[Crohn's disease].

Over 1 million residents in the USA and 2.5 million in Europe are estimated to have IBD, with substantial costs for health care. These estimates do not factor in the 'real' price of IBD, which can impede career aspirations, instil social stigma and impair quality of life in patients. The majority of patients are diagnosed early in life and the incidence continues to rise; therefore, the effect of IBD on health-care systems will rise exponentially. Moreover, IBD has emerged in newly industrialized countries in Asia, South America and Middle East and has evolved into a global disease with rising prevalence in every continent. Understanding the worldwide epidemiological patterns of IBD will prepare us to manage the burden of IBD over time. The goal of this article is to establish the current epidemiology of IBD in the Western world, contrast it with the increase in IBD in newly industrialized countries and forecast the global effects of IBD in 2025.

The global burden of IBD: from 2015 to 2025

/pdf/second-european-evidence-based-consensus-on-the-diagnosis-hg0loy9hft.pdf

Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management

The management of inflammatory bowel disease represents a key component of clinical practice for members of the British Society of Gastroenterology (BSG). There has been considerable progress in management strategies affecting all aspects of clinical care since the publication of previous BSG guidelines in 2004, necessitating the present revision. Key components of the present document worthy of attention as having been subject to re-assessment, and revision, and having direct impact on practice include: The data generated by the nationwide audits of inflammatory bowel disease (IBD) management in the UK in 2006, and 2008. The publication of 'Quality Care: service standards for the healthcare of people with IBD' in 2009. The introduction of the Montreal classification for Crohn's disease and ulcerative colitis. The revision of recommendations for the use of immunosuppressive therapy. The detailed analysis, guidelines and recommendations for the safe and appropriate use of biological therapies in Crohn's disease and ulcerative colitis. The reassessment of the role of surgery in disease management, with emphasis on the importance of multi-disciplinary decision-making in complex cases. The availablity of new data on the role of reconstructive surgery in ulcerative colitis. The cross-referencing to revised guidelines for colonoscopic surveillance, for the management of metabolic bone disease, and for the care of children with inflammatory bowel disease. Use of the BSG discussion forum available on the BSG website to enable ongoing feedback on the published document http://www.bsg.org.uk/forum (accessed Oct 2010). The present document is intended primarily for the use of clinicians in the United Kingdom, and serves to replace the previous BSG guidelines in IBD, while complementing recent consensus statements published by the European Crohn's and Colitis Organisation (ECCO) https://www.ecco-ibd.eu/index.php (accessed Oct 2010).

https://gut.bmj.com/content/gutjnl/60/5/571.full.pdf

Guidelines for the management of inflammatory bowel disease in adults

aDepartment of Pharmacology and Therapeutics, University of Porto; MedInUP, Centre for Drug Discovery and Innovative Medicines; Centro Hospitalar São João, Porto, Portugal bIBD Unit, DIMEC, University of Bologna, Bologna, Italy cDepartment of Gastroenterology and Hepatology, Chaim Sheba Medical Center, Tel Hashomer, Israel dGastrointestinal Unit ASST Fatebenefratelli Sacco—University of Milan—Milan, Italy eIBD Unit Complesso Integrato Columbus, Gastroenterological and Endocrino-Metabolical Sciences Department, Fondazione Policlinico Universitario Gemelli Universita’ Cattolica del Sacro Cuore, Rome, Italy fDepartment of Gastroenterology, IBD Unit, University Hospital Santiago De Compostela (CHUS), A Coruña, Spain gDepartment of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark hFirst Department of Medicine, Semmelweis University, Budapest, Hungary iIBD Unit, St Mark’s Hospital, Middlesex, UK jDepartment of Gastroenterology, University Hospital of Ghent, Ghent, Belgium kInstitute of Pathology, Medical University of Graz, Graz, Austria lDepartment of Gastroenterology, Pennine Acute Hospitals NHS Trust; Institute of Inflammation and Repair, University of Manchester, Manchester, UK mUnit of General Surgery, Second University of Naples, Napoli, Italy nMaria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Oncological Gastroenterology Warsaw; Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland oDepartment of Medicine, University of Cambridge, Cambridge, UK pImperial College London; Chelsea and Westminster Hospital, London, UK qDepartment of Pathobiology /NC22, Lerner Research Institute; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

/pdf/third-european-evidence-based-consensus-on-diagnosis-and-2g4pj48jlg.pdf

Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders.

Sir, malignant melanoma metastases to the gastrointestinal tract are not uncommon. Within the gastrointestinal tract, the small bowel is most frequently involved, followed by the stomach, large bowel, and esophagus.1,2 Metastatic melanoma to the gallbladder is extremely rare.3 Of interest in rare cases paraclinical examination cannot reveal any lesions or nodules as a primary site of the metastatic disease.4 The vast majority of gastrointestinal melanoma is metastatic from a cutaneous primary; however, there is evidence that melanoma can arise de novo from within certain areas of the gastrointestinal system5 and may sometimes be masquerading as a rectal polyp.6

Metastatic melanoma in stomach and large bowel

OP05 Validation of the Lémann index in Crohn’s disease

TO THE EDITOR: Sir, spontaneous hBsAg+ clearance in patients with acute and chronic hepatitis B virus (hBV) infection has been reported worldwide.1 Spontaneous loss of hBsAg is infrequent in adult hBV carriers. In children with chronic hepatitis B loss of hBsAg is rare (average incidence 0.6%/year), especially if they have been infected during the perinatal period and have mild histological changes. however, among hBV cases with spontaneous hBsAg clearance we can hardly find reports with co-existing pleural effusions in the absence of ascites. We report herein the therapeutic management of a patient with acute hBV infection and symptomatic pleural exudate who succeeded in hBsAg+ seroconversion.

Spontaneous HBsAg clearance in a patient with acute hepatitis B and pleural exudates

TO THE EDITOR: Sir, Listeria monocytogenes has been reported as a possible cause of infection in patients receiving anti-TNFa therapies.1-8 Immediate therapy is important and careful patient follow up is mandatory as Listeria meningitis, encephalitis and meningoencephalitis may have unfavorable outcomes.9-18 Prevention of such an infection is not possible, thus any symptom should alert treating physician as the timing of diagnosing this an infection cannot be predicted and may occur any time. We report herein on a patient who has been diagnosed with Listeria monocytogenes infection two days after infliximab initiation.

Listeria monocytogenes infection two days after infliximab initiation in a patient with ulcerative colitis

AIM OF STUDY: To investigate the prevalence of electrocardiograph (ECG) abnormalities in a cohort of patients with active inflammatory bowel disease (IBD) followed up in a referral center and to compare them with ECG abnormalities in controls. PATIENTS-METHODS: We retrospectively
studied surface ECGs from a random selected cohort of IBD patients with active disease and we compared them with ECGs from age and sex matched control individuals. The IBD cohort consisted in total of 34 patients, 22 males (aged 42.3±11.6 years) and 12 females (aged 48.1±13.4 years). Twenty-seven patients were diagnosed with ulcerative colitis (UC) and 7 with Crohn’s disease (CD). Disease duration was 10.4±6.2 and 7.8± 4.9 years respectively. Control population consisted of 35 age and sex matched individuals (22 healthy and 13 with viral gastroenteritis). Two cardiologists analyzed ECGs throughout a standard protocol. Differential diagnosis of all abnormal ECGs was based on medical history, concomitant medication and co-morbidity. RESULTS: Twelve out of this 34-IBD patient cohort (35.2%) and 13/35 (37.1%) of control cohort were diagnosed with abnormal ECG’s (p=NS). In total 10 UC patients out of 27 (37%) and 2 out of 7 (28.6%) CD patients had evidence of some kind of ECG abnormality. Additionally, seven IBD patients had PR or QRS or QT interval at the upper normal limit. There was no significant difference in the number of ECG abnormalities between patients and controls but we recorded some qualitative differences between them regarding the type of
abnormalities. DISCUSSION: In a cohort of IBD patients with active disease we recorded ECG abnormalities commonly found in healthy individuals and in individuals with viral gastroenteritis. Although we were not able to demonstrate significant differences in overall numbers, we showed qualitative differences regarding types of ECG abnormalities between patients and controls.

K.H. Katsanos

Papers

Metastatic melanoma in stomach and large bowel

OP05 Validation of the Lémann index in Crohn’s disease

Spontaneous HBsAg clearance in a patient with acute hepatitis B and pleural exudates

Listeria monocytogenes infection two days after infliximab initiation in a patient with ulcerative colitis

Electrocardiograph abnormalities in patients with active inflammatory bowel disease