Accuracy of Bowel Ultrasound for Detecting Inflammatory Bowel Disease at a Tertiary Hospital in Central South Africa

Noninvasive monitoring of inflammatory bowel disease in the post COVID-19 era

DOP10 Intestinal Ultrasound at IBD diagnosis predicts major disease events – A Copenhagen IBD cohort study

BackgroundThe association of autoimmune liver disease (AILD) and inflammatory bowel disease (IBD) is well documented. IBD affects about 45% of children with autoimmune sclerosing cholangitis (AISC) and about 20% of...

Preclinical IBD: One more piece of the puzzle

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

P158 Intestinal Ultrasound at IBD diagnosis predicts surgery – a Copenhagen IBD cohort study

There is currently no single test available to confidently diagnose cases of inflammatory bowel disease (IBD). Physicians rely on a number of diagnostic tools, including clinical evaluation, serum testing, and imaging, which are used on conjunction with endoscopic evaluation. It is often difficult to determine whether patients with abdominal pain and change in bowel habit have functional bowel symptoms or whether they have a true diagnosis of IBD. Even once a diagnosis of IBD has been made, a significant proportion of patients are labeled with the term "indeterminate colitis" where histological sampling cannot confidently subclassify patients as either Crohn's or ulcerative colitis. Colonoscopy is an inconvenient and uncomfortable test for most patients. In addition, it is not without serious risks of perforation, as well as risks which can be associated with sedation and analgesia given during the procedure. The use of biomarkers to aid in the diagnosis, subclassification, and monitoring of IBD is an ever expanding area. In this review, we have concentrated on noninvasive biomarkers of IBD, because these are more acceptable to patients and easier to perform in everyday clinical practice. We will first touch on those biomarkers currently well established and in wide clinical use, such as C-reactive protein, erythrocyte sedimentation rate. Faecal calprotectin and their use in the diagnosis of IBD. Following on, we will review more novel biomarkers and their use in subclassification and monitoring of IBD, including a variety of antibodies, genetics, and microRNAs, as well as touching on metabolomics.

Baseline Disease Activity and Steroid Therapy Stratify Risk of COVID-19 in Patients With Inflammatory Bowel Disease

BackgroundThe incidence and diagnosis of inflammatory bowel disease (IBD) has increased considerably in recent years. Many clinical practice guidelines (CPG) have been developed for the management of this disease across different clinical contexts, however, little evidence exists on their methodological quality. Therefore, we aimed to systematically evaluate the quality of CPGs for the diagnosis and treatment of IBD using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.MethodsWe identified CPGs by searching databases (MEDLINE - PubMed, EMBASE, CINAHL, LILACS) and other sources of gray literature on January 2022. We included guidelines with specific recommendations for the diagnosis and treatment of IBD and evaluated them with the AGREE II instrument to assess their methodological quality. Six independent reviewers assessed the quality of the guidelines and resolved conflicts by consensus. We assessed the degree of agreement using the intraclass correlation coefficient (ICC) and change in quality over time was appraised in two periods: from 2012 to 2017 and from 2018 to 2022.ResultsWe analyzed and evaluated 26 CPGs that met the inclusion criteria. The overall agreement among reviewers was moderate (ICC: 0.74; 95% CI 0.36 - 0.89). The mean scores of the AGREE II domains were: “Scope and purpose” 84.51%, “Stakeholder involvement” 60.90%, “Rigor of development” 69.95%, “Clarity of presentation” 85.58%, “Applicability” 26.60%, and “Editorial independence” 62.02%. No changes in quality were found over time.ConclusionsThe quality of the CPGs evaluated was generally good, with a large majority of the assessed guidelines being “recommended” and “recommended with modifications”; despite this, there is still room for improvement, especially in terms of stakeholder involvement and applicability. Efforts to develop high quality CPGs for IBD need to be further optimized.

Inflammatory bowel disease (IBD) encompasses a group of chronic inflammatory disorders that affect the gastrointestinal tract, with Crohn’s disease and ulcerative colitis being the primary subtypes. Diagnosis and treatment of IBD are challenging due to their unknown etiology and complex pathology. Smart bionanomaterials, which are biocompatible nanometer-sized materials that respond to external stimuli, can be used in the treatment and diagnosis of diseases. In the context of IBD, these materials can deliver drugs, primarily aminosalicylates, and corticosteroids, as well as live probiotics to the inflamed parts of the intestine, with a specific focus on the colon. The controlled release of drugs can be triggered by the conditions present in the IBD-affected intestine, such as inflammation, anaerobic environment, neutral pH, and gut microbiota. This article provides an overview of the use of smart bionanomaterials, including hydrogels, nanoparticles, nanofibers, and hybrid systems. It discusses their manufacturing process and their ability to deliver active ingredients in response to various stimuli, such as pH, temperature, reactive oxygen species, magnetic field, and biomolecules, for the treatment of IBD. We also describe the use of smart probiotics, which have been genetically engineered to recognize specific stimuli and synthesize recombinant proteins for the treatment of IBD. The qualitative or quantitative response to inflammatory stimuli can be exploited in diagnostic applications, with some examples already developed. Smart bionanomaterials offer several advantages, such as encapsulation, targeted delivery, responsiveness to stimuli, and controlled release. These features make them a valuable adjunct tool in the diagnosis and treatment of IBD.

Background: The diagnosis and monitoring of inflammatory bowel disease (IBD) has traditionally relied on clinical assessment, serum markers of inflammation and endoscopic examination. Fecal biomarkers such as calprotectin (FC) and lactoferrin (FL) are predominantly derived from neutrophils, are easily detectable in the feces and are now established as valuable markers of intestinal inflammation. In recent years, a ‘treat to target' concept has emerged for the management of IBD. Adequate control of inflammation in IBD at a biochemical level is quickly becoming an important target in IBD management. Key Messages: Fecal biomarkers have been shown to be significantly and consistently increased in both adult and pediatric patients with IBD versus those without IBD. Fecal biomarkers are therefore useful in determining those patients with gastrointestinal symptoms who are likely to benefit from colonoscopy versus those in whom colonoscopy is likely to be normal. Fecal biomarkers correlate significantly with endoscopic disease in both Crohn's disease and ulcerative colitis. Suggested cutoffs for FC for endoscopically active disease in IBD range from 50 to 280 μg/g. Fecal biomarkers reflect the success of treatment intensification and can help predict clinical relapse. Both FC and FL are accurate in the detection of postoperative endoscopic recurrence of Crohn's disease, and FC may be clinically useful in predicting those patients with acute severe ulcerative colitis who may progress to colectomy. There are limitations to these fecal tests including a false positive rate and intra-individual variability. Conclusions: This review focuses on the role of fecal biomarkers in the diagnosis, monitoring and management of IBD and how best to interpret results. We will discuss the emerging role of these biomarkers in the IBD management landscape including FC-guided drug dosing and the development of home-based testing and e-health applications. Fecal biomarker results must always be interpreted in a clinical context. Endoscopic assessment remains the gold standard for diagnosis and monitoring of IBD.

Objective To investigate the clinical significance of serum anti-Saccharomyces cerevisias antibody （ASCA）,anti-outer membrane porin C （anti-OmpC）,antibody to Pseudomonas fluorescens-associated sequence I2 （anti-I2 ）and antibody to bacterial flagellin （anti-CBirl ）in the diagnosis and treatment of inflammatory bowel disease （IBD）.Methods From 2011 to 2013,87 patients with IBD were enrolled and divided into Crohn′s disease （CD）group （66 cases）and ulcerative colitis （UC）group （21 cases）.A total of 62 age and gender matched healthy individuals were enrolled as the control group. Fasting blood samples （2 mL）of the subjects were collected.The expression of ASCA,anti-OmpC,anti-I2 and anti-Cbirl antibodies was detected with enzyme-linked immunosorbent assay （ELISA）kits.The diagnosis value of each antibody in IBD and the differential diagnostic value of in UC and CD were compared by receiver operating characteristic （ROC）curve.Results The area under the curve （AUC）of ASCA between IBD and the healthy control group,between CD group and UC group was 0.580 and 0.512, respectively;the accuracy in diagnosis was low.The AUC of anti-CBirl between IBD and the healthy control group was 0.617.There was no differential diagnosis significance of the other antibodies.The positive rate of ASCA in IBD group was 62.1 % （54/87）,which was significantly higher than that in the control group （38.7%,24/62）.The positive rates of anti-OmpC and anti-I2 in IBD group was significantly lower than those in the control group and the differences were statistically significant （both P 〈0.05）.No difference was observed in positive rates of serum antibodies among the others groups （all P 〉0.05）.The specificity,sensitivity,positive predictive value （PPV）and negative predictive value （NPV）of ASCA in differential diagnosis of CD and UC was 52.4%,66.7%,81 .48% and 33.33%,respectively.The specificity and sensitivity of anti-OmpC,anti-I2 and anti-CBirl in differential diagnosis of CD and UC was 81 .0% to 100.0% and 9.1 % to 37.9%,respectively.The specificity,sensitivity,PPV and NPV of double-positive ASCA and anti-I2 in the diagnosis of CD was 57.1 %,86.4%,82.6% and 50.0%, respectively.The positive rate of ASCA and anti-I2 in CD group was significantly higher than that in UC group （84.8%（56/66）vs 57.1 % （12/21 ）;χ2 =5 .633,P =0.018 ）.Conclusions Positive ASCA has some significance in the diagnosis of patients with IBD in our country.The detection of anti-I2 can help to diagnose ASCA negative CD.Because of low sensitivity and positive rate,anti-OmpC and anti-CBirl have limited value in the diagnosis of IBD and the differential diagnosis of UC and CD in our country. Key words: Inflammatory bowel diseases; Diagnosis, differential; Antibodies, fungal; Antibodies, bacterial; Anti-Saccharomyces cerevisiae antibodies~ Bacterial outer membrane pore protein C; Pseudomonas fluorescens associated sequence I2

THE PURPOSE OF THE STUD. Determination of ultrasound semiotics of Crohn’s disease and ulcerative colitis by evaluation of activity of inflammatory process, assessment of the possibilities of echography in the differential diagnosis of these diseases. MATERIALS AND METHODS. The study included 91 patients between the ages of 4 months up to 17 years. There were examined 24 patients with verified Crohn's disease and 37 patients with verified ulcerative colitis. 30 patients without any clinical and laboratory data of the gastrointestinal diseases were included in to control group. Bowel ultrasound was done without any preparation and contrast enhancement. RESULT OF RESEARCH. Sensitivity of the test «bowel wall thickness >2.5 mm - inflammatory bowel disease» - 90,2 %, specificity - 100.0 %, positive predictive value -100.0 %, negative predictive value - 83,3 %, and AUC - 0,957. Sensitivity of the test «doppler signals amount in bowel wall >2 - inflammatory bowel disease» - 93,4 %, specificity -100.0 %, positive predictive value - 100.0 %, negative predictive value - 88,2 %, and AUC -0,967. Significant differences in pathological vascularization, ascites, terminal ileum affection, mesentery and (or) omentum inflammatory infiltration and lymph nodes size were revealed between group ofCrohn's disease and ulcerative colitis (P<0,05 for all comparisons). Significant differences in pathological vascularization during the activity and remission periods were revealed in all groups; in lymphatic nodes size - in group of ulcerative colitis and combined group of bowel inflammatory disease; in ascites, terminal ileum affection, and mesentery and (or) omentum inflammatory infiltration - in group of Crohn's disease (P<0.05 for all comparisons). CONCLUSION. Ultrasound examination is an essential method in the diagnosis and monitoring of inflammatory bowel disease in children.

Bowel ultrasound (BU) is a non-invasive, inexpensive, widely available tool, valuable for inflammatory bowel disease (IBD) assessment. The aim of the present study was to investigate the clinical utility of BU to predict the need to intensify therapy in IBD patients. One hundred seventeen IBD patients (89 Crohn's disease, and 28 ulcerative colitis) diagnosis established at least 6 months before enrolment, undergoing maintenance therapy were prospectively included in the study. Bowel ultrasound investigated the following parameters: the bowel wall thickness (BWT), loss of wall stratification, the presence of the bowel wall Doppler signal, the visible lymph nodes, the mucosal hyperechoic spots, and the irregular external bowel wall. The patients were followed-up for 6 months, registering the need to escalate the treatment regimen. Subgroup analyses were conducted for patients requiring immediate treatment intensification (37 subjects), due to active disease at baseline and patients with subsequent treatment intensification, in the 6 months follow-up period (21 cases) in comparison to patients that required no therapeutic optimization (59). During the follow-up, 49.6% of patients needed treatment escalation. All the investigated BU variables were significantly associated with the main outcome. In the multivariate analysis, the mean BWT (p<0.0001), and the presence of the bowel wall Doppler signal (p=0.007) were independent predictors of the main outcome. For the subgroup analyses: mean BWT (p=0.0001) and the presence of the bowel wall Doppler signal (p=0.01) were independent predictors for immediate treatment intensification (active disease at baseline) and mean BWT (p=0.0003) and the lack of bowel wall stratification (p=0.05) were independent predictors for the need of subsequent therapeutic optimization. Logistic regression prediction models and prediction scores (BU score) had the best AUROC values (>0.91) when compared to traditional biomarkers of active inflammation, such as C reactive protein or fecal calprotectin. Bowel ultrasound could be used as a non-invasive, easy to use diagnostic tool to predict the need to intensify therapy in patients with IBD.

IntroductionFaecal calprotectin (FCP) is a non-invasive marker of intestinal inflammation that is used as a marker of inflammation primarily related to Inflammatory Bowel Disease (IBD). It is used as a...