scholarly journals Current Use of EEN in Pre-Operative Optimisation in Crohn’s Disease

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4389
Author(s):  
Sharafaath Shariff ◽  
Gordon Moran ◽  
Caris Grimes ◽  
Rachel Margaret Cooney
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Patient Outcomes ◽  
Surgical Procedures ◽  
Treatment Options ◽  
Paediatric Population ◽  
Mucosal Healing ◽  
Bowel Surgery ◽  
Operative Complications

Despite the increasing array of medications available for the treatment of Crohn’s disease and a focus on mucosal healing, approximately 35% of patients with Crohn’s disease undergo bowel surgery at some stage. The importance of nutritional optimisation before Crohn’s surgery is well-highlighted by surgical, nutritional, and gastroenterological societies with the aim of reducing complications and enhancing recovery. Surgical procedures are frequently undertaken when other treatment options have been unsuccessful, and, thus, patients may have lost weight and/or required steroids, and are therefore at higher risk of post-operative complications. EEN is used extensively in the paediatric population to induce remission, but is not routinely used in the induction of remission of adult Crohn’s disease or in pre-operative optimisation. Large prospective studies regarding the role of pre-operative EEN are lacking. In this review, we evaluate the current literature on the use of EEN in pre-operative settings and its impact on patient outcomes.

scholarly journals Therapeutic role of methotrexate in pediatric Crohn’s disease

2018 ◽  
Vol 18 (3) ◽  
pp. 211-216
Author(s):  
Zlatko Djurić ◽  
Ljiljana Šaranac ◽  
Ivana Budić ◽  
Voja Pavlović ◽  
Jelena Djordjević
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Remission ◽  
Normal Growth ◽  
Mucosal Healing ◽  
Main Role ◽  
Therapeutic Role ◽  
Hepatosplenic T Cell Lymphoma ◽  
Maintenance Of Remission

The main role of therapy in Crohn’s disease (CD) is to achieve long-term clinical remission, and to allow for normal growth and development of children. The immunomodulatory drugs used for the maintenance of remission in CD include thiopurines (azathioprine and 6-mercaptopurine) and methotrexate (MTX). Development of hepatosplenic T-cell lymphoma in some patients with inflammatory bowel disease, treated with thiopurines only or in combination with anti-tumor necrosis factor agents, resulted in a growing interest in the therapeutic application of MTX in children suffering from CD. This review summarizes the literature on the therapeutic role of MTX in children with CD. MTX is often administered as a second-line immunomodulator, and 1-year clinical remission was reported in 25–69% of children with CD after excluding for the use of thiopurines. Initial data on MTX effectiveness in mucosal healing, and as a first-line immunomodulator in pediatric patients with CD, are promising. A definite conclusion, however, may only be made on the basis of additional research with a larger number of subjects.

scholarly journals P182 Multiparametric evaluation of Crohn's disease: possible role of intestinal healing beyond mucosal healing

2014 ◽  
Vol 8 ◽  
pp. S138
Author(s):  
I. Scoleri ◽  
L. Laterza ◽  
L. Larosa ◽  
A. Poscia ◽  
E. Gaetani ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Mucosal Healing

scholarly journals Targeting mucosal healing in Crohn’s disease: what the clinician needs to know

2019 ◽  
Vol 12 ◽  
pp. 175628481985686 ◽  
Author(s):  
Entcho Klenske ◽  
Christian Bojarski ◽  
Maximilian Waldner ◽  
Timo Rath ◽  
Markus F. Neurath ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Clinical Practice ◽  
Crohn's Disease ◽  
Clinical Management ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Mucosal Healing ◽  
Ongoing Debate ◽  
Definition Of

In recent years, mucosal healing has emerged as a key therapeutic goal in the clinical management of patients with Crohn’s disease, as it has been associated with improved long-term clinical outcomes. With the vast improvements in endoscopic imaging techniques and the increase in available treatment options, which reportedly are able to induce mucosal healing, the practising physician is left to wonder: how is endoscopic mucosal healing exactly defined in Crohn’s disease, and how can it effectively be achieved and monitored in daily clinical practice? Within this review, we will give an overview of the ongoing debate about the definition of mucosal healing and the modalities to monitor inflammation, and finally present available therapies with the capacity to induce mucosal healing.

scholarly journals Partial Enteral Nutrition in Crohn’s Disease

2021 ◽  
Author(s):  
Evgen Benedik ◽  
Darja Urlep ◽  
Anija Orel ◽  
Rok Orel
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Treatment Option ◽  
Paediatric Population ◽  
Treatment Modalities ◽  
Effective Treatment Option ◽  
Exclusive Enteral Nutrition ◽  
Randomised Controlled

Exclusive enteral nutrition (EEN) has proven to be a highly effective treatment option in inducing remission in active Crohn’s disease (CD) in the paediatric population. In adults with CD, the results of meta-analyses demonstrated that therapy with corticosteroids was more effective in comparison with EEN. The most important limitation of the success of EEN treatment is patients’ compliance. Exclusivity of enteral nutrition and its substantial impact on the quality of life are the main reasons why EEN is not acceptable to many patients. Therefore, the treatment with partial enteral nutrition (PEN), where patients are allowed to eat some ordinary food besides enteral formulas, is becoming an important treatment option, not only in inducing, but also in maintaining remission in CD. However, strong evidence on the efficacy of PEN for induction and maintenance of CD remission is still lacking. Due to the excellent safety profile of the treatment with enteral nutrition in comparison with other treatment modalities, further well-designed, randomised, controlled studies are necessary to elucidate the exact role of PEN in inducing and maintaining of remission in CD patients. Herein, the most relevant studies on the efficacy and the role of PEN in active and quiescent CD are reviewed.

Tu1327 Factors Associated With Achievement of Mucosal Healing in Crohn's Disease: Role of Repeated Endoscopy Assessment in Treating to Target

2015 ◽  
Vol 148 (4) ◽  
pp. S-860
Author(s):  
Ren Mao ◽  
Yun Qiu ◽  
Bai-li Chen ◽  
Yao He ◽  
Zhi-rong Zeng ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Mucosal Healing ◽  
Factors Associated

scholarly journals OP24 A novel subcutaneous infliximab (CT-P13): 1-year results including switching results from intravenous infliximab (CT-P13) in patients with active Crohn’s disease and ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S021-S022 ◽  
Author(s):  
S Ben-Horin ◽  
J Leszczyszyn ◽  
R Dudkowiak ◽  
A Lahat ◽  
B Gawdis-Wojnarska ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Treatment Options ◽  
Maintenance Phase ◽  
Mucosal Healing ◽  
Comparable Efficacy ◽  
Clinical Activity ◽  
Efficacy And Safety ◽  
The Mean

Abstract Background Two randomised controlled trials of a novel subcutaneous (SC) formulation of infliximab in patients with active rheumatoid arthritis1 and in patients with active Crohn’s disease (CD) and ulcerative colitis (UC)2 confirmed comparable clinical efficacy and safety of CT-P13 SC with CT-P13 intravenous (IV) up to Week 30. We now present the efficacy, pharmacokinetics (PK) and safety of CT-P13 SC over 1-year in the active CD and UC trial, including the outcomes of switching from CT-P13 IV to CT-P13 SC. Methods After loading doses of IV 5 mg/kg at Weeks 0 and 2, patients were randomised at Week 6 to receive either SC 120 mg (<80 kg) or 240 mg (≥80 kg) every 2 weeks (SC arm), or continued on IV 5 mg/kg every 8 weeks (IV arm). From Week 30, IV 5 mg/kg was switched to either SC 120 or 240 mg based on the patients’ body weight at Week 30. Patients who initially responded but experienced loss-of-response at Week 30 or beyond, were dose-escalated to SC 240 mg every 2 weeks. Results A total of 131 patients were randomised (66 to the SC arm and 65 to the IV arm); of whom, 105 (80.2%) patients completed the Week 54 visit (55 in the SC arm and 50 in the IV arm). The mean CDAI and partial Mayo scores decreased over time in the 2 arms until Week 30 and comparable improvement in clinical activity was observed at Week 54 after switching the remaining IV patients to SC (Figure 1 and 2). The rates of clinical response and remission were also maintained at Week 54 and the rate of mucosal healing in combined CD and UC was further improved at Week 54 (Table 1). The mean pre-dose serum concentrations in the IV arm increased to a similar level to SC arm after switching and maintained consistent levels until Week 54 (Figure 3). The safety profiles during the maintenance phase and on or after Week 30 were generally comparable between the 2 arms (Table 1). All of the localised injection site reactions were grade 1 or 2 in intensity and majority of patients recovered without any treatments. Conclusion These results of CT-P13 SC 1-year study in active CD and UC show comparable efficacy and safety of the SC and IV formulations, which were not affected by a switch of IV patients to SC route. The PK as manifested by trough concentrations of the drug, increased after switching from IV to SC. These observations support the first infliximab SC formulation as a viable therapeutic agent to expand patients’ treatment options. References

P056 DISCRIMINATORY ROLE OF ANTI-MICROBIAL ANTIBODIES IN DIAGNOSIS OF CROHN'S DISEASE AGAINST NORMAL AND OTHER MIMICS

2020 ◽  
Vol 158 (3) ◽  
pp. S21-S22
Author(s):  
Peilin Zhang ◽  
Lawrence Minardi ◽  
J. Todd Kuenstner ◽  
Steve Zekan ◽  
Rusty Kruzelock
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease
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