The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management

Dignaß, Axel; Assche, Gert Van; Lindsay, James O.; Lémann, Marc; Söderholm, Johan D.; Colombel, Jean Fréd́eric; Danese, Silvio; D’Hoore, André; Gassull, Miquel A.; Gomollón, Fernando; Hommes, Daan W.; Michetti, Pierre; O’Moráin, Colm; Øresland, Tom; Windsor, Alastair; Stange, Eduard F.; Travis, Simon

doi:10.1016/j.crohns.2009.12.002

Cited by 1,298 publications

(1,081 citation statements)

References 235 publications

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“…These data support the hypothesis of a need for a powerful anti-inflammatory intervention in IBD for preventing atherosclerosis and its consequences. Indeed, the ECCO guidelines [39] for the management of CD, have minimized the role of 5-ASA in the maintenance of remission for its limited efficacy showed by randomized clinical trials and meta-analyses [40]. Though being effective in the maintenance of remission of mild-to-moderate UC and possibly effective in chemoprevention, in other indications the role of 5-ASA is questioned and definitely not enough for the proper control of inflammation in Crohn's Disease.…”

Section: Discussionmentioning

confidence: 99%

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

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Calvaruso

et al. 2017

European Journal of Internal Medicine

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Background & Aims:Recent studies documented an increased cardiovascular risk in patients with inflammatory bowel disease (IBD). Our study aimed at investigating the prevalence of intima-media thickness (IMT) of the carotid arteries and the arterial stiffness indices as markers of early atherosclerosis in young IBD patients. Methods: We recruited 68 consecutive IBD patients, and 38 matched healthy controls less than 45 years old (median age 31.6 ± 8.1 years). Clinical and demographic features, cardiovascular risk factors, history of cardiovascular events, concomitant therapies were registered on a dedicate database. Carotid IMT was evaluated by using high resolution B-mode ultrasonography. Arterial stiffness was assessed by measurement of carotidfemoral Pulse Wave Velocity (PWV) and Augmentation Index (AIx). Results: Total cholesterol (P b 0.013) and LDL-cholesterol (P b 0.019) levels were significantly lower in IBD patients compared to controls. Carotid IMT was higher in IBD than in controls (P b 0.047), but there was no statistically significant difference among Crohn's Disease (CD) and Ulcerative Colitis (UC) patients. Moreover, PWV and AIx were significantly higher in patients as compared to controls (P b 0.006 and P b 0.004 respectively). No medication seemed to affect vascular measurements, though stiffness parameters were significantly higher in patients treated with 5-ASA (11.9 (9.7) vs 18.2 (10.2), P b 0.021), suggesting a lack of efficacy of 5-ASA in protecting IBD patients from early atherogenesis. Conclusions: Young IBD patients show an increase in subclinical markers of atherosclerosis. Future studies need to address whether these markers result in an increased risk of cardiovascular events in these patient.

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Section: Discussionmentioning

confidence: 99%

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

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Calvaruso

et al. 2017

European Journal of Internal Medicine

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“…In the 2009 European Crohn's and Colitis Organization (ECCO) guidelines [23], surgery is viewed as a treatment of last resort, mainly as a result of continuing progress in the field of anti-inflammatory therapies. The ECCO acknowledges, however, that with this approach, surgery is reserved for patients with advanced disease (B3), who are at high risk for septic complications.…”

Section: Epidemiologymentioning

confidence: 99%

“…Early surgical intervention in patients with B1 disease and short-segment lesions allows one to perform simple procedures, which can be carried out with minimally invasive techniques and without the increased risk of complications (postoperative infections in particular) associated with surgical treatment of more complex disease (B3) (Fig. 3) or disease that is being managed with steroids [23,26]. Thiopurine therapy is not believed to increase the surgical risk [26], but the risks posed by biological therapies are less well defined: there is evidence to suggest that if these drugs are not discontinued several weeks before surgery, they can negatively affect the outcome of the procedure [26].…”

Section: Epidemiologymentioning

confidence: 99%

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Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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Surgery is well-established option for the treatment of Crohn's disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn's disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors' opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn's disease and the roles played in these cases by diagnostic imaging modalities.Riassunto La chirurgia è un'opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell'anastomosi. Secondo l'opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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“…The immunosuppressants, azathioprine (AZA) and 6‐mercaptopurine (6‐MP), are used as a second‐line therapy in almost 60% of patients with IBD to induce and maintain remission 1, 2, 3, 4, 5, 6. The recommended dose of AZA is up to 2.5 mg/kg and that of 6‐MP is 1–1.5 mg/kg/day.…”

Section: Introductionmentioning

confidence: 99%

Thiopurine metabolite level and toxicity in Indians with inflammatory bowel disease

et al. 2017

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Background and AimA lower dose requirement and higher toxicity of thiopurine is reported in Asian patients with inflammatory bowel disease (IBD) as compared with Caucasian patients. These reports are based on thiopurine methyltransferase measurement studies rather than metabolite estimation.We studied the utility of thiopurine metabolite estimation in Indian patients with IBD and compared dose and toxicity with Asian and Caucasian patients.MethodsIn this prospective study, 6‐thioguanine nucleotide (6‐TGN) and 6‐methylmercaptopurine levels were determined by HPLC in 76 IBD patients treated with thiopurines. The levels were correlated with dose, disease activity, and toxicity. The dose‐related metabolite levels and toxicity were compared with Caucasian and Asian patients reported in literature.ResultsOf the 76 patients (32 women, mean age: 35.9 [SD: 14.54] years, 36 Crohn's disease and 40 ulcerative colitis), 1 non‐compliant patient had undetectable level of metabolites. Of the 75 patients, 21(28%) had therapeutic level of 6‐TGN, 37(49%) had subtherapeutic level and 17(23%) had supratherapeutic level. The 6‐methylmercaptopurine levels ranged up to 4971 pmol/8 × 108 red blood cells. Six (8%) patients showed toxicity. Thiopurine dose was optimized in 20 (26.31%) patients. Dose‐based metabolite levels were comparable to Asian and Caucasian patients. The toxicity (8%) observed in our patients was less than that reported (12–39%).ConclusionHalf of the patients in this study had low and a quarter had high 6‐TGN levels. One‐fourth of the patients needed dose modification. The dose‐based metabolite levels were comparable and the toxicity was less than that reported in Asian and Caucasian patients.

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The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management

Cited by 1,298 publications

References 235 publications

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

Surgery and diagnostic imaging in abdominal Crohn’s disease

Thiopurine metabolite level and toxicity in Indians with inflammatory bowel disease

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