BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to...BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to activate CD.Additionally,n-3 PUFAs are metabolized by the same enzyme as n-6 PUFAs and known to inhibit the arachidonic acid cascade.Our previous study noted that the presence of erythrocyte membrane fatty acids is a characteristic finding in Japanese CD patients.It was thus speculated that FADS2 gene polymorphisms,which induce PUFA metabolizing enzymes,are involved in the pathogenesis of CD,though no such relationship was found.AIM To investigate the relationship of FADS2 polymorphisms with serum and erythrocyte membrane fatty acid composition ratios,and disease activity.METHODS Using previously reported findings regarding FADS2 genetic polymorphisms,the records of 52 CD patients undergoing treatment at Jikei University Kashiwa Hospital were analyzed.Mutations noted were divided into three groups;wild-type(GG),heterozygous mutants(GA),and homozygous(AA),with the activities of delta-6 and delta-5 desaturases compared using redefined d6d index(rd.d6di)and d5d index(d5di).Additionally,comparisons of serum and erythrocyte membranes for fatty acid composition,and also gene polymorphisms and CD activity index(CDAI)were performed.RESULTS The presence of the rs174538 mutation in FADS2 resulted in reduction of only rd.d6di in the erythrocyte membrane(P<0.01).In contrast,that mutation was found to be associated with d5di induced by FADS1 in serum(P=0.019)as well as the erythrocyte membrane(P<0.0001),and also with reduction in the fatty acid composition of arachidonic acid in both serum(P<0.0001)and the erythrocyte membrane(P<0.01).Regarding disease activity,a positive correlation of CDAI score with rd.d6di in both serum(P<0.05)and the erythrocyte membrane(P<0.05)was found only in the rs174538 wild-type group.In contrast,there was no correction between CDAI and d5di in either serum or erythrocyte membrane samples.CONCLUSION The rs174538 mutation alters the fatty acid profile through strong linkage to the FADS1 gene.In wild-type individuals,rd.d6di was positively correlated with CDAI,suggesting predictive utility of disease severity.展开更多
In the pre-biologic era,immunomodulators such as azathioprine,6-mercaptopurine,and methotrexate(MTX)were widely used as first-line maintenance therapies in Crohn’s disease.However,in the current era shaped by biologi...In the pre-biologic era,immunomodulators such as azathioprine,6-mercaptopurine,and methotrexate(MTX)were widely used as first-line maintenance therapies in Crohn’s disease.However,in the current era shaped by biologics,their role has shifted toward adjunctive use,primarily in combination with anti-tumor necrosis factor agents to reduce immunogenicity.Amid growing concerns about thiopurine-associated risks,MTX is receiving renewed attention for its favorable safety profile;however,this agent remains inconsistently utilized in gastroenterology despite its frontline status in rheumatology.This discrepancy was highlighted in a recent nationwide survey by Bonnaud et al published in the World Journal of Gastroenterology,which offers timely insights into MTX prescribing behaviors among French gastroenterologists.Although 71%of respondents reported using MTX,primarily via subcutaneous injection,it is still perceived as a secondary choice after thiopurines.Importantly,this underuse appears to be driven more by clinical inertia and limited guidance rather than by lack of efficacy or safety concerns.Clinicians increasingly recognize the value of MTX,particularly in patients with joint involvement,Epstein-Barr virus negativity,or increased malignancy risk.Notably,even non-prescribers viewed the drug favorably,suggesting that usage barriers may be modifiable.In light of evolving treatment goals that prioritize safety,cost-effectiveness,and individualized care,this editorial argues that MTX should no longer be viewed as a fallback but as a strategic first-line option in well-defined high-risk populations.The survey underscores a persistent gap between guidelines and real-world practice,reinforcing the urgent need for clearer algorithms and education to support the repositioning of MTX in modern Crohn’s disease management.展开更多
In this article,we explored the role of adipose tissue,especially mesenteric adipose tissue and creeping fat,and its association with the gut microbiota in the pathophysiology and progression of Crohn’s disease(CD).C...In this article,we explored the role of adipose tissue,especially mesenteric adipose tissue and creeping fat,and its association with the gut microbiota in the pathophysiology and progression of Crohn’s disease(CD).CD is a form of inflammatory bowel disease characterized by chronic inflammation of the gastrointestinal tract,influenced by genetic predisposition,gut microbiota dysbiosis,and environmental factors.Gut microbiota plays a crucial role in modulating immune response and intestinal inflammation and is associated with the onset and progression of CD.Further,visceral adipose tissue,particularly creeping fat,a mesenteric adipose tissue characterized by hypertrophy and fibrosis,has been implicated in CD pathogenesis,inflammation,and fibrosis.The bacteria from the gut microbiota may translocate into mesenteric adipose tissue,contributing to the formation of creeping fat and influencing CD progression.Although creeping fat may be a protective barrier against bacterial invasion,its expansion can damage adjacent tissues,leading to complications.Modulating gut microbiota through interventions such as fecal microbiota transplantation,probiotics,and prebiotics has shown potential in managing CD.However,more research is needed to clarify the mechanisms linking gut dysbiosis,creeping fat,and CD progression and develop targeted therapies for microbiota modulation and fat-related complications in patients with CD.展开更多
Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particu...Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particularly anti-tumor necrosis factor agents,the majority of patients still require surgical intervention.Accurate diagnosis and monitoring are essential to optimise outcomes and guide multidisciplinary management.Although clinical scoring systems such as the perianal disease activity index are widely used,their subjective application limits their reproducibility and reliability,underscoring the need for more objective methods of evaluating perianal fistulising Crohn’s disease activity.Imaging has thus become central to the objective assessment of perianal fistulising Crohn’s disease,with magnetic resonance imaging(MRI)recognised as the gold standard in view of its ability to provide clear,detailed images of the perianal region in a radiation-free manner.Guidelines also endorse the use of imaging modalities such as endoanal ultrasound and transperineal ultrasound as viable alternatives to MRI for the assessment of perianal fistulising Crohn’s disease in centres with appropriate expertise.This article aims to evaluate and compare the diagnostic accuracy and clinical utility of MRI,endoanal ultrasound,and transperineal ultrasound in the assessment of perianal fistulising Crohn’s disease,highlighting their respective strengths,limitations,and roles in clinical practice.展开更多
Inflammatory bowel disease(IBD)is an incurable disease of the digestive system;however,the therapeutic methods for IBD remain limited.The pathogenesis of IBD was systematically discussed and compared in this paper,pri...Inflammatory bowel disease(IBD)is an incurable disease of the digestive system;however,the therapeutic methods for IBD remain limited.The pathogenesis of IBD was systematically discussed and compared in this paper,primarily comprising Crohn’s disease and ulcerative colitis.This paper focused on six common aspects:(1)Dysregulated immune responses;(2)Gene function changes;(3)Intestinal microbes disorder and imbalance;(4)Microbial infections;(5)Associations between IBD and other inflammatory diseases;and(6)Other factors.In addition,the pathogenesis differences between these two forms of IBD were unraveled and clearly distinguished.These unique aspects of pathogenesis provide crucial insights for the precise treatment of both Crohn’s disease and ulcerative colitis.This paper illustrates the root causes and beneficial factors of resistance to IBD,which provides novel insights on early prevention,development of new therapeutic agents,and treatment options of this disease.展开更多
BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significan...BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.展开更多
Extensive research has investigated the etiology of Crohn’s disease(CD),encompassing genetic predisposition,lifestyle factors,and environmental triggers.Recently,the gut microbiome,recognized as the human body’s sec...Extensive research has investigated the etiology of Crohn’s disease(CD),encompassing genetic predisposition,lifestyle factors,and environmental triggers.Recently,the gut microbiome,recognized as the human body’s second-largest gene pool,has garnered significant attention for its crucial role in the patho-genesis of CD.This paper investigates the mechanisms underlying CD,focusing on the role of‘creeping fat’in disease progression and exploring emerging therapeutic strategies,including fecal microbiota transplantation,enteral nutri-tion,and therapeutic diets.Creeping fat has been identified as a unique patho-logical feature of CD and has recently been found to be associated with dysbiosis of the gut microbiome.We characterize this dysbiotic state by identi-fying key microbiome-bacteria,fungi,viruses,and archaea,and their contributions to CD pathogenesis.Additionally,this paper reviews contemporary therapies,empha-sizing the potential of biological therapies like fecal microbiota transplantation and dietary interventions.By elucidating the complex interactions between host-microbiome dynamics and CD pathology,this article aims to advance our under-standing of the disease and guide the development of more effective therapeutic strategies for managing CD.展开更多
BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD....BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.展开更多
Introduction: Crohn’s Disease (CD) is a chronic inflammatory disorder with a heterogeneous presentation. While diarrhea, abdominal pain, and weight loss are hallmarks, atypical manifestations can obscure the diagnosi...Introduction: Crohn’s Disease (CD) is a chronic inflammatory disorder with a heterogeneous presentation. While diarrhea, abdominal pain, and weight loss are hallmarks, atypical manifestations can obscure the diagnosis. This report highlights an unusual presentation of CD to emphasize the need for comprehensive diagnostic strategies. Case Report: A 25-year-old male presented with peripheral edema, anorexia, and abdominal distension but lacked classic gastrointestinal (GI) symptoms. Laboratory findings included microcytic anemia and hypoalbuminemia, while imaging revealed ascites and bowel wall thickening. Elevated fecal calprotectin and positive Anti-Saccharomyces cerevisiae antibodies (ASCA) supported the diagnosis. Endoscopy confirmed ileocolic Crohn’s Disease (L3 + L4). Infliximab therapy resulted in marked clinical improvement. Discussion: This case underscores the complexity of atypical CD presentations. Early use of serological markers, imaging, and endoscopy guided the diagnosis. Recognition of CD’s diverse manifestations is critical for timely intervention. Conclusion: Atypical CD presentations require heightened clinical suspicion and a multidisciplinary approach to reduce diagnostic delays and improve patient outcomes.展开更多
近年来中医药治疗炎症性肠病(IBD)取得了显著进展。全面检索2010年1月1日至2024年12月30日中国知网、万方数据知识服务平台、维普中文科技期刊数据库、中国生物医学文献服务系统等中文数据库,以及PubMed、Web of Science、Embase等英文...近年来中医药治疗炎症性肠病(IBD)取得了显著进展。全面检索2010年1月1日至2024年12月30日中国知网、万方数据知识服务平台、维普中文科技期刊数据库、中国生物医学文献服务系统等中文数据库,以及PubMed、Web of Science、Embase等英文数据库,系统梳理中医药在IBD临床诊疗及机制方面的研究文献。总结IBD中医病因病机研究的现状及临床实践创新认识及多元疗法(包括中药复方、单药/单体、针灸、中药灌肠、穴位贴敷等特色疗法),以及与西医常规治疗的协同增效作用。IBD的中成药研发与应用正呈现出从疗效验证向机制探索的深刻转变,中药治疗IBD疗效机制研究主要包括调节肠道菌群稳态、修复肠黏膜屏障、调节肠道免疫平衡方面。提出中医药诊疗IBD未来研究方向为中医诊疗模型的建立、拓展中医外治法与内治法的联合应用模式、创新针对个性化治疗方案、推进药物研发,旨在为IBD中医诊疗的规范化、精准化发展提供思路。展开更多
Perianal fistulizing Crohn’s disease(PFCD)is a complication of CD that signi-ficantly impacts patients’quality of life,particularly their social and sexual well-being.Despite advances in therapy,its treatment remain...Perianal fistulizing Crohn’s disease(PFCD)is a complication of CD that signi-ficantly impacts patients’quality of life,particularly their social and sexual well-being.Despite advances in therapy,its treatment remains a major challenge in the field of inflammatory bowel disease.The pathogenesis of PFCD involves in-creased production of inflammatory cytokines by infiltrating macrophages and lymphocytes,stimulation of the epithelial-to-mesenchymal transition,activation of myofibroblasts,and elevated levels of matrix metalloproteinases.Mesenchymal stem cells(MSCs)are multipotent stromal cells with self-renewal and differen-tiation capabilities.Evidence from animal models and clinical trials indicates that MSC injection into PFCD lesions suppresses the infiltration of inflammatory cells and cytokines,resulting in complete fistula healing.More recently,MSC-derived extracellular vesicles(EVs)have shown promising results in promoting fistula healing,particularly in cases of refractory or relapsing fistulas.Notably,the activation of macroautophagy(hereafter referred to as autophagy)in MSCs has been shown to accelerate the healing process.This narrative review discusses the mechanisms underlying PFCD pathogenesis,the therapeutic roles of MSCs and their EVs,and the potential role of autophagy upregulation in enhancing MSC function and EV production.展开更多
BACKGROUND Discordance between endoscopic and histologic assessments in Crohn’s disease(CD)have been observed,however the prevalence and cause are unclear.AIM To assess if a protocolized approach to biopsy collection...BACKGROUND Discordance between endoscopic and histologic assessments in Crohn’s disease(CD)have been observed,however the prevalence and cause are unclear.AIM To assess if a protocolized approach to biopsy collection facilitates understanding of this discordance in patients with ileal CD.METHODS Patients with known ileal CD underwent colonoscopy with endoscopic disease activity assessment.Three protocolized biopsies were taken respectively from an ulcer edge,7-mm,and 14-mm away from the ulcer edge in patients with discrete ileal ulcer(s).In patients with no ulcers as controls,the same 3-site biopsy protocol was applied in a randomly selected area of endoscopically-unremarkable terminal ileal mucosa.A blinded pathologist assessed mucosal inflammation in each biopsy using 3 validated histologic indices.RESULTS Twenty-four participants had visible ulcer(s)on endoscopy and 12 served as no-ulcer controls.Of biopsies taken from an ulcer edge,only 67%showed histologic evidence of active(neutrophilic)inflammation,and 33%showed histologic features of ulcer or erosion;all were from either large(n=4)or very large(n=4)ulcers.In the no-ulcer controls,no biopsies showed histologic features of ulcer or erosion,but 8%showed active inflammation.CONCLUSION A striking discordance exists between endoscopic and histologic assessments for mucosal inflammation in patients with active ileal CD,even in biopsies targeted at an ulcer edge,while a higher concordance is seen in patients with no endoscopic disease activity.It remains unclear how to incorporate histologic disease activity into the treatment paradigm.Further research is needed to optimize biopsy protocols and histologic assessments for CD.展开更多
Objectives:A common side effect of inflammatory bowel disease(IBD)is intestinal fibrosis,which frequently leads to intestinal blockage and stricture formation.Although Thalidomide(THD)has shown anti-fibrotic benefits ...Objectives:A common side effect of inflammatory bowel disease(IBD)is intestinal fibrosis,which frequently leads to intestinal blockage and stricture formation.Although Thalidomide(THD)has shown anti-fibrotic benefits in hepatic and renal models,little is known about how it affects intestinal fibrosis and the underlying processes.The present research examines the molecular targets of THD and its potential as a treatment for intestinal fibrosis brought on by colitis.Methods:Clinical samples from Crohn’s disease(CD)patients with intestinal strictures treated with infliximab(IFX)and THD combined with IFX were collected.Dextran sulfate sodium(DSS)was used to develop a mouse model of intestinal fibrosis in C57BL/6 mice.Anti-tumor necrosis factor-alpha(Anti-TNFα),THD,or a combination of the two were administered to the mice.Body weight,colon length,histology,and disease activity index were used to evaluate the disease’s severity.In vitro,THD was tested on colonic fibroblast lines(CCD-18Co and MPF)to assess its effects on cell proliferation,motility,and transdifferentiation.To examine changes in gene expression and signaling pathway modifications,namely in the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin(PI3K/AKT/mTOR)pathway,RNA sequencing,qRT-PCR,and Western blotting were carried out.Results:In DSS-induced colitis,THD therapy lowered fibrosis,as seen by downregulated fibrotic markers(α-smooth muscle actin(α-SMA),collagen I,and collagen III)and decreased collagen deposition.Mechanistically,THD prevented fibroblasts from transdifferentiating and decreased their vitality.Furthermore,THD inhitited the PI3K/AKT/mTOR pathway in vivo and in vitro.Conclusion:THD inhibits the PI3K/AKT/mTOR signaling cascade and suppresses colonic fibroblast transdifferentiation,which protects against DSS-induced colitis-associated fibrosis,especially when combined with anti-TNFαtherapy.展开更多
BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicti...BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicting therapeutic response is challenging and an area of active research.Gut microbiota has emerged as an important player in the pathogenesis of CD and also appears to be a promising biomarker for predicting therapeutic response.AIM To systematically review the literature on the current status of gut microbiota as a tool to predict response to treatment in adults with CD.METHODS We searched the literature database(PubMed,Scopus,and Cochrane database)from inception to August 2025.We screened for studies reporting on adult patients with CD receiving biologic or immunomodulator therapies,with baseline microbiome analyses performed prior to treatment.Papers reporting on baseline gut microbiota as a predictor of therapeutic response were finally included.The utility of bacterial diversity,microbial community structure,and the role of specific operational taxonomic units as biomarkers of therapeutic response was reviewed.The results were grouped based on the bacterial parameters studied and presented in separate tables.The quality of the included studies was assessed using the MINORS criteria.The review was registered prospectively in PROSPERO.RESULTS After applying the selection criteria,sixteen studies were included in this systematic review.The majority of the papers were from Europe and the United States.All except two papers assessed gut bacterial population using 16S rRNA gene sequencing.Ten of the sixteen studies were of high quality.Among the sixteen studies included,most identified an association between microbial taxa and treatment response,while the relation with alpha-diversity was inconsistent.The functional characteristics were reported in only four studies and were found to be useful.The best prediction was achieved when microbial characteristics were combined with clinical and other parameters,with area under the curve values up to 0.96.CONCLUSION The overall results suggest good performance of microbial parameters as a novel biomarker of therapeutic response.However,there are variations across individual studies,probably related to the methodology of assessing microbial communities and the therapeutic agent used.Future multicenter studies integrating microbial,clinical,and metabolomic data are warranted to develop predictive models for personalized therapy in CD.展开更多
BACKGROUND At present,there is a lack of non-invasive indicators to evaluate the changes in endoscopic activity between two visits for patients with Crohn's disease(CD).AIM To develop a model for predicting whethe...BACKGROUND At present,there is a lack of non-invasive indicators to evaluate the changes in endoscopic activity between two visits for patients with Crohn's disease(CD).AIM To develop a model for predicting whether endoscopic activity will improve in CD patients.METHODS This is a single-center retrospective study that included patients diagnosed with CD from January 2014 to December 2022.The patients were randomly divided into a modeling group(70%)and an internal validation group(30%),with an external validation group from January 2023 to March 2024.Univariate and binary logistic regression analyses were conducted to identify independent risk factors,which were used to construct a nomogram model.The model's performance was evaluated using receiver operating characteristic curves,calibration curves,and decision curve analysis(DCA).Additionally,further sensitivity analyses were performed.RESULTS One hundred seventy patients were included in the training group,while 64 were included in the external validation group.A binary logistic stepwise regression analysis revealed that the changes in the amplitudes of albumin(ALB)and fibrinogen(FIB)were independent risk factors for endoscopic improvement.A nomogram model was developed based on these risk factors.The area under the curve of the model for the training group,internal validation group,and external validation group were 0.802,0.788,and 0.787,respectively.The average absolute errors of the calibration curves were 0.011,0.016,and 0.018,respectively.DCA indicated that the model performs well in clinical practice.Additionally,sensitivity analysis demonstrated that the model has strong robustness and applicability.CONCLUSION Our study shows that changes in the amplitudes of ALB and FIB are effective predictors of endoscopic improvement in patients with CD during follow-up visits compared to their previous ones.展开更多
Surgery for ileocolic and colonic Crohn’s disease(CD)remains challenging.Over the past decade,there have been significant advances in surgical techniques,and the timing of surgery for CD patients has been debated.Wit...Surgery for ileocolic and colonic Crohn’s disease(CD)remains challenging.Over the past decade,there have been significant advances in surgical techniques,and the timing of surgery for CD patients has been debated.With advances in biological agents,the rate of surgery has significantly decreased,but early ileocolic resection has been advocated.Recently,there has been significant interest in the role of the mesentery in the pathogenesis of CD,with Kono-S mesenteric exclusion anastomosis and extended mesenteric excision advocated by various groups to minimise CD recurrence.There have also been controversies regarding the utility of ileal pouch anal anastomosis after total proctocolectomy.Compared with open surgery,most CD surgeries are now minimally invasive,with increasing evidence for improving short-term outcomes with conventional laparoscopic techniques.The evidence for robotic-assisted surgery in patients with CD is limited at present.展开更多
BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts ...BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts score commonly used to predict endoscopic recurrence.AIM To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.METHODS This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023.Resection specimens were histopathologically re-examined,and postoperative colonoscopy reports were classified according to the Rutgeerts score.The association between pathological findings and endoscopic recurrence was analyzed statistically.RESULTS No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence(P>0.05).However,the presence and severity of neutrophilic cryptitis(P=0.035)and crypt abscesses(P=0.010)in microscopic findings were significantly associated with higher Rutgeerts scores,indicating a parallel increase with endoscopic recurrence.Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence(P>0.05).CONCLUSION The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence.Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence,with treatment decisions made by a weekly multidisciplinary council involving General Surgery,Gastroenterology,and Radiology.展开更多
BACKGROUND Crohn’s disease(CD)is a chronic inflammatory disease of the intestinal tract that can alternate between disease phases and remission.Currently,endoscopy is the gold standard for diagnosis of CD and evaluat...BACKGROUND Crohn’s disease(CD)is a chronic inflammatory disease of the intestinal tract that can alternate between disease phases and remission.Currently,endoscopy is the gold standard for diagnosis of CD and evaluation of its activity and complications.However,gastrointestinal ultrasound(GIUS)is a valuable technique in the management of CD because it is noninvasive,convenient,and highly accurate,sensitive,and specific.CASE SUMMARY A 15-year-old female presented with recurrent right lower quadrant abdominal pain that had persisted for 2 weeks.Initial GIUS and computed tomography revealed significant edema of the appendix and ascending colon wall,thickening,and multiple lymphadenopathies of the mesentery.Clinicians suspected appendicitis involving the adjacent bowel,and laparoscopic appendectomy was performed.The pathological diagnosis was acute simple appendicitis.However,the patient’s symptoms persisted and aggravated with the occurrence of hematochezia.Follow-up GIUS revealed persistent edema of the ascending and transverse colon walls,intestinal polyps,and local luminal stenosis.CD was suspected and confirmed by endoscopy.CONCLUSION CD should be suspected with persistent right lower quadrant abdominal pain.GIUS is essential for initial evaluation,before the confirmatory endoscopy,to assess CD-typical signs like bowel edema and thickening.展开更多
This article explores the significant implications of the study by Ovadia et al,which innovatively compares the efficacy of a nutritional intervention(Modulen)to conventional pharmaceutical therapy(budesonide)in promo...This article explores the significant implications of the study by Ovadia et al,which innovatively compares the efficacy of a nutritional intervention(Modulen)to conventional pharmaceutical therapy(budesonide)in promoting mucosal healing in Crohn’s disease.Highlighting the paradox of a well-established yet underutilized nutritional approach,the findings suggest that Modulen may offer comparable therapeutic benefits despite its high withdrawal rate due to adherence challenges.This advancement underscores the evolving paradigm in inflammatory bowel disease treatment,shifting focus toward non-pharmacologic alternatives that target both clinical remission and endoscopic healing.The article advocates for the development of integrative treatment strategies that balance efficacy,patient adherence,and long-term disease management,emphasizing the need for further research to refine and optimize the role of nutritional therapies in clinical practice.展开更多
BACKGROUND In the biologic era,postoperative recurrence(POR)of Crohn’s disease(CD)remains a significant concern.The underlying cause of this phenomenon remains unclear at present.AIM To examine whether intestinal fib...BACKGROUND In the biologic era,postoperative recurrence(POR)of Crohn’s disease(CD)remains a significant concern.The underlying cause of this phenomenon remains unclear at present.AIM To examine whether intestinal fibrosis increases the likelihood of POR when antitumor necrosis factor biologics are used following ileocecal resection(ICR).METHODS We performed a single-centre,retrospective cohort study of patients with CD who underwent ICR.Recurrence was defined by endoscopy(Rutgeerts score≥i2),radiography(active inflammation in the neoterminal ileum)or surgery(another resection>3 months post-ICR),and patients were categorised by the presence of intestinal fibrosis on histopathological evaluation.RESULTS Among 102 patients with CD who underwent ICR and received infliximab within 3 months,69(67.6%)had intestinal fibrosis.In addition,60 patients(58.8%)experienced POR in various forms:52.6%,41.2%,and 10.8%had endoscopic,radiographic,and surgical recurrence,respectively.Patients with intestinal fibrosis experienced faster radiographic recurrence(log rank P=0.03).After adjusting for risk factors associated with POR,intestinal fibrosis increased the risk of early radiographic recurrence(adjusted hazard ratio=4;95%confidence interval:1.03-15.56;P=0.045).CONCLUSION Despite the limited sample size,our study revealed a strong correlation between radiographic POR and intestinal fibrosis in patients who received postoperative anti-tumor necrosis factorαprophylaxis.展开更多
文摘BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to activate CD.Additionally,n-3 PUFAs are metabolized by the same enzyme as n-6 PUFAs and known to inhibit the arachidonic acid cascade.Our previous study noted that the presence of erythrocyte membrane fatty acids is a characteristic finding in Japanese CD patients.It was thus speculated that FADS2 gene polymorphisms,which induce PUFA metabolizing enzymes,are involved in the pathogenesis of CD,though no such relationship was found.AIM To investigate the relationship of FADS2 polymorphisms with serum and erythrocyte membrane fatty acid composition ratios,and disease activity.METHODS Using previously reported findings regarding FADS2 genetic polymorphisms,the records of 52 CD patients undergoing treatment at Jikei University Kashiwa Hospital were analyzed.Mutations noted were divided into three groups;wild-type(GG),heterozygous mutants(GA),and homozygous(AA),with the activities of delta-6 and delta-5 desaturases compared using redefined d6d index(rd.d6di)and d5d index(d5di).Additionally,comparisons of serum and erythrocyte membranes for fatty acid composition,and also gene polymorphisms and CD activity index(CDAI)were performed.RESULTS The presence of the rs174538 mutation in FADS2 resulted in reduction of only rd.d6di in the erythrocyte membrane(P<0.01).In contrast,that mutation was found to be associated with d5di induced by FADS1 in serum(P=0.019)as well as the erythrocyte membrane(P<0.0001),and also with reduction in the fatty acid composition of arachidonic acid in both serum(P<0.0001)and the erythrocyte membrane(P<0.01).Regarding disease activity,a positive correlation of CDAI score with rd.d6di in both serum(P<0.05)and the erythrocyte membrane(P<0.05)was found only in the rs174538 wild-type group.In contrast,there was no correction between CDAI and d5di in either serum or erythrocyte membrane samples.CONCLUSION The rs174538 mutation alters the fatty acid profile through strong linkage to the FADS1 gene.In wild-type individuals,rd.d6di was positively correlated with CDAI,suggesting predictive utility of disease severity.
文摘In the pre-biologic era,immunomodulators such as azathioprine,6-mercaptopurine,and methotrexate(MTX)were widely used as first-line maintenance therapies in Crohn’s disease.However,in the current era shaped by biologics,their role has shifted toward adjunctive use,primarily in combination with anti-tumor necrosis factor agents to reduce immunogenicity.Amid growing concerns about thiopurine-associated risks,MTX is receiving renewed attention for its favorable safety profile;however,this agent remains inconsistently utilized in gastroenterology despite its frontline status in rheumatology.This discrepancy was highlighted in a recent nationwide survey by Bonnaud et al published in the World Journal of Gastroenterology,which offers timely insights into MTX prescribing behaviors among French gastroenterologists.Although 71%of respondents reported using MTX,primarily via subcutaneous injection,it is still perceived as a secondary choice after thiopurines.Importantly,this underuse appears to be driven more by clinical inertia and limited guidance rather than by lack of efficacy or safety concerns.Clinicians increasingly recognize the value of MTX,particularly in patients with joint involvement,Epstein-Barr virus negativity,or increased malignancy risk.Notably,even non-prescribers viewed the drug favorably,suggesting that usage barriers may be modifiable.In light of evolving treatment goals that prioritize safety,cost-effectiveness,and individualized care,this editorial argues that MTX should no longer be viewed as a fallback but as a strategic first-line option in well-defined high-risk populations.The survey underscores a persistent gap between guidelines and real-world practice,reinforcing the urgent need for clearer algorithms and education to support the repositioning of MTX in modern Crohn’s disease management.
基金Supported by the Postdoctoral Scholarship Grant,No.5552/2024 PROPG/PROPE N°06/2024.
文摘In this article,we explored the role of adipose tissue,especially mesenteric adipose tissue and creeping fat,and its association with the gut microbiota in the pathophysiology and progression of Crohn’s disease(CD).CD is a form of inflammatory bowel disease characterized by chronic inflammation of the gastrointestinal tract,influenced by genetic predisposition,gut microbiota dysbiosis,and environmental factors.Gut microbiota plays a crucial role in modulating immune response and intestinal inflammation and is associated with the onset and progression of CD.Further,visceral adipose tissue,particularly creeping fat,a mesenteric adipose tissue characterized by hypertrophy and fibrosis,has been implicated in CD pathogenesis,inflammation,and fibrosis.The bacteria from the gut microbiota may translocate into mesenteric adipose tissue,contributing to the formation of creeping fat and influencing CD progression.Although creeping fat may be a protective barrier against bacterial invasion,its expansion can damage adjacent tissues,leading to complications.Modulating gut microbiota through interventions such as fecal microbiota transplantation,probiotics,and prebiotics has shown potential in managing CD.However,more research is needed to clarify the mechanisms linking gut dysbiosis,creeping fat,and CD progression and develop targeted therapies for microbiota modulation and fat-related complications in patients with CD.
文摘Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particularly anti-tumor necrosis factor agents,the majority of patients still require surgical intervention.Accurate diagnosis and monitoring are essential to optimise outcomes and guide multidisciplinary management.Although clinical scoring systems such as the perianal disease activity index are widely used,their subjective application limits their reproducibility and reliability,underscoring the need for more objective methods of evaluating perianal fistulising Crohn’s disease activity.Imaging has thus become central to the objective assessment of perianal fistulising Crohn’s disease,with magnetic resonance imaging(MRI)recognised as the gold standard in view of its ability to provide clear,detailed images of the perianal region in a radiation-free manner.Guidelines also endorse the use of imaging modalities such as endoanal ultrasound and transperineal ultrasound as viable alternatives to MRI for the assessment of perianal fistulising Crohn’s disease in centres with appropriate expertise.This article aims to evaluate and compare the diagnostic accuracy and clinical utility of MRI,endoanal ultrasound,and transperineal ultrasound in the assessment of perianal fistulising Crohn’s disease,highlighting their respective strengths,limitations,and roles in clinical practice.
基金Supported by Tianjin Municipal Science and Technology Commission Grant,No.24ZXRKSY00010Program for Innovative Research Team in Peking Union Medical College,CAMS Initiative for Innovative Medicine,No.2023-I2M-2-008.
文摘Inflammatory bowel disease(IBD)is an incurable disease of the digestive system;however,the therapeutic methods for IBD remain limited.The pathogenesis of IBD was systematically discussed and compared in this paper,primarily comprising Crohn’s disease and ulcerative colitis.This paper focused on six common aspects:(1)Dysregulated immune responses;(2)Gene function changes;(3)Intestinal microbes disorder and imbalance;(4)Microbial infections;(5)Associations between IBD and other inflammatory diseases;and(6)Other factors.In addition,the pathogenesis differences between these two forms of IBD were unraveled and clearly distinguished.These unique aspects of pathogenesis provide crucial insights for the precise treatment of both Crohn’s disease and ulcerative colitis.This paper illustrates the root causes and beneficial factors of resistance to IBD,which provides novel insights on early prevention,development of new therapeutic agents,and treatment options of this disease.
基金Supported by Natural Science Foundation of Anhui Medical University,No.2023xkj130.
文摘BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.
文摘Extensive research has investigated the etiology of Crohn’s disease(CD),encompassing genetic predisposition,lifestyle factors,and environmental triggers.Recently,the gut microbiome,recognized as the human body’s second-largest gene pool,has garnered significant attention for its crucial role in the patho-genesis of CD.This paper investigates the mechanisms underlying CD,focusing on the role of‘creeping fat’in disease progression and exploring emerging therapeutic strategies,including fecal microbiota transplantation,enteral nutri-tion,and therapeutic diets.Creeping fat has been identified as a unique patho-logical feature of CD and has recently been found to be associated with dysbiosis of the gut microbiome.We characterize this dysbiotic state by identi-fying key microbiome-bacteria,fungi,viruses,and archaea,and their contributions to CD pathogenesis.Additionally,this paper reviews contemporary therapies,empha-sizing the potential of biological therapies like fecal microbiota transplantation and dietary interventions.By elucidating the complex interactions between host-microbiome dynamics and CD pathology,this article aims to advance our under-standing of the disease and guide the development of more effective therapeutic strategies for managing CD.
文摘BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.
文摘Introduction: Crohn’s Disease (CD) is a chronic inflammatory disorder with a heterogeneous presentation. While diarrhea, abdominal pain, and weight loss are hallmarks, atypical manifestations can obscure the diagnosis. This report highlights an unusual presentation of CD to emphasize the need for comprehensive diagnostic strategies. Case Report: A 25-year-old male presented with peripheral edema, anorexia, and abdominal distension but lacked classic gastrointestinal (GI) symptoms. Laboratory findings included microcytic anemia and hypoalbuminemia, while imaging revealed ascites and bowel wall thickening. Elevated fecal calprotectin and positive Anti-Saccharomyces cerevisiae antibodies (ASCA) supported the diagnosis. Endoscopy confirmed ileocolic Crohn’s Disease (L3 + L4). Infliximab therapy resulted in marked clinical improvement. Discussion: This case underscores the complexity of atypical CD presentations. Early use of serological markers, imaging, and endoscopy guided the diagnosis. Recognition of CD’s diverse manifestations is critical for timely intervention. Conclusion: Atypical CD presentations require heightened clinical suspicion and a multidisciplinary approach to reduce diagnostic delays and improve patient outcomes.
文摘近年来中医药治疗炎症性肠病(IBD)取得了显著进展。全面检索2010年1月1日至2024年12月30日中国知网、万方数据知识服务平台、维普中文科技期刊数据库、中国生物医学文献服务系统等中文数据库,以及PubMed、Web of Science、Embase等英文数据库,系统梳理中医药在IBD临床诊疗及机制方面的研究文献。总结IBD中医病因病机研究的现状及临床实践创新认识及多元疗法(包括中药复方、单药/单体、针灸、中药灌肠、穴位贴敷等特色疗法),以及与西医常规治疗的协同增效作用。IBD的中成药研发与应用正呈现出从疗效验证向机制探索的深刻转变,中药治疗IBD疗效机制研究主要包括调节肠道菌群稳态、修复肠黏膜屏障、调节肠道免疫平衡方面。提出中医药诊疗IBD未来研究方向为中医诊疗模型的建立、拓展中医外治法与内治法的联合应用模式、创新针对个性化治疗方案、推进药物研发,旨在为IBD中医诊疗的规范化、精准化发展提供思路。
文摘Perianal fistulizing Crohn’s disease(PFCD)is a complication of CD that signi-ficantly impacts patients’quality of life,particularly their social and sexual well-being.Despite advances in therapy,its treatment remains a major challenge in the field of inflammatory bowel disease.The pathogenesis of PFCD involves in-creased production of inflammatory cytokines by infiltrating macrophages and lymphocytes,stimulation of the epithelial-to-mesenchymal transition,activation of myofibroblasts,and elevated levels of matrix metalloproteinases.Mesenchymal stem cells(MSCs)are multipotent stromal cells with self-renewal and differen-tiation capabilities.Evidence from animal models and clinical trials indicates that MSC injection into PFCD lesions suppresses the infiltration of inflammatory cells and cytokines,resulting in complete fistula healing.More recently,MSC-derived extracellular vesicles(EVs)have shown promising results in promoting fistula healing,particularly in cases of refractory or relapsing fistulas.Notably,the activation of macroautophagy(hereafter referred to as autophagy)in MSCs has been shown to accelerate the healing process.This narrative review discusses the mechanisms underlying PFCD pathogenesis,the therapeutic roles of MSCs and their EVs,and the potential role of autophagy upregulation in enhancing MSC function and EV production.
文摘BACKGROUND Discordance between endoscopic and histologic assessments in Crohn’s disease(CD)have been observed,however the prevalence and cause are unclear.AIM To assess if a protocolized approach to biopsy collection facilitates understanding of this discordance in patients with ileal CD.METHODS Patients with known ileal CD underwent colonoscopy with endoscopic disease activity assessment.Three protocolized biopsies were taken respectively from an ulcer edge,7-mm,and 14-mm away from the ulcer edge in patients with discrete ileal ulcer(s).In patients with no ulcers as controls,the same 3-site biopsy protocol was applied in a randomly selected area of endoscopically-unremarkable terminal ileal mucosa.A blinded pathologist assessed mucosal inflammation in each biopsy using 3 validated histologic indices.RESULTS Twenty-four participants had visible ulcer(s)on endoscopy and 12 served as no-ulcer controls.Of biopsies taken from an ulcer edge,only 67%showed histologic evidence of active(neutrophilic)inflammation,and 33%showed histologic features of ulcer or erosion;all were from either large(n=4)or very large(n=4)ulcers.In the no-ulcer controls,no biopsies showed histologic features of ulcer or erosion,but 8%showed active inflammation.CONCLUSION A striking discordance exists between endoscopic and histologic assessments for mucosal inflammation in patients with active ileal CD,even in biopsies targeted at an ulcer edge,while a higher concordance is seen in patients with no endoscopic disease activity.It remains unclear how to incorporate histologic disease activity into the treatment paradigm.Further research is needed to optimize biopsy protocols and histologic assessments for CD.
文摘Objectives:A common side effect of inflammatory bowel disease(IBD)is intestinal fibrosis,which frequently leads to intestinal blockage and stricture formation.Although Thalidomide(THD)has shown anti-fibrotic benefits in hepatic and renal models,little is known about how it affects intestinal fibrosis and the underlying processes.The present research examines the molecular targets of THD and its potential as a treatment for intestinal fibrosis brought on by colitis.Methods:Clinical samples from Crohn’s disease(CD)patients with intestinal strictures treated with infliximab(IFX)and THD combined with IFX were collected.Dextran sulfate sodium(DSS)was used to develop a mouse model of intestinal fibrosis in C57BL/6 mice.Anti-tumor necrosis factor-alpha(Anti-TNFα),THD,or a combination of the two were administered to the mice.Body weight,colon length,histology,and disease activity index were used to evaluate the disease’s severity.In vitro,THD was tested on colonic fibroblast lines(CCD-18Co and MPF)to assess its effects on cell proliferation,motility,and transdifferentiation.To examine changes in gene expression and signaling pathway modifications,namely in the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin(PI3K/AKT/mTOR)pathway,RNA sequencing,qRT-PCR,and Western blotting were carried out.Results:In DSS-induced colitis,THD therapy lowered fibrosis,as seen by downregulated fibrotic markers(α-smooth muscle actin(α-SMA),collagen I,and collagen III)and decreased collagen deposition.Mechanistically,THD prevented fibroblasts from transdifferentiating and decreased their vitality.Furthermore,THD inhitited the PI3K/AKT/mTOR pathway in vivo and in vitro.Conclusion:THD inhibits the PI3K/AKT/mTOR signaling cascade and suppresses colonic fibroblast transdifferentiation,which protects against DSS-induced colitis-associated fibrosis,especially when combined with anti-TNFαtherapy.
文摘BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicting therapeutic response is challenging and an area of active research.Gut microbiota has emerged as an important player in the pathogenesis of CD and also appears to be a promising biomarker for predicting therapeutic response.AIM To systematically review the literature on the current status of gut microbiota as a tool to predict response to treatment in adults with CD.METHODS We searched the literature database(PubMed,Scopus,and Cochrane database)from inception to August 2025.We screened for studies reporting on adult patients with CD receiving biologic or immunomodulator therapies,with baseline microbiome analyses performed prior to treatment.Papers reporting on baseline gut microbiota as a predictor of therapeutic response were finally included.The utility of bacterial diversity,microbial community structure,and the role of specific operational taxonomic units as biomarkers of therapeutic response was reviewed.The results were grouped based on the bacterial parameters studied and presented in separate tables.The quality of the included studies was assessed using the MINORS criteria.The review was registered prospectively in PROSPERO.RESULTS After applying the selection criteria,sixteen studies were included in this systematic review.The majority of the papers were from Europe and the United States.All except two papers assessed gut bacterial population using 16S rRNA gene sequencing.Ten of the sixteen studies were of high quality.Among the sixteen studies included,most identified an association between microbial taxa and treatment response,while the relation with alpha-diversity was inconsistent.The functional characteristics were reported in only four studies and were found to be useful.The best prediction was achieved when microbial characteristics were combined with clinical and other parameters,with area under the curve values up to 0.96.CONCLUSION The overall results suggest good performance of microbial parameters as a novel biomarker of therapeutic response.However,there are variations across individual studies,probably related to the methodology of assessing microbial communities and the therapeutic agent used.Future multicenter studies integrating microbial,clinical,and metabolomic data are warranted to develop predictive models for personalized therapy in CD.
文摘BACKGROUND At present,there is a lack of non-invasive indicators to evaluate the changes in endoscopic activity between two visits for patients with Crohn's disease(CD).AIM To develop a model for predicting whether endoscopic activity will improve in CD patients.METHODS This is a single-center retrospective study that included patients diagnosed with CD from January 2014 to December 2022.The patients were randomly divided into a modeling group(70%)and an internal validation group(30%),with an external validation group from January 2023 to March 2024.Univariate and binary logistic regression analyses were conducted to identify independent risk factors,which were used to construct a nomogram model.The model's performance was evaluated using receiver operating characteristic curves,calibration curves,and decision curve analysis(DCA).Additionally,further sensitivity analyses were performed.RESULTS One hundred seventy patients were included in the training group,while 64 were included in the external validation group.A binary logistic stepwise regression analysis revealed that the changes in the amplitudes of albumin(ALB)and fibrinogen(FIB)were independent risk factors for endoscopic improvement.A nomogram model was developed based on these risk factors.The area under the curve of the model for the training group,internal validation group,and external validation group were 0.802,0.788,and 0.787,respectively.The average absolute errors of the calibration curves were 0.011,0.016,and 0.018,respectively.DCA indicated that the model performs well in clinical practice.Additionally,sensitivity analysis demonstrated that the model has strong robustness and applicability.CONCLUSION Our study shows that changes in the amplitudes of ALB and FIB are effective predictors of endoscopic improvement in patients with CD during follow-up visits compared to their previous ones.
文摘Surgery for ileocolic and colonic Crohn’s disease(CD)remains challenging.Over the past decade,there have been significant advances in surgical techniques,and the timing of surgery for CD patients has been debated.With advances in biological agents,the rate of surgery has significantly decreased,but early ileocolic resection has been advocated.Recently,there has been significant interest in the role of the mesentery in the pathogenesis of CD,with Kono-S mesenteric exclusion anastomosis and extended mesenteric excision advocated by various groups to minimise CD recurrence.There have also been controversies regarding the utility of ileal pouch anal anastomosis after total proctocolectomy.Compared with open surgery,most CD surgeries are now minimally invasive,with increasing evidence for improving short-term outcomes with conventional laparoscopic techniques.The evidence for robotic-assisted surgery in patients with CD is limited at present.
文摘BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts score commonly used to predict endoscopic recurrence.AIM To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.METHODS This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023.Resection specimens were histopathologically re-examined,and postoperative colonoscopy reports were classified according to the Rutgeerts score.The association between pathological findings and endoscopic recurrence was analyzed statistically.RESULTS No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence(P>0.05).However,the presence and severity of neutrophilic cryptitis(P=0.035)and crypt abscesses(P=0.010)in microscopic findings were significantly associated with higher Rutgeerts scores,indicating a parallel increase with endoscopic recurrence.Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence(P>0.05).CONCLUSION The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence.Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence,with treatment decisions made by a weekly multidisciplinary council involving General Surgery,Gastroenterology,and Radiology.
文摘BACKGROUND Crohn’s disease(CD)is a chronic inflammatory disease of the intestinal tract that can alternate between disease phases and remission.Currently,endoscopy is the gold standard for diagnosis of CD and evaluation of its activity and complications.However,gastrointestinal ultrasound(GIUS)is a valuable technique in the management of CD because it is noninvasive,convenient,and highly accurate,sensitive,and specific.CASE SUMMARY A 15-year-old female presented with recurrent right lower quadrant abdominal pain that had persisted for 2 weeks.Initial GIUS and computed tomography revealed significant edema of the appendix and ascending colon wall,thickening,and multiple lymphadenopathies of the mesentery.Clinicians suspected appendicitis involving the adjacent bowel,and laparoscopic appendectomy was performed.The pathological diagnosis was acute simple appendicitis.However,the patient’s symptoms persisted and aggravated with the occurrence of hematochezia.Follow-up GIUS revealed persistent edema of the ascending and transverse colon walls,intestinal polyps,and local luminal stenosis.CD was suspected and confirmed by endoscopy.CONCLUSION CD should be suspected with persistent right lower quadrant abdominal pain.GIUS is essential for initial evaluation,before the confirmatory endoscopy,to assess CD-typical signs like bowel edema and thickening.
文摘This article explores the significant implications of the study by Ovadia et al,which innovatively compares the efficacy of a nutritional intervention(Modulen)to conventional pharmaceutical therapy(budesonide)in promoting mucosal healing in Crohn’s disease.Highlighting the paradox of a well-established yet underutilized nutritional approach,the findings suggest that Modulen may offer comparable therapeutic benefits despite its high withdrawal rate due to adherence challenges.This advancement underscores the evolving paradigm in inflammatory bowel disease treatment,shifting focus toward non-pharmacologic alternatives that target both clinical remission and endoscopic healing.The article advocates for the development of integrative treatment strategies that balance efficacy,patient adherence,and long-term disease management,emphasizing the need for further research to refine and optimize the role of nutritional therapies in clinical practice.
基金Supported by the National Natural Science Foundation of China,No.82200621the Original Research Projects,Shanghai Ninth People’s Hospital,No.2022LHA08 and No.YBKB202220.
文摘BACKGROUND In the biologic era,postoperative recurrence(POR)of Crohn’s disease(CD)remains a significant concern.The underlying cause of this phenomenon remains unclear at present.AIM To examine whether intestinal fibrosis increases the likelihood of POR when antitumor necrosis factor biologics are used following ileocecal resection(ICR).METHODS We performed a single-centre,retrospective cohort study of patients with CD who underwent ICR.Recurrence was defined by endoscopy(Rutgeerts score≥i2),radiography(active inflammation in the neoterminal ileum)or surgery(another resection>3 months post-ICR),and patients were categorised by the presence of intestinal fibrosis on histopathological evaluation.RESULTS Among 102 patients with CD who underwent ICR and received infliximab within 3 months,69(67.6%)had intestinal fibrosis.In addition,60 patients(58.8%)experienced POR in various forms:52.6%,41.2%,and 10.8%had endoscopic,radiographic,and surgical recurrence,respectively.Patients with intestinal fibrosis experienced faster radiographic recurrence(log rank P=0.03).After adjusting for risk factors associated with POR,intestinal fibrosis increased the risk of early radiographic recurrence(adjusted hazard ratio=4;95%confidence interval:1.03-15.56;P=0.045).CONCLUSION Despite the limited sample size,our study revealed a strong correlation between radiographic POR and intestinal fibrosis in patients who received postoperative anti-tumor necrosis factorαprophylaxis.
