Biologic agents have now been used in the management of inflammatory bowel disease(IBD)for many years where experience,expertise and confidence in their use has developed over time.In the United Kingdom,there are well...Biologic agents have now been used in the management of inflammatory bowel disease(IBD)for many years where experience,expertise and confidence in their use has developed over time.In the United Kingdom,there are well established guidelines and recommendations for both single agent biologic treatments,and with combination therapy of a biologic agent with a small molecule agent in maintenance therapy.In recent times,there has been increasing interest and experience using dual biologic therapy(DBT)in IBD,primarily in difficult to treat and refractory cases with high disease burden.However,published data on use,experience and safety profiles is limited and large-scale studies remain low in number in this developing area.We therefore aim to present a summary and review of the available published data in this area to help us better understand the emerging role of DBT in IBD.展开更多
As medical care progresses and the number of patients with chronic conditions increases there is the inevitable challenge of managing patients with multiple comorbidities.Inflammatory bowel disease(IBD)is an umbrella ...As medical care progresses and the number of patients with chronic conditions increases there is the inevitable challenge of managing patients with multiple comorbidities.Inflammatory bowel disease(IBD)is an umbrella term for are inflammatory conditions affecting the gastrointestinal tract,the two most common forms being Ulcerative Colitis and Crohn’s disease.These diseases,usually diagnosed in young adults,exhibit a relapsing and remitting course and usually require longterm treatment.IBD can be treated with a number of topical and systemic treatments.We conducted a review of the current published evidence for the effects these medications can have on diabetes mellitus(DM)and glycaemic control.Searches were conducted on medline and embase with a timeframe from 1947(the date from which studies on embase are recorded)to November 2020.Suitable publications were selected and reviewed.Current evidence of the impact of aminosalicylates,corticosteroids,thiopurines,and biologic agents was reviewed.Though there was limited evidence for certain agents,IBD medications have been shown to have an effect of DM and these effects should be considered in managing patients with dual pathologies.The effects of steroids on blood sugar control is well documented,but consideration of other agents is also important.In patients requiring steroids for Ulcerative Colitis,locally acting steroid agents delivered rectally may be preferred to minimise side effects in those with distal bowel Ulcerative Colitis.A switch to other agents should be considered as soon as possible in people with diabetes to limit the impact on glycaemic control.5-aminosalicylates appear to play a role in the reduction of hemoglobin A1c(HbA1c),although the literature suggests these may be falsely low readings.Consequently,monitoring of people with diabetes on these agents may require daily monitoring of capillary blood sugars rather than relying simply on HbA1c;for example fructosamine performed 3-6 monthly,although this risks missing the rise in readings.There is only limited evidence of the effects of thiopurines on diabetes and further investigation is needed into the possible relationship between them.However,given the current available evidence it may be preferable to commence patients with diabetes on thiopurines as soon as possible,whilst also monitoring for side effects such as pancreatitis.There appears to be more evidence supporting a link between tumor necrosis factor-αinhibitors and DM.Both infliximab and adalimumab have evidence suggesting that both can cause reduced blood sugar levels.Further studies on the effects of the various biological agents mentioned are required alongside any novel biologic therapy and the impact of dual biologic therapy in the future.展开更多
Microscopic enteritis(ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms,nutrient and micronutrient deficiency.It is characterised by microscopic or sub-microscopic abnormaliti...Microscopic enteritis(ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms,nutrient and micronutrient deficiency.It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy.This work recognises a need to characterize disorders with microscopic and submicroscopic features,currently regarded as functional or non-specific entities,to obtain further understanding of their clinical relevance.The consensus working party reviewed statements about the aetiology,diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment.Following the 5th International Course in Digestive Pathology in Bucharest in November 2012,an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME.A five-step agreement scale(from strong agreement to strong disagreement) was used to score 21 statements,independently.There was strong agreement on all statements about ME histology(95%-100%).Statements concerning diagnosis achieved 85% to 100% agreement.A statement on the management of ME elicited agreement from the lowest rate(60%) up to 100%.The remaining two categories showed general agreement between experts on clinical presentation(75%-95%) and pathogenesis(80%-90%) of ME.There was strong agreement on the histological definition of ME.Weaker agreement on management indicates a need for further investigations,better definitions and clinical trials to produce quality guidelines for management.This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.展开更多
文摘Biologic agents have now been used in the management of inflammatory bowel disease(IBD)for many years where experience,expertise and confidence in their use has developed over time.In the United Kingdom,there are well established guidelines and recommendations for both single agent biologic treatments,and with combination therapy of a biologic agent with a small molecule agent in maintenance therapy.In recent times,there has been increasing interest and experience using dual biologic therapy(DBT)in IBD,primarily in difficult to treat and refractory cases with high disease burden.However,published data on use,experience and safety profiles is limited and large-scale studies remain low in number in this developing area.We therefore aim to present a summary and review of the available published data in this area to help us better understand the emerging role of DBT in IBD.
文摘As medical care progresses and the number of patients with chronic conditions increases there is the inevitable challenge of managing patients with multiple comorbidities.Inflammatory bowel disease(IBD)is an umbrella term for are inflammatory conditions affecting the gastrointestinal tract,the two most common forms being Ulcerative Colitis and Crohn’s disease.These diseases,usually diagnosed in young adults,exhibit a relapsing and remitting course and usually require longterm treatment.IBD can be treated with a number of topical and systemic treatments.We conducted a review of the current published evidence for the effects these medications can have on diabetes mellitus(DM)and glycaemic control.Searches were conducted on medline and embase with a timeframe from 1947(the date from which studies on embase are recorded)to November 2020.Suitable publications were selected and reviewed.Current evidence of the impact of aminosalicylates,corticosteroids,thiopurines,and biologic agents was reviewed.Though there was limited evidence for certain agents,IBD medications have been shown to have an effect of DM and these effects should be considered in managing patients with dual pathologies.The effects of steroids on blood sugar control is well documented,but consideration of other agents is also important.In patients requiring steroids for Ulcerative Colitis,locally acting steroid agents delivered rectally may be preferred to minimise side effects in those with distal bowel Ulcerative Colitis.A switch to other agents should be considered as soon as possible in people with diabetes to limit the impact on glycaemic control.5-aminosalicylates appear to play a role in the reduction of hemoglobin A1c(HbA1c),although the literature suggests these may be falsely low readings.Consequently,monitoring of people with diabetes on these agents may require daily monitoring of capillary blood sugars rather than relying simply on HbA1c;for example fructosamine performed 3-6 monthly,although this risks missing the rise in readings.There is only limited evidence of the effects of thiopurines on diabetes and further investigation is needed into the possible relationship between them.However,given the current available evidence it may be preferable to commence patients with diabetes on thiopurines as soon as possible,whilst also monitoring for side effects such as pancreatitis.There appears to be more evidence supporting a link between tumor necrosis factor-αinhibitors and DM.Both infliximab and adalimumab have evidence suggesting that both can cause reduced blood sugar levels.Further studies on the effects of the various biological agents mentioned are required alongside any novel biologic therapy and the impact of dual biologic therapy in the future.
文摘Microscopic enteritis(ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms,nutrient and micronutrient deficiency.It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy.This work recognises a need to characterize disorders with microscopic and submicroscopic features,currently regarded as functional or non-specific entities,to obtain further understanding of their clinical relevance.The consensus working party reviewed statements about the aetiology,diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment.Following the 5th International Course in Digestive Pathology in Bucharest in November 2012,an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME.A five-step agreement scale(from strong agreement to strong disagreement) was used to score 21 statements,independently.There was strong agreement on all statements about ME histology(95%-100%).Statements concerning diagnosis achieved 85% to 100% agreement.A statement on the management of ME elicited agreement from the lowest rate(60%) up to 100%.The remaining two categories showed general agreement between experts on clinical presentation(75%-95%) and pathogenesis(80%-90%) of ME.There was strong agreement on the histological definition of ME.Weaker agreement on management indicates a need for further investigations,better definitions and clinical trials to produce quality guidelines for management.This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.
