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Clinical Advances in Inflammatory Bowel Disease
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Clinical Advances in Inflammatory Bowel Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (1 July 2024) | Viewed by 13690

Special Issue Editor

Dr. Lorenzo Bertani

E-Mail Website
Guest Editor
Department of General Surgery and Gastroenterology, Tuscany Northwest ASL—Pontedera Hospital, 56025 Pontedera, Italy
Interests: inflammatory bowel diseases; biomarkers; clinical gastroenterology; translational medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The incidence of inflammatory bowel diseases (IBD) has significantly increased in the last decades. This has led to an ever-greater impact of these diseases on society since the vast majority of patients with IBD are of working age. Fortunately, in recent years, several different drugs with different mechanisms of action have been approved or are about to be approved for clinical practice. Therefore, clinicians involved in IBD management will have an increased therapeutic armamentarium, and the effectiveness of these drugs could be demonstrated in real-world clinical practice in the near future. Furthermore, IBD research should focus on the important issue of the choice of the right drug for the right patient, which could significantly reduce the healthcare expenditure, maximizing therapeutic response rates. This Special Issue of JCM could be an important option to publish studies addressing these points, which may have a significant impact on the clinical management of IBD in the near future.

Dr. Lorenzo Bertani
Guest Editor

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Keywords

  • inflammatory bowel diseases
  • IBD
  • Crohn’s disease
  • ulcerative colitis
  • biomarkers
  • biologics
  • anti-JAKs
  • personalized medicine

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Published Papers (7 papers)

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Research

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11 pages, 264 KiB  
Article
Inflammatory Bowel Diseases in the Elderly: A Focus on Disease Characteristics and Biological Therapy Patterns
by Renata Talar-Wojnarowska, Miłosz Caban, Marta Jastrzębska, Małgorzata Woźniak, Aleksandra Strigáč and Ewa Małecka-Wojciesko
J. Clin. Med. 2024, 13(10), 2767; https://doi.org/10.3390/jcm13102767 - 8 May 2024
Cited by 2 | Viewed by 1136
Abstract
Background: The incidence of inflammatory bowel diseases (IBDs) in elderly patients is constantly increasing. It results from the combination of an aging population with compounding prevalence of IBD, as well as the growing burden of elderly-onset IBD. The clinical characteristics of elderly [...] Read more.
Background: The incidence of inflammatory bowel diseases (IBDs) in elderly patients is constantly increasing. It results from the combination of an aging population with compounding prevalence of IBD, as well as the growing burden of elderly-onset IBD. The clinical characteristics of elderly patients differ from young subjects with IBD due to the multimorbidity or polypharmacy, affecting the choice of adequate therapeutic options. The aim of this study was to determine the clinical aspects and biological therapy safety in elderly Polish IBD patients. Methods: We conducted a retrospective study aimed at describing the demographic, clinical, and management characteristics of IBD patients treated with a biological therapy in two referral centers within the National Drug Program in Poland. Results: Out of the entire group of 366 studied patients, 51 (13.9%) were aged over 60—32 with ulcerative colitis (UC) and 19 with Crohn’s disease (CD). The disease location was predominantly ileocolonic (57.89%) in patients with CD and pancolitis for patients with UC (56.25%). Most of the elderly IBD subjects were characterized by significant comorbidities, with Charlson Comorbidity Index (CCI) ≥ 1 in 66.67% patients. The probability of stopping biological therapy due to adverse events had the tendency to be higher in the CCI ≥ 1 group (20.58% vs. 5.88% in CCI = 0; p = 0.087). The main reasons for the therapy discontinuation included hypersensitivity reactions and liver enzyme abnormalities. Conclusions: In conclusion, our results underline the importance of assessing the comorbidity status instead of the age prior to initiating biological therapy, analyzing additional safety risks, and close monitoring in IBD patients with multiple comorbidities. Full article
(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)
14 pages, 307 KiB  
Article
Role of Serum Interleukin-6, Interleukin-1β and Interleukin-10 in Assessment of Disease Activity and Nutritional Status in Patients with Inflammatory Bowel Disease
by Małgorzata Godala, Ewelina Gaszyńska, Konrad Walczak and Ewa Małecka-Wojciesko
J. Clin. Med. 2023, 12(18), 5956; https://doi.org/10.3390/jcm12185956 - 13 Sep 2023
Cited by 1 | Viewed by 1367
Abstract
Inflammatory bowel diseases (IBD) are characterised by multifactorial and chronic inflammation. Much attention has been paid to immune dysfunction in inflammatory bowel diseases. The aim of this study was to assess the usefulness of serum IL-6, IL-1β and IL-10 in determining the activity [...] Read more.
Inflammatory bowel diseases (IBD) are characterised by multifactorial and chronic inflammation. Much attention has been paid to immune dysfunction in inflammatory bowel diseases. The aim of this study was to assess the usefulness of serum IL-6, IL-1β and IL-10 in determining the activity and nutritional status in IBD patients. The case–control study was carried out on 82 patients with IBD; the control group consisted of 25 clinically healthy subjects. The serum concentrations of IL-6, IL-1 β and IL-10 were determined by the quantitative sandwich enzyme-linked immunosorbent assay. There were no significant differences in IL-6 and IL-1β levels in UC and CD patients according to disease activity as assessed by the Montreal classification, Partial Mayo Score and CDAI. Significantly higher IL-6 levels were found in patients with low body fat in comparison to patients with normal body fat. Furthermore, significantly higher mean IL-6 levels were observed in patients with excess body fat in comparison to patients with normal body fat, and also in comparison to patients with deficient body fat. IL-6 and IL-1β may provide extra information regarding the nutritional status of IBD patients. IL-10 can be considered a non-invasive biomarker of IBD activity. Full article
(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)
19 pages, 1857 KiB  
Article
Benefits of Paediatric to Adult Transition Programme in Inflammatory Bowel Disease: The BUTTERFLY Study of GETECCU and SEGHNP
by Cristina Rubín de Célix, Javier Martín-de-Carpi, Gemma Pujol-Muncunill, Laura María Palomino, Marta Velasco Rodríguez-Belvís, Rafael Martín-Masot, Víctor Manuel Navas-López, Elena Ricart, María José Casanova, Alejandro Rodríguez-Martínez, Eduardo Leo-Carnerero, Alba Alcaraz, Miriam Mañosa, Vicent Hernández, María Consuelo Cobelas Cobelas, César Sánchez, Luis Menchén, Francisco Mesonero, Manuel Barreiro-De Acosta, Nazareth Martinón-Torres, Coral Tejido Sandoval, Alicia Rendo Vázquez, Pilar Corsino, Raquel Vicente, Alejandro Hernández-Camba, José Ramón Alberto Alonso, I. Alonso-Abreu, Ana María Castro Millán, Laia Peries Reverter, Beatriz Castro, Estela Fernández-Salgado, M. Mercedes Busto Cuiñas, José Manuel Benítez, Lucía Madero, Fernando Clemente, Sabino Riestra, Santiago Jiménez-Treviño, Maia Boscá-Watts, Elena Crehuá-Gaudiza, Marta Calvo Moya, José María Huguet, Ester-María Largo-Blanco, Leticia González Vives, Rocío Plaza, Iván Guerra, Josefa Barrio, Laura Escartín, Erika Alfambra, Noelia Cruz, M. Carmen Muñoz, María Guadalupe Muñoz Pino, Manuel Van Domselaar, Belén Botella, David Monfort Miquel, M. Carmen Rodríguez Grau, Agustín De La Mano, Yolanda Ber, María Calvo Iñiguez, Teresa de Jesús Martínez-Pérez, María Chaparro and Javier P. Gisbertadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(14), 4813; https://doi.org/10.3390/jcm12144813 - 21 Jul 2023
Cited by 4 | Viewed by 1855
Abstract
(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. [...] Read more.
(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. (2) Methods: Multicentre, retrospective and observational study of IBD paediatric patients transferred to an adult IBD unit between 2017–2020. Two groups were compared: transition (≥1 joint visit involving the gastroenterologist, the paediatrician, a programme coordinator, the parents and the patient) and no-transition. Outcomes within one year after transfer were analysed. The main variable was poor clinical outcome (IBD flare, hospitalisation, surgery or any change in the treatment because of a flare). Predictive factors of poor clinical outcome were identified with multivariable analysis. (3) Results: A total of 278 patients from 34 Spanish hospitals were included. One hundred eighty-five patients (67%) from twenty-two hospitals (65%) performed a structured transition. Eighty-nine patients had poor clinical outcome at one year after transfer: 27% in the transition and 43% in the no-transition group (p = 0.005). One year after transfer, no-transition patients were more likely to have a flare (36% vs. 22%; p = 0.018) and reported more hospitalisations (10% vs. 3%; p = 0.025). The lack of transition, as well as parameters at transfer, including IBD activity, body mass index < 18.5 and corticosteroid treatment, were associated with poor clinical outcome. One patient in the transition group (0.4%) was lost to follow-up. (4) Conclusion: Transition care programmes improve patients’ outcomes after the transfer from paediatric to adult IBD units. Active IBD at transfer impairs outcomes. Full article
(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)
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9 pages, 1058 KiB  
Article
Development of Antibodies to Ustekinumab Is Associated with Loss of Response in Patients with Inflammatory Bowel Disease
by Xavier Roblin, Gérard Duru, Konstantinos Papamichael, Adam S. Cheifetz, Sandy Kwiatek, Anne-Emmanuelle Berger, Mathilde Barrau, Louis Waeckel, Stephane Nancey and Stephane Paul
J. Clin. Med. 2023, 12(10), 3395; https://doi.org/10.3390/jcm12103395 - 10 May 2023
Cited by 4 | Viewed by 2145
Abstract
Monitoring of anti-drug antibodies in patients on ustekinumab is not routinely recommended in patients with inflammatory bowel disease (IBD) due to low rates of immunogenicity. Aim of study: The purpose of this study was to investigate the relationship between anti-drug antibodies detected by [...] Read more.
Monitoring of anti-drug antibodies in patients on ustekinumab is not routinely recommended in patients with inflammatory bowel disease (IBD) due to low rates of immunogenicity. Aim of study: The purpose of this study was to investigate the relationship between anti-drug antibodies detected by a drug-tolerant assay and loss of response (LOR) to therapy in a cohort of patients with IBD being treated with ustekinumab. Patients and Methods: This retrospective study consecutively enrolled all adult patients with moderate to severe active IBD who had at least 2 years of follow-up after ustekinumab was initiated. LOR was defined as CDAI > 220 or HBI > 4 for Crohn’s disease (CD) and partial Mayo subscore > 3 for ulcerative colitis (UC) and with a modification in disease management. Results: Ninety patients were included (78 CD and 12 UC; mean age 37 years). Median levels of anti-ustekinumab antibodies (ATU) were significantly higher in patients with LOR compared to those with ongoing clinical response (15.2 µg/mL-eq CI (7.9–21.5) and 4.7 µg/mL-eq CI (2.1–10.5), respectively; p = 0.04). The area under the ROC curve (AUROC) for ATU in predicting LOR was 0.76. The optimal cut-off point for identifying patients with LOR was 9.5 µg/mL-eq with a sensitivity of 80% and specificity of 85%. Uni- and multivariate analyses showed that serum ATU ≥ 9.5 µg/mL-eq (hazard ratio (HR) 2.54, 95%CI (1.80–5.93)), p = 0.022, prior vedolizumab (HR 2.78, 95%CI (1.09–3.34), p = 0.019) and prior azathioprine (HR 0.54, 95%CI (0.20–0.76), p = 0.014) exposures were the only factors independently associated with LOR to UST. Conclusion: In our real-life cohort, ATU was identified as an independent predictor of LOR to ustekinumab in patients with IBD. Full article
(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)
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Review

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10 pages, 235 KiB  
Review
Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target
by Christopher Pavel, Mircea Mihai Diculescu, Alex-Emilian Stepan, Gabriel Constantinescu, Vasile Sandru, Cristian George Ţieranu, Luiza Tomescu, Alexandru Constantinescu, Cristina Patoni, Oana-Mihaela Plotogea and Madalina Ilie
J. Clin. Med. 2024, 13(1), 289; https://doi.org/10.3390/jcm13010289 - 4 Jan 2024
Cited by 2 | Viewed by 1797
Abstract
Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion [...] Read more.
Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion of patients continue to relapse despite a normal-appearing mucosa, highlighting that endoscopy may underestimate the true extent of the disease. A subtle hint of the importance that histology plays in the long-term course of the disease has been endorsed by the STRIDE-II consensus, which recommends considering histologic healing for ulcerative colitis (UC), even though it is not stated to be a compulsory formal target. It is a continuum-changing paradigm, and it is almost a certainty that in the near future, histologic healing may become the new formal target for ulcerative colitis. It must be emphasized that there is great heterogeneity in defining histological remission, and the main criteria or cut-off values for inflammatory markers are still in an ill-defined area. The complexity of some histologic scores is a source of confusion among clinicians and pathologists, leading to low adherence in clinical practice when it comes to a homogenous histopathological report. Therefore, a standardized and more practical approach is urgently needed. Full article
(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)
21 pages, 2795 KiB  
Review
The Optimal Management of Inflammatory Bowel Disease in Patients with Cancer
by Panu Wetwittayakhlang, Paraskevi Tselekouni, Reem Al-Jabri, Talat Bessissow and Peter L. Lakatos
J. Clin. Med. 2023, 12(6), 2432; https://doi.org/10.3390/jcm12062432 - 22 Mar 2023
Cited by 8 | Viewed by 3318
Abstract
Patients with inflammatory bowel disease (IBD) have an increased risk of cancer secondary to chronic inflammation and long-term use of immunosuppressive therapy. With the aging IBD population, the prevalence of cancer in IBD patients is increasing. As a result, there is increasing concern [...] Read more.
Patients with inflammatory bowel disease (IBD) have an increased risk of cancer secondary to chronic inflammation and long-term use of immunosuppressive therapy. With the aging IBD population, the prevalence of cancer in IBD patients is increasing. As a result, there is increasing concern about the impact of IBD therapy on cancer risk and survival, as well as the effects of cancer therapies on the disease course of IBD. Managing IBD in patients with current or previous cancer is challenging since clinical guidelines are based mainly on expert consensus. Evidence is rare and mainly available from registries or observational studies. In contrast, excluding patients with previous/or active cancer from clinical trials and short-term follow-up can lead to an underestimation of the cancer or cancer recurrence risk of approved medications. The present narrative review aims to summarize the current evidence and provide practical guidance on the management of IBD patients with cancer. Full article
(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)
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Other

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10 pages, 1249 KiB  
Systematic Review
Does Elderly-Onset Inflammatory Bowel Disease Increase Risk of Colorectal Cancer? A Systematic Review and Meta-Analysis
by Mohammad Zamani and Shaghayegh Alizadeh-Tabari
J. Clin. Med. 2024, 13(1), 148; https://doi.org/10.3390/jcm13010148 - 27 Dec 2023
Cited by 1 | Viewed by 1467
Abstract
Background: Although younger adults with inflammatory bowel disease (IBD) are known to have an increased risk of developing colorectal cancer (CRC), the impact of IBD on CRC risk in elderly patients is not yet fully understood. Therefore, we conducted this systematic review and [...] Read more.
Background: Although younger adults with inflammatory bowel disease (IBD) are known to have an increased risk of developing colorectal cancer (CRC), the impact of IBD on CRC risk in elderly patients is not yet fully understood. Therefore, we conducted this systematic review and meta-analysis to address this knowledge gap. Methods: We thoroughly searched Embase, PubMed, and Scopus, covering the literature from inception to 31 August 2023, in any language. We enrolled population-based cohort studies that appraised the risk of CRC development in elderly patients (≥60 years) with IBD as compared to the non-IBD population. Our meta-analysis provided pooled relative risk (RR) with 95% confidence intervals (CIs) using a random-effect model. Results: Out of 3904 citations, 3 eligible cohort studies were ultimately included, reporting 694 CRC events in 35,187 patients with IBD. According to analysis, the risk of developing CRC did not increase in patients with elderly-onset IBD (RR = 1.17 [95% CI: 0.86–1.47]; I2 = 62.6%). This lack of a significant association was observed in both patients with Crohn’s disease (RR = 1.28 [95% CI: 0.88–1.69]) and ulcerative colitis (RR = 0.99 [95% CI: 0.90–1.09]) (p for interaction = 0.166). Conclusion: Our findings revealed no significant increase in the risk of incident CRC in patients with elderly-onset IBD, suggesting that intense screening of these patients for CRC may not be necessary. Full article
(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)
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