https://www.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/IBD,%20CROHN'S%20AND%20U.C/accent%20i%20trial.pdf

Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial

https://www.thelancet.com/article/S0140673618322256/pdf

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Enterocutaneous fistulas are a serious complication of Crohn's disease and are difficult to treat. Infliximab, a chimeric monoclonal antibody to tumor necrosis factor alpha, has recently been developed as a treatment for Crohn's disease. We conducted a randomized, multicenter, double-blind, placebo-controlled trial of infliximab for the treatment of fistulas in patients with Crohn's disease. Methods The study included 94 adult patients who had draining abdominal or perianal fistulas of at least three months' duration as a complication of Crohn's disease. Patients were randomly assigned to receive one of three treatments: placebo (31 patients), 5 mg of infliximab per kilogram of body weight (31 patients), or 10 mg of infliximab per kilogram (32 patients); all three were to be administered intravenously at weeks 0, 2, and 6. The primary end point was a reduction of 50 percent or more from base line in the number of draining fistulas observed at two or more consecutive study visits. A secondary end point was the closure of all fistulas. Results Sixty-eight percent of the patients who received 5 mg of infliximab per kilogram and 56 percent of those who received 10 mg per kilogram achieved the primary end point, as compared with 26 percent of the patients in the placebo group (P=0.002 and P=0.02, respectively). In addition, 55 percent of the patients assigned to receive 5 mg of infliximab per kilogram and 38 percent of those assigned to 10 mg per kilogram had closure of all fistulas, as compared with 13 percent of the patients assigned to placebo (P=0.001 and P=0.04, respectively). The median length of time during which the fistulas remained closed was three months. More than 60 percent of patients in all the groups had adverse events. For patients treated with infliximab, the most common were headache, abscess, upper respiratory tract infection, and fatigue. Conclusions Infliximab is an efficacious treatment for fistulas in patients with Crohn's disease.

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Infliximab for the treatment of fistulas in patients with Crohn's disease.

Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial

Marked changes in socio-economic status, cultural traditions, population growth and agriculture are affecting diets worldwide. Understanding how our diet and nutritional status influence the composition and dynamic operations of our gut microbial communities, and the innate and adaptive arms of our immune system, represents an area of scientific need, opportunity and challenge. The insights gleaned should help to address several pressing global health problems.

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Human nutrition, the gut microbiome and the immune system.

The Assessment of Wireless Capsule Endoscopy in Paediatrics

Immunologic tolerance and dietary antigens.

N-acetyl glucosamine - a novel “neutraceutical” therapy for ibd.

Since the introduction of the Crosby capsule (a device used for obtaining biopsies of small bowel mucosa, necessary for the diagnosis of various small bowel diseases) in the 1970s, small intestinal biopsy has been the cornerstone of diagnosis of coeliac disease. In paediatric practice, successive position statements from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) have defined criteria for childhood diagnosis: initially based on three successive biopsies at presentation, on a gluten-free diet, and then challenge. Since 1990, the diagnosis has been dependent on a single biopsy with a clear clinical response to a gluten-free diet, supported by positive serology.1 This approach is similar to that recommended for adults2 and has been adopted by the National Institute for Health and Care Excellence (NICE).3

Great strides have been made in serological assessment and understanding coeliac disease pathogenesis since the 1990 guidelines were introduced. First, the non-specific gliadin antibodies used at that time were supplanted by the highly specific IgA endomyseal antibody (EMA) test. Subsequently tissue transglutaminase-2 (tTG) was identified as the true autoantigen causing EMA reactivity. EMA testing depends on immunofluorescence, giving a yes–no answer dependent on operator expertise. Importantly, assay of tTG autoantibody is performed by enzyme-linked immunosorbent assay (ELISA), allowing a quantitative assessment of immune response. The second major diagnostic advance was the determination of the relevant human leukocyte antigen (HLA) types that allow presentation of gliadin/tTG complexes to T cells, thus causing the autoimmune response to tTG. Persons of tissue types HLA-DQ2 and HLA-DQ8 (more than a quarter of the UK population) make up 99% of cases of coeliac disease, and true coeliac disease is very unusual in someone …

/pdf/diagnosis-of-coeliac-disease-in-children-in-primary-care-and-2yn5jmpwfw.pdf

Simon Murch

Papers

The Assessment of Wireless Capsule Endoscopy in Paediatrics

Immunologic tolerance and dietary antigens.

N-acetyl glucosamine - a novel “neutraceutical” therapy for ibd.

Diagnosis of coeliac disease in children in primary care and clinical implications.

Imbalance between th1 and t-regulatory cytokines in enteropathy of malnutrition