Migraine, celiac disease, and cerebral calcifications: a new case

Celiac disease is sometimes associated with neurological complications. Only one case of celiac disease associated with migraine and cerebral calcifications has been reported. We present a patient with migraine (with and without aura) in whom neuroimaging revealed cerebral calcifications in the occipital and parietal regions bilaterally. Visual examination showed bilateral double scotoma, and further investigations revealed celiac disease. Migraine may on occasion be a sentinel symptom of mild celiac disease.     

Strengthening causal inference in cardiovascular epidemiology through Mendelian randomization

Observational studies have contributed in a major way to understanding modifiable determinants of cardiovascular disease risk, but several examples exist of factors that were identified in observational studies as potentially protecting against coronary heart disease, that in randomized controlled trials had no such effect. The likely reason for misleading findings from observational epidemiological studies is that associations are influenced by confounding, bias, and reverse causation—where disease influences a risk factor, rather than vice versa. Mendelian randomization utilizes genetic variants that serve as proxy measures for modifiable risk factors to allow estimation of the causal influence of the modifiable risk factor in question. We present examples of the use of the Mendelian randomization approach and discuss both the limitations and potentials of this strategy.     

炎症性肠病的营养相关疾病

炎症性肠病（IBD）中的溃疡性结肠炎和克罗恩病都属于病因不清,病情反复发作的以肠道受累为主的炎症性疾病。这样的疾病特点使得大多数患者历经数十年的病痛困扰,在漫长的病史中不论疾病的活动程度如何,甚至在疾病的缓解期营养不良的情况都是十分常见的。营养不良的情况包括蛋白质能量营养不足、超重、维生素、矿物质和微量元素的缺乏等。与IBD患者的营养不良相关的因素众多,如肠道吸收功能不良、肠道溃疡和炎症引发的营养素丢失、小肠细菌过度生长、糖皮质激素类药物的使用和饮食限制。营养支持治疗对于IBD患者至关重要,尤其是对维持儿童期IBD患者正常的生长发育、诱导活动期CD患者的临床缓解、减少IBD患者围手术期并发症等都是至关重要的。     

Open-label, uncontrolled trial of bowel sterilization and repopulation with normal bowel flora for treatment of inflammatory bowel disease

In this open-label, uncontrolled study, six patients with inflammatory bowel disease (IBD) (2 with ulcerative colitis, 1 with collagenous colitis, 1 with Crohn's disease, and 2 with indeterminate type) were treated with bowel decontamination using mechanical cleansing and antibiotics followed by repopulation with 12 strains of colonic bacteria from normal donors. One patient relapsed after 13 months following treatment with an antibiotic for an upper respiratory infection. One patient remains in full clinical remission after 18 months, and another patient after 32 months; the other three patients' symptoms did not change with treatment. No evidence of toxicity from treatments was observed. None of the patients who were in remission required therapy for IBD.     

Therapeutic peptides in inflammatory bowel disease

Introduction: Therapeutic peptides in inflammatory bowel diseases essentially comprise cytokines affecting immune response, growth factors and monoclonal antibodies directed against key targets of mucosal inflammation, in particular, tumor necrosis factor-α (TNF-α). The latter have revolutionized standard medical treatment which previously was restricted to mesalamine, corticosteroids or classical immunosuppressants.

Areas covered: We review current evidence of the use of the so-called biologicals, including the well-established TNF-α antagonists and novel peptides and monoclonal antibodies developed for these diseases. The focus is on controlled clinical trials and meta-analyses, if available. Limitations and biases of these studies are important but tend to be ignored. Safety is also an important issue with opportunistic infections and lymphoma as relevant risks. There is significant heterogeneity between different countries, guidelines and opinions within the scientific community regarding clinical indications, even apart from pharmacoeconomics and reimbursement.

Expert opinion: TNF blockers have greatly extended medical options in inflammatory bowel diseases. Their more or less extensive use in nearly all patients or only a few selected indications is a matter of debate. It proved difficult to reproduce this success with other antibody targets as well as with immunomodulatory cytokines and growth factors. The most promising novel peptide is vedolizumab, an antibody against α4β7 integrin.     

极早发炎症性肠病1例

回顾性分析2018年10月广州市妇女儿童医疗中心消化科收治的1例极早发炎症性肠病（very early onset inflammatory bowel disease,VEO-IBD）患儿的临床资料。患儿女,因呼吸促、腹胀住院。胃肠道表现腹泻、黏液血便、喂养不耐受、体质量不增;肠外表现肝功能损害、关节损害。内镜检查考...     

炎症性肠病病人自我管理研究进展

介绍了炎症性肠病病人自我管理的定义和意义,从心理因素、治疗因素、社会因素3方面阐述了影响炎症性肠病病人自我管理的因素,提出了健康教育、心理干预、社会支持等干预措施,并指出了目前该领域研究的局限性.     

Symptom burden: A forgotten area of measurement in inflammatory bowel disease

Inflammatory bowel disease (IBD) collectively known as Crohn's disease and ulcerative colitis are chronic inflammatory diseases of the digestive tract. Periods of active and inactive disease are common along the trajectory of this illness. A range of symptoms such as fatigue, diarrhoea and abdominal pain are experienced and are often very debilitating in nature resulting in significance interference in daily life. Despite this, to date, research in the area of symptoms remains an underexplored topic. This paper aims to discuss current approaches to symptom assessment in IBD and the potential to measure symptom burden in further research, in order to gain a greater understanding into the experiences of individuals with IBD.     

炎症性肠病病情活动监测指标的临床价值

目的探讨髓过氧化物酶(MPO)和超氧化物歧化酶(SOD)作为炎症性肠病(IBD)病情活动临床监测指标的价值。方法分别观察了IBD活动组患者15例[其中活动期溃疡性结肠炎(UC)10例,活动期克罗恩病(CD)5例],IBD非活动组患者15例(其中缓解期UC10例,缓解期CD5例)和12例对照组患者的结肠黏膜病理变化,按Oshitani评分标准和d'Haens评分标准进行UC和CD组织学评分,测定结肠黏膜MPO和SOD活性。结果IBD活动组、IBD非活动组病理组织评分均比对照组高(8±5 vs 3±1)、(5±2 vs 3±1)(P<0.01),IBD活动组病理组织评分亦较IBD非活动组高(8±5 vs 5±2)(P<0.01);IBD活动组、IBD非活动组肠黏膜MPO活性均较对照组高[(3.55±0.38)U/g vs(1.52±0.24)U/g、(2.28±0.30)U/g vs(1.52±0.24)U/g](P<0.01),IBD活动组MPO活性较IBD非活动组高[(3.55±0.38)U/g vs(2.28±0.30)U/g](P<0.01);IBD活动组、IBD非活动组肠黏膜SOD活性均较对照组低[(104.58±18.91)U/mg vs(212.44±14.22)U/mg、(170.91±13.57)U/mg vs(212.44±14.22)U/mg](P<0.01),IBD活动组SOD活性较IBD非活动组低[(104.58±18.91)U/mg vs(170.91±13.57)U/mg](P<0.01)。结论MPO活性与IBD病情活动程度呈正相关,SOD活性与IBD病情活动程度呈负相关,两者可作为IBD病情活动的临床监测指标。     

机会性感染与炎症性肠病

免疫抑制剂和生物制剂的应用为炎症性肠病（inflammatory bowel disease, IBD）的治疗打开了一扇门,但同时增加了机会性感染的风险。其常见病原学包括病毒、细菌、真菌及寄生虫等。机会性感染增加了IBD患者的致死率和致残率,降低了患者的生活质量。因此,IBD治疗过程中,早期发现、识别IBD合并的机会性感染以及早期采取措施治疗或预防性治疗极其重要。     

炎症性肠病病人对疾病的应对方式及相关因素的调查研究

[目的]探讨炎症性肠病(IBD)病人对疾病的应对方式及相关的影响因素,为实施针对性健康教育提供依据。[方法]采用便利抽样法对78例IBD病人应用一般资料调查表和医学应对方式问卷表进行调查。[结果]IBD病人的回避、屈服应对方式得分高于常模(P0.05),而面对应对方式得分与常模比较差异无统计学意义(P0.05);其应对方式受年龄、婚姻状况、经济能力、文化程度、居住地域、病程等因素的影响(P0.01)。[结论]IBD病人对于疾病的慢性过程多采取回避和屈服的应对方式,尤其是家居农村、生活贫困、低文化、婚姻缺失、病程冗长的弱势群体,护理人员在实施健康教育时应考虑病人应对方式的影响因素,引导病人积极面对,提高自信心。     

炎症性肠病的肠内营养治疗与肠道菌群

在环境因素中,如饮食、地域、抗生素治疗、补充益生菌、肠内营养等对肠道菌群产生的影响与炎症性肠病的发生、发展密切相关。对于肠道菌群的作用机制的学说包罗万千,可以说是对宿主的各个方面都产生了影响。尽管益生菌的作用机制没有被破译,但是它们可以刺激黏液分泌,抑制致病菌定植,纠正菌群失衡,改善屏障功能,下调先天免疫系统受体的表达,平衡T细胞亚群之间的均衡,改变一些基因的表达。另外免疫调节还产生了短链脂肪酸和其他代谢产物,这些对炎症性肠病的发病都是非常重要的。