to the low rates of immunogenicity.

12 Review Adverse events in IBD therapy: the 2018 update. 2018

Quezada, Sandra M / McLean, Leon P / Cross, Raymond K. ·a Department of Medicine, Division of Gastroenterology and Hepatology , University of Maryland School of Medicine , Baltimore , MD , USA. · b Department of Medicine , Geisel School of Medicine at Dartmouth , Hanover , NH , USA. · c Granite State Gastrointestinal Consultants , Derry , NH , USA. ·Expert Rev Gastroenterol Hepatol · Pubmed #30791788.

ABSTRACT: INTRODUCTION: Crohn's disease and ulcerative colitis affect an increasing number of patients, and utilization of immune suppressant and biologic therapies is also increasing. These agents are linked to adverse events ranging from mild nuisance symptoms to potentially life-threatening complications including infections and malignancies. Areas covered: This review provides an updated discussion on adverse events associated with immunomodulator, anti-TNF-α, anti-integrin, and anti-IL 12/IL-23 antibody therapies. In addition, we review the risk profile of the currently widely available infliximab biosimilar medication. Expert commentary: Providers should engage in risk-benefit discussion with information specific to each medication discussed, and consider individualized risk factors when selecting therapeutic agents. Drug monitoring and shared decision-making results in more personalized medical management of inflammatory bowel disease.

13 Review A multidisciplinary approach to diagnosis and management of bowel obstruction. 2018

Sarani, Babak / Paspulati, Raj Mohan / Hambley, Jana / Efron, David / Martinez, Jose / Perez, Armando / Bowles-Cintron, Robert / Yi, Fia / Hill, Susanna / Meyer, David / Maykel, Justin / Attalla, Sara / Kochman, Michael / Steele, Scott. ·Center for Trauma and Critical Care, George Washington University School of Medicine, Washington, DC. Electronic address: bsarani@mfa.gwu.edu. · University Hospitals, Case Western Reserve University, Cleveland, OH. · Department of Trauma and Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. · Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. · Division of Minimally Invasive Surgery, Minimally Invasive Surgery/Flexible Endoscopy Fellowship Program, University of Miami Miller School of Medicine, Miami, FL. · University of Miami Miller School of Medicine, Miami, FL. · Brooke Army Medical Center, San Antonio, TX. · University of Massachusetts Medical Center, Worcester, MA. · Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA. · Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. · Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. · Cleveland Clinic, Cleveland, OH. ·Curr Probl Surg · Pubmed #30526888.

ABSTRACT: -- No abstract --

14 Review The Role of NLRP3 and IL-1β in the Pathogenesis of Inflammatory Bowel Disease. 2018

Mao, Liming / Kitani, Atsushi / Strober, Warren / Fuss, Ivan J. ·Mucosal Immunity Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States. ·Front Immunol · Pubmed #30455704.

ABSTRACT: It is logical to assume that a major pro-inflammatory mechanism, i.e., the NLRP3 inflammasome would play a prominent role in the pathogenesis of the Inflammatory Bowel Disease (IBD) in humans. However, while both studies of murine models of gut disease and patients provide data that the main cytokine product generated by this inflammasome, IL-1β, does in fact contribute to inflammation in IBD, there is no evidence that IL-1β plays a decisive or prominent role in "ordinary" patients with IBD (Crohn's disease). On the other hand, there are several definable point mutations that result in over-active NLRP3 inflammasome activity and in these cases, the gut inflammation is driven by IL-1β and is treatable by biologic agents that block the effects of this cytokine.

15 Review Using genes to triangulate the pathophysiology of granulomatous autoinflammatory disease: NOD2, PLCG2 and LACC1. 2018

Szymanski, Ann Marie / Ombrello, Michael J. ·Translational Genetics and Genomics Unit, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA. ·Int Immunol · Pubmed #29538758.

ABSTRACT: The intersection of granulomatosis and autoinflammatory disease is a rare occurrence that can be generally subdivided into purely granulomatous phenotypes and disease spectra that are inclusive of granulomatous features. NOD2 (nucleotide-binding oligomerization domain-containing protein 2)-related disease, which includes Blau syndrome and early-onset sarcoidosis, is the prototypic example of granulomatous inflammation in the context of monogenic autoinflammation. Granulomatous inflammation has also been observed in two related autoinflammatory diseases caused by mutations in PLCG2 (phospholipase Cγ2). More recently, mutations in LACC1 (laccase domain-containing protein 1) have been identified as the cause of a monogenic form of systemic juvenile idiopathic arthritis, which does not itself manifest granulomatous inflammation, but the same LACC1 mutations have also been shown to cause an early-onset, familial form of a well-known granulomatous condition, Crohn's disease (CD). Rare genetic variants of PLCG2 have also been shown to cause a monogenic form of CD, and moreover common variants of all three of these genes have been implicated in polygenic forms of CD. Additionally, common variants of NOD2 and LACC1 have been implicated in susceptibility to leprosy, a granulomatous infection. Although no specific mechanistic link exists between these three genes, they form an intriguing web of susceptibility to both monogenic and polygenic autoinflammatory and granulomatous phenotypes.

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

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

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

17 Review Optimization of biologic therapy in Crohn's disease. 2018

Razvi, Mohammed / Lazarev, Mark. ·a Division of Gastroenterology and Hepatology, Department of Medicine , Johns Hopkins Hospital , Baltimore , MD , USA. ·Expert Opin Biol Ther · Pubmed #29191059.

ABSTRACT: INTRODUCTION: Crohn's disease (CD) is a manifestation of inflammatory bowel disease (IBD), which can result in significant morbidity. Biologic therapy with anti-TNF medication has been effective in treating inflammation and reducing complications in CD. It is important for clinicians to have better knowledge of the various biologic therapies including mechanisms of action and optimization strategies. AREAS COVERED: The review describes optimization of biologic therapy in CD including different mechanisms of loss of response, therapeutic drug monitoring in CD, clinical implications and management strategies which utilize drug monitoring, and areas of future development and research in optimization of biologic therapy. EXPERT OPINION: Achieving adequate levels of the drug (antibody unbound) is one of the most important determinants of attaining clinical remission and mucosal healing. Drug level is also critical in determining if a patient requires combination therapy with an immunomodulator. Certain populations, including those with active perianal disease, may require higher serum levels to achieve healing or closure. Treat to target level is an algorithm that is not universally accepted and more data is need. Additionally, there are numerous assays that don't always correlate, especially regarding measuring anti-drug antibodies.

18 Review Surgical care of the pediatric Crohn's disease patient. 2017

Stewart, Dylan. ·Department of Surgery, Johns Hopkins School of Medicine, Johns Hopkins Children's Center, 1800 Orleans St, Bloomberg Suite 7335, Baltimore, MD 21287. Electronic address: dstewart@jhmi.edu. ·Semin Pediatr Surg · Pubmed #29126506.

ABSTRACT: Despite the significant advances in the medical management of inflammatory bowel disease over the last decade, surgery continues to play a major role in the management of pediatric Crohn's disease (CD). While adult and pediatric Crohn's disease may share many clinical characteristics, pediatric Crohn's patients often have a more aggressive phenotype, and the operative care given by the pediatric surgeon to the newly diagnosed Crohn's patient is very different in nature to the surgical needs of adult patients after decades of disease progression. Children also have the unique surgical indication of growth failure to consider in the overall clinical decision making. While surgery is never curative in CD, it has the ability to transform the disease process in children, and appropriately timed operations may have tremendous impact on a child's physical and mental maturation. This monograph aims to address the surgical care of Crohn's disease in general, with a specific emphasis on the surgical treatment of small intestinal and ileocecal involvement.

19 Review Medical versus surgical management of penetrating Crohn's disease: the current situation and future perspectives. 2017

Patil, Seema A / Cross, Raymond K. ·a University of Maryland School of Medicine , Department of Medicine, Division of Gastroenterology and Hepatology , Baltimore , United States. ·Expert Rev Gastroenterol Hepatol · Pubmed #28633544.

ABSTRACT: INTRODUCTION: The development of penetrating Crohn's disease (CD) occurs in up to 50% of patients over the course of their lifetime. While the presentation of these complications, including free perforation, intra-abdominal abscess, and enteric fistula, are usually obvious, the management can require a nuanced approach, with distinct short and long-term approaches. Areas covered: This review discusses medical and surgical methods of treating these complications, including the role of percutaneous drainage of abscesses, the implications of a stricture associated with a fistula, and the efficacy of postoperative anti-TNF therapy in preventing recurrence after surgical treatment. Expert commentary: An approach to the management of these complications that begins with control of sepsis, including broad-spectrum antibiotics, bowel rest, and nutritional support is proposed. The next appropriate step is a diagnostic evaluation to determine the utility of medical versus surgical therapy, considering the presence of a stricture and prior immunosuppressive therapy. Postoperative anti-TNF therapy, a highly effective method to prevent recurrence, should be considered in many cases.

20 Review White Paper AGA: The Impact of Mental and Psychosocial Factors on the Care of Patients With Inflammatory Bowel Disease. 2017

Szigethy, Eva M / Allen, John I / Reiss, Marci / Cohen, Wendy / Perera, Lilani P / Brillstein, Lili / Cross, Raymond K / Schwartz, David A / Kosinski, Lawrence R / Colton, Joshua B / LaRusso, Elizabeth / Atreja, Ashish / Regueiro, Miguel D. ·University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan. Electronic address: allenji@med.umich.edu. · University of Southern California, San Diego, California. · American Gastroenterological Association, Bethesda, Maryland. · Aurora Healthcare, Grafton, Wisconsin. · Episodes of Care, Market Innovations, Horizon Blue Cross Blue Shield of New Jersey, Newark, New Jersey. · University of Maryland School of Medicine, Baltimore, Maryland. · Vanderbilt University Medical Center, Nashville, Tennessee. · Illinois Gastroenterology, Chicago, Illinois. · Minnesota Gastroenterology PA, Minneapolis, Minnesota. · Department of Psychiatry, Allina Health, Minneapolis, Minnesota. · Icahn School of Medicine at Mount Sinai, New York City, New York. ·Clin Gastroenterol Hepatol · Pubmed #28300693.

ABSTRACT: Patients with chronic medically complex disorders like inflammatory bowel diseases (BD) often have mental health and psychosocial comorbid conditions. There is growing recognition that factors other than disease pathophysiology impact patients' health and wellbeing. Provision of care that encompasses medical care plus psychosocial, environmental and behavioral interventions to improve health has been termed "whole person care" and may result in achieving highest health value. There now are multiple methods to survey patients and stratify their psychosocial, mental health and environmental risk. Such survey methods are applicable to all types of IBD programs including those at academic medical centers, independent health systems and those based within independent community practice. Once a practice determines that a patient has psychosocial needs, a variety of resources are available for referral or co-management as outlined in this paper. Included in this white paper are examples of psychosocial care that is integrated into IBD practices plus innovative methods that provide remote patient management.

21 Review Psoriasis and comorbid diseases: Implications for management. 2017

Takeshita, Junko / Grewal, Sungat / Langan, Sinéad M / Mehta, Nehal N / Ogdie, Alexis / Van Voorhees, Abby S / Gelfand, Joel M. ·Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: Junko.Takeshita@uphs.upenn.edu. · Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, United Kingdom. · National Heart, Lung and Blood Institute, Bethesda, Maryland. · Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia. · Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. ·J Am Acad Dermatol · Pubmed #28212760.

ABSTRACT: As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article.

22 Review Psoriasis and comorbid diseases: Epidemiology. 2017

Takeshita, Junko / Grewal, Sungat / Langan, Sinéad M / Mehta, Nehal N / Ogdie, Alexis / Van Voorhees, Abby S / Gelfand, Joel M. ·Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: Junko.Takeshita@uphs.upenn.edu. · Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, United Kingdom. · National Heart, Lung and Blood Institute, Bethesda, Maryland. · Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia. · Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. ·J Am Acad Dermatol · Pubmed #28212759.

ABSTRACT: Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis.

23 Review Genital and reproductive organ complications of Crohn disease: technical considerations as it relates to perianal disease, imaging features, and implications on management. 2017

Kammann, Steven / Menias, Christine / Hara, Amy / Moshiri, Mariam / Siegel, Cary / Safar, Bashar / Brandes, Steven / Shaaban, Akram / Sandrasegaran, Kumar. ·Department of Radiology, Dartmouth-Hitchcock Medical Center, 100 Hitchcock Way, Manchester, NH, 03104, USA. Steven.e.Kammann@hitchcock.org. · Department of Radiology, Mayo Clinic-Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA. · Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St., Seattle, WA, 98195, USA. · Mallinkrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA. · Department of Surgery, John Hopkins School of Medicine, 600 N. Wolfe Street, Sheikh Zayed Tower, Baltimore, MD, 21287, USA. · Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue, 11thFloor, New York, NY, 10032, USA. · Department of Radiology, University Hospital Radiology, University of Utah, 50 N Medical Dr., Salt Lake City, UT, 84132, USA. · Department of Radiology, Indiana University, 550 N. University Blvd. Rm 0663, Indianapolis, IN, 46202, USA. ·Abdom Radiol (NY) · Pubmed #28194515.

ABSTRACT: OBJECTIVE: A relatively large proportion of patients with Crohn disease (CD) develop complications including abscess formation, stricture, and penetrating disease. A subset of patients will have genital and reproductive organ involvement of CD, resulting in significant morbidity. These special circumstances create unique management challenges that must be tailored to the activity, location, and extent of disease. Familiarity with the epidemiology, pathogenesis, imaging features, and treatment strategies for patients with genital CD can aid imaging diagnoses and guide appropriate patient management. The purpose of this study is to illustrate the spectrum of CD in the genital tract and reproductive organs and discuss the complex management strategies in these patients as it relates to imaging. CONCLUSION: Given the impact on patient outcome and treatment planning, familiarity with the epidemiology, pathogenesis, imaging features, and treatment of patients with genital Crohn disease can aid radiologic diagnoses and guide appropriate patient management.

24 Review Central Endoscopy Reading in Inflammatory Bowel Diseases. 2016

Panés, Julián / Feagan, Brian G / Hussain, Fez / Levesque, Barrett G / Travis, Simon P. ·Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain jpanes@clinic.cat. · Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada. · Quintiles Immunology and Internal Medicine, Medical Strategy & Science, Rockville, MD, USA. · Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA. · Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK. ·J Crohns Colitis · Pubmed #27604978.

ABSTRACT: Endoscopic assessment of the presence and severity of endoscopic lesions has become an essential part of clinical trials in ulcerative colitis and Crohn's disease, for both patient eligibility and outcome measures. Variability in lesion interpretation between and within observers and the potential bias of local investigators in patient assessment have long been recognized. This variability can be reduced, although not completely removed, by independent evaluation of the examinations by experienced off-site (central) readers, properly trained in regard to lesion definition and identification, that should be removed from direct patient contact and blinded to any other clinical or study data. Adding endoscopic demonstration of active disease to eligibility criteria has the potential to reduce placebo response rates, whereas in outcome assessment it has the potential to provide a more precise estimation of the treatment effect, increasing the efficiency of the study. Central endoscopy reading is still at the beginning of its development, and the paradigms of central reading need refinement in terms of the number of readers, the process by which a final score is assigned, the selection and sequence of central readers, and the endoscopic indices of choice.

25 Review Racial and Ethnic Minorities with Inflammatory Bowel Disease in the United States: A Systematic Review of Disease Characteristics and Differences. 2016

Afzali, Anita / Cross, Raymond K. ·*Department of Medicine, Division of Gastroenterology, Harborview Medical Center, University of Washington, Seattle, Washington; University of Washington Inflammatory Bowel Disease Program; and†Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland; University of Maryland Inflammatory Bowel Disease Program. ·Inflamm Bowel Dis · Pubmed #27379446.

ABSTRACT: BACKGROUND: Inflammatory bowel disease (IBD) has predominantly affected whites, particularly Ashkenazi Jews. Over the last 2 decades, IBD has "emerged" in minorities. Differences in natural history and disease characteristics have been suggested. The objective of this systematic review is to summarize these differences in studies from the United States. METHODS: A structured search was performed within the Medline database through PubMed, EMBASE, and Cochrane databases. Published studies of genetics, pathogenesis, prevalence or incidence, disease location and behavior, extraintestinal manifestations, disparities and access to care in patients with IBD who are of African American, Asian, and Hispanic descent living in the United States were eligible. RESULTS: A total of 47 studies were included for African Americans (n = 20,054), Hispanics (n = 10,762), and Asians (n = 2668). The incidence and prevalence of IBD is increasing among minorities. There is less of a genetic influence in the pathogenesis of IBD among African Americans; however, novel variants have been identified. There is a predilection for pancolonic ulcerative colitis among Hispanics and Asians. Crohn's disease-related hospitalizations are increasing in Asians, whereas African Americans are more likely to use the emergency department. No major differences are seen in disease location and behavior, upper gastrointestinal tract, and perianal involvement and extraintestinal manifestations among races and ethnic groups. Medication utilization seems to be similar. Differences in surgery are likely explained by health insurance status. CONCLUSIONS: Future prospective studies are needed to fully characterize disease characteristics and treatment response among minorities. With novel IBD therapies in the pipeline, enrollment in clinical trials should emphasize increased representation of all races and ethnic groups.

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