Perianal disease is one of the most disabling manifestations of Crohn's disease.A multidisciplinary approach of gastroenterologist,colorectal surgeon and radiologist is necessary for its management.A correct diagn...Perianal disease is one of the most disabling manifestations of Crohn's disease.A multidisciplinary approach of gastroenterologist,colorectal surgeon and radiologist is necessary for its management.A correct diagnosis,based on endoscopy,magnetic resonance imaging,endoanal ultrasound and examination under anesthesia,is crucial for perianal fistula treatment.Available medical and surgical therapies are discussedin this review,including new local treatment modalities that are under investigation.展开更多
Ulcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab ...Ulcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab (IFX), that has demonstrated efficacy in inducing fast symptoms remission, promoting mucosal healing and maintaining long-term remission. However, surgery is still needed for UC patients: in case of failure of medical therapy and if acute complications or a malignancy occurred. Surgical treatment is associated with a short-term post-operative mortality and morbidity respectively of 0%-4% and 30%. In this study we systematically analyzed: the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy. Four of 5 analyzed randomized controlled trials demonstrated that therapy with IFX significantly reduces the colectomy rate. Moreover, pre-operative treatment with IFX doesn’t seem to increase post-operative infectious complications. By an economic point of view, the cost-effectiveness of IFX-therapy was demonstrated for UC patients suffering from moderate to severe UC in a study based on a cost estimation of the National Health Service of England and Wales. However, the argument is debated.展开更多
Inflammatory bowel diseases,namely ulcerative colitis and Crohn’s disease,are chronic and relapsing conditions that pose a growing burden on healthcare systems worldwide.Because of their complex and partly unknown et...Inflammatory bowel diseases,namely ulcerative colitis and Crohn’s disease,are chronic and relapsing conditions that pose a growing burden on healthcare systems worldwide.Because of their complex and partly unknown etiology and pathogenesis,the management of ulcerative colitis and Crohn’s disease can prove challenging not only from a clinical point of view but also for resource optimization.Artificial intelligence,an umbrella term that encompasses any cognitive function developed by machines for learning or problem solving,and its subsets machine learning and deep learning are becoming ever more essential tools with a plethora of applications in most medical specialties.In this regard gastroenterology is no exception,and due to the importance of endoscopy and imaging numerous clinical studies have been gradually highlighting the relevant role that artificial intelligence has in inflammatory bowel diseases as well.The aim of this review was to summarize the most recent evidence on the use of artificial intelligence in inflammatory bowel diseases in various contexts such as diagnosis,follow-up,treatment,prognosis,cancer surveillance,data collection,and analysis.Moreover,insights into the potential further developments in this field and their effects on future clinical practice were discussed.展开更多
Inflammatory bowel disease(IBD)is a chronic condition that requires continuous medical treatment.To date,the medical management of patients with moderatelyto-severely active IBD who develop dependence or resistance to...Inflammatory bowel disease(IBD)is a chronic condition that requires continuous medical treatment.To date,the medical management of patients with moderatelyto-severely active IBD who develop dependence or resistance to corticosteroids is based on immunomodulator drugs.Such therapies are licenced after passing through three phases of randomized controlled trials(RCTs),and are subsequently adopted in clinical practice.However,the real-life population of IBD patients who require these therapies can significantly differ from those included in RCTs.As a matter of fact,there is a number of exclusion criteria–nearly ubiquitous in all RCTs–that prevent the enrolment of specific patients:Chronic refractory pouchitis or isolated proctitis in ulcerative colitis,short-bowel syndrome and stomas in Crohn’s disease,ileorectal anastomosis in both ulcerative colitis and Crohn’s disease,and elderly age are some representative examples.In this frontier article,we aim to give an overview of current literature on this topic,in order to address the main knowledge gaps that need to be filled in the upcoming years.展开更多
BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis(UC) in the different Italian regions,mainly derived from the absence of a national registry.This ...BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis(UC) in the different Italian regions,mainly derived from the absence of a national registry.This prevents correct interpretation of the disease burden.AIM To assess the main clinical and epidemiological features of adult patients diagnosed with UC in Sardinia,Italy.METHODS We performed a multicenter,observational,cross-sectional study that included adult patients with UC enrolled in seven gastroenterology unit centers in Sardinia.Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.RESULTS Four hundred and forty-two patients with UC were included.The median age at diagnosis was 39years(interquartile range 28-48).After a median disease duration of 10 years,53 patients experienced proximal extension of proctitis or left-sided colitis.Seventy-five patients developed extraintestinal manifestations.Nineteen patients(4.3%) developed cancer:two with colorectal cancer and seventeen with extracolonic cancers.Mesalazine(5-ASA) remains the mainstay of treatment for UC.Overall,95 patients(21.5%) were treated with one or more biologic agents,whereas 15 patients(3.4%) underwent surgery,mostly colectomy.CONCLUSION Our results provide important insights into the clinical and epidemiological features of patients with UC,and while waiting for a national Italian registry,present eligible data on the UC population in Sardinia.展开更多
The use of biological agents and immunomodulators for inflammatory bowel disease(IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existen...The use of biological agents and immunomodulators for inflammatory bowel disease(IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination in those patients with IBD, which are candidate for biologic therapy. Available strategies to screen, diagnose and prevent bacterial and viral infections in patients with IBD prior to start biological therapy are discussed in this review.展开更多
Introduction Epiploic appendagitis(EA)is an acute inflammation of the pedunculated mesenteric fat attached to the colonic surface,distinguished into two forms:primary EA,seemingly elicited by local ischaemic factors;a...Introduction Epiploic appendagitis(EA)is an acute inflammation of the pedunculated mesenteric fat attached to the colonic surface,distinguished into two forms:primary EA,seemingly elicited by local ischaemic factors;and secondary EA(SEA),elicited by the inflammation of the adjacent organs,with diverticulitis being the most common trigger[1].Few case series have described the association between SEA and inflammatory bowel disease(IBD);however,information about clinical,laboratory and imaging findings,outcomes,and the impact of IBD-specific therapy were not reported.We first report the case of a woman affected by ulcerative colitis(UC)who developed a SEA during vedolizumab therapy(Figure 1A).展开更多
文摘Perianal disease is one of the most disabling manifestations of Crohn's disease.A multidisciplinary approach of gastroenterologist,colorectal surgeon and radiologist is necessary for its management.A correct diagnosis,based on endoscopy,magnetic resonance imaging,endoanal ultrasound and examination under anesthesia,is crucial for perianal fistula treatment.Available medical and surgical therapies are discussedin this review,including new local treatment modalities that are under investigation.
文摘Ulcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab (IFX), that has demonstrated efficacy in inducing fast symptoms remission, promoting mucosal healing and maintaining long-term remission. However, surgery is still needed for UC patients: in case of failure of medical therapy and if acute complications or a malignancy occurred. Surgical treatment is associated with a short-term post-operative mortality and morbidity respectively of 0%-4% and 30%. In this study we systematically analyzed: the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy. Four of 5 analyzed randomized controlled trials demonstrated that therapy with IFX significantly reduces the colectomy rate. Moreover, pre-operative treatment with IFX doesn’t seem to increase post-operative infectious complications. By an economic point of view, the cost-effectiveness of IFX-therapy was demonstrated for UC patients suffering from moderate to severe UC in a study based on a cost estimation of the National Health Service of England and Wales. However, the argument is debated.
文摘Inflammatory bowel diseases,namely ulcerative colitis and Crohn’s disease,are chronic and relapsing conditions that pose a growing burden on healthcare systems worldwide.Because of their complex and partly unknown etiology and pathogenesis,the management of ulcerative colitis and Crohn’s disease can prove challenging not only from a clinical point of view but also for resource optimization.Artificial intelligence,an umbrella term that encompasses any cognitive function developed by machines for learning or problem solving,and its subsets machine learning and deep learning are becoming ever more essential tools with a plethora of applications in most medical specialties.In this regard gastroenterology is no exception,and due to the importance of endoscopy and imaging numerous clinical studies have been gradually highlighting the relevant role that artificial intelligence has in inflammatory bowel diseases as well.The aim of this review was to summarize the most recent evidence on the use of artificial intelligence in inflammatory bowel diseases in various contexts such as diagnosis,follow-up,treatment,prognosis,cancer surveillance,data collection,and analysis.Moreover,insights into the potential further developments in this field and their effects on future clinical practice were discussed.
文摘Inflammatory bowel disease(IBD)is a chronic condition that requires continuous medical treatment.To date,the medical management of patients with moderatelyto-severely active IBD who develop dependence or resistance to corticosteroids is based on immunomodulator drugs.Such therapies are licenced after passing through three phases of randomized controlled trials(RCTs),and are subsequently adopted in clinical practice.However,the real-life population of IBD patients who require these therapies can significantly differ from those included in RCTs.As a matter of fact,there is a number of exclusion criteria–nearly ubiquitous in all RCTs–that prevent the enrolment of specific patients:Chronic refractory pouchitis or isolated proctitis in ulcerative colitis,short-bowel syndrome and stomas in Crohn’s disease,ileorectal anastomosis in both ulcerative colitis and Crohn’s disease,and elderly age are some representative examples.In this frontier article,we aim to give an overview of current literature on this topic,in order to address the main knowledge gaps that need to be filled in the upcoming years.
文摘BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis(UC) in the different Italian regions,mainly derived from the absence of a national registry.This prevents correct interpretation of the disease burden.AIM To assess the main clinical and epidemiological features of adult patients diagnosed with UC in Sardinia,Italy.METHODS We performed a multicenter,observational,cross-sectional study that included adult patients with UC enrolled in seven gastroenterology unit centers in Sardinia.Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.RESULTS Four hundred and forty-two patients with UC were included.The median age at diagnosis was 39years(interquartile range 28-48).After a median disease duration of 10 years,53 patients experienced proximal extension of proctitis or left-sided colitis.Seventy-five patients developed extraintestinal manifestations.Nineteen patients(4.3%) developed cancer:two with colorectal cancer and seventeen with extracolonic cancers.Mesalazine(5-ASA) remains the mainstay of treatment for UC.Overall,95 patients(21.5%) were treated with one or more biologic agents,whereas 15 patients(3.4%) underwent surgery,mostly colectomy.CONCLUSION Our results provide important insights into the clinical and epidemiological features of patients with UC,and while waiting for a national Italian registry,present eligible data on the UC population in Sardinia.
文摘The use of biological agents and immunomodulators for inflammatory bowel disease(IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination in those patients with IBD, which are candidate for biologic therapy. Available strategies to screen, diagnose and prevent bacterial and viral infections in patients with IBD prior to start biological therapy are discussed in this review.
文摘Introduction Epiploic appendagitis(EA)is an acute inflammation of the pedunculated mesenteric fat attached to the colonic surface,distinguished into two forms:primary EA,seemingly elicited by local ischaemic factors;and secondary EA(SEA),elicited by the inflammation of the adjacent organs,with diverticulitis being the most common trigger[1].Few case series have described the association between SEA and inflammatory bowel disease(IBD);however,information about clinical,laboratory and imaging findings,outcomes,and the impact of IBD-specific therapy were not reported.We first report the case of a woman affected by ulcerative colitis(UC)who developed a SEA during vedolizumab therapy(Figure 1A).
