scholarly journals High serum concentrations of growth differentiation factor-15 in male Crohn’s disease patients with low skeletal muscle index

2021 ◽  
Author(s):  
Hiroyuki Yamamoto ◽  
Fuminao Takeshima ◽  
Masafumi Haraguchi ◽  
Kayoko Matsushima ◽  
Moto Kitayama ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Handgrip Strength ◽  
Intestinal Resection ◽  
Bioelectrical Impedance ◽  
Japanese Patients ◽  
High Serum ◽  
Skeletal Muscle Index ◽  
Significant Difference

Abstract Sarcopenia is defined as low skeletal muscle index (SMI) in addition to low muscle strength (MS) or low physical function, and many biomarkers have been reported. In Crohn's disease (CD), low SMI is associated with predictors and complications of intestinal resection. Therefore, in many reports of CD, sarcopenia was defined only by SMI. However, there have been no reports of MS in Japan. Our study aimed to investigate the frequency of sarcopenia by assessing both SMI and MS in Japanese patients with CD and biomarkers predicting low SMI. We evaluated SMI using bioelectrical impedance analysis, handgrip strength, and blood tests, including CRP, ALB, IL-6, TNFα, GDF-8, and GDF-15 as biomarker candidates for 78 CD patients in our hospital. Sarcopenia and low SMI were 8% and 42.3%, respectively. Each candidate biomarker and SMI were negatively correlated with GDF-15 (Pearson's r=-0.414, P = 0.0031) in males and positively correlated with ALB (r = 0.377, P = 0.048), and negatively correlated with IL-6 (r=-0.484, P = 0.012) in females. Multivariate analysis adjusted for these items, age, and BMI showed a significant difference in male GDF-15 (P = 0.011, OR: 7.86, 95% CI: 1.09–56.58). Therefore, GDF-15 in male patients is considered a biomarker of low SMI.

scholarly journals 64 Biomarker-based index for detecting sarcopenia in patients with cardiovascular disease

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
H Kai ◽  
H Harada ◽  
N Niiyama ◽  
A Katoh
Keyword(s):  
Cardiovascular Disease ◽  
Skeletal Muscle ◽  
Sialic Acid ◽  
Handgrip Strength ◽  
Bioelectrical Impedance ◽  
Multivariate Regression Analysis ◽  
Roc Curve Analysis ◽  
Skeletal Muscle Index ◽  
Simple Index ◽  
N 93

Abstract Background Clinical significance of sarcopenia has been highlighted in patients with cardiovascular disease (CVD). Sarcopenia is generally diagnosed based on the decrease in skeletal muscle index (SMI) and the reduction of either handgrip strength or gait speed. However, SMI is difficult to measure for general physicians or cardiologists, because special, expensive equipment (i.e. bioelectrical impedance assay (BIA) or dual-energy X-ray absorptiometry) is necessary. Purpose The aim of this study was to seek a new, simple index to detect sarcopenia in CVD patients. Methods We retrospectively investigated the association of sarcopenia with physical examination data and circulating biomarkers of nutrition, inflammation, skeletal muscle homeostasis in 132 CVD patients who admitted in our hospital. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) guidelines using SMI measurements by BIA method. Results Among the screened biomarkers (e.g. hsCRP and IL-6), serum adiponectin and sialic acid was significantly higher in sarcopenic patients (n = 39) than non-sarcopenic patients (n = 93). On stepwise multivariate regression analysis, adiponectin, sialic acid, sex, age, and body mass index were independent detecting factors for sarcopenia based on AWGS criteria. ROC curve analysis revealed high accuracy for sarcopenia detection of the biomarker-based sarcopenia index (BMI), obtained from the regression formula using the independent factors (Figure). Conclusions: Novel biomarker-based sarcopenia index would be a simple, useful tool for detecting sarcopenia in CVD patients. Abstract 64 Figure. Sarcopenia Detection using BSI

scholarly journals P502 Tumour necrosis factor antagonists are superior to anti-integrin and anti-IL-12/23 therapies for preventing postoperative recurrence in adult Crohn’s disease patients requiring postoperative therapy

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S436-S437
Author(s):  
T Nakamura ◽  
R Shah ◽  
M Sachs ◽  
S Chang ◽  
D Hudesman ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Propensity Score ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Intestinal Resection ◽  
Postoperative Recurrence ◽  
Treatment Groups ◽  
Significant Difference ◽  
Necrosis Factor

Abstract Background Crohn’s disease (CD) recurrence is common after surgical resection. Prior data have demonstrated that postoperative tumour necrosis factor antagonists (anti-TNF) may reduce recurrence, although little is known about the efficacy of other biologic therapies. The aim of this study was to compare biologic type and timing for preventing postoperative objective recurrence in adult CD patients. Methods We performed a retrospective chart review of CD patients who underwent intestinal resection from 2009 to 2019 at two academic medical centres. We tabulated baseline variables against treatment groups based on the type of postoperative biologic (anti-TNF, anti-integrin, anti-IL-12/23) and timing of postoperative biologic initiation (before or after 6 months post-op). Propensity score matching was utilised for treatment groups using baseline variables as predictors. Recurrence was defined by endoscopy (>i2 Rutgeerts’ score) or radiography (active inflammation in neoterminal ileum). Survival analysis was performed to assess risk of recurrence by treatment group and timing of biologic initiation. Results One hundred and forty-four patients were included (51% male, 13.2% active smokers, 97.9% stricturing and/or penetrating CD, 41.7% prior resection). The majority of patients received anti-TNF therapy. Adjusting for the propensity scores, fewer patients relapsed under anti-TNF compared with anti-integrin (HR 2.87, 1.04–7.99; p = 0.042) and anti-IL-12/23 (HR 3.51, 1.51–8.14; p = 0.03). There was no significant difference in objective relapse between patients on postoperative anti-TNF and no therapy (HR 0.71, 0.31–1.66; p = 0.44) (Figure 1). More patients relapsed when biologics were started after 6 months postoperatively compared with within 6 months (HR = 0.20, 0.08–0.53; p = 0.001) and never started (HR = 0.26, 0.11–0.59; p = 0.001) (Figure 2). Conclusion Among propensity score-adjusted CD patients, initiation of biologics within 6 months and anti-TNF agents were superior in preventing postoperative recurrence among patients receiving postoperative biologic therapy.

scholarly journals P635 Assessment of sarcopenia and nutritional status in a cohort of patients with Crohn’s disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S570-S571
Author(s):  
O M Nardone ◽  
R de Sire ◽  
A Ponsiglione ◽  
A Rispo ◽  
A Testa ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Outcome ◽  
Visceral Fat ◽  
Visceral Fat Area ◽  
Skeletal Muscle Index ◽  
Female Sex ◽  
Low Bmi ◽  
One Year

Abstract Background Altered body composition may negatively impact on the clinical outcome and quality of life of patients with IBD. Sarcopenia, defined as a progressive loss of skeletal muscle mass and function, is commonly observed in patients with IBD and can be reliably assessed by computed tomography (CT) which allows accurate and reproducibile quantification of both abdominal adipose tissues (subcutaneous and visceral), as well as skeletal muscles. We aimed to assess the prevalence of sarcopenia in Crohn’s disease (CD) patients undergoing contrast-enhanced CT(CECT). We further investigated the associations of sarcopenia with visceral fat parameters, disease severity and surgery Methods 40 CD patients (22F, aged 44±16 yrs; BMI 20.8±3.7) who underwent CECT for clinical assessment were retrospectively enrolled. CECT was performed using a 64-rows multi-detector equipment after i.v. injection of non ionic iodinated contrast media with a tailored scan delay. Demographic and clinical data were collected at the date of abdominal CT. Clinical outcome included the rate of surgery within one year. The skeletal muscle index (SMI) at the level of third lumbar vertebra was used to assess sarcopenia defined as a SMI<38.5cm2/m2 in women and <42cm2/m2 in men (Fig1).Clinical malnutrition was defined by a BMI<18.5 kg/m2, while visceral obesity as a visceral fat area ≥130cm2 Results Mean duration of disease was 117 months ± 84. Most patients 60% had a moderate-severe clinical activity based on Harvey Bradshaw index (HBI) >8, whereas 35% had a mild activity (HBI 5–7) and 5% were in remission (HBI<5). Overall, 17(42.5%) patients were sarcopenic. In detail, 14 out of 22 (63.6%) females and only 3 out of 18 (16.6%) males (p=0.04). The majority (65%) had moderate activity of inflammation with a mean of HBI 9.2 ± 1.6. Malnutrition occurred in 41,2% sarcopenic patients with a mean BMI of 16.5±3.75. A significant correlation was observed between BMI and sarcopenia (r=0.4,p<0.001). A total of 25 (62.5%) patients underwent surgery within one year. Among them, 40% patients were sarcopenic, while 60% non sarcopenic (p=0.7). In the total population the mean of visceral fat was 48,03±58.04 and only 4 patients had a visceral fat area ≥104 cm2. The ratio between visceral fat and subcutaneous fat area (VFA/SFA) was 0,57±0.5. The correlation between SMI and visceral fat was significant (r=0.4,p=0.02),while it was not significant with VFA/SFA (p=0.7). For all IBD patients, univariate analysis revealed that female sex (p=0.002) and low BMI (p=0.003) were significantly associated with sarcopenia Conclusion Approximately 42.5%CD patients were sarcopenic. Female sex and low BMI were significantly associated with sarcopenia but this latter did not correlate with the clinical outcome

scholarly journals P618 Post-operative Crohn’s disease patients undergoing colonoscopy require significantly more analgesia and sedation compared with a non-IBD population

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S514-S514
Author(s):  
C Rowan ◽  
M Janjua ◽  
C Foley ◽  
J Burke ◽  
K Boland ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Significant Proportion ◽  
Intestinal Resection ◽  
Patient Characteristics ◽  
Median Dose ◽  
Electronic Reporting ◽  
Significant Difference ◽  
System Data

Abstract Background Rates of surgical intervention in Crohn’s disease have declined. However, a significant proportion of patients still require surgical resection and have been shown to have higher post-op pain scores and analgesia requirements. The aim of this study was to assess sedation requirements and comfort scores of post-operative Crohn’s disease patients at endoscopy. Methods Patients with a previous intestinal resection undergoing colonoscopy in 2017 were identified using an electronic reporting system. Data regarding patient demographics, disease characteristics, sedation requirements, comfort scores and endoscopy reports were collected. Patients with Crohn’s disease were compared with a non-IBD post-op population. Results n = 153 patients were included. n = 56 Crohn’s disease, n = 2 UC and n = 95 non-IBD patients underwent colonoscopy. Patient characteristics in Table 1. 13.6% of patients had a documented history of chronic pain or other relevant conditions that may affect comfort scores. 68.3% of patients with Crohn’s disease were on therapy at the time of endoscopy. The median dose of midazolam administered was 3 mg (IQR 2–4 mg); median fentanyl dose was 50 μg. (IQR 50–75 μg). The median dose of Midazolam was significantly higher in patients with Crohn’s disease (3 mg IQR 3–4 mg vs. 3 mg IQR 2–3; p = 0.006). The median dose of fentanyl required was also significantly higher in post-operative Crohn’s patients (50 μg IQR 50–100 μg vs. 50 μg; p = 0.001). The median comfort score in Crohn’s disease patients was higher (indicating more discomfort) when compared with the non-IBD cohort. (median score 2 and 1 respectively) There was no significant difference in the proportion of patients with chronic pain or multiple intestinal resections (p = 0.84 and p = 0.142). There was a statistically significant difference in comfort scores;n = 19 Crohn’s disease patients (39.6%) had comfort score 1, compared with n = 70 non-IBD patients (71.4%) (p = 0.04). There was no significant difference in the median doses of midazolam or fentanyl when comparing Crohn’s disease patients with and without active endoscopic disease. (p = 0.07 and p = 0.10 respectively). Conclusion Patients with Crohn’s disease undergoing colonoscopy in the post-operative setting have significantly higher analgesia requirements. Comfort scores are significantly worse when compared with non-IBD patients who have had similar intestinal resections. Endoscopists should use techniques, e.g. CO2 insufflation in addition to medication to ensure comfort amongst patients with Crohn’s disease.

Anxiety and Depression in Patients with Abdominal Bloating

1993 ◽  
Vol 38 (7) ◽  
pp. 475-479 ◽  
Author(s):  
Ji-Yung Song ◽  
Harold Merskey ◽  
Stephen Sullivan ◽  
Sam Noh
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Sex Education ◽  
Depression Scale ◽  
Normal Subjects ◽  
Anxiety And Depression ◽  
Childhood Experience ◽  
Personality Variables ◽  
Abdominal Bloating ◽  
Significant Difference

Eighteen patients with a syndrome of abdominal bloating and discomfort were examined to explore the relationship between their symptoms and their emotional problems. They were compared with 33 patients with Crohn's disease and 38 normal, healthy volunteers. Using the Hospital Anxiety and Depression Scale, patients with bloating were found to resemble patients with Crohn's disease. Both groups showed increased anxiety and depression. After controlling for age, sex, education, occupation, personality variables and childhood experience, there was a trend towards more anxiety in the bloating group compared with normal subjects and a significant difference for depression. These characteristics appear to be related to the effects of the illness or to selection, but not to personality or childhood experience. Although psychiatric problems are common among patients with abdominal bloating and pain who stay in touch with a clinic, they are not the primary cause of the disorder.

scholarly journals Appendiceal Carcinoids In Crohn’s Disease

2003 ◽  
Vol 17 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Hugh J Freeman
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Carcinoid Tumour ◽  
Intestinal Resection ◽  
Case Review ◽  
Appendiceal Neoplasms ◽  
Increased Risk ◽  
Intestinal Neoplasms ◽  
Resection Specimen ◽  
Sporadic Cases

Earlier investigations demonstrate an increased risk for colon cancer in Crohn's disease. For other intestinal neoplasms, such as carcinoids, studies are limited. In Crohn's disease, repeated endoscopic and imaging studies along with intestinal resections may facilitate clinical recognition of neoplastic diseases, including appendiceal neoplasms. To date, however, only sporadic cases of appendiceal carcinoids have been described in Crohn's disease. In the present study, in a single clinician database of 1000 Crohn's disease patients, three of the 441 patients who had undergone intestinal resection had appendiceal carcinoids, all of which were pathologically confirmed. All were observed in female patients and were not suspected before surgical treatment. In one case, even though management was not altered, the tumour had already invaded serosal fat indicating a potential for more advanced disease. In this series, a carcinoid tumour was found in a resection specimen during a later clinical case review and another was a microcarcinoid, implying that these tumours may be overlooked in Crohn's disease. The percentage detected in the entire database (0.3%) exceeds the reported rates of detection of appendiceal carcinoids after removal of the appendix for appendicitis, as well as the rate of detection of appendiceal carcinoids in autopsy studies. This percentage would be higher if only those having an intestinal resection were considered (0.68%). Additional studies are needed to further define this risk of appendiceal carcinoids in Crohn's disease.

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