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Crohn Disease: HELP
Articles from Wales
Based on 20 articles published since 2008
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These are the 20 published articles about Crohn Disease that originated from Wales during 2008-2019.
 
+ Citations + Abstracts
1 Editorial Editorial: preventing disease progression in Crohn's--can we shut the stable door before the horse bolts? 2015

Hawthrone, A B. ·Department of Medicine, University Hospital of Wales, Cardiff, UK. barney.hawthorne@wales.nhs.uk. ·Aliment Pharmacol Ther · Pubmed #26427754.

ABSTRACT: -- No abstract --

2 Review Crohn's disease for the general physician: management. 2017

Barlow, J J / Hawthorne, A B. ·Gastroenterology Specialist Trainee, Department of Gastroenterology, University Hospital of Wales, Cardiff. · Consultant Physician and Gastroenterologist, Department of Gastroenterology, University Hospital of Wales, Cardiff CF14 4XW. ·Br J Hosp Med (Lond) · Pubmed #28165796.

ABSTRACT: Crohn's disease presents to general physicians in a variety of ways. The previous article outlined clinical features and initial investigations, and this article covers management of Crohn's disease, including monitoring and drug toxicity.

3 Review Crohn's disease for the general physician: presentation and investigations. 2017

Barlow, J J / Hawthorne, A B. ·Gastroenterology Specialist Trainee, Department of Gastroenterology, University Hospital of Wales, Cardiff. · Consultant Physician and Gastroenterologist, Department of Gastroenterology, University Hospital of Wales, Cardiff CF14 4XW. ·Br J Hosp Med (Lond) · Pubmed #28165787.

ABSTRACT: Crohn's disease presents to general physicians in a variety of ways. This article outlines the clinical features and initial investigation of suspected Crohn's disease. The accompanying article reviews treatment strategies.

4 Review The gut microbiota and host health: a new clinical frontier. 2016

Marchesi, Julian R / Adams, David H / Fava, Francesca / Hermes, Gerben D A / Hirschfield, Gideon M / Hold, Georgina / Quraishi, Mohammed Nabil / Kinross, James / Smidt, Hauke / Tuohy, Kieran M / Thomas, Linda V / Zoetendal, Erwin G / Hart, Ailsa. ·School of Biosciences, Museum Avenue, Cardiff University, Cardiff, UK Centre for Digestive and Gut Health, Imperial College London, London, UK. · NIHR Biomedical Research Unit, Centre for Liver Research, University of Birmingham, Birmingham, UK. · Nutrition and Nutrigenomics Group, Department of Food Quality and Nutrition, Research and Innovation Centre, Trento, Italy. · Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands. · Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK. · Section of Computational and Systems Medicine, Faculty of Medicine, Imperial College London, London, UK. · Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands. · Yakult UK Limited, Middlesex, UK. · IBD Unit, St Mark's Hospital and Imperial College London, London, UK. ·Gut · Pubmed #26338727.

ABSTRACT: Over the last 10-15 years, our understanding of the composition and functions of the human gut microbiota has increased exponentially. To a large extent, this has been due to new 'omic' technologies that have facilitated large-scale analysis of the genetic and metabolic profile of this microbial community, revealing it to be comparable in influence to a new organ in the body and offering the possibility of a new route for therapeutic intervention. Moreover, it might be more accurate to think of it like an immune system: a collection of cells that work in unison with the host and that can promote health but sometimes initiate disease. This review gives an update on the current knowledge in the area of gut disorders, in particular metabolic syndrome and obesity-related disease, liver disease, IBD and colorectal cancer. The potential of manipulating the gut microbiota in these disorders is assessed, with an examination of the latest and most relevant evidence relating to antibiotics, probiotics, prebiotics, polyphenols and faecal microbiota transplantation.

5 Review Characterizing unmet medical need and the potential role of new biologic treatment options in patients with ulcerative colitis and Crohn's disease: a systematic review and clinician surveys. 2015

Gordon, Jason P / McEwan, Phil C / Maguire, Andy / Sugrue, Daniel M / Puelles, Jorge. ·aHealth Economics and Outcomes Research Ltd, Monmouth bSwansea Centre for Health Economics, Swansea University, Wales cOxon Epidemiology dTakeda Pharmaceuticals, Takeda Development Centre, London, UK eUniversity of Adelaide, Department of Public Health, Adelaide, Australia. ·Eur J Gastroenterol Hepatol · Pubmed #25933126.

ABSTRACT: OBJECTIVES: Comparative outcomes of patients with ulcerative colitis (UC) and Crohn's disease (CD) prescribed a biologic therapy are inconclusive. The aim of this research was to characterize the degree of unmet medical need in patients with UC or CD and to identify the potential role for new therapies. METHODS: A systematic literature review was undertaken of studies reporting outcomes associated with the use of existing biologic therapies in patients with UC or CD, focusing on the nature and rate of treatment failure. To complement the systematic review, contemporaneous data were obtained from a survey of practising gastroenterologists in the UK and France. Data were qualitatively combined in a narrative framework to evaluate the degree of unmet medical need among patients with UC or CD. RESULTS: Studies identified in the systematic review (n = 120) were heterogeneous, particularly with respect to the definitions of treatment failure; estimates of treatment failure were high but uncertain. On the basis of standardized definitions, estimates of treatment failure provided by clinicians (n = 102) were high, and they were higher for second-line treatment failure (primary: ≤ 37%; secondary: ≤ 41%) compared with first-line treatment failure (primary: ≤ 26%; secondary: ≤ 28%). The majority of the systematic review and survey data were reflective of outcomes with infliximab and adalimumab. CONCLUSION: High treatment failure rates associated with existing biologics, identified by the review and clinician surveys, indicate a need for other biologic treatment options to improve the management and outcomes for people with UC and CD. Outcomes associated with existing and new biologic treatments should be investigated in head-to-head randomized trials in the context of their likely uses in clinical practice.

6 Article A multi-centre audit of excess steroid use in 1176 patients with inflammatory bowel disease. 2017

Selinger, C P / Parkes, G C / Bassi, A / Fogden, E / Hayee, B / Limdi, J K / Ludlow, H / McLaughlin, S / Patel, P / Smith, M / Raine, T. ·Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Royal London Hospital, Barts Heath, London, UK. · St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK. · Sandwell and West Birmingham Hospitals, Birmingham, UK. · King's College Hospital NHS Foundation Trust, London, UK. · Pennine Acute Hospitals NHS Trust, Manchester, UK. · Cardiff and Vale University Health Board, Cardiff, UK. · The Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK. · Epsom and St Helier University Hospitals NHS, Epsom, UK. · Brighton and Sussex University Hospitals, Brighton, UK. · Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. ·Aliment Pharmacol Ther · Pubmed #28949018.

ABSTRACT: BACKGROUND: Corticosteroids are central to inducing remission in inflammatory bowel disease (IBD) but are ineffective maintenance agents. AIM: To benchmark steroid usage in British outpatients and assess factors associated with excess exposure. METHODS: We recorded steroid use in unselected IBD outpatients. Cases meeting criteria for steroid dependency or excess were blind peer reviewed to determine whether steroid prescriptions were avoidable. Associations between steroid use and patient/institutional factors were analysed. RESULTS: Of 1176 patients, 30% received steroids in the prior 12 months. 14.9% had steroid dependency or excess, which was more common in moderate/severe ulcerative colitis (UC) than Crohn's disease (CD) (42.6% vs 28.1%; P = .027). Steroid dependency or excess was deemed avoidable in 49.1%. The annual incidence of inappropriate steroid excess was 7.1%. Mixed-effects logistic regression analysis revealed independent predictors of inappropriate steroid excess. The odds ratio (OR, 95%CI) for moderate/severe compared to mild/quiescent disease activity was 4.59 (1.53-20.64) for UC and 4.60 (2.21-12.00) for CD. In CD, lower rates of inappropriate steroid excess were found in centres with an IBD multi-disciplinary team (OR 0.62 [0.46-0.91]), whilst dedicated IBD clinics protected against inappropriate steroid excess in UC (OR 0.64, 95% CI 0.21-0.94). The total number of GI trainees was associated with rates of inappropriate steroid excess. CONCLUSIONS: Steroid dependency or excess occurred in 14.9% of British IBD patients (in 7.1% potentially avoidable). We demonstrated positive effects of service configurations (IBD multi-disciplinary team, dedicated IBD clinics). Routine recording of steroid dependency or excess is feasible and should be considered a quality metric.

7 Article Pleiotropic Effects of Trait-Associated Genetic Variation on DNA Methylation: Utility for Refining GWAS Loci. 2017

Hannon, Eilis / Weedon, Mike / Bray, Nicholas / O'Donovan, Michael / Mill, Jonathan. ·University of Exeter Medical School, Exeter EX2 5DW, UK. · MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff CF24 4HQ, UK. · University of Exeter Medical School, Exeter EX2 5DW, UK. Electronic address: j.mill@exeter.ac.uk. ·Am J Hum Genet · Pubmed #28528868.

ABSTRACT: Most genetic variants identified in genome-wide association studies (GWASs) of complex traits are thought to act by affecting gene regulation rather than directly altering the protein product. As a consequence, the actual genes involved in disease are not necessarily the most proximal to the associated variants. By integrating data from GWAS analyses with those from genetic studies of regulatory variation, it is possible to identify variants pleiotropically associated with both a complex trait and measures of gene regulation. In this study, we used summary-data-based Mendelian randomization (SMR), a method developed to identify variants pleiotropically associated with both complex traits and gene expression, to identify variants associated with complex traits and DNA methylation. We used large DNA methylation quantitative trait locus (mQTL) datasets generated from two different tissues (blood and fetal brain) to prioritize genes for >40 complex traits with robust GWAS data and found considerable overlap with the results of SMR analyses performed with expression QTL (eQTL) data. We identified multiple examples of variable DNA methylation associated with GWAS variants for a range of complex traits, demonstrating the utility of this approach for refining genetic association signals.

8 Article Mercaptopurine versus placebo to prevent recurrence of Crohn's disease after surgical resection (TOPPIC): a multicentre, double-blind, randomised controlled trial. 2016

Mowat, Craig / Arnott, Ian / Cahill, Aiden / Smith, Malcolm / Ahmad, Tariq / Subramanian, Sreedhar / Travis, Simon / Morris, John / Hamlin, John / Dhar, Anjan / Nwokolo, Chuka / Edwards, Cathryn / Creed, Tom / Bloom, Stuart / Yousif, Mohamed / Thomas, Linzi / Campbell, Simon / Lewis, Stephen J / Sebastian, Shaji / Sen, Sandip / Lal, Simon / Hawkey, Chris / Murray, Charles / Cummings, Fraser / Goh, Jason / Lindsay, James O / Arebi, Naila / Potts, Lindsay / McKinley, Aileen J / Thomson, John M / Todd, John A / Collie, Mhairi / Dunlop, Malcolm G / Mowat, Ashley / Gaya, Daniel R / Winter, Jack / Naismith, Graham D / Ennis, Holly / Keerie, Catriona / Lewis, Steff / Prescott, Robin J / Kennedy, Nicholas A / Satsangi, Jack / Anonymous11047. ·Gastrointestinal Unit, Ninewells Hospital, Dundee, UK. · Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. · Gastrointestinal Unit, Glasgow Royal Infirmary, Glasgow, UK. · Gastrointestinal Unit, Aberdeen Royal Infirmary, Aberdeen, UK. · Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK; IBD Pharmacogenetics Unit, University of Exeter, Exeter, UK. · Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK. · Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK. · Department of Gastroenterology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Department of Gastroenterology, Darlington Memorial Hospital, Darlington, UK. · Department of Gastroenterology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK. · Department of Gastroenterology, Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Torbay, Devon, UK. · Department of Gastroenterology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. · Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK. · Department of Gastroenterology, Rotherham NHS Foundation Trust Hospital, Rotherham, UK. · Department of Gastroenterology, Singleton Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK. · Department of Gastroenterology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. · Department of Gastroenterology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK. · Department of Gastroenterology, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK. · Department of Gastroenterology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK. · Department of Gastroenterology, Salford Royal NHS Foundation Trust Hospital, Salford, UK. · Department of Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK. · Department of Gastroenterology, Royal Free London NHS Foundation Trust Hospital, London, UK. · Department of Gastroenterology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Department of Gastroenterology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. · Department of Gastroenterology, Barts Health NHS Trust, Barts and the London School of Medicine, London, UK. · Inflammatory Bowel Disease Unit, St Mark's Hospital, North West London Hospitals NHS Trust, London, UK. · Gastrointestinal Unit, Raigmore Hospital, Inverness, UK. · Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK. · Colorectal Surgery, Western General Hospital, Edinburgh, UK. · Gastrointestinal Unit, Princess Alexandra Hospital, Paisley, UK. · Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK. · Usher Institute, University of Edinburgh, Edinburgh, UK. · Gastrointestinal Unit, Western General Hospital, Edinburgh, UK; IBD Pharmacogenetics Unit, University of Exeter, Exeter, UK. · Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. Electronic address: jack.satsangi@igmm.ed.ac.uk. ·Lancet Gastroenterol Hepatol · Pubmed #28404197.

ABSTRACT: BACKGROUND: Up to 60% of patients with Crohn's disease need intestinal resection within the first 10 years of diagnosis, and postoperative recurrence is common. We investigated whether mercaptopurine can prevent or delay postoperative clinical recurrence of Crohn's disease. METHODS: We did a randomised, placebo-controlled, double-blind trial at 29 UK secondary and tertiary hospitals of patients (aged >16 years in Scotland or >18 years in England and Wales) who had a confirmed diagnosis of Crohn's disease and had undergone intestinal resection. Patients were randomly assigned (1:1) by a computer-generated web-based randomisation system to oral daily mercaptopurine at a dose of 1 mg/kg bodyweight rounded to the nearest 25 mg or placebo; patients with low thiopurine methyltransferase activity received half the normal dose. Patients and their carers and physicians were masked to the treatment allocation. Patients were followed up for 3 years. The primary endpoint was clinical recurrence of Crohn's disease (Crohn's Disease Activity Index >150 plus 100-point increase in score) and the need for anti-inflammatory rescue treatment or primary surgical intervention. Primary and safety analyses were by intention to treat. Subgroup analyses by smoking status, previous thiopurines, previous infliximab or methotrexate, previous surgery, duration of disease, or age at diagnosis were also done. This trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN89489788) and the European Clinical Trials Database (EudraCT number 2006-005800-15). FINDINGS: Between June 6, 2008, and April 23, 2012, 240 patients with Crohn's disease were randomly assigned: 128 to mercaptopurine and 112 to placebo. All patients received at least one dose of study drug, and no randomly assigned patients were excluded from the analysis. 16 (13%) of patients in the mercaptopurine group versus 26 (23%) patients in the placebo group had a clinical recurrence of Crohn's disease and needed anti-inflammatory rescue treatment or primary surgical intervention (adjusted hazard ratio [HR] 0·54, 95% CI 0·27-1·06; p=0·07; unadjusted HR 0·53, 95% CI 0·28-0·99; p=0·046). In a subgroup analysis, three (10%) of 29 smokers in the mercaptopurine group and 12 (46%) of 26 in the placebo group had a clinical recurrence that needed treatment (HR 0·13, 95% CI 0·04-0·46), compared with 13 (13%) of 99 non-smokers in the mercaptopurine group and 14 (16%) of 86 in the placebo group (0·90, 0·42-1·94; p INTERPRETATION: Mercaptopurine is effective in preventing postoperative clinical recurrence of Crohn's disease, but only in patients who are smokers. Thus, in smokers, thiopurine treatment seems to be justified in the postoperative period, although smoking cessation should be strongly encouraged given that smoking increases the risk of recurrence. FUNDING: Medical Research Council.

9 Article Zinc in denture adhesive: a rare cause of copper deficiency in a patient on home parenteral nutrition. 2015

Prasad, Rakesh / Hawthorne, Barney / Durai, Dharmaraj / McDowell, Ian. ·Department of Gastroenterology, Abertawe Bro Morgannwg University Health Board, Swansea, UK. · Department of Gastroenterology, University Hospital of Wales, Cardiff, UK. · Department of Clinical Biochemistry, University Hospital of Wales, Cardiff, UK. ·BMJ Case Rep · Pubmed #26452740.

ABSTRACT: A 65-year-old woman with Crohn's disease, who had been on home parenteral nutrition for many years, presented with perioral paraesthesia and a burning sensation in the mouth. Initial blood tests including serum ferritin, vitamin B12 and folate, were normal apart from mild pancytopaenia. Serum copper was low, in spite of receiving regular copper in her parenteral feeds. The copper in her parenteral feeds was increased initially, but when it did not improve, she was started on weekly intravenous copper infusions. She was using dental adhesive, which had zinc in it, and a possibility that this was causing her copper deficiency was raised. Serum zinc levels were normal, but urinary zinc was very high. The patient was advised to use zinc-free dental adhesive and her copper level returned to normal within a few months with normalisation of her pancytopaenia, and partial resolution of her oral paraesthesia.

10 Article Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial. 2015

de Groof, E Joline / Buskens, Christianne J / Ponsioen, Cyriel Y / Dijkgraaf, Marcel G W / D'Haens, Geert R A M / Srivastava, Nidhi / van Acker, Gijs J D / Jansen, Jeroen M / Gerhards, Michael F / Dijkstra, Gerard / Lange, Johan F M / Witteman, Ben J M / Kruyt, Philip M / Pronk, Apollo / van Tuyl, Sebastiaan A C / Bodelier, Alexander / Crolla, Rogier M P H / West, Rachel L / Vrijland, Wietske W / Consten, Esther C J / Brink, Menno A / Tuynman, Jurriaan B / de Boer, Nanne K H / Breukink, Stephanie O / Pierik, Marieke J / Oldenburg, Bas / van der Meulen, Andrea E / Bonsing, Bert A / Spinelli, Antonino / Danese, Silvio / Sacchi, Matteo / Warusavitarne, Janindra / Hart, Ailsa / Yassin, Nuha A / Kennelly, Rory P / Cullen, Garret J / Winter, Desmond C / Hawthorne, A Barney / Torkington, Jared / Bemelman, Willem A. ·Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands. e.j.degroof@amc.uva.nl. · Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. e.j.degroof@amc.uva.nl. · Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands. c.j.buskens@amc.uva.nl. · Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. c.y.ponsioen@amc.uva.nl. · Clinical Research Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. m.g.dijkgraaf@amc.uva.nl. · Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. g.dhaens@amc.uva.nl. · Department of Gastroenterology and Hepatology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA Den Haag, The Netherlands. n.srivastava@mchaaglanden.nl. · Department of Surgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA Den Haag, The Netherlands. g.van.acker@mchaaglanden.nl. · Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands. j.m.jansen@olvg.nl. · Department of Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands. m.f.gerhards@olvg.nl. · Department of Gastroenterology and Hepatology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. g.dijkstra@int.umcg.nl. · Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. j.lange@umcg.nl. · Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands. WittemanB@zgv.nl. · Department of Surgery, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands. KruytF@zgv.nl. · Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands. APronk@diakhuis.nl. · Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands. bvtuyl@diakhuis.nl. · Department of Gastroenterology and Hepatology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands. abodelier@amphia.nl. · Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands. · Department of Gastroenterology and Hepatology, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands. r.west@sfg.n. · Department of Surgery, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands. w.vrijland@sfg.nl. · Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands. ecj.consten@meandermc.nl. · Department of Gastroenterology and Hepatology, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands. ma.brink@meandermc.nl. · Department of Surgery, VU Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands. j.tuynman@vumc.nl. · Department of Gastroenterology and Hepatology, VU Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands. KHN.deBoer@vumc.nl. · Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. s.breukink@mumc.nl. · Department of Gastroenterology and Hepatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. m.pierik@mumc.nl. · Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. b.oldenburg@umcutrecht.nl. · Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. ae.meulen@lumc.nl. · Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. B.A.Bonsing@lumc.nl. · Department of Surgery, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy. antonino.spinelli@humanitas.it. · Department of Gastroenterology and Hepatology, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy. silvio.danese@humanitas.it. · Department of Surgery, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy. matteo.sacchi@humanitas.it. · Department of Surgery, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK. j.warusavitarne@nhs.net. · Department of Gastroenterology and Hepatology, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, England. ailsa.hart@nhs.net. · Department of Surgery, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK. nuhayassin@nhs.net. · Department of Surgery, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland. rorykennelly@rcsi.ie. · Department of Gastroenterology and Hepatology, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland. g.cullen@st-vincents.ie. · Department of Surgery, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland. des.winter@gmail.com. · Department of Gastroenterology and Hepatology, Spire Cardiff Hospital, Glamorgan House, Croescadarn Rd, Cardiff, South Glamorgan CF23 8XL, UK. Barney.Hawthorne@wales.nhs.uk. · Department of Surgery, Spire Cardiff Hospital, Glamorgan House, Croescadarn Rd, Cardiff, South Glamorgan CF23 8XL, England. Jared.Torkington@wales.nhs.uk. · Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands. w.a.bemelman@amc.uva.nl. ·Trials · Pubmed #26289163.

ABSTRACT: BACKGROUND: Currently there is no guideline for the treatment of patients with Crohn's disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs. METHODS/DESIGN: This is a multicentre, randomized controlled trial. Patients with Crohn's disease who are over 18 years of age, with newly diagnosed or recurrent active high perianal fistulas, with one internal opening and no anti-TNF usage in the past three months will be considered. Patients with proctitis, recto-vaginal fistulas or anal stenosis will be excluded. Prior to randomisation, an MRI and ileocolonoscopy are required. All treatment will start with seton placement and a course of antibiotics. Patients will then be randomised to: (1) chronic seton drainage (with oral 6-mercaptopurine (6MP)) for one year, (2) anti-TNF medication (with 6MP) for one year (seton removal after six weeks) or (3) advancement plasty after eight weeks of seton drainage (under four months anti-TNF and 6MP for one year). The primary outcome parameter is the number of patients needing fistula-related re-intervention(s). Secondary outcomes are the number of patients with closed fistulas (based on an evaluated MRI score) after 18 months, disease activity, quality of life and costs. DISCUSSION: The PISA trial is a multicentre, randomised controlled trial of patients with Crohn's disease and high perianal fistulas. With the comparison of three generally accepted treatment strategies, we will be able to comment on the efficiency of the various treatment strategies, with respect to several long-term outcome parameters. TRIAL REGISTRATION: Nederlands Trial Register identifier: NTR4137 (registered on 23 August 2013).

11 Article Orofacial granulomatosis as a presenting feature of Crohn's disease. 2015

Jennings, Victoria Caroline Elizabeth / Williams, Lisa / Henson, Sophie. ·Department of Gastroenterology, Singleton Hospital, Swansea, UK. ·BMJ Case Rep · Pubmed #25576503.

ABSTRACT: An 11-year-old girl was referred to oral medicine with persistent facial swelling. She was diagnosed with orofacial granulomatosis (OFG) and was treated conservatively for 7 years, with no evidence of systemic illness. Aged 17 she re-presented with a flare up of her OFG, watery diarrhoea and fluctuating febrile episodes. Inflammatory markers were raised and an MR enterogram revealed terminal ileal Crohn's disease. This case highlights that OFG may precede the onset of intestinal Crohn's disease.

12 Article Development of a short questionnaire to assess the quality of life in Crohn's disease and ulcerative colitis. 2015

Alrubaiy, Laith / Cheung, Wai-Yee / Dodds, Phedra / Hutchings, Hayley Anne / Russell, Ian Trevor / Watkins, Alan / Williams, John Gordon. ·Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK l.alrubaiy@swansea.ac.uk. · Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK. ·J Crohns Colitis · Pubmed #25518049.

ABSTRACT: BACKGROUND AND AIMS: Most of the disease-specific quality of life (QoL) measures for inflammatory bowel disease (IBD) are lengthy and time consuming. None have been established for routine use in clinical practice. We designed this study to develop a short QoL measure in IBD. METHODS: A 32-item questionnaire, the Crohn's and ulcerative colitis questionnaire (CUCQ)-32 was developed by reviewing the literature of the previously validated questionnaires and by consultation with patients and experts. Construct validity was carried out using the Short Form 12 and the EuroQol 5 dimensions questionnaires and two disease severity measures (the Simple Clinical Colitis Activity Index and the Harvey-Bradshaw Index). Test-retest analysis was done by asking patients to complete the CUCQ questionnaire twice within a period of two weeks. RESULTS: Data were obtained from 205 patients with IBD who completed the CUCQ-32. Psychometric analysis showed that Cronbach's α was 0.88, item-total correlations were good, and there were no ceiling or flooring effects. Stepwise regression identified eight items that accounted for >95% of the variance in the CUCQ-32. The resulting CUCQ-8 demonstrated good internal consistency (Cronbach's α = 0.84), had good reproducibility (intraclass correlation coefficient = 0.94), was well correlated with the EuroQol 5 dimensions questionnaire (r = 0.58) and the Short Form-12 (r = 0.65 for physical component and r = 0.63 for mental component), and was responsive to change (responsiveness ratio was 0.64, p-value < 0.05). CONCLUSIONS: CUCQ-8 is a short questionnaire that has the potential to be an efficient tool for assessing the QoL of all patients with IBD in clinical practice.

13 Article Crohn's disease in adults and children. 2012

Ludlow, Helen / Brennan, Mary. ·University Hospital Llandough, Cardiff. ·Nurs Times · Pubmed #23350180.

ABSTRACT: -- No abstract --

14 Article Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates. 2010

Ramadas, A V / Gunesh, S / Thomas, G A O / Williams, G T / Hawthorne, A B. ·Department of Gastroenterology, University Hospital of Wales Cardiff, UK. ·Gut · Pubmed #20650924.

ABSTRACT: INTRODUCTION: Benefits of immunosuppressive therapy in Crohn's disease have been demonstrated in controlled trials; however, it is unclear whether these drugs alter the longer-term natural history of this condition. AIMS AND METHODS: To assess changes in disease outcomes in a population-based cohort of patients diagnosed in Cardiff from 1986 to 2003. Case notes from Crohn's disease incidence studies in Cardiff were reviewed retrospectively for disease characteristics and follow-up information on drug therapy, and the need for surgery for Crohn's disease. The study population was divided into three groups by year of diagnosis (Group A=1986-1991, Group B=1992-1997 and Group C=1998-2003). RESULTS: 341 patients were included. Kaplan-Meier (KM) analysis showed increasing use of immunosuppressants over time. At 5 years after diagnosis this was 11% in Group A, 28% in Group B, and 45% in Group C (p=0.001) and the median time to start of thiopurines was 77, 21 and 11 months in Group A, B and C respectively. There was a significant reduction in long-term steroid use at 5 years post diagnosis: 45 (44%), 31 (31%) and 24 (19%) patients in Group A, B and C respectively (p=0.001). KM analysis showed a significant reduction in the cumulative probability of intestinal surgery: At 5 years this was 59% (Group A), 37% (Group B) and 25% (Group C) (p=0.001). In a multivariate Cox analysis, year of diagnosis, disease location, oral corticosteroids within 3 months of diagnosis and early thiopurine use (within the first year of diagnosis) were all independent factors affecting likelihood of intestinal surgery. CONCLUSION: This population-based cohort shows marked changes in rates of surgery, and the reduction is independently associated with year of diagnosis, and associated temporally with increased and earlier thiopurine use.

15 Article Hospitalized prevalence and 5-year mortality for IBD: record linkage study. 2010

Button, Lori A / Roberts, Stephen E / Goldacre, Michael J / Akbari, Ashley / Rodgers, Sarah E / Williams, John G. ·School of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK. ·World J Gastroenterol · Pubmed #20101767.

ABSTRACT: AIM: To establish the hospitalized prevalence of severe Crohn's disease (CD) and ulcerative colitis (UC) in Wales from 1999 to 2007; and to investigate long-term mortality after hospitalization and associations with social deprivation and other socio-demographic factors. METHODS: Record linkage of administrative inpatient and mortality data for 1467 and 1482 people hospitalised as emergencies for > or = 3 d for CD and UC, respectively. The main outcome measures were hospitalized prevalence, mortality rates and standardized mortality ratios for up to 5 years follow-up after hospitalization. RESULTS: Hospitalized prevalence was 50.1 per 100 000 population for CD and 50.6 for UC. The hospitalized prevalence of CD was significantly higher (P < 0.05) in females (57.4) than in males (42.2), and was highest in people aged 16-29 years, but the prevalence of UC was similar in males (51.0) and females (50.1), and increased continuously with age. The hospitalized prevalence of CD was slightly higher in the most deprived areas, but there was no association between social deprivation and hospitalized prevalence of UC. Mortality was 6.8% and 14.6% after 1 and 5 years follow-up for CD, and 9.2% and 20.8% after 1 and 5 years for UC. For both CD and UC, there was little discernible association between mortality and social deprivation, distance from hospital, urban/rural residence and geography. CONCLUSION: CD and UC have distinct demographic profiles. The higher prevalence of hospitalized CD in more deprived areas may reflect higher prevalence and higher hospital dependency.

16 Article Role of labeled white cell scintigraphy with SPECT/CT in Crohn disease. 2009

Rachapalli, Vamsidhar / Goyal, Nimit / Bartley, Lee / Facey, Philip / Rees, John I. ·Division of Nuclear Medicine, Department of Clinical radiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. r_vamsidhar@yahoo.com ·Clin Nucl Med · Pubmed #20139828.

ABSTRACT: -- No abstract --

17 Article Gene ontology analysis of GWA study data sets provides insights into the biology of bipolar disorder. 2009

Holmans, Peter / Green, Elaine K / Pahwa, Jaspreet Singh / Ferreira, Manuel A R / Purcell, Shaun M / Sklar, Pamela / Anonymous5730631 / Owen, Michael J / O'Donovan, Michael C / Craddock, Nick. ·MRC Centre for Neuropsychiatric Genetics and Genomics, Department of Psychological Medicine and Neurology, School of Medicine, Heath Park, CF23 6BQ Cardiff, UK. holmanspa@cardiff.ac.uk ·Am J Hum Genet · Pubmed #19539887.

ABSTRACT: We present a method for testing overrepresentation of biological pathways, indexed by gene-ontology terms, in lists of significant SNPs from genome-wide association studies. This method corrects for linkage disequilibrium between SNPs, variable gene size, and multiple testing of nonindependent pathways. The method was applied to the Wellcome Trust Case-Control Consortium Crohn disease (CD) data set. At a general level, the biological basis of CD is relatively well known for a complex genetic trait, and it thus acted as a test of the method. The method, known as ALIGATOR (Association LIst Go AnnoTatOR), successfully detected biological pathways implicated in CD. The method was also applied to a meta-analysis of bipolar disorder, and it implicated the modulation of transcription and cellular activity, including that which occurs via hormonal action, as an important player in pathogenesis.

18 Article The surgical management of fistula-in-ano in a specialist colorectal unit. 2008

Davies, M / Harris, D / Lohana, P / Chandra Sekaran, T V / Morgan, A R / Beynon, J / Carr, N D. ·Department of Colorectal Surgery, Singleton Hospital, Sketty, Swansea, SA2 8QA, Wales, UK. markdavies999@hotmail.com ·Int J Colorectal Dis · Pubmed #18427814.

ABSTRACT: INTRODUCTION: Fistula-in-ano can be associated with a number of conditions, including Crohn's disease. The majority, however, are classified as idiopathic or cryptoglandular. The aim of this study was to review the outcome of surgical management of fistula-in-ano in a specialist colorectal unit. MATERIALS AND METHODS: One hundred and four consecutive patients underwent surgery for anal fistulae between 1st January 2000 and December 2004. Data was analysed in two main groups, according to the aetiology, cryptoglandular (n = 86) and Crohn's disease (n = 18). Follow-up data was available on 91 patients. RESULTS: In the cryptoglandular group, 62 patients had an inter-sphincteric tract, of which 48 underwent a single-stage fistulotomy. Of those patients with a trans-sphincteric tract, six patients underwent a single-stage fistulotomy, 13 had a seton and staged fistulotomy. Follow-up data revealed that two fistulae recurred. The median number of procedures in this group was 1 (range 1-3). There was a significant difference in the inpatient stay depending of Park's classification (p = 0.001). In the Crohn's group, three patients with an inter-sphincteric tract underwent a single-stage fistulotomy, two patients with a trans-sphincteric tract had single-stage fistulotomy, and five required a loose seton and staged fistulotomy. Eight patients had multiple fistulae which required long-term setons. Four patients from this group eventually required proctectomy. In the Crohn's group, there was a significantly increased complexity of surgery and higher recurrence. This was reflected in an increased inpatient length of stay and a greater reliance on imaging (p = 0.001). The median number of procedures in this group was 3 (range 1-5). DISCUSSION: The majority of cryptoglandular fistula-in-ano were treated by primary fistulotomy or staged fistulotomy with a loose seton. This was associated with a low recurrence rate and low rates of faecal incontinence. There was a low reliance on imaging techniques in this group. However, we would urge caution when dealing with fistula-in-ano related to Crohn's disease. In this group of patients, the fistulae tended to be more complex and require additional imaging and multiple procedures.

19 Article Current practice in management of Crohn's disease in Wales. 2008

Dhruva, P K Rao / Price, P E / Torkington, J. ·Department of Colorectal Surgery, Cardiff and Vale NHS Trust, Cardiff. ·Surgeon · Pubmed #18318085.

ABSTRACT: METHODS: Consultant gastroenterologists and colorectal surgeons treating CD in Wales were sent a questionnaire aimed at determining their current practice and their responses were analysed. RESULTS: Eighty-eight consultants--46 (52%) gastroenterologists and 42 (48%) surgeons-- were invited to participate in the survey. Sixty-one (69%) of them responded. Coherent practice was seen across Wales, especially with respect to diagnosis of CD in line with British Society of Gastroenterology guidelines. Variation was detected in disease severity assessment and some aspects of management. CONCLUSION: Practice in Wales is in line with the guidelines for managing CD. While the diagnostic process follows a standard approach, variations exist in treatment and monitoring of disease. Validated disease measurement instruments are seldom used in routine practice. Disease assessment tools need to be simpler to use if they are to help objective measurement of disease activity and treatment decisions.

20 Minor Early use of azathioprine in Crohn's disease. 2014

Hawthorne, A B / Probert, C S J / Sanderson, J D. ·Department of Medicine, University Hospital of Wales, Cardiff, UK. ·Gastroenterology · Pubmed #24468182.

ABSTRACT: -- No abstract --