AIM： TO explore if C-reactive protein （CRP） levels might serve as a prognostic factor with respect to the clinical course of Crohn＇s disease and might be useful for classification. METHODS： In this retrospective ...AIM： TO explore if C-reactive protein （CRP） levels might serve as a prognostic factor with respect to the clinical course of Crohn＇s disease and might be useful for classification. METHODS： In this retrospective cohort study we enrolled 94 patients from the inflammatory bowel disease （IBD） database of the University Medical Centre Utrecht. CRP levels during relapse were correlated with the number of relapses per year. Severity of relapses was based on endoscopic reports and prednisone use. Furthermore, patients were categorized in a low or high CRP group based on their CRP response during relapse and demographic and clinical features were compared. RESULTS： Overall, a positive correlation between CRP levels, number of relapses, and severity of relapse was found （respectively rs = 0.31, P 〈 0.01 and rs = 0.50, P 〈 0.001）. Employing a cut-off level of 15 mg/L, the index CRP level was found to discriminate patients with respect to the number of relapses per year, as well as for severity of relapses （respectively 0.25 ± 0.16 vs 0.36 ± 0.24, P 〈 0.05 and 4.4 ± 1.2 vs 3.2 ± 1.1 on a 10-point visual analogue scale, P 〈 0.001 for the high CRP and low CRP groups respectively）. In addition, the high CRP group showed more cumulative days of prednisone use per year （107 ± 95 vs 58 ± 48, P 〈 0.05）, as well as a better response to infiiximab （93 % vs 33 %, P = 0.06）. CONCLUSION： A higher CRP level during relapse seems to be associated with a more severe clinical course of disease.展开更多
AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. R...AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS: The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION: Most Dutch gastroenterologists performendoscopic surveillance without following international recommended guidelines. This practice potentially leads to a decreased sensitivity for dysplasia, rendering screening for colorectal cancer in this population highly ineffective.展开更多
AIM: To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn's disease (CD) patients. METHODS: Fourteen CD patients were blinded for treatment and received placebo at baseline, and inf...AIM: To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn's disease (CD) patients. METHODS: Fourteen CD patients were blinded for treatment and received placebo at baseline, and infliximab 2 wk later, with a follow-up of 4 wk. Blood samples were drawn on a regular basis, and questionnaires on fatigue, depression, quality of life, and clinical disease activity were completed at regular intervals. RESULTS: After placebo infusion, fatigue scores decreased within 3 d (3.5 points±1.1, P≤0.01), but returned to baseline values 14 d after this infusion. The drop of fatigue scores following infliximab infusion sustained until the end of the study (3.8 points±1.4, P≤0.05). Quality of life was increased at the end of the study compared to baseline values (138.6±9.4 vs 179.4±6.7; P≤0.005), whereas depression scores were decreased (20.4±9.4 vs 11.3±2.2; P≤0.01). No correlation between the severity of fatigue and the level of cytokines was observed. CONCLUSION: The reduction of fatigue after infliximab infusion is subjective to a placebo effect. The effect of infliximab on fatigue, however, persists while the placebo effect disappears after a short period of time. A clear role of cytokines could not be substantiated.展开更多
AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD),and to assess risk factors associated with work disability.METHODS For this retrospective cohort study,we retrieved clinical data f...AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD),and to assess risk factors associated with work disability.METHODS For this retrospective cohort study,we retrieved clinical data from the Dutch IBD Biobank on July 2014,containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands.Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population.Multivariate analyses were performed for work disability(sick leave,partial and full disability)and long-term full work disability(>80%work disability for>2 years).RESULTS Prevalence of work disability was higher in Crohn's disease(CD)(29%)and ulcerative colitis(UC)(19%)patients compared to the general Dutch population(7%).In all IBD patients,female sex,a lower education level,and extra-intestinal manifestations,were associated with work disability.In CD patients,an age>40 years at diagnosis,disease duration>15 years,smoking,surgical interventions,and anti-TNFαuse were associated with work disability.In UC patients,an age>55 years,and immunomodulator use were associated with work disability.In CD patients,a lower education level(OR=1.62,95%CI:1.02-2.58),and in UC patients,disease complications(OR=3.39,95%CI:1.09-10.58)were associated with long-term full work disability.CONCLUSION The prevalence of work disability in IBD patients is higher than in the general Dutch population.Early assessment of risk factors for work disability is necessary,as work disability is substantial among IBD patients.展开更多
AIM:To investigate adherence rates in tumor necrosis factor-α (TNF-α)-inhibitors in Crohn's disease (CD) and rheumatoid arthritis (RA) by systematic review of medical literature. METHODS:A structured search of P...AIM:To investigate adherence rates in tumor necrosis factor-α (TNF-α)-inhibitors in Crohn's disease (CD) and rheumatoid arthritis (RA) by systematic review of medical literature. METHODS:A structured search of PubMed between 2001 and 2011 was conducted to identify publications that assessed treatment with TNF-α inhibitors providing data about adherence in CD and RA. Therapeutic agents of interest where adalimumab, infliximab and etanercept, since these are most commonly used for both diseases. Studies assessing only drug survival or continuation rates were excluded. Data describing adherence with TNF-α inhibitors were extracted for each selected study. Given the large variation between definitions of measurement of adherence, the definitions as used by the authors where used in our calculations. Data were tabulated and also presented descriptively. Sample size-weighted pooled proportions of patients adherent to therapy and their 95%CI were calculated.To compare adherence between infliximab, adalimumab and etanercept, the adherence rates where graphed alongside two axes. Possible determinants of adherence were extracted from the selected studies and tabulated using the presented OR. RESULTS:Three studies on CD and three on RA were identified, involving a total of 8147 patients (953 CD and 7194 RA). We identified considerable variation in the definitions and methodologies of measuring adherence between studies. The calculated overall sample size-weighted pooled proportion for adherence to TNF-α inhibitors in CD was 70% (95%CI:67%-73%) and 59% in RA (95%CI:58%-60%). In CD the adherence rate for infliximab (72%) was highercompared to adalimumab (55%), with a relative risk of 1.61 (95%CI:1.27-2.03), whereas in RA adherence for adalimumab (67%) was higher compared to both infliximab (48%) and etanercept (59%), with a relative risk of 1.41 (95%CI:1.3-1.52) and 1.13 (95%CI:1.10-1.18) respectively. In comparative studies in RA adherence to infliximab was better than etanercept and etanercept did better than adalimumab. In three studies, the most consistent factor associated with lower adherence was female gender. Results for age, immunomodulator use and prior TNF-α inhibitors use were conflicting. CONCLUSION:One-third of both CD and RA patients treated with TNF-α inhibitors are non-adherent. Female gender was consistently identified as a negative determinant of adherence.展开更多
文摘AIM： TO explore if C-reactive protein （CRP） levels might serve as a prognostic factor with respect to the clinical course of Crohn＇s disease and might be useful for classification. METHODS： In this retrospective cohort study we enrolled 94 patients from the inflammatory bowel disease （IBD） database of the University Medical Centre Utrecht. CRP levels during relapse were correlated with the number of relapses per year. Severity of relapses was based on endoscopic reports and prednisone use. Furthermore, patients were categorized in a low or high CRP group based on their CRP response during relapse and demographic and clinical features were compared. RESULTS： Overall, a positive correlation between CRP levels, number of relapses, and severity of relapse was found （respectively rs = 0.31, P 〈 0.01 and rs = 0.50, P 〈 0.001）. Employing a cut-off level of 15 mg/L, the index CRP level was found to discriminate patients with respect to the number of relapses per year, as well as for severity of relapses （respectively 0.25 ± 0.16 vs 0.36 ± 0.24, P 〈 0.05 and 4.4 ± 1.2 vs 3.2 ± 1.1 on a 10-point visual analogue scale, P 〈 0.001 for the high CRP and low CRP groups respectively）. In addition, the high CRP group showed more cumulative days of prednisone use per year （107 ± 95 vs 58 ± 48, P 〈 0.05）, as well as a better response to infiiximab （93 % vs 33 %, P = 0.06）. CONCLUSION： A higher CRP level during relapse seems to be associated with a more severe clinical course of disease.
文摘AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS: The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION: Most Dutch gastroenterologists performendoscopic surveillance without following international recommended guidelines. This practice potentially leads to a decreased sensitivity for dysplasia, rendering screening for colorectal cancer in this population highly ineffective.
文摘AIM: To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn's disease (CD) patients. METHODS: Fourteen CD patients were blinded for treatment and received placebo at baseline, and infliximab 2 wk later, with a follow-up of 4 wk. Blood samples were drawn on a regular basis, and questionnaires on fatigue, depression, quality of life, and clinical disease activity were completed at regular intervals. RESULTS: After placebo infusion, fatigue scores decreased within 3 d (3.5 points±1.1, P≤0.01), but returned to baseline values 14 d after this infusion. The drop of fatigue scores following infliximab infusion sustained until the end of the study (3.8 points±1.4, P≤0.05). Quality of life was increased at the end of the study compared to baseline values (138.6±9.4 vs 179.4±6.7; P≤0.005), whereas depression scores were decreased (20.4±9.4 vs 11.3±2.2; P≤0.01). No correlation between the severity of fatigue and the level of cytokines was observed. CONCLUSION: The reduction of fatigue after infliximab infusion is subjective to a placebo effect. The effect of infliximab on fatigue, however, persists while the placebo effect disappears after a short period of time. A clear role of cytokines could not be substantiated.
基金Supported by the Netherlands Organisation for Scientific Research,VIDI grant No.016.136.308 to Weersma RKCareer Development grant of the Dutch Digestive Foundation,No.CDG 14-04 to Festen EAM
文摘AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD),and to assess risk factors associated with work disability.METHODS For this retrospective cohort study,we retrieved clinical data from the Dutch IBD Biobank on July 2014,containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands.Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population.Multivariate analyses were performed for work disability(sick leave,partial and full disability)and long-term full work disability(>80%work disability for>2 years).RESULTS Prevalence of work disability was higher in Crohn's disease(CD)(29%)and ulcerative colitis(UC)(19%)patients compared to the general Dutch population(7%).In all IBD patients,female sex,a lower education level,and extra-intestinal manifestations,were associated with work disability.In CD patients,an age>40 years at diagnosis,disease duration>15 years,smoking,surgical interventions,and anti-TNFαuse were associated with work disability.In UC patients,an age>55 years,and immunomodulator use were associated with work disability.In CD patients,a lower education level(OR=1.62,95%CI:1.02-2.58),and in UC patients,disease complications(OR=3.39,95%CI:1.09-10.58)were associated with long-term full work disability.CONCLUSION The prevalence of work disability in IBD patients is higher than in the general Dutch population.Early assessment of risk factors for work disability is necessary,as work disability is substantial among IBD patients.
文摘AIM:To investigate adherence rates in tumor necrosis factor-α (TNF-α)-inhibitors in Crohn's disease (CD) and rheumatoid arthritis (RA) by systematic review of medical literature. METHODS:A structured search of PubMed between 2001 and 2011 was conducted to identify publications that assessed treatment with TNF-α inhibitors providing data about adherence in CD and RA. Therapeutic agents of interest where adalimumab, infliximab and etanercept, since these are most commonly used for both diseases. Studies assessing only drug survival or continuation rates were excluded. Data describing adherence with TNF-α inhibitors were extracted for each selected study. Given the large variation between definitions of measurement of adherence, the definitions as used by the authors where used in our calculations. Data were tabulated and also presented descriptively. Sample size-weighted pooled proportions of patients adherent to therapy and their 95%CI were calculated.To compare adherence between infliximab, adalimumab and etanercept, the adherence rates where graphed alongside two axes. Possible determinants of adherence were extracted from the selected studies and tabulated using the presented OR. RESULTS:Three studies on CD and three on RA were identified, involving a total of 8147 patients (953 CD and 7194 RA). We identified considerable variation in the definitions and methodologies of measuring adherence between studies. The calculated overall sample size-weighted pooled proportion for adherence to TNF-α inhibitors in CD was 70% (95%CI:67%-73%) and 59% in RA (95%CI:58%-60%). In CD the adherence rate for infliximab (72%) was highercompared to adalimumab (55%), with a relative risk of 1.61 (95%CI:1.27-2.03), whereas in RA adherence for adalimumab (67%) was higher compared to both infliximab (48%) and etanercept (59%), with a relative risk of 1.41 (95%CI:1.3-1.52) and 1.13 (95%CI:1.10-1.18) respectively. In comparative studies in RA adherence to infliximab was better than etanercept and etanercept did better than adalimumab. In three studies, the most consistent factor associated with lower adherence was female gender. Results for age, immunomodulator use and prior TNF-α inhibitors use were conflicting. CONCLUSION:One-third of both CD and RA patients treated with TNF-α inhibitors are non-adherent. Female gender was consistently identified as a negative determinant of adherence.
