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Validation of the IBD-Control Questionnaire across different sociodemographic and clinical subgroups: secondary analysis of a nationwide electronic survey. 在不同社会人口和临床亚群中验证 IBD 控制问卷:对一项全国性电子调查的二次分析。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad147
Gerum G Gebeyehu, Frederick Taylor, Liz Dobson, J R Fraser Cummings, Stuart Bloom, Nicholas A Kennedy, Paul Christiansen, Keith Bodger

Background: The IBD-Control Questionnaire is a simple, generic measure of patient-perceived disease control used increasingly in clinical practice and research. We aimed to address knowledge gaps in its psychometric performance, to ensure that it can be used with confidence in a variety of contexts.

Methods: We analysed 7341 responses to the IBD Registry COVID-19 survey, sent to 40 911 patients who completed an online self-assessment tool during the pandemic. Questions covered demographics, comorbidities, inflammatory bowel disease [IBD] sub-type, and IBD-Control Questionnaire and symptom scores [CD-PRO2 or UC-PRO2]. Psychometric properties of IBD-Control-8 were tested overall and within subgroups (Crohn's disease [CD], ulcerative colitis [UC] and IBD unclassified; male and female; ≤65 and >65 years; number of co-morbidities; deprivation status).

Results: Internal consistency was very strong overall [α: 0.84, ω: 0.89] and for each subgroup [α range: 0.81-0.85; ω: 0.86-0.90]. Construct validity was demonstrated by moderate correlation of each item with global rating [VAS] [rs range: 0.47-0.65], strong correlation between IBD-Control-8 score and VAS [rs = 0.74], moderate-to-strong with PRO2 scores [CD: rs = -0.718; UC: rs = -0.602] and significantly higher IBD-Control-8 scores for PRO2-remission vs PRO2-active, consistent across subgroups. Exploratory and confirmatory factor analyses demonstrated a two-factor model (items loading onto 'Health-related Quality of Life' [HRQoL] or 'Treatment' domains). Extensive tests for factorial invariance confirmed consistency.

Conclusions: IBD-Control-8 is a psychometrically robust scale which can be used across a range of populations. It offers a quick, reliable, and valid method of assessing patient-perceived control. The construct of 'control' includes traditional HRQoL and a novel domain relating to treatment perception.

背景:IBD控制问卷是一种简单、通用的患者感知疾病控制情况的测量方法,在临床实践和研究中的应用越来越广泛。我们的目标是解决其心理测量性能方面的知识差距,以确保它能在各种情况下放心使用:我们分析了对 IBD Registry COVID-19 调查的 7341 份回复,该调查在大流行期间发送给了 40 911 名完成在线自我评估工具的患者。问题涉及人口统计学、合并症、炎症性肠病 [IBD] 亚型、IBD-对照问卷和症状评分 [CD-PRO2 或 UC-PRO2]。对IBD-Control-8的总体心理计量特性进行了测试,并在亚组(克罗恩病[CD]、溃疡性结肠炎[UC]和未分类的IBD;男性和女性;≤65岁和>65岁;合并疾病的数量;贫困状况)内进行了测试:总体内部一致性很强[α:0.84,ω:0.89],各分组的内部一致性也很强[α范围:0.81-0.85;ω:0.86-0.90]。每个项目与总体评分[VAS]的中度相关性[rs 范围:0.47-0.65]、IBD-Control-8 评分与 VAS 的强相关性[rs = 0.74]、与 PRO2 评分的中度至强度相关性[CD:rs = -0.718;UC:rs = -0.602]以及 PRO2 缓解与 PRO2 激活的 IBD-Control-8 评分显著较高,这些都证明了结构效度在各亚组之间是一致的。探索性和确认性因子分析显示了一个双因子模型(项目加载到 "健康相关生活质量"[HRQoL] 或 "治疗 "域)。广泛的因子不变性测试证实了模型的一致性:结论:IBD-Control-8 是一个心理测量学上可靠的量表,可用于各种人群。它提供了一种快速、可靠和有效的方法来评估患者感知到的控制。控制 "结构包括传统的 HRQoL 和一个与治疗感知相关的新领域。
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引用次数: 0
Definitions of Histological Abnormalities in Inflammatory Bowel Disease: an ECCO Position Paper. 炎症性肠病组织学异常的定义:ECCO 立场文件。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad142
Roger Feakins, Paula Borralho Nunes, Ann Driessen, Ilyssa O Gordon, Nina Zidar, Pamela Baldin, Britt Christensen, Silvio Danese, Naoimh Herlihy, Marietta Iacucci, Maurice B Loughrey, Fernando Magro, Aart Mookhoek, Magali Svrcek, Francesca Rosini

Histological assessment of endoscopic biopsies in inflammatory bowel disease [IBD] plays an important role in clinical management, investigative studies, and clinical trials. Scoring schemes consisting of multiple histological items and offering considerable precision are widely available. However, definitions of histological abnormalities are often inconsistent. Furthermore, interobserver variability for their recognition and assessment may be high. The European Crohn's and Colitis Organisation [ECCO] formed an expert panel to explore definitions of histological abnormalities in IBD, with the aim of improving the quality of diagnosis and facilitating development of scoring schemes. The process confirmed that the current definitions often have no evidence base and vary between sources. Using available evidence and expert knowledge, the panel produced a series of ECCO consensus position statements on histological features in IBD.

炎症性肠病(IBD)内镜活检组织学评估在临床管理、调查研究和临床试验中发挥着重要作用。由多个组织学项目组成的评分方案具有相当高的精确度,目前已广泛应用。然而,组织学异常的定义往往不一致。此外,观察者之间对组织学异常的识别和评估可能存在很大差异。欧洲克罗恩病与结肠炎组织 [ECCO] 成立了一个专家小组来探讨 IBD 组织学异常的定义,目的是提高诊断质量并促进评分方案的制定。这一过程证实,目前的定义往往没有证据基础,而且不同来源的定义也不尽相同。该小组利用现有证据和专家知识,就 IBD 组织学特征提出了一系列 ECCO 共识立场声明。
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引用次数: 0
Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset. 急性结肠炎 ACE [白蛋白、CRP 和内镜] 指数的验证:CONSTRUCT 数据集分析。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad148
Rebecca K Grant, Gareth-Rhys Jones, Nikolas Plevris, Ruairi W Lynch, William M Brindle, Hayley A Hutchings, John G Williams, Laith Alrubaiy, Alan Watkins, Charlie W Lees, Ian D R Arnott

Background and aims: In 2020 we reported the ACE Index in acute colitis which used biochemical and endoscopic parameters to predict steroid non-response on admission in patients with acute ulcerative colitis [UC]. We aimed to validate the ACE Index in an independent cohort.

Methods: The validation cohort comprised patients screened as eligible for inclusion in the CONSTRUCT study, a prospective, randomized, placebo-controlled trial which compared the effectiveness of treatment with infliximab vs ciclosporin in patients admitted with acute UC. The CONSTRUCT cohort database was reviewed at The Edinburgh IBD Unit and the same biochemical and endoscopic variables and cut-off values as those in the derivation cohort were applied to the validation cohort.

Results: In total, 800 patients were identified; 62.5% [55/88] of patients with a maximum ACE Index of 3 did not respond to intravenous [IV] steroids (positive predictive value [PPV] 62.5%, negative predictive value [NPV] 79.8%). Furthermore, 79.8% [158/198] of patients with an ACE Index of 0 responded to IV steroids [PPV 79.8%, NPV 62.5%]. Receiver operator characteristic [ROC] curve analysis produced an area under the curve [AUC] of 0.663 [p < 0.001].

Conclusions: We have now reported and externally validated the ACE Index in acute colitis in a combined cohort of over 1000 patients from across the UK. The ACE Index may be used in conjunction with clinical judgement to help identify patients admitted with active UC who are at high risk of not responding to IV steroids. Further studies are required to improve objectivity and accuracy of assessment.

背景和目的:2020 年,我们报告了急性结肠炎 ACE 指数,该指数使用生化和内镜参数预测急性溃疡性结肠炎(UC)患者入院时的类固醇无应答情况。我们的目的是在一个独立队列中验证 ACE 指数:该研究是一项前瞻性、随机、安慰剂对照试验,比较了英夫利昔单抗与环孢素对急性溃疡性结肠炎患者的治疗效果。爱丁堡 IBD 中心对 CONSTRUCT 队列数据库进行了审查,并对验证队列采用了与推导队列相同的生化和内镜变量及临界值:共鉴定出 800 例患者;在 ACE 指数最高为 3 的患者中,62.5% [55/88] 的患者对静脉注射类固醇无效(阳性预测值 [PPV] 62.5%,阴性预测值 [NPV] 79.8%)。此外,79.8% [158/198] ACE 指数为 0 的患者对静脉注射类固醇有反应 [PPV 79.8%,NPV 62.5%]。接收者操作特征曲线(ROC)分析得出的曲线下面积(AUC)为 0.663 [p 结论:我们现已报告并从外部验证了 ACE 指数在急性结肠炎中的应用,研究对象是来自英国的 1000 多名患者。ACE 指数可与临床判断结合使用,以帮助识别对静脉注射类固醇无效的高风险活动性 UC 患者。为提高评估的客观性和准确性,还需要进一步研究。
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引用次数: 0
Superior predictive value of transmural over endoscopic severity for colectomy risk in ulcerative colitis: a multicentre prospective cohort study. 溃疡性结肠炎结肠切除术风险的跨膜预测价值优于内镜严重程度:一项多中心前瞻性队列研究。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad152
Nicole Piazza O Sed, Daniele Noviello, Elisabetta Filippi, Francesco Conforti, Federica Furfaro, Mirella Fraquelli, Andrea Costantino, Silvio Danese, Maurizio Vecchi, Gionata Fiorino, Mariangela Allocca, Flavio Caprioli

Background and aims: Endoscopic activity is associated with an increased risk of surgery in patients with ulcerative colitis [UC]. Transmural activity, as defined by Milan Ultrasound Criteria [MUC] > 6.2, reliably detects endoscopic activity in patients with UC. The present study aimed to assess in UC patients whether transmural severity is a better predictor of colectomy as compared to endoscopy.

Methods: Consecutive adult UC patients were recruited in two IBD Referral Centres and underwent colonoscopy and intestinal ultrasound in a blinded fashion. The need for colectomy was assessed at follow-up. Univariable and multivariable logistic and Cox regression analyses were performed. Receiver operating characteristic [ROC] analysis was used to compare MUC baseline values and Mayo Endoscopic Scores [MES] in predicting colectomy risk.

Results: Overall, 141 patients were enrolled, and 13 underwent colectomy in the follow-up period. Both MES (hazard ratio [HR]: 3.15, 95% confidence interval [CI]: 1.18-8.37, p = 0.02) and MUC [HR: 1.48, 95% CI: 1.19-1.76, p < 0.001] were associated with colectomy risk, but only MUC was independently associated with this event on multivariable analysis [HR: 1.46, 95% CI: 1.06-2.02, p = 0.02]. MUC was the only independent variable associated with colectomy risk in patients with clinically active disease (odds ratio [OR]: 1.53 [1.03-2.27], p = 0.03). MUC demonstrated higher accuracy than MES (area under ROC curve [AUROC] 0.83, 95% CI: 0.75-0.92 vs 0.71, 95% CI: 0.62-0.80) and better performance for predicting colectomy [p = 0.02]. The optimal MUC score cut-off value for predicting colectomy, as assessed by the Youden index, was 7.7.

Conclusions: A superior predictive value was found for transmural vs endoscopic severity for colectomy risk in UC patients.

背景和目的:内镜活动与溃疡性结肠炎(UC)患者手术风险增加有关。米兰超声标准[MUC] > 6.2所定义的经壁活动度能可靠地检测出UC患者的内镜活动度。本研究旨在评估与内镜检查相比,经膜严重程度是否能更好地预测 UC 患者是否需要进行结肠切除术:方法:在两家 IBD 转诊中心连续招募成年 UC 患者,在盲法下进行结肠镜检查和肠道超声检查。随访时评估是否需要进行结肠切除术。进行了单变量和多变量逻辑回归分析以及 Cox 回归分析。受体操作特征[ROC]分析用于比较MUC基线值和梅奥内镜评分[MES]在预测结肠切除术风险方面的作用:结果:共有 141 名患者入选,其中 13 名患者在随访期间接受了结肠切除术。MES(危险比 [HR]:3.15,95% 置信区间 [CI]:1.18-8.37,P = 0.02)和 MUC [HR:1.48,95% 置信区间 [CI]:1.19-1.76,P经膜严重程度与内镜严重程度对 UC 患者结肠切除术风险的预测价值更高。
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引用次数: 0
Thiopurines Have Sustained Long-term Effectiveness in Patients with Inflammatory Bowel Disease, Which is Independent of Disease Duration at Initiation: A Propensity Score Matched Analysis. 硫嘌呤类药物对炎症性肠病患者具有持续的长期疗效,这与开始使用时的病程无关:倾向得分匹配分析
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad135
Mukesh Kumar Ranjan, Peeyush Kumar, Sudheer Kumar Vuyyuru, Bhaskar Kante, Sandeep K Mundhra, Rithvik Golla, Shubi Virmani, Raju Sharma, Peush Sahni, Prasenjit Das, Mani Kalaivani, Ashish Datt Upadhyay, Govind Makharia, Saurabh Kedia, Vineet Ahuja

Background and aims: Thiopurines are viable option for the treatment of inflammatory bowel disease [IBD] in resource-limited countries. However, data on the effect of disease duration at thiopurines initiation on long-term effectiveness are limited.

Method: We performed a propensity matched analysis of a retrospective cohort of patients with ulcerative colitis [UC] and Crohn's disease [CD]. Patients initiated on thiopurines early in the disease course [≤2 years] were compared with those started late [>2 years]. Effectiveness was defined as no requirement for hospitalisation, anti-tumour necrosis factor [TNF] agents, or surgery, and minimum steroid requirement [≤1 steroid course in 2 years] during follow-up.

Results: A total of 988 [UC: 720, CD: 268] patients were included (male: 665 [60.8%], median age: 40 [32-51] years, median follow-up: 40 [19-81] months). Overall effectiveness at 5 and 10 years was 79% and 72% in UC, and 69% and 63% in CD, respectively. After propensity score matching, there was no difference in 5- and 10-year effectiveness between early and late thiopurine initiation groups either for UC [81% and 80% vs 82% and 74%; p = 0.92] or CD [76% and 66% vs 72% and 51%, p = 0.32]. Male sex for UC (negative: hazard ratio [HR]: 0.67, 95% confidence interval [CI): 0.45-0.97; p = 0.03), and ileal involvement [positive: HR: 3.03, 95% CI: 1.32-6.71; p = 0.008], steroid-dependent disease [positive: HR: 2.70, 95% CI: 1.26-5.68; p = 0.01] and adverse events [negative: HR: 0.47, 95% CI:0.27-0.80; p = 0.005] for CD were predictors of thiopurine effectiveness.

Conclusion: Thiopurines have sustained long-term effectiveness in both UC and CD. However, early thiopurine initiation had no better effect on long-term disease outcome compared with late initiation.

背景和目的:在资源有限的国家,硫嘌呤类药物是治疗炎症性肠病(IBD)的可行选择。然而,有关开始使用硫嘌呤类药物时疾病持续时间对长期疗效影响的数据十分有限:我们对溃疡性结肠炎(UC)和克罗恩病(CD)患者的回顾性队列进行了倾向匹配分析。我们将病程早期(≤2 年)开始使用硫嘌呤类药物的患者与病程晚期(>2 年)开始使用硫嘌呤类药物的患者进行了比较。疗效的定义是在随访期间无需住院、无需使用抗肿瘤坏死因子(TNF)药物或手术,以及最少的类固醇需求量[2年内≤1个类固醇疗程]:共纳入988名[UC:720名,CD:268名]患者(男性:665名[60.8%],中位年龄:40岁[32-51岁],中位随访时间:40个月[19-81个月])。5 年和 10 年的总体有效率在 UC 中分别为 79% 和 72%,在 CD 中分别为 69% 和 63%。经过倾向得分匹配后,硫嘌呤起始时间早的组别和起始时间晚的组别在 UC [81% 和 80% vs 82% 和 74%; p = 0.92]或 CD [76% 和 66% vs 72% 和 51%, p = 0.32]的 5 年和 10 年有效率方面均无差异。男性性别对 UC(阴性:危险比 [HR]:0.67,95% 置信区间 [CI]:0.45-0.97;P = 0.03)、回肠受累 [阳性:HR:3.03,95% CI:1.32-6.71;P = 0.008]、类固醇依赖性疾病[阳性:HR:2.70,95% CI:1.26-5.68;P = 0.01]和CD的不良事件[阴性:HR:0.47,95% CI:0.27-0.80;P = 0.005]是硫嘌呤有效性的预测因素:结论:硫嘌呤类药物对 UC 和 CD 均有长期疗效。结论:硫嘌呤类药物对 UC 和 CD 均有持续的长期疗效,但与晚期使用硫嘌呤类药物相比,早期使用硫嘌呤类药物对疾病的长期预后没有更好的影响。
{"title":"Thiopurines Have Sustained Long-term Effectiveness in Patients with Inflammatory Bowel Disease, Which is Independent of Disease Duration at Initiation: A Propensity Score Matched Analysis.","authors":"Mukesh Kumar Ranjan, Peeyush Kumar, Sudheer Kumar Vuyyuru, Bhaskar Kante, Sandeep K Mundhra, Rithvik Golla, Shubi Virmani, Raju Sharma, Peush Sahni, Prasenjit Das, Mani Kalaivani, Ashish Datt Upadhyay, Govind Makharia, Saurabh Kedia, Vineet Ahuja","doi":"10.1093/ecco-jcc/jjad135","DOIUrl":"10.1093/ecco-jcc/jjad135","url":null,"abstract":"<p><strong>Background and aims: </strong>Thiopurines are viable option for the treatment of inflammatory bowel disease [IBD] in resource-limited countries. However, data on the effect of disease duration at thiopurines initiation on long-term effectiveness are limited.</p><p><strong>Method: </strong>We performed a propensity matched analysis of a retrospective cohort of patients with ulcerative colitis [UC] and Crohn's disease [CD]. Patients initiated on thiopurines early in the disease course [≤2 years] were compared with those started late [>2 years]. Effectiveness was defined as no requirement for hospitalisation, anti-tumour necrosis factor [TNF] agents, or surgery, and minimum steroid requirement [≤1 steroid course in 2 years] during follow-up.</p><p><strong>Results: </strong>A total of 988 [UC: 720, CD: 268] patients were included (male: 665 [60.8%], median age: 40 [32-51] years, median follow-up: 40 [19-81] months). Overall effectiveness at 5 and 10 years was 79% and 72% in UC, and 69% and 63% in CD, respectively. After propensity score matching, there was no difference in 5- and 10-year effectiveness between early and late thiopurine initiation groups either for UC [81% and 80% vs 82% and 74%; p = 0.92] or CD [76% and 66% vs 72% and 51%, p = 0.32]. Male sex for UC (negative: hazard ratio [HR]: 0.67, 95% confidence interval [CI): 0.45-0.97; p = 0.03), and ileal involvement [positive: HR: 3.03, 95% CI: 1.32-6.71; p = 0.008], steroid-dependent disease [positive: HR: 2.70, 95% CI: 1.26-5.68; p = 0.01] and adverse events [negative: HR: 0.47, 95% CI:0.27-0.80; p = 0.005] for CD were predictors of thiopurine effectiveness.</p><p><strong>Conclusion: </strong>Thiopurines have sustained long-term effectiveness in both UC and CD. However, early thiopurine initiation had no better effect on long-term disease outcome compared with late initiation.</p>","PeriodicalId":15547,"journal":{"name":"Journal of Crohns & Colitis","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007291","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
Tofacitinib Versus Oral Prednisolone for Induction of Remission in Moderately Active Ulcerative Colitis [ORCHID]: A Prospective, Open-Label, Randomized, Pilot Study. 托法替尼与口服泼尼松龙诱导中度活动性溃疡性结肠炎缓解[ORCHID]:一项前瞻性、开放标签、随机试验研究。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad153
Arshdeep Singh, Vandana Midha, Kirandeep Kaur, Ramit Mahajan, Dharmatma Singh, Ramandeep Kaur, Aditya Kohli, Avantika Chawla, Kriti Sood, Namita Bansal, Ajit Sood

Background: Oral corticosteroids are first-line agents to induce remission in moderately active ulcerative colitis [UC], but are associated with adverse effects. We compared the efficacy and safety of tofacitinib and prednisolone for induction of remission in moderately active UC.

Methods: This was a single-centre, prospective, open-label, randomized, active-controlled pilot study. Eligible patients [aged ≥18 years] had moderately active UC. Participants were randomly assigned to receive either prednisolone [40 mg daily, tapered by 5 mg every week] or tofacitinib [10 mg twice daily] for 8 weeks. The primary endpoint was composite remission [defined as total Mayo clinic score ≤2, with endoscopic sub-score of 0 and faecal calprotectin <100 µg/g] at 8 weeks.

Results: Seventy-eight patients were randomly assigned to either of the treatment groups. At week 8, the proportion of patients achieving composite remission in the tofacitinib [7/43, 16.28%] and prednisolone groups [3/35, 8.57%] were not significantly different (odds ratio [OR] 2.07, 95% confidence interval [CI] 0.49-8.70; p = 0.31). The time to achieve symptomatic remission [normal stool frequency with absence of rectal bleeding] was similar (10 days, interquartile range [IQR 7-18.75] and 10 days [IQR 5-12.5] for tofacitinib and prednisolone, respectively; p = 0.25) in the two groups. One patient each in the tofacitinib and prednisolone group discontinued treatment due to development of pulmonary tuberculosis and pustular acne, respectively. One patient receiving tofacitinib developed herpes zoster, but did not require cessation of therapy. No serious adverse events or major adverse cardiovascular events were observed.

Conclusion: In patients with moderately active UC, there was no difference in the efficacy and safety of tofacitinib and oral prednisolone for induction of remission at 8 weeks.

Trail registration: Clinical Trials Registry of India [CTRI/2021/10/037641].

背景:口服皮质类固醇是诱导中度活动性溃疡性结肠炎[UC]缓解的一线药物,但与不良反应相关。我们比较了托法替尼和泼尼松龙诱导中度活动性 UC 缓解的疗效和安全性:这是一项单中心、前瞻性、开放标签、随机、主动对照试验研究。符合条件的患者[年龄≥18岁]均为中度活动性UC。参与者被随机分配接受泼尼松龙(每天40毫克,每周减少5毫克)或托法替尼(每天两次,每次10毫克)治疗,为期8周。主要终点是综合缓解[定义为梅奥诊所总分≤2分,内镜评分为0分,粪便钙蛋白结果为0分]:78 名患者被随机分配到任一治疗组。第8周时,托法替尼组[7/43,16.28%]和泼尼松龙组[3/35,8.57%]实现综合缓解的患者比例无显著差异(几率比[OR]2.07,95% 置信区间[CI]0.49-8.70;P = 0.31)。两组患者达到症状缓解[大便次数正常且无直肠出血]的时间相似(托法替尼和泼尼松龙分别为10天,四分位数间距[IQR 7-18.75]和10天[IQR 5-12.5];P = 0.25)。托法替尼组和泼尼松龙组各有一名患者分别因出现肺结核和脓疱性痤疮而中断治疗。一名接受托法替尼治疗的患者出现带状疱疹,但无需停止治疗。未观察到严重不良事件或主要心血管不良事件:在中度活动性UC患者中,托法替尼和口服泼尼松龙诱导缓解8周的疗效和安全性没有差异:印度临床试验注册中心[CTRI/2021/10/037641]。
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引用次数: 0
Disease Activity Patterns of Paediatric Inflammatory Bowel Disease: A Danish Nationwide Cohort Study (1996-2018). 儿科炎症性肠病的疾病活动模式:丹麦全国队列研究(1996-2018)》。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad144
Mads Damsgaard Wewer, Sabine Jansson, Mikkel Malham, Johan Burisch, Vibeke Wewer

Background and aims: Inflammatory bowel diseases [IBD] are heterogeneous in the frequency and severity of their flare-ups. We aimed to describe disease activity patterns in a Danish nationwide paediatric IBD cohort.

Methods: Paediatric patients [<18 years at diagnosis] with Crohn's disease [pCD] or ulcerative colitis [pUC] in the study period from 1996 to 2018 were identified in national registers. Disease activity [severe, moderate-to-mild, remission] was assessed at diagnosis according to medications prescribed, hospitalizations, and surgeries.

Results: In total, 1965 pCD and 1838 pUC incident patients were included in the cohort. At diagnosis, severe disease activity was found in 87%/80% of pCD/pUC and in addition 6.1% of pUC patients had undergone a colectomy during the first year after diagnosis. Five years after diagnosis, the annual proportions of pCD/pUC with no disease activity were 70%/61%, and 10 years after diagnosis the proportions were 72%/64%. Colectomy was required in 6.1, 12, and 16% of pUC patients after 1, 5 and 10 years. No improvement of disease activity was seen in the proportion of prevalent pCD [N = 2515] and pUC [N = 2428] in the study period 2000-2018 concomitant with the introduction of biological treatment. However, decreasing disease activity was the most common pattern in both pCD and pUC [43 and 47%], respectively.

Conclusions: pIBD was characterized by a high proportion of patients with severe activity at diagnosis, followed by an improvement after 5 and 10 years of follow-up. Notably, the proportion of patients with no disease activity was unchanged when biological treatment was introduced and the number of colectomies in pUC remained high.

背景和目的:炎症性肠病 [IBD] 的发作频率和严重程度各不相同。我们旨在描述丹麦全国儿童 IBD 队列中的疾病活动模式:方法:儿科患者[结果:结果:队列中共纳入了 1965 名 pCD 和 1838 名 pUC 患者。确诊时,87%的pCD/80%的pUC患者有严重的疾病活动,此外,6.1%的pUC患者在确诊后第一年接受了结肠切除术。确诊五年后,pCD/pUC 每年无疾病活动的比例分别为 70%/61% ,确诊十年后,这一比例分别为 72%/64% 。1年、5年和10年后,分别有6.1%、12%和16%的pCD/pUC患者需要进行结肠切除术。在 2000 年至 2018 年的研究期间,随着生物治疗的引入,pCD [N = 2515] 和 pUC [N = 2428] 的发病比例没有出现疾病活动性的改善。然而,疾病活动性下降是pCD和pUC最常见的模式[分别为43%和47%]。结论:pIBD的特点是确诊时有严重活动性的患者比例较高,随访5年和10年后情况有所改善。值得注意的是,在引入生物治疗后,无疾病活动的患者比例保持不变,而在pUC中结肠切除术的数量仍然很高。
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引用次数: 0
Short-term Psychodynamic Psychotherapy in Addition to Standard Medical Therapy Increases Clinical Remission in Adolescents and Young Adults with Inflammatory Bowel Disease: a Randomised Controlled Trial. 在标准药物治疗基础上进行短期心理动力学心理治疗可提高青少年炎症性肠病患者的临床缓解率:一项随机对照试验。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad145
Francesco Milo, Chiara Imondi, Carmen D'Amore, Giulia Angelino, Daniela Knafelz, Fiammetta Bracci, Luigi Dall'Oglio, Paola De Angelis, Paola Tabarini

Background: Inflammatory bowel diseases [IBD] are chronic and pervasive conditions of the gastrointestinal tract with a rising incidence in paediatric and young adult populations. Evidence suggests that psychological disorders might be associated with relapse of disease activity. This study aims to evaluate the efficacy of short-term psychodynamic psychotherapy [STPP] in addition to standard medical therapy [SMT] in maintaining clinical remission in adolescents and young adults [AYA] with quiescent IBD, compared with SMT alone.

Methods: A two-arm, single-centre, randomised, controlled trial was conducted in 60 IBD AYA in clinical remission. Patients were randomised to receive an 8-week STPP + SMT [n = 30] or SMT alone [n = 30]. The primary outcome was the steroid-free remission rate at 52 weeks after treatment. Secondary outcomes included the overall hospitalisation rate within 52 weeks after treatment, and medication adherence obtained from patient's electronic medical records.

Results: Intention-to-treat analysis showed significant improvement in maintaining disease remission rates in the 8-week STPP + SMT group compared with the control one. The proportion of patients maintaining steroid-free remission at 52 weeks was higher in patients in STTP group [93.1%] compared with patients randomised to control group [64.3%; p = 0.01]. There were no significant differences in secondary outcomes, except for depression reduction in STPP + SMT group.

Conclusions: An 8-week STPP intervention in addition to SMT effectively increases the steroid-free remission rates in AYA with quiescent IBD. Results do not support effects for other secondary outcomes, except for depression reduction.

背景:炎症性肠病(IBD)是一种慢性、普遍的胃肠道疾病,在儿童和青少年人群中的发病率不断上升。有证据表明,心理障碍可能与疾病复发有关。本研究旨在评估短期心理动力学心理疗法(STPP)与标准药物疗法(SMT)相比,在维持静止期 IBD 患者临床缓解方面的疗效:在 60 名临床缓解的 IBD 青少年中开展了一项双臂、单中心、随机对照试验。患者被随机分配接受为期 8 周的 STPP + SMT [n = 30] 或单独 SMT [n = 30]。主要结果是治疗后 52 周的无类固醇缓解率。次要结果包括治疗后52周内的总体住院率,以及从患者电子病历中获得的用药依从性:结果:意向治疗分析显示,与对照组相比,STPP + SMT 8 周治疗组的疾病缓解率显著提高。STTP组患者在52周时维持无类固醇缓解的比例[93.1%]高于随机对照组患者[64.3%;P = 0.01]。除了STPP + SMT组的抑郁减轻率外,其他次要结果无明显差异:结论:在SMT基础上进行为期8周的STPP干预,可有效提高静止期IBD青壮年患者的无类固醇缓解率。结果不支持对其他次要结果的影响,抑郁减少除外。
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引用次数: 0
Lémman Index in Paediatric Crohn's disease-Evidence Is Accumulating. 儿童克罗恩病的勒曼指数-证据正在积累。
IF 8 2区 医学 Q1 Medicine Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad161
Gili Focht, Dan Turner
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引用次数: 0
The Diagnostic Utility of Volatile Organic Compounds in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. 挥发性有机化合物在炎症性肠病中的诊断效用:系统回顾与元分析》。
IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-26 DOI: 10.1093/ecco-jcc/jjad132
Ashwin Krishnamoorthy, Subashini Chandrapalan, Marriam Ahmed, Ramesh P Arasaradnam

Background: Volatile organic compounds [VOCs] show promise as potential biomarkers of for ulcerative colitis and Crohn's disease, two chronic, idiopathic, gastrointestinal disorders with diagnostic and management challenges. Non-invasive biomarkers aid early diagnosis and management. In this study we review studies of diagnostic accuracy of VOCs in inflammatory bowel disease.

Methods: A systematic search was carried out on the Pubmed and Scopus databases; with 16 studies reviewed and meta-analysis carried out on 10.

Results: Meta-analysis of 696 inflammatory bowel disease [IBD] cases against 605 controls revealed a pooled sensitivity and specificity of 87% (95% confidence interval [CI], 0.79 - 0.92) and 83% [95% CI, 0.73 - 0.90], respectively. Area under the curve [AUC] was 0.92.

Conclusion: VOCs perform very well as non-invasive biomarkers of IBD, with much scope for future improvement and research.

背景:挥发性有机化合物有望成为溃疡性结肠炎和克罗恩病的潜在生物标志物。非侵入性生物标志物有助于早期诊断和治疗。在本研究中,我们回顾了有关炎症性肠病 VOC 诊断准确性的研究:方法:我们在 Pubmed 和 Scopus 数据库中进行了系统搜索,共审查了 16 项研究,并对 10 项研究进行了荟萃分析:对 696 例炎症性肠病[IBD]病例和 605 例对照病例进行的荟萃分析表明,总体灵敏度和特异度分别为 87%(95% 置信区间 [CI],0.79 - 0.92)和 83%(95% 置信区间 [CI],0.73 - 0.90)。曲线下面积[AUC]为 0.92:作为 IBD 的非侵入性生物标记物,VOC 的表现非常出色,未来还有很大的改进和研究空间。
{"title":"The Diagnostic Utility of Volatile Organic Compounds in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.","authors":"Ashwin Krishnamoorthy, Subashini Chandrapalan, Marriam Ahmed, Ramesh P Arasaradnam","doi":"10.1093/ecco-jcc/jjad132","DOIUrl":"10.1093/ecco-jcc/jjad132","url":null,"abstract":"<p><strong>Background: </strong>Volatile organic compounds [VOCs] show promise as potential biomarkers of for ulcerative colitis and Crohn's disease, two chronic, idiopathic, gastrointestinal disorders with diagnostic and management challenges. Non-invasive biomarkers aid early diagnosis and management. In this study we review studies of diagnostic accuracy of VOCs in inflammatory bowel disease.</p><p><strong>Methods: </strong>A systematic search was carried out on the Pubmed and Scopus databases; with 16 studies reviewed and meta-analysis carried out on 10.</p><p><strong>Results: </strong>Meta-analysis of 696 inflammatory bowel disease [IBD] cases against 605 controls revealed a pooled sensitivity and specificity of 87% (95% confidence interval [CI], 0.79 - 0.92) and 83% [95% CI, 0.73 - 0.90], respectively. Area under the curve [AUC] was 0.92.</p><p><strong>Conclusion: </strong>VOCs perform very well as non-invasive biomarkers of IBD, with much scope for future improvement and research.</p>","PeriodicalId":15547,"journal":{"name":"Journal of Crohns & Colitis","volume":null,"pages":null},"PeriodicalIF":8.3,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9989114","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
期刊
Journal of Crohns & Colitis
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