Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the...Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.展开更多
Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical ...Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.展开更多
Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often ...Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.展开更多
Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease result...Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.展开更多
There is considerable controversy on the role of physical activity in irritable bowel disease(IBD)since published reports are conflicting.It is well known that there is known relapse with specific treatment in IBD.Thi...There is considerable controversy on the role of physical activity in irritable bowel disease(IBD)since published reports are conflicting.It is well known that there is known relapse with specific treatment in IBD.This,in addition to onset of extraintestinal symptoms creates a need to think of alternate approaches.In this context,the current article describes the need of a multi-institutional study with standard protocol of physical activity for documenting its effect on both the primary disease and the extra alimentary manifestations.This paper also points out the possibility of using adjuvant complementary medicine such as yoga,whose effects have been documented in other diseases like irritable bowel syndrome.A third approach could be to focus on the intestinal dysbiosis in IBD and concentrate on research on restoring the microbial flora to normal,to see whether the extraintestinal symptoms are alleviated.展开更多
Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims ...Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims to address this significant gap.To identify key gaps in IBD research within Nigeria and highlight opportunities for advancing future investigations to improve patient outcomes.A comprehensive review of the existing literature was conducted to evaluate current trends in IBD research,healthcare barriers,and potential areas for investigation specific to the Nigerian context.The analysis highlights significant deficiencies,including scarce epidemiological data,low levels of awareness among clinicians and patients,limited access to healthcare,and inadequate diagnostic and treatment resources.Additionally,there is a profound lack of localized research addressing genetic,environmental,and dietary factors relevant to the Nigerian population.Future investigations should prioritize epidemiological studies to assess IBD prevalence in Nigeria,establish specialized care centers for diagnosis and management,and launch public health initiatives to promote awareness and education.Strengthening collaboration between researchers,healthcare providers,and policymakers is imperative to achieving these goals.Bridging these research gaps presents an invaluable opportunity to enhance IBD healthcare delivery and patient outcomes in Nigeria.Collaborative,multidisciplinary efforts are essential for advancing knowledge,improving resources,and ultimately elevating the quality of life for individuals living with IBD in the country.展开更多
Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immu...Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.展开更多
Inflammatory bowel disease(IBD)is a persistent gastrointestinal ailment driven by a range of immunological and pathophysiological factors,and often exposes patients to persistent pain and a greater risk of tumor devel...Inflammatory bowel disease(IBD)is a persistent gastrointestinal ailment driven by a range of immunological and pathophysiological factors,and often exposes patients to persistent pain and a greater risk of tumor development.In clinical settings,sulfasalazine is among the most common treatments used to manage IBD,but such treatment can result in a range of side effects in addition to leading to relatively poor efficacy.In certain refractory cases,patients must undergo surgical resection of affected tissues,underscoring the need to devise safer and more efficacious forms of alternative treatment.Mesenchymal stem cells(MSCs)have recently been shown to exhibit been shown to exhibit robust immunomodulatory activity and potential for differentiation such that they may be an effective tool for treating IBD.Acupuncture has also shown promise as an efficacious treatment option for IBD,performing better than drug-based treatments in certain clinical trials.Acupuncture is capable of enhancing endogenous MSC proliferation and homing,enabling these cells to more effectively migrate toward target lesion sites and to promote tissue repair.In light of these findings,this review was formulated to survey the potential therapeutic advantages of combining MSCs and acupuncture when attempting to treat IBD.展开更多
BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patie...BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.展开更多
Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic ...Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.展开更多
Natural phytoconstituents exhibit distinct advantages in the management and prevention of inflammatory bowel disease(IBD),attributed to their robust biological activity,multi-target effects,and elevated safety profile...Natural phytoconstituents exhibit distinct advantages in the management and prevention of inflammatory bowel disease(IBD),attributed to their robust biological activity,multi-target effects,and elevated safety profile.Although promising,the clinical application of phytoconstituents have been impeded by poor water solubility,low oral bioavailability,and inadequate colonic targeting.Recent advancements in nanotechnology has offered prospective avenues for the application of phytoconstituents in the treatment of IBD.A common strategy involves encapsulating or conjugating phytoconstituents with nanocarriers to enhance their stability,prolong intestinal retention,and facilitate targeted delivery to colonic inflammatory tissues.Furthermore,drawing inspiration from the self-assembling nanostructures that emerge during the decoction process of Chinese herbs,a variety of natural active compounds-based nanoassemblies have been developed for the treatment of IBD.They exhibit high drug-loading capacities and surmount the challenges posed by poor water solubility and low bioavailability.Notably,phyto-derived nanovesicles,owing to their unique structure and biological functions,can serve as therapeutic agents or novel delivery vehicles for the treatment of IBD.Consequently,this review provides an extensive overview of emerging phytoconstituent-derived nano-medicines/vesicles for the treatment of IBD,intending to offer novel insights for the clinical management of IBD.展开更多
BACKGROUND Children with juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)face an elevated risk of severe infection owing to their diseases and the immunosuppressive treatment for disease control.A...BACKGROUND Children with juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)face an elevated risk of severe infection owing to their diseases and the immunosuppressive treatment for disease control.AIM To compare scheduled vaccination coverage and the levels of post-vaccine antibodies against measles,mumps,rubella(MMR)and hepatitis B in pediatric patients with IBD and JIA.METHODS A comparative cohort study included 97 patients with IBD and 170 patients with JIA.Vaccination history was obtained from medical records,while post-vaccination immunity was assessed prospectively by measuring specific IgG antibody titers using enzyme-linked immunosorbent assays(Vector-Best JSC,Russia;IBL International,Germany)during routine visits between January 2022 and April 2023.RESULTS A complete two-dose MMR course had been administered to 66.3%of IBD patients and 55.9%of JIA patients(P=0.121).By contrast,the three-dose hepatitis B schedule was completed in 74.2%of IBD and 100%of JIA patients(P<0.001).Protective level of anti-vaccine antibodies against measles(47.7%vs 57.7%;P=0.168);mumps(75.3%vs 80.0%;P=0.366);rubella(74.4%vs 98.2%;P<0.0001);and hepatitis B(44.8%vs 50.0%;P=0.514)were detected in IBD and JIA patients,respectively.CONCLUSION Patients with IBD and JIA demonstrated different vaccination coverage patterns and levels of anti-vaccine antibodies.Routine baseline serology and timely booster vaccination should be implemented for all pediatric patients receiving chronic immunosuppression.展开更多
Objective Observational studies have found associations between inflammatory bowel disease(IBD)and the risk of dementia,including Alzheimer’s dementia(AD)and vascular dementia(VD);however,these findings are inconsist...Objective Observational studies have found associations between inflammatory bowel disease(IBD)and the risk of dementia,including Alzheimer’s dementia(AD)and vascular dementia(VD);however,these findings are inconsistent.It remains unclear whether these associations are causal.Methods We conducted a meta-analysis by systematically searching for observational studies on the association between IBD and dementia.Mendelian randomization(MR)analysis based on summary genome-wide association studies(GWASs)was performed.Genetic correlation and Bayesian colocalization analyses were used to provide robust genetic evidence.Results Ten observational studies involving 80,565,688 participants were included in this metaanalysis.IBD was significantly associated with dementia(risk ratio[RR]=1.36,95%CI=1.04-1.78;I2=84.8%)and VD(RR=2.60,95%CI=1.18-5.70;only one study),but not with AD(RR=2.00,95%CI=0.96-4.13;I^(2)=99.8%).MR analyses did not supported significant causal associations of IBD with dementia(dementia:odds ratio[OR]=1.01,95%CI=0.98-1.03;AD:OR=0.98,95%CI=0.95-1.01;VD:OR=1.02,95%CI=0.97-1.07).In addition,genetic correlation and co-localization analyses did not reveal any genetic associations between IBD and dementia.Conclusion Our study did not provide genetic evidence for a causal association between IBD and dementia risk.The increased risk of dementia observed in observational studies may be attributed to unobserved confounding factors or detection bias.展开更多
BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the...BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the Cochrane Library databases were searched from inception to March 2024.Eligible articles included observational studies that reported on outcomes such as mortality,colectomy,hospitalization,intensive care unit(ICU)admission,complication rates,and length of hospital stay in IBD patients with and without CDI.Data were extracted,and a randomeffects model was used to calculate pooled odds ratios(ORs)and mean differences(MDs).RESULTS As shown in the data from 21 studies with 1249158 participants,CDI significantly increased the risk of mortality in IBD patients[pooled OR=4.569,95%confidence intervals(95%CI):2.584 to 8.079].Although the pooled OR for colectomy was 1.409(95%CI:0.922 to 2.155),it was not statistically significant.Similarly,CDI did not impact hospitalization(pooled OR=1.056,95%CI:0.512 to 2.179)and ICU admission outcomes(pooled OR=1.970,95%CI:0.420 to 9.246)of patients with IBD.The rate of complications was comparable in the two groups(pooled OR=0.658,95%CI:0.378 to 1.147).However,CDI was associated with a significantly more extended hospital stay(pooled MD=0.349 days,95%CI:0.002 to 0.696).CONCLUSION CDI is linked to increased mortality and prolonged hospitalization in IBD patients.These results emphasize the need for early detection and appropriate management.Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.展开更多
Over the past decade,the therapeutic armamentarium for inflammatory bowel disease(IBD)has substantially expanded with the incorporation of multiple classes of advanced therapies.Currently,in addition to tumor necrosis...Over the past decade,the therapeutic armamentarium for inflammatory bowel disease(IBD)has substantially expanded with the incorporation of multiple classes of advanced therapies.Currently,in addition to tumor necrosis factor-α inhibitors,the therapeutic arsenal for IBD includes anti-integrin agents,interleukin(IL)-12/23p40 and IL-23p19 antibodies,Janus kinase inhibitors,and sphingosine 1-phosphate receptor modulators.Although advances in IBD pharmacotherapy have enabled disease remission and improved control of intestinal inflammation in many individuals previously considered clinically'intractable',they have also increased the complexity of decision-making related to the initial positioning and sequencing of therapies in the heterogeneous clinical presentations of IBD.Until molecular and genetic markers capable of predicting therapeutic responses become available in practice,the choice of initial and subsequent therapy in individuals with IBD is based on factors including disease severity,phenotype,risk of complications,comorbidities,extraintestinal manifestations,and the balance between efficacy,safety,convenience,and access.This review explores the factors that influence treatment decisions regarding initial therapy selection and sequencing across IBD scenarios,offering practical tips for personalizing therapy based on the safety and efficacy of advanced treatments and the individual's risk of disease-or therapy-related adverse outcomes.展开更多
BACKGROUND Inflammatory bowel diseases(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),are chronic gastrointestinal disorders with an increasing global prevalence and significant healthcare impact.The ex...BACKGROUND Inflammatory bowel diseases(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),are chronic gastrointestinal disorders with an increasing global prevalence and significant healthcare impact.The exact etiology of this condition remains unclear.Neutrophils play a critical role in IBD pathogenesis.Translocator protein(TSPO),a mitochondrial protein linked to immune responses,has demonstrated potential as an inflammatory marker.However,its role in IBD remains underexplored.AIM To investigate the role of TSPO in IBD pathogenesis,particularly in neutrophils.METHODS Bioinformatics analyses of Gene Expression Omnibus datasets(GE75214,GSE94648,GSE156776)assessed TSPO expression in IBD patients.TSPO expression was evaluated in human IBD samples,neutrophiles and a chronic colitis mouse model.Neutrophil function was examined in 18 samples using reactive oxygen species(ROS)production and neutrophil extracellular trap(NET)formation assays.Positron emission tomography-computed tomography(PET-CT)imaging and histology from 12 mice revealed TSPO expression in colitis.PET-CT and immunofluorescence staining assessed TSPO expression in brain under neuroinflammation condition.RESULTS Bioinformatics analysis revealed elevated TSPO expression in the intestinal mucosa and peripheral blood of patients with IBD,especially in neutrophils.This was confirmed by quantitative real-time polymerase chain reaction and immunohistochemical staining,which showed a significant upregulation of TSPO in active IBD.Neutrophils from patients with UC and CD exhibited higher TSPO expression,which correlated with increased ROS production and NET formation.In a mouse model of dextran sodium sulfate-induced chronic colitis,TSPO was upregulated in the colonic neutrophils and brain tissues,indicating its systemic involvement.PET-CT imaging showed enhanced TSPO uptake in the inflamed colon and brain regions,particularly in the microglia,highlighting neuroinflammation.CONCLUSION TSPO is significantly upregulated in neutrophils in IBD and contributes to intestinal inflammation.Its elevated expression in gut highlights its potential as a promising therapeutic target for IBD.展开更多
The oral microbiome is the second largest microbial community in the human body after the gut microbiome.It includes an array of fungi,bacteria,amoebae,flagellates,archaea,and viruses,all of which are potential pathog...The oral microbiome is the second largest microbial community in the human body after the gut microbiome.It includes an array of fungi,bacteria,amoebae,flagellates,archaea,and viruses,all of which are potential pathogens.This microbiome can act as a facilitator not only for protection but also for aggravation when dysbiosis occurs.Although conventional thought is this is primarily in terms of oral health issues,such as dental caries and gingival disease.The systemic effects of the oral microbiome however,are relevant to both gastrointestinal(GI)disease and non-GI disease.These systemic risks occur for several reasons,including upregulation of cytokines,adhesion cell-like processes,toll-like receptors,reactive oxidative species or generation of mutation inducing DNA changes.Additionally,there is translocation risk of potential active pathogens or their metabolic byproducts.There is a substantial and growing body of evidence that the oral microbiome influences diseases including Barrett’s esophagus,metabolicassociated steatosis liver disease,and GI cancers.Additionally,there is burgeoning evidence of a causal association with systemic inflammatory diseases,including inflammatory bowel disease.This report discusses the most recent evidence of this association and highlights new approaches to potentially enhance our“best practice”strategies for optimal care of patients with inflammatory bowel disease.展开更多
BACKGROUND Diagnosis of inflammatory bowel disease and assessment of disease activity are fundamentally reliant on endoscopy.Nonetheless,it is costly and invasive,highlighting the necessity for more accessible and non...BACKGROUND Diagnosis of inflammatory bowel disease and assessment of disease activity are fundamentally reliant on endoscopy.Nonetheless,it is costly and invasive,highlighting the necessity for more accessible and non-invasive biomarkers to assist in the diagnosis and evaluation of inflammatory bowel disease.AIM To examine the correlation of biomarkers with endoscopic activity,evaluate their diagnostic significance,and develop models to forecast endo-scopic activity.METHODS We performed a retrospective single-center analysis of 365 patients with ulcerative colitis(UC),319 with Crohn’s disease(CD)and 100 controls at the First Affiliated Hospital of Zhengzhou University from January 2022 to September 2024.The following biomarkers were analyzed:White blood cell,hemoglobin(Hb),platelet(PLT),neutrophil(N),lymphocyte(L),hematocrit(HCT),eosinophil,albumin(ALB),globulin(GLB),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),ALB/GLB(AGR),CRP/ALB(CAR),CRP/L(CLR),PLT/ALB(PAR),PLT/L(PLR),and N/L(NLR).RESULTS Serum N,PLT,GLB,CRP,ESR,CAR,CLR,PLR,PAR,and NLR levels were significantly elevated(P<0.001 or P<0.05)in the UC and CD groups compared to controls,whereas Hb,HCT,L,ALB,and AGR were reduced(P<0.001 or P<0.05).Aside from L and eosinophil,substantial differences were observed between mild and severe activity in UC and CD(P<0.001 or P<0.05).UC and CD patients who exhibited an endoscopic response after 14 weeks of treatment had elevated CRP,CAR,and CLR levels at baseline compared to endoscopic nonresponders(P<0.01 or P<0.05).The UC nomogram model utilizing ESR,CAR,and PAR,along with the CD nomogram model employing AGR and PAR,demonstrate predictive significance and clinical applicability for assessing endoscopic activity.CONCLUSION White blood cell,Hb,HCT,PLT,N,CRP,ESR,ALB,GLB,AGR,CAR,CLR,PLR,PAR and NLR are significantly correlated with the endoscopic activity of UC and CD.Patients with UC and CD exhibiting elevated CRP,CAR,and CLR levels are more inclined to respond to treatment.Our nomogram models can precisely forecast endoscopic activity.展开更多
Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),has been increasingly associated with the progression of neurodegenerative disorders,particularly Alzheimer’s disease(AD).Emerg...Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),has been increasingly associated with the progression of neurodegenerative disorders,particularly Alzheimer’s disease(AD).Emerging data from population-based meta-analyses and in vivo experimental models demonstrate that systemic inflammation associated with IBD exacerbates disruption of the gut-brain axis(GBA).This disruption promotes the deposition of amyloid-β(Aβ)plaques,and cognitive decline.Together,these effects contribute to the progression of AD.Chronic colitis,a hallmark of IBD,accelerates Aβpathology and induces cognitive impairment in transgenic mouse models,providing direct evidence of the detrimental effects of gut inflammation on neurodegeneration.Although numerous clinical and meta-analytical studies have examined the prevalence of AD in IBD patients,the molecular mechanisms underlying this association remain inadequately understood.In particular,the roles of immune regulation and GBA interactions require further investigation.This review aims to critically compile current evidence that elucidates the shared pathophysiological mechanisms underlying this association,such as chronic systemic inflammation,gut dysbiosis,and dysregulated immune responses.Although anti-inflammatory therapies,probiotics,and modulation of the gut microbiota have the potential to reduce the risk of AD and slow its progression,age-related gut inflammation and dysbiosis can aggravate AD pathology.This underscores the necessity for treatments that specifically target IBD-associated inflammation to limit AD progression.In addition,this review also meticulously examines how immune signaling and regulatory pathways in IBD,such as triggering receptor expression via myeloid cell receptor activation;NLRP3 inflammasome-driven inflammation;disrupted interleukin(IL)-1β,IL-6,and tumor necrosis factor-alpha(TNF-α)signaling;and elevated C-reactive protein levels,contribute to increased amyloidogenesis.This paper proposes a comprehensive framework for therapeutic strategies targeting IBD-related inflammation and elucidates their potential to attenuate the progression of AD.展开更多
文摘Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.
基金Supported by The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008。
文摘Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.
文摘Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.
文摘Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.
文摘There is considerable controversy on the role of physical activity in irritable bowel disease(IBD)since published reports are conflicting.It is well known that there is known relapse with specific treatment in IBD.This,in addition to onset of extraintestinal symptoms creates a need to think of alternate approaches.In this context,the current article describes the need of a multi-institutional study with standard protocol of physical activity for documenting its effect on both the primary disease and the extra alimentary manifestations.This paper also points out the possibility of using adjuvant complementary medicine such as yoga,whose effects have been documented in other diseases like irritable bowel syndrome.A third approach could be to focus on the intestinal dysbiosis in IBD and concentrate on research on restoring the microbial flora to normal,to see whether the extraintestinal symptoms are alleviated.
文摘Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims to address this significant gap.To identify key gaps in IBD research within Nigeria and highlight opportunities for advancing future investigations to improve patient outcomes.A comprehensive review of the existing literature was conducted to evaluate current trends in IBD research,healthcare barriers,and potential areas for investigation specific to the Nigerian context.The analysis highlights significant deficiencies,including scarce epidemiological data,low levels of awareness among clinicians and patients,limited access to healthcare,and inadequate diagnostic and treatment resources.Additionally,there is a profound lack of localized research addressing genetic,environmental,and dietary factors relevant to the Nigerian population.Future investigations should prioritize epidemiological studies to assess IBD prevalence in Nigeria,establish specialized care centers for diagnosis and management,and launch public health initiatives to promote awareness and education.Strengthening collaboration between researchers,healthcare providers,and policymakers is imperative to achieving these goals.Bridging these research gaps presents an invaluable opportunity to enhance IBD healthcare delivery and patient outcomes in Nigeria.Collaborative,multidisciplinary efforts are essential for advancing knowledge,improving resources,and ultimately elevating the quality of life for individuals living with IBD in the country.
文摘Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.
基金Supported by the National Natural Science Foundation of China,No.82174524.
文摘Inflammatory bowel disease(IBD)is a persistent gastrointestinal ailment driven by a range of immunological and pathophysiological factors,and often exposes patients to persistent pain and a greater risk of tumor development.In clinical settings,sulfasalazine is among the most common treatments used to manage IBD,but such treatment can result in a range of side effects in addition to leading to relatively poor efficacy.In certain refractory cases,patients must undergo surgical resection of affected tissues,underscoring the need to devise safer and more efficacious forms of alternative treatment.Mesenchymal stem cells(MSCs)have recently been shown to exhibit been shown to exhibit robust immunomodulatory activity and potential for differentiation such that they may be an effective tool for treating IBD.Acupuncture has also shown promise as an efficacious treatment option for IBD,performing better than drug-based treatments in certain clinical trials.Acupuncture is capable of enhancing endogenous MSC proliferation and homing,enabling these cells to more effectively migrate toward target lesion sites and to promote tissue repair.In light of these findings,this review was formulated to survey the potential therapeutic advantages of combining MSCs and acupuncture when attempting to treat IBD.
基金Supported by the China Health Promotion Foundation Young Doctors'Research Foundation for Inflammatory Bowel Disease,the Taishan Scholars Program of Shandong Province,China,No.tsqn202306343National Natural Science Foundation of China,No.82270578.
文摘BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.
文摘Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.
基金supported by the National Natural Science Foundation of China(Nos.82273824,31670359 and 82372111)the Liao Ning Revitalization Talents Program(No.XLYC 1905019)。
文摘Natural phytoconstituents exhibit distinct advantages in the management and prevention of inflammatory bowel disease(IBD),attributed to their robust biological activity,multi-target effects,and elevated safety profile.Although promising,the clinical application of phytoconstituents have been impeded by poor water solubility,low oral bioavailability,and inadequate colonic targeting.Recent advancements in nanotechnology has offered prospective avenues for the application of phytoconstituents in the treatment of IBD.A common strategy involves encapsulating or conjugating phytoconstituents with nanocarriers to enhance their stability,prolong intestinal retention,and facilitate targeted delivery to colonic inflammatory tissues.Furthermore,drawing inspiration from the self-assembling nanostructures that emerge during the decoction process of Chinese herbs,a variety of natural active compounds-based nanoassemblies have been developed for the treatment of IBD.They exhibit high drug-loading capacities and surmount the challenges posed by poor water solubility and low bioavailability.Notably,phyto-derived nanovesicles,owing to their unique structure and biological functions,can serve as therapeutic agents or novel delivery vehicles for the treatment of IBD.Consequently,this review provides an extensive overview of emerging phytoconstituent-derived nano-medicines/vesicles for the treatment of IBD,intending to offer novel insights for the clinical management of IBD.
文摘BACKGROUND Children with juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)face an elevated risk of severe infection owing to their diseases and the immunosuppressive treatment for disease control.AIM To compare scheduled vaccination coverage and the levels of post-vaccine antibodies against measles,mumps,rubella(MMR)and hepatitis B in pediatric patients with IBD and JIA.METHODS A comparative cohort study included 97 patients with IBD and 170 patients with JIA.Vaccination history was obtained from medical records,while post-vaccination immunity was assessed prospectively by measuring specific IgG antibody titers using enzyme-linked immunosorbent assays(Vector-Best JSC,Russia;IBL International,Germany)during routine visits between January 2022 and April 2023.RESULTS A complete two-dose MMR course had been administered to 66.3%of IBD patients and 55.9%of JIA patients(P=0.121).By contrast,the three-dose hepatitis B schedule was completed in 74.2%of IBD and 100%of JIA patients(P<0.001).Protective level of anti-vaccine antibodies against measles(47.7%vs 57.7%;P=0.168);mumps(75.3%vs 80.0%;P=0.366);rubella(74.4%vs 98.2%;P<0.0001);and hepatitis B(44.8%vs 50.0%;P=0.514)were detected in IBD and JIA patients,respectively.CONCLUSION Patients with IBD and JIA demonstrated different vaccination coverage patterns and levels of anti-vaccine antibodies.Routine baseline serology and timely booster vaccination should be implemented for all pediatric patients receiving chronic immunosuppression.
基金supported by the China Postdoctoral Science Foundation(Grant No.2021M703366)Shenzhen Science and Technology Program(Grant No.KQTD20190929172835662).
文摘Objective Observational studies have found associations between inflammatory bowel disease(IBD)and the risk of dementia,including Alzheimer’s dementia(AD)and vascular dementia(VD);however,these findings are inconsistent.It remains unclear whether these associations are causal.Methods We conducted a meta-analysis by systematically searching for observational studies on the association between IBD and dementia.Mendelian randomization(MR)analysis based on summary genome-wide association studies(GWASs)was performed.Genetic correlation and Bayesian colocalization analyses were used to provide robust genetic evidence.Results Ten observational studies involving 80,565,688 participants were included in this metaanalysis.IBD was significantly associated with dementia(risk ratio[RR]=1.36,95%CI=1.04-1.78;I2=84.8%)and VD(RR=2.60,95%CI=1.18-5.70;only one study),but not with AD(RR=2.00,95%CI=0.96-4.13;I^(2)=99.8%).MR analyses did not supported significant causal associations of IBD with dementia(dementia:odds ratio[OR]=1.01,95%CI=0.98-1.03;AD:OR=0.98,95%CI=0.95-1.01;VD:OR=1.02,95%CI=0.97-1.07).In addition,genetic correlation and co-localization analyses did not reveal any genetic associations between IBD and dementia.Conclusion Our study did not provide genetic evidence for a causal association between IBD and dementia risk.The increased risk of dementia observed in observational studies may be attributed to unobserved confounding factors or detection bias.
文摘BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the Cochrane Library databases were searched from inception to March 2024.Eligible articles included observational studies that reported on outcomes such as mortality,colectomy,hospitalization,intensive care unit(ICU)admission,complication rates,and length of hospital stay in IBD patients with and without CDI.Data were extracted,and a randomeffects model was used to calculate pooled odds ratios(ORs)and mean differences(MDs).RESULTS As shown in the data from 21 studies with 1249158 participants,CDI significantly increased the risk of mortality in IBD patients[pooled OR=4.569,95%confidence intervals(95%CI):2.584 to 8.079].Although the pooled OR for colectomy was 1.409(95%CI:0.922 to 2.155),it was not statistically significant.Similarly,CDI did not impact hospitalization(pooled OR=1.056,95%CI:0.512 to 2.179)and ICU admission outcomes(pooled OR=1.970,95%CI:0.420 to 9.246)of patients with IBD.The rate of complications was comparable in the two groups(pooled OR=0.658,95%CI:0.378 to 1.147).However,CDI was associated with a significantly more extended hospital stay(pooled MD=0.349 days,95%CI:0.002 to 0.696).CONCLUSION CDI is linked to increased mortality and prolonged hospitalization in IBD patients.These results emphasize the need for early detection and appropriate management.Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.
文摘Over the past decade,the therapeutic armamentarium for inflammatory bowel disease(IBD)has substantially expanded with the incorporation of multiple classes of advanced therapies.Currently,in addition to tumor necrosis factor-α inhibitors,the therapeutic arsenal for IBD includes anti-integrin agents,interleukin(IL)-12/23p40 and IL-23p19 antibodies,Janus kinase inhibitors,and sphingosine 1-phosphate receptor modulators.Although advances in IBD pharmacotherapy have enabled disease remission and improved control of intestinal inflammation in many individuals previously considered clinically'intractable',they have also increased the complexity of decision-making related to the initial positioning and sequencing of therapies in the heterogeneous clinical presentations of IBD.Until molecular and genetic markers capable of predicting therapeutic responses become available in practice,the choice of initial and subsequent therapy in individuals with IBD is based on factors including disease severity,phenotype,risk of complications,comorbidities,extraintestinal manifestations,and the balance between efficacy,safety,convenience,and access.This review explores the factors that influence treatment decisions regarding initial therapy selection and sequencing across IBD scenarios,offering practical tips for personalizing therapy based on the safety and efficacy of advanced treatments and the individual's risk of disease-or therapy-related adverse outcomes.
基金Supported by National Natural Science Foundation of China,No.82300604Science and Technology Innovation Action Plan Star Project Application Guide/Star Project Incubation(Yangfan Special Program)of Shanghai,No.24YF2727600.
文摘BACKGROUND Inflammatory bowel diseases(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),are chronic gastrointestinal disorders with an increasing global prevalence and significant healthcare impact.The exact etiology of this condition remains unclear.Neutrophils play a critical role in IBD pathogenesis.Translocator protein(TSPO),a mitochondrial protein linked to immune responses,has demonstrated potential as an inflammatory marker.However,its role in IBD remains underexplored.AIM To investigate the role of TSPO in IBD pathogenesis,particularly in neutrophils.METHODS Bioinformatics analyses of Gene Expression Omnibus datasets(GE75214,GSE94648,GSE156776)assessed TSPO expression in IBD patients.TSPO expression was evaluated in human IBD samples,neutrophiles and a chronic colitis mouse model.Neutrophil function was examined in 18 samples using reactive oxygen species(ROS)production and neutrophil extracellular trap(NET)formation assays.Positron emission tomography-computed tomography(PET-CT)imaging and histology from 12 mice revealed TSPO expression in colitis.PET-CT and immunofluorescence staining assessed TSPO expression in brain under neuroinflammation condition.RESULTS Bioinformatics analysis revealed elevated TSPO expression in the intestinal mucosa and peripheral blood of patients with IBD,especially in neutrophils.This was confirmed by quantitative real-time polymerase chain reaction and immunohistochemical staining,which showed a significant upregulation of TSPO in active IBD.Neutrophils from patients with UC and CD exhibited higher TSPO expression,which correlated with increased ROS production and NET formation.In a mouse model of dextran sodium sulfate-induced chronic colitis,TSPO was upregulated in the colonic neutrophils and brain tissues,indicating its systemic involvement.PET-CT imaging showed enhanced TSPO uptake in the inflamed colon and brain regions,particularly in the microglia,highlighting neuroinflammation.CONCLUSION TSPO is significantly upregulated in neutrophils in IBD and contributes to intestinal inflammation.Its elevated expression in gut highlights its potential as a promising therapeutic target for IBD.
文摘The oral microbiome is the second largest microbial community in the human body after the gut microbiome.It includes an array of fungi,bacteria,amoebae,flagellates,archaea,and viruses,all of which are potential pathogens.This microbiome can act as a facilitator not only for protection but also for aggravation when dysbiosis occurs.Although conventional thought is this is primarily in terms of oral health issues,such as dental caries and gingival disease.The systemic effects of the oral microbiome however,are relevant to both gastrointestinal(GI)disease and non-GI disease.These systemic risks occur for several reasons,including upregulation of cytokines,adhesion cell-like processes,toll-like receptors,reactive oxidative species or generation of mutation inducing DNA changes.Additionally,there is translocation risk of potential active pathogens or their metabolic byproducts.There is a substantial and growing body of evidence that the oral microbiome influences diseases including Barrett’s esophagus,metabolicassociated steatosis liver disease,and GI cancers.Additionally,there is burgeoning evidence of a causal association with systemic inflammatory diseases,including inflammatory bowel disease.This report discusses the most recent evidence of this association and highlights new approaches to potentially enhance our“best practice”strategies for optimal care of patients with inflammatory bowel disease.
基金Supported by Henan Natural Science Foundation,No.232300421181.
文摘BACKGROUND Diagnosis of inflammatory bowel disease and assessment of disease activity are fundamentally reliant on endoscopy.Nonetheless,it is costly and invasive,highlighting the necessity for more accessible and non-invasive biomarkers to assist in the diagnosis and evaluation of inflammatory bowel disease.AIM To examine the correlation of biomarkers with endoscopic activity,evaluate their diagnostic significance,and develop models to forecast endo-scopic activity.METHODS We performed a retrospective single-center analysis of 365 patients with ulcerative colitis(UC),319 with Crohn’s disease(CD)and 100 controls at the First Affiliated Hospital of Zhengzhou University from January 2022 to September 2024.The following biomarkers were analyzed:White blood cell,hemoglobin(Hb),platelet(PLT),neutrophil(N),lymphocyte(L),hematocrit(HCT),eosinophil,albumin(ALB),globulin(GLB),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),ALB/GLB(AGR),CRP/ALB(CAR),CRP/L(CLR),PLT/ALB(PAR),PLT/L(PLR),and N/L(NLR).RESULTS Serum N,PLT,GLB,CRP,ESR,CAR,CLR,PLR,PAR,and NLR levels were significantly elevated(P<0.001 or P<0.05)in the UC and CD groups compared to controls,whereas Hb,HCT,L,ALB,and AGR were reduced(P<0.001 or P<0.05).Aside from L and eosinophil,substantial differences were observed between mild and severe activity in UC and CD(P<0.001 or P<0.05).UC and CD patients who exhibited an endoscopic response after 14 weeks of treatment had elevated CRP,CAR,and CLR levels at baseline compared to endoscopic nonresponders(P<0.01 or P<0.05).The UC nomogram model utilizing ESR,CAR,and PAR,along with the CD nomogram model employing AGR and PAR,demonstrate predictive significance and clinical applicability for assessing endoscopic activity.CONCLUSION White blood cell,Hb,HCT,PLT,N,CRP,ESR,ALB,GLB,AGR,CAR,CLR,PLR,PAR and NLR are significantly correlated with the endoscopic activity of UC and CD.Patients with UC and CD exhibiting elevated CRP,CAR,and CLR levels are more inclined to respond to treatment.Our nomogram models can precisely forecast endoscopic activity.
文摘Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD),has been increasingly associated with the progression of neurodegenerative disorders,particularly Alzheimer’s disease(AD).Emerging data from population-based meta-analyses and in vivo experimental models demonstrate that systemic inflammation associated with IBD exacerbates disruption of the gut-brain axis(GBA).This disruption promotes the deposition of amyloid-β(Aβ)plaques,and cognitive decline.Together,these effects contribute to the progression of AD.Chronic colitis,a hallmark of IBD,accelerates Aβpathology and induces cognitive impairment in transgenic mouse models,providing direct evidence of the detrimental effects of gut inflammation on neurodegeneration.Although numerous clinical and meta-analytical studies have examined the prevalence of AD in IBD patients,the molecular mechanisms underlying this association remain inadequately understood.In particular,the roles of immune regulation and GBA interactions require further investigation.This review aims to critically compile current evidence that elucidates the shared pathophysiological mechanisms underlying this association,such as chronic systemic inflammation,gut dysbiosis,and dysregulated immune responses.Although anti-inflammatory therapies,probiotics,and modulation of the gut microbiota have the potential to reduce the risk of AD and slow its progression,age-related gut inflammation and dysbiosis can aggravate AD pathology.This underscores the necessity for treatments that specifically target IBD-associated inflammation to limit AD progression.In addition,this review also meticulously examines how immune signaling and regulatory pathways in IBD,such as triggering receptor expression via myeloid cell receptor activation;NLRP3 inflammasome-driven inflammation;disrupted interleukin(IL)-1β,IL-6,and tumor necrosis factor-alpha(TNF-α)signaling;and elevated C-reactive protein levels,contribute to increased amyloidogenesis.This paper proposes a comprehensive framework for therapeutic strategies targeting IBD-related inflammation and elucidates their potential to attenuate the progression of AD.
