Early Diagnosis Of Inflammatory Bowel Disease Research Articles

Iron oxide nanoparticles for inflammatory bowel disease: Recent advances in diagnosis and targeted drug therapy

Gastrointestinal tract (GI) is the second largest and essential organ in the body responsible for the absorption of nutrients and removal of wastes from the body. The proper functioning of GI is pivotal for healthy lifestyle as it regulates various metabolic processes directly or indirectly. The compromised intestinal permeability and other metabolic disorders are the major factors contributing to inflammatory bowel disease (IBD). The ulcerative colitis (UC) and Crohn's disease (CD) are the types of IBD characterized by chronic inflammation in the GI tract and carries a higher risk to develop colon cancer. Early diagnosis of IBD using pro-inflammatory cytokines as biomarkers is often challenging. Iron oxide nanoparticles (IONPs) are gaining increasing attention as they offer early and reliable confirmation of the type of IBD. Moreover, IONPs that are either encapsulated to conjugated or even engineered, can render site specific drug delivery and thus reduce high-dose induced toxic effects at the non-target sites. In this focused review, we review emphasize the diagnostic, therapeutic, theranostic applications of IONPs for IBD. In addition, current research involving studies on IONPs in experimental IBD models and clinical trials are also reviewed. The IONPs proven to have higher biodistribution in the cell compared to other conventional drug delivery systems. The surveyed literature conclusively establishes the magnificent properties, and broad-spectrum applicability of IONPs, which can be promptly used for both diagnosis and therapy including image guided drug delivery to the colon region.

P168 Development of predictive model for early detection of Inflammatory Bowel Disease in Korea

Abstract Background Diagnostic delay in inflammatory bowel disease (IBD) was frequent and may be associated with poor outcomes. The aim of this study was to develop a predictive model for early diagnosis of IBD. Methods From March 2020 to January 2022, a 15-item Red Flags questionnaire was administered to all patients who visited outpatient clinic with gastrointestinal symptoms suspected of IBD. All patients underwent additional diagnostic tests to confirm IBD. We estimated a model that could predict the early diagnosis of IBD using questionnaire and laboratory test results. Results A total of 186 patients were enrolled in this study and 114 (61.2%) patients were finally confirmed with IBD. The logistic regression identified 4-item independently associated with a diagnosis of IBD. 1) Perianal fistula/abscess or perianal lesions (apart from hemorrhoids) (OR, 2.6; p=0.044). 2) Chronic abdominal pain/discomfort (>3 months) (OR, 0.3; p=0.013). 3) Rectal bleeding (OR, 7.4; p<0.001). 4) First-degree relative with confirmed IBD (OR, 12.0; p=0.033). A receiver operating characteristic curve was used to evaluate predictability of the model for diagnosis of IBD and each area under the curve was as follows. 1) Questionnaire only : AUC 0.831 (95% confidence interval; 0.766-0.896), 2) Questionnaire and serum laboratory tests including blood cell counts, erythrocyte sedimentation rate and C-reactive protein : AUC 0.885 (95% C.I.; 0.834-0.936), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.895 (95% C.I.; 0.845-0.944). This model confirmed that the predictive value was particularly excellent for early diagnosis of Crohn's disease. 1) Questionnaire only : AUC 0.891 (95% C.I.; 0.818-0.964), 2) Questionnaire and serum laboratory tests : AUC 0.960 (95% C.I.; 0.914-1.000), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.975 (95% C.I.; 0.944-1.000). Conclusion The predictive model for early diagnosis of IBD has a high predictive value. The model allows for early detection of IBD from non-IBD patients.

Ранняя диагностика воспалительных заболеваний кишечника у пациентов со спондилоартритами

Seronegative spondyloarthritis (SpA) (psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA)), inflammatory bowel disease (IBD) and psoriasis form a group of immunoinflammatory diseases (IIDs). The increased risk of developing IBD in patients with IIDs is known and, on the contrary, the risk of skeletal-muscle IIDs in patients with IBD was demonstrated. This indicates the necessity of early diagnosis of IBD in patients with SpA. In connection with this, a screening tool «Universal questionnaire for identifying signs of immunoinflammatory diseases» was developed and put into practice. The article shows the results of the «Universal questionnaire for IIDs» use in rheumatology practice by 140 patients with SpA. It was found that 17.2% patients with PsA and 20.8% with AxSpA required further exclusion of IBD. The need to exclude IBD was equally frequent in patients with PsA and AxSpA. Clinical and laboratory parameters in groups with the alleged IBD did not significantly differ from those in other patients, which confirms the need to introduce the «Universal questionnaire» into the practice for the purpose of early diagnosis of combined IIDs.

A Regional Survey of Awareness of Inflammatory Bowel Disease among the Saudi Population

Introduction: Inflammatory bowel disease (IBD) is common worldwide, including the gulf region. Early diagnosis of IBD can improve patients’ outcomes. However, early diagnosis is dependent on patients’ awareness of the disease to seek medical advice. This study aimed to survey the awareness of IBD in the general population of the western region of Saudi Arabia. Methods: A questionnaire about Crohn’s disease (CD) and ulcerative colitis (UC) was distributed to the general public. A score of 1 was given for the right response and 0 for an incorrect response, giving a maximum of 3 and a minimum of 0 for the three questions in the questionnaire. Results: 1,304 participants responded. Twenty nine percentage had not heard or read about CD, while 19% had not heard or read about UC. The mean awareness level score was 1.72 ± 1.19. Females showed a significantly higher score compared to males (p < 0.001). The age-group 31 to 40 had the highest score (p = 0.002). Moreover, responders who had a PhD. showed significantly higher scores than those with other educational degrees (p < 0.001). Responders who dealt with CD or UC patients showed significantly higher scores than their peers (p < 0.001) for both. Conclusion: The general population in Saudi Arabia has an unacceptable level of awareness of IBD. Females, young adults (age-group: 31–40 years), educated individuals (with a PhD), and those who had dealt with IBD patients previously had better awareness compared to the rest of the population. National acts are essential to improve public awareness toward the disease.

P360 Aggressive Inflammatory Bowel Disease is associated to Hermansky-Pudlak Syndrome: Characterization of a Puerto Rican Cohort

Abstract Background Hermansky-Pudlak Syndrome (HPS), a rare autosomal recessive disorder, is the most common single-gene disorder in Puerto Rico. It is characterized by an aberrant biogenesis of lysosome-related organelles inducing oculocutaneous albinism, bleeding diathesis, and damage to other organs. Around 30% of patients with HPS develop granulomatous enterocolitis, a Crohn’s-like inflammatory bowel disease (IBD). The mutant HPS1 gene is associated with a more severe Early Onset IBD (EO-IBD). We wish to describe a group of patients with HPS-associated IBD. Methods Puerto Ricans with HPS and concomitant IBD were recruited in our IBD clinic for a prospective cohort study. After informed consent, demographic and medical data were collected from the patient and the medical record. Variables included sex, HPS genotype, age at the time of IBD diagnosis, IBD location and behavior according to Montreal and Paris Classification, surgical interventions, medications, and extra-intestinal manifestations (EIM). Descriptive analysis was performed calculating mean and standard deviations. This study is approved by the MSC IRB. Results 13 patients with HPS and IBD, 9 with confirmed genotype 1, were identified: 8 males and 5 females. The mean age at the time of IBD diagnosis was 22 ± 11 years. 6 were diagnosed at ≤ 16 y/o (A1), 6 were diagnosed between 17-40 years (A2) and 1 patient was in the range of EO-IBD (7 y/o). 9 patients had advanced penetrating behavior (B3) of which 7 had concomitant perianal involvement. Most patients (9) had a surgical intervention; 8 have an ostomy. The majority (10) are using biologics (4 with concurrent immunomodulators). The most frequent EIM was peripheral arthropathy seen in 45%. Conclusion HPS patients had a severe course of IBD, as shown by age at diagnosis, phenotype, the prevalence of perianal disease, surgery and use of biologics. In comparison to a database of 836 Puerto Ricans with non HPS Crohn’s Disease, those with HPS were more likely to have surgeries (69% vs 55%, P=.303) and use biologics (77% vs 43%, P=.015). Gastrointestinal symptoms including bleeding may be overlooked by the primary physician. Proactive vigilance in patients with HPS to make an early diagnosis of IBD and aggressive medical treatment may result in better outcomes for these patients.

Inflammatory Bowel Disease Is More Common in Patients with IgA Nephropathy and Predicts Progression of ESKD: A Swedish Population-Based Cohort Study.

Case reports suggest an association between inflammatory bowel disease, a chronic autoimmune condition linked to increased circulating IgA levels, and IgA nephropathy, the most common form of primary GN and a leading cause of ESKD. In a Swedish population-based cohort study, we compared 3963 biopsy-verified IgA nephropathy patients with 19,978 matched controls between 1974 and 2011, following up participants until 2015. Inflammatory bowel disease data and ESKD status were obtained through national medical registers. We applied Cox regression to estimate hazard ratios (HRs) for future inflammatory bowel disease in IgA nephropathy and conditional logistic regression to assess risk of earlier inflammatory bowel disease in IgA nephropathy. We also explored whether inflammatory bowel disease affects development of ESKD in IgA nephropathy. During a median follow-up of 12.6 years, 196 (4.95%) patients with IgA nephropathy and 330 (1.65%) matched controls developed inflammatory bowel disease (adjusted HR, 3.29; 95% confidence interval [95% CI], 2.73 to 3.96). Inflammatory bowel disease also was more common before a confirmed IgA nephropathy diagnosis. Some 103 (2.53%) IgA nephropathy patients had an earlier inflammatory bowel disease diagnosis compared with 220 (1.09%) controls (odds ratio [OR], 2.37; 95% CI, 1.87 to 3.01). Both logistic regression (OR, 2.60; 95% CI, 2.02 to 3.35) and time-varying Cox regression (HR, 1.84; 95% CI, 1.33 to 2.55) demonstrated that inflammatory bowel disease was associated with increased ESKD risk in patients with IgA nephropathy. Patients with IgA nephropathy have an increased risk of inflammatory bowel disease both before and after their nephropathy diagnosis. In addition, among patients with IgA nephropathy, comorbid inflammatory bowel disease elevates the risk of progression to ESKD.

Comparison of a rapid test and an automated method for faecal calprotectin measurement

Faecal calprotectin (FC) is a sensitive and non-invasive marker for gastrointestinal mucosal inflammation [1]. Since Calprotectin is a small calcium-binding protein released by neutrophils (S100 family) as a result of an inflammatory process [2], it is an excellent inflammatory marker to distinguish organic inflammatory bowel disease (IBD) - Crohn’s disease (CD) or Ulcerative Colitis (UC) from functional disease- Irritable Bowel Syndrome (IBS) [1,2]. In pediatric patients, FC is useful for an early diagnosis of IBD significantly reducing the number of invasive procedures in children with gastrointestinal symptoms. Endoscopic procedures are unpleasant for the patient, time-consuming and bear the risk of intestinal perforation. In addition, FC is more sensitive than C-reactive protein (CRP) in reflecting IBD activity [3], being for this reason also used to monitor IBD therapy and to predict relapse in these patients [1,3]. Because of its enormous potential as biomarker, many methods have been developed for its measurement. Although the quantitative enzyme-linked immune sorbent assay (ELISA) is considered the “gold” standard method to quantify FC, there are also immunochromatographic tests that are regularly used. More recently, automated immunoassays have been developed as an alternative, leading to an improved solution in the routine laboratory in view of an exponential increase in workload [4,5]. In our hospital, we have been using a rapid test to measure FC in pediatric samples. As the number of tests for these samples has been increasing in the last years, the possibility to automate this parameter was considered as worth to evaluate. The main purpose of this study was to determine FC levels with an immunoassay test adapted to an automated equipment and compare with a rapid routine test.

Breath analysis using eNose technology to diagnose inflammatory bowel disease – early results

This study aimed to determine if exhaled volatile organic compounds (VOCs), analysed with electronic nose (eNose) and gas chromatograph – ion mobility spectrometer (GC-IMS) technology, can be used to distinguish inflammatory bowel disease (IBD) from controls and Crohn’s disease (CD) from ulcerative colitis (UC). Early diagnosis of IBD, including CD and UC, remains a clinical challenge with current tests being invasive. About 0.5–1% of people in Europe have IBD. Colonoscopy …

Inflammatory bowel disease in neonates: report of seven cases

Objective To analyze the clinical characteristics of inflammatory bowel disease (IBD) in neonates. Methods From July 2010 to July 2015, seven neonates were diagnosed with IBD in Affiliated BaYi Children's Hospital, Clinical Medical College in Chinese People's Liberation Army General Hospital, Southern Medical University. The data regarding these neonatal cases were analyzed and compared with 45 children with IBD from literature. The t-test and Chi-square test were used for statistical analysis of the data. Results Six cases had ulcerative colitis, and one case had Crohn's disease, both occurred 2-20 days after birth, and were characterized by diarrhea, no increase in body weight, anemia and intermittent higher hypersensitive C-reactive protein. Compared with IBD in children, abdominal pain and abdominal mass were rarer, while anemia was more common in neonatal IBD. All fecal cultures and blood cultures in the seven cases of neonatal IBD were negative. Abdominal X-ray revealed intestinal wall thickening in four cases. Multiple ulcers were observed from the cecum to the rectum by colonoscopy. Chronic intestinal mucosal inflammation associated with acute inflammation were found on pathological examination. Six infants received treatment with 5-aminosalicylic acid (combined with glucocorticoid in four cases), and one received glucocorticoid treatment only. One infant was started on infliximab treatment from two years old. One of these seven cases died one month after discharge due to refusal to continue treatment, and the disease was controlled in the other six cases. After treatment, one infant was lost to follow-up six months after discharge, two were cured at six and 12 months old without further treatment, and three improved and continued treatment. Conclusions In neonates with diarrhea, anemia and no increase in body weight, especially when antibiotic treatment is ineffective, colonoscopy should be performed to facilitate early diagnosis of IBD. Standard treatments result in good outcomes. Key words: Inflammatory bowel diseases; Infant, newborn

MicroRNAs in inflammatory bowel disease - pathogenesis, diagnostics and therapeutics

The pathogenesis of inflammatory bowel disease (IBD) is complex and largely unknown. Until recently, research has focused on the study of protein regulators in inflammation to reveal the cellular and molecular networks in the pathogenesis of IBD. However, in the last few years, new and promising insights have been generated from studies describing an association between an altered expression of a specific class of non-coding RNAs, called microRNAs (miRs or miRNAs) and IBD. The short (approximately 22 nucleotides), endogenous, single-stranded RNAs are evolutionary conserved in animals and plants, and regulate specific target mRNAs at the post-transcriptional level. MiRNAs are involved in several biological processes, including development, cell differentiation, proliferation and apoptosis. Furthermore, it is estimated that miRNAs may be responsible for regulating the expression of nearly one-third of the genes in the human genome. Thus, miRNA deregulation often results in an impaired cellular function, and a disturbance of downstream gene regulation and signaling cascades, suggesting their implication in disease etiology. Despite the identification of more than 1900 mature human miRNAs, very little is known about their biological functions and functional targets. Recent studies have identified dysregulated miRNAs in tissue samples of IBD patients and have demonstrated similar differences in circulating miRNAs in the serum of IBD patients. Thus, there is great promise that miRNAs will aid in the early diagnosis of IBD, and in the development of personalized therapies. Here, we provide a short review of the current state-of-the-art of miRNAs in IBD pathogenesis, diagnostics and therapeutics.