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CMAJ : Canadian Medical Association... Sep 2023
PubMed: 37748783
DOI: 10.1503/cmaj.230960 -
Journal of Crohn's & Colitis Jul 2023With the recent acceptance of multiple treatment goals for inflammatory bowel diseases [IBD], it becomes increasingly important to accurately quantify the measurable... (Review)
Review
With the recent acceptance of multiple treatment goals for inflammatory bowel diseases [IBD], it becomes increasingly important to accurately quantify the measurable concepts. These include patient-reported symptoms, intestinal damage, mucosal activity, transmural inflammation, and histologicl appearance, as well as quality of life, disability, and other patient-centred attributes. Standardised indices which show sufficient validity, reliability, and responsiveness to change are not only mandatory for implementing the treat to target approach but are also critical for assessing the effectiveness of emerging medications in clinical trial settings. Some concepts can be accurately assessed through the use of existing measurement tools used for adults [eg, capsule endoscopy, ultrasonic, endoscopic, and histological scoring] and others may be age specific. Although several paediatric indices and scales are well established (eg, IMPACT questionnaire, Paediatric Crohn's Disease Activity Index [PCDAI], and Paediatric Ulcerative Colitis Activity Index [PUCAI]), recent years have seen the development of newer indices for children, including the Mucosal Inflammation Noninvasive Index [MINI] to predict endoscopic healing in Crohn's disease, magnetic resonance imaging [MRI] indices that measure inflammation (ie, the Paediatric Inflammatory Crohn's Magnetic Resonance Enterography Index [PICMI]) and perianal disease (ie, Paediatric MRI-based Perianal Crohn's Disease [PEMPAC]), and patient-reported outcome measures in ulcerative colitis [ie, TUMMY-UC], upper gastrointestinal inflammatory score [ie, UGI-SES-CD], simplified endoscopic mucosal assessment score for Crohn's disease [SEMA-CD], and the parent-completed IMPACT questionnaire [ie, IMPACT-III-P]. Despite these advances, quantifiable paediatric IBD-specific tools are still lacking for disability and fatigue. In this review, we provide a contemporary, clinically focused overview of the indices that a paediatric gastroenterologist can use to quantify disease status.
Topics: Adult; Child; Humans; Crohn Disease; Quality of Life; Reproducibility of Results; Inflammatory Bowel Diseases; Colitis, Ulcerative; Inflammation; Capsule Endoscopy; Severity of Illness Index
PubMed: 36734262
DOI: 10.1093/ecco-jcc/jjad019 -
Abdominal Radiology (New York) Apr 2024Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and... (Review)
Review
Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.
PubMed: 38580791
DOI: 10.1007/s00261-024-04300-0 -
Inflammatory Bowel Diseases Mar 2024Perianal fistulas and abscesses occur commonly as complications of pediatric Crohn's disease (CD). A validated imaging assessment tool for quantification of perianal... (Review)
Review
BACKGROUND
Perianal fistulas and abscesses occur commonly as complications of pediatric Crohn's disease (CD). A validated imaging assessment tool for quantification of perianal disease severity and activity is needed to evaluate treatment response. We aimed to identify magnetic resonance imaging (MRI)-based measures of perianal fistulizing disease activity and study design features appropriate for pediatric patients.
METHODS
Seventy-nine statements relevant to MRI-based assessment of pediatric perianal fistulizing CD activity and clinical trial design were generated from literature review and expert opinion. Statement appropriateness was rated by a panel (N = 15) of gastroenterologists, radiologists, and surgeons using modified RAND/University of California Los Angeles appropriateness methodology.
RESULTS
The modified Van Assche Index (mVAI) and the Magnetic Resonance Novel Index for Fistula Imaging in CD (MAGNIFI-CD) were considered appropriate instruments for use in pediatric perianal fistulizing disease clinical trials. Although there was concern regarding the use of intravascular contrast material in pediatric patients, its use in clinical trials was considered appropriate. A clinically evident fistula tract and radiologic disease defined as at least 1 fistula or abscess on pelvic MRI were considered appropriate trial inclusion criteria. A coprimary clinical and radiologic end point and inclusion of a patient-reported outcome were also considered appropriate.
CONCLUSION
Outcomes of treatment of perianal fistulizing disease in children must include MRI. Existing multi-item measures, specifically the mVAI and MAGNIFI-CD, can be adapted and used for children. Further research to assess the operating properties of the indices when used in a pediatric patient population is ongoing.
Topics: Child; Humans; Abscess; Crohn Disease; Fistula; Magnetic Resonance Imaging; Clinical Trials as Topic
PubMed: 37524088
DOI: 10.1093/ibd/izad134 -
Therapeutische Umschau. Revue... Dec 2023Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect the entire gastrointestinal tract. The pathophysiology of CD includes a disrupted interplay...
Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect the entire gastrointestinal tract. The pathophysiology of CD includes a disrupted interplay of intestinal bacteria, the intestinal immune system and the intestinal surface in genetically susceptible individuals, which remains incompletely understood. Conventional therapies include steroids, but numerous advanced therapies are also available. Three tumor necrosis factor (TNF) inhibitors (infliximab, adalimumab and certolizumab pegol (Switzerland)) have been approved for MC. Additional treatment options include the interleukin (IL)-12/23 inhibitors ustekinumab and the integrin inhibitors vedolizumab. With risankizumab, a first selective IL-23 inhibitor for CD has been approved by the EMA in 2022. Moreover, the Janus kinase-1 inhibitor upadacitinib has been available for the treatment of CD in the EU since 2023. For localized CD, elective surgical resection also remains a valid option with good long-term outcomes. Perianal and fistulizing CD are difficult to treat and require a close interdisciplinary collaboration between gastroenterologists and colorectal surgeons. Surgical fistula treatment with curative intent should only be performed in well-controlled CD. The recent increase in therapeutic options in CD is encouraging, since more safe and effective therapies are now available to patients. Nevertheless, CD remains an incurable disease and so far, for all existing treatments only a fraction of patients responds to the therapy. Therefore, the development of new therapies should continue.
Topics: Humans; Crohn Disease; Tumor Necrosis Factor-alpha; Infliximab; Certolizumab Pegol; Adalimumab; Treatment Outcome
PubMed: 38095250
DOI: No ID Found -
Pediatric Dermatology 2024Infantile anogenital digitate keratoses (IADK) represent a distinct and under-recognized pediatric condition of the perianal area of infants, significantly more frequent...
Infantile anogenital digitate keratoses (IADK) represent a distinct and under-recognized pediatric condition of the perianal area of infants, significantly more frequent in males than females. The average age of onset is 3.2 months, and it is self-remitting by 2 years of age. Perianal spiny keratoses resistant to usual topical therapies are the hallmark of IADK. We present a series of three cases of IADK seen at the dermatology clinic of the CHU Sainte-Justine to raise awareness on this pediatric condition, and to prevent invasive workup.
Topics: Humans; Male; Infant; Female; Keratosis; Anus Diseases; Anal Canal
PubMed: 38299678
DOI: 10.1111/pde.15521 -
American Journal of Cancer Research 2023Extramammary Paget's disease (EMPD) is a rare form of adenocarcinoma usually found in apocrine gland-containing cutaneous regions. EMPD affects the vulvar area most... (Review)
Review
Extramammary Paget's disease (EMPD) is a rare form of adenocarcinoma usually found in apocrine gland-containing cutaneous regions. EMPD affects the vulvar area most commonly, followed by the perianal area, scrotum, penis, and axillary region. In its initial form, EMPD presents as an erythematous plaque with well-defined edges, fine scaling, excoriations, exulcerations, and lichenification. Generally, a definitive diagnosis can be made through histopathological analysis. Importantly, associated malignancies should be investigated prior to treatment initiation. Photodynamic therapy (PDT) is a modern, noninvasive treatment strategy for non-oncological diseases as well as various cancers. In recent years, PDT has been widely used to treat EMPD. This present article presents a discussion of the diagnosis and treatment of EMPD as well as the usefulness of PDT in its management.
PubMed: 37970368
DOI: No ID Found -
Journal of Surgical Case Reports Dec 2023Perianal Paget's disease (PPD) is a rare intraepidermal neoplastic disease, presenting with nonspecific symptoms, such as pruritis ani or eczema. Perianal Paget's...
Perianal Paget's disease (PPD) is a rare intraepidermal neoplastic disease, presenting with nonspecific symptoms, such as pruritis ani or eczema. Perianal Paget's disease may present as a primary lesion or as a paramalignant phenomenon. Uniform evidence-based treatment strategies have not been defined for this rare condition, and currently, different treatment methods are suggested. This case report presents three cases of perianal Paget's disease with three different treatments and outcomes. Pathogenesis, treatment, and the importance of a strict follow-up program are discussed.
PubMed: 38163059
DOI: 10.1093/jscr/rjad684 -
Cancers Dec 2023Distinction between anal canal and perianal squamous cell carcinomas (pSCCs) is essential, as these two subgroups have different anatomical, histological, and lymphatic... (Review)
Review
Nodal Elective Volume Selection and Definition during Radiation Therapy for Early Stage (T1-T2 N0 M0) Perianal Squamous Cell Carcinoma: A Narrative Clinical Review and Critical Appraisal.
Distinction between anal canal and perianal squamous cell carcinomas (pSCCs) is essential, as these two subgroups have different anatomical, histological, and lymphatic drainage features. Early-stage true perianal tumors are very uncommon and have been rarely included in clinical trials. Perianal skin cancers and aCCs are included in the same tumor classification, even though they have different lymphatic drainage features. Furthermore, pSCCs are treated similarly to carcinomas originating from the anal canal. Radiation therapy (RT) is an essential treatment for anal canal tumors. Guidelines do not differentiate between treatment volumes for perianal tumors and anal cancers. So far, in pSCC, no study has considered modulating treatment volume selection according to the stage of the disease. We conducted a narrative literature review to describe the sites at higher risk for microscopic disease in patients with early-stage perianal cancers (T1-T2 N0 M0) to propose a well-thought selection of RT elective volumes.
PubMed: 38136378
DOI: 10.3390/cancers15245833 -
Orvosi Hetilap Jul 2023Endoscopic ultrasound is a minimally invasive modality that combines endoscopy with ultrasound, providing a possibility to visualize the wall of the gastrointestinal... (Review)
Review
Endoscopic ultrasound is a minimally invasive modality that combines endoscopy with ultrasound, providing a possibility to visualize the wall of the gastrointestinal tract and adjacent tissues and organs. Since the development of the modality in the 1980s, advancements in endoscopic ultrasound technology have led to increasingly broadening indications: besides diagnostic indications, therapeutic indications have also expanded greatly. According to recent guidelines regarding rectal cancer staging, rectal ultrasonography is mainly considered to be a secondary imaging modality compared to magnetic resonance imaging. With the use of forward-viewing echoendoscopes and ultrasound miniprobes that can be inserted through the working channel of the endoscope, endoscopic ultrasound technology can be expanded to proximal, colonic areas as well. Rectal ultrasonography can also play an important role in the differential diagnosis of subepithelial lesions, in the detection of rectal varices, in the diagnosis of inflammatory bowel diseases as well as perianal complications. Diagnostic accuracy can further be improved with the addition of ultrasound-guided sampling in certain cases. Currently, therapeutic indications are more like promising possibilities, than part of everyday clinical practice, but this might change in the near future. The purpose of this review is to summarize the current indications of rectal ultrasound in the clinical practice, including diagnostic and therapeutic ones as well. Orv Hetil. 2023; 164(30): 1176-1186.
Topics: Humans; Endosonography; Rectum; Rectal Neoplasms; Inflammatory Bowel Diseases; Endoscopy, Gastrointestinal
PubMed: 37516992
DOI: 10.1556/650.2023.32794