Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases

Beaugerie, Laurent; Rahier, Jean–François; Kirchgesner, Julien

doi:10.1016/j.cgh.2020.02.009

Cited by 81 publications

(57 citation statements)

References 76 publications

(88 reference statements)

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“…Several immunotherapies in patients with IBD have been associated with an increased risk of infections as they may inhibit intracellular signalling cascades needed for the host to fight pathogens. [55][56][57] Corticosteroids, for instance, are potentially associated with an increased risk for infections and have been widely used in studies from China for treatment of ARDS and hyperinflammation in covid-19. Although these studies were not designed to evaluate the effects of steroids, one study even suggested that treatment with methylprednisolone decreases the risk of death in covid-19.…”

Section: Immunotherapy In Ibd: Potential Effects On Covid-19mentioning

confidence: 99%

COVID-19 and immunomodulation in IBD

Neurath

2020

Gut

252

293

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The current coronavirus pandemic is an ongoing global health crisis due to COVID-19, caused by severe acute respiratory syndrome coronavirus 2. Although COVID-19 leads to little or mild flu-like symptoms in the majority of affected patients, the disease may cause severe, frequently lethal complications such as progressive pneumonia, acute respiratory distress syndrome and organ failure driven by hyperinflammation and a cytokine storm syndrome. This situation causes various major challenges for gastroenterology. In the context of IBD, several key questions arise. For instance, it is an important question to understand whether patients with IBD (eg, due to intestinal ACE2 expression) might be particularly susceptible to COVID-19 and the cytokine release syndrome associated with lung injury and fatal outcomes. Another highly relevant question is how to deal with immunosuppression and immunomodulation during the current pandemic in patients with IBD and whether immunosuppression affects the progress of COVID-19. Here, the current understanding of the pathophysiology of COVID-19 is reviewed with special reference to immune cell activation. Moreover, the potential implications of these new insights for immunomodulation and biological therapy in IBD are discussed.

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Section: Immunotherapy In Ibd: Potential Effects On Covid-19mentioning

confidence: 99%

COVID-19 and immunomodulation in IBD

Neurath

2020

Gut

252

293

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“…None of the currently available treatments for IBD are curative, and some are associated with significant adverse drug reactions. 1,2 Today's drug treatments for IBD eventually fail to induce or maintain remission in about 30% of patients, which often leads to surgical procedures. 3 Although some promising novel small-molecule drugs (such as Janus kinase inhibitors) are now in clinical development, 4 the main conventional treatments for IBD are oral corticosteroids (eg, budesonide and prednisone), immunomodulators (eg, azathioprine, 6-mercaptopurine, and methotrexate), salicylates, and biologics (ie, monoclonal antibodies against cytokines or cytokine receptors, which may themselves be a risk factor for infection).…”

Section: Introductionmentioning

confidence: 99%

“…Although the exact etiology of IBD is still unclear, the reduction or prevention of mucosal inflammation in the gastrointestinal tract (GIT) is a key therapeutic objective. None of the currently available treatments for IBD are curative, and some are associated with significant adverse drug reactions 1,2 . Today’s drug treatments for IBD eventually fail to induce or maintain remission in about 30% of patients, which often leads to surgical procedures 3 .…”

Section: Introductionmentioning

confidence: 99%

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High‐dose dietary supplementation with zinc prevents gut inflammation: Investigation of the role of metallothioneins and beyond by transcriptomic and metagenomic studies

et al. 2020

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Although it is known that zinc has several beneficial roles in the context of gut inflammation, the underlying mechanisms have not been extensively characterized. Zinc (Zn) is known to be the primary physiological inducer of the expression of the metallothionein (MT) superfamily of small stress‐responsive proteins. The expression of MTs in various tissues is induced or enhanced (including the gastrointestinal tract (GIT)) by a variety of stimuli, including infection and inflammation. However, the MTs’ exact role in inflammation is still subject to debate. In order to establish whether or not MTs are the sole vectors in the Zn‐based modulation of intestinal inflammation, we used transcriptomic and metagenomic approaches to assess the potential effect of dietary Zn, the mechanisms underlying the MTs’ beneficial effects, and the induction of previously unidentified mediators. We found that the expression of endogenous MTs in the mouse GIT was stimulated by an optimized dietary supplementation with Zn. The protective effects of dietary supplementation with Zn were then evaluated in mouse models of chemically induced colitis. The potential contribution of MTs and other pathways was explored via transcriptomic analyses of the ileum and colon in Zn‐treated mice. The microbiota’s role was also assessed via fecal 16S rRNA sequencing. We found that high‐dose dietary supplementation with Zn induced the expression of MT‐encoding genes in the colon of healthy mice. We next demonstrated that the Zn diet significantly protected mice in the two models of induced colitis. When comparing Zn‐treated and control mice, various genes were found to be differentially expressed in the colon and the ileum. Finally, we found that Zn supplementation did not modify the overall structure of the fecal microbiota, with the exception of (i) a significant increase in endogenous Clostridiaceae, and (ii) some subtle but specific changes at the family and genus levels. Our results emphasize the beneficial effects of excess dietary Zn on the prevention of colitis and inflammatory events in mouse models. The main underlying mechanisms were driven by the multifaceted roles of MTs and the other potential molecular mediators highlighted by our transcriptomic analyses although we cannot rule out contributions by other factors from the host and/or the microbiota.

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“…In CD, 13-40% of patients are primary anti-TNF non-responders [1], and 23-46% develop secondary loss of response over time [2]. What is more, the treatment used is fraught with many side effects [3]. Therefore, patients are looking for other treatment methods on their own, which they consider more effective or more "natural" -with fewer side effects.…”

Section: Introductionmentioning

confidence: 99%

The use of complementary and alternative medicine in Polish children with inflammatory bowel disease: single-centre survey-based study

Gerkowicz¹,

Kołakowska²,

Pawlak³

et al. 2020

polp

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Introduction: The paediatric population represents a substantial group of patients suffering from inflammatory bowel disease (IBD). Because IBD is a chronic condition, children and their parents are more willing to try complementary and alternative medicines (CAM). There has been no study on this subject in Poland. The aim of our study was to investigate the usage of CAM in children with IBD and parental attitudes towards them. Material and methods: An anonymous survey was conducted among parents of children suffering from IBD. The questionnaire included socio-demographic data, medical history of the child, as well as the parental opinion on their knowledge and attitude towards CAM. Results: Thirty-seven surveys were filled in. The mean patient and parent ages were, respectively, 14.0 ±3.2 years (range 5.4-17.9) and 40.2.2 ±5.1 years (range 25-49). The mean disease duration was 3.7 ±2.4 years. CAM was used in 32.4% of patients at any time. The most frequently used CAM treatments were fermented food (10.8%), linseed (10.8%), and a lactose-free diet (8.1%). 25% of CAM users declared a decrease in symptoms intensity/frequency, and 8.3% reported total symptom resolution. The most common sources of CAM information were the Internet (76.5%) and recommendations from relatives or acquaintances (35.3%); only 5.9% of responders indicated a healthcare provider. The only factors associated with using CAM therapies was family income and parental education level. Conclusions: CAM is relatively common among children with IBD. It does not affect the attitude towards conventional treatment and vaccination. Because the main source of information about CAM is Internet, there is a great need to educate healthcare practitioners about CAM methods in the treatment of IBD, in order to deliver help and professional advice to paediatric patients and their parents.

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Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases

Abstract: Author contributions: LB was responsible for writing coordination and final assembly of the article. LB, JFR and JK were jointly responsible for designing and writing the different sections of the article.

Cited by 81 publications

References 76 publications

COVID-19 and immunomodulation in IBD

COVID-19 and immunomodulation in IBD

High‐dose dietary supplementation with zinc prevents gut inflammation: Investigation of the role of metallothioneins and beyond by transcriptomic and metagenomic studies

The use of complementary and alternative medicine in Polish children with inflammatory bowel disease: single-centre survey-based study

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