Inflammatory Bowel Disease Group Research Articles

Oxidative and Antioxidative Stress Status in Children with Inflammatory Bowel Disease as a Result of a Chronic Inflammatory Process.

Oxidative stress (OS) has been recently implicated in the disease pathogenesis in inflammatory bowel disease (IBD). The aim of the study was to evaluate oxidative and antioxidative stress status and the risk of the atherosclerotic process in children with IBD and functional gastrointestinal disorders (FGID). The prospective study included a group of 71 children during a period of 2 years. In all children, laboratory tests were performed and intima-media complex in the carotid artery was measured (IMC). Low values of OS were more frequent in children with IBD than in the FGID group. The average concentration of oxidized lipoprotein with average density (oxLDL) was lower in patients with IBD. Among patients with IBD, higher concentrations of oxLDL were recorded in patients with longer-duration disease and with higher concentrations of total cholesterol. In the IBD group, more often, higher concentrations of anti-oxLDL were recorded among patients with longer-duration disease. The obtained results did not support the hypothesis of total antioxidant capacity depletion and greater overall OS in patients with IBD. Patients with IBD with a longer duration of the disease have higher concentrations of oxLDL and anti-oxLDL.

Performance of da Vinci Stapler during robotic-assisted right colectomy with intracorporeal anastomosis.

Applications for surgical staplers continue to grow, due to the increase in minimally invasive surgical approaches, and range from vessel ligation to tissue transection and anastomoses. Complications associated with stapled tissue, such as bleeding or leaks, continue to be a concern for surgeons, as both can be associated with prolonged operative times and can contribute to postoperative morbidity and mortality. The goal of this retrospective study was to evaluate the performance of the da Vinci® Xi EndoWrist® Stapler 45 with SmartClamp™ technology during robotic-assisted right colectomy with intracorporeal anastomosis. We reviewed 113 consecutive cases from four medical centers. Preclinical diagnoses were inflammatory bowel disease (IBD) (n = 5), benign bowel disease (n = 77), and malignant bowel disease (n = 31). No anastomotic leaks occurred; one event of anastomotic bleeding (0.88%) resolved without surgical intervention. Overall, there were 643 clamp attempts (5.7 attempts per case), and 570 fires (5.0 fires per case). SmartClamp™ occurrences happened in approximately one out of three cases, with the highest proportion of occurrences in the IBD group (2.0 occurrences per case). The most commonly fired reload was blue (1.5mm closed height) with 4.1 blue reloads fired per case overall. No incomplete fires occurred during the procedures. The study data demonstrate the performance of the da Vinci Xi EndoWrist® Stapler 45 as used in right colon resection with intracorporeal anastomosis. The collection and analysis of these data provide surgeons with information related to stapler firings, which were not previously available; as such, this analysis may lead to deductions that are useful for intraoperative decision-making and clinical outcomes.

Naringin protects against bone loss in steroid-treated inflammatory bowel disease in a rat model

We observed the effects of naringin on bone loss in glucocorticoid-treated inflammatory bowel disease (IBD) in a rat model. The IBD model was established in Sprague-Dawley rats by administering 5.0% dextran sodium sulfate. Dexamethasone (DEX) and naringin were given at the second week. Blood, colon and bone samples were collected for biomarker assay, histological analysis or microCT analysis. Superoxide dismutase, catalase and malonaldehyde were measured in bone. A significant decrease of procollagen type 1 N-terminal propeptide (P1NP) level was observed in DEX-treated IBD groups compared with the control (p < 0.05). P1NP levels were dose-dependently increased in the presence of naringin intervention. Bone loss and decreased bone biomechanical properties were observed in DEX-treated IBD rats compared with control rats (p < 0.01). Naringin intervention protected against bone loss and decreased bone biomechanical properties. Bone formation related gene mRNA expressions were significantly decreased in DEX-treated IBD rats compared with control rats. Naringin administration reversed the down-regulation of the expressions of those genes. Naringin treatment reduced the oxidative stress in bone from DEX-treated IBD rats. Our data indicated that naringin may have great potential for the treatment of bone loss in glucocorticoid-treated IBD patients via blocking oxidative stress and promoting bone formation.

Cyclooxygenase-2 immunoexpression in intestinal epithelium and lamina propria of cats with inflammatory bowel disease and low grade alimentary lymphoma

BackgroundCyclooxygenase 2 (COX-2) is an inducible isoform by cellular activation, proinflammatory cytokines and growth factors. The aims of the current study were to evaluate COX-2 immunoexpression in epithelial and lamina propria (LP) of cats with inflammatory bowel disease (IBD) and low grade alimentary lymphoma (LGAL), as well as to correlate them with clinical signs and histopathological scoring. Cats diagnosed with IBD and LGAL (2007–2013) were included in the current study. Feline chronic enteropathy activity index (FCEAI) was calculated for all cases. Control group was composed by 3 healthy indoor cats and 5 sick cats died or were euthanized (non-gastrointestinal illness). Diagnosis and classification of IBD and LGAL was established according to the WSAVA gastrointestinal standardization group template and the National Cancer Institute formulation, respectively. Furthermore, a modified WSAVA template was applied for LGAL evaluation. Immunolabelling for COX-2 (polyclonal rabbit anti-murine antibody) was performed on biopsy samples. Epithelial and LP (inflammatory or neoplastic cells) COX-2 immunolabelling was calculated according to the grade and intensity. The most representative segment scored by the WSAVA and the modified WSAVA were used for statistical analysis.ResultsSignificant difference was found regarding COX-2 intensity overexpression in the epithelial cells of IBD and LGAL groups when compared to control cats, but not between the groups of sick cats, whereas no differences were found regarding the grade of immunoreactivity between groups. No difference was found for COX-2 immunoexpression at the LP between all groups. However, 3 cats from LGAL group showed COX-2 expression in neoplastic cells at the LP. There were no correlations between epithelial or LP COX-2 expression and FCEAI and histological alterations.ConclusionsIncreased COX-2 intensity at the epithelial cells observed in cats with IBD and LGAL may be secondary to the inflammatory response or a protective function in the intestinal reparation. COX-2 expression at the LP was presented in 33% of LGAL. This result provides a reason for further investigation concerning the role of COX-2 expression in feline alimentary lymphoma.

Comparison of comorbid depression between irritable bowel syndrome and inflammatory bowel disease: A meta-analysis of comparative studies

BackgroundThe prevalence of comorbid depression is high in chronic gastrointestinal disorders, including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). For these two disorders in particular, the findings have not been consistent. This meta-analysis systematically compares the rates and severity of comorbid depression between IBS and IBD patients. MethodsA systematic literature search was conducted using PubMed, PsycINFO, Embase, Cochrane Library, Wan Fang, SinoMed, Chinese National Knowledge Infrastructure from their inception date to September 12, 2017 for comparative studies on IBS and IBD patients. Standardized mean differences (SMDs) and odds ratios (OR) of comorbid depression were calculated using random effect models. Data on comorbid anxiety in the included studies were also extracted and analyzed. ResultsAltogether, 22 studies with 1,244 IBS and 1,048 IBD patients were included. While there was no significant group difference in the prevalence of depression (10 studies, OR = 1.18, 95%CI: 0.87–1.60, P = 0.29), the IBS group had more severe depression (pooled SMD = 0.18, 95%CI: 0.04–0.33, P = 0.01) and anxiety than the IBD group (pooled SMD = 0.31, 95%CI: 0.14–0.49, P = 0.0006). Sixteen (72.7%) studies were assessed as ‘high quality’ using the Newcastle–Ottawa Scale (NOS). ConclusionsAlthough the prevalence of comorbid depression was similar between groups, IBS patients had more severe comorbid depressive and anxiety symptoms compared to IBD patients. Appropriate assessment and treatment of depressive and anxiety symptoms in these patient groups should be implemented.

The effects of dihydroartemisinin on inflammatory bowel disease-related bone loss in a rat model.

Bone loss is one of the important extra-intestinal manifestations in patients with inflammatory bowel diseases (IBDs). Compounds derived from natural products have been used to treat IBDs. However, the role of natural products on IBD-induced bone loss is not completely clarified. In the present study, we observed the effects of dihydroartemisinin (DHA), an antimalaria drug, on IBD and IBD-induced bone loss in a rat model. Chronic IBD model was established in Sprague-Dawley rats by giving them 2.5% dextran sodium sulfate in drinking water. DHA was given by intraperitoneal injection. Blood, colon, and bone samples were collected for biomarker assay and histological analysis. There was an obvious increase in tumor necrotic factor (TNF) α and receptor activator of nuclear factor (NF)-kB ligand (RANKL), and decrease in procollagen type 1 N-terminal propeptide (P1NP) level in IBD groups compared with the normal control (p < 0.05). The disease activity score of IBD rats was significantly higher than the control (p < 0.01). Obvious decrease in disease activity score, TNFα, and RANKL level and increase in P1NP were observed in DHA-treated IBD rats. Bone loss, shown as the decrease in bone mineral density, bone volume fraction, and trabecular number and increase in trabecular separation were observed in IBD rats compared with control (p < 0.01). DHA treatment obviously abolished the bone loss, in particular in the high-dose group (p < 0.05). DHA treatment also inhibited the excessive osteoclast formation; RANKL protein expression; and RANK, TRAF6, Fra-1, NFATc1 mRNA expression induced by IBD. Our data indicated that DHA may be a potential therapeutic agent for IBD and IBD-induced bone loss. Impact statement Bone loss is one of the important extra-intestinal manifestations in patients with inflammatory bowel diseases (IBDs). Studies have shown that compounds derived from natural products are useful in the treatment of IBDs. However, few studies have investigated the role of compounds derived from natural products in treatment of osteoporosis in IBDs. The current study aimed to show the effects of dihydroartemisinin (DHA), antimalaria drug, on bone loss in a rat model of IBD. The findings showed that DHA intervention dose dependently protected against bone loss in IBD rats by inhibiting tumor necrotic factor α production and osteoclast formation. These findings highlights that DHA may be beneficial for bone health in those patients with IBD.

Nonalcoholic Fatty Liver Disease in Inflammatory Bowel Disease: Prevalence and Risk Factors.

Nonalcoholic fatty liver disease (NAFLD) is common in inflammatory bowel diseases (IBD). Herein, NAFLD prevalence and risk factors in a large IBD cohort were evaluated and compared to that of a non-IBD sample. Crohn's disease/ulcerative colitis outpatients referred to IBD service of our Gastroenterology Unit were enrolled. Subjects affected by functional and motor gastrointestinal disorders, in whom IBD was ruled out, referred to general outpatient service in the same area, were considered as nonIBD group. Exclusion criteria were based on previous diagnosis of nonNAFLD chronic liver diseases and secondary causes of fat liver overload. Characteristics of IBD and liver status were collected. Risk factors for metabolic syndrome were analyzed. Ultrasonographic presence and degree of steatosis were assessed. Data were examined by univariate and multivariate analyses. For this study 465 IBD and 189 non-IBD subjects were consecutively enrolled. NAFLD was found in 28.0% and 20.1% in IBD and non-IBD subjects, respectively (P = 0.04). IBD patients with NAFLD were younger than non-IBD ones. There was no significant difference in steatosis grade and association between NAFLD and IBD behavior, extension, activity, and drugs. In the IBD group, multivariate analysis demonstrated that NAFLD was independently associated to metabolic syndrome (OR=2.24, 95%CI 1.77-28.81), diabetes (OR=1.71, 95%CI 1.43-12.25), fasting blood glucose (OR=1.36, 95%CI 1.13-1.68), and abdominal circumference (OR=1.68, 95%CI 1.15-14.52). NAFLD is more common and occurs at a younger age in IBD than in nonIBD subjects. However, further investigation is required to ascertain possible NAFLD pathogenic IBD-related factors other than conventional/metabolic ones. 10.1093/ibd/izy051_video1izy051.video15774874877001.

Detection of B. fragilis group and diversity of bft enterotoxin and antibiotic resistance markers cepA, cfiA and nim among intestinal Bacteroides fragilis strains in patients with inflammatory bowel disease

We compared frequency of the members of B. fragilis group in 100 and 20 colon biopsy specimens of inflammatory bowel disease (IBD) and non-IBD patients. Agar dilution and PCR were orderly used to detect minimal inhibitory concentration of ampicillin, imipenem, and metronidazole, and carriage of related resistance genes cepA, cfi, and nim. B. fragilis group was detected in 38% of IBD (UC: 36/89; CD:1/11) and 25% (5/20) of non-IBD patients. While B. vulgatus (UC: 20/36, CD: 1/2, control: 1/6); B. fragilis (UC: 18/36, CD: 1/2, control: 5/6); B. ovatus (UC: 2/36); B. caccae (UC: 1/36); and B. eggerthii (UC: 1/36) were characterized, colonization of B. thetaiotamicron, B. merdae, B. distasonis, B. stercoris and B. dorei species was not detected in these specimens. Co-existence of B. fragilis + B. vulgatus (5 patients) and B. vulgatus + B. caccae (1 patient) was detected just in UC patients. bft was detected among 31.5% (6/19) of B. fragilis strains in the IBD and 40% (2/5) in the non-IBD groups. Nearly, 73.6% of the strains from the patient group and 80% in control group harbored cepA; 31.5% and 20% in the patients and control groups harbored cfiA, and none of them harbored nim determinant. Co-occurrence of the cepA and cfiA was orderly detected in 10.5% (2/19) and 20% (1/5) of the strains in these groups. The resistance rates were detected as 95.8% (23/24 (to ampicillin (MIC range of ≤0.5-≥16 μg/ml), 0% to metronidazole and 29.1% to imipenem (7/24, MIC range ≤4–32 μg/ml). Nearly 25% (6/24) of the strains were resistant to ampicillin and imipenem, simultaneously. No statistically significant difference was detected between the IBD and control groups for drug resistance phenotypes. Statistical analysis showed significant associations between resistance to ampicillin or imipenem and carriage of cepA or cfiA, respectively (p value = 0.0007). PCR results on the extracted plasmids confirmed their roles in carriage of cfiA and cepA. These data provide guide for antibiotic therapy and highlights wide distribution of β-lactam resistant B. fragilis strains in patients with IBD and non-IBD intestinal disorders.

Quality of Life, Anxiety, Depression and Sexual Dysfunction in Patients With Chronic Intestinal Diseases

BACKGROUND: "Quality of life" (QoL) has been emphasized to assess the impact of a disease and its treatment in the patient's life. The QoL of chronic patients is significantly impaired, and it can lead to psychological and social changes, engendering anxiety, depression and other injuries, including sexual dysfunction. The aim of this study is to compare the QoL, the presence of anxious and depressive symptoms, the frequency of female sexual dysfunction and erectile dysfunction, and patient's self-esteem in the following groups: Inflammatory Bowel Diseases (IBD), Functional Bowel Disorders (FBD), Colon Cancer (CC) and Control Group (CG). METHODS: Cross-sectional study with specific questionnaires application, approved in the Research Ethics Committee (n.1.356.518). Ninety-nine patients with IBD (43 with Ulcerative Colitis and 56 with Crohn's Disease), 35 with FBD (20 with Chronic Constipation and 13 with Irritable Bowel Syndrome), 33 with CC and 150 healthy controls were interviewed. The SF-36 questionnaire was used to evaluate the Quality of Life, the Hospital Anxiety and Depression Scale (HADS) to assess the presence of anxiety and depression, the Rosenberg Self-esteem Scale to study the patients' self-esteem, the International Index of Erectile Function to evaluate the erectile dysfunction and the Female Sexual Function Index to assess the female sexual dysfunction. Statistical: descriptive and association tests, p <0.05. RESULTS: The mean age was 38.89 (± 10.15) years in the IBD group; 46.77 (± 15.87) in FBD patients; 62.88 (± 11.46) years in the CC group and 36.26 (± 12.39) in the CG. There was a predominance of women in IBD (56.6%), in FBD (97.1%) and in control (67.33%) groups, p <0.0001. Men had a small predominance in the CC group (51.5%), p <0.0001. The quality of life was impaired in the FBD group, with a significant difference compared to IBD (p <0.001) and control groups (p <0.0001). The prevalence of anxiety was higher in FBD patients (77.1%) compared to IBD (47.5%), CC (34.4%) and CG (38.7%), P=0.0003 Depression prevalence was higher in FBD group (60%) compared to the others: CC (40.63%), IBD (24.2%) and CG (21.33%), P<0.0001. Patients had high self-esteem in the majority of cases: CG (96%), IBD (90.9%), CC (93.75%), except in FBD group (61.76%), P<0.0001. There was a high prevalence of Erectile Dysfunction in the sample: FBD (100%), CC (50%), IBD (27.9%) and CG (35.42%) with no difference among groups (P=0.19). The Female Sexual Dysfunction was more prevalent in CC group (100%) compared to the others FBD (66.67%), IBD (46.4%) and CG (33.33%), P<0.0001. CONCLUSION(S): Patients with FBD had a greater impairment in their quality of life compared to IBD and control groups, as well as a higher prevalence of mood disorders compared to patients with organic diseases and the CG. They also had lower rates of high self-esteem. The female sexual dysfunction was higher in CC compared to the others and no difference in erectile dysfunction rates between the groups was found.

Evidence‐based consensus on opportunistic infections in inflammatory bowel disease

Evidence‐based consensus on opportunistic infections in inflammatory bowel disease

Steroids Use Is the Major Factor Associated With Clostridium Difficile Infection During IBD Flares in the Outpatient Setting

BACKGROUND: The prospective assessment of Clostridium difficile infection (CDI) impact in inflammatory bowel disease (IBD) patients with colitis flare in outpatient setting has far been poorly investigated. We aimed to explore the prevalence and factors associated with CDI in IBD outpatients presenting with colitis flares as well as the outcomes following treatment. METHODS: In this prospective cohort study, conducted between October, 2013 and July, 2016, 120 IBD patients (55% presenting a colitis flare) and 40 non-IBD controls were assessed for CDI. Multivariate regression was performed to identify predictors of CDI. Outcome analysis was accomplished for recurrent CDI, hospitalization, colectomy, and CDI-associated mortality. RESULTS: The proportion of patients with CDI was significantly higher in IBD patients experiencing flares than in both inactive IBD and non-IBD groups (28.8% vs. 5.6% vs. 0%, respectively; P=0.001). Females (OR=1.39, 95% CI, 1.13-17.18), younger age (OR=0.77, 95% CI, 0.65-0.92), steroids treatment (OR=7.42, 95% CI, 5.17-40.20), and infliximab therapy (OR=2.97, 95% CI, 1.99-24.63) were independently associated with CDI. There was a dose-related increase in the odds of having CDI on patients using prednisone. All patients treated with vancomycin had a satisfactory response to therapy, but 21% presented recurrent CDI and 16% were hospitalized. Neither colectomy nor mortality was noticed. CONCLUSION(S): In IBD outpatients presenting with colitis flares, CDI is highly prevalent. Females, younger age, infliximab use, and notably steroids therapy were independently associated with CDI. Most patients with CDI experienced mild-to-moderate disease and prompt treatment with vancomycin was highly effective, what seems to reduce the serious complications risks.

Evaluation of autonomic nervous system functions in frame of heart rate variability in children with inflammatory bowel disease in remission.

Aghdasi-Bornaun H, Kutluk G, Keskindemirci G, Öztarhan K, Dedeoğlu R, Yılmaz N, Tosun Ö. Evaluation of autonomic nervous system functions in frame of heart rate variability in children with inflammatory bowel disease in remission. Turk J Pediatr 2018; 60: 407-414. Heart Rate Variability (HRV) is one of the reliable and noninvasive parameters to evaluate autonomic control of the cardiovascular system in patients. The aim of our study was to assess autonomic function in pediatric patients with inflammatory bowel disease (IBD) in remission using Power Spectral Analysis of HRV. Autonomic cardiovascular function was evaluated by time and frequency-domain indexes of spontaneous heart rate in 36 IBD children patients in remission phase and 36 sex and age matched healthy controls. Twenty children with Ulcerative Colitis (UC) and 16 patients with Crohn`s disease (CD) were diagnosed according to their history, physical and laboratory examination, endoscopic, histopathological and radiological findings of upper and lower gastrointestinal system. Significant decrease was observed at HRV parameters in IBD patients when compared with control group. These differences was found in some of time domain parameters (NNmean, SDNNtotal, SDNNday) and frequency domain parameters (TP, LF,VLF) (p < 0.05). Also, there was a significant higher minimum heart rate ratio (p < 0.04) in patients in comparison to the control group. In the IBD group, there was a relative tendency for parasympathetic suppression and sympathetic predominance which reflects an autonomic dysfunction. This imbalance has a circadian rhythm and it is more obvious during the day. These observations may suggest a previously unrecognized role of chronic inflammation for autonomic modulation in IBD.

Descriptive Analysis of Infective Colitis in A Large Hospital Cohort, Features in IBD and Non-IBD Patients

Background: Clinical features associated with infective colitis and flare up of Inflammatory Bowel Disease (IBD) are very similar and presents a challenge to gastroenterologists to distinguish the two. This is especially difficult in patients with established IBD disease in whom the incidence of bacterial infections is comparable to the general population. Methods: This was a retrospective analytical cohort study conducted at Leeds Teaching Hospitals (LTHT), UK. Subjects included were those with diarrhoeal symptoms, referred by the emergency department or primary care physicians to the Gastroenterology unit of LTHT, over an eight-year period between 2004-2012, with a positive stool culture for Campylobacter, Salmonella, Shigella or E.Coli O157. Results: We analysed 102 consecutive cases. Median duration of symptoms was 4 days (IQR 2 – 7). The most common reported symptom was abdominal pain 91 patients (91%), followed by rectal bleeding 53 patients (52%) and vomiting 44 patients (43%). Blood tests revealed that 98% patients had a substantially elevated C-reactive protein (CRP) concentration [median 95 mg/L (IQR 44-143)]. Thirteen patients had pre-existing IBD, who when compared to non-IBD patients, showed no difference in clinical presentation. In the IBD group, however, median platelet count was significantly higher [282 (IQR 225-415) vs 237 (IQR 194-281) p=0.03) and haemoglobin concentration lower [12.1 (IQR 11-14) v 14.3 (IQR 13-15) p=0.01). Conclusions: In patients where infective diarrhoea is suspected a short duration of symptoms, abdominal pain and elevated CRP concentration are pointers that can support the diagnosis, whereas low Haemoglobin and high Platelet count favours a background of IBD.

Inverse association between Helicobacter pylori and inflammatory bowel disease: myth or fact?

Background: Inflammatory bowel diseases (IBD), are chronic, relapsing-remitting diseases of the gastrointestinal tract, including Crohn’s disease (CD), Ulcerative colitis (UC) and Unclassified IBD (IBDU). Their pathogenesis involves genes and environment as cofactors in inducing autoimmunity; particularly the interactions between enteric pathogens and immunity is being studied. Helicobacter pylori (HP) is common pathogen causing gastric inflammation. Studies found an inverse prevalence association between HP and IBD, suggesting a potential protecting role of HP from IBD. Methods: A literature search of the PubMed database was performed using the key words‘’helicobacter pylori’’,‘’inflammatory bowel disease’’,‘’crohn disease’’, “ulcerative colitis”. Embase, Medline (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane and Google Scholar were also searched. Prevalence rate-ratios among HP in IBD patients, HP in CD patients, HP in UC patients, HP in IBDU patients were extracted, each group was compared with controls, to verify the inverse association between HP and IBD prevalence. Results: In all groups the dispersion of data suggested an inverse association between IBD group and controls, even when the comparison was carried out separately between each group of newly diagnosed patients and controls, to rule out the possible bias of ongoing pharmacologic therapy. Conclusions: The results of this review show a striking inverse association between HP infection and the prevalence of IBD, independently from the type of IBD considered across distinct geographic regions. Anyway, data should be interpreted cautiously, as wider, prospective and more homogeneous research on this topic are awaited, which could open new scenarios about environmental etiology of IBD. (www.actabiomedica.it)

Higher Morbidity of Monogenic Inflammatory Bowel Disease Compared to the Adolescent Onset Inflammatory Bowel Disease.

PurposeMonogenic inflammatory bowel disease (IBD) patients do not respond to conventional therapy and are associated with a higher morbidity. We summarized the clinical characteristics of monogenic IBD patients and compared their clinical outcomes to that of non-monogenic IBD patients.MethodsWe performed a retrospective cohort study of all children <18 years old who were diagnosed with IBD between 2005 and 2016. A total of 230 children were enrolled. Monogenic IBD was defined as a presentation age less than 6 years old with confirmation of a genetic disorder. We subdivided the groups into monogenic IBD (n=18), non-monogenic very early-onset IBD (defined as patients with a presentation age <6 years old without a confirmed genetic disorder, n=12), non-monogenic IBD (defined as all patients under 18 years old excluding monogenic IBD, n=212), and severe IBD (defined as patients treated with an anti-tumor necrosis factor excluding monogenic IBD, n=92). We compared demographic data, initial pediatric Crohn disease activity index/pediatric ulcerative colitis activity index (PCDAI/PUCAI) score, frequency of hospitalizations, surgical experiences, and height and weight under 3rd percentile among the patients enrolled.ResultsThe initial PCDAI/PUCAI score (p<0.05), incidence of surgery per year (p<0.05), and hospitalization per year (p<0.05) were higher in the monogenic IBD group than in the other IBD groups. Additionally, the proportion of children whose weight and height were less than the 3rd percentile (p<0.05 and p<0.05, respectively) was also higher in the monogenic IBD group.ConclusionMonogenic IBD showed more severe clinical manifestations than the other groups.

Patients with inflammatory bowel disease have higher abdominal adiposity and less skeletal mass than healthy controls.

BackgroundAbdominal fat type and distribution have been associated with complicated Crohn’s disease and adverse postoperative outcomes. Few studies have assessed the abdominal distribution of fat and lean stores in patients with inflammatory bowel disease (IBD) and compared this with healthy controls. This retrospective study aimed to compare the abdominal body composition in IBD patients who failed medical treatment and who underwent computed tomography (CT) imaging prior to gastrointestinal surgery with healthy controls. Associations between preoperative abdominal body composition and postoperative outcomes within a year of surgery were explored.MethodsAbdominal body composition was evaluated in 22 presurgical patients with medically refractory IBD (18 with Crohn’s disease) and 22 healthy controls, using routinely acquired CT. Total fat, subcutaneous fat, visceral fat, and skeletal muscle cross-sectional area were measured.ResultsAn independent disease effect was observed, explaining a fat deposition excess of 38 cm2 and a skeletal muscle deficit of 15 cm2 in IBD. Abdominal skeletal muscle correlated with visceral fat for the control (rho=0.51, P=0.015), but not for the IBD group (rho=-0.13, P=0.553). A positive correlation observed between subcutaneous fat with skeletal muscle in the controls (rho=0.47, P=0.026) was inverted in the IBD group (rho=-0.43, P=0.045). Preoperative abdominal body composition was not predictive of postoperative outcomes.ConclusionsA higher degree of abdominal adiposity, a lower skeletal mass and a larger body size for the same anthropometry can be expected in IBD patients. Preoperative abdominal body composition is not associated with surgical outcomes.

Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication).

Inflammatory bowel disease (IBD) patients are a high-risk population for opportunistic infections. The IBD group of the Chinese Society of Gastroenterology of the Chinese Medical Association organized an expert group to discuss and develop this consensus opinion. This consensus opinion referenced clinical study results from China and other countries to provide guidance for clinical practices. Eight major topics, including cytomegalovirus infection, Epstein-Barr virus infection, viral hepatitis, bacterial infection, Mycobacterium tuberculosis infection, fungal infection, parasitic infection, and vaccines were introduced in this article.

Psychological wellbeing and physical activity in children and adolescents with inflammatory bowel disease compared to healthy controls

BackgroundChildren and adolescents with inflammatory bowel disease (IBD) report impairments in daily activities, social interactions and coping. Findings regarding psychological functioning are inconsistent, while limited information is available on objectively assessed physical activity (PA). The aims of the present study were therefore to compare anthropometric dimensions, blood values, psychological functioning and PA of children and adolescents with IBD with healthy controls.MethodsForty-seven children and adolescents took part in the study. Of these, 23 were diagnosed with IBD (mean age: 13.88 years, 44% females). The IBD group was divided into a medically well adjusted “remission-group” (n = 14; IBD-RE) and a group with an “active state” of disease (n = 8; IBD-AD). Healthy controls (n = 24; HC) were age- and gender-matched. Participants’ anthropometric data, blood values and objective PA were assessed. Further, participants completed questionnaires covering socio-demographic data and psychological functioning.ResultsParticipants with IBD-AD showed higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values, haemoglobin, and leukocyte values. IBD-AD had poorer psychological functioning and lower PA (average steps per day) compared to IBD-RE and HC. No mean differences were found between IBD-RE and HC.ConclusionsThe pattern of results suggests that effective medical treatment of IBD in children and adolescents is associated with favorable physiological parameters, psychological dimensions and PA. Psychological counselling of children and adolescents in an active state of IBD seem to be advised in addition to standard treatment schedules.Trial registrationNCT NCT02264275; Registered 8 October 2014.

Utility of Fecal Calprotectin in Evaluation of Chronic Gastrointestinal Symptoms in Primary Care.

Fecal calprotectin (FC) is a marker of intestinal inflammation. Data are limited on utility of routine FC testing in pediatric primary care. Participants 0 to 18 years old who had an FC test in the years 2010-2014 were retrospectively identified. Those with less than a year of follow-up or a prior diagnosis of inflammatory bowel disease (IBD) were excluded. In all, 84% (689/822) had normal FC; no participant with normal FC was diagnosed with IBD in the subsequent 12 months. Also, 16% (133/822) had elevated FC, and 31% of those (42/133) were diagnosed with IBD. FC values for IBD and non-IBD groups were 1084 µg/g (interquartile range [IQR] = 514.4-2000) and 27.05 µg/g (IQR = 15.6-62.6; P < .001), respectively. Abdominal pain was the primary indication. In this cohort, sensitivity of FC for IBD is 100%, and specificity is 88%. The FC test can be an excellent tool in the primary care setting to exclude IBD and avoid unnecessary referrals and colonoscopies.

Comparison of Clinical Features between Pyoderma Gangrenosum Concomitant by Inflammatory Bowel Disease and Idiopathic Pyoderma Gangrenosum.

Background:Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that is highly associated with inflammatory bowel disease (IBD). Certain PG patients with no systemic disorders have been diagnosed with idiopathic PG. This study sought to clarify the difference between PG with IBD and idiopathic PG based on clinical features, laboratory tests, and medications.Methods:Twelve patients with PG and IBD and 24 patients with idiopathic PG, who were hospitalized in Peking Union Medical College Hospital from 2000 to 2017, were retrospectively categorized into the IBD group and control group, respectively. Data of clinical features, laboratory tests, and medications were collected and compared between the two groups.Results:Both groups were similar with respect to their clinical features. However, the IBD group had an increased occurrence of arthralgia or arthritis (58.3% vs. 12.5%, P = 0.007), anemia (83.3% and 29.2%, P = 0.004), and an increased percentage of antineutrophilic cytoplasmic antibody (ANCA)-positive patients (85.7% and 0.0%, P < 0.001), compared to the control group.Conclusion:PG patients with IBD had increased occurrence rates of arthralgia or arthritis, anemia, and ANCA-positive status compared to idiopathic PG patients.