Journal of Clinical Medicine

Research

11 pages, 850 KiB

Open AccessArticle

Reporting of Magnetic Resonance Enterography in Inflammatory Bowel Disease: Results of an Italian Survey

by Cristiana Bonifacio, Arianna Dal Buono, Riccardo Levi, Roberto Gabbiadini, Christian Reca, Cristina Bezzio, Marco Francone, Alessandro Armuzzi and Luca Balzarini

J. Clin. Med. 2024, 13(13), 3953; https://doi.org/10.3390/jcm13133953 - 5 Jul 2024

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Abstract

Background/Objectives: Inflammatory bowel diseases (IBDs) are chronic disorders that require close monitoring with imaging techniques such as magnetic resonance enterography (MRE). Standardization of radiological reports is crucial for the optimal management of IBD. We surveyed Italian radiologists regarding their experiences with MRE examinations [...] Read more.

Background/Objectives: Inflammatory bowel diseases (IBDs) are chronic disorders that require close monitoring with imaging techniques such as magnetic resonance enterography (MRE). Standardization of radiological reports is crucial for the optimal management of IBD. We surveyed Italian radiologists regarding their experiences with MRE examinations and reporting for IBD. Methods: All members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited to complete an anonymous questionnaire in April 2023. Comparison tests between variables were assessed using the χ² test or Fisher exact test according to the least frequency group. Significance level was set for p-value < 0.05. Results: A total of 253 radiologists responded to the survey. Around 70% of the respondents declared personal clinical experience with IBD. Great agreement with the items included and described for both disease activity (i.e., intestinal wall thickness, presence of mucosal ulcers, presence of edema, mucous enhancement) and complications was reported. One-third of the respondents regularly used a structured MRE report. Centers with a high number of IBD patients per year (>1000) mostly used 3 T scanners or both 1.5 T and 3 T scanners (p < 0.001). The incorporation of scores of disease activity was associated with university and high-volume hospitals (p < 0.001). Conclusions: This survey highlighted the current routine practice and experience of MRE reports of IBD patients among Italian radiologists. We found deficiencies in the use of radiological scores in MRE reports and attendance at IBD multidisciplinary meetings. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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13 pages, 1679 KiB

Open AccessArticle

Low ALT Is Associated with IBD and Disease Activity: Results from a Nationwide Study

by Asher Shafrir, Lior H. Katz, Michal Shauly-Aharonov, Adar Zinger, Rifaat Safadi, Joshua Stokar and Itay Kalisky

J. Clin. Med. 2024, 13(7), 1869; https://doi.org/10.3390/jcm13071869 - 24 Mar 2024

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Abstract

Background: Sarcopenia is underdiagnosed in patients with inflammatory bowel disease (IBD). Low alanine transaminase (ALT) is associated with sarcopenia. We evaluated the association between low ALT and the presence of IBD and disease activity. Methods: Data were collected from a national [...] Read more.

Background: Sarcopenia is underdiagnosed in patients with inflammatory bowel disease (IBD). Low alanine transaminase (ALT) is associated with sarcopenia. We evaluated the association between low ALT and the presence of IBD and disease activity. Methods: Data were collected from a national Israeli health insurer cohort comprising 976,615 patients. Patients with a diagnosis of IBD were compared to healthy controls. After exclusion of patients with liver disease, ALT > 40 IU/L and age < 18, a total of 233,451 patients were included in the analysis. Low ALT was defined as <10 IU/L. Results: Low ALT was more common amongst patients with IBD than in healthy controls (7.76% vs. 5.7% p < 0.001). Low ALT was found in 148 (7.9%) of the patients with CD and 69 (6.9%) of the patients with UC. For CD, low ALT was associated with increased fecal calprotectin (FC) and CRP (223.00 μg/mg [63.45–631.50] vs. 98.50 [31.98–324.00], p < 0.001, 9.10 mg/L [3.22–19.32] vs. 3.20 [1.30–8.30], p < 0.001) and decreased albumin and hemoglobin (3.90 g/dL [3.60–4.20] vs. 4.30 [4.00–4.50], p < 0.001,12.20 g/dL [11.47–13.00] vs. 13.60 [12.60–14.70], p < 0.001). For UC, low ALT was associated with higher FC and CRP (226.50 μg/mg [143.00–537.00] vs. 107.00 [40.85–499.50], p = 0.057, 4.50 mg/L [1.90–11.62] vs. 2.30 [1.00–6.20], p < 0.001) and with lower albumin and hemoglobin (4.00 g/dL [3.62–4.18] vs. 4.30 [4.10–4.40], p < 0.001, 12.40 g/dL [11.60–13.20] vs. 13.60 [12.60–14.60], p < 0.001). These findings remained consistent following multivariate regression and in a propensity score-matched cohort. Conclusions: Low ALT is more common in patients with IBD and is associated with biochemical disease activity indices. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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13 pages, 1498 KiB

Open AccessArticle

Longitudinal Measurements of Blood Biomarkers in Patients with Crohn’s Disease or Ulcerative Colitis Treated with Infliximab: Only the Latest Values in the Induction Period Predict Treatment Failure

by Kim Oren Gradel, Bente Mertz Nørgård, Sonia Friedman, Jens Kjeldsen and Michael Due Larsen

J. Clin. Med. 2024, 13(4), 926; https://doi.org/10.3390/jcm13040926 - 6 Feb 2024

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Abstract

Background: Few studies have incorporated longitudinal assessments or used combinations of blood biomarkers as predictors of loss of response to biologic therapy for patients with Crohn’s disease (CD) or ulcerative colitis (UC). Methods: This is a population-based cohort study comprising Danish patients with [...] Read more.

Background: Few studies have incorporated longitudinal assessments or used combinations of blood biomarkers as predictors of loss of response to biologic therapy for patients with Crohn’s disease (CD) or ulcerative colitis (UC). Methods: This is a population-based cohort study comprising Danish patients with CD or UC from 2008 to 2018. We used logistic regression to analyze whether levels and changes in levels of C-reactive protein (CRP), serum albumin, and hemoglobin, routinely measured during a 14-week infliximab induction period, predicted a change to another biologic medication or cessation of biologic therapy. Results: During the induction period, 2883 (1626 CD, 1257 UC) patients had 12,730, 12,040, and 13,538 specimens with CRP, serum albumin, and hemoglobin, respectively. In all, 284 patients (9.9%) switched to another biologic medication, and 139 (4.8%) ceased biologic therapy in the follow-up period. Only the most recent CRP and hemoglobin levels predicted the efficacy of infliximab treatment at approximately 14 weeks, a time point when the clinician often determines whether to continue treatment. Conclusion: Measurement of blood biomarkers prior to the clinical assessment does not predict the effectiveness of infliximab. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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9 pages, 759 KiB

Open AccessArticle

Intensification with Intravenous Ustekinumab in Refractory Crohn’s Disease

by Cristina Suárez Ferrer, José Arroyo Argüelles, Jose Luis Rueda García, Laura García Ramírez, Eduardo Martin Arranz, María Sánchez Azofra, Joaquín Poza Cordón, Jesús Noci Belda and Maria Dolores Martin-Arranz

J. Clin. Med. 2024, 13(3), 669; https://doi.org/10.3390/jcm13030669 - 24 Jan 2024

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Abstract

Background: The rates of clinical and biochemical responses in Crohn’s disease (CD) patients treated with intravenous (IV) ustekinumab (UST) intensification are scarcely described. Methods: Patients with diagnosis of CD who were under intensified IV ustekinumab treatment (130 mg every 4 weeks) were retrospectively [...] Read more.

Background: The rates of clinical and biochemical responses in Crohn’s disease (CD) patients treated with intravenous (IV) ustekinumab (UST) intensification are scarcely described. Methods: Patients with diagnosis of CD who were under intensified IV ustekinumab treatment (130 mg every 4 weeks) were retrospectively included, evaluating the clinical and biochemical response 12 weeks after the change in treatment regimen (switch from SC to IV), as well as the serum levels of the drug. Results: Twenty-seven patients, all of whom had transitioned to intensified intravenous ustekinumab treatment due to a secondary loss of response to the drug, were included in the retrospective analysis. At the baseline visit, prior to changing IV UST, differences in levels were observed between intensified and non-intensified patients (7216 vs. 2842 ng/mL, p = 0.00005). However, no significant differences were found between these two groups 12 weeks after IV intensification (7949 vs. 7937 ng/mL; p = 0.99). In patients with previous intensified UST SC, a decrease in fecal calprotectin was observed 12 weeks after starting IV intensification, going from a mean of 1463 ug/g to 751 ug/g, although the differences were not significant (p = 0.14). Conclusion: In our experience, intensifying treatment with IV UST leads to clinical and biochemical improvements in CD patients with a secondary loss of response to SC maintenance with this drug, and an increase in drug levels was observed 12 weeks after IV UST intensification. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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9 pages, 276 KiB

Open AccessArticle

Hematological Composite Scores in Patients with Inflammatory Bowel Disease

by Marta Carrillo-Palau, Belén Vera-Santana, Andrea Morant-Domínguez, Alejandro Hernández-Camba, Laura Ramos, Inmaculada Alonso-Abreu, Noemi Hernández Álvarez-Buylla, Laura Arranz, Milagros Vela, Manuel Hernández-Guerra, Cristina Gómez-Moreno, Miguel Á. González-Gay and Iván Ferraz-Amaro

J. Clin. Med. 2023, 12(23), 7248; https://doi.org/10.3390/jcm12237248 - 23 Nov 2023

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Abstract

The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and the systemic immune-inflammatory index (SIRI, neutrophils × monocytes/lymphocytes) have been identified as potential inflammatory biomarkers. In this work we aimed to analyze whether the hematological composite scores differ between inflammatory bowel disease [...] Read more.

The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and the systemic immune-inflammatory index (SIRI, neutrophils × monocytes/lymphocytes) have been identified as potential inflammatory biomarkers. In this work we aimed to analyze whether the hematological composite scores differ between inflammatory bowel disease (IBD) patients and healthy controls, and if they are related to disease activity. A total of 197 IBD patients—130 Crohn’s (CD) disease and 67 ulcerative colitis (UC)—and 208 age- and sex-matched healthy controls were enrolled. C-reactive protein and fecal calprotectin were assessed. Multivariable linear regression analysis was executed. After adjustment, NLR and PLR, but not SIRI and MLR, were significantly higher in IBD patients compared to controls. C-reactive protein and SIRI and NLR were correlated in IBD patients. However, fecal calprotectin was not related to any of these blood scores. Furthermore, disease activity parameters were not associated with any of the blood composite scores in both CD and UC patients. In conclusion, NLR and PLR, but not SIRI and MLR, are independently higher in IBD patients compared to controls. However, the four hematological scores are not related to disease activity in either CD or UC patients. Based on these results, blood-based inflammatory scores may not serve as subrogated biomarkers of disease activity in IBD. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

0 pages, 1191 KiB

Open AccessArticle

Biomarkers for Monitoring of Changes in Disease Activity in Ulcerative Colitis

by Yoshihiro Tatsumi, Kazuki Kakimoto, Azusa Hara, Noboru Mizuta, Keijiro Numa, Naohiko Kinoshita, Kei Nakazawa, Ryoji Koshiba, Yuki Hirata, Kazuhiro Ota, Takako Miyazaki, Shiro Nakamura, Kayoko Sakagami, Shoko Arimitsu, Hiroaki Ito and Hiroki Nishikawa

J. Clin. Med. 2023, 12(22), 7165; https://doi.org/10.3390/jcm12227165 - 18 Nov 2023

Cited by 4 | Viewed by 1181 | Correction

Abstract

Background: In recent years, various biomarkers of ulcerative colitis (UC) have emerged; however, few studies have simultaneously examined the utility of multiple biomarkers for monitoring disease activity. Additionally, serum leucine-rich alpha-2 glycoprotein (LRG), a new biomarker, may show a blunt response to anti-TNF [...] Read more.

Background: In recent years, various biomarkers of ulcerative colitis (UC) have emerged; however, few studies have simultaneously examined the utility of multiple biomarkers for monitoring disease activity. Additionally, serum leucine-rich alpha-2 glycoprotein (LRG), a new biomarker, may show a blunt response to anti-TNF antibody therapy. This prospective study explored effective biomarkers that could monitor disease activity changes in patients with UC. In addition, we examined the effect of anti-TNF antibody therapy on changes in LRG. Methods: Blood and stool samples were collected twice from patients with UC: at baseline and at least 8 weeks later. Changes in serum LRG, interleukin (IL)-6, prealbumin (pre-Alb), high-sensitivity C-reactive protein (hs-CRP), CRP, and fecal calprotectin (FC) were measured and correlated with changes in disease activity. The relationship between anti-TNF antibody therapy and LRG levels was also examined in patients with the same disease activity. Results: Forty-eight patients with UC (96 samples) were analyzed. ΔLRG and ΔIL-6 correlated strongly with the change in the partial Mayo (pMayo) score between the two time points (ΔpMayo) (r = 0.686, 0.635, respectively). In contrast, FC and IL-6 were particularly accurate predictors of clinical remission, and their area under the curves (AUCs) were significantly higher than that of CRP (AUC: 0.81, 0.76 vs. 0.50; p = 0.001, 0.005). No association was found between the administration of anti-TNF antibody preparations and the LRG values. Conclusions: Correlations were found between changes in UC disease activity and LRG, IL-6, pre-Alb, hs-CRP, CRP, and FC. LRG reflects disease activity during anti-TNF antibody therapy. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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Review

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29 pages, 30890 KiB

Open AccessReview

Crohn’s Disease: Radiological Answers to Clinical Questions and Review of the Literature

by Laura Maria Minordi, Francesca Bice D’Angelo, Giuseppe Privitera, Alfredo Papa, Luigi Larosa, Lucrezia Laterza, Franco Scaldaferri, Brunella Barbaro, Luigi Carbone and Daniela Pugliese

J. Clin. Med. 2024, 13(14), 4145; https://doi.org/10.3390/jcm13144145 - 16 Jul 2024

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Abstract

Background: Crohn’s disease (CD) is a chronic, progressive inflammatory condition, involving primarily the bowel, characterized by a typical remitting–relapsing pattern. Despite endoscopy representing the reference standard for the diagnosis and assessment of disease activity, radiological imaging has a key role, providing information about [...] Read more.

Background: Crohn’s disease (CD) is a chronic, progressive inflammatory condition, involving primarily the bowel, characterized by a typical remitting–relapsing pattern. Despite endoscopy representing the reference standard for the diagnosis and assessment of disease activity, radiological imaging has a key role, providing information about mural and extra-visceral involvement. Methods: Computed Tomography and Magnetic Resonance Imaging are the most frequently used radiological techniques in clinical practice for both the diagnosis and staging of CD involving the small bowel in non-urgent settings. The contribution of imaging in the management of CD is reported on by answering the following practical questions: (1) What is the best technique for the assessment of small bowel CD? (2) Is imaging a good option to assess colonic disease? (3) Which disease pattern is present: inflammatory, fibrotic or fistulizing? (4) Is it possible to identify the presence of strictures and to discriminate inflammatory from fibrotic ones? (5) How does imaging help in defining disease extension and localization? (6) Can imaging assess disease activity? (7) Is it possible to evaluate post-operative recurrence? Results: Imaging is suitable for assessing disease activity, extension and characterizing disease patterns. CT and MRI can both answer the abovementioned questions, but MRI has a greater sensitivity and specificity for assessing disease activity and does not use ionizing radiation. Conclusions: Radiologists are essential healthcare professionals to be involved in multidisciplinary teams for the management of CD patients to obtain the necessary answers for clinically relevant questions. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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16 pages, 1211 KiB

Open AccessReview

Eosinophils, Eosinophilic Gastrointestinal Diseases, and Inflammatory Bowel Disease: A Critical Review

by Giulia Migliorisi, Elisabetta Mastrorocco, Arianna Dal Buono, Roberto Gabbiadini, Gaia Pellegatta, Paola Spaggiari, Francesca Racca, Enrico Heffler, Edoardo Vincenzo Savarino, Cristina Bezzio, Alessandro Repici and Alessandro Armuzzi

J. Clin. Med. 2024, 13(14), 4119; https://doi.org/10.3390/jcm13144119 - 14 Jul 2024

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Abstract

Background/Objectives: Inflammatory bowel disease (IBD) and eosinophilic gastrointestinal diseases (EGIDs) are complex, multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. Their epidemiology, particularly for eosinophilic esophagitis (EoE), is increasing worldwide, with a rise in the co-diagnosis of IBD and EGIDs. Both disorders share [...] Read more.

Background/Objectives: Inflammatory bowel disease (IBD) and eosinophilic gastrointestinal diseases (EGIDs) are complex, multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. Their epidemiology, particularly for eosinophilic esophagitis (EoE), is increasing worldwide, with a rise in the co-diagnosis of IBD and EGIDs. Both disorders share common risk factors, such as early exposure to antibiotics or specific dietary habits. Moreover, from a molecular perspective, eosinophilic infiltration is crucial in the diagnosis of eosinophilic disorders, and it also plays a pivotal role in IBD histological diagnosis. Indeed, recent evidence highlights the significant role of eosinophils in the health of the intestinal mucosal barrier and as mediators between innate and acquired immunity, even indicating a potential role in IBD pathogenesis. This narrative review aims to summarize the current evidence regarding the common clinical and molecular aspects of EGIDs and IBD and the current state of knowledge regarding overlap conditions and their pathogenesis. Methods: Pubmed was searched until May 2023 to assess relevant studies describing the epidemiology, pathophysiology, and therapy of EGIDs in IBD. Results: The immune pathways and mechanisms underlying both EGIDs and IBD remain partially known. An improved understanding of the role of eosinophils in overlapping conditions could lead to enhanced diagnostic precision, the development of more effective future therapeutic strategies, and a more accurate prediction of patient response. Consequently, the identification of red flags indicative of an eosinophilic disorder in IBD patients is of paramount importance and must be evaluated on a case-by-case basis. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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12 pages, 263 KiB

Open AccessReview

Role of Device-Assisted Enteroscopy in Crohn’s Disease

by Giulia Catassi, Clelia Marmo, Antonio Gasbarrini and Maria Elena Riccioni

J. Clin. Med. 2024, 13(13), 3919; https://doi.org/10.3390/jcm13133919 - 4 Jul 2024

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Abstract

Crohn’s Disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, posing diagnostic and management challenges due to its potential involvement of any segment from the mouth to the anus. Device-assisted enteroscopy (DAE) has emerged as a significant advancement in the management [...] Read more.

Crohn’s Disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, posing diagnostic and management challenges due to its potential involvement of any segment from the mouth to the anus. Device-assisted enteroscopy (DAE) has emerged as a significant advancement in the management of CD, particularly for its ability to access the small intestine—a region difficult to evaluate with conventional endoscopic methods. This review discusses the pivotal role of DAE in the nuanced management of CD, emphasizing its enhanced diagnostic precision and therapeutic efficacy. DAE techniques, including double-balloon enteroscopy (DBE), single-balloon enteroscopy (SBE), and the now-withdrawn spiral enteroscopy, enable comprehensive mucosal assessment, targeted biopsies, and therapeutic interventions like stricture dilation, bleeding control, and foreign body removal. Despite its benefits, DAE carries risks such as perforation, bleeding, and pancreatitis, which require careful procedural planning and a skilled execution. The review highlights DAE’s impact on reducing surgical interventions and improving patient outcomes through minimally invasive approaches, thereby enhancing the quality of life for patients with CD. Continuous improvement and research are essential in order to maximize DAE’s utility and safety in clinical practice. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

Other

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11 pages, 2334 KiB

Open AccessSystematic Review

Small Intestinal Contrast Ultrasonography (SICUS) in Crohn’s Disease: Systematic Review and Meta-Analysis

by Giuseppe Losurdo, Margherita De Bellis, Raffaella Rima, Chiara Maria Palmisano, Paola Dell’Aquila, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo and Mariabeatrice Principi

J. Clin. Med. 2023, 12(24), 7714; https://doi.org/10.3390/jcm12247714 - 15 Dec 2023

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Abstract

The diagnosis of Crohn’s Disease (CD) is based on a combination of clinical symptoms, laboratory tests, endoscopy, and imaging data. In Small Intestine Contrast Ultrasonography (SICUS), the ingestion of a macrogol solution as an oral contrast medium may optimize image quality. We performed [...] Read more.

The diagnosis of Crohn’s Disease (CD) is based on a combination of clinical symptoms, laboratory tests, endoscopy, and imaging data. In Small Intestine Contrast Ultrasonography (SICUS), the ingestion of a macrogol solution as an oral contrast medium may optimize image quality. We performed a meta-analysis to evaluate the diagnostic performance of SICUS for CD. A literature search was performed in August 2023. We selected only studies where SICUS was compared to a technique that allows the assessment of the whole gastrointestinal tract, such as an MRE, a CT scan, or a surgical evaluation. We estimated pooled weighted sensitivity, specificity, and likelihood ratio for positive and negative tests (PLR/NLR) of SICUS. Summary receiver operating characteristic curves (SROC) were drawn, and pooled areas under the curve (AUC) were calculated. Five studies with 325 CD patients were included. SICUS showed a pooled sensitivity for the diagnosis of 95% (95% confidence interval CI 89–99%), a specificity = 77% (95% CI 60–90%), and the AUC was 0.94. SICUS demonstrated a pooled sensitivity for strictures of 78% (95% CI 63–88%) and a specificity = 96% (95% CI 85–99%), with AUC = 0.93. For abscesses, SICUS demonstrated a pooled sensitivity of 100% (95% CI 59–100%) and a specificity of 90% (95% CI 74–98%). Fistulae were detected with a pooled sensitivity of 77% (95% CI 46–95%) and a specificity of 92% (95% CI 75–99%). SICUS demonstrated excellent diagnostic performance compared to the gold standard despite some clinical scenarios (stenosis/fistulae) showing suboptimal diagnostic effectiveness. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

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