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Crohn Disease: HELP
Articles from Hamilton
Based on 81 articles published since 2010
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These are the 81 published articles about Crohn Disease that originated from Hamilton during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn's Disease. 2019

Mack, David R / Benchimol, Eric I / Critch, Jeff / deBruyn, Jennifer / Tse, Frances / Moayyedi, Paul / Church, Peter / Deslandres, Colette / El-Matary, Wael / Huynh, Hien / Jantchou, Prévost / Lawrence, Sally / Otley, Anthony / Sherlock, Mary / Walters, Thomas / Kappelman, Michael D / Sadowski, Dan / Marshall, John K / Griffiths, Anne. ·Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada. · Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Section of Pediatric Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. · Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; IBD Centre, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire, Sainte-Justine, Montréal, Quebec, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Section of Pediatric Gastroenterology, Department of Pediatrics, Health Sciences Centre, Winnipeg, Manitoba, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Department of Pediatrics (Gastroenterology), Stollery Children's Hospital, Edmonton, Alberta, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Division of Gastroenterology and Nutrition, IWK Health Centre, Halifax, Nova Scotia, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; Division of Pediatric Gastroenterology, McMaster University, Hamilton, Ontario, Canada. · Division of Pediatric Gastroenterology, University of North Carolina, Hospital-Children's Specialty Clinic, Chapel Hill, North Carolina. · Division of Gastroenterology, Royal Alexandra Hospital, Edmonton, Alberta, Canada. · Ch.I.L.D. Foundation Canadian Children IBD Network, Vancouver, British Columbia, Canada; IBD Centre, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: anne.griffiths@sickkids.ca. ·Gastroenterology · Pubmed #31320109.

ABSTRACT: BACKGROUND & AIMS: We aim to provide guidance for medical treatment of luminal Crohn's disease in children. METHODS: We performed a systematic search of publication databases to identify studies of medical management of pediatric Crohn's disease. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. We developed statements through an iterative online platform and then finalized and voted on them. RESULTS: The consensus includes 25 statements focused on medical treatment options. Consensus was not reached, and no recommendations were made, for 14 additional statements, largely due to lack of evidence. The group suggested corticosteroid therapies (including budesonide for mild to moderate disease). The group suggested exclusive enteral nutrition for induction therapy and biologic tumor necrosis factor antagonists for induction and maintenance therapy at diagnosis or at early stages of severe disease, and for patients failed by steroid and immunosuppressant induction therapies. The group recommended against the use of oral 5-aminosalicylate for induction or maintenance therapy in patients with moderate disease, and recommended against thiopurines for induction therapy, corticosteroids for maintenance therapy, and cannabis in any role. The group was unable to clearly define the role of concomitant immunosuppressants during initiation therapy with a biologic agent, although thiopurine combinations are not recommended for male patients. No consensus was reached on the role of aminosalicylates in treatment of patients with mild disease, antibiotics or vedolizumab for induction or maintenance therapy, or methotrexate for induction therapy. Patients in clinical remission who are receiving immunomodulators should be assessed for mucosal healing within 1 year of treatment initiation. CONCLUSIONS: Evidence-based medical treatment of Crohn's disease in children is recommended, with thorough ongoing assessments to define treatment success.

2 Guideline Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn's Disease or Ulcerative Colitis. 2018

Kemp, Karen / Dibley, Lesley / Chauhan, Usha / Greveson, Kay / Jäghult, Susanna / Ashton, Katherine / Buckton, Stephanie / Duncan, Julie / Hartmann, Petra / Ipenburg, Nienke / Moortgat, Liesbeth / Theeuwen, Rosaline / Verwey, Marthe / Younge, Lisa / Sturm, Andreas / Bager, Palle. ·Department of Gastroenterology, Manchester NHS University Foundation Trust / School of Nursing, Midwifery and Social Work, University of ManchesterManchester, UK. · Faculty of Education and Health, University of Greenwich, London. · Barts Health NHS Trust, London, UK. · Digestive Disease, McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Canada. · Department of Gastroenterology, Royal Free Hospital, London, UK. · Karolinska Institutet Danderyd Hospital, Stockholm Gastro Centre, Stockholm, Sweden. · Department of Gastroenterology, Hull & East Yorkshire Hospitals NHS Trust, Hull, UK. · Department of Gastroenterology, Sunshine Coast University Hospital, Birtinya QLD, Australia. · Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK. · Gastroenterologische Gemeinschaftspraxis Minden, Minden, Germany. · IJsselland Hospital, Capelle a/d IJssel, The Netherlands. · Department of Gastroenterology, AZ Delta Roeselare-Menen, Roeselare, Belgium. · Department of Gastroenterology, Leiden University Medical Center [LUMC], Leiden, The Netherlands. · IBD Nurse Specialist, Barts Health - Royal London Hospital, London, UK. · Department of Gastroenterology, German Red Cross Hospital, DRK Kliniken Berlin I Westend, Berlin, Germany. · Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark. ·J Crohns Colitis · Pubmed #29509882.

ABSTRACT: -- No abstract --

3 Guideline The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. 2016

Nguyen, Geoffrey C / Seow, Cynthia H / Maxwell, Cynthia / Huang, Vivian / Leung, Yvette / Jones, Jennifer / Leontiadis, Grigorios I / Tse, Frances / Mahadevan, Uma / van der Woude, C Janneke / Anonymous5510852 / Anonymous5520852. ·Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: geoff.nguyen@utoronto.ca. · Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. · Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. · Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. · Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada. · Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, University of California, San Francisco, San Francisco, California. · Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. ·Gastroenterology · Pubmed #26688268.

ABSTRACT: BACKGROUND & AIMS: The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. METHODS: A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS: Consensus was reached on 29 of the 30 recommendations considered. Preconception counseling and access to specialist care are paramount in optimizing disease management. In general, women on 5-ASA, thiopurine, or anti-tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy. Discontinuation of anti-TNF therapy or switching from combination therapy to monotherapy may be considered in very select low-risk patients. Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy. Endoscopy or urgent surgery should not be delayed during pregnancy if indicated. Decisions regarding cesarean delivery should be based on obstetric considerations and not the diagnosis of IBD alone, with the exception of women with active perianal Crohn's disease. With the exception of methotrexate, the use of medications for IBD should not influence the decision to breast-feed and vice versa. Live vaccinations are not recommended within the first 6 months of life in the offspring of women who were on anti-TNF therapy during pregnancy. CONCLUSIONS: Optimal management of IBD before and during pregnancy is essential to achieving favorable maternal and neonatal outcomes.

4 Editorial Thiopurines and the natural course of Crohn's disease: did we finally find the right therapeutic target? 2014

Rieder, Florian / Reinisch, Walter. ·Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. · Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. ·Am J Gastroenterol · Pubmed #24989094.

ABSTRACT: The disease course of Crohn's disease (CD) can be highly heterogeneous, leading to stricturing or perforating complications and surgery in the majority of patients. Evidence is accumulating about the lack of efficacy of azathioprine (AZA) started early in the disease course for achieving steroid-free remission. Novel information, however, indicates that long-term treatment targets addressing structural damage, such as delay of disease progression or avoidance of surgery, can be achieved by early and prolonged use of AZA with or without anti-tumor necrosis factor therapy. It is hence worth reconsidering the treat-to-target strategy of immunosuppressant and immunomodulatory therapy in CD.

5 Editorial Combination therapy with methotrexate in inflammatory bowel disease: time to COMMIT? 2014

Narula, Neeraj / Peyrin-Biroulet, Laurent / Colombel, Jean-Frederic. ·Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada. · Inserm U954 and Department of Hepato-Gastroenterology, Université de Lorraine, Vandœuvre-lès-Nancy, France. · Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: jean-frederic.colombel@mssm.edu. ·Gastroenterology · Pubmed #24468168.

ABSTRACT: -- No abstract --

6 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.

7 Review The Unique Lifestyle of Crohn's Disease-Associated Adherent-Invasive Escherichia coli. 2019

Shaler, Christopher R / Elhenawy, Wael / Coombes, Brian K. ·Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Infectious Disease Research, Hamilton, ON, Canada. · Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Infectious Disease Research, Hamilton, ON, Canada; Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada. Electronic address: coombes@mcmaster.ca. ·J Mol Biol · Pubmed #31029703.

ABSTRACT: Escherichia coli is one of the most genetically and phenotypically diverse species of bacteria. This remarkable diversity produces a plethora of clinical outcomes following infection and has informed much of what we currently know about host-pathogen interactions for a wide range of bacteria-host relationships. In studying the role of microbes in disease, adherent-invasive E. coli (AIEC) has emerged as having a strong association with Crohn's disease (CD). Thus, there has been an equally strong effort to uncover the root origins of AIEC, to appreciate how AIEC differs from other well-known pathogenic E. coli variants, and to understand its connection to disease. Emerging from a growing body of research on AIEC is the understanding that AIEC itself is remarkably diverse, both in phylogenetic origins, genetic makeup, and behavior in the host setting. Here, we describe the unique lifestyle of CD-associated AIEC and review recent research that is uncovering the inextricable link between AIEC and its host in the context of CD.

8 Review Eosinophil Extracellular Traps and Inflammatory Pathologies-Untangling the Web! 2018

Mukherjee, Manali / Lacy, Paige / Ueki, Shigeharu. ·Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, ON, Canada. · Department of Medicine, Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada. · Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan. ·Front Immunol · Pubmed #30534130.

ABSTRACT: Eosinophils are an enigmatic white blood cell, whose immune functions are still under intense investigation. Classically, the eosinophil was considered to fulfill a protective role against parasitic infections, primarily large multicellular helminths. Although eosinophils are predominantly associated with parasite infections, evidence of a role for eosinophils in mediating immunity against bacterial, viral, and fungal infections has been recently reported. Among the mechanisms by which eosinophils are proposed to exert their protective effects is the production of DNA-based extracellular traps (ETs). Remarkably, DNA serves a role that extends beyond its biochemical function in encoding RNA and protein sequences; it is also a highly effective substance for entrapment of bacteria and other extracellular pathogens, and serves as valuable scaffolding for antimicrobial mediators such as granule proteins from immune cells. Extracellular trap formation from eosinophils appears to fulfill an important immune response against extracellular pathogens, although overproduction of traps is evident in pathologies. Here, we discuss the discovery and characterization of eosinophil extracellular traps (EETs) in response to a variety of stimuli, and suggest a role for these structures in the pathogenesis of disease as well as the establishment of autoimmunity in chronic, unresolved inflammation.

9 Review Current Evidence for the Management of Inflammatory Bowel Diseases Using Fecal Microbiota Transplantation. 2018

Jeon, Seong Ran / Chai, Jocelyn / Kim, Christiana / Lee, Christine H. ·Digestive Disease Centre, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, South Korea. · University of Victoria, Victoria, British Columbia, Canada. · University of British Columbia, Vancouver, Canada. · Vancouver Island Health Authority, Cumberland, Canada. · University of Victoria, Victoria, British Columbia, Canada. Christine.Lee@VIHA.CA. · University of British Columbia, Vancouver, Canada. Christine.Lee@VIHA.CA. · Vancouver Island Health Authority, Cumberland, Canada. Christine.Lee@VIHA.CA. · Department of Pathology and Molecular Medicine, McMaster University, St Joseph's Healthcare, Hamilton, Ontario, Canada. Christine.Lee@VIHA.CA. ·Curr Infect Dis Rep · Pubmed #29804272.

ABSTRACT: PURPOSE OF REVIEW: Fecal microbiota transplantation (FMT) has been investigated as a potential treatment for inflammatory bowel disease (IBD). This review examines current evidence around the efficacy and safety of FMT for patients with IBD. RECENT FINDINGS: Randomized controlled trials (RCTs) and meta-analyses have suggested that FMT may facilitate clinical and endoscopic remission in patients with active ulcerative colitis (UC). Although the evidence for FMT in Crohn's disease (CD) is more limited, positive outcomes have been observed in small cohort studies. Most adverse events (AEs) were mild and included transient gastrointestinal symptoms. Serious adverse events (SAEs) did not differ significantly between the FMT and control groups, and a marginal increased rate of IBD flares following FMT was observed. Microbiota analysis following FMT showed increased intestinal bacterial diversity and a shift towards the donor microbial profile in recipients' stools. FMT for patients with IBD is promising as RCTs have shown the benefit of FMT for UC, although the efficacy of FMT for CD is less clear. Further large and well-designed trials are necessary to resolve critical issues such as the donor selection, the ideal route of administration, duration, frequency of FMT, and the long-term sustained efficacy and safety.

10 Review Enteral nutritional therapy for induction of remission in Crohn's disease. 2018

Narula, Neeraj / Dhillon, Amit / Zhang, Dongni / Sherlock, Mary E / Tondeur, Melody / Zachos, Mary. ·Division of Gastroenterology, McMaster University, 1280 Main Street West, Hamilton, ON, Canada, L8S 4K1. ·Cochrane Database Syst Rev · Pubmed #29607496.

ABSTRACT: BACKGROUND: Corticosteroids are often preferred over enteral nutrition (EN) as induction therapy for Crohn's disease (CD). Prior meta-analyses suggest that corticosteroids are superior to EN for induction of remission in CD. Treatment failures in EN trials are often due to poor compliance, with dropouts frequently due to poor acceptance of a nasogastric tube and unpalatable formulations. This systematic review is an update of a previously published Cochrane review. OBJECTIVES: To evaluate the effectiveness and safety of exclusive EN as primary therapy to induce remission in CD and to examine the importance of formula composition on effectiveness. SEARCH METHODS: We searched MEDLINE, Embase and CENTRAL from inception to 5 July 2017. We also searched references of retrieved articles and conference abstracts. SELECTION CRITERIA: Randomized controlled trials involving patients with active CD were considered for inclusion. Studies comparing one type of EN to another type of EN or conventional corticosteroids were selected for review. DATA COLLECTION AND ANALYSIS: Data were extracted independently by at least two authors. The primary outcome was clinical remission. Secondary outcomes included adverse events, serious adverse events and withdrawal due to adverse events. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). A random-effects model was used to pool data. We performed intention-to-treat and per-protocol analyses for the primary outcome. Heterogeneity was explored using the Chi MAIN RESULTS: Twenty-seven studies (1,011 participants) were included. Three studies were rated as low risk of bias. Seven studies were rated as high risk of bias and 17 were rated as unclear risk of bias due to insufficient information. Seventeen trials compared different formulations of EN, 13 studies compared one or more elemental formulas to a non-elemental formula, three studies compared EN diets of similar protein composition but different fat composition, and one study compared non-elemental diets differing in glutamine enrichment. Meta-analysis of 11 trials (378 participants) demonstrated no difference in remission rates. Sixty-four per cent (134/210) of patients in the elemental group achieved remission compared to 62% (105/168) of patients in the non-elemental group (RR 1.02, 95% CI 0.88 to 1.18; GRADE very low quality). A per-protocol analysis (346 participants) produced similar results (RR 1.04, 95% CI 0.91 to 1.18). Subgroup analyses performed to evaluate the different types of elemental and non-elemental diets (elemental, semi-elemental and polymeric) showed no differences in remission rates. An analysis of 7 trials including 209 patients treated with EN formulas of differing fat content (low fat: < 20 g/1000 kCal versus high fat: > 20 g/1000 kCal) demonstrated no difference in remission rates (RR 1.03; 95% CI 0.85 to 1.26). Very low fat content (< 3 g/1000 kCal) and very low long chain triglycerides demonstrated higher remission rates than higher content EN formulas. There was no difference between elemental and non-elemental diets in adverse event rates (RR 1.00, 95% CI 0.63 to 1.60; GRADE very low quality), or withdrawals due to adverse events (RR 1.29, 95% CI 0.80 to 2.09; GRADE very low quality). Common adverse events included nausea, vomiting, diarrhea and bloating.Ten trials compared EN to steroid therapy. Meta-analysis of eight trials (223 participants) demonstrated no difference in remission rates between EN and steroids. Fifty per cent (111/223) of patients in the EN group achieved remission compared to 72% (133/186) of patients in the steroid group (RR 0.77, 95% CI 0.58 to 1.03; GRADE very low quality). Subgroup analysis by age showed a difference in remission rates for adults but not for children. In adults 45% (87/194) of EN patients achieved remission compared to 73% (116/158) of steroid patients (RR 0.65, 95% CI 0.52 to 0.82; GRADE very low quality). In children, 83% (24/29) of EN patients achieved remission compared to 61% (17/28) of steroid patients (RR 1.35, 95% CI 0.92 to 1.97; GRADE very low quality). A per-protocol analysis produced similar results (RR 0.93, 95% CI 0.75 to 1.14). The per-protocol subgroup analysis showed a difference in remission rates for both adults (RR 0.82, 95% CI 0.70 to 0.95) and children (RR 1.43, 95% CI 1.03 to 1.97). There was no difference in adverse event rates (RR 1.39, 95% CI 0.62 to 3.11; GRADE very low quality). However, patients on EN were more likely to withdraw due to adverse events than those on steroid therapy (RR 2.95, 95% CI 1.02 to 8.48; GRADE very low quality). Common adverse events reported in the EN group included heartburn, flatulence, diarrhea and vomiting, and for steroid therapy acne, moon facies, hyperglycemia, muscle weakness and hypoglycemia. The most common reason for withdrawal was inability to tolerate the EN diet. AUTHORS' CONCLUSIONS: Very low quality evidence suggests that corticosteroid therapy may be more effective than EN for induction of clinical remission in adults with active CD. Very low quality evidence also suggests that EN may be more effective than steroids for induction of remission in children with active CD. Protein composition does not appear to influence the effectiveness of EN for the treatment of active CD. EN should be considered in pediatric CD patients or in adult patients who can comply with nasogastric tube feeding or perceive the formulations to be palatable, or when steroid side effects are not tolerated or better avoided. Further research is required to confirm the superiority of corticosteroids over EN in adults. Further research is required to confirm the benefit of EN in children. More effort from industry should be taken to develop palatable polymeric formulations that can be delivered without use of a nasogastric tube as this may lead to increased patient adherence with this therapy.

11 Review Systematic review: advice lines for patients with inflammatory bowel disease. 2018

Bager, Palle / Chauhan, Usha / Greveson, Kay / Jäghult, Susanna / Moortgat, Liesbeth / Kemp, Karen. ·a Department of Hepatology and Gastroenterology, Department of Clinical Medicine , Aarhus University Hospital/Aarhus University , Aarhus , Denmark. · b Hamilton Health Sciences , McMaster Medical Centre Hamilton , Hamilton , Ontario , Canada. · c Centre for Gastroenterology , Royal Free Hospital , London , UK. · d Karolinska Institutet Department of Clinical Science , Stockholm Gastro Center , Stockholm , Sweden. · e Department of Gastroenterology , AZ Delta Roeselare-Menen , Roeselare , Belgium. · f Department of Gastroenterology , Manchester Royal Infirmary/School of Nursing, University of Manchester , Manchester , UK. ·Scand J Gastroenterol · Pubmed #29130761.

ABSTRACT: OBJECTIVE: Advice lines for patients with inflammatory bowel diseases (IBD) have been introduced internationally. However, only a few publications have described the advice line service and evaluated the efficiency of it with many results presented as conference posters. A systematic synthesis of evidence is needed and the aim of this article was to systematically review the evidence of IBD advice lines. MATERIALS AND METHODS: A broad systematic literature search was performed to identify relevant studies addressing the effect of advice lines. The process of selection of the retrieved studies was undertaken in two phases. In phase one, all abstracts were review by two independent reviewers. In phase two, the full text of all included studies were independently reviewed by two reviewers. The included studies underwent quality assessment and data synthesis. RESULTS: Ten published studies and 10 congress abstracts were included in the review. The studies were heterogeneous both in scientific quality and in the focus of the study. No rigorous evidence was found to support that advice lines improve disease activity in IBD and correspondingly no studies reported worsening in disease activity. Advice lines were found to be health economically beneficial with clear indications of the positive impact of advice lines from the patient perspective. CONCLUSION: The levels of evidence of the effect of advice lines in IBD are low. However, the use of advice lines was found to be safe, and cost-effective. Where investigated, patients with IBD overwhelmingly welcome an advice line with high levels of patient satisfaction reported.

12 Review The Disease Burden and Clinical Characteristics of Inflammatory Bowel Disease in the Chinese Population: A Systematic Review and Meta-Analysis. 2017

Li, Xue / Song, Peige / Li, Jun / Tao, Yuchang / Li, Guowei / Li, Xiumin / Yu, Zengli. ·School of Public Health, Xinxiang Medical University, Xinxiang 453003, China. xue.li@ed.ac.uk. · Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK. xue.li@ed.ac.uk. · School of Public Health, Xinxiang Medical University, Xinxiang 453003, China. p.song@sms.ed.ac.uk. · Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK. p.song@sms.ed.ac.uk. · The 153 Hospital of People's Liberation Army, Zhengzhou 450001, China. shuaidexue@126.com. · School of Public Health, Xinxiang Medical University, Xinxiang 453003, China. yuyuzaijia@163.com. · Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON L8S 4L8, Canada. lig28@mcmaster.ca. · Department Gastroenterology, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453003, China. lxm3029981@126.com. · School of Public Health, Xinxiang Medical University, Xinxiang 453003, China. yuzengli@outlook.com. ·Int J Environ Res Public Health · Pubmed #28264519.

ABSTRACT: The temporal trend of inflammatory bowel disease (IBD) incidence is reported to be increasing in worldwide regions; however, reports focusing on China are sparse. The aim of this study was to provide an overview of the disease burden and clinical features of IBD in the Chinese population. We searched Medline, EMBASE, and another two Chinese databases. A parallel literature review and data extraction were conducted. Meta-analysis was performed to estimate the summary incidence rate of Crohn's disease (CD) and ulcerative colitis (UC). The constituent ratios with 95% CI were calculated for clinical phenotypes and classifications. The literature review included 47 publications. The summary incidence rate of IBD was 1.74 (95% CI: 1.08; 2.40) per 100,000 person years, and the corresponding incidence rates of CD and UC were 0.40 (95% CI: 0.23; 0.57) and 1.18 (95% CI: 0.81; 1.56) per 100,000 person years, respectively. The sex distribution analysis indicated a male predominance in both CD (sex ratio: 1.64; 95% CI: 1.47-1.84) and UC (sex ratio: 1.29; 95% CI: 1.21-1.38). The clinical characteristics were summarized using data from 2283 CD cases and 17,958 UC cases; in which the majority of CD patients were diagnosed between 17-40 years of age, with non-stricturing and non-penetrating disease, varied disease locations, and less extra-intestinal manifestation. UC cases were featured with later disease diagnosis, a more severe disease course, more segmental lesions, and less extra-intestinal manifestations. Our study provided an estimated disease burden of IBD and demonstrated distinct clinical features in the Chinese population. Large-scale population-based studies are needed to further evaluate these findings.

13 Review Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. 2017

Enns, Robert A / Hookey, Lawrence / Armstrong, David / Bernstein, Charles N / Heitman, Steven J / Teshima, Christopher / Leontiadis, Grigorios I / Tse, Frances / Sadowski, Daniel. ·Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: renns@ubc.ca. · Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada. · Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. · Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. · Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. · Division of Gastroenterology, Royal Alexandria Hospital, Edmonton, Alberta, Canada. ·Gastroenterology · Pubmed #28063287.

ABSTRACT: BACKGROUND & AIMS: Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice. METHODS: A systematic literature search identified studies on the use of CE in patients with Crohn's disease, celiac disease, gastrointestinal bleeding, and anemia. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The consensus includes 21 statements focused on the use of small-bowel CE and colon capsule endoscopy. CE was recommended for patients with suspected, known, or relapsed Crohn's disease when ileocolonoscopy and imaging studies were negative if it was imperative to know whether active Crohn's disease was present in the small bowel. It was not recommended in patients with chronic abdominal pain or diarrhea, in whom there was no evidence of abnormal biomarkers typically associated with Crohn's disease. CE was recommended to assess patients with celiac disease who have unexplained symptoms despite appropriate treatment, but not to make the diagnosis. In patients with overt gastrointestinal bleeding, and negative findings on esophagogastroduodenoscopy and colonoscopy, CE should be performed as soon as possible. CE was recommended only in selected patients with unexplained, mild, chronic iron-deficiency anemia. CE was suggested for surveillance in patients with polyposis syndromes or other small-bowel cancers, who required small-bowel studies. Colon capsule endoscopy should not be substituted routinely for colonoscopy. Patients should be made aware of the potential risks of CE including a failed procedure, capsule retention, or a missed lesion. Finally, standardized criteria for training and reporting in CE should be defined. CONCLUSIONS: CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.

14 Review Fecal microbial transplant for the treatment of pediatric inflammatory bowel disease. 2016

Wang, Alice Yuxin / Popov, Jelena / Pai, Nikhil. ·Alice Yuxin Wang, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada. ·World J Gastroenterol · Pubmed #28058011.

ABSTRACT: The role of fecal microbial transplant (FMT) in the treatment of pediatric gastrointestinal disease has become increasingly popular among pediatric practitioners, patients, and parents. The success of FMT for the treatment of recurrent

15 Review Fecal transplantation: any real hope for inflammatory bowel disease? 2016

Moayyedi, Paul. ·Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada. ·Curr Opin Gastroenterol · Pubmed #27152872.

ABSTRACT: PURPOSE OF REVIEW: Fecal microbiota transplant (FMT) has emerged as an important treatment for antibiotic resistant or recurrent Clostridium difficile infection. There has been a great deal of media coverage of the efficacy of FMT, and patients with inflammatory bowel disease (IBD) understandably wonder if this approach would also work for them. There are also instructions on 'do it yourself' FMT therapy on the web. It is important to understand whether there is evidence that this approach is effective in IBD so that we can advise our patients appropriately. RECENT FINDINGS: Systematic reviews have identified four case series involving 27 ulcerative colitis patients with a pooled remission rate of 24% (95% confidence interval (CI) = 11-45%). Two randomized controlled trials evaluating a total of 123 active ulcerative colitis patients have given conflicting results but the pooled data do suggest benefit with a number needed to treat of 6 (95% CI = 3-33). There are four case series involving 38 patients with Crohn's disease with a clinical response in 60.5% (95% CI = 28-86%). There are no randomized trials in Crohn's disease. SUMMARY: At present there are insufficient data to recommend FMT in IBD, and patients certainly should not be administering this themselves. This remains an interesting approach to treating IBD and more studies are needed to establish the optimal method of delivery as well as randomized, placebo controlled trials to establish the efficacy of FMT.

16 Review Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature. 2016

Sy, Alice / Khalidi, Nader / Dehghan, Natasha / Barra, Lillian / Carette, Simon / Cuthbertson, David / Hoffman, Gary S / Koening, Curry L / Langford, Carol A / McAlear, Carol / Moreland, Larry / Monach, Paul A / Seo, Philip / Specks, Ulrich / Sreih, Antoine / Ytterberg, Steven R / Van Assche, Gert / Merkel, Peter A / Pagnoux, Christian / Anonymous6940840 / Anonymous6950840. ·Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9. · Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada. · Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada. · Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada. · Department of Biostatistics, University of South Florida, Tampa, FL. · Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH. · Division of Rheumatology, University of Utah, Salt Lake City, UT. · Division of Rheumatology, University of Pennsylvania, Philadelphia, PA. · Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA. · The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, MA; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA. · Division of Rheumatology, Johns Hopkins University, Baltimore, MD. · Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN. · Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN. · Division of Gastroenterology, University of Toronto-Inflammatory Bowel Disease Clinic, Toronto, Ontario, Canada. · Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9. Electronic address: cpagnoux@msn.com. ·Semin Arthritis Rheum · Pubmed #26315859.

ABSTRACT: BACKGROUND: Published small case series suggest that inflammatory bowel disease [IBD; Crohn's disease (CD) or ulcerative colitis (UC)] and vasculitis co-occur more frequently than would be expected by chance. OBJECTIVES: To describe this association by an analysis of a large cohort of carefully studied patients and through a systematic literature review. METHODS: Patients with both IBD and vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Studies, followed in Canadian Vasculitis research network (CanVasc) centers and/or in the University of Toronto's IBD clinic were included in this case series. A systematic literature review of patients with IBD and vasculitis involved a PubMed search through February 2014. The main characteristics of patients with Takayasu arteritis (TAK) and IBD were compared to those in patients with TAK without IBD followed in the VCRC. RESULTS: The study identified 32 patients with IBD and vasculitis: 13 with large-vessel vasculitis [LVV; 12 with TAK, 1 with giant cell arteritis (GCA); 8 with CD, 5 with UC]; 8 with ANCA-associated vasculitis [AAV; 6 granulomatosis with polyangiitis (GPA), 2 with eosinophilic granulomatosis with polyangiitis (EGPA)]; 5 with isolated cutaneous vasculitis; and 6 with other vasculitides. Patients with LVV and AAV were mostly female (18/21). The diagnosis of IBD preceded that of vasculitis in 12/13 patients with LVV and 8/8 patients with AAV. The review of the literature identified 306 patients with IBD and vasculitis: 144 with LVV (133 TAK; 87 with IBD preceding LVV), 19 with AAV [14 GPA, 1 EGPA, 4 microscopic polyangiitis (MPA)], 66 with isolated cutaneous vasculitis, and 77 with other vasculitides. Patients with IBD and TAK were younger and had more frequent headaches, constitutional symptoms, or gastrointestinal symptoms compared to those patients in the VCRC who had TAK without IBD. CONCLUSIONS: These findings highlight the risk of vasculitis, especially TAK, in patients with IBD (both CD and UC).

17 Review Convergence of External Crohn's Disease Risk Factors on Intestinal Bacteria. 2015

Oberc, Alexander / Coombes, Brian K. ·Department of Biochemistry and Biomedical Sciences, McMaster University , Hamilton, ON , Canada ; Michael G. DeGroote Institute for Infectious Disease Research , Hamilton, ON , Canada. · Department of Biochemistry and Biomedical Sciences, McMaster University , Hamilton, ON , Canada ; Michael G. DeGroote Institute for Infectious Disease Research , Hamilton, ON , Canada ; Farncombe Family Digestive Health Research Institute , Hamilton, ON , Canada. ·Front Immunol · Pubmed #26579131.

ABSTRACT: Crohn's disease (CD) is an immune-mediated intestinal illness that significantly compromises health in many developed countries. Although definitive causes remain elusive, the required contribution of microbes in the progression of disease has become an accepted concept. Known CD risk factors, such as antibiotic use and acute infectious gastroenteritis, may impact the gut. This concept is now being explored with a view toward understanding the beneficial and unfavorable microbes that may be altered in numbers during such external insults. A comprehensive understanding of the microbial component to CD could be useful clinically as future therapies may focus on preventing risk exposures on susceptible individuals, eliminating harmful microbes, or restoring a protective gut microbiome. Here, we examine how acute infectious gastroenteritis and antibiotic exposure may impact the gut microbiota in the context of inflammation in CD.

18 Review New Applications for Traditional Drugs in Inflammatory Bowel Disease: What Do Cochrane Reviews Tell Us? 2015

Chande, Nilesh / Marshall, John K / Seow, Cynthia H / Sandborn, William J / Parker, Claire E / Nelson, Sigrid / Feagan, Brian G. ·*Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, CA; †Division of Gastroenterology, McMaster University, Hamilton, Ontario, CA; ‡Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, CA; §Division of Gastroenterology, University of California San Diego, La Jolla, CA; ‖Robarts Clinical Trials, Inc, Robarts Research Institute, Western University, London, Ontario, CA; Departments of ¶Medicine, and **Epidemiology and Statistics, Western University, London, Ontario, CA. ·Inflamm Bowel Dis · Pubmed #26540276.

ABSTRACT: Although multiple innovative treatments of inflammatory bowel disease have become available, research continues to refine the value of existing drug therapies for Crohn's disease and ulcerative colitis. What can Cochrane reviews tell us about evolving applications for traditional agents in inflammatory bowel disease? A Cochrane Collaboration symposium held at the 2014 Digestive Diseases Week annual meeting addressed this question. This article reviews the data presented at that session.

19 Review Placebo response rate in clinical trials of fistulizing Crohn's disease: systematic review and meta-analysis. 2014

Ford, Alexander C / Luthra, Pavit / Hanauer, Stephen B / Travis, Simon P / Harris, M Scott / Reinisch, Walter. ·Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom. Electronic address: alexf12399@yahoo.com. · Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom. · Digestive Health Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom. · Georgetown University School of Medicine, Washington, District of Columbia. · Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada. ·Clin Gastroenterol Hepatol · Pubmed #25218669.

ABSTRACT: BACKGROUND & AIMS: It is important to determine the magnitude and identify modifiers of the rate of response to placebo in clinical trials of fistulizing Crohn's disease (CD), to understand disease progression, and to calculate sample size. We conducted a systematic review and meta-analysis of rates of response to placebo in trials of patients with fistulizing CD. METHODS: We searched MEDLINE, EMBASE, EMBASE CLASSIC, and the Cochrane central register of controlled trials for randomized controlled trials (RCTs) comparing pharmacologic agents with placebo in adults with fistulizing CD. We identified studies that reported complete fistula closure, partial closure, or response. Data were extracted as intention-to-treat analyses and pooled by using a random-effects model. Proportions of patients who received placebo and had complete or partial fistula(e) closure were calculated, with 95% confidence intervals (CIs). The effects of trial characteristics on the magnitude of response to placebo were examined. RESULTS: Thirteen RCTs were eligible for our analysis; these included 579 patients assigned to placebo groups. The pooled rate of response to placebo, among all RCTs, for complete fistula closure was 15.6% (95% CI, 10.9%-20.9%), with significant heterogeneity (I(2) = 62.5%, P = .001). The pooled rate of response to placebo for partial fistula closure or response in 9 trials, comprising 423 patients, was 18.3% (95% CI, 14.8%-22.1%). Rates of response to placebo were significantly lower in trials with shorter durations of therapy and shorter intervals to assessment of fistula closure. Neither exposure to the pharmacologic agent during the induction phase of the same (or related) RCT nor concomitant medications had any effect. CONCLUSIONS: In a meta-analysis of rate of response to placebo in patients with fistulizing CD, we found that fistulae closed in almost 1/6 patients given placebo in RCTs of pharmacologic agents. Future research should identify characteristics of patients that predict response to placebo.

20 Review Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology. 2014

Nguyen, Geoffrey C / Bernstein, Charles N / Bitton, Alain / Chan, Anthony K / Griffiths, Anne M / Leontiadis, Grigorios I / Geerts, William / Bressler, Brian / Butzner, J Decker / Carrier, Marc / Chande, Nilesh / Marshall, John K / Williams, Chadwick / Kearon, Clive. ·Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: geoff.nguyen@utoronto.ca. · IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. · Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. · Division of Gastroenterology, Hepatology, and Nutrition, Sick Kids Hospital, Toronto, Ontario, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Thromboembolism Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Department of Medicine, Division of Gastroenterology, St Paul's Hospital, Vancouver, British Columbia, Canada. · Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. · Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario, Canada. · Division of Gastroenterology, Western University, London, Ontario, Canada. · Hamilton Health Sciences Centre, Hamilton, Ontario, Canada. · Dalhousie University, Halifax, Nova Scotia; Memorial University, St John's, Newfoundland, Canada. ·Gastroenterology · Pubmed #24462530.

ABSTRACT: BACKGROUND & AIMS: Guidelines for the management of venous thromboembolism (VTE) from the American College of Chest Physicians do not address patients with inflammatory bowel disease (IBD), a group with a high risk of both VTE and gastrointestinal bleeding. We present recommendations for the prevention and treatment of VTE in patients with IBD. METHODS: A systematic literature search was performed to identify studies on VTE in IBD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were developed through an iterative online platform, then finalized and voted on by a working group of adult and pediatric gastroenterologists and thrombosis specialists. RESULTS: IBD patients have an approximately 3-fold higher risk of VTE compared with individuals without IBD, and disease flares further increase this risk. Anticoagulant thromboprophylaxis is recommended for IBD patients who are hospitalized with IBD flares without active bleeding and is suggested when bleeding is nonsevere. Anticoagulant thromboprophylaxis is suggested during moderate-severe IBD flares in outpatients with a history of VTE provoked by an IBD flare or an unprovoked VTE, but not otherwise. The recommended duration of anticoagulation after a first VTE is based on the presence of provoking factors. Specific suggestions are made for the prevention and treatment of VTE in pediatric and pregnant IBD patients. CONCLUSIONS: Using the American College of Chest Physicians' guidelines as a foundation, we have integrated evidence from IBD studies to develop specific recommendations for the management of VTE in this high-risk population.

21 Review Sargramostim (GM-CSF) for induction of remission in Crohn's disease: a cochrane inflammatory bowel disease and functional bowel disorders systematic review of randomized trials. 2012

Roth, Lee / MacDonald, John K / McDonald, John W D / Chande, Nilesh. ·Faculty of Health Sciences, McMaster University, Hamilton, Canada. ·Inflamm Bowel Dis · Pubmed #22552871.

ABSTRACT: BACKGROUND: We planned to systematically review the efficacy of sargramostim (granulocyte colony stimulating factor [GM-CSF]) for remission induction in patients with Crohn's disease (CD). METHODS: A literature search to April 2011 was performed to identify all randomized trials studying sargramostim in patients with CD. The Cochrane risk of bias tool was used to evaluate study quality and the GRADE criteria were utilized to assess the overall quality of the evidence. RESULTS: Three randomized studies (total 537 patients) were identified. The risk of bias was low for the three included studies. There was no statistically significant difference in the proportion of patients who achieved clinical remission (GM-CSF 25.3%; placebo 17.5%; relative risk [RR] 1.67; 95% confidence interval [CI] 0.80-3.50; P = 0.17), or 100-point clinical response (GM-CSF 38.3%; placebo 24.8%; RR 1.71 95% CI 0.98-2.97; P = 0.06). There was no statistically significant difference in the proportion of patients (GM-CSF 95.8%; placebo 89.3%) who experienced adverse events (RR 1.07; 95% CI 0.99-1.16; P = 0.08), or serious adverse events (GM-CSF 12.0% vs. placebo 4.8%; RR 2.21; 95% CI 0.84-5.81; P = 0.11). CONCLUSIONS: Sargramostim does not appear to be more effective than placebo for induction of clinical remission or improvement in active CD. However, the GRADE analysis indicates that the overall quality of the evidence for the primary and secondary outcomes was low due to sparse data and heterogeneity, indicating that further research likely would have a significant impact on the effect estimates.

22 Review Medical therapy for pediatric inflammatory bowel disease. 2012

Sherlock, Mary E / Griffiths, Anne M. ·Division of Gastroenterology, McMaster Children's Hospital, Hamilton, Canada. sherlom@mcmaster.ca ·Curr Gastroenterol Rep · Pubmed #22350842.

ABSTRACT: Pediatric inflammatory bowel disease encompasses a spectrum of disease phenotype, severity, and responsiveness to treatment. Intestinal healing rather than merely symptom control is an especially important therapeutic goal in young patients, given the potential for growth impairment as a direct effect of persistent chronic inflammation and the long life ahead, during which other disease complications may occur. Corticosteroids achieve rapid symptom control, but alternate steroid-sparing strategies with greater potential to heal the intestine must be rapidly adopted. Exclusive enteral nutrition is an alternate short-term treatment in pediatric Crohn's disease. The results of multi-center pediatric clinical trials of both infliximab and adalimumab in Crohn's disease and of infliximab in ulcerative colitis (all in children with unsatisfactory responses to other therapies) have now been reported and guide treatment regimens in clinical practice. Optimal patient selection and timing of anti-TNF therapy requires clinical judgment. Attention must be paid to sustaining responsiveness safely.

23 Review Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. 2011

Khan, Khurram J / Ullman, Thomas A / Ford, Alexander C / Abreu, Maria T / Abadir, Amir / Marshall, John K / Talley, Nicholas J / Moayyedi, Paul. ·McMaster University Medical Centre, Hamilton, Ontario, Canada. ·Am J Gastroenterol · Pubmed #21407187.

ABSTRACT: The etiology of inflammatory bowel disease (IBD) is unknown but may relate to an unidentified bacterial pathogen or an immunological reaction to gut microbiota. Antibiotics have therefore been proposed as a therapy for Crohn's disease (CD) and ulcerative colitis (UC) to induce remission in active disease to prevent relapse. Current data are conflicting and we therefore conducted a systematic review of randomized controlled trials (RCTs) evaluating antibiotics in IBD. Only parallel group RCTs were considered eligible. Studies with adult patients receiving any dose of therapy for at least 7 days and up to 16 weeks for active disease, or at least 6 months of follow-up for preventing relapse in quiescent disease were analyzed. We included any antibiotics alone or in combination using predefined definitions of remission and relapse. Two reviewers independently assessed eligibility and extracted data. The primary outcome was remission or relapse using an intention-to-treat methodology. The data were summarized using relative risk (RR) and pooled using a random effects model. For active CD, there were 10 RCTs involving 1,160 patients. There was a statistically significant effect of antibiotics being superior to placebo (RR of active CD not in remission=0.85; 95% confidence interval (CI)=0.73-0.99, P=0.03). There was moderate heterogeneity between results (I(2)=48%) and a diverse number of antibiotics were tested (anti-tuberculosis therapy, macrolides, fluroquinolones, 5-nitroimidazoles, and rifaximin) either alone or in combination. Rifamycin derivatives either alone or in combination with other antibiotics appeared to have a significant effect at inducing remission in active CD. In perianal CD fistula there were three trials evaluating 123 patients using either ciprofloxacin or metronidazole. There was a statistically significant effect in reducing fistula drainage (RR=0.8; 95% CI=0.66-0.98) with no heterogeneity (I(2)=0%) and an number needed to treat 5 (95% CI=3-20). For quiescent CD, there were 3 RCTs involving 186 patients treated with different antibiotics combinations (all including antimycobacterials) vs. placebo. There was a statistically significant effect in favor of antibiotics vs. placebo (RR of relapse=0.62; 95% CI=0.46-0.84), with no heterogeneity (I(2)=0%). In active UC, there were 9 RCTs with 662 patients and there was a statistically significant benefit for antibiotics inducing remission (RR of UC not in remission=0.64; 95% CI=0.43-0.96). There was moderate heterogeneity (I(2)=69%) and antibiotics used were all different single or combination drugs. Antibiotic therapy may induce remission in active CD and UC, although the diverse number of antibiotics tested means the data are difficult to interpret. This systematic review is a mandate for further trials of antibiotic therapy in IBD.

24 Review Efficacy of immunosuppressive therapy for inflammatory bowel disease: a systematic review and meta-analysis. 2011

Khan, Khurram J / Dubinsky, Marla C / Ford, Alexander C / Ullman, Thomas A / Talley, Nicholas J / Moayyedi, Paul. ·Health Sciences Center, McMaster University, Hamilton, Ontario, Canada. khankj@mcmaster.ca ·Am J Gastroenterol · Pubmed #21407186.

ABSTRACT: OBJECTIVES: There remains controversy regarding the efficacy of thiopurine analogs (azathioprine (AZA) and 6-mercaptopurine (6-MP)), methotrexate (MTX), and cyclosporine for the treatment of inflammatory bowel disease (IBD). We performed an updated systematic review of the literature to clarify the efficacy of immunosuppressive therapy at inducing remission and preventing relapse in ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Only parallel group randomized controlled trials (RCTs) were considered eligible. Studies with adult IBD patients receiving immunosuppressive therapy compared with placebo for at least 14 days and up to 17 weeks for active disease, or at least 6 months in quiescent disease were analyzed. Two reviewers independently assessed eligibility and extracted data. The primary outcome was remission or relapse using an intention-to-treat analysis. The data were summarized using relative risk (RR) and pooled using a random effects model. RESULTS: Data on MTX and cyclosporine in IBD were limited although there were some data to support the use of intramuscular MTX in CD but not UC. There were five trials of AZA/6-MP in 380 active CD patients and there was no significant effect of therapy inducing remission (RR=0.87; 95% confidence interval (CI)=0.71-1.06). In quiescent CD, there were two trials involving 198 patients with no significant benefit of active therapy preventing relapse compared with placebo (RR=0.64; 95% CI=0.34-1.23). There were, however, three additional AZA withdrawal trials in 163 patients that indicated continuing medication did prevent relapse (RR=0.39; 95% CI=0.21-0.74). There were two AZA RCTs in 130 active UC patients that suggested a trend for benefit of therapy, but this did not reach statistical significance (RR=0.85; 95% CI=0.71-1.01). In quiescent UC, there were three trials involving 127 patients and there was a statistically significant benefit of AZA preventing relapse (RR=0.60; 95% CI=0.37-0.95). CONCLUSIONS: Most evidence relates to AZA/6-MP where there is no statistically significant benefit at inducing remission in active CD and UC. Thiopurine analogs may prevent relapse in quiescent UC and CD. However, there is a paucity of data for immunosuppressive therapy in IBD and more research is needed.

25 Review IgG₄-related sclerosing disease: a novel mimic of inflammatory bowel disease. 2010

Narula, Neeraj / Vasudev, Monica / Marshall, John K. ·Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada. ·Dig Dis Sci · Pubmed #20521111.

ABSTRACT: High levels of IgG₄-positive plasma cells are commonly seen in autoimmune pancreatitis. It has recently become evident that autoimmune pancreatitis is one component of a larger multi-system disease. IgG₄-positive plasma cells have been identified in many extrapancreatic tissues, including the colon, biliary tract, liver, and lungs, and thus the term "IgG₄-related sclerosing disease" has been proposed. Awareness of IgG₄-related sclerosing disease is important, as it has been shown to mimic other conditions like malignancy. This review discusses IgG₄-related colitis and its potential for mimicking inflammatory bowel disease.

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