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Ulcerative Colitis: HELP
Articles from Beth Israel Deaconess
Based on 61 articles published since 2008
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These are the 61 published articles about Colitis, Ulcerative that originated from Beth Israel Deaconess during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis. 2019

Ko, Cynthia W / Singh, Siddharth / Feuerstein, Joseph D / Falck-Ytter, Corinna / Falck-Ytter, Yngve / Cross, Raymond K / Anonymous1721094. ·Division of Gastroenterology, University of Washington, Seattle, Washington. · Division of Gastroenterology, University of California, San Diego, La Jolla, California. · Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Division of Internal Medicine, Louis Stokes Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio. · Division of Gastroenterology, Case Western Reserve University, and Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio. · Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland. ·Gastroenterology · Pubmed #30576644.

ABSTRACT: -- No abstract --

2 Review AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis. 2019

Singh, Siddharth / Feuerstein, Joseph D / Binion, David G / Tremaine, William J. ·Division of Gastroenterology, University of California, San Diego, La Jolla, California. · Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. ·Gastroenterology · Pubmed #30576642.

ABSTRACT: Most patients with ulcerative colitis (UC) have mild-to-moderate disease activity, with low risk of colectomy, and are managed by primary care physicians or gastroenterologists. Optimal management of these patients decreases the risk of relapse and proximal disease extension, and may prevent disease progression, complications, and need for immunosuppressive therapy. With several medications (eg, sulfasalazine, diazo-bonded 5-aminosalicylates [ASA], mesalamines, and corticosteroids, including budesonide) and complex dosing formulations, regimens, and routes, to treat a disease with variable anatomic extent, there is considerable practice variability in the management of patients with mild-moderate UC. Hence, the American Gastroenterological Association prioritized clinical guidelines on this topic. To inform clinical guidelines, this technical review was developed in accordance with the Grading of Recommendations Assessment, Development and Evaluation framework for interventional studies. Focused questions included the following: (1) comparative effectiveness and tolerability of different oral 5-ASA therapies (sulfalsalazine vs diazo-bonded 5-ASAs vs mesalamine; low- (<2 g) vs standard (2-3 g/d) vs high-dose (>3 g/d) mesalamine); (2) comparison of different dosing regimens (once-daily vs multiple times per day dosing) and routes (oral vs rectal vs both oral and rectal); (3) role of oral budesonide in patients mild-moderate UC; (4) comparative effectiveness and tolerability of rectal 5-ASA and corticosteroid formulations in patients with distal colitis; and (5) role of alternative therapies like probiotics, curcumin, and fecal microbiota transplantation in the management of mild-moderate UC.

3 Review Biologics and immunomodulators for treating Crohn's disease developing after surgery for an initial diagnosis of ulcerative colitis: a review of current literature. 2018

Yadav, Abhijeet / Foromera, Joshua / Falchuk, Kenneth R / Feuerstein, Joseph D. ·a Department of Medicine and Division of Gastroenterology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA. ·Scand J Gastroenterol · Pubmed #29719998.

ABSTRACT: Crohn's Disease (CD) or CD-like (CDL) conditions of the pouch are rare long-term inflammatory complications of patients who were initially diagnosed with ulcerative colitis (UC) who undergo total proctocolectomy with ileo-anal anastomosis (IPAA). There are no societal guidelines nor a consensus on their treatment, resulting in significant challenges for clinicians for their diagnosis and management. It is important to differentiate them from other more common pouch-related complications like pouchitis, cuffitis, irritable pouch syndrome, surgery associated stricture, and fistula. In this review, we focus on the less common presentation of CD and CDL conditions of the pouch and their treatment with the use of anti-TNF therapy with or without immunomodulator.

4 Review Impact of mucosal inflammation on risk of colorectal neoplasia in patients with ulcerative colitis: a systematic review and meta-analysis. 2017

Flores, Brisas M / O'Connor, Anthony / Moss, Alan C. ·Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. · Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom. ·Gastrointest Endosc · Pubmed #28750838.

ABSTRACT: BACKGROUND AND AIMS: Long-standing ulcerative colitis is an established risk factor for colorectal neoplasia. A number of observational studies have suggested that evidence of mucosal inflammation (endoscopic or histologic) is associated with a greater risk for colorectal neoplasia than is mucosal healing. Our goal was to systematically analyze the risk of colorectal neoplasia in patients with ulcerative colitis who have ongoing mucosal inflammation to better inform surveillance strategies. METHODS: We performed a systematic review and meta-analysis of the effect of endoscopic and/or histologic inflammation on the risk of colorectal neoplasia in cohort and case-control studies. Sensitivity analyses for study setting and case definition were performed. RESULTS: Six studies met the inclusion criteria, incorporating outcomes in 1443 patients. No study used a single validated measure for mucosal inflammation. The pooled odds ratio for colorectal neoplasia was 3.5 (95% confidence interval [CI], 2.6-4.8; P < .001) in those with any mucosal inflammation and 2.6 (95% CI, 1.5-4.5; P = .01) in those with histologic inflammation, when compared with those with mucosal healing. The overall quality of the studies was good. CONCLUSION: The presence of objective evidence of mucosal inflammation during follow-up in patients with ulcerative colitis is associated with a greater risk of subsequent colorectal neoplasia than in those with mucosal healing. This risk factor should be considered in guidelines on surveillance intervals for these patients.

5 Review Optimizing Biologic Agents in Ulcerative Colitis and Crohn's Disease. 2015

O'Toole, Aoibhlinn / Moss, Alan C. ·Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA. ·Curr Gastroenterol Rep · Pubmed #26188882.

ABSTRACT: The goals of therapy in inflammatory bowel disease (IBD) are the induction and maintenance of clinical and biological remission. Mucosal healing is desirable to prevent complications and reduce the need for surgery, hospitalizations, and steroid exposure. Therapeutic monoclonal antibodies (biologic agents) have revolutionized the treatment of IBD. The initial magnitude of the clinical/biologic response to these agents has been associated with a number of underlying phenotypic features in the recipient. In addition, the durability of the initial response often declines over time. This can occur due to low drug serum drug levels, anti-drug antibodies, and a shift to alternative inflammatory pathways. This review discusses strategies that may optimize the initial response to biologics and sustain this to improve patient outcomes.

6 Review Ulcerative colitis: epidemiology, diagnosis, and management. 2014

Feuerstein, Joseph D / Cheifetz, Adam S. ·Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: jfeuerst@bidmc.harvard.edu. · Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. ·Mayo Clin Proc · Pubmed #25199861.

ABSTRACT: Ulcerative colitis is a chronic idiopathic inflammatory bowel disease characterized by continuous mucosal inflammation that starts in the rectum and extends proximally. Typical presenting symptoms include bloody diarrhea, abdominal pain, urgency, and tenesmus. In some cases, extraintestinal manifestations may be present as well. In the right clinical setting, the diagnosis of ulcerative colitis is based primarily on endoscopy, which typically reveals evidence of continuous colonic inflammation, with confirmatory biopsy specimens having signs of chronic colitis. The goals of therapy are to induce and maintain remission, decrease the risk of complications, and improve quality of life. Treatment is determined on the basis of the severity of symptoms and is classically a step-up approach. 5-Aminosalycilates are the mainstay of treatment for mild to moderate disease. Patients with failed 5-aminosalycilate therapy or who present with more moderate to severe disease are typically treated with corticosteroids followed by transition to a steroid-sparing agent with a thiopurine, anti-tumor necrosis factor agent, or adhesion molecule inhibitor. Despite medical therapies, approximately 15% of patients still require proctocolectomy. In addition, given the potential risks of complications from the disease itself and the medications used to treat the disease, primary care physicians play a key role in optimizing the preventive care to reduce the risk of complications.

7 Review A fatal case of diffuse enteritis after colectomy for ulcerative colitis: a case report and review of the literature. 2014

Feuerstein, Joseph D / Shah, Sveta / Najarian, Robert / Nagle, Deborah / Moss, Alan C. ·Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. · Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. · Department of Surgery and Division of Colo-Rectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ·Am J Gastroenterol · Pubmed #24989103.

ABSTRACT: -- No abstract --

8 Review The meaning of low-grade inflammation in clinically quiescent inflammatory bowel disease. 2014

Moss, Alan C. ·Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. ·Curr Opin Gastroenterol · Pubmed #24811053.

ABSTRACT: PURPOSE OF REVIEW: Low-grade inflammation can persist in many patients with inflammatory bowel disease (IBD) who have otherwise obtained clinical remission. This review will summarize the prognostic implications of this finding for patients. RECENT FINDINGS: At least 40% of patients with IBD in clinical remission have ongoing histological evidence of inflammation, despite continued use of maintenance therapy. Follow-up endoscopy and biopsy is the current gold standard for identifying these patients. Recent studies have suggested that an elevated C-reactive protein is associated with underlying histological abnormalities in this setting. Patients with histological inflammation at baseline are at increased risk of clinical relapse, hospitalization, surgery, and colon cancer in observational longitudinal studies. Even when endoscopic healing has been achieved, the presence of underlying architectural changes on biopsies can identify patients at a higher risk of complications. Prospective studies to determine if 'histological healing' provides additional outcome benefits beyond endoscopic or clinical remission alone have not been performed to date, but warrant inclusion in future trials. SUMMARY: Chronic low-grade inflammation is common in patients with IBD in clinical remission. Clinicians should actively try to identify these patients and consider a lower threshold for intervention to reduce their higher risk of adverse outcomes over time.

9 Review Current and emerging maintenance therapies for ulcerative colitis. 2014

O'Connor, Anthony / Moss, Alan C. ·Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. ·Expert Rev Gastroenterol Hepatol · Pubmed #24650224.

ABSTRACT: Ulcerative colitis (UC) is a chronic idiopathic intestinal disease that requires life-long maintenance therapy to maintain clinical remission. This article reviews the current literature on maintenance treatments in UC. It examines the natural history of the condition and the proposed benefits of treatment. These include improving quality of life parameters, decreasing corticosteroid intake, the prevention of relapse, the prevention of colorectal cancer and the avoidance of colectomy. The immunosuppressive era appears to be reducing the need for elective colectomy in UC. The article explores the classes of drug currently used for maintenance of UC, reviews the literature around adherence issues, and summarizes emerging agents in this space.

10 Review Heme oxygenase-1 and carbon monoxide regulate intestinal homeostasis and mucosal immune responses to the enteric microbiota. 2014

Onyiah, Joseph C / Sheikh, Shehzad Z / Maharshak, Nitsan / Otterbein, Leo E / Plevy, Scott E. ·Departments of Medicine, Microbiology, and Immunology; University of North Carolina School Medicine; Chapel Hill, NC USA. · Departments of Medicine, Microbiology, and Immunology; University of North Carolina School Medicine; Chapel Hill, NC USA; Department of Gastroenterology and Liver Diseases; Tel Aviv Sourasky Medical Center; Tel Aviv University; Tel Aviv, Israel. · Department of Surgery; Transplant Institute; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston, MA USA. ·Gut Microbes · Pubmed #24637794.

ABSTRACT: Heme oxygenase-1 (HO-1) and its enzymatic by-product carbon monoxide (CO) have emerged as important regulators of acute and chronic inflammation. Mechanisms underlying their anti-inflammatory effects are only partially understood. In this addendum, we summarize current understanding of the role of the HO-1/CO pathway in regulation of intestinal inflammation with a focus on innate immune function. In particular, we highlight our recent findings that HO-1 and CO ameliorate intestinal inflammation through promotion of bacterial clearance. Our work and that of many others support further investigation of this global homeostatic pathway in the human inflammatory bowel diseases (IBDs).

11 Review Management of active Crohn disease. 2013

Cheifetz, Adam S. ·Division of Gastroenterology, Rabb-Rose 425, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. acheifet@bidmc.harvard.edu ·JAMA · Pubmed #23695484.

ABSTRACT: IMPORTANCE: Treatment of Crohn disease is rapidly evolving, with the induction of novel biologic therapies and newer, often more intensive treatment approaches. Knowing how to treat individual patients in this quickly changing milieu can be a challenge. OBJECTIVE: To review the diagnosis and management of moderate to severe Crohn disease, with a focus on newer treatments and goals of care. EVIDENCE REVIEW: MEDLINE was searched from 2000 to 2011. Additional citations were procured from references of select research and review articles. Evidence was graded using the American Heart Association level-of-evidence guidelines. RESULTS: Although mesalamines are still often used to treat Crohn disease, the evidence for their efficacy is lacking. Corticosteroids can be effectively used to induce remission in moderate to severe Crohn disease, but they do not maintain remission. The mainstays of treatment are immunomodulators and biologics, particularly anti-tumor necrosis factor. CONCLUSION AND RELEVANCE: Immunomodulators and biologics are now the preferred treatment options for Crohn disease.

12 Review Efficacy and safety of drugs for ulcerative colitis. 2010

Rosenberg, Laura Noddin / Peppercorn, Mark A. ·Harvard Medical School, Beth Israel Deaconess Medical Center, Center for Inflammatory Bowel Disease, Department of Gastroenterology, 330 Brookline Ave. Boston, MA 02215, USA. ·Expert Opin Drug Saf · Pubmed #20377475.

ABSTRACT: IMPORTANCE OF THE FIELD: Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon that carries considerable burden and morbidity for patients and presents a constant challenge in management for gastroenterologists. Continued advances in medical therapies provide a range of treatment options for patients, but with this is the need to balance the potential benefits of a particular medication with its side effect profile in both the short and the long term. AREAS COVERED IN THIS REVIEW: This article will review the current drugs used in the treatment of UC, including 5-amninosalicylates, antibiotics, steroids, immunomodulators and biologics, with particular attention to their indications, efficacy and toxicity profile. WHAT THE READER WILL GAIN: The reader will gain a comprehensive understanding of the various medical therapies used in the treatment of UC with focus on efficacy and toxicity profiles, allowing providers to choose appropriate medical therapies for their patients. TAKE HOME MESSAGE: The particular agent used depends upon the extent and severity of disease, with mild-to-moderate disease treated with conventional therapy including 5-amninosalicylates. Steroids are used in the short term to bring active disease into remission, and the more aggressive immunomodulators and biologics are reserved for more severe disease given their toxicity profiles.

13 Review Management of acute severe ulcerative colitis. 2009

Doherty, Glen A / Cheifetz, Adam S. ·Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. gdoherty@bidmc.harvard.edu ·Expert Rev Gastroenterol Hepatol · Pubmed #19673626.

ABSTRACT: Ulcerative colitis is a chronic relapsing and remitting inflammatory disorder that can generally be managed successfully with maintenance oral medications. However, approximately 15% of patients with ulcerative colitis will develop a severe exacerbation and require hospitalization. While many patients with acute severe ulcerative colitis will respond to a short course of intravenous corticosteroids, up to a third will fail to improve. In these patients with steroid-refractory colitis, the choice is between rescue medical therapy with ciclosporin or infliximab, or surgery. Well-timed rescue medical therapy is generally safe when administered by experienced physicians, and is effective in the majority of cases. Surgery is unavoidable in some cases, but is the treatment of choice in others. While ileal pouch-anal anastomosis offers the prospect of life without a permanent ileostomy, there are issues with its long-term functional outcome.

14 Review Balsalazide disodium for the treatment of ulcerative colitis. 2008

Patil, Seema A / Moss, Alan C. ·Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. spatil@bidmc.harvard.edu ·Expert Rev Gastroenterol Hepatol · Pubmed #19072352.

ABSTRACT: 5-aminosalicylates remain the first-line treatment for patients with ulcerative colitis. A number of formulations are available for the treatment of active ulcerative colitis, including encapsulated mesalazine and mesalazine in combination with other molecules. Balsalazide is an aminosalicylate prodrug that releases mesalazine in the colon, thus exerting its multiple anti-inflammatory effects in areas of colitis. This review will examine the pharmacological and therapeutic features of balsalazide as an anti-inflammatory agent in ulcerative colitis. The introduction of novel aminosalicylate formulations and an appreciation of their molecular mode of action, has renewed interest in these agents in both maintenance of disease remission and cancer prevention.

15 Review Steroid-refractory severe ulcerative colitis: what are the available treatment options? 2008

Moss, Alan C / Peppercorn, Mark A. ·Harvard Medical School, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. amoss@bidmc.harvard.edu ·Drugs · Pubmed #18547130.

ABSTRACT: Approximately 15% of patients with ulcerative colitis will experience a severe episode requiring hospitalization. Although intravenous corticosteroids are the current first-line therapy for these patients, about 30% of patients do not respond to corticosteroids and require either an alternative anti-inflammatory agent or surgery. Ciclosporin has proven its efficacy in a number of controlled trials in this setting and is characterized by high early response rates. Patients who respond to ciclosporin and avoid colectomy are more likely to retain their colon if they bridge to immunomodulators in the medium term. Infliximab has also demonstrated efficacy in reducing early colectomy rates and longer term data are awaited. Other agents, such as tacrolimus and basiliximab, and leukocytapheresis, have been studied in small trials and may be alternative options. Key issues remain as to what should be first- and second-line therapies, when surgery should be undertaken, and the risk of switching between immunosuppressants in these critical patients.

16 Review Improving delivery of aminosalicylates in ulcerative colitis: effect on patient outcomes. 2008

Fernandez-Becker, Nielsen Q / Moss, Alan C. ·Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. ·Drugs · Pubmed #18484800.

ABSTRACT: Developments in drug delivery technology have expanded the formulations of 5-aminosalicylic acid (5-ASA) available to clinicians over the last 50 years. Delivery of adequate doses of 5-ASA to the colon can be achieved by pH-dependent, delayed-release or pro-drug formulations. Despite some variations in the pharmacokinetics between individual preparations, the clinical effects in induction of response and maintenance of remission in ulcerative colitis appear to be consistent. Direct comparison studies between different preparations have yielded similar results in primary endpoints, although differences in secondary endpoints or post hoc analyses have been noted. The development of delivery methods that allow once-daily administration represents a potential means to improve the low medication adherence rates reported in patients with ulcerative colitis.

17 Review MMX mesalamine: a novel high-dose, once-daily 5-aminosalicylate formulation for the treatment of ulcerative colitis. 2008

Hu, Mary Y / Peppercorn, Mark A. ·Division of Gastroenterology, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA 02215, USA. ·Expert Opin Pharmacother · Pubmed #18377346.

ABSTRACT: BACKGROUND: 5-Aminosalicylate (5-ASA) agents are the first-line therapy for ulcerative colitis (UC). A high-dose, once-daily formulation of 5-ASA known as MMX mesalamine has recently been approved for the treatment of UC. OBJECTIVE: To summarize current data on MMX mesalamine and to discuss its impact on management of UC. METHODS: A systematic review of published literature was performed on PubMed using the search terms 'MMX mesalamine' and 'Lialda'. Abstracts presented at US gastroenterology conferences between 2006 and 2007, were also reviewed. RESULTS: MMX mesalamine uses a novel multi-matrix delivery system to achieve a sustained release of 5-ASA throughout the colon. Clinical trials have demonstrated MMX mesalamine 2.4 g/day or 4.8 g/day to be superior to placebo in inducing remission in active mild to moderate UC. The drug is well tolerated with a safety profile comparable to other oral 5-ASA agents. With a high-dose formulation of 1.2 g 5-ASA per tablet, MMX mesalamine can be administered conveniently at two to four pills once a day. CONCLUSION: MMX mesalamine is the first and only approved once-daily 5-ASA treatment option for patients with UC. It is efficacious for the induction of remission in mild to moderate UC and has a favorable safety profile. With the advantage of low pill burden and easy dosing schedule, it may potentially improve patient compliance and treatment success.

18 Clinical Trial Higher serum vitamin D levels are associated with protective serum cytokine profiles in patients with ulcerative colitis. 2018

Gubatan, John / Mitsuhashi, Shuji / Longhi, Maria Serena / Zenlea, Talia / Rosenberg, Laura / Robson, Simon / Moss, Alan C. ·Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. Electronic address: jgubatan@alumni.harvard.edu. · Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. ·Cytokine · Pubmed #29324259.

ABSTRACT: BACKGROUND & AIMS: Vitamin D has immune modulating effects on cytokines. Serum vitamin D levels are associated with the risk of relapse in patients with ulcerative colitis (UC), through unknown mechanisms. We tested the hypothesis that this beneficial role of vitamin D on UC is mediated through anti-inflammatory serum cytokine profiles. METHODS: Serum samples from a prospective cohort of seventy UC patients in clinical remission were collected and baseline histological and endoscopic scores were recorded at enrollment. Clinical relapse events were recorded over the 12-month follow-up period. Serum vitamin D and cytokines levels (IL-6, IL-8, IL-17A, TNF-α, IFN-γ, IL-4, IL-10) were quantified using ELISA. Linear regression was used to determine correlation between vitamin D and cytokine profiles. Logistic regression models were used to determine the association between serum cytokine profiles and baseline histologic mucosal healing and clinical relapse. RESULTS: Higher serum vitamin D levels positively correlated with higher ratios of IL-4 + IL-10/IL-17A + TNF-α (r = 0.37, P < .01), and IL-4 + IL-10/IL-6 + TNF-α (r = 0.32, P < .01). In multivariate analysis, IL-4 + IL-10/IL-17A + TNF-α ratios at baseline were associated with the presence of histologic mucosal healing (O.R. 1.29, 95% CI 1.02-1.62, P = .03). A higher ratio of serum IL-4 + IL-10 to IL-6 + TNF-α was associated with a reduced risk of clinical relapse (O.R. 0.72, 95% CI 0.58-0.89, P = .003), and longer time to relapse (p = .03), over the 12-month follow-up period. This ratio during remission had an AUC of 0.7 in predicting later clinical relapse. CONCLUSIONS: Vitamin D is associated with anti-inflammatory serum cytokine profiles. Anti-inflammatory cytokine patterns may mediate the protective effects of higher serum vitamin D levels in patients with ulcerative colitis.

19 Clinical Trial Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission. 2013

Rosenberg, Laura / Lawlor, Garrett O / Zenlea, Talia / Goldsmith, Jeffrey D / Gifford, Anne / Falchuk, Kenneth R / Wolf, Jacqueline L / Cheifetz, Adam S / Robson, Simon C / Moss, Alan C. ·Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. ·Inflamm Bowel Dis · Pubmed #23446338.

ABSTRACT: BACKGROUND: Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of active endoscopic disease, and factors associated with it, in patients with UC who are in clinical remission. METHODS: Prospective observational study in a single center. Patients with UC in clinical remission (by Simple Clinical Colitis Activity Index) were enrolled prospectively at the time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo subscore), and histologic score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers. RESULTS: Overall, 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for >6 months, and 86% were currently prescribed maintenance medications. At endoscopy, 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy subscore >0), and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for <6 months (P = 0.001), white blood count (P = 0.01), and C-reactive protein level (P = 0.009). A model combining these 3 variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-to-severe endoscopic activity in patients in clinical remission (area under the curve, 0.86). In an unselected subgroup of patients who had peripheral blood mononuclear cell messenger RNA profiling, GATA3 messenger RNA levels were significantly higher in patients with endoscopic activity. CONCLUSIONS: Duration of clinical remission, white blood count, and C-reactive protein level can predict the probability of ongoing endoscopic activity, despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.

20 Article Meta-analysis comparing the efficacy and adverse events of biologics and thiopurines for Crohn's Disease after surgery for ulcerative colitis. 2018

Yadav, Abhijeet / Kurada, Satya / Foromera, Joshua / Falchuk, Kenneth R / Feuerstein, Joseph D. ·Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: ayadav@bidmc.harvard.edu. · Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: skurada@bidmc.harvard.edu. · Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: joshua.foromera@ucdenver.edu. · Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: kfalchuk@bidmc.harvard.edu. · Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: jfeuerst@bidmc.harvard.edu. ·Dig Liver Dis · Pubmed #29903546.

ABSTRACT: BACKGROUND: Long-term inflammatory complications of IPAA include Crohn's Disease (CD) or "CD-like" (CDL) condition. We performed a meta-analysis to evaluate the efficacy of anti-tumor necrosis factor (anti-TNF) with or without immunomodulator (IM) therapy in this group of patients. METHODS: Literature databases were searched from inception to October 4, 2017. Further searches using references from papers of interest were conducted and, abstracts from major GI conferences were searched. The primary endpoint was: complete clinical response in the two arms. RESULTS: Out of 9 identified studies 4 were included for quantitative analysis. 48% (84/175) were female and mean age was 30.7 years. There was no significant difference in complete clinical response rates, RR 0.58 (95%CI 0.13-2.54, p = 0.5) or partial clinical response rates of RR 0.98 (95%CI 0.52-1.83, p = 0.94). All patients achieved endoscopic and deep remission in the only study reporting these outcomes comparatively in the two arms. There was a trend towards higher risk of major [RR 3.89, (95%C 0.92-16.45 p = 0.09)], and minor adverse events [RR 3.07 (95%CI 0.7-13.52 p = 0.28)] when using anti-TNF therapy compared to anti-TNF with IM. CONCLUSION: We found no difference in outcomes with anti-TNF monotherapy compared to concurrent anti-TNF therapy with IM. Additional studies are needed to define the optimal therapy for CD after IPAA.

21 Article Proactive Infliximab Monitoring Following Reactive Testing is Associated With Better Clinical Outcomes Than Reactive Testing Alone in Patients With Inflammatory Bowel Disease. 2018

Papamichael, Konstantinos / Vajravelu, Ravy K / Vaughn, Byron P / Osterman, Mark T / Cheifetz, Adam S. ·Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA. · Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA. · Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis MN, USA. ·J Crohns Colitis · Pubmed #29590345.

ABSTRACT: Background and Aims: Reactive testing has emerged as the new standard of care for managing loss of response to infliximab in inflammatory bowel disease [IBD]. Recent data suggest that proactive infliximab monitoring is associated with better therapeutic outcomes in IBD. Nevertheless, there are no data regarding the clinical utility of proactive infliximab monitoring after first reactive testing. We aimed to evaluate long-term outcomes of proactive infliximab monitoring following reactive testing compared with reactive testing alone in patients with IBD. Methods: This was a retrospective multicenter cohort study of consecutive IBD patients on infliximab maintenance therapy receiving a first reactive testing between September 2006 and January 2015. Patients were divided into two groups; Group A [proactive infliximab monitoring after reactive testing] and Group B [reactive testing alone]. Patients were followed through December 2015. Time-to-event analysis for treatment failure and IBD-related surgery and hospitalization was performed. Treatment failure was defined as drug discontinuation due to either loss of response or serious adverse event. Results: The study population consisted of 102 [n = 70, 69% with CD] patients [Group A, n = 33 and Group B, n = 69] who were followed for (median, interquartile range [IQR]) 2.7 [1.4-3.8] years. Multiple Cox regression analysis identified proactive following reactive TDM as independently associated with less treatment failure (hazard ratio [HR] 0.15; 95% confidence interval [CI] 0.05-0.51; p = 0.002) and fewer IBD-related hospitalizations [HR: 0.18; 95% CI 0.05-0.99; p = 0.007]. Conclusions: This study showed that proactive infliximab monitoring following reactive testing was associated with greater drug persistence and fewer IBD-related hospitalizations than reactive testing alone.

22 Article Mortality Is Rare Following Elective and Non-elective Surgery for Ulcerative Colitis, but Mild Postoperative Complications Are Common. 2018

Feuerstein, Joseph D / Curran, Thomas / Alosilla, Michael / Cataldo, Thomas / Falchuk, Kenneth R / Poylin, Vitaliy. ·Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street 8E Gastroenterology, Boston, MA, 02215, USA. jfeuerst@bidmc.harvard.edu. · Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Department of Surgery and Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street 8E Gastroenterology, Boston, MA, 02215, USA. ·Dig Dis Sci · Pubmed #29353444.

ABSTRACT: BACKGROUND DATA: Currently, data regarding the rates of morbidity and mortality following non-elective colectomy for ulcerative colitis (UC) are variable. We sought to determine the rates and predictors of 90-day mortality and complications following colectomy for UC. METHODS: Patients undergoing an initial surgery for UC at a tertiary care center between January 2002 and January 2014 were included. Patients were identified using ICD-9 code 556.x. Each record was manually reviewed for demographic information, medical histories, UC history, medications, and data regarding the admission and discharge. Charts were reviewed for mortality and complications within 90 days of surgery. Complications were classified using the Clavien-Dindo classification system. Univariate and multivariate analyses were performed using IBM SPSS Statistics, version 23.0. RESULTS: Two hundred and fifty-eight patients underwent surgery for UC. 69% were elective, and 31% were urgent/emergent. There were no deaths reported within 30 days of surgery. At 90 days, there were 2 deaths in the elective group and 1 death in the urgent/emergent group. The death in the urgent/emergent group was likely related to the initial surgery, while the elective group death was not directly related to the initial surgery for UC. Complications occurred in 47% of patients. There were no significant differences in rates of complications in either surgical cohort. Majority (62%) of the complications were Clavien-Dindo grade 1 or 2 with no difference in the elective or urgent/emergent group. Unplanned readmissions occurred in 24% of cases. CONCLUSION: Surgery for UC is not associated with any mortality at 30 days and very low mortality at 90 days. However, surgery is associated with an increased rate of minor postoperative complications and readmissions.

23 Article Infliximab trough concentrations during maintenance therapy are associated with endoscopic and histologic healing in ulcerative colitis. 2018

Papamichael, K / Rakowsky, S / Rivera, C / Cheifetz, A S / Osterman, M T. ·Division of Gastroenterology, Center for Inflammatory Bowel Diseases, Harvard Medical School, Beth-Israel Deaconess Medical Center, Boston, MA, USA. · Department of Internal Medicine, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. ·Aliment Pharmacol Ther · Pubmed #29210094.

ABSTRACT: BACKGROUND: Endoscopic and histologic healing are emerging as new therapeutic goals in ulcerative colitis (UC), as these endpoints are associated with less relapse, hospitalization and colectomy. AIM: To investigate the association of serum infliximab trough concentrations during maintenance therapy with endoscopic or histologic healing in UC. METHODS: In this multi-center retrospective cohort study, we included consecutive patients with moderate-to-severe UC on infliximab maintenance therapy who had an endoscopic evaluation and underwent therapeutic drug monitoring within three months of the colonoscopy, between February 2008 and March 2016. Per event analysis was performed. Endoscopic healing was defined as Mayo endoscopic sub-score of ≤1. Histologic healing was defined as no or only focal mild active inflammation. RESULTS: Seventy colonoscopies from 56 patients were evaluated. Infliximab trough concentrations (median [interquartile range]) were significantly higher in patients with endoscopic (11.3 [7.6-14.5] vs 6.3 [0-9.8] μg/mL, P < .001) or histologic (11.1 [6.7-14.5] vs 6.7 [0-9.9] μg/mL, P = .002) healing, respectively, compared to patients without healing. Receiver-operating characteristic analyses identified infliximab trough concentration thresholds of 7.5 (area under the curve [AUC]: 0.758) and 10.5 (AUC: 0.721) μg/mL to be associated with endoscopic and histologic healing, respectively. Multiple logistic regression analysis identified infliximab trough concentration ≥7.5 (P = .013; odds ratio [OR]: 4.3; 95% confidence intervals [CI]: 1.4-13.3) and ≥10.5 μg/mL (P = .013; OR: 3.8; 95% CI: 1.3-11) as independent factors associated with endoscopic and histologic healing, respectively. CONCLUSIONS: This study demonstrated that infliximab trough concentrations during maintenance therapy are associated with endoscopic and histologic healing in patients with UC.

24 Article Rectal Eversion Technique: A Method to Achieve Very Low Rectal Transection and Anastomosis With Particular Value in Laparoscopic Cases. 2017

Poylin, Vitaliy / Mowschenson, Peter / Nagle, Deborah / Cataldo, Thomas. ·Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. ·Dis Colon Rectum · Pubmed #29112570.

ABSTRACT: INTRODUCTION: Transection of the rectum at the anorectal junction is required for proper resection in ulcerative colitis and restorative proctocolectomy. Achieving stapled transection at the pelvic floor is often challenging, particularly during laparoscopic proctectomy. Transanal mucosectomy and handsewn anastomosis are frequently used to achieve adequate resection. Rectal eversion provides an alternative for low anorectal transection and maintains the ability to perform stapled anastomosis. TECHNIQUE: The purpose of this article is to describe a technique for low anorectal transection. The work was conducted at tertiary care center by 2 colon and rectal surgeons on patients undergoing total proctocolectomy with creation of ileal pouch rectal anastomosis for ulcerative colitis. We measured the ability to achieve low stapled anastomosis. RESULTS: Very low transection was achieved, allowing for creation of IPAA without leaving significant rectal cuff. This study was limited because it is an early experience that was not performed in the setting of a scientific investigation. No sphincter or bowel functional data were obtained or evaluated. CONCLUSIONS: Rectal eversion technique provides an alternative to mucosectomy when low pelvic transection is difficult to achieve. See Video at http://links.lww.com/DCR/A441.

25 Article Histological healing beyond endoscopic healing in ulcerative colitis: Shall we target the "ultra-deep" remission? 2017

Katsanos, Konstantinos H / Papamichael, Konstantinos / Christodoulou, Dimitrios K / Cheifetz, Adam S. ·Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece. Electronic address: khkostas@hotmail.com. · Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA. · Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece. ·Dig Liver Dis · Pubmed #28964677.

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