Database : MEDLINE
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[PMID]: 29361101
[Au] Autor:Huguet M; Pereira B; Goutte M; Goutorbe F; Dubois A; Bommelaer G; Buisson A
[Ad] Address:Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.
[Ti] Title:Systematic Review With Meta-Analysis: Anti-TNF Therapy in Refractory Pouchitis and Crohn's Disease-Like Complications of the Pouch After Ileal Pouch-Anal Anastomosis Following Colectomy for Ulcerative Colitis.
[So] Source:Inflamm Bowel Dis;24(2):261-268, 2018 Jan 18.
[Is] ISSN:1536-4844
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Background: Inflammatory complications including chronic refractory pouchitis and Crohn's disease (CD)-like complications of the pouch are common complications after ileal pouch-anal anastomosis (IPAA) following colectomy for ulcerative colitis (UC). We performed a systematic review and meta-analysis to evaluate the efficacy of anti-TNF therapy in distinguishing patients with chronic refractory pouchitis from those with CD-like complications of the pouch. Methods: We performed a systematic literature search to identify articles and abstracts reporting anti-TNF agents efficacy in treating inflammatory complications of the pouch after IPAA for UC. Short-term and long-term remissions were evaluated at 8 weeks 95%CI[5-10] and 12 months 95%CI[12-18.5], respectively. Results: We identified 21 articles and 3 abstracts including 313 patients treated either with infliximab (n = 194) or adalimumab (n = 119) for inflammatory complications of the pouch. The rates of short-term and long-term clinical remission were 0.50 (95%CI [0.37-0.63]; I2 = 0.57) and 0.52 (95%CI[0.39-0.65]; I2 = 0.59), respectively. The rate of remission after anti-TNF induction therapy seemed to be higher in CD-like complications of the pouch 0.64 (95%CI[0.5-0.77]; I2 = 0.18), compared to refractory pouchitis 0.10 (95%CI [0.00-0.35]; I2 = 0.00) (P = 0.06), whereas no such difference appeared after long-term maintenance therapy 0.57 (95%CI[0.43-0.71]; I2 = 0.32) and 0.37 (95%CI [0.14-0.62]; I2 = 0.47), respectively (P = 0.57). Sensitivity analyses suggested no difference in outcomes. No significant publication bias has been detected. Conclusion: Anti-TNF agents have a clear trend to have higher and faster efficacy in CD-like complications of the pouch compared to refractory pouchitis, highlighting the need to differentiate these two entities both in daily practice and clinical trials.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1093/ibd/izx049

  2 / 12933 MEDLINE  
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[PMID]: 29361088
[Au] Autor:Haberman Y; BenShoshan M; Di Segni A; Dexheimer PJ; Braun T; Weiss B; Walters TD; Baldassano RN; Noe JD; Markowitz J; Rosh J; Heyman MB; Griffiths AM; Crandall WV; Mack DR; Baker SS; Kellermayer R; Patel A; Otley A; Steiner SJ; Gulati AS; Guthery SL; LeLeiko N; Moulton D; Kirschner BS; Snapper S; Avivi C; Barshack I; Oliva-Hemker M; Cohen SA; Keljo DJ; Ziring D; Anikster Y; Aronow B; Hyams JS; Kugathasan S; Denson LA
[Ad] Address:Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
[Ti] Title:Long ncRNA Landscape in the Ileum of Treatment-Naive Early-Onset Crohn Disease.
[So] Source:Inflamm Bowel Dis;24(2):346-360, 2018 Jan 18.
[Is] ISSN:1536-4844
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Background: Long noncoding RNAs (lncRNA) are key regulators of gene transcription and many show tissue-specific expression. We previously defined a novel inflammatory and metabolic ileal gene signature in treatment-naive pediatric Crohn disease (CD). We now extend our analyses to include potential regulatory lncRNA. Methods: Using RNAseq, we systematically profiled lncRNAs and protein-coding gene expression in 177 ileal biopsies. Co-expression analysis was used to identify functions and tissue-specific expression. RNA in situ hybridization was used to validate expression. Real-time polymerase chain reaction was used to test lncRNA regulation by IL-1ß in Caco-2 enterocytes. Results: We characterize widespread dysregulation of 459 lncRNAs in the ileum of CD patients. Using only the lncRNA in discovery and independent validation cohorts showed patient classification as accurate as the protein-coding genes, linking lncRNA to CD pathogenesis. Co-expression and functional annotation enrichment analyses across several tissues and cell types 1showed that the upregulated LINC01272 is associated with a myeloid pro-inflammatory signature, whereas the downregulated HNF4A-AS1 exhibits association with an epithelial metabolic signature. We confirmed tissue-specific expression in biopsies using in situ hybridization, and validated regulation of prioritized lncRNA upon IL-1ß exposure in differentiated Caco-2 cells. Finally, we identified significant correlations between LINC01272 and HNF4A-AS1 expression and more severe mucosal injury. Conclusions: We systematically define differentially expressed lncRNA in the ileum of newly diagnosed pediatric CD. We show lncRNA utility to correctly classify disease or healthy states and demonstrate their regulation in response to an inflammatory signal. These lncRNAs, after mechanistic exploration, may serve as potential new tissue-specific targets for RNA-based interventions.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1093/ibd/izx013

  3 / 12933 MEDLINE  
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[PMID]: 29361086
[Au] Autor:Truffi M; Sorrentino L; Monieri M; Fociani P; Mazzucchelli S; Bonzini M; Zerbi P; Sampietro GM; Di Sabatino A; Corsi F
[Ad] Address:Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
[Ti] Title:Inhibition of Fibroblast Activation Protein Restores a Balanced Extracellular Matrix and Reduces Fibrosis in Crohn's Disease Strictures Ex Vivo.
[So] Source:Inflamm Bowel Dis;24(2):332-345, 2018 Jan 18.
[Is] ISSN:1536-4844
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Background: Crohn's disease (CD) is a chronic bowel inflammation that ultimately leads to fibrosis, for which medical therapy is currently unavailable. Fibrotic strictures in CD are characterized by excessive extracellular matrix (ECM) deposition, altered balance between matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), and overexpression of fibroblast activation protein (FAP), a marker of active fibroblasts. Here we investigated the role of FAP-targeted therapy in ECM remodeling in CD strictures ex vivo. Methods: Bowel specimens were obtained from stenotic and nonstenotic ileal segments from 30 patients with fibrostenotic CD undergoing surgery. FAP expression was evaluated in isolated mucosal myofibroblasts by immunoblotting and flow cytometry. Bowel tissue cultures were treated with anti-FAP antibody, and soluble collagen, TIMP-1, and MMPs were measured in tissue culture supernatants by immunoblotting. Anti-FAP-treated myofibroblasts were analyzed for TIMP-1 expression by immunoblotting, for migratory potential by wound healing assay, and for apoptosis by Annexin V staining. Results: Myofibroblasts from stenotic CD mucosa showed upregulation of FAP expression when compared with nonstenotic mucosa. Treatment of stenotic tissues with anti-FAP antibody induced a dose-dependent decrease in collagen production, particularly affecting type I collagen. The treatment also reduced TIMP-1 production in CD strictures, without altering MMP-3 and MMP-12 secretion. Accordingly, anti-FAP treatment inhibited TIMP-1 expression in stenotic CD myofibroblasts and enhanced myofibroblast migration without affecting survival. Conclusions: FAP inhibition reduced type I collagen and TIMP-1 production by CD strictures ex vivo without compromising uninvolved bowel areas. These results suggest that targeting FAP could reconstitute ECM homeostasis in fibrostenotic CD.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1093/ibd/izx008

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[PMID]: 29390318
[Au] Autor:Hench J; Cathomas G; Dettmer MS
[Ad] Address:Institute of Pathology, Cantonal Hospital Baselland, Liestal.
[Ti] Title:Hymenolepis nana: A case report of a perfect IBD camouflage warrior.
[So] Source:Medicine (Baltimore);96(50):e9146, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: There is evidence that parasitic helminths can ameliorate colitis in animal models and humans. Although infections with Hymenolepis sp. are clinically benign, the immunomodulatory interactions between host and parasite are largely unknown. PATIENT CONCERNS: In this study we examined the intestinal mucosa of an adult asymptomatic patient harboring adult and larval dwarf tapeworms (Hymenolepis nana) who underwent surgery for an unrelated reason. INTERVENTIONS: Routine histology and immunohistochemistry were performed to characterize the host's response to the parasite. Parasitic DNA was sequenced to identify the tapeworm species. DIAGNOSES: Morphological and immunohistochemical studies showed a nearly complete absence of an anti-parasite host immune response. The outer surface of the parasite also showed prominent cross-reactivity with various tested leukocyte antigens. Our findings closely resemble experimentally obtained data from the H. diminuta-infected rat at the state of persistent colonization. OUTCOMES: Cross-reactivity of parasite-borne molecules with anti-human-leukocyte antibodies indicates a potential functional role in active modulation of the host's immune response. LESSIONS: We believe that better understanding of the host-cestode interaction will certainly extend our knowledge on auto-aggressive disorders such as inflammatory bowel disease and might provide potential treatment options.
[Mh] MeSH terms primary: Hymenolepiasis/diagnosis
Hymenolepis nana
Inflammatory Bowel Diseases/parasitology
Meckel Diverticulum/parasitology
[Mh] MeSH terms secundary: Adult
Animals
Appendicitis/surgery
Diagnosis, Differential
Female
Humans
Incidental Findings
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009146

  5 / 12933 MEDLINE  
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[PMID]: 29429506
[Au] Autor:Jachiet M; Rybojad M; Bouaziz JD
[Ad] Address:Service de dermatologie, hôpital Saint-Louis, INSERM U976, université Paris-Diderot-Paris VII, Sorbonne-Paris-Cité, Paris, France.
[Ti] Title:Quoi de neuf en médecine interne ? [What's new in internal medecine?]
[So] Source:Ann Dermatol Venereol;143 Suppl 3:S23-S28, 2016 Dec.
[Is] ISSN:0151-9638
[Cp] Country of publication:France
[La] Language:fre
[Ab] Abstract:Answering the question « what's new in internal medecine in 2016? ¼ is very challenging. We used 3 methods of article selection to reduce the selection bias: 3 authors, a systematic review of the articles discussed in the weekly bibliographic meeting of our unit (Dermatology department, Saint-Louis Hospital, Paris, France) and a selection of the best articles by several internal medecine practitioners in Paris. Eleven « hot topics ¼ were analyzed: i/lowering cholesterol level but not blood blessure has a significant impact on cardiovascular morbi-mortality in cardiovascular intermediate risk patients; ii/the « treat to treat target ¼ is efficient in psoriatic arthritis; iii/ a genotype/ phenotype correlation favors the separation of ileal Crohn's disease, colonic Crohn's disease and ulcerative colitis; iv/ tocilizumab treatment (anti-IL-6 monoclonal antibody ) is very efficient in giant cell arteritis and slightly efficient in systemic sclerosis; v/ combination therapy using methotrexate plus steroids compared with steroids alone becomes the « gold standard ¼ treatment for juvenile dermatomyositis; vi/ dupilumab treatment (antibody blocking IL-4 and IL-13 receptors) is not only efficient in atopic dermatitis but also in asthma; vii/ think of eosinophilic oesophagitis in a patient with atopic dermatitis and dypshagia or food impaction; viii/ genetic A2 protein dysfunction induces NF-kB hyperactivation and an autoinflammatory disorder with features similar to Behcet's disease; ix/ no new biotherapies have shown high efficacy in systemic lupus erythematosus; x/ nanoparticles loaded with autoantigens induce Tregs and Bregs and may be a promising therapeutic option to treat auto-immune disease in the future; xi/ ipilimumab treatment (anti-CTLA4 antibody, immune checkpoint inhibitor) may induce complete remission in acute myeloid leukemia patients relapsing after haematological stem cell transplantation. Year 2016 is full of great discoveries in internal medicine keeping the dermatologist brain fully open minded.
[Mh] MeSH terms primary: Internal Medicine
[Mh] MeSH terms secundary: Antibodies, Monoclonal/therapeutic use
Antihypertensive Agents/therapeutic use
Antineoplastic Agents, Immunological/therapeutic use
Arthritis, Rheumatoid/drug therapy
Asthma/drug therapy
Autoimmune Diseases/drug therapy
Behcet Syndrome/genetics
Cardiovascular Diseases/prevention & control
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
Inflammatory Bowel Diseases/genetics
Ipilimumab/therapeutic use
Skin Diseases/therapy
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Nm] Name of substance:0 (Antibodies, Monoclonal); 0 (Antihypertensive Agents); 0 (Antineoplastic Agents, Immunological); 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors); 0 (Ipilimumab); 0 (SAR231893)
[Em] Entry month:1802
[Cu] Class update date: 180221
[Lr] Last revision date:180221
[Js] Journal subset:IM
[Da] Date of entry for processing:180213
[St] Status:MEDLINE

  6 / 12933 MEDLINE  
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[PMID]: 29462381
[Au] Autor:Nordenvall C; Olén O; Johan Nilsson P; Ekbom A; Bottai M; Myrelid P; Bergquist A
[Ad] Address:Department of Molecular Medicine and Surgery, Stockholm, Sweden.
[Ti] Title:Restorative Surgery in Patients With Primary Sclerosing Cholangitis and Ulcerative Colitis Following a Colectomy.
[So] Source:Inflamm Bowel Dis;24(3):624-632, 2018 Feb 15.
[Is] ISSN:1536-4844
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Background: Studies on surgical procedures in patients with concomitant primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) have mainly been restricted to single centers. The aim was to compare surgical treatment of UC with or without PSC in a nationwide study. Methods: A cohort study including all patients diagnosed with UC between 1987 and 2014 in Sweden was undertaken. The impact of PSC on the risk of colectomy, the chance of restorative surgery, and risk of failure (presence of a stoma) following restorative surgery were estimated. Survival analyses were performed using the Kaplan-Meier method and multivariable Cox regression models. Results: Of 49 882 UC patients, 2079 had a PSC diagnosis at the end of follow-up. The risk of colectomy was unaffected by PSC diagnosis, whereas the chance of restorative surgery was elevated in PSC-UC patients (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.02-1.44). Ileorectal anastomosis (IRA) was performed in 63% of the PSC-UC patients and 43% of the non-PSC-UC-patients, and the corresponding numbers for ileal pouch anal anastomosis (IPAA) were 35% and 53%. There was no significantly increased risk of failure following restorative surgery in PSC patients (HR, 1.44; 95% CI, 0.93-2.22). In PSC-UC patients, the cumulative failure rates following an IRA at 3 and 5 years were 15% and 18%, and following an IPAA they were 11% and 18%, respectively. Conclusions: Presence of PSC is not associated with the risk of colectomy, whereas the chance of restorative surgery in PSC-UC patients is higher than in UC alone.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180220
[Lr] Last revision date:180220
[St] Status:In-Data-Review
[do] DOI:10.1093/ibd/izx048

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[PMID]: 29458157
[Au] Autor:Chia JH; Wu TS; Wu TL; Chen CL; Chuang CH; Su LH; Chang HJ; Lu CC; Kuo AJ; Lai HC; Chiu CH
[Ad] Address:Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan.
[Ti] Title:Clostridium innocuum is a vancomycin-resistant pathogen that may cause antibiotic-associated diarrhea.
[So] Source:Clin Microbiol Infect;, 2018 Feb 16.
[Is] ISSN:1469-0691
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Clostridium innocuum can cause extra-intestinal infection in patients with underlying diseases. The role of C. innocuum in antibiotic-associated diarrhea (AAD) remains unknown. METHODS: Clinical information of 103 patients in which C. innocuum was isolated from was reviewed. We carried out cellular and animal experiments to examine the pathogenic potential of C. innocuum in AAD. RESULTS: Eighty-eight percent (91/103) of the 103 patients received antibiotics within 2 weeks of diarrhea onset. Patients were further classified into two groups: severe colitis and diarrhea, according to their clinical severity level. The mortality rate was 13.6% (14/103) among the patients C. innocuum was isolated from. The MIC for metronidazole and vancomycin were 0.5 and 16 mg/L, respectively. All isolates tested were susceptible to metronidazole but resistant to vancomycin. Nineteen randomly selected isolates (10 from severe colitis group, 9 from diarrhea group) were subjected to further in vitro, cellular examinations. The level of cytotoxicity to Vero cells was significantly higher in isolates from the severe colitis group at both 24 and 48 hours after inoculation (24 and 48 hours, P = 0.042 and 0.033). We observed apoptotic changes that subsequently led to cell death in C. innocuum-infected Vero cells. Tissue damages, necrotic changes and edema were observed in the mouse ileal loop infected by C. innocuum. CONCLUSIONS: The present study suggests that vancomycin-resistant C. innocuum may play a potential role as a causative agent of AAD. The clinical manifestations of AAD caused by C. innocuum were diarrhea or severe colitis, including pseudomembranous colitis.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180219
[Lr] Last revision date:180219
[St] Status:Publisher

  8 / 12933 MEDLINE  
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Coy, Cláudio Saddy Rodrigues
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[PMID]: 29422639
[Au] Autor:Paiva NM; Pascoal LB; Negreiros LMV; Portovedo M; Coope A; Ayrizono MLS; Coy CSR; Milanski M; Leal RF
[Ad] Address:IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil.
[Ti] Title:Ileal pouch of ulcerative colitis and familial adenomatous polyposis patients exhibit modulation of autophagy markers.
[So] Source:Sci Rep;8(1):2619, 2018 Feb 08.
[Is] ISSN:2045-2322
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Total retocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgery of choice for patients with ulcerative colitis (UC) that are refractory to clinical treatment. Pouchitis is one of the most common complications after this procedure. Defects in autophagy have been reported in inflammatory bowel diseases. However, there are no studies on the IP. Therefore, we studied markers for autophagy in the IP mucosa of UC and FAP patients comparing them to controls with a normal distal ileum. Sixteen patients with IP in "J" shape, asymptomatic and with endoscopically normal IP were evaluated. The control group consisted of eight patients with normal colonoscopy. There was a significant decrease in the transcriptional levels of ATG5, MAP1LC3A and BAX in the FAP group. There was also a decrease in the protein level of Beclin-1 in the UC and FAP compared to the control group. Although the LC3II levels by immunoblot were higher in the UC group, LC3/p62 co-localization were lower in the immunofluorescence analysis in the UC and FAP compared to the control group. Corroborating these results, there was an increase of p62 by immunoblot in the UC group. These findings indicated a modulation of macroautophagy markers in the IP, which may explain the mucosa inflammation predisposition.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180218
[Lr] Last revision date:180218
[St] Status:In-Data-Review
[do] DOI:10.1038/s41598-018-20938-5

  9 / 12933 MEDLINE  
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[PMID]: 29444370
[Au] Autor:Kumar A; Chatterjee I; Anbazhagan AN; Jayawardena D; Priyamvada S; Alrefai WA; Sun J; Borthakur A; Dudeja PK
[Ad] Address:Division of Gastroenterology & Hepatology, Department of Medicine, UIC, and Jesse Brown VA Medical Center, Chicago, IL.
[Ti] Title:Cryptosporidium parvum disrupts intestinal epithelial barrier function via altering expression of key tight junction and adherens junction proteins.
[So] Source:Cell Microbiol;, 2018 Feb 14.
[Is] ISSN:1462-5822
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Infection with the protozoan parasite Cryptosporidium parvum (CP) causes cryptosporidiosis, a widespread diarrheal disease. Impaired intestinal epithelial barrier function and increased permeability are most commonly associated with diarrheal diseases caused by enteric infections. However, studies on barrier disruption and underlying mechanisms in cryptosporidiosis are extremely limited. Epithelial tight junctions (TJ) and adherens junctions (AJ) are important in maintaining barrier integrity. Therefore, we examined the effects of CP infection on paracellular permeability and on the expression of the major TJ and AJ proteins utilizing in vitro, ex vivo, and in vivo models. CP infection (0.5 x 10 oocysts/well in Transwell inserts, 24 h) increased paracellular permeability (FITC-dextran flux) in Caco-2 cell monolayers and substantially decreased the protein levels of occludin, claudin 4 and E-cadherin. Claudin 3, zonula occludens-1 (ZO1) and α-catenin were also significantly decreased, whereas claudin 1 and 2 and ß-catenin were not altered. Substantial downregulation of occludin, claudin 4 and E-cadherin was also observed in response to CP infection ex vivo in mouse enteroid-derived monolayers, and in vivo in the ileal and jejunal mocosa of C57BL/6 mice. The mRNA levels of these proteins were also significantly decreased in CP infected mouse ileum and jejunum, but were unaltered in Caco-2 cells. Further, bafilomycin, an inhibitor of lysosomal proton pump, partially abrogated CP effects on occludin expression in Caco-2 cells, suggesting a potential role of posttranslational mechanisms, such as induction of protein degradation pathways, in mediating the effects of the parasite. Our studies suggest that disruption of barrier function via downregulation of specific key components of TJ and AJ could be a major mechanism underlying CP infection-induced diarrhea.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180217
[Lr] Last revision date:180217
[St] Status:Publisher
[do] DOI:10.1111/cmi.12830

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[PMID]: 28595172
[Au] Autor:Cai JX; Barrow J; Parian A; Brant SR; Dudley-Brown S; Efron J; Fang S; Gearhart S; Marohn M; Safar B; Truta B; Wick E; Lazarev M
[Ad] Address:Department of Medicine, Division of Gastroenterology and Hepatology, Meyerhoff Inflammatory Bowel Disease Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
[Ti] Title:Routine Pouchoscopy Prior to Ileostomy Takedown May Not Be Necessary in Patients with Chronic Ulcerative Colitis.
[So] Source:Dig Dis;36(1):72-77, 2018.
[Is] ISSN:1421-9875
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:BACKGROUND: Creation of a J pouch is the gold standard surgical intervention in the treatment of chronic ulcerative colitis (UC). Pouchoscopy prior to ileostomy takedown is commonly performed. We describe the frequency, indication, and findings on pouchoscopy, and determine if pouchoscopy affects rates of complications after takedown. METHODS: All UC or indeterminate inflammatory bowel disease patients with a J pouch were retrospectively evaluated from January 1994 to December 2014. Cases were defined as having routine (asymptomatic) pouchoscopy after pouch creation but before ileostomy takedown. Controls were defined as having no pouchoscopy or pouchoscopy on the same day as that of takedown. RESULTS: The study included 178 patients (81.5% cases, 18.5% controls). Fifty two percent of pouchoscopies were reported as normal. Common abnormal endoscopy findings included stricture (35%), pouchitis (7%), and cuffitis (0.7%). Length of stay during takedown hospitalization was shorter for cases than controls (3 vs. 5 days; p = 0.001), but neither short- nor long-term complications were statistically different between cases and controls. Abnormalities on pouchoscopy were not predictive for short-term complications (p = 0.73) or long-term complications (p = 0.55). Routine pouchoscopy did not delay takedown surgery in any of the included patients. CONCLUSIONS: Routine pouchoscopy may not be necessary prior to ileostomy takedown; its greatest utility is in patients with suspected pouch complications.
[Mh] MeSH terms primary: Colitis, Ulcerative/surgery
Colonic Pouches
Endoscopy
Ileostomy
[Mh] MeSH terms secundary: Adult
Aged
Chronic Disease
Colitis, Ulcerative/complications
Constriction, Pathologic/surgery
Female
Humans
Inflammatory Bowel Diseases/complications
Male
Middle Aged
Postoperative Complications/etiology
Pouchitis/surgery
Retrospective Studies
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180216
[Lr] Last revision date:180216
[Js] Journal subset:IM
[Da] Date of entry for processing:170609
[St] Status:MEDLINE
[do] DOI:10.1159/000475808


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