Towards a Food Pharmacy: Immunologic Modulation through Diet

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Safety of Anti-TNF Treatment in Liver Transplant Recipients: A Systematic Review and Meta-analysis

Development and application of statistical models for medical scientific researc

Disease activity in inflammatory bowel disease patients is associated with increased liver fat content and liver fibrosis during follow-up

Purpose Liver steatosis is a frequently reported condition in patients with inflammatory bowel disease (IBD). Different factors, both metabolic and IBD-associated, are believed to contribute to the pathogenesis. The aim of our study was to calculate the prevalence of liver steatosis and fibrosis in IBD patients and to evaluate which factors influence changes in steatosis and fibrosis during follow-up. Methods From June 2017 to February 2018, demographic and biochemical data was collected at baseline and after 6-12 months. Measured by transient elastography (FibroScan), liver steatosis was defined as Controlled Attenuation Parameter (CAP) >= 248 and fibrosis as liver stiffness value (Emed) >= 7.3 kPa. IBD disease activity was defined as C-reactive protein (CRP) >= 10 mg/l and/or fecal calprotectin (FCP) >= 150 mu g/g. Univariate and multivariate regression analysis was performed; a p-value of <= 0.05 was considered significant. Results Eighty-two out of 112 patients were seen for follow-up; 56% were male. The mean age was 43 +/- 16.0 years, and mean BMI was 25.1 +/- 4.7 kg/m(2). The prevalence of liver steatosis was 40% and of fibrosis was 20%. At baseline, 26 patients (32%) had an active episode of IBD. Using a multivariate analysis, disease activity at baseline was associated with an increase in liver steatosis (B = 37, 95% CI 4.31-69.35, p = 0.027) and liver fibrosis (B = 1.2, 95% CI 0.27-2.14, p = 0.016) during follow-up. Conclusions This study confirms the relatively high prevalence of liver steatosis and fibrosis in IBD patients. We demonstrate that active IBD at baseline is associated with both an increase in liver steatosis and fibrosis during follow-up.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Ustekinumab trough concentrations are associated with biochemical outcomes in patients with Crohn's disease

Objective: It is unknown whether ustekinumab (UST) levels can predict clinical outcomes in Crohn's disease (CD) patients. We assessed the exposure-response relationship of UST trough concentrations with biochemical outcomes at week 24 in a prospective, real-world setting. Methods: We performed a prospective study in patients with CD starting UST in four academic centres in the Netherlands. All patients received a weight-adjusted intravenous (IV) UST induction dose, followed by one subcutaneous (SC) dose of 90 mg UST at 8 weeks. Maintenance therapy consisted of 90 mg subcutaneous UST every 8 or 12 weeks. Individual UST concentration time course during treatment were estimated using a population pharmacokinetic (PK) model. Quartile analysis and logistic regression were performed to analyse if UST concentrations at week 8 were associated with biochemical remission rates at week 24 (C-reactive protein (CRP) = 6.3 mu g/mL at week 8) had higher biochemical remission rates at week 12 and week 24. There was no association between UST levels at and corticosteroid-free clinical remission rates .Conclusion: In this real-world cohort of patients with CD, UST levels in the highest quartile (>= 6.3 mu g/mL) at week 8 were associated with higher biochemical remission rates at week 24.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Prophylactic Medication for the Prevention of Endoscopic Recurrence in Crohn's Disease: a Prospective Study Based on Clinical Risk Stratification

Background To prevent recurrence after ileocolonic resection [ICR] in Crohn's disease [CD], postoperative prophylaxis based on risk stratification is recommended in international guidelines. This study aimed to evaluate postoperative CD recurrence after implementation of a clinical management algorithm and to determine the predictive value of clinical and histological risk factors [RFs]. Methods In this multicentre, prospective cohort study, CD patients [>= 16 years] scheduled for ICR were included. The algorithm advised no postoperative medication for low-risk patients, and treatment with prophylaxis [immunosuppressant/biological] for high-risk patients [>= 1 RF: active smoking, penetrating disease, prior ICR]. Clinical and histological RFs [active inflammation, granulomas, plexitis in resection margins] for endoscopic recurrence [Rutgeerts' score >= i2b at 6 months] were assessed using logistic regression and ROC curves based on predicted probabilities. Results In total, 213 CD patients after ICR were included [age 34.5 years; 65% women] (93 [44%] low-risk; 120 [56%] high-risk: 45 [38%] smoking; 51 [43%] penetrating disease; 51 [43%] prior ICR). Adherence to the algorithm was 82% in low-risk [no prophylaxis] and 51% in high-risk patients [prophylaxis]. Endoscopic recurrence was higher in patients treated without prophylaxis than with prophylaxis in both low [45% vs 16%, p = 0.012] and high-risk patients [49% vs 26%, p = 0.019]. Clinical risk stratification including the prescription of prophylaxis corresponded to an area under the curve [AUC] of 0.70 (95% confidence interval [CI] 0.61-0.79). Clinical RFs combined with histological RFs increased the AUC to 0.73 [95% CI 0.64-0.81]. Conclusion Adherence to this management algorithm is 65%. Prophylactic medication after ICR prevents endoscopic recurrence in low- and high-risk patients. Clinical risk stratification has an acceptable predictive value, but further refinement is needed.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Fats and satiety

Fat is an important macronutrient with a high caloric density. Therefore, considerable interest exists in how fat exerts an effect on satiety and food intake, and how this effect can be increased. Here, we will discuss how digestion of fat leads to fatty acid sensing by oral and intestinal receptors, which in turn influences satiety and food intake. A number of strategies that have been developed to increase the satiating effect of fat will be discussed. A better understanding of the precise mechanisms of fatty acid sensing will assist in the development of effective ligands that maximize the satiating effect of dietary fats. Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Editorial: is age just a number when it comes to treatment of inflammatory bowel disease? Authors' reply

Contains fulltext : 229408.pdf (Publisher’s version ) (Closed access

Systematic Review: Components of a Comprehensive Geriatric Assessment in Inflammatory Bowel Disease-A Potentially Promising but Often Neglected Risk Stratification

Pathophysiology, epidemiology and therapy of agein