Recurrent Pericarditis: A Rare Adverse Effect of Mesalamine

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

The extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) can be classified as the following: (a) true EIMs due to reactive IBD affecting organ systems, (b) complications secondary to IBD activity, (c) non–IBD-specific autoimmune disease which occurs in increased frequency in individuals with IBD. Overlap is frequent between EIMs and extraintestinal complications, and it is increasingly evident that multiple organ systems may be involved. This review covers EIMs through their epidemiology, etiology/genetics/pathogenesis, prognosis, complications, and treatment. Also detailed are the organ systems involved with reactive IBD, including musculoskeletal, pulmonary, dermatological, ophthalmic, and hepatobiliary manifestations. Figures show the classification, etiology, and pathogenesis of EIMs of IBD, musculoskeletal and pulmonary manifestations of IBD, metastatic Crohn disease of the intergluteal cleft, pyoderma gangrenosum, oral apthous ulcers, Sweet syndrome, leucocytoclastic vasculitis, anti-tumor necrosis factor–induced psoriasis, uveitis, episcleritis, and primary sclerosing cholangitis. Tables list the modified New York criteria for ankylosing spondylitis, pulmonary manifestations of IBD and IBD-related treatment, diagnostic techniques in lung disorders associated with IBD, dermatologic manifestations of IBD based on classifications, specific cutaneous manifestations or granulomatous cutaneous lesions with the same histological features as the underlying bowel disease, reactive cutaneous manifestation of IBD with immunological mechanisms triggered by common antigens shared by gut bacteria and skin, cutaneous disorders or dermatosis associated with IBD, secondary cutaneous manifestations due to complications of IBD and adverse effects of IBD treatment, treatment of dermatological manifestations of IBD, diagnosis of ophthalmological manifestations of IBD, and other hepatobiliary manifestations of IBD. This review contains 13 highly rendered figures, 12 tables, and 79 references.

Background: Inflammatory bowel disease (IBD) is the common cause of chronic gastrointestinal signs in dogs. The treatment possesses numerous difficulties due to the idiopathic nature of the disease. Conventional steroid therapy usually produces side effects on long term usage. Thus, there is a need for alternative therapies. When compared to human medicine, there is no published data on the use of budesonide and probiotic in the treatment of canine IBD in India. The present study was proposed to compare oral prednisolone, budesonide and probiotics in the management of canine inflammatory bowel disease. Methods: Thirty dogs with idiopathic IBD were selected and randomly grouped. They were subjected to therapy involving prednisolone, budesonide or probiotics. Clinical assessment was performed by calculation of the post treatment Clinical Inflammatory Bowel Disease Activity Index (CIBDAI) score, faecal score and endoscopy. Biochemical analysis of alkaline phosphatase and alanine transaminase were done to record side effects of steroid administration. Result: It was observed from the present study that both prednisolone and budesonide are equally effective in the management of IBD in dogs. Probiotics were found to be less effective when compared to prednisolone and budesonide in the treatment of IBD.

<p indent="0mm">Inflammatory bowel disease (IBD) is a non-specific, chronic and easily relapsing inflammatory bowel disease, consisting of Crohn’s disease and ulcerative colitis. IBD is not limited to intestinal lesions, but also involves organs and tissues throughout the body. In recent years, the global incidence of IBD has been rising rapidly and become a common and frequently-occurring disease in China. The pathogenesis of IBD may be related to interactions between immunity, genetics, environment and microorganisms. Since oral administration has good compliance with patients, high safety, convenience, ease of operation, and can directly act on intestinal mucosa, it is suitable for the long-term administration of chronic intestinal diseases, and is the most ideal administration route for IBD therapy. However, due to the poor water solubility and stability of oral drugs, the gastrointestinal physiological environment, systemic toxicity and side effects and single therapeutic function, the bioavailability is low and the therapeutic efficacy is poor. Therefore, it is urgent to develop novel functionalized oral administration therapy methods for IBD, improve the solubility and bioavailability of drugs, and realize colon targeting and multifunctional diagnosis and treatment, so as to provide new ideas and approaches for the precision treatment of IBD. Polymer drug delivery systems can effectively improve the solubility and stability of drugs and significantly improve the efficacy of drugs. Excessive reactive oxygen species (ROS) can cause intestinal mucosal layer damage, stimulate immune response, and accelerate the occurrence and development of IBD. Nanoparticles with colonic and inflammatory targeted ROS clearance can effectively alleviate IBD symptoms while reducing systemic side effects of the drug. In addition, nano-enzymes play unique biological functions while have a variety of enzyme activities, such as cascade reaction, antioxidant, fluorescence imaging, and photothermal effect, becoming an important means of adjuvant therapy for IBD. By imitating the special structure and function of organisms through biomimetic methods such as morphological bionics, living-organism biomimetics, microecological bionics and biomimetic mineralization, a range of bionic drug delivery systems with strong gastrointestinal adhesion, efficient intestinal targeted delivery, collaborative therapy and resistance to harsh gastrointestinal environments have been developed for functional treatment of IBD. The use of synthetic biology to design engineered probiotics with specific gene products to reduce oxidative stress, repair the intestinal barrier, and regulate the immune response while regulating the intestinal flora. Currently, patients with IBD are usually diagnosed via endoscopy, an invasive test that is extremely painful for patients and difficult to achieve early diagnosis. Non-invasive biomarker detection provides an important basis for early diagnosis and subsequent stratified treatment of IBD. Nanodiagnostic probes integrate diagnostic and therapeutic functions, realizing multi-functional diagnosis of enteritis, targeted therapy and efficacy evaluation. The use of synthetic biology to construct intelligent engineered bacteria for the integration of diagnosis, recording and treatment is a promising approach. In this paper, we first review polymer drug delivery systems, which can improve drug solubility and achieve targeted therapy for colon and inflammation. We then introduced nanozyme preparations for the treatment of IBD through antioxidant cascades, CT imaging, photothermal effects, and colon targeting. Thirdly, the design of new biomimetic delivery systems based on biomimetic materials such as morphological biomimetic, living-organism, microecological biomimetic and biomimetic mineralization is reviewed to achieve functional treatment of IBD. In addition, the construction of genetically engineered probiotics not only regulates the intestinal flora, but also eliminates ROS, repairs the intestinal barrier and regulates the immune response. Furthermore, the application of biomarker detection, nanodiagnostic probes and intelligent engineered bacteria in the integration of diagnosis and treatment of IBD is introduced, which is expected to realize the multifunctional integration of detection, personalized treatment and remote guidance. Although these new functionalized treatment strategies offer new directions and new possibilities for the precision treatment of IBD, several challenges remain. Firstly, there is a need to evaluate the safety and efficacy of treatment strategies. Secondly, there is a lack of development and research on delivery systems based on drugs that promote mucosal repair. Thirdly, the pathogenesis of IBD needs to be further elucidated. Fourthly, multiple approaches should be used to increase the screening of novel biomarkers in the early diagnosis and treatment of IBD, so as to guide the development of new drugs for IBD and achieve precise treatment.

Inflammatory bowel disease (IBD) is a chronic condition which is characterized by recurrent immune-mediated inflammation of the gastrointestinal system. IBD is frequently associated with extraintestinal manifestations (EIM) characterized by involvement of multiple organs. EIM occur in 21% to 47% of IBD patients (Navaneethan & Shen, 2010). While some extraintestinal manifestations are encountered more frequently in Crohn’s disease (CD) than in ulcerative colitis (UC), some are encountered equally in CD and UC. While the degree of involvement of the skin, eyes, and joints is parallel to disease activity, hepatobiliary and pulmonary involvement is independent of disease activity and intestinal inflammation (Greenstein AJ, et al., 1996). Hepatopancreatobiliary (HPB) manifestations are the most frequently encountered EIM in patients with IBD. They can be encountered in various ways: 1. HPB conditions sharing the same pathological mechanisms with IBD (Primary Sclerosing Cholangitis (PSC), small-duct PSC/pericholangitis, and PSC/autoimmune hepatitis overlap, IBD associated acute or chronic idiopathic pancreatitis) 2. HPB conditions that reflect the degree of pathophysiologic damage seen in IBD (Cholelithiasis and portal vein thrombosis) 3. HPB conditions related to side effects of drugs used in treatment of IBD (Drug induced or associated hepatitis, pancreatitis, cirrhosis, Hepatitis B reactivation, hepatosplenic T cell lymphoma) 4. HPB conditions possibly related to IBD (Autoimmune pancreatitis, IgG4-associated cholangitis, fatty liver, hepatic amiloidosis, granulomatous hepatitis, primary biliary cirrhosis) (Navaneethan & Shen, 2010) The various HPB manifestations and their associations are summarized in Tables 1 and 2. The aim of this chapter is to cover in detail primary sclerosing cholangitis, which is an important and frequently encountered HPB manifestation of ulcerative colitis.

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

Background and Objectives: Inflammatory bowel disease (IBD) is a chronic condition and mainly affects the intestines, however, the involvement of the other organs of the gastrointestinal tract (upper part, pancreas, and liver) have been observed. The coexistence of IBD with pancreatic pathology is rare, however, it has been diagnosed more frequently during recent years in the pediatric population. This article reviews the current literature on the most common pancreatic diseases associated with IBD in the pediatric population and their relationship with IBD activity and treatment. Materials and Methods: We performed a systematic review of data from published studies on pancreatic disorders, also reported as extraintestinal manifestations (EIMs), among children with IBD. We searched PubMed and Web of Science to identify eligible studies published prior to 25 April 2020. Results: Forty-four papers were chosen for analysis after a detailed inspection, which aimed to keep only the research studies (case control studies and cohort studies) or case reports on children and only those which were written in English. The manifestations of IBD-associated pancreatic disorders range from asymptomatic increase in pancreatic enzymes activity to severe disease such as acute pancreatitis. Acute pancreatitis (AP) induced by drugs, mainly thiopurine, seems to be the most- often-reported pancreatic disease associated with IBD in children. AP associated with other than drug etiologies, and chronic pancreatitis (CP), are rarely observed in the course of pediatric IBD. The pancreatic involvement can be strictly related to the activity of IBD and can also precede the diagnosis of IBD in some pediatric patients. The course of AP is mild in most cases and may occasionally lead to the development of CP, mainly in cases with a genetic predisposition. Conclusions: The involvement of the pancreas in the course of IBD may be considered as an EIM or a separate co-morbid disease, but it can also be a side effect of IBD therapy, therefore a differential diagnosis should always be performed. As the number of IBD incidences with concomitant pancreatic diseases is constantly increasing in the pediatric population, it is important to include pancreatic enzymes level measurement in the workup of IBD.

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

INTRODUCTION: Fecal microbiota transplantation (FMT) is an attractive therapeutic option for patients with inflammatory bowel disease (IBD). While recent studies have shown benefit of FMT in UC, there are no guidelines for the use of FMT in IBD and current regulations limit FMT to treat C difficile infections. Despite these constraints, patients have used FMT for IBD. Our aim is to assess interest and attitudes of patients as well as current clinical practices and attitudes of gastroenterologists as it relates to FMT as therapy for IBD. METHODS: We performed IRB-approved cross-sectional web-based surveys of both patients and providers at a tertiary IBD center from November 2019 to January 2020. All English-speaking patients ≥18 years old with a self-reported diagnosis of IBD were eligible. RESULTS: 100 patients completed the study, 55% female, 56% with Crohn’s, 39% with UC and 5% with IBD-U (Table 1). 40% of patients had heard about FMT as treatment for IBD, though only 12% had discussed it with their GI. No patients had used FMT, but 17% had considered it for their IBD. Most patients (68%) felt more comfortable discussing FMT with their GI after this survey. Patients’ biggest concern of FMT was risk of infection. When told that the FDA recently reported a death related to drug resistant bacteria from FMT, most (53.3%) patients said this changed the way they felt about FMT. 56 providers (GIs) completed the study, 159 were approached: including 19 GI fellows, 22 General GI and 15 IBD specialists with a median of 14 years (range 0-56) in practice. Only 23% of GIs typically ask patients about FMT to treat IBD, though a majority (75%) report that a patient has previously asked them about FMT. A quarter of providers report that their patients have used FMT to treat IBD. Most GIs (84%) have referred a patient for FMT, most commonly for C difficile. The majority of GIs (86%) would consider entering IBD patients into FMT clinical trials. GIs’ biggest concern of FMT was lack of evidence (Figure 2). CONCLUSION: There was a significant minority (17%) of patients that have considered using FMT as a treatment for IBD, but only 23% of providers are asking their patients about FMT. Patients and providers had very different concerns about FMT, with patients concerned about risk of infection and GIs concerned about lack of evidence and efficacy. There is an opportunity to provide resources to providers to help initiate these conversations, and to educate patients on the risks and benefits of FMT for IBD.Table 1.: Characteristics of the Patient Population. Demographics of a patient population for a survey evaluating the patient perceptions and opinions of patients towards fecal microbiota transplantation (FMT) as a treatment for inflammatory bowel disease (IBD) performed at a single tertiary care centerFigure 1.: Patients' Concerns. Graph of patients concerns' about FMT as a treatment for IBD. For those patients with concerns about FMT we asked them to rank their concerns from biggest concern to least concern.Figure 2.: Gastroenterologists' Concerns. Graph of gastroenterologists' concerns regarding FMT as a potential treatment for IBD. We asked them to rank their concerns from most concerning to least concerning.

The incidence of inflammatory bowel disease (IBD) has increased considerably over the past few decades. In the present review, we discuss several disadvantages existing in the treatment of IBD and current understandings of the structures, sources, and natures of various kinds of non-starch polysaccharides (NSPs). Available evidences for the use of different sources of NSPs in IBD treatment both in vitro and in vivo are analyzed, including glucan from oat bran, mushroom, seaweed, pectin, gum, prebiotics, etc. Their potential mechanisms, especially their related molecular mechanism of protective action in the treatment and prevention of IBD, are also summarized, covering the anti-inflammation, immune-stimulating, and gut microbiota-modulating activities, as well as short-chain fatty acids (SCFAs) production, anti-oxidative stress accompanied with inflammation, the promotion of gastric epithelial cell proliferation and tissue healing, and the reduction of the absorption of toxins of NSPs, thus ameliorating the symptoms and reducing the reoccurrence rate of IBD. In summary, NSPs exhibit the potential to be promising agents for an adjuvant therapy and for the prevention of IBD. Further investigating of the crosstalk between immune cells, epithelial cells, and gut microorganisms in addition to evaluating the effects of different kinds and different molecular weights of NSPs will lead to well-designed clinical intervention trials and eventually improve the treatment and prevention of IBD.

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Thiopurines, available as azathioprine, mercaptopurine, and thioguanine, are immunomodulating agents primarily used to maintain corticosteroid-free remission in patients with inflammatory bowel disease. To provide a state-of-the-art overview of thiopurine treatment in inflammatory bowel disease, this clinical review critically summarises the available literature, as assessed by several experts in the field of thiopurine treatment and research in inflammatory bowel disease.

Multiple in vitro and in vivo model investigations have suggested a broad spectrum of potential mechanisms by which plant/macrofungi-derived non-starch polysaccharides may play a role in the treatment of inflammatory bowel disease (IBD). This article reviews the in vivo and in vitro evidence of different plant-derived polysaccharides for IBD therapy. Their underlying mechanisms, particularly the molecular mechanisms associated with protective effects in the treatment and prevention of IDB, have been well summarized, including anti-inflammatory, epithelial barrier repair, and the regulation of intestinal flora. Emerging studies have observed the potent role of probiotics in IBD, particularly its ability to modulate gut microbiota, a well-known key factor for IBD. In summary, plant/macrofungi-derived polysaccharides have the potential to be a promising agent for the adjuvant treatment and prevention of IBD and will contribute to the design of well-designed clinical intervention trials that will ultimately improve the therapy of IBD.

Increased Risk of Venous Thromboembolic Events With Corticosteroid Versus Biologic Therapy for Inflammatory Bowel Disease

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