Epidemiology, Disease Spectrum and Burden of Inflammatory Bowel Disease

Background: Ulcerative colitis (UC) and Crohn’s Disease (CD) are the two main manifestations of inflammatory bowel disease (IBD). Recently, incidence and prevalence rates of IBD have changed rapidly throughout the world. The most recent incidence rates from the Netherlands, date back to 1991-1995. Prevalence rates on IBD in The Netherlands have never been published. Aim: Firstly, to update incidence and prevalence rates of UC, CD and inflammatory bowel disease, type unclassified (IBD-U) in the adherence area of a large community hospital in central Netherlands in a prospective and population-based fashion. Secondly, to determine disease phenotypes and disease burden in a well-defined population. Methods: Several sources were scrutinized for case finding. IBD was diagnosed according to the criteria of Lennard-Jones. According to the ECCO criteria, cases were grouped into those with CD, UC or IBD-U. Distribution of phenotypes was made according to the Montreal classification. Data on disease burden and other clinical characteristics were registered. Results: In a population of 85,604, the incidence of UC was 14.3/100,000 per year, for CD 8.0/100,000 per year, and for IBD-U 3.3/100,000 per year. Ultimo 2009, age-sex adjusted point prevalence for UC was 160.0, for CD 134.3, and for IBD-U 39.7 per 100,000. Ulcerative proctitis was seen in 8% of male and 24% of female UC patients. Left sided colitis was seen in 46% (male) and 47% (female) of UC patients. Pancolitis occurred in 45% of male and 28% of female patients. 25% of UC patients had mild, 74% moderate and 1% severe disease. CD was located in 31% of patients in terminal ileum, in 34% in colon and in 33% in ileocolon. In 7% of CD patients sole or additional involvement of the upper gastrointestinal tract occurred. Behaviour of CD was non-stricturing, non-penetrating in 49%, stricturing but non-penetrating in 26% and penetrating in 26%. Extraintestinal manifestations (EIM) occurred in equal numbers of CD and UC patients. More CD than UC patients were ever treated with a steroid course, thiopurines, methotrexate, and anti-TNF agents. More CD than UC patients ever used a systemically administered steroid > 1 year, underwent a bowel resection, and were admitted to hospital. CD patients used more steroid courses than UC patients and were more often admitted to hospital. 36% of CD patients and 40% of UC patients were currently employed. 23% of CD and 6% of UC patients were, as a result of their disease, disabled or on invalidity benefit (P = 0.020). Conclusion: Incidence rates of both UC and CD have increased in The Netherlands. In a community hospital setting, CD patients have higher disease burden than UC patients in terms of hospital admissions, profound medical and surgical therapy, and occupational disability. This Dutch study is the first reporting on prevalence rates of IBD in The Netherlands, setting a basis for further epidemiological IBD studies. It also provides an inception cohort for further studies on risk factors in IBD.

Heterogeneity in Clinical, Endoscopic, and Histologic Outcome Measures and Placebo Response Rates in Clinical Trials of Eosinophilic Esophagitis: A Systematic Review.

Agents are being developed for treatment of eosinophilic esophagitis (EoE). However, it is not clear what outcome measures would best determine the efficacy and safety of these agents in clinical trials. We performed a systematic review of outcomes used in randomized placebo-controlled trials of EoE and we estimate the placebo response and rates of remission. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and the EU Clinical Trials Register from inception through February 20, 2018 for randomized controlled trials of pharmacologic therapies for EoE. Efficacy outcome definitions, measurement tools, and the proportion of patients responding to placebo were collected and stratified by based on histologic, endoscopic, and patient-reported outcomes. We analyzed data from 22 placebo-controlled trials, comprising 1112 patients with EoE. Ten additional active registered trials were identified. Most published trials evaluated topical corticosteroid therapy (13/22, 59.1%). Histologic outcomes measuring eosinophil density and patient-reported outcomes were reported in 21/22 published trials (95.5%). No consistently applied definitions of histologic or patient-reported response or remission were identified. Endoscopic outcomes were described in 60% (12/20) of published trials. The EoE Endoscopic Reference Score is the most commonly applied tool for describing changes in endoscopic appearance. The median histologic response to placebo was 3.7% (range, 0%-31.6%) and the median rate of remission in patients given placebo was 0.0% (range, 0%-11.0%). The median patient-reported response to placebo was 14.4% (range, 8.6%-77.8%) and rate of remission in patients given placebo was 26.2% (range, 13.2%-35.7%). In a systematic review of the literature, we found that no standardized definitions of histologic, endoscopic, or patient-reported outcomes are used to determine whether pharmacologic agents produce a response or remission in patients with EoE. A core outcome set is needed to reduce heterogeneity in outcome reporting and facilitate trial interpretation and comparison of results from trials

Arbuscular mycorrhizal networks: process and functions. A review

International audienceAn unprecedented, rapid change in environmental conditions is being observed, which invariably overrules the adaptive capacity of land plants. These environmental changes mainly originate from anthropogenic activities, which have aggravated air and soil pollution, acid precipitation, soil degradation, salinity, contamination of natural and agro-ecosystems with heavy metals such as cadmium (Cd), lead (Pb), mercury (Hg), arsenic (As), global climate change, etc. The restoration of degraded natural habitats using sustainable, low-input cropping systems with the aim of maximizing yields of crop plants is the need of the hour. Thus, incorporation of the natural roles of beneficial microorganisms in maintaining soil fertility and plant productivity is gaining importance and may be an important approach. Symbiotic association of the majority of crop plants with arbuscular mycorrhizal (AM) fungi plays a central role in many microbiological and ecological processes. In mycorrhizal associations, the fungal partner assists its plant host in phosphorus (P) and nitrogen (N) uptake and also some of the relatively immobile trace elements such as zinc (Zn), copper (Cu) and iron (Fe). AM fungi also benefit plants by increasing water uptake, plant resistance and biocontrol of phytopathogens, adaptation to a variety of environmental stresses such as drought, heat, salinity, heavy metal contamination, production of growth hormones and certain enzymes, and even in the uptake of radioactive elements. The establishment of symbiotic association usually involves mutual recognition and a high degree of coordination at the morphological and physiological level, which requires a continuous cellular and molecular dialogue between both the partners. This has led to the identification of the genes, signal transduction pathways and the chemical structures of components relevant to symbiosis; however, scientific knowledge on the physiology and function of these fungi is still limited. This review unfolds our current knowledge on signals and mechanisms in the development of AM symbiosis; the molecular basis of nutrient exchange between AM fungi and host plants; and the role of AM fungi in water uptake, disease protection, alleviation of various abiotic soil stresses and increasing grain production