Usefulness of contrast-enhanced ultrasound (CEUS) in Inflammatory Bowel Disease (IBD)

Intestinal ultrasonography has emerged as a cheap, non-invasive and readily accessible modality for the assessment of a number of gastroenterological diseases. Over the last decade, particularly due to the widespread use of biological agents in Inflammatory Bowel Disease (IBD), guidelines regarding management and follow-up advise more regular disease assessment and surveillance in order to guide treatment adjustments, and provide more personalised care. Given the young age of the majority of patients with IBD the availability of an alternative modality to harmful radiation or the risks of endoscopy for this indication offers an appealing advantage. Intestinal ultrasonography has been shown to be as sensitive and specific for detecting IBD as both computed tomography and magnetic resonance enterography, and endoscopic evaluation. More recent developments in the technology of ultrasonography equipment and the use of intravenous contrast agents (contrast enhanced ultrasonography, known as CEUS), have significantly increased the ability to both detect disease location, determine the disease activity and also potentially the difference between fibrotic and inflammatory segments. This review focusses specifically on the value of CEUS for the diagnosis of both Crohn’s disease and Ulcerative Colitis, in determining disease activity, extraintestinal complications, determination of fibrosis as well as its more recent use in assessing and predicting response to biological and immunosuppressive therapies.     

Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review

Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients.The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD.Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004.A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia should be administered with a target to restore/replenish the iron stores and the hemoglobin level in a suitable way. However, in patients with IBD flares and inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice. Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD, and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics.In conclusion, because many physicians are in doubt as to how to manage anemia and iron deficiency in IBD, there is a clear need for the implementation of evidence-based recommendations on this matter. Based on the data presented, oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency anemia unless such patients are intolerant or have an inadequate response, whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron.     

Pulmonary Function in Patients with Inflammatory Bowel Disease

Pulmonary function has been assessed in 36 outpatients with inflammatory bowel disease. The carbon monoxide transfer factor was found to be significantly reduced in patients as compared with matched controls (P less than 0.01). The reason for this reduction is not clear but it is unlikely to be due to sulfasalazine (Salazosulphapyridine).     

Vitamin Status in Patients with Inflammatory Bowel Disease

The status of water- and fat-soluble vitamins was prospectively evaluated in 23 patients (13 men, 10 women, mean age 33 +/- 3 yr) admitted to the hospital with acute or subacute attacks of inflammatory bowel disease. Protein-energy status was also assessed by means of simultaneous measurement of triceps skinfold thickness, mid-arm muscle circumference, and serum albumin. Fifteen patients (group A) had extensive acute colitis (ulcerative or Crohn's colitis), and eight cases (group B) had small bowel or ileocecal Crohn's disease. Eighty-nine healthy subjects (36 men, 53 women, mean age 34 +/- 2 yr) acted as controls. In both groups of patients, the levels of biotin, folate, beta-carotene, and vitamins A, C, and B1 were significantly lower than in controls (p less than 0.01). Plasma levels of vitamin B12 were decreased only in group B (p less than 0.01), whereas riboflavin was lower in group A (p less than 0.01). The percentage of patients at risk of developing hypovitaminosis was 40% or higher for vitamin A, beta-carotene, folate, biotin, vitamin C, and thiamin in both groups of patients. Although some subjects had extremely low vitamin values, in no case were clinical symptoms of vitamin deficiency observed. Only a weak correlation was found between protein-energy nutritional parameters and vitamin values, probably due to the small size of the sample studied. The pathophysiological and clinical implications of the suboptimal vitamin status observed in acute inflammatory bowel disease are unknown. Further studies on long-term vitamin status and clinical outcome in these patients are necessary.     

Pancreatic Disorders in Patients with Inflammatory Bowel Disease

Digestive Diseases and Sciences - Inflammatory bowel disease (IBD) can involve multiple organ systems, and pancreatic manifestations of IBD are not uncommon. The incidence of several pancreatic...     

Smoking Habits in Patients with Inflammatory Bowel Disease

The proportion of smokers in this study was significantly lower among patients with ulcerative colitis (13%) than among patients with Crohn's disease (47%), the difference being significant for both sexes and for the age groups both below and above 40 years. The proportion of male ex-smokers among patients with ulcerative colitis (28%) was higher than among patients with Crohn's disease (8%), whereas the proportions of non-smokers differed less. Many of the patients with ulcerative colitis who had a late onset were male ex-smokers. The smoking patients with ulcerative colitis were mainly women. They smoked less than the smoking patients with Crohn's disease and less than the ex-smokers in each group. No smoking patient with ulcerative colitis smoked > 20 cigarettes/day. In the group of male ex-smokers with ulcerative colitis, there was an accumulation of onsets during the 4 years after the definitive smoking stop. The number of colectomies performed on patients with ulcerative colitis did not vary with smoking habits. In the group of ex-smokers the colectomy was performed after the smoking stop in 19 out of 20 patients.     

Hyperhomocysteinemia in Greek Patients with Inflammatory Bowel Disease

In recent years hyperhomocysteinemia has been established as a new risk factor for arterial and venous thrombosis. Since patients with inflammatory bowel disease (IBD) frequently suffer from thromboembolic events, we studied the prevalence and clinical significance of hyperhomocysteinemia in Greek patients with ulcerative colitis (UC) and Crohn's disease (CD). In 108 consecutive fasting IBD patients (53 UC and 55 CD) and 74 healthy controls (HC), a standard record of various clinical thrombotic risk factors was completed by interview, and fasting serum concentrations of total homocysteine (tHcy), folate, cobalamin, creatinine, cholesterol, HDL, LDL, and triglycerides were measured. The concentration (mean ± sd) of serum tHcy was significantly higher in UC (15.9 ± 10.3 mol/liter) and CD patients (13.6 ± 6.5) than in controls (9.6 ± 3.4, P < 0.05). Both UC and CD patients had lower levels of folate than HC (P < 0.05). Covariance analysis of age, gender, and all clinical variables indicated that the differences in homocysteine levels between IBD patients and HC remain significant even after adjustment for these covariates. In conclusion, mild hyperhomocysteinemia is common in Greek IBD patients and may account for the increased thrombotic risk of these patients.     

Anti-Cardiolipin Antibodies in Patients with Inflammatory Bowel Disease

Elevated levels of anti-cardiolipin antibodiesare associated with an increased risk for venous andarterial thrombosis. In patients with inflammatory boweldisease thrombosis is a well known complication. We determined the prevalence of elevatedanti-cardiolipin antibodies in 136 patients withinflammatory bowel disease compared with 136 healthycontrols and analyzed thromboembolic complications inpatients with increased anti-cardiolipin antibodylevels. Anti-cardiolipin antibody titers weresignificantly elevated in patients with Crohn's disease(5.7 units/ml) and ulcerative colitis (5.3 units/ml)compared to the control group (2.5 units/ml). We foundno correlation between disease activity andanti-cardiolipin antibody levels. Seven patients haddeep venous thrombosis in their history, in three ofthem this was complicated by pulmonary embolism. In onlytwo of the seven patients with deep venous thrombosiswere anti-cardiolipin antibody levels increased. Inconclusion, anti-cardiolipin antibody titers were significantly increased in patients withinflammatory bowel disease. Elevated anti-cardiolipinantibody levels appear to play no role in thepathogenesis of thromboembolic events in patients withinflammatory bowel disease.     

Surgical Management of Inflammatory Bowel Disease

Opinion statement Surgery continues to be a central component in the treatment of patients with inflammatory bowel disease (IBD). The most important aspect of caring for patients with IBD is a close and ongoing interaction between the surgeon and gastroenterologist both before and after surgery. Surgery in patients with chronic ulcerative colitis (CUC) is curative. In the appropriate patient, we recommend proctocolectomy with ileal pouch anal anastomosis (IPAA). In contrast, patients with Crohn’s disease cannot be cured with surgery. Instead, surgery is used in conjunction with maximal medical therapy to treat symptoms of the disease and improve the patient’s quality of life. Surgical interventions should be limited in scope. Small bowel disease should be treated with either limited resection or strictureplasty, if possible, to conserve bowel length. For limited involvement of the colon, segmental resection yields good results. Minimal surgical intervention, drainage of abscesses, placing draining setons, and aggressive medical therapy is recommended as treatment of perianal Crohn’s disease.     

Inflammation-Related Erythrocyte Aggregation in Patients with Inflammatory Bowel Disease

Chronic inflammation is associated with increased erythrocyte adhesiveness/aggregation. This might have deleterious effects on the microcirculatory flow and tissue oxygenation. We aimed to determine the degree of erythrocyte adhesiveness/aggregation in the peripheral blood of individuals with inflammatory bowel disease (IBD). Fifty-two patients (24 women and 28 men) with ulcerative colitis (UC) at a mean age of 44.0 ± 16.8 years and 96 patients (44 women and 52 men) with Crohns disease (CD) at a mean age of 38.0 ± 15.5 years, with various degrees of disease activity, were matched to normal controls. A simple slide test and image analysis were used to determine the degree of erythrocyte adhesiveness/aggregation. CD activity index (CDAI) was determined in patients with CD, while clinical colitis activity index was applied for patients with UC. A significant (P < 0.0005) increment in the degree of erythrocyte adhesiveness/aggregation was noted in both groups of IBD patients compared with matched control groups. This increment was evident even in individuals with a low index of disease activity and during remission. The highly significant correlation with the concentrations of fibrinogen suggests that the degree of erythrocyte adhesiveness/aggregation is an inflammation-related phenomenon. An enhanced state of erythrocyte adhesiveness/aggregation was noted in the peripheral blood of patients with IBD. This might have a deleterious effect on intestinal microcirculatory flow and tissue oxygenation.     

Cytomegalovirus Infection in Patients with Active Inflammatory Bowel Disease

Background  

The reported prevalence of cytomegalovirus (CMV) infection with active inflammatory bowel disease (IBD) is highly variable, and whether CMV negatively impacts the clinical course is controversial.     

Antiglycan Antibodies in Greek Patients with Inflammatory Bowel Disease

Background  

Antiglycan antibodies have recently been reported to be associated with Crohn’s disease (CD). These antibodies include anti-Saccharomyces cerevisiae mannan antibodies (ASCA), anti-laminariobioside carbohydrate antibodies (ALCA), anti-chitobioside carbohydrate antibodies (ACCA), and anti-mannobioside carbohydrate antibodies (AMCA).     

Pancreatic Autoantibodies in Greek Patients with Inflammatory Bowel Disease

Pancreatic autoantibodies (PAbs) have been suggested as a specific but not sensitive marker for Crohn's disease (CD). The aim of this study was to assess the value of detecting PAbs in Greek patients with ulcerative colitis (UC) and CD. Sera were collected from 150 patients with IBD (73 with UC and 77 with CD), 31 cases with non-IBD intestinal inflammation, 16 cases with other autoimmune diseases, and 104 healthy controls. Determination of PAbs was performed by a standard indirect immunofluorescence technique. PAbs were detected in 18 of 73 (24.7%) samples from UC patients and in 32 of 77 (41.6%) samples from CD patients. The prevalence of positive PAbs was significantly higher in CD than in UC (P= 0.04). None of the 104 samples from healthy controls and the 31 cases with non-IBD intestinal inflammation had detectable PAbs. One patient with Sjogren's syndrome was PAbs positive. No association of PAbs with IBD activity, IBD localization, or medical treatment was found. Patients with stenotic CD had a significantly higher prevalence of PAbs positivity (60%) compared with patients with inflammatory (28.6%) and fistulizing (41.2%) disease (P= 0.02). The prevalence of PAbs in Greek CD patients was found to be similar to that in previous reports. In contrast to these studies we found also increased prevalence of PAbs in UC patients. These findings suggest that PAbs should be considered as a specific marker for IBD rather than for CD.     

Antinuclear Autoantibodies in Patients with Inflammatory Bowel Disease (High Prevalence in First-Degree Relatives)

Crohn's disease and ulcerative colitis show afamilial aggregation. The role of antinuclearautoantibodies, which occur in both diseases, remains tobe defined. In 76 patients with Crohn's disease, 61patients with ulcerative colitis, 105 first-degreerelatives of patients with Crohn's disease, 101first-degree relatives of patients with ulcerativecolitis, and 40 healthy unrelated controls antinuclearautoantibodies were detected by indirect immunofluorescence.Existence of autoantibodies was correlated with clinicalfeatures. Eighteen percent of patients with Crohn'sdisease (14/76), 43% of patients with ulcerative colitis (26/61), 13% of relatives of patientswith Crohn's disease (14/105), 24% of relatives ofulcerative colitis patients (24/101), and 2% of thehealthy controls (1/40) were positive for antinuclear autoantibodies. The difference between controlsand patients and the first-degree relatives of patientswith ulcerative colitis, respectively, was statisticallysignificant (P 0.0144). In ulcerative colitis, the existence of antinuclear autoantibodies wasnegatively correlated with immunosuppressive therapy orextraintestinal manifestations (P = 0.0004 and 0.0273,respectively). Antinuclear autoantibodies may represent a factor disposing to the developmentof ulcerative colitis.     

REVIEW: Concerns of Patients with Inflammatory Bowel Disease

Idiopathic, chronic inflammatory bowel disease (IBD) refers to two diseases—ulcerative colitis (UC) and Crohn's disease (CD). Despite an abundant literature discussing the pathophysiology and treatment of these diseases, little if any empirical studies have focused on patients' subjective experiences with their diseases. The purpose of this paper was to identify and discuss the concerns of individuals with IBD and to suggest that the integration of concerns in clinical management is necessary for a comprehensive understanding of these chronic and debilitating diseases. In addition, case studies were included to highlight the concerns of people with IBD. Our review of the literature identified eight categories of concerns for individuals with IBD. They included loss of energy, loss of control, body image, isolation and fear, not reaching full potential, feeling dirty, and lack of information from the medical community. In conclusion, we argue that the efficacy of treatment for IBD would be greatly improved if psychosocial issues were to be integrated into treatment protocols.