[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

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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.

SUMMARY Objective: We conducted a retrospective study to evaluate the use of total parenteral nutrition (TPN) and octreotide (OC), in comparison to standard treatment for the management of external digestive tract fistulas (EDTF) at a major tertiary referral University Hospital. Patients: We analyzed the clinical course of 112 patients with EDTF treated from 1978 to 2001. Thirty-nine patients admitted during the period 1978-1990 (group A) and 73 patients admitted during the period 1991-2001 (group B) were studied. Group A received standard supportive treatment while group B received standard supportive treatment in combination with TPN and OC. The main outcome measures were the duration of hospitalization, the fistula spontaneous closure time, the mortality rate and complications of treatment. Results: A dramatic reduction (81‐4.5%) in fistula output was observed within 48 hours after administration of TPN and OC in group B compared to group A (p<0.05). The incidence of spontaneous fistula closure was increased from 64% in group A to 81% in group B (p<0.05) and the mean fistula closure time decreased from 38‐2.7 in group A to 17‐1.8 days in group B (p<0.05). Complications occurred in 61.5% of group A patients and in 45% of patient group B respectively (p<0.05). The direct fistula related mortality was 7.5% and 2% respectively (p<0.05). Conclusions: The introduction of TPN and OC in EDTF ameliorated in a statistically significant way all the parameters of EDTF healing that were studied. Although fistula related direct mortality was decreased, further studies with well-designed comparative prospective trials are needed. This abstract was accepted and was be presented as a poster at Digestive Disease Week, Chicago, IL, May 14-19, 2005

Octreotide plus Total Parenteral Nutrition in Patients with External Digestive Tract Fistulas ñ An Evaluation of our Experience

We report a 63 years old man with hand morhea who was admitted because of 6 weeks history of weight loss, weakness, low grade fever and jaundice. Physical examination revealed jaundice, hand morphea and a thin patient. Laboratory tests revealed aneamia, increased serum transaminase levels and an every day increasing of alkaline phosphatase, gamma-glutamyl transpeptidase and direct bilirubin, with a 3-fold increasing of Ca 19.9. The U/S, C.T and MRI of the abdomen were in favor of malignacy in the head of pancreas althought ERCP was within normal limits. Serologic tests for microbial infections were negative but immunoserologic tests, revealed ANA +1/160 (type fine speckled), AMA (-), SMA (-),centromere antibody (-), cryoglobulins (-), RF=1/320, C3=34 ui/ml, C4<6 ui/ml. Liver biopsy revealed autoimmune cholangitis and the patient was started on 0,5 mg/kg methylprednisolone. He recovered totally within 2 months and he is still alive in exellent health with normal clinical and laboratory profile. It is known that scleroderma can co-exist with other autoimmune phenomena. We add to this that also a localized scleroderma (morphea) can co-exist with autoimmune cholangitis presenting as pangreatic malignancy. Althought in this case the clinical, serological and radiological findings, exept ERCP, were in favor of neoplasia, immunoserologic tests and liver biopsy offered the true diagnosis before unnessescary laparotomy was performed. Keywords: autoimmune cholangitis, morphea, Ca19.9, ERCP, pancreatic malignancy, (autoimmune pancreatitis).

Autoimmune cholangitis presenting as pancreatic malignancy in a man with hand morphea

All biologic therapies have the potential to induce immunogenicity. Homology reduces antigenicity, but ‘humanization’ does not equate with homology and human antibodies may be also immunogenic. Despite of its proved efficacy in Crohn’s disease patients, adalimumab carries the potential of molecule-specific toxicities which may be expressed with several types of antibody responses, and which are usually divided as allergic, autoimmunity and immunogenicity phenomena.

Patterns and clinical relevance of antibody responses during adalimumab therapy

All patients with inflammatory bowel disease (IBD) with
peristoma and stoma disorders who receive immunomodulatory
therapy must undergo a detailed clinical, histological
and microbiological examination including detailed history
for pre-existing skin diseases.
A 34-year old woman with Crohns disease during Infliximab
treatment presented with tender verrucous lesions in
the perianal area and a small verrucous lesion involving
the ileostoma. Perianal lesions were enlarged and had a
condylomatous appearance, and had become painful. At the
same time, a small grayish-white papillomatous plaque on
the upper circumference of the ileostoma, with a sharp
outline but with no downward extension into the ileum, was
noticed. Light microscopic analysis of the stoma lesion
demonstrated only signs of mild chronic inflammation but
no definite koilocytosis. In addition, immunohistochemical
analysis for HPV was negative. Cryotherapy of perianal
lesions was performed successfully while Infliximab
infusions were interrupted. The patient was on regular
follow-up and was receiving azathioprine and low doses of
steroids.
In all IBD cases with long-term immunomodulatory drug
use, clinical follow-up is mandatory as long term toxicity
and carcinogenecity of these new biological agents still remain
under investigation.
Key words: human papillomavirus (HPV), Crohn, inflammatory
bowel disease, Infliximab, Remicade, anti-TNFa

Perianal condylomata and HPV-negative ileostomal papillomatous lesion in Crohns disease during Infliximab therapy

http://academic.oup.com/ecco-jcc/article-pdf/12/supplement_1/S074/23742832/jjx180.101.pdf

K.H. Katsanos

Papers

Octreotide plus Total Parenteral Nutrition in Patients with External Digestive Tract Fistulas ñ An Evaluation of our Experience

Autoimmune cholangitis presenting as pancreatic malignancy in a man with hand morphea

Patterns and clinical relevance of antibody responses during adalimumab therapy

Perianal condylomata and HPV-negative ileostomal papillomatous lesion in Crohns disease during Infliximab therapy

DOP064 ECCO expert consensus and topical review on treatment exit strategies in inflammatory bowel disease