Sarcopenia, severe anxiety and increased C-reactive protein are associated with severe fatigue in patients with inflammatory bowel diseases

Patients with inflammatory bowel disease (IBD) report fatigue more frequently than healthy population, but the precise mechanisms underlying its presence are unknown. This study aimed to evaluate the prevalence of fatigue in IBD and its relation with potential causative factors. A survey on fatigue, depression, anxiety, sleep disorders, and the presence of sarcopenia and malnutrition, was sent by email to 244 IBD outpatients of the Gastroenterology Unit of Academic Hospital of Padua. Demographics and clinical data, including the levels of fecal calprotectin (FC) and C-reactive protein (CRP), and current pharmacological treatments were obtained from patients’ medical records. Ninety-nine (40.5%) subjects answered the survey. Ninety-two (92.9%) patients reported fatigue, with sixty-six having mild to moderate fatigue and twenty-six severe fatigue. Multivariate analysis showed that abnormal values of CRP (OR 5.1), severe anxiety (OR 3.7) and sarcopenia (OR 4.4) were the factors independently associated with severe fatigue. Fatigue has a high prevalence in subject affected by IBD. Subjects with altered CRP, sarcopenia and severe anxiety appear more at risk of severe fatigue

The multidisciplinary health care team in the management of stenosis in Crohn's disease

Marco Gasparetto,1 Imerio Angriman,2 Graziella Guariso1 1Department of Women and Children's Health, Paediatric Gastroenterology Unit, Padua University Hospital, Padova, Italy; 2Department of Surgery, Gastroenterology and Oncology, Padua University, Padova, Italy Background: Stricture formation is a common complication of Crohn's disease (CD), occurring in approximately one-third of all patients with this condition. Our aim was to summarize the available epidemiology data on strictures in patients with CD, to outline the principal evidence on diagnostic imaging, and to provide an overview of the current knowledge on treatment strategies, including surgical and endoscopic options. Overall, the unifying theme of this narrative review is the multidisciplinary approach in the clinical management of patients with stricturing CD. Methods: A Medline search was performed, using “Inflammatory Bowel Disease”, “stricture”, “Crohn's Disease”, “Ulcerative Colitis”, “endoscopic balloon dilatation” and “strictureplasty” as keywords. A selection of clinical cohort studies and systematic reviews were reviewed. Results: Strictures in CD are described as either inflammatory or fibrotic. They can occur de novo, at sites of bowel anastomosis or in the ileal pouch. CD-related strictures generally show a poor response to medical therapies, and surgical bowel resection or surgical strictureplasty are often required. Over the last three decades, the potential role of endoscopic balloon dilatation has grown in importance, and nowadays this technique is a valid option, complementary to surgery. Conclusion: Patients with stricturing CD require complex clinical management, which benefits from a multidisciplinary approach: gastroenterologists, pediatricians, radiologists, surgeons, specialist nurses, and dieticians are among the health care providers involved in supporting these patients throughout diagnosis, prevention of complications, and treatment. Keywords: Crohn’s disease, endoscopic balloon dilatation, multidisciplinary team, stricture, strictureplast

A clinical and instrumental study of the functionality of ileoanal "reservoirs".

Twenty-five patients with ileo-anal "reservoir" have been evaluated by clinical examination, manometry, proctography, endoscopy and biopsy, at least six months from the closure of ileostomy. 80% of them presented with a satisfactory condition, although only one third reached a normal function; 20% suffered for one or more dysfunctions which lead to a variable degree of social handicap. The most frequent dysfunctions were incontinence (13 patients), urgency (10), frequency (9), pouchitis (6), incapacity to evacuate (2). The mean values at manometry showed a halved anal tone, a slightly impaired external sphincter, a halved compliance of the pouch in comparison to normal rectum. Radiology demonstrated that half the patients with dysfunctions had a reduced motility of the pouch and anomalies in sphincter coordination. Endoscopy and biopsies demonstrated inflammation in 12 patients and 6 of them developed an acute pouchitis. From a general point of view, apart from particular conditions, it has been impossible to correlate clinical dysfunctions with a specific abnormality at the instrumental evaluation. Therefore, while good results are assumed to be due to a normally restored anatomical and motility condition, we must recognize that most clinical dysfunctions are not univocally correlated to abnormalities of the pouch or of the sphincteric apparatus

Fistula\u2010related cancer in Crohn\u2019s disease: A systematic review

Perianal fistulizing Crohn\u2019s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn\u2019s disease are also at risk of perianal fistula\u2010related squa-mous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn\u2019s disease and there is a paucity of data regarding its incidence, diagnosis and manage-ment. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn\u2019s disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula\u2010related carcinoma in CD (Chron\u2019s disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diag-nosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long\u2010standing disease in the perineum are present. Future studies are needed to under-stand the role of HPV vaccination in preventing fistula\u2010related cancer