Long-Term Outcomes of Biological Therapy in Crohn's Disease Complicated With Internal Fistulizing Disease: BIOSCOPE Study From GETECCU.

INTRODUCTION: The prevalence of penetrating complications in Crohn's disease (CD) increases progressively over time, but evidence on the medical treatment in this setting is limited. The aim of this study was to evaluate the effectiveness of biologic agents in CD complicated with internal fistulizing disease. METHODS: Adult patients with CD-related fistulae who received at least 1 biologic agent for this condition from the prospectively maintained ENEIDA registry were included. Exclusion criteria involved those receiving biologics for perianal disease, enterocutaneous, rectovaginal, anastomotic, or peristomal fistulae. The primary end point was fistula-related surgery. Predictive factors associated with surgery and fistula closure were evaluated by multivariate logistic regression and survival analyses. RESULTS: A total of 760 patients from 53 hospitals (673 receiving anti-tumor necrosis factors, 69 ustekinumab, and 18 vedolizumab) were included. After a median follow-up of 56 months (interquartile range, 26-102 months), 240 patients required surgery, with surgery rates of 32%, 41%, and 24% among those under anti-tumor necrosis factor, vedolizumab, or ustekinumab, respectively. Fistula closure was observed in 24% of patients. Older patients, ileocolonic disease, entero-urinary fistulae, or an intestinal stricture distal to the origin of the fistula were associated with a higher risk of surgery, whereas nonsmokers and combination therapy with an immunomodulator reduced this risk. DISCUSSION: Biologic therapy is beneficial in approximately three-quarters of patients with fistulizing CD, achieving fistula closure in 24%. However, around one-third still undergo surgery due to refractory disease. Some patient- and lesion-related factors can identify patients who will obtain more benefit from these drugs.

Effects of a nutritional intervention with yogurt on lymphocyte subsets and cytokine production capacity in anorexia nervosa patients.

BACKGROUND: The benefits of probiotic therapy in immunocompromised subjects still need strong scientific evidences. AIM OF THE STUDY: To assess the effects of yogurt on certain immunological parameters in anorexia nervosa (AN) patients during refeeding. METHODS: A parallel 10-week nutritional intervention with yogurt was conducted on a group of patients with AN and on a group of healthy adolescents (HA). In total, 16 AN patients and 16 HA consumed 375 g/d of yogurt containing L. bulgaricus and S. thermophilus (groups AN-y and HA-y, respectively). The control groups for AN patients (n = 14) and healthy subjects (n = 19) consumed 400 ml/d of semi-skimmed milk (groups AN-c and HA-c, respectively). Blood lymphocyte subsets were assessed by flow cytometry and the in vitro production of IL-2, IFN-gamma, IL-1, IL-6 and TNF-alpha by PHA-stimulated PBMC was measured by ELISA. RESULTS: A significant combined effect of time and nutritional intervention was found for the CD8+ subset and IFN-gamma production, both in HA and AN patients. The CD8+ subset showed a significant increase after 10 weeks in HA-c and AN-c. As a consequence, the CD4+/CD8+ ratio was significantly lower in AN-c than in AN-y after treatment. A significant increase in IFN-gamma production was found after yogurt intake in AN-y, while it decreased significantly in AN-c. CONCLUSION: The findings suggest that the inclusion of yogurt in the refeeding therapy of AN patients may exert positive effects on the immunological markers related to the nutritional status of these patients, such as the CD4+/CD8+ ratio and the production of IFN-gamma by lymphocytes.