What is the place of complementary and alternative therapies in the management of inflammatory bowel disease?

Les patients atteints de maladies inflammatoires chroniques intestinales (MICI) sont classés parmi les plus grands consommateurs de thérapies complémentaires et alternatives. En effet, les MICI impactent fortement la qualité de vie des patients du fait de leur caractère chronique et de la limite des traitements et de la réticence des patients pour les médicaments actuellement disponibles. Les thérapies complémentaires et alternatives deviennent actuellement très populaires y compris dans les pays occidentaux. L'objectif de cette mise au point est de développer les principales thérapies complémentaires, leur mécanisme d'action ainsi que l'evidence-based-medicine disponibles pour chacune d'entre elles tout en ayant conscience de la nécessité de faire appel aux sciences humaines pour leur évaluation.Patients with inflammatory bowel disease (IBD) are among the largest consumers of complementary and alternative therapies. IBD have a strong impact on patients' quality of life because of their chronic nature and the limitations and the reluctance of patients for the drugs currently available. Complementary and alternative medicines (CAMs) are currently becoming very popular, including in Western countries. The aim of this review is to develop main CAMs, their mechanism of action as well as the evidence-based-medicine available for each of them

Patient and Public Involvement in Research:Lessons for Inflammatory Bowel Disease

Participatory research, also referred to as patient and public involvement, is an approach that involves collaborating with patients affected by the focus of the research, on the design, development and delivery of research to improve outcomes. There are two broad justifications for this: first, that it enhances the quality and relevance of research, and second, that it satisfies the ethical argument for patient inclusion in decisions about them. This synergistic and collaborative effort, which bridges the divide between researchers and participants with the lived condition, is now a mainstream activity and widely accepted as best practice. Although there has been a substantial increase in the literature over the past two decades, little has been published on how participatory research has been used in inflammatory bowel disease [IBD] research and little guidance as to how researchers should go about this. With an increasing incidence and prevalence worldwide, combined with declining study enrolment in an era of perennial unmet need, there are a multitude of benefits of participatory research to IBD patients and investigators, including research output that is informed and relevant to the real world. A key example of participatory research in IBD is the I-CARE study, a large-scale, pan-European observational study assessing the safety of advanced therapies, which had significant patient involvement throughout the study. In this review, we provide a comprehensive overview of the benefits and challenges of participatory research and discuss opportunities of building strategic alliances between IBD patients, healthcare providers and academics to strengthen research outcomes.</p

JAK or GUT Selectivity: Tipping the Balance for Efficacy and Safety in Ulcerative Colitis.

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Looking for Innovative Digital Solutions to Optimize Patient Recruitment in Inflammatory Bowel Disease Trials.

peer reviewe

Physiopathologie des maladies inflammatoires chroniques de l’intestin (MICI)

Les maladies inflammatoires chroniques de l’intestin (MICI) sont des pathologies multifactorielles complexes d’étiologie inconnue. Différentes mutations génétiques, l’exposition à des facteurs environnementaux ou une perte d’homéostasie du microbiote intestinal sont impliqués en proportions variables dans la perte de la fonction de barrière de la muqueuse, son invasion par les microorganismes intestinaux et finalement, le déclenchement d’une réponse inflammatoire excessive et chronique provoquant les lésions caractéristiques de ces pathologies. Différents composants du système immunitaire muqueux comme les cellules épithéliales intestinales, les cellules du système immunitaire inné et adaptatif et les médiateurs de l’inflammation sont impliqués dans la pathogenèse des MICI. D’autres mécanismes cellulaires comme des carences nutritionnelles, l’immuno-récepteur TREM-1 ainsi que l’autophagie amplifient l’inflammation intestinale et accentuent la sévérité de ces pathologies. Cette revue présente les différents mécanismes impliqués dans la physiopathologie des MICI en comparant les muqueuses intestinales saines et pathologiques.Inflammatory bowel disease (IBD) is a complex multifactorial pathology of unknown etiology. Different genetic mutations, exposition of environmental factors or the loss of intestinal microbiota homeostasis are contribute to the loss of intestinal mucosal barrier function, its invasion by intestinal microorganims and finally the activation of excessive and chronic inflammatory response, which induce the typical lesions found in these pathologies. Various components of the mucosal immune system such as intestinal epithelial cells, cells of the innate and adaptive immune system and the mediators of inflammation are involved in the pathogenesis of IBD. Other cellular mechanisms as nutritional deficiencies, TREM-1 immunoreceptor and autophagy amplify the intestinal inflammation and increase the severity of these pathologies. In this review, the different mechanisms involved in the pathophysiology of IBD will be presented by comparing healthy and pathological intestinal mucosa

Intravenous Versus Oral Iron for the Treatment of Anemia in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Anemia is the most prevalent extraintestinal complication of inflammatory bowel disease (IBD). Our aim was to evaluate the comparative efficacy and harm of intravenous (IV) versus oral iron supplementation for correcting anemia in adult IBD patients. We conducted a systematic review and meta-analysis to integrate evidence from randomized controlled trials having enrolled adults with IBD, and comparing IV versus oral iron (head-to-head) for correcting iron-deficiency anemia. Medline, Embase, Scopus, and the Web of Science database were searched through July 2015. The Cochrane Central Register of Controlled Trials, the WHO International Clinical Trials Registry Platform, the ClinicalTrials.gov, and international conference proceedings were also investigated. Two reviewers independently abstracted study data and outcomes, and rated each trial's risk-of-bias. Pooled odds ratio (OR) estimates with their 95% CIs were calculated using fixed- and random-effects models. Five eligible studies, including 694 IBD patients, were identified. In meta-analysis, IV iron demonstrated a higher efficacy in achieving a hemoglobin rise of ≥2.0 g/dL as compared to oral iron (OR: 1.57, 95% CI: 1.13, 2.18). Treatment discontinuation rates, due to adverse events or intolerance, were lower in the IV iron groups (OR: 0.27, 95% CI: 0.13, 0.59). Similarly, the occurrence of gastrointestinal adverse events was consistently lower in the IV iron groups. On the contrary, serious adverse events (SAEs) were more frequently reported among patients receiving IV iron preparations (OR: 4.57, 95% CI: 1.11, 18.8); however, the majority of the reported SAEs were judged as unrelated or unlikely to be related to the study medication. We found no evidence of publication bias, or between-study heterogeneity, across all analyses. Risk of bias was high across primary studies, because patients and personnel were not blinded to the intervention. IV iron appears to be more effective and better tolerated than oral iron for the treatment of IBD-associated anemia

anti tnf biosimilars in crohn s disease a patient centric interdisciplinary approach

ABSTRACTIntroduction: The purpose of this review is to highlight the role of biosimilars in early treatment in IBD and introduce ways to facilitate a patient-centric switching process through multi..

Defining biological remission in Crohn's disease: interest, challenges and future directions.

peer reviewedIn Crohn's disease, the treat-to-target strategy has been highly encouraged and became a standard of care. In this context, defining the target (remission) constitutes a major stake which fuels the literature. Currently, clinical remission (symptoms control) is no longer the only objective of treatments since it does not allow to well control inflammation-induced tissue damage. The introduction of endoscopic remission as a therapeutic target was clearly a progress but this examination remains invasive, costly, not well accepted by patients and does not allow a tight control of disease activity. More fundamentally, morphological techniques (eg, endoscopy, histology, ultrasonography) are limited since they do not evaluate the biological activity of the disease but only its consequences. Besides, emerging evidence suggest that biological signs of disease activity could better guide treatment decisions than clinical parameters. In this context, we stress the necessity to define a novel treatment target: biological remission. Based on our previous work, we propose a conceptual definition of biological remission which goes beyond the classical normalisation of inflammatory markers (C-reactive protein and faecal calprotectin): absence of biological signs associated with the risk of short-term relapse and mid/long-term relapse. The risk of short-term relapse seems essentially characterised by a persistent inflammatory state while the risk of mid/long-term relapse implicates a more heterogeneous biology. We discuss the interest of our proposal (guiding treatment maintenance, escalation or de-escalation) but also the fact that its clinical implementation would require overcoming major challenges. Finally, future directions are proposed to better define biological remission