クローン病における非アルコール性脂肪性肝疾患合併の臨床的重要性 : コリン欠乏がマウス実験腸炎に及ぼす影響に関する基礎的検討を含めて 1.クローン病におけるNAFLD合併の臨床的意義に関する検討 2.コリン欠乏がマウス実験腸炎に及ぼす影響に関する検討

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Milan Ultrasound Criteria predict relapse of ulcerative colitis in remission

Introduction Bowel ultrasound is a non-invasive alternative to endoscopy for assessing the disease activity of ulcerative colitis; however, it is unclear whether bowel ultrasound can predict subsequent relapse from remission. Materials and Methods A retrospective cohort study enrolled patients with ulcerative colitis who underwent bowel ultrasound between July 2018 and July 2021 during clinical remission (patient-reported outcome-2 ≤ 1 and no rectal bleeding) for at least 3 months and were followed up for 1 year. Ultrasonographic findings (bowel wall thickness, bowel wall flow, bowel wall stratification, and enlarged lymph nodes), Milan Ultrasound Criteria, Mayo endoscopic subscore, C-reactive protein, and fecal calprotectin levels and their association with subsequent clinical relapse were assessed. Relapse was defined as rectal bleeding score ≥ 1, stool frequency score ≥ 2, or treatment intensification for symptoms. Results 31% of the patients (18/58) relapsed within 1 year. No single ultrasonographic finding predicted relapse, whereas Milan Ultrasound Criteria > 6.2 (p = 0.019), Mayo endoscopic subscore ≥ 1 (p = 0.013), and fecal calprotectin ≥ 250 μg/g (p = 0.040) were associated with a shorter time to relapse in the log-rank test. Milan Ultrasound Criteria > 6.2 (hazard ratio 3.22; 95% confidence interval 1.14-9.08, p = 0.027) and Mayo endoscopic subscore ≥ 1 (hazard ratio 8.70; 95% confidence interval 1.11-68.1, p = 0.039) showed a higher risk of relapse according to a Cox proportional hazards model. Discussion/Conclusion Bowel ultrasound can predict subsequent clinical relapse from remission in patients with ulcerative colitis using the Milan Ultrasound Criteria

Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease.

Background/aimsThe small bowel is affected in more than half of patients with Crohn's disease (CD) at the time of diagnosis, and small bowel involvement has a negative impact on the long-term outcome. Many patients reportedly have active lesions in the small intestine even in patients in clinical remission. This study was performed to compare findings of magnetic resonance enterography (MRE) and ileocolonoscopy.MethodsA single-center retrospective study was conducted in 50 patients (60 imaging series) with CD, for whom MRE was additionally performed during the bowel preparation for subsequent ileocolonoscopy. Endoscopic remission was defined as a Simple Endoscopic Score for CD (SES-CD) of ResultsImportantly, 7 of 29 patients (24.1%) with endoscopic remission had a MaRIA score of ≥50. Both SES-CD and MaRIA correlated with the need for treatment escalation (P = 0.025, P = 0.009, respectively). MRE predicted the need for treatment escalation even in patients with endoscopic remission. Although no correlation was present between SES-CD and MaRIA score in patients with structuring/penetrating disease, or insufficient ileal insertion (ConclusionsThe MaRIA score predicts the need for treatment escalation even in patients with endoscopic remission, indicating that addition of MRE to conventional ileocolonoscopy alone can be a useful, noninvasive tool for monitoring CD especially in stricturing or penetrating disease

Two Cases of Severe Ulcerative Colitis with Colonic Dilatation Resolved with Tacrolimus Therapy

We report 2 cases of ulcerative colitis (UC) with intestinal tract dilatation treated with tacrolimus. They were 53- and 64-year-old males, who had been admitted to local hospitals for increasing severity of their UC symptoms. Treatment for severe UC was immediately started, but both cases were refractory to corticosteroid therapy; they were then transferred to our hospital. When they were referred to our hospital, they had frequent bloody diarrhea, fever, severe abdominal pain, and even dilatation of the transverse colon on abdominal X-ray test. They were treated with oral tacrolimus medication, and their symptoms improved immediately. Dilatation of the transverse colon was improved on plain X-ray at 2 weeks after starting therapy, and emergency colectomy could be avoided. These 2 cases may suggest that tacrolimus is effective for UC with colonic dilatation as a rescue therapy

Role of artificial intelligence in imaging and endoscopy for the diagnosis, monitoring and prognostication of inflammatory bowel disease: a scoping review protocol

Introduction Inflammatory bowel diseases (IBD) are immune-mediated conditions that are increasing in incidence and prevalence worldwide. Their assessment and monitoring are becoming increasingly important, though complex. The best disease control is achieved through tight monitoring of objective inflammatory parameters (such as serum and stool inflammatory markers), cross-sectional imaging and endoscopic assessment. Considering the complexity of the information obtained throughout a patient’s journey, artificial intelligence (AI) provides an ideal adjunct to existing tools to help diagnose, monitor and predict the course of disease of patients with IBD. Therefore, we propose a scoping review assessing AI’s role in diagnosis, monitoring and prognostication tools in patients with IBD. We aim to detect gaps in the literature and address them in future research endeavours.Methods and analysis We will search electronic databases, including Medline, Embase, Cochrane CENTRAL, CINAHL Complete, Web of Science and IEEE Xplore. Two reviewers will independently screen the abstracts and titles first and then perform the full-text review. A third reviewer will resolve any conflict. We will include both observational studies and clinical trials. Study characteristics will be extracted using a data extraction form. The extracted data will be summarised in a tabular format, following the imaging modality theme and the study outcome assessed. The results will have an accompanying narrative review.Ethics and dissemination Considering the nature of the project, ethical review by an institutional review board is not required. The data will be presented at academic conferences, and the final product will be published in a peer-reviewed journal

Choline Deficiency Causes Colonic Type II Natural Killer T (NKT) Cell Loss and Alleviates Murine Colitis under Type I NKT Cell Deficiency

<div><p>Serum levels of choline and its derivatives are lower in patients with inflammatory bowel disease (IBD) than in healthy individuals. However, the effect of choline deficiency on the severity of colitis has not been investigated. In the present study, we investigated the role of choline deficiency in dextran sulfate sodium (DSS)-induced colitis in mice. Methionine-choline-deficient (MCD) diet lowered the levels of type II natural killer T (NKT) cells in the colonic lamina propria, peritoneal cavity, and mesenteric lymph nodes, and increased the levels of type II NKT cells in the livers of wild-type B6 mice compared with that in mice fed a control (CTR) diet. The gene expression pattern of the chemokine receptor CXCR6, which promotes NKT cell accumulation, varied between colon and liver in a manner dependent on the changes in the type II NKT cell levels. To examine the role of type II NKT cells in colitis under choline-deficient conditions, we assessed the severity of DSS-induced colitis in type I NKT cell-deficient (Jα18^-/-) or type I and type II NKT cell-deficient (CD1d^-/-) mice fed the MCD or CTR diets. The MCD diet led to amelioration of inflammation, decreases in interferon (IFN)-γ and interleukin (IL)-4 secretion, and a decrease in the number of IFN-γ and IL-4-producing NKT cells in Jα18^-/- mice but not in CD1d^-/- mice. Finally, adaptive transfer of lymphocytes with type II NKT cells exacerbated DSS-induced colitis in Jα18^-/- mice with MCD diet. These results suggest that choline deficiency causes proinflammatory type II NKT cell loss and alleviates DSS-induced colitis. Thus, inflammation in DSS-induced colitis under choline deficiency is caused by type II NKT cell-dependent mechanisms, including decreased type II NKT cell and proinflammatory cytokine levels.</p></div

Adaptive transfer of Jα18-CTR lamina propria cells, but not CD1d-CTR lamina propria cells, restored colonic inflammation in DSS-induced colitis.

<p>(A) Experimental setup. (B) Disease activity index (DAI) scores of colons of DSS-treated Jα18^-/- and CD1d^-/- mice fed the MCD or CTR diets, and transferred with lamina propria cells from Jα18^-/- and CD1d^-/- mice. <i>N</i> = 4, *<i>P</i> < 0.05, Student’s <i>t</i>-test. (C) Histological examination (H & E staining) and (D) histological scores of the colons of Jα18^-/- and CD1d^-/- mice fed the MCD or CTR diets 7 days after 2.0% DSS treatment. Original magnification × 100. All data are presented as means ± SE. <i>N</i> = 4, *<i>P</i> < 0.05, Student’s <i>t</i>-test.</p

MCD diet reduces proinflammatory cytokine levels and the number of type II NKT cells in type I NKT cell-deficient mice.

<p>(A) Experimental setup. (B) IFN-γ, (C) IL-4, and (D) IL-10 production by colonic lamina propria mononuclear cells following treatment with 100 ng/mL lipopolysaccharide (LPS) at 24 h, as analyzed by ELISA. <i>N</i> = 4, *<i>P</i> < 0.05, Student’s <i>t</i>-test. (E) Three subsets of colonic lamina propria cells separated using NK1.1 and CD3. <i>Ex vivo</i> intracellular IL-4 and IFN-γ production stimulated by LPS (1 μg/mL) or phorbol myristate acetate (PMA) + ionomycin for 5 h in NKT cells in the lamina propria in MCD vs. CTR diet-fed mice.</p