Advanced Endoscopic Imaging for Diagnosis of Crohn's Disease

Endoscopy in IBD has tremendous importance to diagnose inflammatory activity, to evaluate therapeutic success and for the surveillance of colitis associated cancer. Thus it becomes obvious that there is a need for new and more advanced endoscopic imaging techniques for better characterization of mucosal inflammation and early neoplasia detection in IBD. This paper describes the concept of advanced endoscopic imaging for the diagnosis and characterization of Crohn's disease, including magnification endoscopy, chromoendoscopy, balloon-assisted enteroscopy, capsule endoscopy, confocal laser endomicroscopy, and endocytoscopy

Inflammatory bowel disease: pathogenesis, diagnosis and current therapeutic approach

Inflammatory bowel disease is a group of conditions of unknown etiology, represented by Crohn’s disease and ulcerative colitis and characterized by the presence of intestinal wall inflammation. From the first cases described to date, several studies have been performed to elucidate the cause of inflammatory bowel disease. Generally, the genetic factors predispose to their occurrence while epigenetic and environmental factors trigger them. Genetic factors are mutations of the genes involved in the response and recognition of immune cells to different pathogens. The most studied epigenetic and environmental factors are smoking (which predisposes to Crohn’s disease and can be protective for ulcerative colitis), lack of vitamin D, a diet rich in sugars and low in flavonoids and fibers. The diagnosis is usually established by endoscopy and biopsy. Recent technologies can perform live biopsies such as endocytoscopy or confocal laser endomicroscopy, with an accuracy of 100% compared to classical methods. Therapy involves several classes of drugs, preferably in association with diet and lifestyle changes. In case of complications or in non-responsive diseases, surgery must be considered, as documented for ulcerative colitis that can be cured by removing the entire colon. The purpose of this review is to present recent findings on pathology, as well as modern diagnosis and treatment methods for IBD

Evaluation of intestinal motility with Magnetic Resonance Enterography and computer post-processing

Small bowel motility is an essential, physiological process central to the processing of ingested food. The small bowel is however anatomically and functionally complex, varying greatly between individuals and located deep within the abdomen making it extremely difficult to access with instrumentation. As a consequence, and in spite of its known or suspected role in a range of diseases, there remain little in the way of objective tests to evaluate or even observe this process in vivo. This thesis details the validation and application of a novel computer post-processing technique that allows the quantification of Magnetic Resonance Enterography derived time-series image data. A background to small bowel physiology and existing techniques is first provided along with an introduction to the registration algorithm used throughout this thesis to quantify small bowel motility. The technique is then applied retrospectively to two Crohn’s disease patient cohorts to explore how this inflammatory bowel disease influences contractility. A prospective evaluation of segmental motility analysis is then presented drawing attention to large within subject variation, in a cohort of healthy volunteers, as a limitation for this technique. As an alternative, a global motility analysis approach is described and validated. Although global measures of motility appeared robust, factors influencing clinical application are further addressed by expanding the technique to allow motility analysis in free-breathing data. In the final piece of research presented, the application of the global technique to a cohort of Chronic Intestinal Pseudo-Obstruction patients is detailed. The thesis is concluded with a reflection of the results and a chapter dedicated to the commercial exploitation of the research to address the ongoing need for a robust test to quantise intestinal motility

Inflammatory Bowel Disease

This book is an overview of invited contributions on recent data of inflammatory bowel diseases. The first part of the book covers topics related to the ethiopathogenesis of inflammatory bowel diseases including the environmental, genetic factors and immunological alternations. The next chapters deal with present day management of disease including radiological diagnosis and surgical treatment, which consider the advances of most up-to-date radiological methodology including MRI techniques and the role of surgical procedures in the therapy. The final part presents medical therapy and its future directions. These chapters discuss natural products exerting anti-inflammatory and anti-tumour effects, methods of colon targeting drug delivery systems including polysaccharides, peptides and nanoparticules; as well as the potential risks of nanotechnology based food materials