Crohnʼs Disease Is On after Copaxone Is Off

Appropriateness of immunosuppressive drugs in inflammatory bowel diseases assessed by RAND method: Italian Group for IBD (IG-IBD) position statement

Positive Role of CCAAT/Enhancer-Binding Protein Homologous Protein, a Transcription Factor Involved in the Endoplasmic Reticulum Stress Response in the Development of Colitis

: The objective of the present study was to quantify the national pediatric inpatient inflammatory bowel disease (IBD) burden in terms of the number of IBD-related hospitalizations, the number of days spent in the hospital, and hospitalization costs. : Hospitalizations for children and adolescents 20 years and younger with a primary diagnosis of either Crohn disease (CD) or ulcerative colitis (UC) were selected from the 2006 Kids' Inpatient Database (KID). Length of the hospital stay in days (LOS) and charges for the hospitalization were found directly in the Kids' Inpatient Database, and cost was calculated using the hospital's cost-to-charge ratio. Predictor variables included patient characteristics, such as age and severity of illness, and hospital characteristics. Ordinary-least-squares regressions were developed and estimated to explain hospitalization costs. : In 2006, there were 10,777 IBD-related hospitalizations. The total and mean costs for CD were $66.3 million and $10,176 (95% confidence interval [CI] $9647-$10,705), and for UC were $48.6 million and $11,836 (95% CI $10,760-$12,912). For CD, 0- to 5-year-old patients had the highest mean LOS (8.10, 95% CI 5.53-10.67, days) and mean cost ($13,894, 95% CI $9053-$18,735), whereas, for UC, 11- to 15-year-old patients had the highest mean LOS (7.49, 95% CI 6.88-8.10, 95% CI 5.53-10.67, days) and mean cost ($13,407, 95% CI $11,704-$15,110). : For a pediatric disease with a rather low prevalence rate, the estimated annual inpatient pediatric burden of IBD is a sizeable $152.4 million (2010 US$) and 64,985 days spent in the hospital. As medications and outpatient treatments improve for the treatment of IBD, there is an opportunity for significant reduction in inpatient burden.

The Commensal Microbiota and Enteropathogens in the Pathogenesis of Inflammatory Bowel Diseases

Inflammatory Bowel Disease Clinical

Manipulation of the Microbiota for Treatment of IBS and IBD—Challenges and Controversies

Although the aetiology of inflammatory bowel disease remains elusive, many agents are available for the control of symptoms and inflammation. Knowledge of drug pharmacology, indications and side effects is essential to ensure the best possible clinical care while minimising toxicity and inappropriate use. Sulfasalazine consists of sulfapyridine linked to mesalazine (5-aminosalicylic acid) via an azobond. Its use is indicated in the treatment of mild to moderately active ulcerative colitis and in the prevention of relapse in patients with quiescent disease. Patients with mild to moderate colonic or ileocolonic Crohn's disease also benefit from this drug, as do a proportion of patients with isolated small bowel disease. Sulfasalazine has not been uniformly effective in preventing relapse in Crohn's disease, although many clinicians continue its use in patients who respond initially. A high incidence of side effects which limit therapy include intolerance, hypersensitivity reactions and impairment of male infertility. The newer aminosalicylates offer targeted delivery of mesalazine to the bowel, with fewer side effects. Topical mesalazine has proved extremely effective in patients with distal ulcerative colitis; oral forms are effective in the treatment of mild to moderately active ulcerative colitis and in relapse. Both types appear to be effective in the treatment of Crohn's disease, and possibly in preventing relapse. There is no current clinical advantage of one mesalazine preparation over another, nor is there an indication for their use in sulfasalazine-treated patients who have satisfactory response without adverse effects. Corticosteroids are indicated for more severe disease activity where the aminosalicylates have limited efficacy-specifically to induce remission in patients with severe or refractory ulcerative colitis or Crohn's disease. They should not be used to maintain disease remission or in the prevention of postoperative recurrence. Topical corticosteroids allow their local use in distal colitis with minimal systemic side effects. Long term use is limited by side effects, many of which are dose related, although alternate-day therapy may lessen the incidence. Immunosuppressive agents are beneficial for the treatment of refractory inflammatory bowel disease unresponsive to other medications, and may also facilitate the withdrawal of steroids in refractory patients. Mercaptopurine has an added benefit in the treatment of Crohn's disease fistulae; the role of cyclosporin in bowel disease has not been established and its use cannot currently be recommended. The potential toxicity of immunosuppressive agents warrants careful consideration of their use by both physician and patient. Metronidazole is indicated for the treatment of mild to moderate Crohn's disease, including perineal disease. Common side effects include peripheral neuropathy and nausea.(ABSTRACT TRUNCATED AT 400 WORDS)

P-049: Reproducibility of serologic antibody activity at diagnosis and after treatment in pediatric ulcerative colitis and Crohn’s disease

Crohn's disease is widely described in the Western literature, but it has not been widely observed in the Middle Eastern community. We diagnosed Crohn's disease in seven Arabs, three whom were Saudi Nationals. Their mean age was 32.4 years (range, 18-40 years) and duration of symptoms varied from three months to ten years. The site of the disease was ileocolic in five patients and colonic in two. Mass lesions in the abdomen were seen in three patients. Four cases were diagnosed from histological specimens obtained at laparotomy and resection and the other three were diagnosed from colonoscopic biopsy specimens. Extraintestinal manifestations were found in three patients. Surgery alone was the treatment in two patients, whereas the remaining required medical therapy, mainly steroids, with or without surgery. We conclude that Crohn's disease does occur in the Arab population, but with milder systemic effects.

Introduction and purpose: Insufficient efficacy and adverse effects of classical therapies for inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn's disease, have prompted the search for new, more targeted treatment methods. Janus kinase (JAK) inhibitors are a new group of oral drugs that modulate the proinflammatory cytokine signaling pathway. The aim of this review is to present the state of knowledge on the efficacy and safety of currently registered JAK inhibitors in the treatment of IBD. Review Methods: A systematic search of the PubMed database was conducted, focusing on publications from the last five years as well as selected key earlier studies. The search strategy included relevant keywords related to Janus kinase (JAK) inhibitors and inflammatory bowel disease (IBD). The most pertinent articles aligned with the study objective were reviewed and included. State of knowledge: JAK inhibitors, such as tofacitinib, upadacitinib, and filgotinib, have shown high efficacy in the treatment of moderate to severe UC and CD, especially in patients with insufficient biological therapy response. Clinical studies confirm their efficacy in inducing and maintaining remission and improving endoscopic findings. The most common adverse events are infections (including herpes zoster), and elevation of creatine kinase and lipids. The safety profile remains acceptable, although it requires monitoring, especially at higher doses, and further investigation. Summary: JAK inhibitors are an effective and promising therapeutic option for IBD, offering a rapid onset of action and good symptom control. Despite the favorable clinical effects, an individual approach to treatment and monitoring for adverse effects are necessary, especially with long-term use.

Chronic inflammatory demyelinating polyradiculoneurophathy and Graves' disease in an adolescent with Crohn's disease.

Recurrent pericarditis due to mesalamine hypersensitivity: a pediatric case report and review of the literature.

BackgroundTraditionally, hyperbaric oxygen treatment (HBOT) has been used to treat a limited repertoire of disease, including decompression sickness and healing of problem wounds. However, some investigators have used HBOT to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.MethodsComprehensive searches were conducted in 8 scientific databases through 2011 to identify publications using HBOT in IBD. Human studies and animal models were collated separately.ResultsThirteen studies of HBOT in Crohn's disease and 6 studies in ulcerative colitis were identified. In all studies, participants had severe disease refractory to standard medical treatments, including corticosteroids, immunomodulators and anti-inflammatory medications. In patients with Crohn's disease, 31/40 (78%) had clinical improvements with HBOT, while all 39 patients with ulcerative colitis improved. One study in Crohn's disease reported a significant decrease in proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) and one study in ulcerative colitis reported a decrease in IL-6 with HBOT. Adverse events were minimal. Twelve publications reported using HBOT in animal models of experimentally-induced IBD, including several studies reporting decreased markers of inflammation or immune dysregulation, including TNF-alpha (3 studies), IL-1beta (2 studies), neopterin (1 study) and myeloperoxidase activity (5 studies). HBOT also decreased oxidative stress markers including malondialdehyde (3 studies) and plasma carbonyl content (2 studies), except for one study that reported increased plasma carbonyl content. Several studies reported HBOT lowered nitric oxide (3 studies) and nitric oxide synthase (3 studies) and one study reported a decrease in prostaglandin E2 levels. Four animal studies reported decreased edema or colonic tissue weight with HBOT, and 8 studies reported microscopic improvements on histopathological examination. Although most publications reported improvements with HBOT, some studies suffered from limitations, including possible publication and referral biases, the lack of a control group, the retrospective nature and a small number of participants.ConclusionsHBOT lowered markers of inflammation and oxidative stress and ameliorated IBD in both human and animal studies. Most treated patients were refractory to standard medical treatments. Additional studies are warranted to investigate the effects of HBOT on biomarkers of oxidative stress and inflammation as well as clinical outcomes in individuals with IBD.

Purpose: Anti-tumor necrosis factor (TNF) therapy has been shown to be highly efficacious in the treatment of inflammatory bowel disease (IBD). However, there is a concern that inhibition of TNF may have immunosuppressive effects leading to HCV replication and worsening of liver disease. The aim of this study was to perform a systematic review of the literature regarding the treatment of IBD with anti-TNF agents in patients with chronic HCV infection. Methods: A systematic search of the literature was performed. Databases of literature examined included MEDLINE, EMBASE and PUBMED using key words: hepatitis C, ulcerative colitis, Crohn's disease, inflammatory bowel disease, anti-TNF, infliximab, certolizumab and adalimumab. Articles searched were from 1910 to May 2010. Only full-length, English-written original studies and case-reports that described the effects of anti-TNF treatment on the course of IBD and the liver function in patients with IBD and concomitant chronic HCV infection were included in the analysis.Table: [1233]Results: The search yielded a total of 1312 articles, of which 10 were included in full review and only 3 met inclusion criteria. These 3 studies were case reports, describing a total of 4 cases of treatment with anti-TNF agent, infliximab, in patients with IBD (namely Crohn's disease [CD]) and concomitant chronic HCV infection. The excluded 7 articles were either review articles, original articles not evaluating anti-TNF treatment in patients with IBD or case report describing the disseminated aspergillosis in patient with chronic HCV infection and CD who was treated with infliximab but not providing any details on the course of CD or the hepatic biochemical tests. The findings of these studies are presented in the Table. There were no original studies identified that assessed the treatment of IBD with anti-TNF agent in patients with chronic HCV infection. Conclusion: There are limited data on the use of anti-TNF agents in patients with IBD and chronic HCV infection. The results of our systematic review indicate that therapy with anti-TNF agents does not exacerbate the course of chronic HCV infection. Further, in the limited data available, interferon based therapy has been successfully used to clear HCV infection, while not inducing a flare of liver disease. Large scale studies are needed to fully evaluate the effects of anti-TNF treatment on the course of chronic HCV infection in patients who have a background of IBD. The course of IBD while on interferon based therapy also needs to be assessed in larger studies. Disclosure: Gary R. Lichtenstein, Md Potential Conflict of Interest Declaration Abbott Corporation Consultant Alaven Consultant Bristol-Myers Squibb Research Centocor Orthobiotech Consultant, Research Elan Consultant Ferring Consultant, Research Millenium Pharmaceuticals Consultant Proctor and Gamble Consultant, Research Prometheus Laboratories, Inc. Consultant, Research Salix Pharmaceuticals Consultant, Research Schering-Plough Corporation Consultant Shire Pharmaceuticals Consultant, Research UCB Consultant, Research Warner Chilcotte Consultant, Research Wyeth Consultant.

Inflammatory bowel diseases (IBD), which include Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory diseases of the digestive tract with periods of remission and relapses. The etiopathogenesis of IBD is multifactorial and has not been fully understood. Hence, only symptomatic treatment of these diseases is possible. The current pharmacological treatment has variable efficacy and is associated with the risk of significant side effects. Therefore, there is a constant need to search for new types of therapies with a high safety profile. Considering that the qualitative and quantitative profile of the gastrointestinal microbiome is often different in patients with IBD than in healthy individuals, there is a need for looking for therapies aimed at restoring intestinal microbiome homeostasis. Thus, the use of strictly defined probiotics, prebiotics and synbiotics may become an alternative form of IBD therapy. There is evidence that treatment with certain probiotic strains, e.g., VSL#3 and Escherischia coli Nissle 1917, is an effective form of therapy to induce remission in patients with mild to moderate UC. So far, the effectiveness of the use of probiotics, prebiotics and synbiotics in inducing or maintaining remission in patients with CD has not been confirmed. There are also reports of possible beneficial effects of fecal microbiota transplantation (FMT) on the course of IBD, especially UC. Further, well-planned studies on a large group of patients are needed to determine the role of specific probiotic strains, prebiotics, synbiotics and FMT in the treatment of IBD in adults and in children.