Tailoring Crohn's disease treatment : the impact of small bowel capsule endoscopy

"Article in Press"; "Epub 2014 Mar 14"BACKGROUND AND AIMS: Small bowel capsule endoscopy (SBCE) may detect proximal small bowel lesions that have been previously missed by ileocolonoscopy and small bowel imaging in patients with known ileal and/or colonic Crohn's disease (CD). We aimed to evaluate whether the therapeutic management is influenced by SBCE findings. METHODS: Retrospective single center study. Inclusion of consecutive patients with known non-stricturing and non-penetrating ileal and/or colonic CD, submitted to SBCE to evaluate disease extension and activity, with ≥ 1year follow-up. Lesions were classified with the Lewis score (LS) as non-significant (LS790). Therapeutic changes were assessed three months after SBCE. RESULTS: Fifty consecutive patients (35±13years, 52% females) were included. At ileocolonoscopy, disease location was ileal (L1) in 60%, colonic (L2) in 10% and ileocolonic (L3) in 30% of the patients. In 33 patients (66%) SBCE detected significant proximal lesions previously missed by other modalities. The proportion of patients on thiopurines and/or biologics before SBCE was 2/50 (4%); this was significantly higher three months after SBCE, 15/50 (30%), p=0.023. Treatment with thiopurines and/or biologics was started more often in patients with proximal small bowel lesions [13/33 (39%) vs. 1/17 (6%), p=0.011, relative risk (RR) 6.5], particularly when severe (6%, 36% and 45% of patients with non-significant, mild and moderate-to-severe inflammation, respectively). CONCLUSIONS: SBCE diagnoses previously undetected lesions and it influences therapeutic management of CD, triggering an earlier introduction of immunomodulators and/or biological therapy

Lilliput

Catalog for the exhibition Lilliput held at the Seton Hall University Walsh Gallery, June 8 - July 24, 2009. Curated by Jeanne Brasile and Asha Ganpat. Includes an essay by Jeanne Brasile and Asha Ganpat. Includes color illustrations

Gentrification and the arts on Mississippi Ave.: Creating two neighborhoods and trying to make them whole

166 p. Examining committee chair: Dr. Doug BlandyGentrification is a complex process of urban development that often leads to the creation of vibrant cultural districts. While this often has a positive effect on the established arts community and on the neighborhoods economic and physical infrastructure, it also causes the displacement of the areas original residents. This research will attempt to explain how the arts fit into this process and make recommendations on how the arts can and should play a role in community revitalization without gentrification

A survey on mortality from non-variceal upper gastrointestinal bleeding: Is the emergency referral system adequate?

Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important cause of mortality and morbidity worldwide. Little information is available on the clinical management of non-variceal upper gastrointestinal bleeding in Italy in relation to the current organization of the Italian Emergency Health Services into Level-I and Level-II Emergency Departments (ED), the latter being more complex structures with greater resources

NEWLY DIAGNOSED NEOPLASIA IN CROHN DISESE PATIENTS TREATED WITH INFLIXIMAB;A 1 YEAR LONGER FOLLOW UP FROM A MULTICENTER MATCHED PAIR STUDY

1. Inflamm Bowel Dis. 2011 Mar;17(3):758-66. doi: 10.1002/ibd.21416. Cancer in Crohn's Disease patients treated with infliximab: a long-term multicenter matched pair study. Biancone L, Petruzziello C, Orlando A, Kohn A, Ardizzone S, Daperno M, Angelucci E, Castiglione F, D'Incà R, Zorzi F, Papi C, Meucci G, Riegler G, Sica G, Rizzello F, Mocciaro F, Onali S, Calabrese E, Cottone M, Pallone F. GI Unit, University, Tor Vergata, Roma. [email protected] BACKGROUND: The long-term risk of neoplasia in Crohn's disease (CD) patients treated with infliximab is undefined. The aim was to assess, in a multicenter, matched-pair study, whether infliximab use in CD is associated with an increased frequency of neoplasia in the long term. METHODS: A multicenter, long-term, matched-pair study was conducted in 12 referral inflammatory bowel disease (IBD) centers. An initial cohort of 808 CD patients, including 404 infliximab-treated (CD-IFX) and 404 matched CD controls never treated with infliximab (CD-C) studied from 1999 to 2004, was followed up for an additional 4 years (2004-2008). Cases and controls were matched for: sex, age (±5 years), CD site, follow-up (±5 years), immunosuppressant use, and CD duration (±5 years). From 1999 to 2008 the frequency and characteristics of neoplasia were compared between CD-IFX and CD-C. RESULTS: In 2008, 591 patients (304 CD-IFX, 287 CD-C) were in follow-up. Matched couples included 442 patients: 221 CD-IFX and 221 CD-C (median follow-up, months: 72, range 48-114 versus 75, range 44-114). From 1999 to 2008 the frequency of neoplasia among the 591 patients did not differ between CD-IFX (12/304; 3.94%) and CD-C (12/287; 4.19%; P = 0.95). A comparable frequency of neoplasia was also observed between the 221 matched couples (CD-IFX: 8/221; 3.61% versus CD-C: 9/221; 4.07%; P = 1). No specific histotype of cancer appeared associated with infliximab use. CONCLUSIONS: The frequency of neoplasia was comparable in an adult population of CD patients treated or not with infliximab, matched for clinical variables and followed up for a median of 6 years. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc. PMID: 20684009 [PubMed - indexed for MEDLINE