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World Journal of Gastroenterology Nov 2020While Crohn's disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well... (Review)
Review
BACKGROUND
While Crohn's disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well established due to a lack of disease registries and diagnostic capacity.
AIM
To describe the published burden, diagnostic/treatment capacity, service utilization, challenges/barriers to individuals with Crohn's in LLMICs and their providers.
METHODS
We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed, Embase and World Health Organization Global Index Medicus. Two independent reviewers screened the titles and abstracts of all of the publications found in this search, reviewed selected publications, and extracted relevant data, which underwent descriptive review and was analyzed in Excel.
RESULTS
The database search yielded 4486 publications, 216 of which were determined to be relevant to the research questions. Of all 79 LLMICs, only 21 (26.6%) have publications describing individuals with Crohn's. Overall, the highest number of studies came from India, followed by Tunisia, and Egypt. The mean number of Crohn's patients reported per study is 57.84 and the median is 22, with a wide range from one to 980.
CONCLUSION
This scoping review has shown that, although there is a severe lack of population-based data about Crohn's in LLMICs, there is a signal of Crohn's in these settings around the world.
Topics: Crohn Disease; Developing Countries; Egypt; Humans; India; Remission Induction; Tunisia
PubMed: 33268969
DOI: 10.3748/wjg.v26.i43.6891 -
BioMed Research International 2013Crohn's disease is a complex disease in which genome, microbiome, and environment interact to produce the immunological background of the disease. Disease in childhood... (Review)
Review
Crohn's disease is a complex disease in which genome, microbiome, and environment interact to produce the immunological background of the disease. Disease in childhood is more extensive and characterized by a rapid progression, leading to severe repercussions in the course of the disorder. Several genetic variations have been associated with an increased risk of developing the disease and most of these are also implicated in other autoimmune disorders. The gut has many tiers of defense against incursion by luminal microbes, including the epithelial barrier and the innate and adaptive immune responses. Moreover, recent evidence shows that bacterial and viral infections, as well as inflammasome genes and genes involved in the autophagy process, are implicated in Crohn's disease pathogenesis. The aim of this review is to establish how much the diagnostic system can improve, thus increasing the success of Crohn's disease diagnosis. The major expectation for the near future is to be able to anticipate the possible consequences of the disease already in childhood, thus preventing associated complications, and to choose the best treatment for each patient.
Topics: Animals; Autophagy; Communicable Diseases; Crohn Disease; Genetic Predisposition to Disease; Humans; Models, Biological
PubMed: 23738324
DOI: 10.1155/2013/297501 -
Revista Espanola de Enfermedades... Jan 2013the low prevalence of enterocutaneous fistulas (ECF) in patients with Crohn´s disease (CD) justifies the scarcity of studies that analyze the effect of medical...
INTRODUCTION
the low prevalence of enterocutaneous fistulas (ECF) in patients with Crohn´s disease (CD) justifies the scarcity of studies that analyze the effect of medical treatment and the need for surgery in these patients. The objective of this study was to evaluate the clinical characteristics of patients with CD who have ECF and the response to different treatments.
MATERIALS AND METHODS
patients with CD who presented ECF fistula between 1970 and 2009 in three tertiary centers in Spain were analyzed retrospectively for their clinical characteristics, response to treatment as well as the correlation between the response to biological therapies for ECF and perianal disease. The inflammatory activity of the disease was measured using the Harvey-Bradshaw index. The definitions of partial or complete response were based on the treating physician´s judgment.
RESULTS
twenty six patients were included (18 women); in more than half of cases (67%), anti-TNF treatment improved fistula drainage. Postoperative fistulas responded better to anti-TNF treatment than did spontaneous fistulas (80 versus 57%). One hundred percent and 60% of spontaneous and postoperative fistulas closed after surgery, respectively.
CONCLUSIONS
although the majority of patients required surgery as the ultimate treatment, anti-TNF drugs improved fistula output in an acceptable percentage of patients who were treated. Therefore, this may be a treatment strategy prior to surgery in a select group of patients.
Topics: Crohn Disease; Cutaneous Fistula; Female; Humans; Intestinal Fistula; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 23548004
DOI: 10.4321/s1130-01082013000100002 -
Journal of Crohn's & Colitis Oct 2021Histological scoring plays a key role in the assessment of disease activity in ulcerative colitis [UC] and is also important in Crohn´s disease [CD]. Currently, there...
BACKGROUND AND AIMS
Histological scoring plays a key role in the assessment of disease activity in ulcerative colitis [UC] and is also important in Crohn´s disease [CD]. Currently, there is no common scoring available for UC and CD. We aimed to validate the Inflammatory Bowel Disease [IBD]-Distribution [D], Chronicity [C], Activity [A] score [IBD-DCA score] for histological disease activity assessment in IBD.
METHODS
Inter- and intra-rater reliability were assessed by 16 observers on biopsy specimens from 59 patients with UC and 25 patients with CD. Construct validity and responsiveness to treatment were retrospectively evaluated in a second cohort of 30 patients.
RESULTS
Inter-rater reliability was moderate to good for the UC cohort (intraclass correlation coefficients [ICCs] = 0.645, 0.623, 0.767 for D, C, and A, respectively) and at best moderate for the CD cohort [ICC = 0.690, 0.303, 0.733 for D, C, and A, respectively]. Intra-rater agreement ranged from good to excellent in both cohorts. Correlation with the Nancy Histological Index [NHI] was moderate and strong with the Simplified Geboes Score [SGS] and a Visual Analogue Scale [VAS], respectively. Large effect sizes were obtained for all three parameters. External responsiveness analysis revealed correlated changes between IBD-DCA score and NHI, SGS and VAS.
CONCLUSIONS
The IBD-DCA score is a simple histological activity score for UC and CD, agreed and validated by a large group of IBD specialists. It provides reliable information on treatment response. Therefore, it has potential value for use in routine diagnostics as well as clinical studies.
Topics: Biopsy; Colitis, Ulcerative; Crohn Disease; Humans; Intestinal Mucosa; Reproducibility of Results; Severity of Illness Index
PubMed: 33773497
DOI: 10.1093/ecco-jcc/jjab055 -
Inflammation Aug 2022Inflammasomes are intracellular protein complexes whose activation results in proinflammatory cytokines. Inflammasomes are implicated in Crohn´s disease (CD)...
Inflammasomes are intracellular protein complexes whose activation results in proinflammatory cytokines. Inflammasomes are implicated in Crohn´s disease (CD) pathogenesis, yet the contribution of inflammasomes in intestinal epithelial cells (IECs) versus lamina propria (LP) macrophages is poorly understood. Whether inflammasome expression in intestinal tissue reflects the serum inflammatory protein profile of patients is also not known. We aimed to determine the intestinal cell types where inflammasome expression is increased in CD and if they correlate with the serum protein profile. RT-PCR and NanoString nCounter technology were used to characterize inflammasome gene expression in CD patients and controls. The mucosa, LP and IEC cell fractions and FACS-sorted cells were analyzed. Proximity extension assay with a 92-protein panel was used to determine the serum inflammatory protein profile. Compositional analysis was used to correlate ileum inflammasome gene expression with intestinal mononuclear phagocyte populations. We show that NLRP3 and MEFV inflammasome sensors and downstream effector expression including IL-1β are increased in inflamed mucosa of IBD patients and correlate with disease activity. Inflammasome gene expression increased with the abundance of immature intestinal macrophages, and increased IL-1β released by CD LP cells correlated with immature macrophage frequency. Inflammasome gene expression was also increased in circulating monocytes, the precursors of immature intestinal macrophages. Finally, the serum inflammatory profile of CD patients correlates with ileal expression of genes related to NLRP3 and MEFV inflammasomes. Overall, we show that MEFV and NLRP3 inflammasome expression in CD intestine is attributed to the accumulation of immature macrophages and correlates with serum inflammatory proteins.
Topics: Blood Proteins; Crohn Disease; Humans; Inflammasomes; Interleukin-1beta; Macrophages; NLR Family, Pyrin Domain-Containing 3 Protein; Pyrin
PubMed: 35190924
DOI: 10.1007/s10753-022-01647-8 -
Gut and Liver May 2024Crohn's disease is a chronic intestinal inflammatory disorder of unknown etiology. Although the pharmacotherapies for Crohn's disease are constantly updating,... (Review)
Review
Crohn's disease is a chronic intestinal inflammatory disorder of unknown etiology. Although the pharmacotherapies for Crohn's disease are constantly updating, nutritional support and adjuvant therapies have recently gained more attention. Due to advancements in clinical nutrition, various clinical nutritional therapies are used to treat Crohn's disease. Doctors treating inflammatory bowel disease can now offer several diets with more flexibility than ever. The Crohn's disease exclusion diet is a widely used diet for patients with active Crohn's disease. The Crohn's disease exclusion diet requires both exclusion and inclusion. Periodic exclusion of harmful foods and inclusion of wholesome foods gradually improves a patient's nutritional status. This article reviews the Crohn's disease exclusion diet, including its structure, mechanisms, research findings, and clinical applications.
Topics: Crohn Disease; Humans; Nutritional Status
PubMed: 37842728
DOI: 10.5009/gnl230093 -
World Journal of Gastroenterology Nov 2022Short bowel syndrome (SBS) with intestinal failure (IF) is a rare but severe complication of Crohn's disease (CD), which is the most frequent benign condition that leads... (Review)
Review
Short bowel syndrome (SBS) with intestinal failure (IF) is a rare but severe complication of Crohn's disease (CD), which is the most frequent benign condition that leads to SBS after repeated surgical resections, even in the era of biologics and small molecules. Glucagon-like peptide-2 analogues have been deeply studied recently for the treatment of SBS-IF. These drugs have a significant intestinotrophic effect and the potential to reduce the chronic dependence of SBS-IF patients on parenteral support or nutrition. Teduglutide has been approved for the treatment of SBS-IF, and apraglutide is currently in clinical development. The use of these drugs was examined with a focus on their use in CD patients.
Topics: Humans; Glucagon-Like Peptide 2; Short Bowel Syndrome; Crohn Disease; Intestinal Failure; Patients
PubMed: 36504557
DOI: 10.3748/wjg.v28.i44.6258 -
CMAJ : Canadian Medical Association... Mar 2021
Topics: Adult; Crohn Disease; Female; Humans; Vulva
PubMed: 33722830
DOI: 10.1503/cmaj.190112 -
United European Gastroenterology Journal Jun 2023
Topics: Humans; Crohn Disease; Infliximab; Antibodies, Monoclonal; Neoplasms
PubMed: 37143413
DOI: 10.1002/ueg2.12401 -
Journal of Crohn's & Colitis Sep 2022Over 80 monogenic causes of very early onset inflammatory bowel disease [VEOIBD] have been identified. Prior reports of the natural history of VEOIBD have not considered...
BACKGROUND AND AIMS
Over 80 monogenic causes of very early onset inflammatory bowel disease [VEOIBD] have been identified. Prior reports of the natural history of VEOIBD have not considered monogenic disease status. The objective of this study is to describe clinical phenotypes and outcomes in a large single-centre cohort of patients with VEOIBD and universal access to whole exome sequencing [WES].
METHODS
Patients receiving IBD care at a single centre were prospectively enrolled in a longitudinal data repository starting in 2012. WES was offered with enrollment. Enrolled patients were filtered by age of diagnosis <6 years to comprise a VEOIBD cohort. Monogenic disease was identified by filtering proband variants for rare, loss-of-function, or missense variants in known VEOIBD genes inherited according to standard Mendelian inheritance patterns.
RESULTS
This analysis included 216 VEOIBD patients, followed for a median of 5.8 years. Seventeen patients [7.9%] had monogenic disease. Patients with monogenic IBD were younger at diagnosis and were more likely to have Crohn's disease phenotype with higher rates of stricturing and penetrating disease and extraintestinal manifestations. Patients with monogenic disease were also more likely to experience outcomes of intensive care unit [ICU] hospitalisation, gastrostomy tube, total parenteral nutrition use, stunting at 3-year follow-up, haematopoietic stem cell transplant, and death. A total of 41 patients [19.0%] had infantile-onset disease. After controlling for monogenic disease, patients with infantile-onset IBD did not have increased risk for most severity outcomes.
CONCLUSIONS
Monogenic disease is an important driver of disease severity in VEOIBD. WES is a valuable tool in prognostication and management of VEOIBD.
Topics: Age of Onset; Crohn Disease; Humans; Inflammatory Bowel Diseases; Intestines; Phenotype
PubMed: 35366317
DOI: 10.1093/ecco-jcc/jjac045