Application of Ultrasound Elastography for Assessing Intestinal Fibrosis in Inflammatory Bowel Disease: Fiction or Reality?

2020 ◽  
Vol 21 ◽  
Author(s):  
Roberto Gabbiadini ◽  
Eirini Zacharopoulou ◽  
Federica Furfaro ◽  
Vincenzo Craviotto ◽  
Alessandra Zilli ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sample Size ◽  
Bowel Disease ◽  
Small Sample Size ◽  
Shear Wave Elastography ◽  
Small Sample ◽  
Ultrasound Elastography ◽  
Invasive Technique ◽  
Intestinal Fibrosis ◽  
Inflammatory Bowel

Background: Intestinal fibrosis and subsequent strictures represent an important burden in inflammatory bowel disease (IBD). The detection and evaluation of the degree of fibrosis in stricturing Crohn’s disease (CD) is important to address the best therapeutic strategy (medical anti-inflammatory therapy, endoscopic dilation, surgery). Ultrasound elastography (USE) is a non-invasive technique that has been proposed in the field of IBD for evaluating intestinal stiffness as a biomarker of intestinal fibrosis. Objective: The aim of this review is to discuss the ability and current role of ultrasound elastography in the assessment of intestinal fibrosis. Results and Conclusion: Data on USE in IBD are provided by pilot and proof-of-concept studies with small sample size. The first type of USE investigated was strain elastography, while shear wave elastography has been introduced lately. Despite the heterogeneity of the methods of the studies, USE has been proven to be able to assess intestinal fibrosis in patients with stricturing CD. However, before introducing this technique in current practice, further studies with larger sample size and homogeneous parameters, testing reproducibility, and identification of validated cut-off values are needed.

THE IMPLEMENTATION OF A PILOT STUDY OF A STANDARDIZED INFLAMMATORY BOWEL DISEASE CURRICULUM FOR GASTROENTEROLOGY FELLOWS

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S51-S52
Author(s):  
Aditi Mulgund ◽  
Poonam Beniwal-Patel
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Small Sample Size ◽  
Core Competencies ◽  
Rapid Change ◽  
Current Approach ◽  
Small Sample ◽  
The Core ◽  
Advanced Therapies ◽  
Inflammatory Bowel

Abstract Introduction There is a need for standardization of the inflammatory bowel disease (IBD) training curriculum in gastroenterology fellowship. This training varies by program and in many cases may be insufficient to provide advanced care in IBD. Prior data has shown only 28% of trainees feel satisfied with their IBD exposure and few feel comfortable with the management of pouches, stomas, and pregnant or post-operative patients. The current approach to IBD education varies widely by training program and may include didactic sessions, web-based education, or clinical exposure. Because of the increase in IBD prevalence and rapid change to the treatment armamentarium, fellows need to be uniformly trained in IBD. There is a need for a standardized curriculum for IBD training across all gastroenterology fellowships. Methods We created an IBD curriculum for our categorical gastroenterology fellows based off the core IBD competencies recommended by the Crohn’s and Colitis Foundation Rising Educators, Academicians, and Clinicians Helping Inflammatory Bowel Disease (REACH-IBD) group. Unique learning objectives and learning resources were provided during the IBD month, each year of fellowship. A pre-test and post-test was administered during the IBD month. Results The core competencies assessed in pre-survey data is shown in table 1. Preliminary data showed that only one trainee close to the end of training felt comfortable with most aspects of IBD management. The remaining trainees closer to the beginning of their fellowship were less comfortable with most aspects of IBD management (Table 1). First year fellows had most difficulty with identifying serious infections associated with advanced therapies for IBD and noting which laboratory testing is needed for monitoring. Second- and third-year fellows did well with assessment and management of the IBD patient, but had difficulty with advanced management of post-surgical or pregnant patient (Fig. 1). Conclusion This single-center prospective study implemented a novel comprehensive IBD curriculum as part of the IBD training month. Through real-time assessment, specific strengths and areas for further improvement were identified so additional training could be provided. The limitation of the study is the small sample size and limited follow up. Further models in IBD education during gastroenterology fellowship need to be explored. Pre-rotation survey, administered to trainees to assess where they feel weakness lies Bar graph demonstrating individual scores and average scores for post-rotation test, separated by year

Immunological Regulation of Intestinal Fibrosis in Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Giorgos Bamias ◽  
Theresa T Pizarro ◽  
Fabio Cominelli
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Large Scale ◽  
Intestinal Inflammation ◽  
Temporal Association ◽  
Stricture Formation ◽  
Intestinal Fibrosis ◽  
Matrix Deposition ◽  
Inflammatory Bowel ◽  
Chronic Intestinal Inflammation

Abstract Intestinal fibrosis is a late-stage phenotype of inflammatory bowel disease (IBD), which underlies most of the long-term complications and surgical interventions in patients, particularly those with Crohn’s disease. Despite these issues, antifibrotic therapies are still scarce, mainly due to the current lack of understanding concerning the pathogenetic mechanisms that mediate fibrogenesis in patients with chronic intestinal inflammation. In the current review, we summarize recent evidence regarding the cellular and molecular factors of innate and adaptive immunity that are considered critical for the initiation and amplification of extracellular matrix deposition and stricture formation. We focus on the role of cytokines by dissecting the pro- vs antifibrotic components of the immune response, while taking into consideration their temporal association to the progressive stages of the natural history of IBD. We critically present evidence from animal models of intestinal fibrosis and analyze inflammation-fibrosis interactions that occur under such experimental scenarios. In addition, we comment on recent findings from large-scale, single-cell profiling of fibrosis-relevant populations in IBD patients. Based on such evidence, we propose future potential targets for antifibrotic therapies to treat patients with IBD.

Role of Epithelial-to-Mesenchymal Transition in Inflammatory Bowel Disease

2018 ◽  
Vol 13 (5) ◽  
pp. 659-668 ◽  
Author(s):  
Sara Lovisa ◽  
Giannicola Genovese ◽  
Silvio Danese
Keyword(s):  
Inflammatory Bowel Disease ◽  
Wound Healing ◽  
Bowel Disease ◽  
Molecular Mechanisms ◽  
Epithelial To Mesenchymal Transition ◽  
Clinical Manifestations ◽  
Mesenchymal Transition ◽  
Intestinal Fibrosis ◽  
Inflammatory Bowel

Abstract Intestinal fibrosis is an inevitable complication in patients with inflammatory bowel disease [IBD], occurring in its two major clinical manifestations: ulcerative colitis and Crohn’s disease. Fibrosis represents the final outcome of the host reaction to persistent inflammation, which triggers a prolonged wound healing response resulting in the excessive deposition of extracellular matrix, eventually leading to intestinal dysfunction. The process of epithelial-to-mesenchymal transition [EMT] represents an embryonic program relaunched during wound healing, fibrosis and cancer. Here we discuss the initial observations and the most recent findings highlighting the role of EMT in IBD-associated intestinal fibrosis and fistulae formation. In addition, we briefly review knowledge on the cognate process of endothelial-to-mesenchymal transition [EndMT]. Understanding EMT functionality and the molecular mechanisms underlying the activation of this mesenchymal programme will permit designing new therapeutic strategies to halt the fibrogenic response in the intestine.

P062 A SYSTEMATIC REVIEW ON POWER ESTIMATION TO SUPPORT SAMPLE SIZE CALCULATION FOR RANDOMISED TRIALS IN INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S9-S9
Author(s):  
Svetlana Lakunina ◽  
Zipporah Iheozor-Ejiofor ◽  
Morris Gordon ◽  
Daniel Akintelure ◽  
Vassiliki Sinopoulou
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sample Size ◽  
Bowel Disease ◽  
Sample Size Calculation ◽  
Sample Size Estimation ◽  
Power Calculation ◽  
Size Estimation ◽  
Target Sample ◽  
Inflammatory Bowel ◽  
Randomised Controlled

Abstract Inflammatory bowel disease is a collection of disorders of the gastrointestinal tract, characterised by relapsing and remitting inflammation. Studies have reported several pharmacological or non-pharmacological interventions being effective in the management of the disease. Sample size estimation with power calculation is necessary for a trial to detect the effect of an intervention. This project critically evaluates the sample size estimation and power calculation reported by randomised controlled studies of inflammatory bowel disease management to effectively conclude appropriateness of the studies results. We conducted a literature search in the Cochrane database to identify systematic literature reviews. Their reference lists were screened, and studies were selected if they met the inclusion criteria. The data was extracted based on power calculation parameters and outcomes, results were analysed and summarised in percentages, means and graphs. We screened almost all trials about the management of inflammatory bowel disease published in the past 25 years. 232 studies were analysed, of which 167 reported power calculation. Less than half (48%) of these studies achieved their target sample size, needed for them to accurately conclude that the interventions were effective. Moreover, the average minimal difference those studies were aimed to detect was 30%, which could be not enough to prove the effect of an intervention. To conclude inaccurate power calculations and failure to achieve the target sample sizes can lead to errors in the results on how effective an intervention is in the management of inflammatory bowel disease.

Heat Shock Protein 47 can be a New Target Molecule for Intestinal Fibrosis Related to Inflammatory Bowel Disease

2010 ◽  
Vol 16 (12) ◽  
pp. 2004-2006 ◽  
Author(s):  
Yusuke Honzawa ◽  
Hiroshi Nakase ◽  
Yasuhiro Takeda ◽  
Kazuhiro Nagata ◽  
Tsutomu Chiba
Keyword(s):  
Inflammatory Bowel Disease ◽  
Heat Shock ◽  
Heat Shock Protein ◽  
Bowel Disease ◽  
Heat Shock Protein 47 ◽  
Intestinal Fibrosis ◽  
Target Molecule ◽  
Inflammatory Bowel

Pathogenesis of Intestinal Fibrosis in Inflammatory Bowel Disease and Perspectives for Therapeutic Implication

2017 ◽  
Vol 35 (1-2) ◽  
pp. 25-31 ◽  
Author(s):  
Dominik Bettenworth ◽  
Florian Rieder
Keyword(s):  
Inflammatory Bowel Disease ◽  
Chronic Inflammation ◽  
Bowel Disease ◽  
Molecular Mechanisms ◽  
Cell Types ◽  
Stricture Formation ◽  
Intestinal Fibrosis ◽  
Conventional View ◽  
Multiple Cell ◽  
Inflammatory Bowel

Background: Intestinal fibrosis with stricture formation is a common feature of inflammatory bowel disease (IBD) and leads to a significantly impaired quality of life in affected patients, intestinal obstruction as well as to the need for surgical intervention. This constitutes a major treatment challenge. Key Messages: Fibrosis results from the response of gut tissue to the insult inflicted by chronic inflammation. Similarly to what occurs in other organs, the underlying fibrogenic mechanisms are complex and dynamic, involving multiple cell types, interrelated cellular events, and a large number of soluble factors. Owing to a breakdown of the epithelial barrier in IBD, luminal bacterial products leak into the interstitium and induce an innate immune response mediated by the activation of both immune and non-immune cells. Other environmental factors as well as chronic inflammation will certainly impact the quality and quantity of intestinal fibrosis. Finally, the composition of the intestinal extracellular matrix is dramatically altered in chronic gut inflammation and actively promotes fibrosis through its mechanical properties. The conventional view that intestinal fibrosis is an inevitable and irreversible process is gradually changing in light of an improved understanding of the cellular and molecular mechanisms that underline its pathogenesis. In addition, clinical observations in patients who undergo strictureplasty have shown that stricture formation is reversible. Conclusions: Identification of the unique mechanisms of intestinal fibrogenesis should create a practical framework to target and block specific fibrogenic pathways, estimate the risk of fibrotic complications, permit the detection of early fibrotic changes and, eventually, allow the development of treatment methods customized to each patient's type and degree of intestinal fibrosis.

scholarly journals QS1: Creeping Fat Adipocytes Drive Intestinal Fibrosis Through Adipocyte-to-fibroblast Conversion in a Novel Model of Inflammatory Bowel Disease

2021 ◽  
Vol 9 (7S) ◽  
pp. 5-6
Author(s):  
Khristian E. Bauer-Rowe ◽  
Jeong Hyunh ◽  
Deshka S. Foster ◽  
Michelle Griffin ◽  
Shamik Mascharak ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Intestinal Fibrosis ◽  
Inflammatory Bowel ◽  
Novel Model
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