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1.
Gut Microbes ; 13(1): 1984105, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34632957

RESUMEN

Infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is responsible for the COVID-19 pandemic. Angiotensin-converting enzyme 2 (Ace2) is expressed in the gastrointestinal (GI) tract and a receptor for SARS-CoV-2, making the GI tract a potential infection site. This study investigated the effects of commensal intestinal microbiota on colonic Ace2 expression using a humanized mouse model. We found that colonic Ace2 expression decreased significantly upon microbial colonization. Humanization with healthy volunteer or dysbiotic microbiota from irritable bowel syndrome (IBS) patients resulted in similar Ace2 expression. Despite the differences in microbiota, no associations between α-diversity, ß-diversity or individual taxa, and Ace2 were noted post-humanization. These results highlight that commensal microbiota play a key role in regulating intestinal Ace2 expression and the need to further examine the underlying mechanisms of this regulation.


Asunto(s)
Enzima Convertidora de Angiotensina 2/metabolismo , Colon/metabolismo , Microbioma Gastrointestinal , Animales , Colon/microbiología , Disbiosis , Regulación de la Expresión Génica , Vida Libre de Gérmenes , Humanos , Enfermedades Inflamatorias del Intestino/microbiología , Ratones , Receptores Virales/metabolismo , SARS-CoV-2
2.
Aerosp Med Hum Perform ; 92(10): 831-834, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34642004

RESUMEN

INTRODUCTION: Military aviators are likely to be first diagnosed with inflammatory bowel diseases (IBD) during military service. Current recommendations support continuing flying with restrictions, but risks may be significant. The aim of the study was to document the long-term results of aviators newly diagnosed with IBD. METHODS: A prospective observational study over a 23-yr period included all Israeli Air Force (IAF) aviators with IBD. Primary end point was the qualification and safety to continue operational flying following IBD diagnosis. RESULTS: Subjects were 16 male aviators with an average follow-up of 130 mo. Average age was 27 (2045) and average time from symptoms onset to final diagnosis was 7.3 mo. Eight (50%) patients had Crohns disease (CD), and the other eight had ulcerative colitis (UC). Eight (50%) were high performance platform aviators. Two patients received biologic treatment, two were treated with repeated corticosteroid courses, and four with immunosuppressive therapy. Two patients underwent surgery and four needed different lengths of hospitalizations. Eight (50%) aviators (3 CD, 5 UC) were grounded for a mean of 177 d (5590). Altogether grounding for IBD aviators was 46/2087 mo (2.2%). Most grounding periods were short term and reversible. All aviators continued flying under annual monitoring or as needed and no compromise of their abilities was documented. CONCLUSIONS: All aviators were able to continue flying and no events of sudden incapacitation or severe disabling flares have been seen among patients. Our study findings support the current recommendation to continue flying when IBD is in stable remission. Tehori O, Koslowsky B, Gabbai D, Shapira S, Ben-Ari O. Military aviators with inflammatory bowel diseases continued flying. Aerosp Med Hum Perform. 2021; 92(10):831834.


Asunto(s)
Medicina Aeroespacial , Enfermedades Inflamatorias del Intestino , Personal Militar , Pilotos , Adulto , Humanos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Masculino
3.
BioDrugs ; 35(5): 473-503, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34613592

RESUMEN

In the last two decades, understanding of inflammatory bowel disease (IBD) immunopathogenesis has expanded considerably. Histopathological examination of the intestinal mucosa in IBD demonstrates the presence of a chronic inflammatory cell infiltrate. Research has focused on identifying mechanisms of immune cell trafficking to the gastrointestinal tract that may represent effective gut-selective targets for IBD therapy whilst avoiding systemic immunosuppression that may be associated with off-target adverse effects such as infection and malignancy. Integrins are cell surface receptors that can bind to cellular adhesion molecules to mediate both leukocyte homing and retention. In 2014, Vedolizumab (Entyvio®) was the first anti-integrin (anti-α4ß7 monoclonal antibody) treatment to be approved for use in IBD. Several other anti-integrin therapies are currently in advanced stages of development, including novel orally administered small-molecule drugs. Drugs targeting alternative trafficking mechanisms such as mucosal addressin cellular adhesion molecule-1 and sphingosine-1-phosphate receptors are also being evaluated. Here, we summarise key established and emerging therapies targeting leukocyte trafficking that may play an important role in realising the goal of stratified precision medicine in IBD care.


Asunto(s)
Enfermedades Inflamatorias del Intestino , Anticuerpos Monoclonales , Humanos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Integrinas , Leucocitos
4.
BMC Gastroenterol ; 21(1): 364, 2021 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-34620103

RESUMEN

BACKGROUND: Undelayed diagnosis is thought to be a major determinant for good prognosis in pediatric inflammatory bowel disease (PIBD). However, factors predicting diagnostic delay and the consequences of this remain poorly defined. We investigated these issues in a well-defined cohort of PIBD patients. METHODS: Comprehensive electronic data were collected from 136 PIBD patients retrospectively. Diagnostic delay was further classified into < 6 and ≥ 6 months, and < 12 and ≥ 12 months. Logistic regression was used to calculate whether the delay was associated with clinical features and/or risk of complications and co-morbidities at diagnosis. RESULTS: The median age of patients was 12.4 years and 43.4% were females. Altogether 35.5% had Crohn´s disease (CD), 59.1% ulcerative colitis (UC) and 6.6% IBD undefined (IBD-U). The median delay before diagnosis was 5.0 months in all, 6.6 months in CD, 4.1 months in UC, and 9.8 months in IBD-U (UC vs. CD, p = 0.010). In all but IBD-U most of the delay occurred before tertiary center referral. Abdominal pain predicted a delay > 6 months in all PIBD (OR 2.07, 95% CI 1.00-4.31) and in UC patients (3.15, 1.14-8.7), while bloody stools predicted a shorter delay in all PIBD (0.28, 0.14-0.59) patients and in CD (0.10, 0.03-0.41) patients. A delay > 6 months was associated with a higher frequency of complications (2.28, 1.01-5.19). CONCLUSIONS: Delay occurred mostly before specialist consultation, was longer in children presenting with abdominal pain and in CD and was associated with risk of complications. These findings emphasize the roles of active case-finding and prompt diagnostic evaluations.


Asunto(s)
Colitis Ulcerosa , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Niño , Colitis Ulcerosa/diagnóstico , Enfermedad de Crohn/diagnóstico , Diagnóstico Tardío , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Estudios Retrospectivos
5.
BMC Gastroenterol ; 21(1): 367, 2021 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-34627159

RESUMEN

BACKGROUND: The clinical features of amoebic colitis resemble those of inflammatory bowel disease (IBD), and therefore the risk of misdiagnosis is very high. The aim of this study was to analyse the characteristics of the endoscopic and pathological findings of amebic colitis and the lessons from our patients, which were useful for diagnosing the amebic colitis timely and avoiding the serious complication. METHODS: We retrospectively reviewed data of all amebic colitis admitted to Beijing Friendship Hospital from January 2015 to January 2020. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and histological examination, no ELISA stool antigen or PCR tests were used. RESULTS: 16 patients were diagnosed with amebic colitis by the colonoscopy accompanied by biopsy and microscopic examination. At first time, 12 (75%) patients were misdiagnosed as IBD. Cecum was the most common site of amebic colitis (100%), and the caecum and rectum were also involved in many lesions (68.75%). Multiple lesions of erosion and/or ulcer were recognized in all patients (100%).The endoscopic findings included multiple irregular shaped ulcers and erosions with surrounding erythema, and the ulcers and erosions were covered by the white or yellow exudates. The intervening mucosae between the ulcers or erosions were normal. The features of rectums can be divided to 2 types: in 6 patients (54.5%), the irregular ulcer or erosions covered with white or yellow exudates were observed in rectum and cecum, and the bloody exudates in rectum were more severe than those in cecum; in other 5 patients (45.5%), rectal lesions were much less severe than those in cecum, the small superficial erosion or reddened mucosa were observed in the rectal ampulla. All patients were diagnosed as detection of amebic trophozoites from HE-stained biopsy specimens. The number of trophozoites ranged from 1/HPF to > 50/HPF. Among 16 cases, mild architectural alteration of colon crypt were observed in 10 cases (62.5%), and serious architectural alteration of colon crypt was found which had crypt branch in 1 case (16.7%). Cryptitis was observed in 12 cases (75%) and its severity was mild or moderate. No crypts abscess was observed in all cases. CONCLUSIONS: The colonoscopy with histological examination are very important to diagnose the amebic colitis. Detect the amoebic trophozoites in the exudates by histological examination is the vital. Sometimes a negative biopsy does not rule out amebiasis, repeated biopsies may be needed to make the diagnosis.


Asunto(s)
Disentería Amebiana , Enfermedades Inflamatorias del Intestino , Colonoscopía , Diagnóstico Diferencial , Disentería Amebiana/diagnóstico , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Estudios Retrospectivos
6.
World J Gastroenterol ; 27(36): 6142-6153, 2021 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-34629825

RESUMEN

BACKGROUND: Patients with inflammatory bowel disease (IBD) are associated with increased cardiovascular risk and have increased overall cardiovascular burden. On the other hand, urotensin II (UII) is one of the most potent vascular constrictors with immunomodulatory effect that is connected with a number of different cardiometabolic disorders as well. Furthermore, patients with ulcerative colitis have shown increased expression of urotensin II receptor in comparison to healthy controls. Since the features of IBD includes chronic inflammation and endothelial dysfunction as well, it is plausible to assume that there is connection between increased cardiac risk in IBD and UII. AIM: To determine serum UII levels in patients with IBD and to compare them to control subjects, as well as investigate possible associations with relevant clinical and biochemical parameters. METHODS: This cross sectional study consecutively enrolled 50 adult IBD patients (26 with Crohn's disease and 24 with ulcerative colitis) and 50 age and gender matched controls. Clinical assessment was performed by the same experienced gastroenterologist according to the latest guidelines. Ulcerative Colitis Endoscopic Index of Severity and Simple Endoscopic Score for Crohn's Disease were used for endoscopic evaluation. Serum levels of UII were determined using the enzyme immunoassay kit for human UII, according to the manufacturer's instructions. RESULTS: IBD patients have significantly higher concentrations of UII when compared to control subjects (7.57 ± 1.41 vs 1.98 ± 0.69 ng/mL, P < 0.001), while there were no significant differences between Crohn's disease and ulcerative colitis patients (7.49 ± 1.42 vs 7.65 ± 1.41 ng/mL, P = 0.689). There was a significant positive correlation between serum UII levels and high sensitivity C reactive peptide levels (r = 0.491, P < 0.001) and a significant negative correlation between serum UII levels and total proteins (r = -0.306, P = 0.032). Additionally, there was a significant positive correlation between serum UII levels with both systolic (r = 0.387, P = 0.005) and diastolic (r = 0.352, P = 0.012) blood pressure. Moreover, serum UII levels had a significant positive correlation with Ulcerative Colitis Endoscopic Index of Severity (r = 0.425, P = 0.048) and Simple Endoscopic Score for Crohn's Disease (r = 0.466, P = 0.028) scores. Multiple linear regression analysis showed that serum UII levels retained significant association with high sensitivity C reactive peptide (ß ± standard error, 0.262 ± 0.076, P < 0.001) and systolic blood pressure (0.040 ± 0.017, P = 0.030). CONCLUSION: It is possible that UII is involved in the complex pathophysiology of cardiovascular complications in IBD patients, and its purpose should be investigated in further studies.


Asunto(s)
Colitis Ulcerosa , Enfermedades Inflamatorias del Intestino , Urotensinas , Adulto , Colitis Ulcerosa/diagnóstico , Estudios Transversales , Humanos
7.
PLoS One ; 16(10): e0258271, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34610041

RESUMEN

OBJECTIVE: Data on the course of severe COVID-19 in inflammatory bowel disease (IBD) patients remains limited. We aimed to determine the incidence rate and clinical course of severe COVID-19 in the heavily affected South-Limburg region in the Netherlands. METHODS: All COVID-19 patients admitted to the only two hospitals covering the whole South-Limburg region between February 27, 2020 and January 4, 2021 were included. Incidence rates for hospitalization due to COVID-19 were determined for the IBD (n = 4980) and general population (n = 597,184) in South-Limburg. RESULTS: During a follow-up of 4254 and 510,120 person-years, 20 IBD patients (0.40%; 11 ulcerative colitis (UC), 9 Crohn's disease (CD)) and 1425 (0.24%) patients from the general population were hospitalized due to proven COVID-19 corresponding to an incidence rate of 4.7 (95% Confidence interval (CI) 3.0-7.1) and 2.8 (95% CI 2.6-2.9) per 1000 patient years, respectively (Incidence rate ratio: 1.68, 95% CI 1.08-2.62, p = 0.019). Median age (IBD: 63.0 (IQR 58.0-75.8) years vs. general population: 72.0 (IQR 62.0-80.0) years, p = 0.10) and mean BMI (IBD: 24.4 (SD 3.3) kg/m2 vs. general population 24.1 (SD 4.9) kg/m2, p = 0.79) at admission were comparable in both populations. As for course of severe COVID-19, similar rates of ICU admission (IBD: 12.5% vs. general population: 15.7%, p = 1.00), mechanical ventilation (6.3% vs. 11.2%, p = 1.00) and death were observed (6.3% vs. 21.8%, p = 0.22). CONCLUSION: We found a statistically significant higher rate of hospitalization due to COVID-19 in IBD patients in a population-based setting in a heavily impacted Dutch region. This finding reflects previous research that showed IBD patients using systemic medication were at an increased risk of serious infection. However, although at an increased risk of hospitalization, clinical course of severe COVID-19 was comparable to hospitalized patients without IBD.


Asunto(s)
COVID-19/patología , Enfermedades Inflamatorias del Intestino/complicaciones , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/virología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Respiración Artificial , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Adulto Joven
8.
Rev Med Chil ; 149(3): 393-398, 2021 Mar.
Artículo en Español | MEDLINE | ID: mdl-34479318

RESUMEN

BACKGROUND: Inflammatory Bowell Diseases (IBD), either ulcerative colitis (UC) or Chron's disease (CD) are commonly associated with intestinal malabsorption, and insufficient levels 1-25 hydroxycholecalciferol (vitamin D). These insufficient levels could be linked with an increased risk of clinical disease activity. AIM: To report vitamin D levels in patients with IBD living in Southern Chile and their possible association with clinical disease activity. MATERIAL AND METHODS: A prospective, observational study in outpatients with IBD living in Los Angeles, Chile. Demographic data and clinical activity using clinical scores were recorded. Vitamin D levels and fecal calprotectin were measured. RESULTS: We studied 44 patients, 32 (73%) with UC and 12 (27%) with CD. The median age at diagnosis was 33 years old. Forty-one (93%) had mild-inactive disease and 3 (7%) a moderate disease. Mean vitamin D levels were 15.2 ± 7.1 ng/ml. Twenty five percent of patients had sufficient levels (> 20 ng/ml), 35% insufficient levels and 40% poor levels. No association between these levels and disease activity was found. CONCLUSIONS: These patients with IBD had a high frequency of hypovitaminosis D.


Asunto(s)
Colitis Ulcerosa , Enfermedades Inflamatorias del Intestino , Deficiencia de Vitamina D , Adulto , Humanos , Estudios Prospectivos , Vitamina D , Deficiencia de Vitamina D/complicaciones
9.
Int J Colorectal Dis ; 36(10): 2081-2092, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34467414

RESUMEN

BACKGROUND: The effect of preoperative vedolizumab (VDZ) therapy on postoperative complications in inflammatory bowel disease (IBD) patients is still controversial. This meta-analysis aims to review postoperative complications of IBD patients who preoperatively received VDZ. METHODS: A meta-analysis of the available literature was performed. Studies of IBD patients who received VDZ and non-VDZ therapy (including anti-TNF-α agents, non-biological therapy, other biological agents, ustekinumab, and placebo) before surgery were included. Primary outcomes included overall complications, infectious complications, and non-infectious complications. RESULTS: Twelve studies with 1925 IBD patients were enrolled, among which 709 patients received VDZ treatment. The results show that, compared with non-VDZ treatment, there is no significant difference in the incidence of overall complications (OR = 1.25, p = 0.43) for adult IBD patients treated with VDZ preoperatively, the incidence of infectious complications (OR = 0.49, p = 0.001) decreases, but the risks of all surgical site infection (SSI) (Crohn's disease (CD): OR = 2.97, p < 0.001), superficial surgical site infection (sSSI) (OR = 2.24, p = 0.02), and ileus (OR = 2.16, p < 0.001) increase. The risk of mucocutaneous separation (MCS) (OR = 4.69, p = 0.03) with VDZ is also higher than non-VDZ. Two studies involved pediatric patients and showed no difference in ileus (OR = 0.55, p = 0.55). CONCLUSIONS: Overall, compared with non-VDZ treatment, preoperative use of VDZ is relatively safer in adult IBD patients, which does not increase the risk of overall postoperative complications and reduces the occurrence of infectious complications. But, it increases the risk of all SSI and sSSI in infectious complications and the incidence of ileus and MCS in non-infectious complications. Due to lack of sufficient data, the safety of VDZ in pediatric patients is uncertain and requires further study.


Asunto(s)
Enfermedades Inflamatorias del Intestino , Inhibidores del Factor de Necrosis Tumoral , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Niño , Fármacos Gastrointestinales/efectos adversos , Humanos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos
10.
World J Gastroenterol ; 27(30): 5037-5046, 2021 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-34497433

RESUMEN

Inflammatory bowel diseases (IBD) include a spectrum of chronic inflammatory disorders of the gastrointestinal tract whose pathogenesis is yet to be elucidated. The intestinal microbiome has been studied as a causal component, with certain microbiotic alterations having been observed in subtypes of IBD. Physical exercise is a modulator of the intestinal microbiome, causing shifts in its composition that are partially corrective of those observed in IBD; furthermore, physical exercise may be beneficial in patients with certain IBD subtypes. This review studies the effects of physical exercise on the human gut microbiome while investigating pathophysiologic mechanisms that could explain physical activity's clinical effects on patients with IBD.


Asunto(s)
Microbioma Gastrointestinal , Enfermedades Inflamatorias del Intestino , Microbiota , Disbiosis , Ejercicio Físico , Humanos , Enfermedades Inflamatorias del Intestino/terapia
11.
Ann Palliat Med ; 10(8): 9215-9222, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34488407

RESUMEN

BACKGROUND: The incidence of inflammatory bowel disease (IBD) increases annually, and IBD patients may experience various psychological symptoms. People with higher levels of psychological resilience tend to cope with negative events in a positive way. So here we explored the correlation of mindfulness level, psychological resilience, and general well-being in patients with inflammatory bowel disease (IBD), and the mediating effect of psychological resilience on mindfulness level and happiness in IBD. METHODS: Five Facet Mindfulness Questionnaire (FFMQ), Connor-Davidson Resilience Scale (CD-RICS), and General Well-Being Schedule (GWB) were used for investigation among the randomly selected IBD patients. Pearson correlation analysis and the structural equation model by Amos 24.0 were applied to explore the relationship between mindfulness level, psychological resilience, and general well-being. The mediating effect of psychological resilience was detected by bootstrap method. RESULTS: A total of 159 of the 184 distributed questionnaires were recovered (recovery rate 73.3%), and 135 of them were used for subsequent investigations. In IBD patients, the score of mindfulness level, psychological resilience, and general well-being were (119.95±8.64), (58.37±19.32), and (73.59±13.88), respectively. Both male and female score were lower than ordinary model (52.7% and 42.9%, respectively). Pearson results displayed that mindfulness level (r=0.312-0.390, P<0.01) and overall well-being (r=0.490-0.590, P<0.01) were positively related to psychological resilience and its 3 dimensions, respectively. Similarly, mindfulness level was positively correlated with overall well-being (r=0.391, P<0.01). Mediating effect of psychological resilience between mindfulness level and overall well-being was 0.232 (P=0.001). The 95% confidence interval (95% CI) of psychological resilience as mediating effect (59.3% of total) was (0.138 to 0.332). CONCLUSIONS: We concluded that psychological resilience in IBD patients has a partially mediating effect between mindfulness level and overall well-being.


Asunto(s)
Enfermedades Inflamatorias del Intestino , Atención Plena , Resiliencia Psicológica , Adaptación Psicológica , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
12.
Nihon Yakurigaku Zasshi ; 156(5): 288-291, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-34470933

RESUMEN

Interleukin-19 (IL-19) is a member of the IL-10 family and is an anti-inflammatory cytokine produced mainly by macrophages, epithelial cells, and vascular smooth muscle cells. In addition, receptors for IL-19, IL-20 receptor 1 and IL-20 receptor 2, are also expressed in the cells mentioned above. The last 10 years from the finding of IL-19, investigations underline the anti-inflammatory role of IL-19 in the human diseases such as psoriasis, asthma, arteriosclerosis, and inflammatory bowel disease. If it is a pro-inflammatory cytokine, therapeutic applications may include the use of neutralizing antibodies, however, because IL-19 exhibits anti-inflammatory effects, recombinant products may be useful in therapeutic applications. However, the therapeutic applications of IL-19 for human disease have not yet been developed. In this review, we present the new findings on the preventive and therapeutic effects of IL-19 on various mouse disease models. Increasing knowledge about mouse disease models will increase the feasibility of future human disease applications.


Asunto(s)
Enfermedades Inflamatorias del Intestino , Psoriasis , Animales , Antiinflamatorios/farmacología , Citocinas , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Interleucinas , Ratones
13.
Int J Mol Sci ; 22(17)2021 Aug 24.
Artículo en Inglés | MEDLINE | ID: mdl-34502047

RESUMEN

Despite considerable epidemiological evidence indicating comorbidity between metabolic disorders, such as obesity, type 2 diabetes, and non-alcoholic fatty liver disease, and inflammatory bowel diseases (IBD), such as Crohn's disease and ulcerative colitis, as well as common pathophysiological features shared by these two categories of diseases, the relationship between their pathogenesis at molecular levels are not well described. Intestinal barrier dysfunction is a characteristic pathological feature of IBD, which also plays causal roles in the pathogenesis of chronic inflammatory metabolic disorders. Increased intestinal permeability is associated with a pro-inflammatory response of the intestinal immune system, possibly leading to the development of both diseases. In addition, dysregulated interactions between the gut microbiota and the host immunity have been found to contribute to immune-mediated disorders including the two diseases. In connection with disrupted gut microbial composition, alterations in gut microbiota-derived metabolites have also been shown to be closely related to the pathogeneses of both diseases. Focusing on these prominent pathophysiological features observed in both metabolic disorders and IBD, this review highlights and summarizes the molecular risk factors that may link between the pathogeneses of the two diseases, which is aimed at providing a comprehensive understanding of molecular mechanisms underlying their comorbidity.


Asunto(s)
Enfermedades Inflamatorias del Intestino/metabolismo , Mucosa Intestinal/metabolismo , Enfermedades Metabólicas/metabolismo , Animales , Microbioma Gastrointestinal , Humanos , Inmunidad Innata , Enfermedades Inflamatorias del Intestino/etiología , Absorción Intestinal , Mucosa Intestinal/inmunología , Mucosa Intestinal/microbiología , Enfermedades Metabólicas/etiología
14.
Am J Gastroenterol ; 116(10): 2029-2031, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34515666

RESUMEN

ABSTRACT: As a plethora of data emerges on therapeutic drug monitoring (TDM) of biologics in inflammatory bowel disease, guidance on its application is needed. In this literature review and consensus statement, the authors recommend reactive TDM for all biologics, summarize concentration targets, and provide guidance on TDM in various scenarios. Proactive TDM with tumor necrosis factor-antagonist monotherapy is recommended as an alternative to the combination of tumor necrosis factor-antagonists with immunomodulators. Although observational data support this approach, randomized controlled trials do not. We argue that there is considerable work left to be performed before embracing proactive TDM as an equivalent alternative to combination therapy in inflammatory bowel disease.


Asunto(s)
Colitis , Enfermedades Inflamatorias del Intestino , Colitis/tratamiento farmacológico , Monitoreo de Drogas , Fármacos Gastrointestinales/uso terapéutico , Humanos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Inhibidores del Factor de Necrosis Tumoral
15.
Rev Med Suisse ; 17(748): 1448-1452, 2021 Sep 01.
Artículo en Francés | MEDLINE | ID: mdl-34468095

RESUMEN

Inflammatory bowel diseases (IBD) comprise Crohn's disease (CD) and ulcerative colitis (UC). IBD develops in patients with genetic susceptibility due to an aberrant response of the intestinal immune system toward gut microbiota. The prevalence of IBD is on the rise in Switzerland, with currently 1/250 persons affected, which corresponds to approximately 35,000 patients. Given the complexity of IBD, patients should be managed by a multidisciplinary team. This article focuses on IBD diagnosis and long-term follow-up.


Asunto(s)
Colitis Ulcerosa , Enfermedad de Crohn , Microbioma Gastrointestinal , Enfermedades Inflamatorias del Intestino , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/terapia , Intestinos
16.
Eur Rev Med Pharmacol Sci ; 25(17): 5542-5546, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34533804

RESUMEN

OBJECTIVE: The role of nurses has great educational-scientific potential in COVID-19 vaccination. The aim of this work is to clarify whether the educational role of IBD nurses in vaccination is perceived by IBD patients. MATERIALS AND METHODS: A cross-sectional study was carried out, through a questionnaire, to evaluate how many IBD patients received health education about vaccinations from the dedicated nurses (IBD nurses). RESULTS: There were four hundred questionnaires, 310 patients (77.5%) answered all questions. The nurse does not appear to help educate patients on influenza vaccination (66.1%) or pneumococcal vaccination (81.6%). Disclosed patients have many doubts about the new COVID-19 vaccination (74.4%) and many seek information (74.8%) and think that the nurse can provide the necessary information (70%). CONCLUSIONS: IBD nurses do not seem very active in the vaccination education role, and they do not meet patients' expectations, which are conversely very high.


Asunto(s)
Vacunas contra la COVID-19/uso terapéutico , COVID-19/prevención & control , Rol de la Enfermera , Educación del Paciente como Asunto , SARS-CoV-2/inmunología , Vacunación/psicología , Adulto , Productos Biológicos/uso terapéutico , Miedo , Femenino , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/psicología , Italia , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros , Confianza , Adulto Joven
17.
World J Gastroenterol ; 27(33): 5520-5535, 2021 Sep 07.
Artículo en Inglés | MEDLINE | ID: mdl-34588749

RESUMEN

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); since its first description in December 2019, it has rapidly spread to a global pandemic. Specific concerns have been raised concerning patients with inflammatory bowel diseases (IBD), which are chronic autoimmune inflammatory disorders of the gut that frequently require immunosuppressive and biological therapies to control their activity. Accumulating evidence has so far demonstrated that patients with IBD are not at increased risk of contracting severe acute respiratory syndrome coronavirus 2 infection. As for the general population, the identified risk factors for severe COVID-19 course among IBD patients have been established to be advanced age and the presence of comorbidities. Treatment with high-dose corticosteroids has also been associated with an increased risk of death in IBD patients with COVID-19. Information on COVID-19 is constantly evolving, with data growing at a rapid pace. This will guarantee better knowledge and stronger evidence to help physicians in the choice of the best therapeutic approach for each patient, concurrently controlling for the risk of IBD disease under treatment and the risk of COVID-19 adverse outcomes and balancing the two. Moreover, the impact of the enormous number of severe respiratory patients on healthcare systems and facilities has led to an unprecedented redeployment of healthcare resources, significantly impacting the care of patients with chronic diseases. In this newly changed environment, the primary aim is to avoid harm whilst still providing adequate management. Telemedicine has been applied and is strongly encouraged for patients without the necessity of infusion therapy and whose conditions are stable. The severe acute respiratory syndrome coronavirus 2 pandemic has already revolutionized the management of patients with chronic immune-mediated diseases such as IBD. Direct and indirect effects of the COVID-19 pandemic will be present for some time. This is the reason why continuous research, rapid solutions and constantly updated guidelines are of utmost importance. The aim of the present review is, therefore, to point out what has been learned so far as well as to pinpoint the unanswered questions and perspectives for the future.


Asunto(s)
COVID-19 , Enfermedades Inflamatorias del Intestino , Telemedicina , Humanos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/epidemiología , Pandemias , SARS-CoV-2
18.
BMC Surg ; 21(1): 353, 2021 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-34579686

RESUMEN

BACKGROUND: Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up. METHODS: The postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions. Hernia recurrence was investigated in the IBD group according to the Kaplan-Meier method and risk factors for recurrence determined by Cox regressions. RESULTS: General complications (≥ Clavien-Dindo I) occurred in 30.9% (72/233) and major complications (≥ Clavien-Dindo IIIb) in 7.7% (18/233) of the overall cohort with IBD being the single independent risk-factor for major complications (OR = 4.2, p = 0.007). Further, IBD patients displayed a recurrence rate of 26.5% (9/34) after a median follow-up of 36 months. Multivariable analysis revealed higher rates of recurrence in patients with ulcerative colitis (UC, 8/15, HR = 11.7) compared to patients with Crohn's disease (CD, 1/19, HR = 1.0, p = 0.021). CONCLUSION: IBD is a significant risk factor for major postoperative morbidity after OVHR. In addition, individuals with IBD show high rates of hernia recurrence over time with UC patients being more prone to recurrence than patients with CD.


Asunto(s)
Hernia Ventral , Hernia Incisional , Enfermedades Inflamatorias del Intestino , Hernia Ventral/epidemiología , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Humanos , Hernia Incisional/epidemiología , Hernia Incisional/etiología , Hernia Incisional/cirugía , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/cirugía , Complicaciones Posoperatorias/epidemiología , Prótesis e Implantes , Recurrencia , Estudios Retrospectivos , Mallas Quirúrgicas
19.
FASEB J ; 35(10): e21888, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34473368

RESUMEN

Endogenous tryptophan metabolism pathways lead to the production of serotonin (5-hydroxytryptamine; 5-HT), kynurenine, and several downstream metabolites which are involved in a multitude of immunological functions in both health and disease states. Ingested tryptophan is largely shunted to the kynurenine pathway (95%) while only minor portions (1%-2%) are sequestered for 5-HT production. Though often associated with the functioning of the central nervous system, significant production of 5-HT, kynurenine and their downstream metabolites takes place within the gut. Accumulating evidence suggests that these metabolites have essential roles in regulating immune cell function, intestinal inflammation, as well as in altering the production and suppression of inflammatory cytokines. In addition, both 5-HT and kynurenine have a considerable influence on gut microbiota suggesting that these metabolites impact host physiology both directly and indirectly via compositional changes. It is also now evident that complex interactions exist between the two pathways to maintain gut homeostasis. Alterations in 5-HT and kynurenine are implicated in the pathogenesis of many gastrointestinal dysfunctions, including inflammatory bowel disease. Thus, these pathways present numerous potential therapeutic targets, manipulation of which may aid those suffering from gastrointestinal disorders. This review aims to update both the role of 5-HT and kynurenine in immune regulation and intestinal inflammation, and analyze the current knowledge of the relationship and interactions between 5-HT and kynurenine pathways.


Asunto(s)
Microbioma Gastrointestinal/inmunología , Enfermedades Inflamatorias del Intestino/inmunología , Quinurenina/inmunología , Serotonina/inmunología , Transducción de Señal/inmunología , Triptófano/inmunología , Animales , Humanos , Inflamación/inmunología , Inflamación/patología , Enfermedades Inflamatorias del Intestino/microbiología , Enfermedades Inflamatorias del Intestino/patología
20.
Int J Pharm ; 608: 121121, 2021 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-34560203

RESUMEN

The objective of this work was to evaluate the potential use of a new polymer (PAMgA) in the development sustained release matrix tablets for the treatment of bowel inflammatory diseases. For this purpose, budesonide, a highly lipophilic compound, was used as model drug. Tablets with two reticulation grades of PAMgA (PAMgA 5 and 40) and with 9 mg of budesonide were developed and characterized. All the studies were carried out using biorelevant media (FaSSGF and FaSSIF). Swelling and erosion of PAMgA tablets was influenced by the reticulation grade of the polymer and the biorelevant media assayed, being water uptake higher for PAMgA 40 tablets in intestinal fluid, whereas PAMgA 5 showed more intense erosion in this biorelevant medium. Budesonide was released slowly from PAMgA tablets, both in gastric and intestinal environment, following Super case II transport kinetics (relaxation-controlled delivery), with a lag time of around 1-2 h. When the dissolution medium was changed sequentially throughout the trial, 75% of the budesonide dose was released in a sustained manner between 4 and 20 h of testing from PAMgA tablets, showing a more controlled budesonide release than Entocort® and Budenofalk® (commercially available sustained release formulations of budesonide). In conclusion, PAMgA polymer allows controlling the release of highly lipophilic drugs as budesonide, being an useful excipient for the development of sustained release matrix tablets.


Asunto(s)
Hidrogeles , Enfermedades Inflamatorias del Intestino , Acrilatos , Preparaciones de Acción Retardada , Humanos , Solubilidad , Comprimidos
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