Biologic Therapy in Crohn’s Disease–What We Have Learnt So Far

2020 ◽  
Vol 21 (8) ◽  
pp. 792-806
Author(s):  
Kinga Majchrzak ◽  
Jakub Fichna
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biologic Therapy ◽  
Clinical Symptoms ◽  
Autoimmune Disorder ◽  
Biological Drugs ◽  
Wide Range ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Maintenance Of Remission

Crohn’s disease (CD) is an autoimmune disorder from the group of inflammatory bowel diseases. The etiology of CD is not clear; currently, the interaction between the genetic, immunological and environmental factors is assumed as the cause of the disease. Partial knowledge of those factors has led to the development of drugs, which control the clinical symptoms and improve the overall condition of the infected; the main objective of the modern therapeutic strategies is the induction and maintenance of remission. Among the wide range of available treatments, older generation molecules: mesalazine, corticosteroids and thiopurine derivatives as well as biological drugs and biosimilars can be distinguished. Moreover, some novel biologics and small molecule drugs have shown potential in CD clinical trials, providing safe and effective results. This article provides an overview of the achievements in the field of biologic therapy, its efficacy and safety with an indication of future directions in CD treatment.

scholarly journals Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

2013 ◽  
Vol 6 (2) ◽  
pp. 137-156 ◽  
Author(s):  
Cosimo Prantera ◽  
Stefano Marconi
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
The United States ◽  
Prolonged Treatment ◽  
Medline Search ◽  
Inflammatory Conditions ◽  
Number Of Patients ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Maintenance Of Remission

Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chronic, uncontrolled inflammation of the gastrointestinal tract. Reported prevalence is high in the United States and northern Europe, while the incidence varies greatly across the rest of Europe. Glucocorticosteroids are the standard treatment for IBD, but due to adverse events their use can be limited. However, new formulations of glucocorticosteroids have been developed to reduce systemic activation. The aim of this review was to assess and summarize the efficacy and safety of new formulations of glucocorticosteroids. A MEDLINE search identified publications focused on new formulations of nonsystemic steroid-based drugs for IBD and benefits and limitations of each of the new glucocorticosteroid formulations were identified. Budesonide has good efficacy and is an established treatment for Crohn’s disease; it has been shown to be beneficial for the induction of remission in these patients, although it is not recommended for the maintenance of induced remission. Glucocorticosteroids are not recommended for the maintenance of remission in patients with IBD. However, a recent study suggested that beclomethasone dipropionate may be effective for prolonged treatment in patients in the postacute phase of Crohn’s disease who were treated with a short course of systemic steroids. The efficacy of fluticasone propionate and prednisolone metasulphobenzoate in IBD is not well established given the small number of patients enrolled in the few published clinical trials. While the tolerability of these glucocorticosteroids is favourable, more research comparing these new agents with traditional systemic glucocorticosteroids is warranted.

scholarly journals Inflammatory Bowel Diseases: Focus on Therapy

2018 ◽  
Vol 24 (1) ◽  
pp. 9-14
Author(s):  
Tocia Cristina ◽  
Achim Anda Carmen ◽  
Alexandrescu Luana ◽  
Dumitru Eugen
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Bowel Diseases ◽  
Biologic Therapy ◽  
Immunosuppressive Drugs ◽  
Surgical Interventions ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Extraintestinal Complications

Abstract INTRODUCTION: Medical management of Inflammatory Bowel Diseases is complex and tailored to disease activity. The primary goal is the induction of remission and maintenance of remission with longterm prevention of disease progression. AIM: to describe current drug treatment practices in Inflammatory Bowel Diseases in Dobrogea. MATERIAL AND METHOD: The retrospective and descriptive study included 128 patients: group 1 = Crohn’s Disease (79), group 2 = Ulcerative Colitis (46) and group 3 = Unclassified Colitis (3). RESULTS: The phenotypic distribution was: 62% with Crohn’s Disease, 36% with Ulcerative Colitis and 3 patients with Unclassified Colitis. CROHN’S DISEASE: According to Montreal Classification, the majority of patients were diagnosed after 40 years (58%); the most frequent involvement was ileo-colonic (47%) and the most frequent phenotype was inflammatory (60%). 40% patients had intestinal complications and 7% had extraintestinal complications. 16.4% required surgical interventions. 67% were treated at some point with aminosalicylates, 44% with immunosuppressive drugs (thiopurines), 80% with corticosteroids for the induction of remission (inaugural flare) and 50% of them received again corticosteroidssteroids in the evolution of the disease, and 29% with biologic therapy. ULCERATIVE COLITIS: Most common location was left colitis in 47% cases. One patient had intestinal complications and no extraintestinal complications were reported in this group. No patients required surgical interventions. 82.5% were treated at some point with aminosalicylates, 37% with immunosuppressive drugs (thiopurines), 17% with corticosteroids and 11% with biologic therapy. UNCLASSIFIED COLITIS: In this group were not reported intestinal and extraintestinal complications and also no patient required surgical interventions. 2 patients were treated at some point with aminosalicylates, all patients were treated with immunomodulators and only one patient was administered biologic therapy. CONCLUSIONS: Particularities of Crohn’s Disease in our region are: widespread use of aminosalicylates, overuse of corticosteroids overtime, underprescribed biologic therapy.

scholarly journals Sources of Bias in Common Diagnosis of Chronic Inflammatory Bowel Diseases

2020 ◽  
Vol 30 (5) ◽  
pp. 26-29
Author(s):  
O. A. Svatkova ◽  
A. A. Sheptulin
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Bowel Diseases ◽  
Clinical Symptoms ◽  
Late Diagnosis ◽  
Chronic Inflammatory Bowel Diseases ◽  
Common Diagnosis ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Chronic Inflammatory Bowel

Aim. Causal analysis of a late diagnosis of chronic inflammatory bowel diseases (CIBD) in general medical practice.Materials and methods. We continuously sampled 80 CIBD histories (44 of ulcerative colitis, UC, and 36 of Crohn’s disease, CD) to estimate the time and nature of first complaints, primary diagnosis, time lapse between the first physician visit and diagnosis and reasons for a late diagnosis.Results. Only 63.6 % of patients with UC and 38.9 % with Crohn’s disease were correctly diagnosed during the first visit and subsequent examination. Abdominal pain in debut of CIBD was registered in 40.9 % of the UC and 75.0 % of CD patients (p < 0.01). Diarrhoea as a CIBD manifestation was significantly more common in the UC than in CD patients (88.6 and 55.5 % of cases, respectively; p < 0.01). Hematochesia was observed in 68.2 % of the UC and 22.2 % of CD cases (p < 0.01). Among the CD patients with primary symptoms, a correct follow-up diagnosis was less frequent compared to the UC patients (38.9 % of cases, p < 0.01). Only 30 patients with UC (68.2 %) and 18 patients with CD (50.0 %) had colonoscopy at a first outpatient visit. The main cause of late diagnoses in CIBD is a delayed ileocolonoscopy.Conclusions. Ileocolonoscopy should be mandatory in all patients suspected for CIBD with clinical symptoms.

Localization and Activity of Inflammatory Bowel Disease Using 111ln Leukocyte Imaging

1988 ◽  
Vol 27 (03) ◽  
pp. 83-86 ◽  
Author(s):  
B. Briele ◽  
F. Wolf ◽  
H. J. Biersack ◽  
F. F. Knapp ◽  
A. Hotze
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Cell Uptake ◽  
Disease Extent ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Leukocyte Imaging

A prospective study was initiated to compare the clinically proven results concerning localization/extent and activity of inflammatory bowel diseases with those of 111ln-oxine leukocyte imaging. All patients studied were completely examined with barium enema x-ray, clinical and laboratory investigations, and endoscopy with histopathology. A total of 31 leukocyte scans were performed in 15 patients (12 with Crohn’s disease, 3 with ulcerative colitis). The scans were graded by comparing the cell uptake of a lesion (when present) and a bone marrow area providing a count ratio (CR). The inflammatory lesions were correctly localized on 26 leukocyte scans, and in 21 scans the scintigraphically estimated extent of disease was identical to endoscopy. In 5 cases the disease extent was underestimated, 4 scans in patients with relapse of Crohn’s disease were falsely negative, and in one patient with remission truly negative. The scintigraphically assessed disease activity was also in a good agreement with clinical disease activity based on histopathology in all cases. We conclude that leukocyte imaging provides valuable information about localization and activity of inflammatory bowel disease.

scholarly journals The role of epigenetic modifications for the pathogenesis of Crohn's disease

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
M. Hornschuh ◽  
E. Wirthgen ◽  
M. Wolfien ◽  
K. P. Singh ◽  
O. Wolkenhauer ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adaptive Immune Response ◽  
Adaptive Immune ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
New Biomarkers ◽  
Insight Into ◽  
Specific Evaluation

AbstractEpigenetics has become a promising field for finding new biomarkers and improving diagnosis, prognosis, and drug response in inflammatory bowel disease. The number of people suffering from inflammatory bowel diseases, especially Crohn's disease, has increased remarkably. Crohn's disease is assumed to be the result of a complex interplay between genetic susceptibility, environmental factors, and altered intestinal microbiota, leading to dysregulation of the innate and adaptive immune response. While many genetic variants have been identified to be associated with Crohn's disease, less is known about the influence of epigenetics in the pathogenesis of this disease. In this review, we provide an overview of current epigenetic studies in Crohn's disease. In particular, we enable a deeper insight into applied bioanalytical and computational tools, as well as a comprehensive update toward the cell-specific evaluation of DNA methylation and histone modifications.

scholarly journals Role of Probiotics and Their Metabolites in Inflammatory Bowel Diseases (IBDs)

2021 ◽  
Vol 12 (1) ◽  
pp. 56-66
Author(s):  
Toumi Ryma ◽  
Arezki Samer ◽  
Imene Soufli ◽  
Hayet Rafa ◽  
Chafia Touil-Boukoffa
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Symptoms ◽  
Therapeutic Potential ◽  
Short Chain Fatty Acids ◽  
Active Metabolites ◽  
Complex Disorders ◽  
Inflammatory Bowel

Inflammatory Bowel Disease (IBD) is a term used to describe a group of complex disorders of the gastrointestinal (GI) tract. IBDs include two main forms: Crohn’s Disease (CD) and Ulcerative Colitis (UC), which share similar clinical symptoms but differ in the anatomical distribution of the inflammatory lesions. The etiology of IBDs is undetermined. Several hypotheses suggest that Crohn’s Disease and Ulcerative Colitis result from an abnormal immune response against endogenous flora and luminal antigens in genetically susceptible individuals. While there is no cure for IBDs, most common treatments (medication and surgery) aim to reduce inflammation and help patients to achieve remission. There is growing evidence and focus on the prophylactic and therapeutic potential of probiotics in IBDs. Probiotics are live microorganisms that regulate the mucosal immune system, the gut microbiota and the production of active metabolites such as Short-Chain Fatty Acids (SCFAs). This review will focus on the role of intestinal dysbiosis in the immunopathogenesis of IBDs and understanding the health-promoting effects of probiotics and their metabolites.

scholarly journals Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Bruno Rafael Ramos de Mattos ◽  
Maellin Pereira Gracindo Garcia ◽  
Julia Bier Nogueira ◽  
Lisiery Negrini Paiatto ◽  
Cassia Galdino Albuquerque ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Severe Disease ◽  
Biological Therapies ◽  
Promising Alternative ◽  
Biological Treatments ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
And Behavior

Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the intestinal tract associated with an imbalance of the intestinal microbiota. Crohn’s disease (CD) and ulcerative colitis (UC) are the most widely known types of IBD and have been the focus of attention due to their increasing incidence. Recent studies have pointed out genes associated with IBD susceptibility that, together with environment factors, may contribute to the outcome of the disease. In ulcerative colitis, there are several therapies available, depending on the stage of the disease. Aminosalicylates, corticosteroids, and cyclosporine are used to treat mild, moderate, and severe disease, respectively. In Crohn’s disease, drug choices are dependent on both location and behavior of the disease. Nowadays, advances in treatments for IBD have included biological therapies, based mainly on monoclonal antibodies or fusion proteins, such as anti-TNF drugs. Notwithstanding the high cost involved, these biological therapies show a high index of remission, enabling a significant reduction in cases of surgery and hospitalization. Furthermore, migration inhibitors and new cytokine blockers are also a promising alternative for treating patients with IBD. In this review, an analysis of literature data on biological treatments for IBD is approached, with the main focus on therapies based on emerging recombinant biomolecules.

Quality of Life Considering Patients with Chronic Inflammatory Bowel Diseases - Natural and Parenteral Nutrition

2014 ◽  
Vol 86 (9) ◽  
Author(s):  
Aneta Raczkowska ◽  
Michał Ławiński ◽  
Aleksandra Gradowska ◽  
Urszula Zielińska-Borkowska
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Parenteral Nutrition ◽  
Inflammatory Bowel Diseases ◽  
Nutritional Therapy ◽  
Bowel Diseases ◽  
Inflammatory Bowel

AbstractOne of the elements of treatment considering inflammatory bowel diseases is nutritional therapy. The duration of the above-mentioned depends on the prevalence of such symptoms as fever, bowel move-ments, length of the functioning gastrointestinal tract, stoma and intestinal fistula presence. Nutritional therapy is an essential element of successful treatment alongside pharmacological, surgical, and biological therapy, as well as other methods. Crohn's disease and ulcerative colitis considered as chronic diseases, lead towards physical and biopsychosocial disability, being responsible for the reduction in the quality of life.was to determine the quality of life after surgical procedures in case of patients diagnosed with Crohn's disease and ulcerative colitis, subjected to natural and parenteral nutrition.The study group comprised 52 patients from the Department of Gastroen-terology, Military Medical Institute, and Department of Surgery and Clinical Nutrition, Clinical Hospital in Warsaw. The study was performed between October, 2011 and April, 2012. The World Health Organization Quality of Life Instrument - Bref (WHOQOL-BREF) questionnaire was used to deter-mine the patients’ quality of life.A lower quality of life was observed in case of patients subjected to parenteral nutrition, poor education, disease symptoms exacerbation, in the majority-rural inhabitants. The quality of life does not depend on gender, type of disease, family status, and additional medical care.

scholarly journals A Rare Case of Gastric Crohn’s Disease Complicated by Gastric Carcinoma

2018 ◽  
pp. 1-6
Author(s):  
Marwah Sami M Hussain ◽  
Bandar Idrees Ali ◽  
Abdullah Alzahrani
Keyword(s):  
Gastric Cancer ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Bowel Diseases ◽  
Rare Case ◽  
Small Bowel Adenocarcinoma ◽  
Disease Case ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Upper Gastrointestinal

Background: Inflammatory bowel diseases are strongly associated with colorectal cancer. In addition, a few cases reported with gastric and small bowel adenocarcinoma in gastroduodenal Crohn’s disease. Case report: We reported a case of a 47-Year-old female, who was referred to our surgical department and after a routine gastroscopy which revealed a lesion. Biopsy confirmed gastric well-differentiated adenocarcinoma of limited gastric Crohn’s disease, for a patient on regular anti Crohn’s medication. The patient underwent varying laparoscopic distal gastrectomy. She received adjuvant chemotherapy treatment and thereafter, she was cancer free within the period of 3- years of regular follow up. Conclusion: The only way to diagnose such lesions of a rare case of gastric cancer in a patient with Crohn’s disease is to regularly carry out upper gastrointestinal examinations. Keywords: Inflammatory bowel diseases, Crohn’s disease, Upper gastrointestinal tract Crohn’s disease, Gastric cancer

scholarly journals Pathogenesis and management of gastrointestinal inflammation and fibrosis: from inflammatory bowel diseases to endoscopic surgery

2021 ◽  
Vol 41 (1) ◽  
Author(s):  
Kentaro Iwata ◽  
Yohei Mikami ◽  
Motohiko Kato ◽  
Naohisa Yahagi ◽  
Takanori Kanai
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Tissue Repair ◽  
Relevant Literature ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Extended Resection ◽  
Bowel Diseases ◽  
Technical Advances ◽  
Inflammatory Bowel

AbstractGastrointestinal fibrosis is a state of accumulated biological entropy caused by a dysregulated tissue repair response. Acute or chronic inflammation in the gastrointestinal tract, including inflammatory bowel disease, particularly Crohn’s disease, induces fibrosis and strictures, which often require surgical or endoscopic intervention. Recent technical advances in endoscopic surgical techniques raise the possibility of gastrointestinal stricture after an extended resection. Compared to recent progress in controlling inflammation, our understanding of the pathogenesis of gastrointestinal fibrosis is limited, which requires the development of prevention and treatment strategies. Here, we focus on gastrointestinal fibrosis in Crohn’s disease and post-endoscopic submucosal dissection (ESD) stricture, and we review the relevant literature.

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