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[PMID]:29505533
[Au] Autor:Asakura K; Yanai S; Nakamura S; Kawaski K; Eizuka M; Ishida K; Endo M; Sugai T; Migita K; Matsumoto T
[Ad] Endereço:Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University.
[Ti] Título:Familial Mediterranean fever mimicking Crohn disease: A case report.
[So] Source:Medicine (Baltimore);97(1):e9547, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Familial Mediterranean fever (FMF) is the most common form of autoinflammatory disease. We report a rare case of FMF with gastrointestinal lesions mimicking Crohn disease. PATIENT CONCERNS: A 21-year-old Japanese man was referred to our institution, complaining of refractory diarrhea and weight loss of 14 kg during the past two years. He had presented with recurrent fever, abdominal pain, anal fistula and stomatitis. His father and one of his brothers had ulcerative colitis. Colonoscopy revealed longitudinal ulcers in the terminal ileum and aphthous erosions in the colorectum. Esophagogastroduodenoscopy revealed multiple linear erosions in the gastric corpus and circular erosions in the duodenal second portion. Biopsy from these lesions failed to detect epithelioid cell granulomas. DIAGNOSES: Analysis of the genomic DNA revealed compound heterozygous mutations of E148Q/L110P in exon 2 of MEFV gene, suggesting a diagnosis of FMF. INTERVENTIONS: The patient was subsequently given 0.5 mg of colchicine per day. OUTCOMES: Follow-up colonoscopy 6 months later demonstrated that both the longitudinal ulcers in the terminal ileum and aphthous lesions in the colorectum had completely disappeared. LESSONS: Our case suggests that patients with FMF possibly manifest gastrointestinal lesions mimicking Crohn disease.
[Mh] Termos MeSH primário: Doença de Crohn/diagnóstico
Febre Familiar do Mediterrâneo/diagnóstico
[Mh] Termos MeSH secundário: Colonoscopia
Diagnóstico Diferencial
Seres Humanos
Masculino
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009547


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[PMID]:28453767
[Au] Autor:Chu TPC; Moran GW; Card TR
[Ad] Endereço:Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
[Ti] Título:The Pattern of Underlying Cause of Death in Patients with Inflammatory Bowel Disease in England: A Record Linkage Study.
[So] Source:J Crohns Colitis;11(5):578-585, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and Aims: Numerous studies have established that mortality risk in inflammatory bowel disease [IBD] patients is higher than in the general population, but the causes of death have seldom been examined. We aimed to describe causes of death in IBD. Methods: A matched cohort study using UK general practice data from Clinical Practice Research Datalink linked to death registration records. We described the distribution of causes of death among IBD patients by age at death and time since IBD diagnosis. We estimated age-specific mortality rates and hazard ratios of death in multivariable Cox proportional hazards models. Results: 20293 IBD patients were matched to 83261 non IBD patients. The mortality rate was 40% higher in IBD patients [2005 deaths] than in non IBD patients [6024 deaths] (adjusted overall hazard ratio: = 1.4, 95% confidence interval [CI]: = 1.4-1.5], with greater risk of death in Crohn's disease [hazard ratio: = 1.6, 1.5-1.7] than in ulcerative colitis [1.3, 1.3-1.4]. Causes attributable to IBD constituted 3.7% of all deaths in ulcerative colitis and 8.3% in Crohn's disease. Among IBD patients, death was less likely to be due to circulatory, respiratory or neoplastic diseases than among non IBD patients. In both IBD and non IBD patients all these causes became more clinically important with advancing age, with the commonest neoplastic cause of death being lung cancer rather than gastrointestinal cancers. Conclusions: IBD patients have an additional risk of death. Most IBD patients die of circulatory or respiratory causes, and the contribution to mortality from long-term complications of IBD is clinically less important.
[Mh] Termos MeSH primário: Causas de Morte
Doenças Inflamatórias Intestinais/mortalidade
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Criança
Pré-Escolar
Colite Ulcerativa/mortalidade
Doença de Crohn/mortalidade
Atestado de Óbito
Feminino
Seres Humanos
Lactente
Recém-Nascido
Armazenamento e Recuperação da Informação
Masculino
Registros Médicos/estatística & dados numéricos
Meia-Idade
Modelos de Riscos Proporcionais
Reino Unido/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw192


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[PMID]:28453765
[Au] Autor:Marafini I; Monteleone I; Dinallo V; Di Fusco D; De Simone V; Laudisi F; Fantini MC; Di Sabatino A; Pallone F; Monteleone G
[Ad] Endereço:Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy.
[Ti] Título:CCL20 Is Negatively Regulated by TGF-ß1 in Intestinal Epithelial Cells and Reduced in Crohn's Disease Patients With a Successful Response to Mongersen, a Smad7 Antisense Oligonucleotide.
[So] Source:J Crohns Colitis;11(5):603-609, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and Aims: The chemokine CCL20 is over-produced in epithelium of Crohn's disease [CD] patients and contributes to recruiting immune cells to inflamed gut. Tumour necrosis factor-α [TNF-α] is a powerful inducer of CCL20 in intestinal epithelial cells. In CD, high levels of Smad7 block the activity of transforming growth factor-ß1 [TGF-ß1], a negative regulator of TNF signalling. We investigated whether intestinal epithelial cell-derived CCL20 is negatively regulated by TGF-ß1 and whether Smad7 knock-down reduces CCL20 in CD. Methods: CCL20 was evaluated in NCM460, a normal colonic epithelial cell line, stimulated with TGF-ß1 and TNF-α, and in Smad7 over-expressing NCM460 cells. CCL20 and Smad7 expression were assessed in sections of CD intestinal specimens by immunochemistry, and in CD colonic explants treated with mongersen, a Smad7 antisense oligonucleotide. CCL20 was examined in serum samples taken from 95 of 166 active CD patients receiving mongersen or placebo for 2 weeks and participating in a phase II, multicentre, double-blind, placebo-controlled study. Results: CCL20 expression was increased by TNF-α, and this effect was inhibited by TGF-ß1 in NCM460 cells, but not in Smad7 over-expressing NCM460 cells. In CD, epithelium CCL20 and Smad7 co-localised, and treatment of CD explants with mongersen reduced CCL20 production. During follow-up, in responders to mongersen, serum CCL20 levels significantly decreased, whereas patients without response/remission to mongersen and placebo patients did not have change in CCL20. Conclusions: TGF-ß1 reduces intestinal epithelial cell-derived CCL20 production, an effect abrogated by Smad7. CD patients responding to mongersen demonstrated a reduction in serum CCL20.
[Mh] Termos MeSH primário: Quimiocina CCL20/metabolismo
Doença de Crohn/tratamento farmacológico
Mucosa Intestinal/metabolismo
Oligonucleotídeos/uso terapêutico
Proteína Smad7/antagonistas & inibidores
Fator de Crescimento Transformador beta1/metabolismo
[Mh] Termos MeSH secundário: Linhagem Celular
Quimiocina CCL20/sangue
Doença de Crohn/metabolismo
Método Duplo-Cego
Seres Humanos
Mucosa Intestinal/efeitos dos fármacos
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (CCL20 protein, human); 0 (Chemokine CCL20); 0 (GED0301); 0 (Oligonucleotides); 0 (SMAD7 protein, human); 0 (Smad7 Protein); 0 (Transforming Growth Factor beta1)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw191


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[PMID]:28453763
[Au] Autor:Zittan E; Kabakchiev B; Kelly OB; Milgrom R; Nguyen GC; Croitoru K; Steinhart AH; Silverberg MS
[Ad] Endereço:Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.
[Ti] Título:Development of the Harvey-Bradshaw Index-pro (HBI-PRO) Score to Assess Endoscopic Disease Activity in Crohn's Disease.
[So] Source:J Crohns Colitis;11(5):543-548, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: There is a need for better, less-invasive disease activity indices that provide a representative assessment of endoscopic disease activity. We developed a new clinical score that incorporates the Harvey-Bradshaw index [HBI] with modified patient-reported outcomes [PROp] and physician [clinician]-reported outcomes [PROc] and assessed its ability to measure endosopic disease activity in ileocolonic Crohn's disease [CD]. Methods: A cohort of 88 CD patients undergoing colonoscopy was accrued in a prospective fashion. In total, 48 of the subjects were CD cases and 40 had already undergone a post-operative ileocolonic resection [post-op CD]. Each patient underwent multiple, endoscopist-blinded assessments including: HBI score, a PROp question asking for patient perception of disease activity status, a PROc question for clinician perception of disease activity status and C-reactive protein [CRP]. Active endoscopic disease was defined as Simple Endoscopic Score for CD [SES-CD] ≥ 3 for CD subjects and Rutgeerts score > i1 for post-op CD subjects. Results: Clinical remission as defined by the HBI did not accurately reflect endoscopic remission as defined by the SES-CD (area under the curve [AUC] = 0.54). Combining the HBI with PROp and PROc scores and then further adding CRP significantly improved the correlation with SES-CD [AUC = 0.78 and AUC = 0.88, respectively, p < 0.00001]. In post-op CD, HBI-defined remission also performed poorly against endoscopic remission defined by the Rutgeerts score [AUC = 0.52]. Combining HBI with PROp and the PROc scores and then further adding CRP did not significantly improve the model [AUC = 0.65 and AUC = 0.61, respectively, p = NS]. Conclusion: In CD, the HBI correlates poorly with endoscopic disease activity. However, the HBI-PRO score, which incorporated PROp, PROc, CRP and HBI, significantly improved its ability to predict endoscopic activity in ileocolonic CD without prior surgery.
[Mh] Termos MeSH primário: Colonoscopia
Doença de Crohn/patologia
Índice de Gravidade de Doença
[Mh] Termos MeSH secundário: Adulto
Colo/patologia
Colo/cirurgia
Colonoscopia/métodos
Doença de Crohn/cirurgia
Feminino
Seres Humanos
Masculino
Indução de Remissão
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw200


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[PMID]:28453762
[Au] Autor:Melesse DY; Lix LM; Nugent Z; Targownik LE; Singh H; Blanchard JF; Bernstein CN
[Ad] Endereço:University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Canada.
[Ti] Título:Estimates of Disease Course in Inflammatory Bowel Disease Using Administrative Data: A Population-level Study.
[So] Source:J Crohns Colitis;11(5):562-570, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and Aims: We sought develop a predictive model of disease course in inflammatory bowel disease [IBD] using health care utilization measures from administrative health data, and to apply this model to estimate disease course at a population level over time. Methods: Study participants were IBD patients who were prospectively followed for a 1-year period between 2009 and 2010 in a Canadian clinic setting to assess their IBD disease course [i.e. remission, mild, moderate, severe]. Clinic data were linked with population-based administrative health data. A multivariable partial proportional odds model tested health care utilization measures that discriminated disease course groups. The model was applied to project the distribution of disease course for the Manitoba IBD population for 1995-2013. Results: There were 407 participants (54.3% females, 64.4% Crohn's disease [CD]) with mean age at diagnosis of 29.8 years [SD 14.9]. Forty-one per cent of participants were clinically in remission, while 14.0% had severe IBD. Mild, moderate or severe disease was associated with three or more gastroenterologist visits (odds ratio [OR] = 3.33, 95% confidence interval [CI]: 2.03-5.54) or three or more general practitioner visits [OR = 2.97, 95% CI: 1.44-6.37] with an IBD diagnosis and ≥1 radiology test [OR = 2.22, 95% CI: 1.31-3.80]. The percentages of the Manitoba IBD population in remission rose steadily from 1995 to 2013 [43.6 to 59.9%], while the percentages of individuals with mild, moderate or severe disease declined. Conclusion: This study demonstrated that health care utilization measures from administrative data can be used to predict disease course in the IBD population.
[Mh] Termos MeSH primário: Doenças Inflamatórias Intestinais/patologia
[Mh] Termos MeSH secundário: Adulto
Colite Ulcerativa/diagnóstico
Colite Ulcerativa/patologia
Doença de Crohn/diagnóstico
Doença de Crohn/patologia
Progressão da Doença
Feminino
Seres Humanos
Doenças Inflamatórias Intestinais/diagnóstico
Masculino
Prognóstico
Estudos Prospectivos
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw201


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[PMID]:28453758
[Au] Autor:Daperno M; Comberlato M; Bossa F; Armuzzi A; Biancone L; Bonanomi AG; Cosintino R; Lombardi G; Mangiarotti R; Papa A; Pica R; Grassano L; Pagana G; D'Incà R; Orlando A; Rizzello F; IGIBDEndo Group
[Ad] Endereço:Gastroenterology Unit, AO Ordine Mauriziano, Torino, TO, Italy.
[Ti] Título:Training Programs on Endoscopic Scoring Systems for Inflammatory Bowel Disease Lead to a Significant Increase in Interobserver Agreement Among Community Gastroenterologists.
[So] Source:J Crohns Colitis;11(5):556-561, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and Aims: Endoscopic outcomes are increasingly used in clinical trials and in routine practice for inflammatory bowel disease [IBD] in order to reach more objective patient evaluations than possible using only clinical features. However, reproducibility of endoscopic scoring systems used to categorize endoscopic activity has been reported to be suboptimal. The aim of this study was to analyse the inter-rated agreement of non-dedicated gastroenterologists on IBD endoscopic scoring systems, and to explore the effects of a dedicated training programme on agreement. Methods: A total of 237 physicians attended training courses on IBD endoscopic scoring systems, and they independently scored a set of IBD endoscopic videos for ulcerative colitis [with Mayo endoscopic subscore], post-operative Crohn's disease [with Rutgeerts score] and luminal Crohn's disease (with the Simple Endoscopic Score for Crohn's Disease [SESCD] and Crohn's Endoscopic Index of Severity [CDEIS]). A second round of scoring was collected after discussion about determinants of discrepancy. Interobserver agreement was measured by means of the Fleiss' kappa [kappa] or intraclass correlation coefficient [ICC] as appropriate. Results: The inter-rater agreement increased from kappa 0.51 (95% confidence interval [95% CI] 0.48-0.55) to 0.76 [95% CI 0.72-0.79] for the Mayo endoscopic subscore, and from 0.45 [95% CI 0.40-0.50] to 0.79 [0.74-0.83] for the Rutgeerts score before and after the training programme, respectively, and both differences were significant [P < 0.0001]. The ICC was 0.77 [95% CI 0.56-0.96] for SESCD and 0.76 [0.54- 0.96] for CDEIS, respectively, with only one measurement. Discussion: The basal inter-rater agreement of inexperienced gastroenterologists focused on IBD management is moderate; however, a dedicated training programme can significantly impact on inter-rater agreement, increasing it to levels expected among expert central reviewers.
[Mh] Termos MeSH primário: Colonoscopia/educação
Gastroenterologistas/educação
Doenças Inflamatórias Intestinais/diagnóstico
[Mh] Termos MeSH secundário: Colite Ulcerativa/diagnóstico
Colite Ulcerativa/patologia
Doença de Crohn/diagnóstico
Doença de Crohn/patologia
Educação Médica Continuada/métodos
Gastroenterologistas/estatística & dados numéricos
Seres Humanos
Doenças Inflamatórias Intestinais/patologia
Variações Dependentes do Observador
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw181


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[PMID]:28453757
[Au] Autor:Bequet E; Sarter H; Fumery M; Vasseur F; Armengol-Debeir L; Pariente B; Ley D; Spyckerelle C; Coevoet H; Laberenne JE; Peyrin-Biroulet L; Savoye G; Turck D; Gower-Rousseau C; EPIMAD Group
[Ad] Endereço:Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France.
[Ti] Título:Incidence and Phenotype at Diagnosis of Very-early-onset Compared with Later-onset Paediatric Inflammatory Bowel Disease: A Population-based Study [1988-2011].
[So] Source:J Crohns Colitis;11(5):519-526, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and Aims: Very-early-onset inflammatory bowel disease [VEO-IBD] is a form of IBD that is distinct from that of children with an older onset. We compared changes over time in the incidence and phenotype at diagnosis between two groups according to age at IBD diagnosis: VEO-IBD diagnosed before the age of 6 years, and early-onset IBD [EO-IBD] diagnosed between 6 and 16 years of age. Methods: Data were obtained from a cohort enrolled in a prospective French population-based registry from 1988 to 2011. Results: Among the 1412 paediatric cases [< 17 years], 42 [3%] were VEO-IBD. In the VEO-IBD group, the incidence remained stable over the study period. In contrast, the incidence of EO-IBD increased from 4.4/105 in 1988-1990 to 9.5/105 in 2009-2011 [+116%; p < 10-4]. Crohn's disease [CD] was the most common IBD, regardless of age, but ulcerative colitis [UC] and unclassified IBD were more common in VEO-IBD cases [40% vs 26%; p = 0.04]. VEO-IBD diagnosis was most often performed in hospital [69% vs 43%; p < 10-3]. Rectal bleeding and mucous stools were more common in patients with VEO-IBD, whereas weight loss and abdominal pain were more frequent in those with EO-IBD. Regarding CD, isolated colonic disease was more common in the VEO-IBD group [39% vs 14%; p = 0.003]. Conclusions: In this large population-based cohort, the incidence of VEO-IBD was low and stable from 1988 to 2011, with a specific clinical presentation. These results suggest a probable genetic origin for VEO-IBD, whereas the increase in EO-IBD might be linked to environmental factors.
[Mh] Termos MeSH primário: Doenças Inflamatórias Intestinais/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Idade de Início
Criança
Pré-Escolar
Colite Ulcerativa/diagnóstico
Colite Ulcerativa/epidemiologia
Colite Ulcerativa/patologia
Doença de Crohn/diagnóstico
Doença de Crohn/epidemiologia
Doença de Crohn/patologia
Feminino
França/epidemiologia
Seres Humanos
Incidência
Doenças Inflamatórias Intestinais/diagnóstico
Doenças Inflamatórias Intestinais/patologia
Masculino
Fenótipo
Estudos Prospectivos
Sistema de Registros
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw194


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[PMID]:28453756
[Au] Autor:Hovde Ø; Høivik ML; Henriksen M; Solberg IC; Småstuen MC; Moum BA
[Ad] Endereço:Department of Gastroenterology, Innlandet Hospital Trust, Gjøvik, Norway.
[Ti] Título:Malignancies in Patients with Inflammatory Bowel Disease: Results from 20 Years of Follow-up in the IBSEN Study.
[So] Source:J Crohns Colitis;11(5):571-577, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and Aims: Whether patients with inflammatory bowel diseases [IBDs] have increased risk of developing cancer has been debated. The aims of the study were to determine the prevalence of intestinal/extraintestinal cancers in an IBD cohort 20 years after diagnosis and to assess whether these patients had an increased cancer-specific risk compared with a matched control population. Methods: Patients with ulcerative colitis [UC] and Crohn's disease [CD] diagnosed 1990-1993 have been prospectively followed up for 20 years. Follow-up visits were carried out 1, 5, 10, and 20 years after inclusion. Data on all cancer cases, deaths, and causes of death were collected from the Cancer Registry of Norway and from the Norwegian Cause of Death Registry. Results: In all, 756 patients [519 UC and 237 CD] were diagnosed with IBD. Increased risk of cancer was seen in UC patients (hazard ratio [HR] = 1.40, 95% confidence interval [CI] 1.08-1.81, p < 0.01), but not in CD patients [HR = 1.23, 95% CI 0.80-2.03, p = 0.30]. Stratified by gender, our data revealed a statistically increased risk for all cancers only in male UC patients compared with the controls [HR = 1.51, 95% CI 1.08-2.11, p = 0.017]. In both groups breast cancer was seen more often than expected. Conclusions: Male UC patients display an increased risk of development of colorectal cancer and, also all cancers combined, compared with the controls. In both UC and CD, standardized incidence ratio for breast cancer was increased.
[Mh] Termos MeSH primário: Doenças Inflamatórias Intestinais/complicações
Neoplasias Intestinais/epidemiologia
Neoplasias/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Causas de Morte
Criança
Pré-Escolar
Colite Ulcerativa/complicações
Doença de Crohn/complicações
Feminino
Seguimentos
Seres Humanos
Neoplasias Intestinais/etiologia
Masculino
Meia-Idade
Neoplasias/etiologia
Neoplasias/mortalidade
Noruega/epidemiologia
Sistema de Registros
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw193


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[PMID]:28453755
[Au] Autor:Davidov Y; Ungar B; Bar-Yoseph H; Carter D; Haj-Natour O; Yavzori M; Chowers Y; Eliakim R; Ben-Horin S; Kopylov U
[Ad] Endereço:Department of Gastroenterology, Sheba Medical Center, Tel-Aviv, Israel.
[Ti] Título:Association of Induction Infliximab Levels With Clinical Response in Perianal Crohn's Disease.
[So] Source:J Crohns Colitis;11(5):549-555, 2017 May 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: The association of infliximab [IFX] trough levels with clinical and endoscopic outcomes in inflammatory bowel disease is well established. However, there is scarce data regarding the association of perianal fistula response with IFX. The aim of this study was to establish whether early induction infliximab levels and anti-infliximab antibodies [ATIs] are associated with perianal fistula response. Methods: Consecutive CD patients with perianal fistulae that were treated with IFX between 2008 and 2016 were included in the study. Response was defined as cessation or significant improvement of fistula drainage. Patients with unavailable IFX level or ATI measurements and/or missing clinical follow-up at Week 14 were excluded. Results: A total of 36 patients with perianal fistulae were included; 25/36 [69.4%] responded to treatment by Week 14. The median induction IFX levels at Weeks 2, 6 and 14 in the responders group at Week 14 were higher compared with those of the non-responders group [20/5.6 µg/mL, P = 0.0001; 13.3/2.55 µg/mL P = 0.0001; 4.1/0.14 µg/mL, P = 0.01]. On multivariate analysis, IFX leve at Weeks 2 and 6 were significantly associated with fistula response at Weeks 14 and 30. IFX drug levels of 9.25 µg/mL at Week 2 and 7.25 µg/mL at Week 6 were the best predictors of fistula response. Conclusion: High IFX trough levels during induction are associated with favorable fistula response to anti-TNF treatment. If validated in a larger prospective study, our findings may help guide anti-TNF treatment in patients with perianal CD, and suggest serum level-guided treatment escalation in non-responders or prompt changing of biologic treatment in non-responders.
[Mh] Termos MeSH primário: Doença de Crohn/tratamento farmacológico
Fármacos Gastrointestinais/uso terapêutico
Infliximab/uso terapêutico
Fístula Retal/etiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Doença de Crohn/complicações
Feminino
Fármacos Gastrointestinais/administração & dosagem
Fármacos Gastrointestinais/sangue
Seres Humanos
Infliximab/administração & dosagem
Infliximab/sangue
Masculino
Fístula Retal/tratamento farmacológico
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Gastrointestinal Agents); B72HH48FLU (Infliximab)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw182


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[PMID]:29295985
[Au] Autor:Conrad C; Di Domizio J; Mylonas A; Belkhodja C; Demaria O; Navarini AA; Lapointe AK; French LE; Vernez M; Gilliet M
[Ad] Endereço:Department of Dermatology, University Hospital CHUV, Lausanne, 1011, Switzerland. curdin.conrad@chuv.ch.
[Ti] Título:TNF blockade induces a dysregulated type I interferon response without autoimmunity in paradoxical psoriasis.
[So] Source:Nat Commun;9(1):25, 2018 01 02.
[Is] ISSN:2041-1723
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Although anti-tumor necrosis factor (TNF) agents are highly effective in the treatment of psoriasis, 2-5% of treated patients develop psoriasis-like skin lesions called paradoxical psoriasis. The pathogenesis of this side effect and its distinction from classical psoriasis remain unknown. Here we show that skin lesions from patients with paradoxical psoriasis are characterized by a selective overexpression of type I interferons, dermal accumulation of plasmacytoid dendritic cells (pDC), and reduced T-cell numbers, when compared to classical psoriasis. Anti-TNF treatment prolongs type I interferon production by pDCs through inhibition of their maturation. The resulting type I interferon overexpression is responsible for the skin phenotype of paradoxical psoriasis, which, unlike classical psoriasis, is independent of T cells. These findings indicate that paradoxical psoriasis represents an ongoing overactive innate inflammatory process, driven by pDC-derived type I interferon that does not lead to T-cell autoimmunity.
[Mh] Termos MeSH primário: Anticorpos Monoclonais/imunologia
Autoimunidade/imunologia
Interferon Tipo I/imunologia
Psoríase/imunologia
Fator de Necrose Tumoral alfa/imunologia
[Mh] Termos MeSH secundário: Adalimumab/efeitos adversos
Adalimumab/imunologia
Adalimumab/uso terapêutico
Adolescente
Adulto
Idoso
Animais
Anticorpos Monoclonais/efeitos adversos
Anticorpos Monoclonais/uso terapêutico
Autoimunidade/efeitos dos fármacos
Células Cultivadas
Doença de Crohn/tratamento farmacológico
Doença de Crohn/imunologia
Doença de Crohn/metabolismo
Citocinas/genética
Citocinas/imunologia
Citocinas/metabolismo
Células Dendríticas/efeitos dos fármacos
Células Dendríticas/imunologia
Células Dendríticas/metabolismo
Feminino
Seres Humanos
Infliximab/efeitos adversos
Infliximab/imunologia
Infliximab/uso terapêutico
Interferon Tipo I/genética
Interferon Tipo I/metabolismo
Masculino
Camundongos Endogâmicos BALB C
Meia-Idade
Psoríase/induzido quimicamente
Linfócitos T/efeitos dos fármacos
Linfócitos T/imunologia
Linfócitos T/metabolismo
Fator de Necrose Tumoral alfa/antagonistas & inibidores
Fator de Necrose Tumoral alfa/metabolismo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 0 (Cytokines); 0 (Interferon Type I); 0 (Tumor Necrosis Factor-alpha); B72HH48FLU (Infliximab); FYS6T7F842 (Adalimumab)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1038/s41467-017-02466-4



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