Updates in the diagnosis and management of small-bowel Crohn's disease

Crohn's disease (CD) can affect any part of the GI tract, but small bowel (SB) involvement is present in 80% of patients with CD; 30% have exclusive SB disease [1] presenting a diagnostic challenge due to the inaccessibility of standard endoscopic techniques. Accurate assessment of treatment response [2] and regular monitoring are crucial to prevent surgery and to identify patients at risk of relapse and/or complications before the onset of clinical symptoms [3]. Ileocolonoscopy (IC) is considered the gold standard for evaluating mucosal healing (MH) in CD, but it is invasive and costly [4] and only allows visualization of the terminal ileum (TI). The CALM study has demonstrated that C-reactive protein (CRP) and faecal calprotectin (FCP) can be effective surrogate markers of MH and help guide treatment [5]. Nonetheless, their efficacy is limited [6] as approximately 30% of patients do not present with elevated CRP levels during relapse [7] and the correlation between FCP and active SB disease is weak [8]. Thus, CD requires a multidisciplinary approach. We aim to provide an overview of recent advances in the diagnosis and management of small bowel CD

Applicability of a short/rapid 13C-urea breath test for Helicobacter pylori: retrospective multicenter chart review study

<p>Abstract</p> <p>Background</p> <p>Carbon labeled urea breath tests usually entail a two point sampling with a 20 to 30-minute gap. Our aim was to evaluate the duration of time needed for diagnosing <it>Helicobacter pylori </it>by the BreathID^®System.</p> <p>Methods</p> <p>This is a retrospective multicenter chart review study. Test location, date, delta over baseline, and duration of the entire test were recorded. Consecutively ¹³C urea breath tests results were extracted from the files over a nine year period.</p> <p>Results</p> <p>Of the 12,791 tests results, 35.1% were positively diagnosed and only 0.1% were inconclusive. A statistically significant difference in prevalence among the countries was found: Germany showing the lowest, 13.3%, and Israel the highest, 44.1%. Significant differences were found in time to diagnosis: a positive diagnosis had the shortest and an inconclusive result had the longest. Overall test duration averaged 15.1 minutes in Germany versus approximately 13 minutes in other countries. Diagnosis was achieved after approximately 9 minutes in Israel, Italy and Switzerland, but after 10 on average in the others. The mean delta over baseline value for a negative diagnosis was 1.03 ± 0.86, (range, 0.9 - 5), versus 20.2 ± 18.9, (range, 5.1 - 159.4) for a positive one.</p> <p>Conclusions</p> <p>The BreathID^®System used in diagnosing <it>Helicobacter pylori </it>can safely shorten test duration on average of 10-13 minutes without any loss of sensitivity or specificity and with no test lasting more than 21 minutes.</p

Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: Current management

info:eu-repo/semantics/publishedVersio

A Genome-Wide Scan of Ashkenazi Jewish Crohn's Disease Suggests Novel Susceptibility Loci

Crohn's disease (CD) is a complex disorder resulting from the interaction of intestinal microbiota with the host immune system in genetically susceptible individuals. The largest meta-analysis of genome-wide association to date identified 71 CD–susceptibility loci in individuals of European ancestry. An important epidemiological feature of CD is that it is 2–4 times more prevalent among individuals of Ashkenazi Jewish (AJ) descent compared to non-Jewish Europeans (NJ). To explore genetic variation associated with CD in AJs, we conducted a genome-wide association study (GWAS) by combining raw genotype data across 10 AJ cohorts consisting of 907 cases and 2,345 controls in the discovery stage, followed up by a replication study in 971 cases and 2,124 controls. We confirmed genome-wide significant associations of 9 known CD loci in AJs and replicated 3 additional loci with strong signal (p<5×10−6). Novel signals detected among AJs were mapped to chromosomes 5q21.1 (rs7705924, combined p = 2×10−8; combined odds ratio OR = 1.48), 2p15 (rs6545946, p = 7×10−9; OR = 1.16), 8q21.11 (rs12677663, p = 2×10−8; OR = 1.15), 10q26.3 (rs10734105, p = 3×10−8; OR = 1.27), and 11q12.1 (rs11229030, p = 8×10−9; OR = 1.15), implicating biologically plausible candidate genes, including RPL7, CPAMD8, PRG2, and PRG3. In all, the 16 replicated and newly discovered loci, in addition to the three coding NOD2 variants, accounted for 11.2% of the total genetic variance for CD risk in the AJ population. This study demonstrates the complementary value of genetic studies in the Ashkenazim

The impact of panenteric capsule endoscopy on the management of Crohn’s disease

Crohn’s disease (CD) is a chronic inflammatory disease, in most patients involving the small and large bowel. In recent years, with the use of small bowel video capsule endoscopy (SBCE), it has become clear that in 50% or more of adults with established CD there is not only distal but also proximal small bowel involvement that suggests poor prognosis. A great deal of effort has been put into early diagnosis and stratification of patients into low versus high risk, thus directing treatment from step-up, or accelerated step-up, to top-down therapies. SBCE has been used for assessment of small bowel pathologies for over 15 years, mainly for occult gastrointestinal bleeding and suspected CD. In recent years, a colonic capsule, with cameras on both sides and a wider angle of view, has been developed and is used by some to survey both small and large bowel. Recently the same capsule, with adjustments, has been released in Europe, concentrating (with specialized software) on inflammatory bowel disease. In this review I summarize the new data regarding the use of SBCE as well as the small bowel colon (SBC) versions of capsule endoscopy in established CD and the ways these could alter the management of such patients