Pub Date : 2016-12-01DOI: 10.33590/emjgastroenterol/10311314
Monjur Ahmed
Barrett’s oesophagus (BO) is one of the most important complications of gastro-oesophageal reflux disease as it may progress to oesophageal adenocarcinoma. There is currently a rising incidence of BO. The pathogenesis of BO is not well-understood although genetic and environmental factors play significant roles. BO can be dysplastic or non-dysplastic. In the case of dysplastic BO, two pathologists’ opinions are required. As patients with BO can be entirely asymptomatic, it is difficult to screen this population group. Currently, screening is recommended only for white males with certain risk factors according to American College of Gastroenterology (ACG) guidelines in the USA. The extent of BO can be reliably measured using the Prague classification. Patients with non-dysplastic BO should have surveillance endoscopy every 3–5 years, whereas dysplastic BO should be ablated endoscopically. Any nodule in the BO should be removed by endoscopic mucosal resection. Patients with BO should be on life-long acid-suppressant therapy. Non-invasive techniques such as the Cytosponge are being investigated as an alternative to endoscopy for BO screening.
{"title":"Barrett’s Oesophagus in 2016","authors":"Monjur Ahmed","doi":"10.33590/emjgastroenterol/10311314","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311314","url":null,"abstract":"Barrett’s oesophagus (BO) is one of the most important complications of gastro-oesophageal reflux disease as it may progress to oesophageal adenocarcinoma. There is currently a rising incidence of BO. The pathogenesis of BO is not well-understood although genetic and environmental factors play significant roles. BO can be dysplastic or non-dysplastic. In the case of dysplastic BO, two pathologists’ opinions are required. As patients with BO can be entirely asymptomatic, it is difficult to screen this population group. Currently, screening is recommended only for white males with certain risk factors according to American College of Gastroenterology (ACG) guidelines in the USA. The extent of BO can be reliably measured using the Prague classification. Patients with non-dysplastic BO should have surveillance endoscopy every 3–5 years, whereas dysplastic BO should be ablated endoscopically. Any nodule in the BO should be removed by endoscopic mucosal resection. Patients with BO should be on life-long acid-suppressant therapy. Non-invasive techniques such as the Cytosponge are being investigated as an alternative to endoscopy for BO screening.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73805283","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/10311269
Morgan McKenzie
Patient adherence is a major problem in the treatment of inflammatory bowel disease (IBD). Research has shown that improved patient adherence and outcomes can be achieved if physicians are able to dedicate more time and attention to analysing patients’ feedback on their healthcare. The US Food and Drug Administration (FDA) has defined patient-reported outcomes (PROs) as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” Such patient reports may include various symptoms that are not obvious or that occur in the absence of an observer; they may describe the frequency and severity of a symptom, and the impact that it has on day-to-day life. They can describe factors such as patient satisfaction, productivity, use of resources, and health-related quality of life (QoL). Interestingly, PROs do not always correlate with the physician’s view. Evidence has shown that physicians often underestimate the severity of a patient’s illness, report fewer problems than patients, and overestimate the improvements of treatment. In order to improve the value of PROs, physicians must engage patients in their disease management, otherwise known as patient empowerment. Empowerment can improve treatment success. As it is becoming clearer that empowered and informed patients who are able to have a role in the decision-making have better outcomes, PROs will not only have further impact on the management of patients with IBD but also on health technology assessments and healthcare payer decisions.
{"title":"Relevance of Patient-Reported Outcomes for the Management of Patients with Inflammatory Bowel Disease","authors":"Morgan McKenzie","doi":"10.33590/emjgastroenterol/10311269","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311269","url":null,"abstract":"Patient adherence is a major problem in the treatment of inflammatory bowel disease (IBD). Research has shown that improved patient adherence and outcomes can be achieved if physicians are able to dedicate more time and attention to analysing patients’ feedback on their healthcare. The US Food and Drug Administration (FDA) has defined patient-reported outcomes (PROs) as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” Such patient reports may include various symptoms that are not obvious or that occur in the absence of an observer; they may describe the frequency and severity of a symptom, and the impact that it has on day-to-day life. They can describe factors such as patient satisfaction, productivity, use of resources, and health-related quality of life (QoL).\u0000\u0000Interestingly, PROs do not always correlate with the physician’s view. Evidence has shown that physicians often underestimate the severity of a patient’s illness, report fewer problems than patients, and overestimate the improvements of treatment. In order to improve the value of PROs, physicians must engage patients in their disease management, otherwise known as patient empowerment. Empowerment can improve treatment success.\u0000\u0000As it is becoming clearer that empowered and informed patients who are able to have a role in the decision-making have better outcomes, PROs will not only have further impact on the management of patients with IBD but also on health technology assessments and healthcare payer decisions.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80033206","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/10311065
Russell J. Hopp
In this century, eosinophilic oesophagitis (EoE) has become a more recognised allergic disease, resulting in the publication of two consensus reports as the information of its pathophysiology has been rapidly elucidated. Its initial appearance in medical literature was in the 1970s, but it was not until the late 1990s that its paediatric-to-adult spectrum became more evident. Currently, it is a commonplace diagnosis in gastroenterology clinics, and the management of the disease commonly involves allergists. Coming from humble beginnings, the true reasons for its emergence on the worldwide allergic diseases stage is not understood. This review explores possible explanations of the origins of EoE. As food intolerance is an important component of EoE, the role of modern food production is discussed, as well as elements of EoE that have been possibly overlooked.
{"title":"Eosinophilic Oesophagitis: From Rare to Commonplace, What Are the Potential Explanations?","authors":"Russell J. Hopp","doi":"10.33590/emjgastroenterol/10311065","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311065","url":null,"abstract":"In this century, eosinophilic oesophagitis (EoE) has become a more recognised allergic disease, resulting in the publication of two consensus reports as the information of its pathophysiology has been rapidly elucidated. Its initial appearance in medical literature was in the 1970s, but it was not until the late 1990s that its paediatric-to-adult spectrum became more evident. Currently, it is a commonplace diagnosis in gastroenterology clinics, and the management of the disease commonly involves allergists. Coming from humble beginnings, the true reasons for its emergence on the worldwide allergic diseases stage is not understood. This review explores possible explanations of the origins of EoE. As food intolerance is an important component of EoE, the role of modern food production is discussed, as well as elements of EoE that have been possibly overlooked.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87559734","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/10310943
Jacqueline Kolston
The objectives of this symposium were to describe the current unmet needs in the treatment and management of inflammatory bowel diseases (IBDs) in clinical practice. Crohn’s disease (CD) is a chronic inflammatory disease affecting several areas of the gastrointestinal tract, which can have a negative impact on patient quality of life (QoL) and may lead to disability. Effective management and early disease intervention combined with control of inflammation in CD are crucial to achieving sustained remission. Clinical remission, however, is not always an indicator of mucosal healing and does not necessarily translate to real-world benefits for patients. Unfortunately, not all patients respond to their current treatment and several experience unacceptable adverse events. Furthermore, treatment with some anti-tumour necrosis factor (TNF) antibodies can paradoxically induce psoriatic lesions that regress after treatment withdrawal, highlighting the need for more therapeutic options. The symposium was opened by Prof Séverine Vermeire, who discussed the unmet needs for patients with IBD and whether CD is sufficiently controlled. Special attention was paid to clinical remission, steroid-free remission, and mucosal healing. Dr Alessandro Armuzzi then reflected upon the current therapeutic options for CD and their application in clinical practice. The final contribution came from Prof Laurent Peyrin-Biroulet, who discussed new developments in the treatment of IBD, and presented data from clinical trials of the monoclonal antibody (mAb) ustekinumab.
{"title":"Crohn’s Disease: Supporting Patients in Their Pursuit of Disease Control","authors":"Jacqueline Kolston","doi":"10.33590/emjgastroenterol/10310943","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310943","url":null,"abstract":"The objectives of this symposium were to describe the current unmet needs in the treatment and management of inflammatory bowel diseases (IBDs) in clinical practice. Crohn’s disease (CD) is a chronic inflammatory disease affecting several areas of the gastrointestinal tract, which can have a negative impact on patient quality of life (QoL) and may lead to disability. Effective management and early disease intervention combined with control of inflammation in CD are crucial to achieving sustained remission. Clinical remission, however, is not always an indicator of mucosal healing and does not necessarily translate to real-world benefits for patients. Unfortunately, not all patients respond to their current treatment and several experience unacceptable adverse events. Furthermore, treatment with some anti-tumour necrosis factor (TNF) antibodies can paradoxically induce psoriatic lesions that regress after treatment withdrawal, highlighting the need for more therapeutic options. The symposium was opened by Prof Séverine Vermeire, who discussed the unmet needs for patients with IBD and whether CD is sufficiently controlled. Special attention was paid to clinical remission, steroid-free remission, and mucosal healing. Dr Alessandro Armuzzi then reflected upon the current therapeutic options for CD and their application in clinical practice. The final contribution came from Prof Laurent Peyrin-Biroulet, who discussed new developments in the treatment of IBD, and presented data from clinical trials of the monoclonal antibody (mAb) ustekinumab.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"296 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79595748","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/10310853
ApotheCom
Inflammatory bowel diseases (IBDs) are chronic disabling conditions. Despite the benefits of anti-tumour necrosis factor-α agents in improving quality of life and reducing the need for surgery in many patients, only one-third achieve clinical remission after 1 year of treatment. It is important that treatments go beyond just the alleviation of symptoms, and help to achieve mucosal healing and deep remission.1 The symposium reviewed the natural course of IBD and discussed how focussing management strategies away from simple symptomatic control towards maintaining mucosal healing can significantly improve the quality of life and wider clinical outcomes of patients with IBD. However, this shift in approach requires the redefining of disease severity to highlight the importance of inflammation control and mucosal healing in preventing long-term damage and disability. Dr Peyrin-Biroulet opened the sessions by reviewing how the Randomised Evaluation of an Algorithm for Crohn’s Treatment (REACT) study has enhanced the understanding of the natural history of IBD, and how complete mucosal healing provides the best outcomes in IBD.2 Dr Colombel highlighted that uncontrolled inflammation in IBD can lead to poor outcomes, and how simple demographic and clinical features can guide the clinician in identifying patients at higher risk for disease complications both at diagnosis and throughout the disease course. Dr Ghosh discussed the importance of defining disease severity in IBD and reinforced that while symptoms related to disease activity are a component of overall disease severity, many factors need to be considered to understand the total impact on a patient’s quality of life.
{"title":"Preventing Collateral Damage in the Inflammatory Bowel Disease Patient: Using Disease Assessment and Prognostic Factors to Optimise Clinical Outcomes","authors":"ApotheCom","doi":"10.33590/emjgastroenterol/10310853","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310853","url":null,"abstract":"Inflammatory bowel diseases (IBDs) are chronic disabling conditions. Despite the benefits of anti-tumour necrosis factor-α agents in improving quality of life and reducing the need for surgery in many patients, only one-third achieve clinical remission after 1 year of treatment. It is important that treatments go beyond just the alleviation of symptoms, and help to achieve mucosal healing and deep remission.1 The symposium reviewed the natural course of IBD and discussed how focussing management strategies away from simple symptomatic control towards maintaining mucosal healing can significantly improve the quality of life and wider clinical outcomes of patients with IBD. However, this shift in approach requires the redefining of disease severity to highlight the importance of inflammation control and mucosal healing in preventing long-term damage and disability.\u0000\u0000Dr Peyrin-Biroulet opened the sessions by reviewing how the Randomised Evaluation of an Algorithm for Crohn’s Treatment (REACT) study has enhanced the understanding of the natural history of IBD, and how complete mucosal healing provides the best outcomes in IBD.2 Dr Colombel highlighted that uncontrolled inflammation in IBD can lead to poor outcomes, and how simple demographic and clinical features can guide the clinician in identifying patients at higher risk for disease complications both at diagnosis and throughout the disease course. Dr Ghosh discussed the importance of defining disease severity in IBD and reinforced that while symptoms related to disease activity are a component of overall disease severity, many factors need to be considered to understand the total impact on a patient’s quality of life.","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":"80516621","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 : 2016-05-12DOI: 10.33590/emjgastroenterol/10312456
Lynsey Stevenson
Inflammatory bowel disease (IBD) describes two inflammatory conditions of the gastrointestinal tract: ulcerative colitis (UC) and Crohn’s disease (CD). For patients with UC, chronic inflammation of the rectum and colon results in faecal urgency, recurring diarrhoea, and abdominal pain. For patients with CD, mucosal inflammation may occur anywhere along the gastrointestinal tract and common symptoms may include diarrhoea, abdominal pain, fatigue, and weight loss. The vast majority of patients with IBD have mild-to-moderate disease at diagnosis: 85% of patients with UC and 70−80% of patients with CD. Evidence-based guidelines for the management of UC recommend 5-aminosalicylic acid (ASA) treatment (mesalazine) as a first-line therapy. There is evidence to suggest that 5-ASA treatment can be optimised in patients with mild-to-moderate UC by optimising the dose, combining oral with rectal therapy, and increasing treatment duration. For ileocaecal CD, guidelines recommend budesonide as a first-line treatment for mildly and moderately active disease. Systemic corticosteroids may be prescribed as an alternative to budesonide in patients with moderately active disease and as initial therapy in severely active disease. As with all chronic therapies, poor adherence impacts treatment efficacy in IBD as a result of a number of patient and treatment-related factors. Approaches to improve adherence include boosting patient motivation and education and reducing treatment complexity. Key factors for ensuring successful treatment of both UC and CD include understanding predictors of outcome, selection of the right drug, at the right dose, at the right time, and having well-informed and motivated patients.
{"title":"How to Improve Your Success in Treating Mild and Moderate Inflammatory Bowel Disease","authors":"Lynsey Stevenson","doi":"10.33590/emjgastroenterol/10312456","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10312456","url":null,"abstract":"Inflammatory bowel disease (IBD) describes two inflammatory conditions of the gastrointestinal tract: ulcerative colitis (UC) and Crohn’s disease (CD). For patients with UC, chronic inflammation of the rectum and colon results in faecal urgency, recurring diarrhoea, and abdominal pain. For patients with CD, mucosal inflammation may occur anywhere along the gastrointestinal tract and common symptoms may include diarrhoea, abdominal pain, fatigue, and weight loss. The vast majority of patients with IBD have mild-to-moderate disease at diagnosis: 85% of patients with UC and 70−80% of patients with CD. Evidence-based guidelines for the management of UC recommend 5-aminosalicylic acid (ASA) treatment (mesalazine) as a first-line therapy. There is evidence to suggest that 5-ASA treatment can be optimised in patients with mild-to-moderate UC by optimising the dose, combining oral with rectal therapy, and increasing treatment duration. For ileocaecal CD, guidelines recommend budesonide as a first-line treatment for mildly and moderately active disease. Systemic corticosteroids may be prescribed as an alternative to budesonide in patients with moderately active disease and as initial therapy in severely active disease. As with all chronic therapies, poor adherence impacts treatment efficacy in IBD as a result of a number of patient and treatment-related factors. Approaches to improve adherence include boosting patient motivation and education and reducing treatment complexity. Key factors for ensuring successful treatment of both UC and CD include understanding predictors of outcome, selection of the right drug, at the right dose, at the right time, and having well-informed and motivated patients.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81774722","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 : 2016-05-06DOI: 10.33590/emjgastroenterol/10313293
J. Phillipson
Inflammatory bowel disease (IBD) management goals have recently focussed on gastrointestinal symptom resolution and mucosal healing. IBD causes systemic disorder, with inflammation occuring both within and outside the gut, with associated morbidity, disability, and quality of life (QoL) impairment. Thus, there is a need to reduce the overall burden of chronic inflammation in IBD. Environmental factors, genetics, gut microbiota, and the immune system significantly impact IBD and its extraintestinal manifestations (EIMs). T cells play a crucial role in immunity, and certain subsets are associated with several chronic inflammatory disorders, including IBD. Targeting such cells and/or key inflammatory cytokines (e.g. interleukins [IL], and tumour necrosis factor [TNF]) provides a basis for several IBD therapies. Systemic inflammation in IBD can involve the development of fistulae and/or EIMs. Common EIMs include musculoskeletal pain, dermatological and ocular lesions, and primary sclerosing cholangitis (PSC). Early diagnosis of fistulae and EIMs should help guide IBD therapy and reduce overall morbidity. Many EIM treatment options are currently available with varying degrees of efficacy e.g. sulfasalazine, COX-2 inhibitors, certain antibiotics, immunomodulators, anti-TNFs, corticosteroids, and ursodeoxycholic acid. However, fistulae and most EIMs respond well to anti-TNFs, such as adalimumab and infliximab. Prognostic markers aid disease treatment. C-reactive protein (CRP) is a valuable marker of systemic inflammation in IBD (particularly Crohn’s disease [CD]). Current anti-TNF agents (e.g. adalimumab) markedly reduce CRP levels in IBD and have a significant effect on IBD and various EIMs. Numerous novel agents for IBD are under development; examples include Janus kinase (JAK) inhibitors, IL inhibitors, SMAD-7 blockers, sphingosine 1-phosphate receptor 1 (S1P1) inhibitors, and anti-adhesion molecules.
{"title":"Beyond the Gut: The Importance of Controlling Systemic Inflammation in Inflammatory Bowel Disease","authors":"J. Phillipson","doi":"10.33590/emjgastroenterol/10313293","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313293","url":null,"abstract":"Inflammatory bowel disease (IBD) management goals have recently focussed on gastrointestinal symptom resolution and mucosal healing. IBD causes systemic disorder, with inflammation occuring both within and outside the gut, with associated morbidity, disability, and quality of life (QoL) impairment. Thus, there is a need to reduce the overall burden of chronic inflammation in IBD.\u0000\u0000Environmental factors, genetics, gut microbiota, and the immune system significantly impact IBD and its extraintestinal manifestations (EIMs). T cells play a crucial role in immunity, and certain subsets are associated with several chronic inflammatory disorders, including IBD. Targeting such cells and/or key inflammatory cytokines (e.g. interleukins [IL], and tumour necrosis factor [TNF]) provides a basis for several IBD therapies.\u0000\u0000Systemic inflammation in IBD can involve the development of fistulae and/or EIMs. Common EIMs include musculoskeletal pain, dermatological and ocular lesions, and primary sclerosing cholangitis (PSC). Early diagnosis of fistulae and EIMs should help guide IBD therapy and reduce overall morbidity. Many EIM treatment options are currently available with varying degrees of efficacy e.g. sulfasalazine, COX-2 inhibitors, certain antibiotics, immunomodulators, anti-TNFs, corticosteroids, and ursodeoxycholic acid. However, fistulae and most EIMs respond well to anti-TNFs, such as adalimumab and infliximab.\u0000\u0000Prognostic markers aid disease treatment. C-reactive protein (CRP) is a valuable marker of systemic inflammation in IBD (particularly Crohn’s disease [CD]). Current anti-TNF agents (e.g. adalimumab) markedly reduce CRP levels in IBD and have a significant effect on IBD and various EIMs. Numerous novel agents for IBD are under development; examples include Janus kinase (JAK) inhibitors, IL inhibitors, SMAD-7 blockers, sphingosine 1-phosphate receptor 1 (S1P1) inhibitors, and anti-adhesion molecules.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"289 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80914992","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 : 2016-04-29DOI: 10.33590/emjgastroenterol/10311197
I. Woolveridge
The challenges of, and opportunities for optimal long-term management of Crohn’s disease (CD) and real-world experience of managing CD and its application in clinical practice were discussed at this symposium. CD is a complex disease, which requires effective treatment options to improve the quality of life for patients, both in terms of intestinal and extraintestinal manifestations (EIMs). Increased gut permeability of luminal antigens may play a primary role in the pathogenesis of CD, leading to dysregulation of the host’s immune response, and resulting in increased levels of tumour necrosis factor (TNF)-α and interferon (IFN)-γ in the inflamed mucosa of patients. Appropriate management goals need to be established by the physician and patient together. Anti-TNF therapy is not suitable for all patients, and a significant proportion of patients will be primary non-responders. Safety must also be considered as part of a patient-tailored assessment. Vedolizumab is a gut-selective antibody to α4β7 integrin for the treatment of ulcerative colitis (UC) and CD. An integrated Phase II and III safety analysis showed that vedolizumab exposure was not associated with increased risk of any infection or serious infection, or any cases of progressive multifocal leukoencephalopathy (PML), a rare and usually fatal viral disease characterised by progressive damage of the white matter of the brain at multiple locations. Data from the GEMINI trials with vedolizumab showed it to be effective versus placebo, in terms of eliciting both initial and sustained responses, and inducing remission in CD. The real-world studies with vedolizumab in >800 CD patients, most of whom failed ≥1 anti-TNF therapy, confirmed the efficacy and safety reported in clinical trials. Up to 30% of CD patients are receiving vedolizumab as a first biologic in the real-world setting.
{"title":"In It for the Long Haul: Managing the Complexity of Crohn’s Disease","authors":"I. Woolveridge","doi":"10.33590/emjgastroenterol/10311197","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311197","url":null,"abstract":"The challenges of, and opportunities for optimal long-term management of Crohn’s disease (CD) and real-world experience of managing CD and its application in clinical practice were discussed at this symposium. CD is a complex disease, which requires effective treatment options to improve the quality of life for patients, both in terms of intestinal and extraintestinal manifestations (EIMs). Increased gut permeability of luminal antigens may play a primary role in the pathogenesis of CD, leading to dysregulation of the host’s immune response, and resulting in increased levels of tumour necrosis factor (TNF)-α and interferon (IFN)-γ in the inflamed mucosa of patients. Appropriate management goals need to be established by the physician and patient together. Anti-TNF therapy is not suitable for all patients, and a significant proportion of patients will be primary non-responders. Safety must also be considered as part of a patient-tailored assessment. Vedolizumab is a gut-selective antibody to α4β7 integrin for the treatment of ulcerative colitis (UC) and CD. An integrated Phase II and III safety analysis showed that vedolizumab exposure was not associated with increased risk of any infection or serious infection, or any cases of progressive multifocal leukoencephalopathy (PML), a rare and usually fatal viral disease characterised by progressive damage of the white matter of the brain at multiple locations. Data from the GEMINI trials with vedolizumab showed it to be effective versus placebo, in terms of eliciting both initial and sustained responses, and inducing remission in CD. The real-world studies with vedolizumab in >800 CD patients, most of whom failed ≥1 anti-TNF therapy, confirmed the efficacy and safety reported in clinical trials. Up to 30% of CD patients are receiving vedolizumab as a first biologic in the real-world setting.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75580430","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}
The American Society of Clinical Oncology’s 2016 Gastrointestinal Cancer Symposium (ASCO-GI), held in San Francisco, California, USA, provided a forum for leading basic scientists and clinical cancer specialists to discuss cutting-edge research in the field of gastrointestinal (GI) oncology. The quest to improve outcomes and patient lives by targeting unmet clinical need, such as refractory illness, fuelled much of the research presented at the 2016 edition of ASCO-GI. The symposium saw the presentation of a number of studies on the current stage of clinical research on regorafenib, an oral tyrosine-kinase inhibitor approved for use in both refractory metastatic colorectal cancer and metastatic GI stromal tumours.
{"title":"Regorafenib in Advanced and Refractory Gastrointestinal Cancers","authors":"Ewen D. Legg","doi":"10.33590/emj/10313749","DOIUrl":"https://doi.org/10.33590/emj/10313749","url":null,"abstract":"The American Society of Clinical Oncology’s 2016 Gastrointestinal Cancer Symposium (ASCO-GI), held in San Francisco, California, USA, provided a forum for leading basic scientists and clinical cancer specialists to discuss cutting-edge research in the field of gastrointestinal (GI) oncology. The quest to improve outcomes and patient lives by targeting unmet clinical need, such as refractory illness, fuelled much of the research presented at the 2016 edition of ASCO-GI. The symposium saw the presentation of a number of studies on the current stage of clinical research on regorafenib, an oral tyrosine-kinase inhibitor approved for use in both refractory metastatic colorectal cancer and metastatic GI stromal tumours.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83153121","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 : 2015-12-15DOI: 10.33590/emjgastroenterol/10314197
A. Johnson
Ulcerative colitis (UC) carries a significant, progressive disease burden that is often underestimated or misinterpreted by healthcare providers. Adverse outcomes have a major impact on patient quality of life, with a significant burden of symptoms both during and between inflammation flares. Chronic, uncontrolled disease leads to epithelial fibrosis and ‘lead pipe’ colon, dysplasia, and potential colonic cancer. Healthcare providers and patients share similar treatment goals, even if these are not verbalised in the same way, and clinicians need to fully understand the issues most important to patients. Understanding and collaboration can improve identification of meaningful treatment goals and overall disease management. In real-world practice, patients should be categorised according to disease characteristics and prognosis, and managed with appropriate, optimised therapies. Early, top-down management should be implemented in high-risk patients and all patient-centric therapeutic decisions made within the context of a full benefit/risk assessment.
{"title":"The Full Picture of Ulcerative Colitis: The Burden, the Patient, the Treatment","authors":"A. Johnson","doi":"10.33590/emjgastroenterol/10314197","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314197","url":null,"abstract":"Ulcerative colitis (UC) carries a significant, progressive disease burden that is often underestimated or misinterpreted by healthcare providers. Adverse outcomes have a major impact on patient quality of life, with a significant burden of symptoms both during and between inflammation flares. Chronic, uncontrolled disease leads to epithelial fibrosis and ‘lead pipe’ colon, dysplasia, and potential colonic cancer. Healthcare providers and patients share similar treatment goals, even if these are not verbalised in the same way, and clinicians need to fully understand the issues most important to patients. Understanding and collaboration can improve identification of meaningful treatment goals and overall disease management. In real-world practice, patients should be categorised according to disease characteristics and prognosis, and managed with appropriate, optimised therapies. Early, top-down management should be implemented in high-risk patients and all patient-centric therapeutic decisions made within the context of a full benefit/risk assessment.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"30 26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76700600","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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