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Inflammatory Bowel Disease and Risk of Colorectal Polyps: A Nationwide Population-Based Cohort Study From Sweden. 炎症性肠病与结直肠息肉的风险:瑞典一项基于全国人群的队列研究。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad056
Jordan E Axelrad, Ola Olén, Jonas Söderling, Bjorn Roelstraete, Hamed Khalili, Mingyang Song, Adam Faye, Michael Eberhardson, Jonas Halfvarson, Jonas F Ludvigsson

Background: Inflammatory bowel disease [IBD] has been linked to an increased risk of colorectal neoplasia. However, the types and risks of specific polyp types in IBD are less clear.

Methods: We identified 41 880 individuals with IBD (Crohn's disease [CD: n = 12 850]; ulcerative colitis [UC]: n = 29 030]) from Sweden matched with 41 880 reference individuals. Using Cox regression, we calculated adjusted hazard ratios [aHRs] for neoplastic colorectal polyps [tubular, serrated/sessile, advanced and villous] defined by histopathology codes.

Results: During follow-up, 1648 [3.9%] IBD patients and 1143 [2.7%] reference individuals had an incident neoplastic colorectal polyp, corresponding to an incidence rate of 46.1 and 34.2 per 10 000 person-years, respectively. This correlated to an aHR of 1.23 (95% confidence interval [CI] 1.12-1.35) with the highest HRs seen for sessile serrated polyps [8.50, 95% CI 1.10-65.90] and traditional serrated adenomas [1.72, 95% CI 1.02-2.91]. aHRs for colorectal polyps were particularly elevated in those diagnosed with IBD at a young age and at 10 years after diagnosis. Both absolute and relative risks of colorectal polyps were higher in UC than in CD [aHRs 1.31 vs 1.06, respectively], with a 20-year cumulative risk difference of 4.4% in UC and 1.5% in CD, corresponding to one extra polyp in 23 patients with UC and one in 67 CD patients during the first 20 years after IBD diagnosis.

Conclusions: In this nationwide population-based study, there was an increased risk of neoplastic colorectal polyps in IBD patients. Colonoscopic surveillance in IBD appears important, especially in UC and after 10 years of disease.

背景:炎症性肠病(IBD)与结直肠肿瘤的风险增加有关。然而,IBD中特定息肉类型的类型和风险尚不清楚。方法:我们鉴定了41880名患有IBD(克罗恩病[CD:n = 12 850];溃疡性结肠炎 = 29 030])与41880个参考个体相匹配。使用Cox回归,我们计算了由组织病理学代码定义的结直肠肿瘤性息肉[管状、锯齿状/无柄、晚期和绒毛状]的调整后危险比[aHRs]。结果:在随访期间,1648例[3.9%]IBD患者和1143例[2.7%]参考个体发生了肿瘤性结肠息肉,发病率分别为46.1和34.2/10000人年。这与1.23的aHR(95%置信区间[CI]1.12-1.35)相关,无柄锯齿状息肉[8.50,95%CI 1.10-65.90]和传统锯齿状腺瘤[1.72,95%CI 1.02-2.91]的HRs最高。结直肠息肉的aHR在年轻时和诊断后10年被诊断为IBD的患者中尤其升高。UC患结直肠息肉的绝对和相对风险均高于CD[aHRs分别为1.31和1.06],UC和CD的20年累积风险差异分别为4.4%和1.5%,相当于在诊断IBD后的前20年,23名UC患者和67名CD患者中各有一人患上额外息肉。结论:在这项全国性的基于人群的研究中,IBD患者发生肿瘤性结肠息肉的风险增加。IBD的结肠镜监测似乎很重要,尤其是在UC和患病10年后。
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引用次数: 0
Multiomics-empowered Deep Phenotyping of Ulcerative Colitis Identifies Biomarker Signatures Reporting Functional Remission States. 溃疡性结肠炎的多组学增强的深层表型鉴定了报告功能性缓解状态的生物标志物特征。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad052
Lukas Janker, Dina Schuster, Patricia Bortel, Gerhard Hagn, Samuel M Meier-Menches, Thomas Mohr, Johanna C Mader, Astrid Slany, Andrea Bileck, Julia Brunmair, Christian Madl, Lukas Unger, Barbara Hennlich, Barbara Weitmayr, Giorgia Del Favero, Dietmar Pils, Tobias Pukrop, Nikolaus Pfisterer, Thomas Feichtenschlager, Christopher Gerner

Introduction: Ulcerative colitis [UC] is a chronic disease with rising incidence and unclear aetiology. Deep molecular phenotyping by multiomics analyses may provide novel insights into disease processes and characteristic features of remission states.

Methods: UC pathomechanisms were assessed by proteome profiling of human tissue specimens, obtained from five distinct colon locations for each of the 12 patients included in the study. Systemic disease-associated alterations were evaluated thanks to a cross-sectional setting of mass spectrometry-based multiomics analyses comprising proteins, metabolites, and eicosanoids of plasma obtained from UC patients during acute episodes and upon remission, in comparison with healthy controls.

Results: Tissue proteome profiling indicated colitis-associated activation of neutrophils, macrophages, B and T cells, fibroblasts, endothelial cells and platelets, and hypoxic stress, and suggested a general downregulation of mitochondrial proteins accompanying the establishment of apparent wound healing-promoting activities including scar formation. Whereas pro-inflammatory proteins were apparently upregulated by immune cells, the colitis-associated epithelial cells, fibroblasts, endothelial cells, and platelets seemed to predominantly contribute anti-inflammatory and wound healing-promoting proteins. Blood plasma proteomics indicated chronic inflammation and platelet activation, whereas plasma metabolomics identified disease-associated deregulations of gut and gut microbiome-derived metabolites. Upon remission several, but not all, molecular candidate biomarker levels recovered back to normal.

Conclusion: The findings may indicate that microvascular damage and platelet deregulation hardly resolve upon remission, but apparently persist as disease-associated molecular signatures. This study presents local and systemic molecular alterations integrated in a model for UC pathomechanisms, potentially supporting the assessment of disease and remission states in UC patients.

引言:溃疡性结肠炎是一种发病率不断上升、病因不明的慢性疾病。通过多组学分析进行的深层分子表型分析可以为疾病过程和缓解状态的特征提供新的见解。方法:通过对人体组织样本的蛋白质组分析来评估UC的病理机制,这些样本取自研究中12名患者的5个不同结肠位置。通过基于质谱的多组学分析的横断面设置,与健康对照组相比,评估了系统性疾病相关的改变,该分析包括UC患者在急性发作和缓解期间获得的血浆中的蛋白质、代谢物和类二十碳烷。结果:组织蛋白质组分析表明,结肠炎与中性粒细胞、巨噬细胞、B和T细胞、成纤维细胞、内皮细胞和血小板的激活以及缺氧应激有关,并表明线粒体蛋白普遍下调,同时建立了明显的促伤愈合活性,包括瘢痕形成。尽管免疫细胞明显上调了促炎蛋白,但结肠炎相关的上皮细胞、成纤维细胞、内皮细胞和血小板似乎主要参与抗炎和促进伤口愈合的蛋白。血浆蛋白质组学表明慢性炎症和血小板活化,而血浆代谢组学则确定了与疾病相关的肠道和肠道微生物组衍生代谢产物的失调。缓解后,一些(但不是全部)候选分子生物标志物水平恢复正常。结论:研究结果可能表明,微血管损伤和血小板失调在病情缓解时很难解决,但作为疾病相关的分子特征明显持续存在。这项研究将局部和全身分子改变整合到UC病理机制模型中,有可能支持评估UC患者的疾病和缓解状态。
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引用次数: 3
Correlation of Ultrasound Scores with Endoscopic Activity in Crohn's Disease: A Prospective Exploratory Study. 克罗恩病超声评分与内镜活动的相关性:一项前瞻性探索性研究。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad068
Gabriele Dragoni, Matteo Gottin, Tommaso Innocenti, Erica Nicola Lynch, Siro Bagnoli, Giuseppe Macrì, Andrea Giovanni Bonanomi, Beatrice Orlandini, Francesca Rogai, Stefano Milani, Andrea Galli, Monica Milla, Maria Rosa Biagini

Background and aims: Intestinal ultrasound [IUS] is widely accepted as a reliable tool to monitor Crohn's disease [CD]. Several IUS scores have been proposed, but none has been formally accepted by international organizations. Our aim here was to compare the available scores regarding their correlation with endoscopic activity.

Methods: Consenting CD patients undergoing ileocolonoscopy at our Unit between September 2021 and February 2023 were included. Endoscopic activity was defined as SES-CD ≥ 3 or Rutgeerts score ≥ i2b for operated patients. IUS was performed within 6 weeks of endoscopy and scored with IBUS-SAS, BUSS, Simple-US and SUS-CD scores. All correlations were performed using Spearman's rank coefficient [rho = ρ]. Receiver operating characteristic [ROC] curves were compared with the Hanley and McNeil method.

Results: Of 73 CD patients, 45 [61.6%] presented endoscopic activity, of whom 22 were severe [30.1%]. All IUS scores showed a significant positive correlation with endoscopy [p < 0.0001], with IBUS-SAS ranking the highest [ρ = 0.87]. Similarly, IBUS-SAS was the most highly correlated with clinical activity [ρ = 0.58]. ROC analysis of IBUS-SAS for any endoscopic activity showed the highest area under the curve (0.95 [95% confidence interval 0.87-0.99]), with sensitivity of 82.2% and specificity of 100% for a cut-off value of 25.2. IBUS-SAS was statistically superior to all the other scores in detecting severe endoscopic activity [SES-CD ≥ 9 or Rutgeerts i4].

Conclusions: All IUS scores provided solid correlation with endoscopy and clinical symptoms. IBUS-SAS outperformed the others due to a more granular description that might help in stratifying different levels of disease activity. Therefore, the use of IBUS-SAS in centres with well-founded expertise in IUS can be suggested.

背景和目的:肠道超声被广泛认为是监测克罗恩病的可靠工具。已经提出了一些IUS分数,但没有一个被国际组织正式接受。我们在这里的目的是比较可用的分数与内窥镜活动的相关性。方法:纳入2021年9月至2023年2月期间在我科接受回结肠镜检查的同意CD患者。内镜活动被定义为SES-CD ≥ 3或Rutgeerts得分 ≥ i2b用于手术患者。IUS在内窥镜检查后6周内进行,并用IBUS-SAS、BUSS、Simple US和SUS-CD评分。所有相关性均使用Spearman秩系数[rho=ρ]进行。将受试者工作特性[ROC]曲线与Hanley和McNeil方法进行比较。结果:73例CD患者中,45例(61.6%)有内镜活动,其中22例为重度(30.1%) 结论:所有IUS评分均与内窥镜检查和临床症状密切相关。IBUS-SAS的表现优于其他疾病,因为它的描述更精细,可能有助于对不同水平的疾病活动进行分层。因此,可以建议在具有充分的IUS专业知识的中心使用IBUS-SAS。
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引用次数: 2
Reduced Serological Response to COVID-19 Booster Vaccine is Associated with Reduced B Cell Memory in Patients With Inflammatory Bowel Disease; VARIATION [VAriability in Response in IBD AgainsT SARS-COV-2 ImmunisatiON]. 新冠肺炎加强疫苗的血清学反应降低与炎症性肠病患者B细胞记忆降低有关;变异[IBD AgainsT严重急性呼吸系统综合征冠状病毒2型免疫应答的变异性]。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad065
Jayne Doherty, Neil O'Morain, Roisin Stack, Miriam Tosetto, Rosanna Inzitiari, Sophie O'Reilly, Lili Gu, Juliette Sheridan, Garret Cullen, Edel Mc Dermott, Maire Buckley, Gareth Horgan, Hugh Mulcahy, Margaret Walshe, Elizabeth J Ryan, Virginie Gautier, John Prostko, Edwin Frias, David Daghfal, Peter Doran, Colm O'Morain, Glen A Doherty

Background and aims: Patients with inflammatory bowel disease [IBD] have an attenuated response to initial COVID-19 vaccination. We sought to characterize the impact of IBD and its treatment on responses after the third vaccine against SARS-CoV-2.

Methods: This was a prospective multicentre observational study of patients with IBD [n = 202] and healthy controls [HC, n = 92]. Serological response to vaccination was assessed by quantification of anti-spike protein [SP] immunoglobulin [Ig]G levels [anti-SPIgG] and in vitro neutralization of binding to angiotensin-converting enzyme 2 [ACE2]. Peripheral blood B-cell phenotype populations were assessed by flow cytometry. SARS-CoV-2 antigen-specific B-cell responses were assessed in ex vivo culture.

Results: Median anti-SP IgG post-third vaccination in our IBD cohort was significantly lower than HCs [7862 vs 19 622 AU/mL, p < 0.001] as was ACE2 binding inhibition [p < 0.001]. IBD patients previously infected with COVID-19 [30%] had similar quantitative antibody response as HCs previously infected with COVID-19 [p = 0.12]. Lowest anti-SP IgG titres and neutralization were seen in IBD patients on anti-tumour necrosis factor [anti-TNF] agents, without prior COVID-19 infection, but all IBD patients show an attenuated vaccine response compared to HCs. Patients with IBD have reduced memory B-cell populations and attenuated B-cell responses to SARS-CoV-2 antigens if not previously infected with COVID-19 [p = 0.01]. Higher anti-TNF drug levels and zinc levels <65 ng/ml were associated with significantly lower serological responses.

Conclusions: Patients with IBD have an attenuated response to three doses of SARS-CoV-2 vaccine. Physicians should consider patients with higher anti-TNF drug levels and/or zinc deficiency as potentially at higher risk of attenuated response to vaccination.

背景和目的:炎症性肠病(IBD)患者对首次接种新冠肺炎疫苗的反应减弱。我们试图描述IBD及其治疗对第三次接种严重急性呼吸系统综合征冠状病毒2型疫苗后反应的影响。方法:这是一项针对IBD患者的前瞻性多中心观察性研究 = 202]和健康对照[HC = 92]。通过定量抗刺突蛋白[SP]免疫球蛋白[Ig]G水平[anti-SPIgG]和体外中和与血管紧张素转换酶2[ACE2]的结合来评估对疫苗接种的血清学反应。通过流式细胞术评估外周血B细胞表型群体。在离体培养中评估了严重急性呼吸系统综合征冠状病毒2型抗原特异性B细胞反应。结果:在我们的IBD队列中,第三次接种后的抗SP IgG中位数显著低于HCs[7862 vs 19222 AU/mL,p 结论:IBD患者对三剂严重急性呼吸系统综合征冠状病毒2型疫苗的反应减弱。医生应将抗TNF药物水平较高和/或锌缺乏的患者视为对疫苗接种反应减弱的潜在风险较高。
{"title":"Reduced Serological Response to COVID-19 Booster Vaccine is Associated with Reduced B Cell Memory in Patients With Inflammatory Bowel Disease; VARIATION [VAriability in Response in IBD AgainsT SARS-COV-2 ImmunisatiON].","authors":"Jayne Doherty,&nbsp;Neil O'Morain,&nbsp;Roisin Stack,&nbsp;Miriam Tosetto,&nbsp;Rosanna Inzitiari,&nbsp;Sophie O'Reilly,&nbsp;Lili Gu,&nbsp;Juliette Sheridan,&nbsp;Garret Cullen,&nbsp;Edel Mc Dermott,&nbsp;Maire Buckley,&nbsp;Gareth Horgan,&nbsp;Hugh Mulcahy,&nbsp;Margaret Walshe,&nbsp;Elizabeth J Ryan,&nbsp;Virginie Gautier,&nbsp;John Prostko,&nbsp;Edwin Frias,&nbsp;David Daghfal,&nbsp;Peter Doran,&nbsp;Colm O'Morain,&nbsp;Glen A Doherty","doi":"10.1093/ecco-jcc/jjad065","DOIUrl":"10.1093/ecco-jcc/jjad065","url":null,"abstract":"<p><strong>Background and aims: </strong>Patients with inflammatory bowel disease [IBD] have an attenuated response to initial COVID-19 vaccination. We sought to characterize the impact of IBD and its treatment on responses after the third vaccine against SARS-CoV-2.</p><p><strong>Methods: </strong>This was a prospective multicentre observational study of patients with IBD [n = 202] and healthy controls [HC, n = 92]. Serological response to vaccination was assessed by quantification of anti-spike protein [SP] immunoglobulin [Ig]G levels [anti-SPIgG] and in vitro neutralization of binding to angiotensin-converting enzyme 2 [ACE2]. Peripheral blood B-cell phenotype populations were assessed by flow cytometry. SARS-CoV-2 antigen-specific B-cell responses were assessed in ex vivo culture.</p><p><strong>Results: </strong>Median anti-SP IgG post-third vaccination in our IBD cohort was significantly lower than HCs [7862 vs 19 622 AU/mL, p < 0.001] as was ACE2 binding inhibition [p < 0.001]. IBD patients previously infected with COVID-19 [30%] had similar quantitative antibody response as HCs previously infected with COVID-19 [p = 0.12]. Lowest anti-SP IgG titres and neutralization were seen in IBD patients on anti-tumour necrosis factor [anti-TNF] agents, without prior COVID-19 infection, but all IBD patients show an attenuated vaccine response compared to HCs. Patients with IBD have reduced memory B-cell populations and attenuated B-cell responses to SARS-CoV-2 antigens if not previously infected with COVID-19 [p = 0.01]. Higher anti-TNF drug levels and zinc levels <65 ng/ml were associated with significantly lower serological responses.</p><p><strong>Conclusions: </strong>Patients with IBD have an attenuated response to three doses of SARS-CoV-2 vaccine. Physicians should consider patients with higher anti-TNF drug levels and/or zinc deficiency as potentially at higher risk of attenuated response to vaccination.</p>","PeriodicalId":15547,"journal":{"name":"Journal of Crohns & Colitis","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Spermidine Ameliorates Colitis via Induction of Anti-Inflammatory Macrophages and Prevention of Intestinal Dysbiosis. 亚精胺通过诱导抗炎巨噬细胞和预防肠道生物失调来改善结肠炎。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad058
Anna Niechcial, Marlene Schwarzfischer, Marcin Wawrzyniak, Kirstin Atrott, Andrea Laimbacher, Yasser Morsy, Egle Katkeviciute, Janine Häfliger, Patrick Westermann, Cezmi A Akdis, Michael Scharl, Marianne R Spalinger

Background and aims: Exacerbated immune activation, intestinal dysbiosis and a disrupted intestinal barrier are common features among inflammatory bowel disease [IBD] patients. The polyamine spermidine, which is naturally present in all living organisms, is an integral component of the human diet, and exerts beneficial effects in human diseases. Here, we investigated whether spermidine treatment ameliorates intestinal inflammation and offers therapeutic potential for IBD treatment.

Methods: We assessed the effect of oral spermidine administration on colitis severity in the T cell transfer colitis model in Rag2-/- mice by endoscopy, histology and analysis of markers of molecular inflammation. The effects on the intestinal microbiome were determined by 16S rDNA sequencing of mouse faeces. The impact on intestinal barrier integrity was evaluated in co-cultures of patient-derived macrophages with intestinal epithelial cells.

Results: Spermidine administration protected mice from intestinal inflammation in a dose-dependent manner. While T helper cell subsets remained unaffected, spermidine promoted anti-inflammatory macrophages and prevented the microbiome shift from Firmicutes and Bacteroides to Proteobacteria, maintaining a healthy gut microbiome. Consistent with spermidine as a potent activator of the anti-inflammatory molecule protein tyrosine phosphatase non-receptor type 2 [PTPN2], its colitis-protective effect was dependent on PTPN2 in intestinal epithelial cells and in myeloid cells. The loss of PTPN2 in epithelial and myeloid cells, but not in T cells, abrogated the barrier-protective, anti-inflammatory effect of spermidine and prevented the anti-inflammatory polarization of macrophages.

Conclusion: Spermidine reduces intestinal inflammation by promoting anti-inflammatory macrophages, maintaining a healthy microbiome and preserving epithelial barrier integrity in a PTPN2-dependent manner.

背景和目的:炎症性肠病(IBD)患者的常见特征是免疫激活加剧、肠道生态失调和肠道屏障紊乱。多胺亚精胺天然存在于所有生物体中,是人类饮食中不可或缺的组成部分,对人类疾病具有有益作用。在这里,我们研究了亚精胺治疗是否能改善肠道炎症,并为IBD治疗提供治疗潜力。方法:通过内窥镜检查、组织学和分子炎症标志物分析,评估口服亚精胺对Rag2-/-小鼠T细胞转移性结肠炎模型中结肠炎严重程度的影响。通过小鼠粪便的16S rDNA测序确定对肠道微生物组的影响。在患者来源的巨噬细胞与肠上皮细胞的共培养中评估了对肠屏障完整性的影响。结果:亚精胺给药以剂量依赖的方式保护小鼠免受肠道炎症的影响。虽然辅助T细胞亚群没有受到影响,但亚精胺促进了抗炎巨噬细胞,并阻止了微生物组从厚壁菌门和拟杆菌门转移到变形菌门,维持了健康的肠道微生物组。与亚精胺作为抗炎分子蛋白酪氨酸磷酸酶非受体2型[PTPN2]的有效激活剂一致,其结肠炎保护作用依赖于肠上皮细胞和髓细胞中的PTPN2。PTPN2在上皮细胞和髓细胞中的损失,而在T细胞中没有,消除了亚精胺的屏障保护和抗炎作用,并阻止了巨噬细胞的抗炎极化。结论:亚精胺通过促进抗炎巨噬细胞、维持健康的微生物组和以PTPN2依赖的方式保持上皮屏障完整性来减少肠道炎症。
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引用次数: 4
Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance. 格拉斯哥独家肠道营养依从性指数的开发和验证。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad063
Aleksandra Jatkowska, Bernadette White, Ben Nichols, Vaios Svolos, Konstantinos Gkikas, Richard Hansen, Richard K Russell, Daniel Gaya, Emily Brownson, John Paul Seenan, Simon Milling, Jonathan MacDonald, Konstantinos Gerasimidis

Background and aims: Treatment adherence is key to the efficacy of exclusive enteral nutrition [100% EN] in active Crohn's disease [CD], but there are no biomarkers to objectively estimate this. We explored faecal parameters as biomarkers of compliance with 100% EN, and subsequently developed and validated the Glasgow Exclusive Enteral Nutrition Index of Compliance [GENIE].

Methods: Healthy adults replaced all [100% EN] or part [85% EN, 50% EN, 20% EN] of their diet with a formula for 7 days. Faecal pH, water content, short chain fatty acids, and branched chain fatty acids [BCFAs] were measured before [D0] and after [D7] each intervention. Optimal biomarkers and threshold values were derived using receiver operating characteristic curve analyses and machine learning to develop the GENIE. The GENIE was then validated in 30 CD children, during and after 100% EN.

Results: In all, 61 adults were recruited. D7 faecal pH and the ratios of BCFAs to either acetate or butyrate performed the best to differentiate between patients on 100% EN from <100% EN. Two models were generated; one included faecal metabolites (Laboratory GENIE, L-GENIE; sensitivity, specificity, and positive predictive value [PPV] of 88%, 94%, and 92%) and a second one [Clinical Genie, C-GENIE] which considers only faecal pH [sensitivity, specificity, and PPV of 84%, 86%, and 81%]. Validation of GENIE in CD children found that C-GENIE outperformed L-GENIE, producing a sensitivity, specificity, and PPV of 85%, 88%, and 88%, respectively.

Conclusions: GENIE can help predict adherence to 100% EN and may complement current conventional dietary assessment.

背景和目的:治疗依从性是完全肠内营养[100%EN]治疗活动性克罗恩病[CD]疗效的关键,但没有生物标志物来客观评估这一点。我们探索了粪便参数作为100%EN依从性的生物标志物,随后开发并验证了格拉斯哥专属肠道营养依从性指数[GENIE]。方法:健康成年人用配方奶粉代替其饮食的全部[100%EN]或部分[85%EN,50%EN,20%EN],持续7天。在每次干预之前[D0]和之后[D7]测量粪便pH、含水量、短链脂肪酸和支链脂肪酸[BCFA]。使用受试者操作特征曲线分析和机器学习来开发GENIE,从而得出最佳生物标志物和阈值。然后,在100%EN期间和之后,在30名CD儿童中验证了GENIE。结果:总共招募了61名成年人。D7粪便pH值和BCFA与乙酸盐或丁酸盐的比率在区分100%EN患者和 结论:GENIE有助于预测100%EN的依从性,并可能补充目前的传统饮食评估。
{"title":"Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance.","authors":"Aleksandra Jatkowska,&nbsp;Bernadette White,&nbsp;Ben Nichols,&nbsp;Vaios Svolos,&nbsp;Konstantinos Gkikas,&nbsp;Richard Hansen,&nbsp;Richard K Russell,&nbsp;Daniel Gaya,&nbsp;Emily Brownson,&nbsp;John Paul Seenan,&nbsp;Simon Milling,&nbsp;Jonathan MacDonald,&nbsp;Konstantinos Gerasimidis","doi":"10.1093/ecco-jcc/jjad063","DOIUrl":"10.1093/ecco-jcc/jjad063","url":null,"abstract":"<p><strong>Background and aims: </strong>Treatment adherence is key to the efficacy of exclusive enteral nutrition [100% EN] in active Crohn's disease [CD], but there are no biomarkers to objectively estimate this. We explored faecal parameters as biomarkers of compliance with 100% EN, and subsequently developed and validated the Glasgow Exclusive Enteral Nutrition Index of Compliance [GENIE].</p><p><strong>Methods: </strong>Healthy adults replaced all [100% EN] or part [85% EN, 50% EN, 20% EN] of their diet with a formula for 7 days. Faecal pH, water content, short chain fatty acids, and branched chain fatty acids [BCFAs] were measured before [D0] and after [D7] each intervention. Optimal biomarkers and threshold values were derived using receiver operating characteristic curve analyses and machine learning to develop the GENIE. The GENIE was then validated in 30 CD children, during and after 100% EN.</p><p><strong>Results: </strong>In all, 61 adults were recruited. D7 faecal pH and the ratios of BCFAs to either acetate or butyrate performed the best to differentiate between patients on 100% EN from <100% EN. Two models were generated; one included faecal metabolites (Laboratory GENIE, L-GENIE; sensitivity, specificity, and positive predictive value [PPV] of 88%, 94%, and 92%) and a second one [Clinical Genie, C-GENIE] which considers only faecal pH [sensitivity, specificity, and PPV of 84%, 86%, and 81%]. Validation of GENIE in CD children found that C-GENIE outperformed L-GENIE, producing a sensitivity, specificity, and PPV of 85%, 88%, and 88%, respectively.</p><p><strong>Conclusions: </strong>GENIE can help predict adherence to 100% EN and may complement current conventional dietary assessment.</p>","PeriodicalId":15547,"journal":{"name":"Journal of Crohns & Colitis","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/8b/jjad063.PMC10588781.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9228275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Systematic Review on Long-Term Efficacy Outcome Measures in Crohn's Disease Patients. 克罗恩病患者长期疗效指标的系统评价。
IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad037
Laura M Janssen, Rob H Creemers, Adriaan A van Bodegraven, Marie J Pierik

Background: The traditional long-term treatment goal of Crohn's disease [CD] is maintenance of corticosteroid-free clinical remission. Additional treatment targets, such as biochemical, endoscopic and patient-reported remission, are advocated. The relapsing-remitting nature of CD provides a challenge to the timing of target assessment. Cross-sectional assessment at predetermined moments disregards the health state in between measurements. In this systematic review, we provide an overview of outcomes used to assess long-term efficacy in clinical trials in CD.

Methods: A systematic search of the PubMed and EMBASE databases was performed to identify clinical trials in luminal CD reporting on maintenance treatment [strategies] since 1995. Two independent reviewers selected eligible articles for full text retrieval, and assessed if long-term corticosteroid-free clinical, biochemical, endoscopic or patient-reported efficacy outcomes were used.

Results: The search resulted in 2452 hits and 82 articles were included. Clinical activity was used in 80 studies [98%] as the long-term efficacy outcome, and in 21 [26%] of these concomitant corticosteroid use was taken into account. C-reactive protein was used in 32 studies [41%], faecal calprotectin in 15 studies [18%], endoscopic activity in 34 studies [41%] and patient-reported outcome in 32 studies [39%]. In seven studies, clinical, biochemical, endoscopic activity and the patient's perspective were measured. In most studies cross-sectional measures or multiple measurements over time were used.

Conclusion: In none of the published clinical trials in CD was sustained remission on all treatment targets reported. Cross-sectional outcomes at predetermined times were widely applied, leading to lack of information regarding sustained corticosteroid-free remission for this relapsing-remitting chronic disease.

背景:克罗恩病的传统长期治疗目标是维持无皮质类固醇的临床缓解。提倡其他治疗目标,如生化、内镜和患者报告的缓解。CD的复发-缓解性质对目标评估的时机提出了挑战。在预定时刻的横截面评估忽略了测量之间的健康状态。在这篇系统综述中,我们概述了用于评估CD临床试验长期疗效的结果。方法:对PubMed和EMBASE数据库进行系统搜索,以确定自1995年以来关于维持治疗[策略]的管腔CD临床试验报告。两名独立评审员选择符合条件的文章进行全文检索,并评估是否使用了长期无皮质类固醇的临床、生化、内镜或患者报告的疗效结果。结果:搜索结果为2452次点击,共收录82篇文章。临床活动在80项研究中被用作长期疗效结果[98%],在21项研究中[26%]考虑了皮质类固醇的伴随使用。32项研究使用C反应蛋白[41%],15项研究使用粪便钙卫蛋白[18%],34项研究使用内镜活动[41%]和32项研究中患者报告的结果[39%]。在七项研究中,测量了临床、生化、内镜活动和患者的视角。在大多数研究中,使用了横截面测量或随时间的多次测量。结论:在已发表的CD临床试验中,没有一项在所有治疗靶点上得到持续缓解。在预定时间的横断面结果被广泛应用,导致缺乏关于这种复发缓解型慢性病持续无皮质类固醇缓解的信息。
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引用次数: 0
Community Types of the Human Gut Virome are Associated with Endoscopic Outcome in Ulcerative Colitis. 人类肠道病毒组的群落类型和溃疡性结肠炎的内镜检查结果有关。
IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad061
Daan Jansen, Gwen Falony, Sara Vieira-Silva, Ceren Simsek, Tine Marcelis, Clara Caenepeel, Kathleen Machiels, Jeroen Raes, Séverine Vermeire, Jelle Matthijnssens

Background: Inflammatory bowel disease [IBD] is a major debilitating disease. Recently, the gut microbiota has gained attention as an important factor involved in the pathophysiology of IBD. As a complement to the established bacterial 'enterotypes' associated with IBD, we focused here on viruses. We investigated the intestinal virome of IBD patients undergoing biological therapy for the presence of virome configurations associated with IBD, and to uncover how those configurations are associated with therapeutic success.

Methods: Viral-like particle enrichment followed by deep sequencing was performed on 432 faecal samples from 181 IBD patients starting biological therapy. Redundancy analysis and Dirichlet Multinomial Mixtures were applied to determine covariates of the virome composition and to condense the gut virota into 'viral community types', respectively.

Results: Patients were stratified based on unsupervised clustering into two viral community types. Community type CA showed a low α-diversity and a high relative abundance of Caudoviricetes [non-CrAss] phages and was associated with the dysbiotic Bact2-enterotype. Community type CrM showed a high α-diversity and a high relative abundance of Crassvirales and Malgrandaviricetes phages. During post-interventional analysis, endoscopic outcome was associated with gut virome composition. Remitting UC patients had a high percentage of community type CrM, a high Shannon diversity and a low lysogenic potential. Pre-interventional analyses also identified five novel phages associated with treatment success.

Conclusions: This study proposed two gut virome configurations that may be involved in the pathophysiology of IBD. Interestingly, those viral configurations are further associated with therapeutic success, suggesting a potential clinical relevance.

背景:炎症性肠病是一种主要的使人衰弱的疾病。近年来,肠道微生物群作为参与IBD病理生理学的重要因素而受到关注。作为对已建立的与IBD相关的细菌“肠道类型”的补充,我们在这里重点关注病毒。我们调查了接受生物治疗的IBD患者的肠道病毒组,以确定是否存在与IBD相关的病毒组构型,并揭示这些构型如何与治疗成功相关。方法:对181名开始生物治疗的IBD患者的432份粪便样本进行病毒样颗粒富集,然后进行深度测序。冗余度分析和Dirichlet多项式混合物分别用于确定病毒组组成的协变量,并将肠道病毒群浓缩为“病毒群落类型”。结果:根据无监督聚类将患者分为两种病毒群落类型。群落型CA表现出较低的α-多样性和较高的Caudoviricetes[非CrAss]噬菌体相对丰度,并与失调菌2型肠型有关。群落型CrM表现出较高的α-多样性和较高的Crassvirales和Malgrandaviretes噬菌体的相对丰度。在介入后分析中,内镜检查结果与肠道病毒组分有关。缓解型UC患者具有较高的社区型CrM百分比、较高的Shannon多样性和较低的溶原潜力。介入前分析还发现了五种与治疗成功相关的新型噬菌体。结论:本研究提出了两种可能参与IBD病理生理学的肠道病毒组结构。有趣的是,这些病毒配置与治疗成功进一步相关,这表明了潜在的临床相关性。
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引用次数: 0
Results of the Eighth Scientific Workshop of ECCO: Diagnosing Postoperative Recurrence of Crohn's Disease After an Ileocolonic Resection With Ileocolonic Anastomosis. ECCO第八次科学研讨会的结果:诊断经回肠造口术后克罗恩病的术后复发。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad055
Gabriele Dragoni, Mariangela Allocca, Pär Myrelid, Nurulamin M Noor, Nassim Hammoudi, Pauline Rivière, Yves Panis, Marc Ferrante

Despite the introduction of potent biologic therapies, many patients with Crohn's disease [CD] still require an ileocolonic resection [ICR] during the course of their disease. Furthermore, the need of redo ICR has not decreased over the past few decades, highlighting the need for better strategies to prevent and treat postoperative recurrence [POR]. The first step to develop such a strategy would be to define and standardise the description of POR with adequate diagnostic instruments. In this article, we will describe the different methodologies used to report POR [endoscopic, histological, radiological, biochemical, clinical, and surgical], and review their potential benefits and limitations, as well as the optimal timing of evaluation.

尽管引入了有效的生物疗法,但许多克罗恩病[CD]患者在病程中仍需要进行回结肠切除[ICR]。此外,在过去的几十年里,重做ICR的需求并没有减少,这突出了需要更好的策略来预防和治疗术后复发[POR]。制定此类策略的第一步是用适当的诊断仪器定义和标准化POR的描述。在这篇文章中,我们将描述用于报告POR的不同方法[内窥镜、组织学、放射学、生物化学、临床和外科],并回顾其潜在的益处和局限性,以及评估的最佳时机。
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引用次数: 2
Ustekinumab as Induction and Maintenance Therapy in Patients with Inflammatory Bowel Disease and Type II Autoimmune Pancreatitis: Report of Two Cases. Ustekinumab作为炎症性肠病和II型自身免疫性胰腺炎患者的诱导和维持治疗:两例报告。
IF 8 2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.1093/ecco-jcc/jjad072
Gaetano Lauri, Ferdinando D'Amico, Mariangela Allocca, Diego Palumbo, Emanuel Della-Torre, Francesco De Cobelli, Claudio Doglioni, Paolo Giorgio Arcidiacon, Gabriele Capurso, Silvio Danese
{"title":"Ustekinumab as Induction and Maintenance Therapy in Patients with Inflammatory Bowel Disease and Type II Autoimmune Pancreatitis: Report of Two Cases.","authors":"Gaetano Lauri, Ferdinando D'Amico, Mariangela Allocca, Diego Palumbo, Emanuel Della-Torre, Francesco De Cobelli, Claudio Doglioni, Paolo Giorgio Arcidiacon, Gabriele Capurso, Silvio Danese","doi":"10.1093/ecco-jcc/jjad072","DOIUrl":"10.1093/ecco-jcc/jjad072","url":null,"abstract":"","PeriodicalId":15547,"journal":{"name":"Journal of Crohns & Colitis","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9385601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Crohns & Colitis
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