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Crohn Disease: HELP
Articles from Milan
Based on 255 articles published since 2008
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These are the 255 published articles about Crohn Disease that originated from Milan during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11
1 Guideline ECCO-ESCP Consensus on Surgery for Crohn's Disease. 2018

Bemelman, Willem A / Warusavitarne, Janindra / Sampietro, Gianluca M / Serclova, Zuzana / Zmora, Oded / Luglio, Gaetano / de Buck van Overstraeten, Anthony / Burke, John P / Buskens, Christianne J / Colombo, Francesco / Dias, Jorge Amil / Eliakim, Rami / Elosua, Tomás / Gecim, I Ethem / Kolacek, Sanja / Kierkus, Jaroslaw / Kolho, Kaija-Leena / Lefevre, Jérémie H / Millan, Monica / Panis, Yves / Pinkney, Thomas / Russell, Richard K / Shwaartz, Chaya / Vaizey, Carolynne / Yassin, Nuha / D'Hoore, André. ·Department of Surgery, Academic Medical Center [AMC], Amsterdam, The Netherlands. · Department of Surgery, St. Mark's Hospital, Harrow, UK. · Department of Surgery, ASST Fatebenefratelli Sacco - Ospedale "Luigi Sacco" Polo Universitario, Milan, Italy. · Department of Surgery, NH Hospital, a.s., Horovice, Czech Republic. · Department of Surgery, Sheba Medical Center, Tel Hashomer, Israel. · Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy. · Department of Abdominal Surgery, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium. · Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland. · Pediatric Gastroenterology Unit, Hospital S. João [University Hospital], Porto, Portugal. · Department of Gastroenterology and Hepatology, Sheba Medical Center, Tel Hashomer, Israel. · Servicio de Cirugía, Complejo Asistencial Universitario de León, León, Spain. · Colorectal Unit, Ankara University Medical School, Ankara, Turkey. · University Department of Paediatrics and Referral Center for Paediatric Gastroenterology & Nutrition, Children's Hospital Zagreb, Zagreb, Croatia. · Department of Gastroenterology, Hepatology, Feeding Disorders, and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland. · Paediatric Gastroenterology of the Children's Hospital, University of Helsinki, Helsinki, Finland. · Department of General and Digestive Surgery, Hôpital Saint-Antoine and University Paris VI, Paris, France. · Department of Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain. · Department of Colorectal Surgery, Beaujon Hospital [APHP] and University Paris VII Denis-Diderot, Clichy, France. · Academic Department of Surgery, University of Birmingham, Birmingham, UK. · Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK. · Department of Surgery, Sheba Medical Center, Ramat Gan, Israel. · IBD Unit, University of Birmingham, Birmingham, St Mark's Hospital, London, UK. ·J Crohns Colitis · Pubmed #28498901.

ABSTRACT: -- No abstract --

2 Guideline Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. 2015

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

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

3 Editorial Beyond remission and mucosal healing in Crohn's disease. Exploring the deep with cross sectional imaging. 2017

Maconi, Giovanni / Armuzzi, Alessandro. ·Gastroenterology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy. Electronic address: giovanni.maconi@unimi.it. · IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy. Electronic address: alearmuzzi@yahoo.com. ·Dig Liver Dis · Pubmed #28449813.

ABSTRACT: -- No abstract --

4 Editorial Diagnostic Delay in Crohn's Disease: Time for Red Flags. 2016

Fiorino, Gionata / Danese, Silvio. ·Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy. · Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy. sdanese@hotmail.com. · Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089, Rozzano, Milan, Italy. sdanese@hotmail.com. ·Dig Dis Sci · Pubmed #27638835.

ABSTRACT: -- No abstract --

5 Editorial Adalimumab and Azathioprine Combination Therapy for Crohn's Disease: A Shining Diamond? 2016

Fiorino, Gionata / Danese, Silvio. ·Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy sdanese@hotmail.com. · Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy. ·J Crohns Colitis · Pubmed #27389085.

ABSTRACT: -- No abstract --

6 Editorial Anal Fistula Plug for Perianal Fistulising Crohn's Disease: an Important Trial for Inflammatory Bowel Disease Surgeons. 2016

Spinelli, Antonino / Kotze, Paulo Gustavo. ·Division of Colon and Rectal Surgery, Humanitas Research Hospital, University of Milan, Rozzano, Milano, Italy antonino.spinelli@humanitas.it. · Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil. ·J Crohns Colitis · Pubmed #26363516.

ABSTRACT: -- No abstract --

7 Editorial Targeting lymphatics in inflammatory bowel disease. 2015

D'Alessio, Silvia / Tacconi, Carlotta / Danese, Silvio. ·Humanitas Clinical and Research Center, IBD Center, Rozzano, Italy. ·Oncotarget · Pubmed #26452136.

ABSTRACT: -- No abstract --

8 Editorial Comparing techniques to achieve high accuracy and low cost: how should we first diagnose Crohn's disease? 2015

Maconi, Giovanni / Magro, Ferdinando. ·Gastroenterology Unit, Department of Biomedical & Clinical Sciences, L. Sacco University Hospital, Via G.B. Grassi, 74, 20157 Milan, Italy. ·J Comp Eff Res · Pubmed #25825838.

ABSTRACT: -- No abstract --

9 Editorial Editorial. Medical challanges in inflammatory bowel disease: quo vadis in disease complexity? 2014

Danese, Silvio / Peyrin-Biroulet, Laurent. ·IBD Center, Humanitas Research Hospital Milan Italy. sdanese@hotmail.com. ·Curr Drug Targets · Pubmed #25213176.

ABSTRACT: -- No abstract --

10 Editorial Regulatory T-cell therapy for Crohn's disease: in vivo veritas. 2012

Danese, Silvio / Fiorino, Gionata / Rutella, Sergio. ·IBD Center, Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy. Electronic address: sdanese@hotmail.com. · IBD Center, Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy. · Pediatric Hematology/Oncology and Transfusion Medicine, IRCCS Bambino Gesù Children's Hospital, Rome, Italy. ·Gastroenterology · Pubmed #23000230.

ABSTRACT: -- No abstract --

11 Review Darvadstrocel for the treatment of patients with perianal fistulas in Crohn's disease. 2019

Kotze, P G / Spinelli, A / Warusavitarne, J / Di Candido, F / Sahnan, K / Adegbola, S O / Danese, S. ·IBD Unit, Health Sciences Postgraduate Program (PPGCS), Catholic University of Paraná (PUCPR), Curitiba, Brazil. pgkotze@hotmail.com. · Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. · Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow, UK; Department of Surgery and Cancer, Imperial College, London, UK. · Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. · Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. ·Drugs Today (Barc) · Pubmed #30816884.

ABSTRACT: Despite significant advances in medical and surgical therapy for perianal fistulas in Crohn's disease (CD), treatment results are still modest, and a specific need for more effective therapies is a reality. Darvadstrocel is composed of expanded human allogeneic mesenchymal adult stem cells extracted from adipose tissue and constitutes the first stem cell therapy for perianal fistulizing CD to receive approval from the European Medicines Agency (EMA). This therapy is injected in both internal and external openings, as well as inside the fistula tracks, to induce fistula healing. In this monograph, the authors review the preclinical pharmacology of darvadstrocel, as well as pharmacokinetics and metabolism, and cover the main indications and detailed information on the efficacy and safety profile of the agent. Possible interactions with other agents used to treat CD are also explored. Darvadstrocel is a safe and effective therapy for perianal complex fistulas in CD, and represents the beginning of a new era of mesenchymal stem cell therapy in this difficult phenotype of the disease.

12 Review Fistula-associated anal carcinoma in Crohn's disease. 2018

Yamamoto, Takayuki / Kotze, Paulo Gustavo / Spinelli, Antonino / Panaccione, Remo. ·a Inflammatory Bowel Disease Center & Department of Surgery , Yokkaichi Hazu Medical Center , Yokkaichi , Japan. · b Colorectal Surgery Unit , Catholic University of Parana (PUCPR) , Curitiba , Brazil. · c Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology , University of Calgary , Calgary , Canada. · d Department of Biomedical Sciences , Humanitas University , Milano , Italy. · e Division of Colon and Rectal Surgery , Humanitas Clinical and Research Center , Milano , Italy. ·Expert Rev Gastroenterol Hepatol · Pubmed #29999429.

ABSTRACT: INTRODUCTION: Fistula-associated anal carcinoma in patients with Crohn's disease (CD) is a rare condition. More recently, this entity has been increasingly reported likely due to increased recognition, and the incidence may be greater than once appreciated. There remains a paucity of data regarding the incidence, diagnosis, treatment, and outcome of fistula-associated anal carcinoma. Area covered: This review evaluates the clinical features, pathology, treatment, and prognosis of fistula-associated anal carcinoma in patients with CD. A strategy for surveillance of this carcinoma is proposed by the authors based on the evidence obtained from this review. Expert commentary: Clinicians caring for patients with CD and perianal involvement need to be aware of the rare yet extremely important association of long-standing perianal disease and fistula-associated carcinoma. Only through awareness, a high level of suspicion will be diagnosed in a timely manner. This involves a thorough history, a proper, and complete anorectal examination, along with early imaging and examination under anesthesia. Through this approach, it is hoped that early diagnose can be achieved in at-risk patients and change the significant morbidity and mortality associated with this diagnosis.

13 Review PF-00547659 for the treatment of Crohn's disease and ulcerative colitis. 2018

Allocca, Mariangela / Gilardi, Daniela / Fiorino, Gionata / Furfaro, Federica / Argollo, Marjorie / Peyrin-Biroulet, Laurent / Danese, Silvio. ·a IBD Centre, Humanitas Clinical and Research Centre , Milan , Italy. · b Gastroenterology and Inserm U954, University Hospital of Nancy , Nancy , France. · c Department of Biomedical Sciences , Humanitas University , Milan , Italy. ·Expert Opin Investig Drugs · Pubmed #29985060.

ABSTRACT: INTRODUCTION: Gut-specific homing is mainly mediated by the expression of MAdCAM-1 on endothelial cells. An increase in MAdCAM-1 expression has been shown in patients with inflammatory bowel disease (IBD). Areas covered: PF-00547659 is a fully human monoclonal antibody (mAb) toward MAdCAM-1 on endothelial cells, blocking its binding with the α4β7 integrin on leukocytes. This review discusses the available data on effectiveness and safety of PF-00547659 in IBD. Expert opinion: A phase II study in moderate-to-severe ulcerative colitis (UC) patients, both naïve and previously exposed to anti-tumor necrosis factors, showed that PF-00547659 was superior to placebo for induction of remission, response, and mucosal healing at week 12. In contrast, preliminary results in a similar study in Crohn's disease (CD) did not show a superiority of PF-00547659, suggesting that PF-00547659 may have limited impact over CD outcomes. However, the time frame needed to evaluate clinical effectiveness of PF-00547659 may be longer in CD patients, given its transmural characteristic. In addition, it should be taken into consideration the possibility of incorporating new tools and more objective parameters in disease assessment that are proven to better correlate with inflammation. Future randomized-controlled trials are needed to confirm the efficacy of PF-00547659 in CD.

14 Review Janus kinase inhibitors for the treatment of inflammatory bowel diseases: developments from phase I and phase II clinical trials. 2018

D'Amico, Ferdinando / Fiorino, Gionata / Furfaro, Federica / Allocca, Mariangela / Danese, Silvio. ·a Department of Biomedical Sciences , Humanitas University , Milan , Italy. · b IBD Center, Department of Gastroenterology , Humanitas Clinical and Research Institute , Milan , Italy. ·Expert Opin Investig Drugs · Pubmed #29938545.

ABSTRACT: INTRODUCTION: A new pharmacological class, Janus kinases (JAK) inhibitors, has been shown to be effective and safe for the treatment of inflammatory bowel diseases (IBDs). The aim of this review is to provide an overview of the JAK inhibitors currently under investigation in phase I and II clinical trials for patients with Crohn's disease and ulcerative colitis and the possible future perspectives for the treatment of IBD patients with this class of drugs. AREAS COVERED: This review describes the JAK-STAT pathway and analyzes the efficacy and safety of new small molecules such as filgotinib, upadacitinib, TD-1473, peficitinib, and Pf-06651600/Pf-06700841, showing data from phase I and II trials. EXPERT OPINION: JAK inhibitors, if approved by the regulatory authorities, could represent a novel and intriguing drug class. In the next years, the approach to patients with IBD will become increasingly personalized.

15 Review The intriguing role of Rifaximin in gut barrier chronic inflammation and in the treatment of Crohn's disease. 2018

Lopetuso, Loris R / Napoli, Marco / Rizzatti, Gianenrico / Gasbarrini, Antonio. ·a Department of Internal Medicine and Gastroenterology , Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore , Roma , Italy. ·Expert Opin Investig Drugs · Pubmed #29865875.

ABSTRACT: INTRODUCTION: The gastrointestinal tract acts as a functional unit organized as a semipermeable multilayer system, in which commensal gut microbiota represents the anatomical barrier. Recently, several studies have highlighted the involvement of gut microbiota in inflammatory bowel diseases (IBD) pathogenesis, in sustaining gut barrier chronic inflammation, and in conditioning disease course and therapeutical response. This evidence provides a rationale for treating patients with gut microbiota modifiers. Among these, Rifaximin represents a non-traditional antibiotic able to act as a 'eubiotic' on intestinal barrier. AREAS COVERED: The purpose of this narrative review is to explore the impact of Rifaximin on gut barrier and gut microbiota in IBD, in particular in Crohn's disease (CD), and to analyze its potential therapeutic applications. EXPERT OPINION: The possibility of a beneficial activity of Rifaximin in chronic intestinal inflammation and CD has been debated and evaluated with different studies having obtained promising but still preliminary data. Larger trials are therefore needed. This gut-specific antibiotic could represent an alternative to systemic antibiotics thanks to its favorable safety profile and promising efficacy data. Rifaximin could exert, when appropriate, a synergic effect with immunomodulators in IBD, acting on both the microbial and the immunological sides of gut barrier impairment.

16 Review Diffusion-weighted MRI in inflammatory bowel disease. 2018

Pouillon, Lieven / Laurent, Valérie / Pouillon, Marc / Bossuyt, Peter / Bonifacio, Christiana / Danese, Silvio / Deepak, Parakkal / Loftus, Edward V / Bruining, David H / Peyrin-Biroulet, Laurent. ·Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France; Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium. · Department of Radiology, Nancy University Hospital, Université de Lorraine, Nancy, France. · Department of Radiology, GZA Ziekenhuizen, Antwerp, Belgium. · Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium. · Department of Radiology, Humanitas Research Hospital, Milan, Italy. · Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy. · Division of Gastroenterology, Washington University in St Louis School of Medicine, St Louis, MO, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA. · Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France. Electronic address: peyrinbiroulet@gmail.com. ·Lancet Gastroenterol Hepatol · Pubmed #29739674.

ABSTRACT: Cross-sectional MRI is an attractive alternative to endoscopy for the objective assessment of patients with inflammatory bowel disease (IBD). Diffusion-weighted imaging is a specialised technique that maps the diffusion of water molecules in biological tissues and can be done without intravenous gadolinium contrast injection. Diffusion-weighted imaging further expands the capability of traditional MRI sequences in IBD. However, the use of quantitative parameters, such as the apparent diffusion coefficient, is limited by low reproducibility. The Nancy score is a luminal disease activity index applied in diffusion-weighted imaging, and comprises only qualitative parameters. The score is accurate in Crohn's disease and ulcerative colitis, and requires no fasting or bowel preparation for assessment of colonic disease. However, deficiency of anatomic detail limits the use of diffusion-weighted imaging for assessment of intra-abdominal Crohn's disease complications. The contribution of such imaging in the prediction of disease course and treatment response in patients with IBD remains to be determined.

17 Review Ustekinumab in the management of Crohn's disease: Expert opinion. 2018

Armuzzi, Alessandro / Ardizzone, Sandro / Biancone, Livia / Castiglione, Fabiana / Danese, Silvio / Gionchetti, Paolo / Orlando, Ambrogio / Rizzello, Fernando / Scribano, Maria Lia / Vecchi, Maurizio / Daperno, Marco. ·IBD Unit Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy. Electronic address: alessandro.armuzzi@unicatt.it. · UOC Gastroenterologia e Endoscopia Digestiva ASST Fatebenefratelli Sacco - DIBIC "L. Sacco" Università degli Studi, Milan, Italy. · Università degli Studi di Roma "Tor Vergata", Rome, Italy. · Gastroenterologia Università "Federico II" di Napoli, Naples, Italy. · Department of Gastroenterology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. · IBD Unit, DIMEC, University of Bologna, S Orsola-Malpighi Hospital Bologna, Italy. · UOSD MICI AO Osp. Riuniti "Villa Sofia-Cervello", Palermo, Italy. · IBD Unit, San Camillo-Forlanini Hospital, Rome, Italy. · Department of Biomedical Sciences for Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Gastroenterology Unit, Mauriziano Hospital, Turin, Italy. ·Dig Liver Dis · Pubmed #29610019.

ABSTRACT: This expert-opinion paper reviews available evidence for the use of ustekinumab, a human interleukin 12/23 monoclonal antibody, in the treatment of Crohn's disease and discusses its potential role in the current treatment scenario for the condition. Ustekinumab appears to be associated with rapid and sustained clinical effect, as reported from the clinical research program, with additional support for potential mucosal healing. These characteristics are paralleled by a favorable safety profile, lack of immunogenicity and the presence of systemic anti-inflammatory activity. Importantly, ustekinumab requires only one single intravenous administration, while subsequent dosing is administered subcutaneously, with potential advantages for home-based therapy. Lastly, the dosage of ustekinumab is flexible. On the basis of the evidence, ustekinumab has a role in patients with primary failure or secondary loss of response to anti-tumor necrosis factor agents, as well as in those who have adverse events on front-line biologics or are reinitiating therapy after a treatment holiday. Current evidence suggests that ustekinumab may be particularly suitable in patients who present extra-intestinal manifestations of the disease or are at risk of infections. Ustekinumab may also be considered in the first-line setting, especially in frail patients, in young subjects or in those who have concomitant immune-mediated diseases.

18 Review Identification of Endpoints for Development of Antifibrosis Drugs for Treatment of Crohn's Disease. 2018

Danese, Silvio / Bonovas, Stefanos / Lopez, Anthony / Fiorino, Gionata / Sandborn, William J / Rubin, David T / Kamm, Michael A / Colombel, Jean-Frederic / Sands, Bruce E / Vermeire, Severine / Panes, Julian / Rogler, Gerhard / D'Haens, Geert / Peyrin-Biroulet, Laurent. ·Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Humanitas Clinical and Research Center, Milan, Italy. Electronic address: sdanese@hotmail.com. · Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Humanitas Clinical and Research Center, Milan, Italy. · Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France. · IBD Center, Humanitas Clinical and Research Center, Milan, Italy. · University of California San Diego, La Jolla, California. · University of Chicago Medicine, Chicago, Illinois. · Departments of Gastroenterology and Medicine, St Vincent's Hospital and University of Melbourne, Melbourne, Australia. · Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium. · Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. · Department of Gastroenterology and Hepatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland. · Academic Medical Center, Amsterdam, The Netherlands. ·Gastroenterology · Pubmed #29601825.

ABSTRACT: BACKGROUND & AIMS: Intestinal fibrosis is a challenge to management of patients with Crohn's disease (CD); there is an urgent need to expedite development of antifibrosis drugs for this disease. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) aimed to identify a set of endpoints that can be used to determine efficacy of antifibrosis agents tested in clinical trials of patients with CD. METHODS: We conducted a systematic review to identify clinical, radiologic, biochemical, endoscopic, and composite endpoints used in assessing activity of fibrostenosing CD and response to treatment, and determined their operational properties. A panel of IOIBD experts performed a consensus process to identify the best endpoints for inclusion in clinical trials, through a 2-round, Delphi-style online survey. RESULTS: A total of 36 potentially relevant endpoints for intestinal fibrosis were selected and assessed. Forty-eight physicians with expertise in inflammatory bowel disease, from 5 regions (North America, Europe, Middle East, Asia/Pacific, and Latin America), participated in the Delphi consensus process. A core set of 13 endpoints (complete clinical response, long-term efficacy, sustained clinical benefit, treatment failure, radiological remission, normal quality of life, clinical remission without steroids, therapeutic failure, deep remission, complete absence of occlusive symptoms, symptom-free survival, bowel damage progression, and no disability) were rated as critical. Agreement was high among the experts. CONCLUSIONS: Members of the IOIBD reached expert consensus on a set of endpoints that can be used to assess antifibrosis agents in trials of patients with CD. Studies are needed to clarify methods for measuring these outcomes and validate measurement instruments.

19 Review Vedolizumab for the treatment of Crohn's disease. 2018

Argollo, Marjorie / Fiorino, Gionata / Peyrin-Biroulet, Laurent / Danese, Silvio. ·a Department of Gastroenterology , Universidade Federal de São Paulo - UNIFESP , São Paulo , Brazil. · b IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Milan , Italy. · c Department of Gastroenterology and Inserm U954 , Nancy University Hospital, Lorraine University , Vandoeuvre , France. · d Department of Biomedical Sciences , Humanitas University , Milan , Italy. ·Expert Rev Clin Immunol · Pubmed #29406811.

ABSTRACT: INTRODUCTION: Crohn's disease (CD) is an immune-mediated condition characterized by inflammation of the gut tissue, associated with progressive damage of the affected intestinal tract and possible complications. A treat-to-target approach is strongly advocated, consisting of early and aggressive inflammatory control. However, a great proportion of affected subjects lack response or are intolerant to conventional therapy. Even though the first-line biologic therapy targeting tumor necrosis factor-alfa (TNF-α) is associated with improvement of inflammation in some patients, others do not respond at first or lose response over time. These findings brought about the possibility of different mechanisms being involved in perpetuating the chronic inflammatory state. Novel drugs targeting different inflammatory pathways have been studied in CD, specifically addressed to leucocyte trafficking. Areas covered: We aim to review the relevant data available in the literature and briefly summarize the efficacy and safety profile of vedolizumab in the treatment of CD. Expert commentary: Vedolizumab has shown, from pivotal and real-life data, significant clinical benefit among CD patients, in addition to a singular safety profile. Future studies will provide helpful data concerning its use in special situations.

20 Review Advanced endoscopic imaging for diagnosis of inflammatory bowel diseases: Present and future perspectives. 2018

Sivanathan, Visvakanth / Tontini, Gian Eugenio / Möhler, Markus / Galle, Peter R / Neumann, Helmut. ·Department of Interdisciplinary Endoscopy, I. Medizinische Klinik und Poliklinik, University Hospital, Mainz, Germany. · Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, Milan, Italy. ·Dig Endosc · Pubmed #29360261.

ABSTRACT: Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) causing severe damage of the luminal gastrointestinal tract. Differential diagnosis between both disease entities is sometimes awkward requiring a multifactorial pathway, including clinical and laboratory data, radiological findings, histopathology and endoscopy. Apart from disease diagnosis, endoscopy in IBD plays a major role in prediction of disease severity and extent (i.e. mucosal healing) for tailored patient management and for screening of colitis-associated cancer and its precursor lesions. In this state-of-the-art review, we focus on current applications of endoscopy for diagnosis and surveillance of IBD. Moreover, we will discuss the latest guidelines on surveillance and provide an overview of the most recent developments in the field of endoscopic imaging and IBD.

21 Review Modern management of perianal fistulas in Crohn's disease: future directions. 2018

Kotze, Paulo Gustavo / Shen, Bo / Lightner, Amy / Yamamoto, Takayuki / Spinelli, Antonino / Ghosh, Subrata / Panaccione, Remo. ·Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada. · Interventional IBD Unit, Cleveland Clinic Foundation, Cleveland, Ohio, USA. · Division of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. · IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan. · Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Italy. · Institute of Translational Medicine, University of Birmingham, Birmingham, UK. ·Gut · Pubmed #29331943.

ABSTRACT: Perianal fistulae in patients with Crohn's disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%. More recently, newer biologics, cell-based therapies as well as novel endoscopic and surgical techniques have been introduced raising new hopes that outcomes can be improved upon. In this review, we describe the modern management and the most recent advances in the management of complex perianal fistulising CD, which will likely impact clinical practice. We will explore optimal use of both older and newer biological agents, as well as new data on cell-based therapies. In addition, new techniques in endoscopic and surgical approaches will be discussed.

22 Review Autologous Haematopoietic Stem Cell Transplantation (AHSCT) in Severe Crohn's Disease: A Review on Behalf of ECCO and EBMT. 2018

Snowden, John A / Panés, Julián / Alexander, Tobias / Allez, Matthieu / Ardizzone, Sandro / Dierickx, Daan / Finke, Jürgen / Hasselblatt, Peter / Hawkey, Chris / Kazmi, Majid / Lindsay, James O / Onida, Francesco / Salas, Azucena / Saccardi, Riccardo / Vermeire, Severine / Rovira, Montserrat / Ricart, Elena / Anonymous1300933 / Anonymous1310933 / Anonymous1320933 / Anonymous1330933. ·Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK. · Department of Gastroenterology, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain. · Department of Rheumatology and Clinical Immunology, Charité - University Medicine, Berlin, Germany. · Department of Gastroenterology, Hôpital Saint Louis, APHP, INSERM U1160, Paris Diderot, Sorbonne Paris-Cité University, Paris, France. · DIBIC - ASST Fatebenefratelli Sacco - University of Milan, Italy. · Department of Haematology, University Hospitals, Leuven, Belgium. · Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK. · Department of Haematology, Guys & St Thomas' NHS Foundation Trust, London, UK. · The Royal London Hospital, Barts Health NHS Trust, London UK & Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Italy. · Department of Haematology, Careggi University Hospital, Firenze, Italy. · Department of Gastroenterology - University Hospitals, Leuven, Belgium. · BMT Unit, Hematology Department, IDIBAPS, Hospital Clinic. Josep Carreras Leukaemia Research Institute (IJC), Barcelona, Spain. ·J Crohns Colitis · Pubmed #29325112.

ABSTRACT: Despite the major recent progress in the treatment of Crohn's disease [CD], there is a subset of patients in whom the disease runs an aggressive course with progressive tissue damage requiring early and repeated surgical management. Increasing evidence supports sustained and profound improvement in gastrointestinal parameters and quality of life following high-dose immunosuppressive therapy and autologous haematopoietic stem cell transplantation [AHSCT] compared to standard therapy in this context. In addition, international transplant registry data reflect the use of AHSCT in CD outside of trials in selected patients. However, AHSCT may be associated with significant treatment-related complications with risk of transplant-related mortality. In a joint initiative, the European Crohn's and Colitis Organisation [ECCO] and the European Society for Blood and Marrow Transplantation [EBMT] have produced a state-of-the-art review of the rationale, evaluation, patient selection, stem cell mobilization and transplant procedures and long-term follow up. Given the unique spectrum of issues, we recommend that AHSCT should only be performed in experienced centres with expertise in both haematological and gastroenterological aspects of the procedure. Where possible, patients should be enrolled on clinical trials and data registered centrally. Future development should be coordinated at both national and international levels.

23 Review Bowel Sonoelastography in Patients with Crohn's Disease: A Systematic Review. 2018

Pescatori, Lorenzo Carlo / Mauri, Giovanni / Savarino, Edoardo / Pastorelli, Luca / Vecchi, Maurizio / Sconfienza, Luca Maria. ·Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy. Electronic address: lorenzo.carlo.pescatori@gmail.com. · Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Milan, Italy. · Divisione di Gastroenterologia, Dipartimenti di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padua, Italy. · Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy. · Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. ·Ultrasound Med Biol · Pubmed #29195757.

ABSTRACT: Sonoelastography is an ultrasound-based method for evaluating the biological properties of a target tissue. It is commonly used in the diagnosis of liver and thyroid disease, but recently its use for monitoring the characteristics of bowel wall in patients affected by Crohn's disease (CD) has been proposed. Our aim was a systematic review of the use of sonoelastography in patients with CD. An initial database search retrieved 32 possible articles. On initial screening, 7 articles, concerning a total of 129 patients and 154 lesions of the small and large bowel, were finally included in the review. The age range varied between 6 and 53 y, and disease duration ranged between 1 and 623 mo. We collected data on the examinations performed (type and time), bowel area considered and parameters evaluated. All authors found that elastography correlates well with the degree of fibrosis, as wall strain significantly decreases in segments affected by fibrotic stenosis. Even though the endpoints proposed in the various articles are relatively inhomogeneous and scarcely comparable, we found that sonoelastography is a promising tool in the evaluation of patients with CD as it can differentiate inflammatory and fibrotic strictures in small case series.

24 Review Review article: the gut microbiome in inflammatory bowel disease-avenues for microbial management. 2018

McIlroy, J / Ianiro, G / Mukhopadhya, I / Hansen, R / Hold, G L. ·School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. · Internal Medicine, Gastroenterology and Liver Unit, Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. · Royal Hospital for Children, Glasgow, UK. ·Aliment Pharmacol Ther · Pubmed #29034981.

ABSTRACT: BACKGROUND: The concept of an altered collective gut microbiota rather than identification of a single culprit is possibly the most significant development in inflammatory bowel disease research. We have entered the "omics" era, which now allows us to undertake large-scale/high-throughput microbiota analysis which may well define how we approach diagnosis and treatment of inflammatory bowel disease (IBD) in the future, with a strong steer towards personalised therapeutics. AIM: To assess current epidemiological, experimental and clinical evidence of the current status of knowledge relating to the gut microbiome, and its role in IBD, with emphasis on reviewing the evidence relating to microbial therapeutics and future microbiome modulating therapeutics. METHODS: A Medline search including items 'intestinal microbiota/microbiome', 'inflammatory bowel disease', 'ulcerative colitis', 'Crohn's disease', 'faecal microbial transplantation', 'dietary manipulation' was performed. RESULTS: Disease remission and relapse are associated with microbial changes in both mucosal and luminal samples. In particular, a loss of species richness in Crohn's disease has been widely observed. Existing therapeutic approaches broadly fall into 3 categories, namely: accession, reduction or indirect modulation of the microbiome. In terms of microbial therapeutics, faecal microbial transplantation appears to hold the most promise; however, differences in study design/methodology mean it is currently challenging to elegantly translate results into clinical practice. CONCLUSIONS: Existing approaches to modulate the gut microbiome are relatively unrefined. Looking forward, the future of microbiome-modulating therapeutics looks bright with several novel strategies/technologies on the horizon. Taken collectively, it is clear that ignoring the microbiome in IBD is not an option.

25 Review European Crohn's and Colitis Organisation Topical Review on Treatment Withdrawal ['Exit Strategies'] in Inflammatory Bowel Disease. 2018

Doherty, Glen / Katsanos, Konstantinos H / Burisch, Johan / Allez, Matthieu / Papamichael, Konstantinos / Stallmach, Andreas / Mao, Ren / Berset, Ingrid Prytz / Gisbert, Javier P / Sebastian, Shaji / Kierkus, Jaroslaw / Lopetuso, Loris / Szymanska, Edyta / Louis, Edouard. ·Centre for Colorectal Disease, St Vincent's University Hospital & University College Dublin, Dublin, Ireland. · Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece. · Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark. · Department of Gastroenterology and Hepatology, Hôpital Saint-Louis, APHP, INSERM UMRS 1160, Université Denis Diderot, Paris, France. · Center for Inflammatory Bowel Diseases, Harvard Medical School, Boston, MA, USA. · Department of Internal Medicine IV [Gastroenterology, Hepatology and Infectious Disease], University Hospital Jena, Jena, Germany. · Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. · Gastroenterology Department, Alesund Hospital, Helse More Romsdal Hospital Trust, Alesund, Norway. · Department of Gastroenterology, Hospital Universitario de la Princesa, Instituto de Investigaciun Sanitaria Princesa (IIS-IP) and Centro de Investigaciun Biomédica en Red de Enfermedades Heprticas y Digestivas (CIBEREHD), Madrid, Spain. · IBD Unit, Department of Gastroenterology, Hull & East Yorkshire Hospitals NHS Trust, Hull, UK. · Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland. · Department of Gastroenterology and Internal Medicine, Catholic University of Rome-A. Gemelli Hospital, Rome, Italy. · Department of Pediatrics, Nutrition, and Metabolic Disorders, Children's Memorial Health Institute, Warsaw, Poland. · Department of Gastroenterology, CHU Liège, Sart Tilman, Liège, Belgium. ·J Crohns Colitis · Pubmed #28981623.

ABSTRACT: Clinically effective therapies now exist for remission maintenance in both ulcerative colitis [UC] and Crohn's Disease [CD]. For each major class of IBD medications [5-aminosalicyclates, immunomodulators, and biologic agents], used alone or in combination, there is a risk of relapse following reduction or cessation of treatment. A consensus expert panel convened by the European Crohn's and Colitis Organisation [ECCO] reviewed the published literature and agreed a series of consensus practice points. The objective of the expert consensus is to provide evidence-based guidance for clinical practice so that physicians can make informed decisions in partnership with their patients. The likelihood of relapse with stopping each class of IBD medication is reviewed. Factors associated with an altered risk of relapse with withdrawal are evaluated, and strategies to monitor and allow early identification of relapse are considered. In general, patients in clinical, biochemical, and endoscopic remission are more likely to remain well when treatments are stopped. Reintroduction of the same treatment is usually, but not always, successful. The decision to stop a treatment needs to be individualized, and shared decision making with the patient should take place.

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