Advances In Inflammatory Bowel Disease Research Articles

P380 Comparison of mucosal healing through segments of ileocolonic Crohn’s disease treated with biologics

Abstract Background Although major advances in Inflammatory bowel disease’s treatment have been observed, the response to the pharmacologic therapies is still unpredictable and highly variable. Mucosal healing (MH) is an important endpoint in Crohn’s disease patients undergoing biologic therapies as it improves outcomes. Nevertheless, endoscopic response is usually evaluated as a whole entity and not by intestinal segments. Moreover, to the best of our knowledge, it has never been assessed whether different plasmatic drug levels (PDL) of biologics result in different response rates by segments of disease. Taking all these considerations into account, this work aimed at assessing putative differences in MH between ileal and colonic disease. Methods Retrospective, single centre, cohort study of 131 consecutive patients undergoing biological therapies for Crohn’s disease. Patients included had at least six months of follow-up and an endoscopic evaluation before and after the initiation of biologic therapy. Clinical and endoscopic data were obtained at baseline and at the time of assessment of response. Potential prognostic factors included were: age at diagnosis, time from diagnosis at beginning of biologic agents, location and behaviour of disease, biologic agent taken, PDL and smoking. MH was defined as absence of ulcers in the previously affected segment. Results Mean age at diagnosis was 28±12.9 years (range 10-67years). 26.7% of patients had ileal disease and 34.5% only had colonic lesions. 61.83% of patients initiated infliximab and 29.8% started treatment with adalimumab. MH was present in 48.85% of patients. Rates of response were significantly different between ileal (48.9%) and colonic lesions (69.8%) both in the whole cohort and in patients with ileocolonic disease (54.9% and 74.5% respectively) (p<0.05). PDL were higher in the patients achieving response comparing subgroups of patients (responders versus non-responders) with ileal and colonic lesions (p<0.05). There were no significant differences in the PDL between ileal and colonic lesions achieving response. In the multivariate analysis, factors independently associated with higher rates of MH were PDL, location (ileum versus colon) of the affected areas and type of disease (ileal versus colonic versus ileocolonic) (p<0.05). Conclusion Rates of MH of ileal lesions are significantly different from colonic segments in Crohn’s Disease. This discrepancy appears not to be related to higher plasmatic concentrations of biologic agents.

2020 Advances in Inflammatory Bowel Diseases: Vision for the Next Decade

The American Journal of Gastroenterology 115():p S1, December 2020. | DOI: 10.14309/ajg.0000000000001079

2019 Advances in Inflammatory Bowel Diseases: Education for the Road Ahead December 12–14, 2019 Orlando, Florida

The American Journal of Gastroenterology 114():p S1, December 2019. | DOI: 10.14309/ajg.0000000000000470

2018 Advances in Inflammatory Bowel Diseases: Putting World Class IBD Education into Practice December 13–15, 2018, Walt Disney World Swan Dolphin Orlando, Florida

The American Journal of Gastroenterology 114():p S1, July 2019. | DOI: 10.14309/01.ajg.0000578072.67278.3e

Report From Advances in Inflammatory Bowel Diseases 2018: An Update.

Report From Advances in Inflammatory Bowel Diseases 2018: An Update.

Key Considerations in the Management of Inflammatory Bowel Disease: Interviews with Key Opinion Leaders

Treatment advances in inflammatory bowel disease (IBD), as well as the development of new biomarkers and technologies to enhance monitoring of the disease and response to treatment, are providing new possibilities in the management of ulcerative colitis (UC) and Crohn’s disease (CD). Awareness of the impact of IBD on patients beyond clinical endpoints is also increasing, including the prevalence and extent of extra-intestinal manifestations, psychological issues, and nutritional deficiencies. This means that the role of physicians in IBD is more important than ever, with continuous investigation required for every patient and a wealth of considerations to take into account when deciding on the most suitable treatment approach to undertake. For this article, the European Medical Journal conducted a series of interviews with five key opinion leaders from across Europe, each with a wealth of experience and expertise in managing IBD, to gain their perspectives on a range of topics in this area. From the UK, we spoke to Dr Ian Arnott, Consultant Gastroenterologist, Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK; from Spain, Dr Manuel Barreiro-de Acosta, Gastroenterology Department, Inflammatory Bowel Disease Unit, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; from Germany, Prof Eduard Stange, Internal Medicine I – Gastroenterology, Hepatology and Infectious diseases, University of Tübingen, Tübingen, Germany; from Italy, Prof Antonio Tursi, Gastroenterology Service, Azienda Sanitaria Locale Barletta Andria Trani, Andria, Italy; and from France, Prof Frank Ruemmele, Professor of Paediatrics, Medical Faculty of the Université Sorbonne, Hôpital Necker Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France. The article begins by discussing monitoring of treatment response and detection of extra-intestinal manifestations, followed by considerations in making treatment decisions before outlining novel therapy options in both UC and CD. Optimal use of anti-TNF therapy, the impact and challenge of psychological issues in IBD, and nutrition and diet in this disease are also explored.

Current perspectives on the diagnosis and management of functional anorectal disorders in patients with inflammatory bowel disease.

Despite advances in inflammatory bowel disease (IBD) therapies, a significant proportion of patients with quiescent disease experience persistent, debilitating symptoms of faecal incontinence (FI), urgency and defaecatory disorders due to anorectal dysfunction. Such symptoms are often underreported or misdiagnosed and can lead to potentially premature treatment ‘escalation’ and under-utilisation of pelvic floor investigations. In this review article, we consider putative pathophysiological post-inflammatory changes resulting in altered anorectal sensitivity, motility and neuromuscular coordination and how this may drive symptoms in quiescent IBD. Finally, we discuss a pragmatic approach to investigating and managing anorectal dysfunction and highlight areas for future research for this often-neglected group of patients.

Systematic Review and Meta-Analysis at Gastroenterology Conferences From 2010 to 2016: Prevalence, Origin and Association of U.S. News & World Report

Introduction: Medical conferences are known to be a prime source of continued learning and knowledge sharing among the medical community. The quantity and importance of systematic review and meta-analysis (SRMA) has been reported to be increasing in the medical field, but has not been reviewed in the gastroenterology (GI) conference world. We aimed to assess the prevalence of SRMA from 2010 to 2016 at common GI conferences, their country of origin, and if there was an association between the United States News & World Report (USNWR) and increased abstract prevalence. Methods: We used the search term of “systematic review” (SR) and “meta-analysis” (MA) on the Digestive Disease Week (DDW), American College of Gastroenterology (ACG), American Association for the Study of Liver Disease (AASLD), and Advances in Inflammatory Bowel Disease (AIBD) databases for conference abstracts from 2010 to 2016. Two reviewers performed the search and assessed which abstracts were SR or MA or SRMA and extracted first and last author institution names and nationality from 2011 to 2016. We used the USNWR to tier institutions in categories of 25 for the top 150 GI/GI surgery scores to see if this predicted increased prevalence of conference abstracts. Results: Total SR, MA, SRMA per year was calculated for DDW (2010 - 2016: 53, 72, 84, 100, 90, 124, 170), ACG (2010 - 2016: 20, 10, 34, 45, 52, 72, 81), AASLD (2010 - 2016: 11, 14, 34, 22, 23, 18, 25), and AIBD (2015 - 2016: 5, 10). We found a linear increase in publication over the years (Figure 1). From 2011-2016, 69.4% (753/1085) of these had a first author and 66% (716/1085) had a senior author from the US. There was an increasing trend of US first authors when compared to international based first authors over time, accounting for the increase of abstracts (Figure 2). The top 150 institutions in the USNWR by first author contributed to 44.9% (333/741) of abstracts and 46.5% (328/706) by senior author. Contribution of abstracts by senior/first author tier were as follows: 1st tier: 201/185, 2nd tier: 56/60, 3rd tier: 28/33, 4th tier: 14/19, 5th tier: 17/22, 6th tier: 12/14.The top 25 senior author hospitals published 74 more abstracts than the remaining 125 hospitals.FigureFigureConclusion: Overall, there is an increasing trend of SRMA abstracts at GI conferences since 2010. US first authors have majorly contributed to the increasing prevalence. The USNWR can predict institutional representations of SRMA at GI conferences.

Inflammatory Bowel Disease-Related Abstracts Presented at National Conferences in the USA Are Frequently Unpublished as Full Manuscripts.

Numerous abstracts related to inflammatory bowel disease (IBD) are presented at national conferences in the USA. The overall rate of publication of these abstracts as complete manuscripts is unknown . Abstracts submitted to the 2010 American College of Gastroenterology (ACG), Advances in Inflammatory Bowel Diseases (AIBD), and the American Gastroenterological Association abstracts at Digestive Disease Week (DDW) were reviewed. Each abstract was reviewed manually by two authors for type of research, study design, patient population, and outcome. Both PubMed and Google were then searched to determine whether the abstract was published as a full manuscript within five years of the conference. Univariate and multivariate logistic regression analysis was carried out using Stata 14.1. In total, 872 abstracts were reviewed. 49% (426/872) were published as complete manuscripts within five years of the conference. The average length of time to publication was 1.87years (range 0-5). 42% of abstracts from ACG, 58% from AIBD, and 23% from DDW were eventually published (p<0.0001). However, abstracts presented at DDW had the shortest time to publication compared to the other conferences (p=0.002). Factors predictive of eventual publication include: number of authors (mean 7.5 for published vs 6.4 for unpublished p=0.0001), clinical research compared to basic and translational (p=0.026), and studies assessing drug safety with no adverse effects reported (p=0.006). Nearly 50% of the abstracts presented at major gastroenterology conferences in the USA are published as full manuscripts 5years after the conference. Further studies are needed to assess why so many abstracts are not published.

Recent advances in inflammatory bowel disease.

Recent advances in inflammatory bowel disease.

Mesenchymal Stem Cell Therapy for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

Recent advances in inflammatory bowel disease (IBD) therapeutics include novel medical, surgical, and endoscopic treatments. Among these, stem cell therapy is still in its infancy, although multiple studies suggest that the immunomodulatory effect of stem cell therapy may reduce inflammation and tissue injury in patients with IBD. This review discusses the novel avenue of stem cell therapy and its potential role in the management of ulcerative colitis and Crohn's disease. We conducted a comprehensive literature search to identify studies examining the role of stem cell therapy (without conditioning and immunomodulatory regimens) in IBD. Taken together, these studies suggest a promising role for stem cell therapy in IBD although the substantial challenges, such as cost and inadequate/incomplete characterization of effect, limit their current use in clinical practice.

Pediatric inflammatory bowel disease: imaging issues with targeted solutions

To date, there have been many advances in inflammatory bowel disease (IBD) imaging in every cross-sectional imaging modality, particularly in children. The main emphasis in pediatric IBD imaging is on robust and reproducible measures of small bowel Crohn's disease inflammation, accurate diagnosis of IBD-related complications, and minimizing radiation burden to the patient, as repeat imaging is necessary over the course of their disease. In this article, we discuss the current state-of-the-art imaging techniques, in addition to routine fluoroscopy, including MR and CT enterography and bowel ultrasound. We also present the emerging use of new methods to characterize disease severity and distinguish active inflammation from fibrosis such as diffusion-weighted imaging, bowel elastography, and contrast-enhanced ultrasound. The diagnostic performance of particular examinations, their strengths and weaknesses, and role in IBD management will be discussed. Although these advanced imaging techniques applied to children are similar to those performed in adults, special considerations related to their application in pediatric patients will also be reviewed.

Recent advances in inflammatory bowel disease: mucosal immune cells in intestinal inflammation

The intestine and its immune system have evolved to meet the extraordinary task of maintaining tolerance to the largest, most complex and diverse microbial commensal habitat, while meticulously attacking and...

Drug advances in inflammatory bowel disease

The pathogenesis of inflammatory bowel disease (IBD) remains incompletely understood, but is thought to be a consequence of immune dysregulation, impaired mucosal integrity, enteric bacterial dysbiosis and genetic susceptibility factors. Recent drug advances in the treatment of IBD have clarified the role of existing medication, including 5-amino-salicylic acids (5-ASAs) and has seen a burgeoning use of treatment with biologicals. With recent advances in our understanding of these debilitating diseases, it is hoped that novel therapeutic targets can be identified.

Advances in inflammatory bowel diseases 2012

The Crohn’s and Colitis Foundation of America’s (CCFA) Conference, Advances in Inflammatory Bowel Diseases 2012, held in Hollywood (FL, USA), was co-chaired by Richard P MacDermott, from Albany Medical College (NY, USA) and Stephen B Hanauer, from the University of Chicago Medicine (IL, USA). This year’s conference saw a record 1947 total registrants and 1862 in attendance. In addition to the scientific meeting, there were committee meetings for the CCFA and several new events this year, including a ‘meet the experts’ breakfast series, a well-attended fellows workshop and a Scrub Run 5k, which brought in more than 100 runners and was a great way to promote the CCFA’s Team Challenge. Highlights of this year’s conference included presentations on the etiopathogenesis of inflammatory bowel disease (IBD), new approaches to management, as well as new therapies in the pipeline. With clinical, nursing, pediatric and basic science tracks, the sessions included a diverse range of topics and debates that focused on...

Pregnancy and Fertility in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic relapsing and remitting disease that includes ulcerative colitis (UC) and Crohn’s disease (CD). It affects the population in a bimodal distribution with the higher peak in the younger population. Approximately fifty percent of patients are less than 35 years of age at the time of diagnosis and twenty five percent conceive for the first time after their diagnosis of inflammatory bowel disease [1]. As medical therapy for IBD advances, more patients are in a position to consider pregnancy. Because ethical considerations generally preclude conducting randomized controlled trials in pregnant patients, the majority of the available information has been gathered from retrospective studies. Most of the drugs used to treat IBD are safe to use during pregnancy. Traces of drugs have been reported in breast milk in women on drug therapy, but no major fetal or neonatal complications have been reported. With the increasing early use of immunosuppressant and biological therapy to treat active IBD, more studies are focusing on these issues. A multidisciplinary team that considers the individual patient wishes and concerns, and that manages them accordingly should care for inflammatory bowel disease patients who are contemplating conception or who are already pregnant. The aim of this review article is to summarize the current literature on fertility, pregnancy and IBD management during and after gestation.

MicroRNAs in inflammatory bowel disease

MicroRNAs (miRNAs) are small, noncoding RNAs that regulate gene and protein expression. miRNAs are critical to a normal immune response and have altered expression in multiple immune-mediated disorders. This emerging role of miRNAs in the pathogenesis of multiple disease states has led to investigations into miRNA expression profiles in inflammatory bowel disease (IBD). The discovery of miRNAs in IBD is likely to contribute to our understanding of IBD pathogenesis and lead to clinical advances in IBD. This review focuses on miRNA expression in inflammation, autoimmune disorders, and inflammation-associated cancer, as well as their function in the biology and management of IBD.

Diagnostic advances in inflammatory bowel disease (imaging and laboratory)

Autoimmune and antimicrobial antibodies currently play only an adjunctive role in the diagnosis of inflammatory bowel disease (IBD). Their sensitivity and specificity are not high enough to be relied upon alone to secure a diagnosis; however, their most promising role seems to be in identifying Crohn's disease patients at a higher risk of progression to intestinal complications. Serum C-reactive protein (CRP) correlates well with other measures of biologic activity but not as well with clinical activity. CRP can help predict IBD relapses, and in patients with severely active ulcerative colitis may indicate which patients are most likely to progress to colectomy. Similarly, fecal lactoferrin and calprotectin are reasonably accurate and noninvasive measures of disease activity, can predict relapse, and identify a high-risk group among acute severe colitis patients. Capsule endoscopy is a highly sensitive tool that can be used in patients with suspected Crohn's disease with a negative traditional workup, but lower specificity and the risk of capsule retention preclude first-line use. CT enterography can delineate the extent and severity of bowel inflammation and detect extraluminal findings. Magnetic resonance enterography is a radiation-free cross-sectional imaging alternative that is comparable to CT enterography in diagnostic accuracy.

Advances In Inflammatory Bowel Diseases

The annual clinical and research conference of the Crohn’s and Colitis Foundation of America, Advances in Inflammatory Bowel Diseases, provided a comprehensive overview of the year’s newest developments regarding inflammatory bowel diseases (IBD). The program was again successful. Attracting a wide range of participants including leaders in the field from around the world, the program offered a unique opportunity to review and debate the most important clinical studies, current controversies in the management of IBD, and the most recent perspectives on current research in the investigation of IBD.

Advances in Inflammatory Bowel Disease: Are Patients Taking Their Medicines?

Dr Subrata Ghosh is the Professor of Gastroenterology at the Imperial College, Hammersmith Hospital, London, England. He has bench-to-bedside research interests in inflammatory bowel disease (IBD) and other intestinal inflammatory diseases. He will become the Head of the Division of Gastroenterology at the University of Calgary, Calgary, Alberta, in March 2009.