Canadian IBD Today最新文献

{"title":"Management of Clostridioides difficile in IBD patients","authors":"Jeffery M. Venner, Harminder Singh","doi":"10.58931/cibdt.2023.1319","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1319","url":null,"abstract":"Clostridioides difficile (C. difficile) is an anaerobic, spore-forming, Gram-positive bacterium. C. difficile is the most frequently reported nosocomial pathogen. C. difficile is also the most commonly identified pathogen associated with antibiotic-associated diarrhea, responsible for up to 30% of antibiotic-associated diarrhea. Spores are transmitted via the fecal-oral route, and acquisition of C. difficile in the healthcare setting is generally by contaminated hands or surfaces. C. difficile has two monoglycosyltransferase virulence factors that are responsible for damage to the intestinal mucosa, enterotoxin A (TcdA) and cytotoxin B (TcdB). These two enzymes enter intestinal epithelium through receptor-mediated endocytosis and irreversibly inactive Rho GTPases. This ultimately disrupts the cytoskeleton and tight junctions, resulting in a loss of parenchymal polarity and eventual apoptosis.","PeriodicalId":492312,"journal":{"name":"Canadian IBD Today","volume":"56 S3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bringing STRIDE2 to Life in Clinical Practice","authors":"Amanda Ricciuto","doi":"10.58931/cibdt.2023.1316","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1316","url":null,"abstract":"STRIDE (Selecting Therapeutic Targets in Inflammatory Bowel Disease [IBD]) is an initiative by the International Organisation for the Study of IBD that aims to delineate a core set of therapeutic targets for IBD based on literature review and expert consensus. The first iteration was published in 2015, with an update in 2021 (STRIDE2), which qualifies targets as short-, intermediate- or long-term and adds pediatric-specific targets. \u0000The goal of treating any disease is to allow patients to feel well and to enjoy good quality of life (QOL), while avoiding disease- and treatment-related complications. The inflammatory bowel diseases, Crohn’s disease (CD) and ulcerative colitis (UC), are no exception. Given this overarching objective, it is not surprising that the traditional target in treating IBD has been symptom resolution, while avoiding corticosteroids. The challenge is that symptom control neither guarantees the absence of intestinal inflammation in a cross-sectional fashion, nor prevents progression to “damage” (including, for example, fibrosis, strictures and fistulae). This does not imply that symptom alleviation is irrelevant; it is a necessary, but insufficient treatment target. STRIDE2 includes clinical response (immediate/short-term) and clinical remission (intermediate) as treatment targets, but the method of symptom assessment has shifted from the physician (physician-administered clinical activity indices) to the patient (patient-reported outcomes [PROs]), aligning with the FDA’s requirement for PROs as a co-primary endpoint in clinical drug trials (typically alongside an objective disease marker such as endoscopy). STRIDE2 also introduces restoration of QOL and disability avoidance as key treatment goals. This further highlights the importance of the patient experience, and acknowledges normal linear growth as a critical pediatric-specific clinical target.","PeriodicalId":492312,"journal":{"name":"Canadian IBD Today","volume":"56 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Today and tomorrow: the use of biomarkers in inflammatory bowel disease","authors":"Catherine R. Rowan, Richard J.M. Ingram","doi":"10.58931/cibdt.2023.1320","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1320","url":null,"abstract":"Biomarkers play important roles in clinical care for people with inflammatory bowel diseases (IBD). Biomarkers are also central to the development of new therapies and as endpoints in their evaluation.
 The recommendations from the STRIDE-II study emphasize the central role of clinical indices and biomarkers such as fecal calprotectin (FC) and C-reactive protein (CRP) in the management of Crohn’s disease (CD) and ulcerative colitis (UC).
 This review will focus on the established roles for FC and CRP, emerging roles for alternative and composite biomarkers, limitations of current biomarkers, and unmet needs in the field. This is an evolving area, with recent clinical practice guidelines from the American Gastroenterological Association in UC. In addition, updates are expected from the European Crohn’s and Colitis Organisation on their multi-society guideline for IBD monitoring.","PeriodicalId":492312,"journal":{"name":"Canadian IBD Today","volume":"56 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal neoplasia surveillance in inflammatory bowel disease","authors":"Sanjay Murthy","doi":"10.58931/cibdt.2023.1318","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1318","url":null,"abstract":"Performing colorectal neoplasia surveillance in persons with inflammatory bowel disease (IBD) that is both clinically effective and cost effective is among the greatest challenges facing endoscopists who care for this population. While heightened colorectal cancer (CRC) risk has long been recognized among persons with IBD, this risk has been declining over time, with recent reports suggesting no more than a 1.5–2-fold higher risk compared to age and sex matched members of the general population. Nonetheless, given that CRC still occurs at a higher rate in this population, current surveillance strategies are inadequate for some persons. Conversely, 80–90% of persons with IBD had no neoplastic lesions identified during colonoscopy surveillance, suggesting that many persons with IBD are unnecessarily exposed to the risks of colonoscopy, with society bearing these excess costs.
 The purpose of colorectal neoplasia surveillance is to reduce the burden of CRC and CRC-related death in the IBD population. Societal guidelines recommend initiating colorectal neoplasia screening with colonoscopy in all persons with colorectal IBD involving at least the rectosigmoid (or at least 1/3 of the colorectum if accompanied by discontinuous inflammation) at 8–10 years following disease diagnosis and continuing lifelong surveillance every 1–5 years. Major factors influencing surveillance frequency include historical disease severity, extent of colorectal inflammation, chronic post-inflammatory changes, family history of CRC, history of colorectal neoplasm, primary sclerosing cholangitis, prior colonoscopy findings, and adequacy of prior surveillance. All guidelines further recommend targeted sampling or resection of suspicious visible abnormalities, and some societies continue to recommend extensive non-targeted biopsies to detect “invisible” neoplasia, particularly if other adjunctive optical modalities, such as dye-spray chromoendoscopy (DCE) or virtual chromoendoscopy (VCE), are not performed, or if the mucosa is poorly visualized, such as in areas of significant inflammation, post-inflammatory polyposis, or poor bowel preparation. Most societies now advocate for DCE or VCE as primary screening tools for IBD neoplasia surveillance or, at a minimum, as alternative modalities to traditional white light colonoscopy with non-targeted biopsies where resources and expertise exists.
 However, there are no prospective studies demonstrating a reduction in the incidence of CRC or of death from CRC with current surveillance strategies in persons with IBD. Furthermore, observations from large retrospective studies are also conflicting. A Cochrane analysis of 3 studies in persons with UC did not find a significant mortality benefit for current surveillance strategies. Considering that IBD afflicts many persons at a young age, is rising in prevalence in Canada and globally, and requires intensive lifelong surveillance , the amount of endoscopy resources directed toward","PeriodicalId":492312,"journal":{"name":"Canadian IBD Today","volume":"56 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical approach to abnormal liver enzymes in patients with inflammatory bowel disease","authors":"Davide De Marco, Amine Benmassaoud","doi":"10.58931/cibdt.2023.1317","DOIUrl":"https://doi.org/10.58931/cibdt.2023.1317","url":null,"abstract":"Inflammatory Bowel Diseases (IBD) are chronic inflammatory conditions that can impact organ systems beyond the gastrointestinal tract. Extraintestinal manifestations (EIMs) of IBDs are common and can occur at any stage of the disease. While EIMS most commonly involve the musculoskeletal system, up to 35% of individuals with IBD exhibit hepatobiliary involvement at some point during the course of their disease, often independently of disease activity. Chronic hepatobiliary diseases are noted in 5% of patients with IBD. These diseases manifest with indicative symptoms, abnormal liver biochemistry tests, or radiological abnormalities. This review provides a comprehensive outline and approach to abnormal liver enzymes in individuals with IBD.","PeriodicalId":492312,"journal":{"name":"Canadian IBD Today","volume":"56 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}