Pub Date : 2017-05-16DOI: 10.33590/emjgastroenterol/10311106
J. Fricker
In the first presentation, Prof Panaccione considered how early treatment of Crohn’s disease (CD) is key for achieving the therapeutic goals, which include symptomatic remission and mucosal healing. The latest STRIDE guidelines,1 published in 2015, endorse endoscopic remission defined as “resolution of ulceration at ileocolonoscopy”, and emphasised the need for tight monitoring of inflammation. He explored data highlighting how the ability to achieve mucosal healing decreases with increased disease duration, that benefits from mucosal healing may not be realised until the second year of treatment, and how patients who experience mucosal healing are less likely to be hospitalised and require surgery. Studies show patients do better with the ‘top-down’ approach, receiving anti-tumour necrosis factor (TNF) drugs early in the disease course, which has led to the introduction of a treatment algorithm suggesting patients with high-risk factors for poor prognosis should receive early ‘top-down’ therapy and lower-risk patients traditional ‘step-up’ therapy. The need for decisive early treatment to slow progression emphasises the importance of facilitating early diagnosis, and identifying patients for early biologic therapy. In the second presentation, Dr Iris Dotan explored data suggesting that optimal positioning for vedolizumab appears to be early in the course of disease. Furthermore, vedolizumab’s effect on clinical remission improves over time, clinical remissions have been shown to be maintained long-term, and vedolizumab reduces rates of hospitalisation. A favourable risk-benefit profile for vedolizumab has been shown for long-term use with no increase in the incidence of adverse events in the 5-year analysis. There are now 77,382 patient-years of post-marketing exposure to vedolizumab worldwide.2 The latest European Crohn’s and Colitis Organisation (ECCO) guidelines recommend the use of vedolizumab in patients with moderate to severe localised ileocaecal and colonic CD refractory to steroids and/or anti-TNF-αs.
{"title":"Targeting Disease Progression in Crohn’s Disease: Fighting an Unrelenting Enemy","authors":"J. Fricker","doi":"10.33590/emjgastroenterol/10311106","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311106","url":null,"abstract":"In the first presentation, Prof Panaccione considered how early treatment of Crohn’s disease (CD) is key for achieving the therapeutic goals, which include symptomatic remission and mucosal healing. The latest STRIDE guidelines,1 published in 2015, endorse endoscopic remission defined as “resolution of ulceration at ileocolonoscopy”, and emphasised the need for tight monitoring of inflammation. He explored data highlighting how the ability to achieve mucosal healing decreases with increased disease duration, that benefits from mucosal healing may not be realised until the second year of treatment, and how patients who experience mucosal healing are less likely to be hospitalised and require surgery. Studies show patients do better with the ‘top-down’ approach, receiving anti-tumour necrosis factor (TNF) drugs early in the disease course, which has led to the introduction of a treatment algorithm suggesting patients with high-risk factors for poor prognosis should receive early ‘top-down’ therapy and lower-risk patients traditional ‘step-up’ therapy. The need for decisive early treatment to slow progression emphasises the importance of facilitating early diagnosis, and identifying patients for early biologic therapy. In the second presentation, Dr Iris Dotan explored data suggesting that optimal positioning for vedolizumab appears to be early in the course of disease. Furthermore, vedolizumab’s effect on clinical remission improves over time, clinical remissions have been shown to be maintained long-term, and vedolizumab reduces rates of hospitalisation. A favourable risk-benefit profile for vedolizumab has been shown for long-term use with no increase in the incidence of adverse events in the 5-year analysis. There are now 77,382 patient-years of post-marketing exposure to vedolizumab worldwide.2 The latest European Crohn’s and Colitis Organisation (ECCO) guidelines recommend the use of vedolizumab in patients with moderate to severe localised ileocaecal and colonic CD refractory to steroids and/or anti-TNF-αs.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85947835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-16DOI: 10.33590/emjgastroenterol/10313444
J. Fricker
Given the progressive nature of ulcerative colitis (UC), Prof Colombel argued that effective therapy is warranted early in the disease course, especially for patients judged at a high risk of colectomy. To slow disease progression clinicians should aim for complete recovery or absence of inflammation in the gut mucosa. This goal has recently been recommended by the US Food and Drug Administration (FDA) who advised that endoscopy should be used in conjunction with histology for the assessment of mucosal healing in UC. Considering remission in UC, Prof Feagan explained that while there is clear evidence that endoscopic remission is associated with better outcomes, challenges remain in achieving remission with current agents. Studies show utility for incorporating histopathological activity into clinical trials, but there are concerns regarding the lack of agreement among pathologists. Two newly validated indices for evaluating histologic disease activity in UC (Robarts Histopathology Index [RHI] and Nancy Histopathology Index) open the way for histopathology to be introduced in early drug development. Prof Schreiber reviewed vedolizumab, a gut-selective α4β7 integrin antagonist recommended by the European Crohn’s and Colitis Organisation (ECCO) guidelines as a first-line biologic therapy for the treatment of moderate-to-severe UC. Data from clinical trials showed that vedolizumab has the greatest efficacy in anti-tumour necrosis factor (TNF)-naïve patients and early in the disease course. Histologic healing, reported in >50% of UC patients with endoscopic remission taking vedolizumab, is likely to be a new endpoint in clinical trials. Vedolizumab has a favourable risk-benefit profile, with >77,382 patient years of post-marketing exposure worldwide.1
{"title":"Changing the Game in Ulcerative Colitis: The Impact of Gut-Selective Therapy","authors":"J. Fricker","doi":"10.33590/emjgastroenterol/10313444","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313444","url":null,"abstract":"Given the progressive nature of ulcerative colitis (UC), Prof Colombel argued that effective therapy is warranted early in the disease course, especially for patients judged at a high risk of colectomy. To slow disease progression clinicians should aim for complete recovery or absence of inflammation in the gut mucosa. This goal has recently been recommended by the US Food and Drug Administration (FDA) who advised that endoscopy should be used in conjunction with histology for the assessment of mucosal healing in UC.\u0000\u0000Considering remission in UC, Prof Feagan explained that while there is clear evidence that endoscopic remission is associated with better outcomes, challenges remain in achieving remission with current agents. Studies show utility for incorporating histopathological activity into clinical trials, but there are concerns regarding the lack of agreement among pathologists. Two newly validated indices for evaluating histologic disease activity in UC (Robarts Histopathology Index [RHI] and Nancy Histopathology Index) open the way for histopathology to be introduced in early drug development.\u0000\u0000Prof Schreiber reviewed vedolizumab, a gut-selective α4β7 integrin antagonist recommended by the European Crohn’s and Colitis Organisation (ECCO) guidelines as a first-line biologic therapy for the treatment of moderate-to-severe UC. Data from clinical trials showed that vedolizumab has the greatest efficacy in anti-tumour necrosis factor (TNF)-naïve patients and early in the disease course. Histologic healing, reported in >50% of UC patients with endoscopic remission taking vedolizumab, is likely to be a new endpoint in clinical trials. Vedolizumab has a favourable risk-benefit profile, with >77,382 patient years of post-marketing exposure worldwide.1","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78403877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-24DOI: 10.33590/emjgastroenterol/10311748
Eweng Legg
Este seminario especializado financiado mediante una contribución independiente realizada por OM/Vifor Pharma reunió a facultativos especializados en cirugía vascular, ginecología y dermatología de Pakistán, Egipto, Turquía, Líbano y Alemania para debatir acerca del manejo actual de la enfermedad venosa crónica y la enfermedad hemorroidal (EH). El seminario estuvo compuesto de presentaciones plenarias y debates interactivos sobre estudios de casos, permitiéndose a delegados y ponentes participar en discusiones de mayor nivel sobre cuestiones candentes en este campo.
{"title":"Manejo de la Enfermedad Hemorroidal","authors":"Eweng Legg","doi":"10.33590/emjgastroenterol/10311748","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311748","url":null,"abstract":"Este seminario especializado financiado mediante una contribución independiente realizada por OM/Vifor Pharma reunió a facultativos especializados en cirugía vascular, ginecología y dermatología de Pakistán, Egipto, Turquía, Líbano y Alemania para debatir acerca del manejo actual de la enfermedad venosa crónica y la enfermedad hemorroidal (EH). El seminario estuvo compuesto de presentaciones plenarias y debates interactivos sobre estudios de casos, permitiéndose a delegados y ponentes participar en discusiones de mayor nivel sobre cuestiones candentes en este campo.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73465178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-24DOI: 10.33590/emjgastroenterol/10313279
E. Legg
This expert masterclass, supported by an independent grant from OM/Vifor Pharma, brought together physicians specialising in vascular surgery, gynaecology, and dermatology, from Pakistan, Egypt, Turkey, Lebanon, and Germany, to discuss the current management of chronic venous disease and haemorrhoidal disease (HD). The meeting included plenary lectures and interactive case study discussions, allowing delegates and presenters to take part in high-level discussions of pressing issues within the field.
{"title":"Haemorrhoidal Disease Management","authors":"E. Legg","doi":"10.33590/emjgastroenterol/10313279","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313279","url":null,"abstract":"This expert masterclass, supported by an independent grant from OM/Vifor Pharma, brought together physicians specialising in vascular surgery, gynaecology, and dermatology, from Pakistan, Egypt, Turkey, Lebanon, and Germany, to discuss the current management of chronic venous disease and haemorrhoidal disease (HD). The meeting included plenary lectures and interactive case study discussions, allowing delegates and presenters to take part in high-level discussions of pressing issues within the field.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"2 7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74588566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.33590/emjgastroenterol/10312373
J. Allport
Biosimilars follow a rigorous regulatory approval pathway designed to collect and review the totality of evidence from non-clinical analytical comparability exercises as well as clinical Phase I and III studies between the biosimilar and the reference biological. Once the European Medicines Agency (EMA) has given a positive opinion on the generated totality of evidence, the agency may extrapolate the biosimilar’s clinical data from the indication in which the biosimilar was studied to other indications for which the reference biological was approved. A prerequisite for this step is a convincing demonstration of biosimilarity within a studied clinical Phase III population that is suitably sensitive to detect potential clinically relevant differences in efficacy, safety, or immunogenicity. This regulatory pathway was used for all currently available biosimilars including SB2 (Flixabi®), a recently approved biosimilar that is licensed for use across all indications approved for its reference biologic infliximab (Remicade®), including inflammatory bowel disease (IBD). Further to robust non-clinical evaluations of SB2 in 46 physicochemical and 23 biological assays, a Phase I study demonstrated pharmacokinetic equivalence between SB2 and reference infliximab. Furthermore, a Phase III study performed in patients with moderate-to-severe rheumatoid arthritis (RA) — a scientifically appropriate, sensitive patient population — showed that SB2 was equivalent to infliximab in terms of its primary endpoint, American College of Rheumatology 20% improvement (ACR20) response rate at Week 30, and comparable with regard to safety and immunogenicity up to Week 54. Additional analyses of treatment-emergent adverse events (TEAEs) by anti-drug antibody (ADA) status up to Week 54 demonstrated a comparable incidence of TEAEs in both treatment arms. The ACR response rates, safety, and incidence of ADAs remained comparable also in the transition extension period up to Week 78 between patients who continued to receive either SB2 or reference infliximab, and patients who transitioned from reference infliximab to SB2. Biosimilars have an important place in the treatment of IBD. Increased use of biosimilars in patients with Crohn’s disease (CD) or ulcerative colitis is likely to reduce costs, expand access of eligible patients to biologic therapy, and improve overall health outcomes.
{"title":"Introducing Biosimilars into Current Inflammatory Bowel Disease Treatment Algorithms","authors":"J. Allport","doi":"10.33590/emjgastroenterol/10312373","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10312373","url":null,"abstract":"Biosimilars follow a rigorous regulatory approval pathway designed to collect and review the totality of evidence from non-clinical analytical comparability exercises as well as clinical Phase I and III studies between the biosimilar and the reference biological. Once the European Medicines Agency (EMA) has given a positive opinion on the generated totality of evidence, the agency may extrapolate the biosimilar’s clinical data from the indication in which the biosimilar was studied to other indications for which the reference biological was approved. A prerequisite for this step is a convincing demonstration of biosimilarity within a studied clinical Phase III population that is suitably sensitive to detect potential clinically relevant differences in efficacy, safety, or immunogenicity. This regulatory pathway was used for all currently available biosimilars including SB2 (Flixabi®), a recently approved biosimilar that is licensed for use across all indications approved for its reference biologic infliximab (Remicade®), including inflammatory bowel disease (IBD). Further to robust non-clinical evaluations of SB2 in 46 physicochemical and 23 biological assays, a Phase I study demonstrated pharmacokinetic equivalence between SB2 and reference infliximab. Furthermore, a Phase III study performed in patients with moderate-to-severe rheumatoid arthritis (RA) — a scientifically appropriate, sensitive patient population — showed that SB2 was equivalent to infliximab in terms of its primary endpoint, American College of Rheumatology 20% improvement (ACR20) response rate at Week 30, and comparable with regard to safety and immunogenicity up to Week 54. Additional analyses of treatment-emergent adverse events (TEAEs) by anti-drug antibody (ADA) status up to Week 54 demonstrated a comparable incidence of TEAEs in both treatment arms. The ACR response rates, safety, and incidence of ADAs remained comparable also in the transition extension period up to Week 78 between patients who continued to receive either SB2 or reference infliximab, and patients who transitioned from reference infliximab to SB2. Biosimilars have an important place in the treatment of IBD. Increased use of biosimilars in patients with Crohn’s disease (CD) or ulcerative colitis is likely to reduce costs, expand access of eligible patients to biologic therapy, and improve overall health outcomes.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88561556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.33590/emjgastroenterol/10313659
Christopher Ma, Eldon A. Shaffer
Eosinophilic oesophagitis (EoE) is an emerging disorder that manifests clinically with characteristic symptoms of oesophageal dysfunction and histologically by tissue eosinophilia. This chronic immune-mediated oesophageal disease represents a response primarily to food antigens. The incidence of EoE is escalating in both adults and children. This rise stems not only from heightened recognition but also an increased frequency of allergic/atopic diseases and defective immune tolerance. In adults, EoE presents as intermittent solid-food dysphagia or food impaction, heartburn, and chest pain, typically presenting in young men with known allergies. Presentation differs in children, who experience upper gastrointestinal complaints: abdominal pain, vomiting, feeding difficulties, and/or failure to thrive. Endoscopic features include circular rings, linear furrows, white exudative plaques, strictures, and mucosal fragility. The pathologic hallmark of EoE is mucosal eosinophilia (>15 eosinophils per high-power field) isolated to the oesophagus. Such tissue eosinophilia must be distinguished from gastro-oesophageal acid reflux that responds to optimal proton pump inhibitor (PPI) treatment and from PPI-responsive oesophageal eosinophilia (PPI-ROE). Innovative modalities such as high resolution digitally-enhanced endoscopy and functional luminal impedance planimetry are emerging to better detect EoE and monitor its response to treatment. Current therapeutic strategies involve elimination and elemental diets to avoid food allergens, topical corticosteroids to counter the inflammatory response, and endoscopic dilation of fibrostenotic complications. Other treatments have employed immunosuppressants, antagonists to the leukotriene and T helper Type 2 inflammatory pathways, and biologics that target interleukins, tumour necrosis factor, or immunoglobulin E with variable success. This review highlights the current understanding of the epidemiology, pathogenesis, presentation, treatment, and natural history of EoE, and scrutinises current controversies and future directions for investigation.
{"title":"Eosinophilic Oesophagitis: Current Understanding and Future Directions","authors":"Christopher Ma, Eldon A. Shaffer","doi":"10.33590/emjgastroenterol/10313659","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313659","url":null,"abstract":"Eosinophilic oesophagitis (EoE) is an emerging disorder that manifests clinically with characteristic symptoms of oesophageal dysfunction and histologically by tissue eosinophilia. This chronic immune-mediated oesophageal disease represents a response primarily to food antigens. The incidence of EoE is escalating in both adults and children. This rise stems not only from heightened recognition but also an increased frequency of allergic/atopic diseases and defective immune tolerance. In adults, EoE presents as intermittent solid-food dysphagia or food impaction, heartburn, and chest pain, typically presenting in young men with known allergies. Presentation differs in children, who experience upper gastrointestinal complaints: abdominal pain, vomiting, feeding difficulties, and/or failure to thrive. Endoscopic features include circular rings, linear furrows, white exudative plaques, strictures, and mucosal fragility. The pathologic hallmark of EoE is mucosal eosinophilia (>15 eosinophils per high-power field) isolated to the oesophagus. Such tissue eosinophilia must be distinguished from gastro-oesophageal acid reflux that responds to optimal proton pump inhibitor (PPI) treatment and from PPI-responsive oesophageal eosinophilia (PPI-ROE). Innovative modalities such as high resolution digitally-enhanced endoscopy and functional luminal impedance planimetry are emerging to better detect EoE and monitor its response to treatment. Current therapeutic strategies involve elimination and elemental diets to avoid food allergens, topical corticosteroids to counter the inflammatory response, and endoscopic dilation of fibrostenotic complications. Other treatments have employed immunosuppressants, antagonists to the leukotriene and T helper Type 2 inflammatory pathways, and biologics that target interleukins, tumour necrosis factor, or immunoglobulin E with variable success. This review highlights the current understanding of the epidemiology, pathogenesis, presentation, treatment, and natural history of EoE, and scrutinises current controversies and future directions for investigation.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80390910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.33590/emjgastroenterol/10313088
T. Jayaraman, Muhammad Ilham Abdul Hafidz, N. Mustaffa, Yeong Yeh Lee
Proton pump inhibitors (PPI) are one of the most widely prescribed drugs worldwide. They are the mainstay for treatment of most gastric acid-related disorders. PPIs are often used for inappropriate indications and unnecessarily prolonged durations. Initially thought to be a very safe class of drugs, concerns have been raised with regard to an increased risk of adverse events thought to be related to the long-term use of PPIs. PPIs are now known to be associated with increased risk of osteoporotic fractures, nutritional deficiencies (vitamin B12, magnesium, and iron), myocardial infarction, Clostridium difficile infection, community-acquired pneumonia, and gastric neoplasia. More recent evidence has shown that PPI use is also associated with renal impairment and dementia. Although these associations do not necessarily imply a causal link, PPIs should be used for the correct indications and for an appropriate duration. Prolonged use should be discouraged unless the benefits of treatment clearly outweigh the associated risks. More studies are needed to further explore these associations and to establish causality if present.
{"title":"Should I Be Concerned with the Long-Term Use of Proton Pump Inhibitor Therapy?","authors":"T. Jayaraman, Muhammad Ilham Abdul Hafidz, N. Mustaffa, Yeong Yeh Lee","doi":"10.33590/emjgastroenterol/10313088","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313088","url":null,"abstract":"Proton pump inhibitors (PPI) are one of the most widely prescribed drugs worldwide. They are the mainstay for treatment of most gastric acid-related disorders. PPIs are often used for inappropriate indications and unnecessarily prolonged durations. Initially thought to be a very safe class of drugs, concerns have been raised with regard to an increased risk of adverse events thought to be related to the long-term use of PPIs. PPIs are now known to be associated with increased risk of osteoporotic fractures, nutritional deficiencies (vitamin B12, magnesium, and iron), myocardial infarction, Clostridium difficile infection, community-acquired pneumonia, and gastric neoplasia. More recent evidence has shown that PPI use is also associated with renal impairment and dementia. Although these associations do not necessarily imply a causal link, PPIs should be used for the correct indications and for an appropriate duration. Prolonged use should be discouraged unless the benefits of treatment clearly outweigh the associated risks. More studies are needed to further explore these associations and to establish causality if present.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91311356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.33590/emjgastroenterol/10310586
A. Melvin, C. L. le Roux, N. Docherty
Roux-en-Y gastric bypass (RYGB) surgery is a very successful option for the management of obesity, and our understanding of how this intervention mediates sustained weight loss continues to grow. Controversy exists regarding whether bariatric surgical procedures such as RYGB may modulate food preferences of individuals, in particular, reducing appetitive and consummatory behaviour toward dietary fat. Herein, we summarise the evidence base regarding changes in food and macronutrient preference following RYGB surgery and discuss the challenges faced by investigators attempting to resolve whether this is a causal phenomenon in RYGB-induced weight loss and whether its development reflects a conditioned response.
{"title":"Assessing Alterations in Food Preference as a Mechanism Contributing to Weight Loss After Gastric Bypass Surgery","authors":"A. Melvin, C. L. le Roux, N. Docherty","doi":"10.33590/emjgastroenterol/10310586","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310586","url":null,"abstract":"Roux-en-Y gastric bypass (RYGB) surgery is a very successful option for the management of obesity, and our understanding of how this intervention mediates sustained weight loss continues to grow. Controversy exists regarding whether bariatric surgical procedures such as RYGB may modulate food preferences of individuals, in particular, reducing appetitive and consummatory behaviour toward dietary fat. Herein, we summarise the evidence base regarding changes in food and macronutrient preference following RYGB surgery and discuss the challenges faced by investigators attempting to resolve whether this is a causal phenomenon in RYGB-induced weight loss and whether its development reflects a conditioned response.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76678582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.33590/emjgastroenterol/10310965
S. Pecere, V. Petito, A. Amato, A. Poscia, A. Armuzzi, L. Lopetuso, A. Sgambato, G. Cammarota, A. Papa, A. Gasbarrini, F. Scaldaferri
Background: Infliximab (IFX) trough levels measurement could partially explain mechanisms of loss in response to this drug. However, little information exists on its concentration at the mucosal level or mucosal pharmacokinetics. Objective: The aim of this study was to investigate whether IFX could be measured within intestinal mucosa, and whether a correlation between mucosal level, serum level, and clinical response could be hypothesised. Methods: Fifteen consecutive patients with inflammatory bowel disease receiving stable doses of IFX who underwent endoscopy were enrolled. Biopsies were taken from an affected and an unaffected area and cultured for 48 hours, and serum samples were also collected. IFX and tumour necrosis factor alpha (TNF-α) levels were measured using commercially available enzyme-linked immunosorbent assay kits. Results: IFX levels were detected in 80% of the colonic biopsy supernatants and in 60% of the serum samples. TNF-α intestinal mucosal levels were detectable in 100% of patients, while TNF-α serum levels were detectable in 75%. Mucosal and serum levels of IFX and TNF-α did not correlate; no correlation was found between the last infusion and serum or intestinal mucosal levels. Levels of IFX were more frequently undetectable in the mucosa of patients not responding to IFX therapy. Conclusions: Detectable levels of IFX and TNF-α can be found in intestinal mucosa. IFX mucosa levels could be useful to stratify patients into responders and non-responders to IXF therapy.
{"title":"Infliximab and Tumour Necrosis Factor Alpha Measurement on Intestinal Mucosa: A New Tool for the Clinic?","authors":"S. Pecere, V. Petito, A. Amato, A. Poscia, A. Armuzzi, L. Lopetuso, A. Sgambato, G. Cammarota, A. Papa, A. Gasbarrini, F. Scaldaferri","doi":"10.33590/emjgastroenterol/10310965","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310965","url":null,"abstract":"Background: Infliximab (IFX) trough levels measurement could partially explain mechanisms of loss in response to this drug. However, little information exists on its concentration at the mucosal level or mucosal pharmacokinetics.\u0000\u0000Objective: The aim of this study was to investigate whether IFX could be measured within intestinal mucosa, and whether a correlation between mucosal level, serum level, and clinical response could be hypothesised.\u0000\u0000Methods: Fifteen consecutive patients with inflammatory bowel disease receiving stable doses of IFX who underwent endoscopy were enrolled. Biopsies were taken from an affected and an unaffected area and cultured for 48 hours, and serum samples were also collected. IFX and tumour necrosis factor alpha (TNF-α) levels were measured using commercially available enzyme-linked immunosorbent assay kits.\u0000\u0000Results: IFX levels were detected in 80% of the colonic biopsy supernatants and in 60% of the serum samples. TNF-α intestinal mucosal levels were detectable in 100% of patients, while TNF-α serum levels were detectable in 75%. Mucosal and serum levels of IFX and TNF-α did not correlate; no correlation was found between the last infusion and serum or intestinal mucosal levels. Levels of IFX were more frequently undetectable in the mucosa of patients not responding to IFX therapy.\u0000\u0000Conclusions: Detectable levels of IFX and TNF-α can be found in intestinal mucosa. IFX mucosa levels could be useful to stratify patients into responders and non-responders to IXF therapy.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82170693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.33590/emjgastroenterol/10310911
G. Walsh
Eosinophilic oesophagitis is an inflammatory condition associated with marked eosinophil accumulation in the mucosal tissues of the oesophagus. Eosinophils are major pro-inflammatory cells thought to make a significant contribution to allergic diseases that affect the upper and lower airways, skin, and gastrointestinal tract. Type 2 cytokines such as interleukin (IL)-5 and IL-13 are central to eosinophil maturation and release from the bone marrow, and their subsequent accumulation, activation, and persistence in the tissues. Humanised monoclonal antibodies with potent IL-5 or IL-13 neutralising effects represent potential treatments for eosinophilic-driven diseases. This review will consider the current status of these biologics in the treatment of eosinophilic esophagitis.
{"title":"Monoclonal Antibody-Based Therapy for Eosinophilic Oesophagitis","authors":"G. Walsh","doi":"10.33590/emjgastroenterol/10310911","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310911","url":null,"abstract":"Eosinophilic oesophagitis is an inflammatory condition associated with marked eosinophil accumulation in the mucosal tissues of the oesophagus. Eosinophils are major pro-inflammatory cells thought to make a significant contribution to allergic diseases that affect the upper and lower airways, skin, and gastrointestinal tract. Type 2 cytokines such as interleukin (IL)-5 and IL-13 are central to eosinophil maturation and release from the bone marrow, and their subsequent accumulation, activation, and persistence in the tissues. Humanised monoclonal antibodies with potent IL-5 or IL-13 neutralising effects represent potential treatments for eosinophilic-driven diseases. This review will consider the current status of these biologics in the treatment of eosinophilic esophagitis.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76226881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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