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Time Doesn’t Heal Parents’ Mental Health Wounds From Kids’ IBD Dx

Zaina Hamza, MedPage Today December 10, 2021

Anxiety and depression symptoms were similar among parents of children with inflammatory bowel disease (IBD), regardless of whether the diagnosis was recent or not, a researcher said.

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Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Blake O. Langley 1,Sara E. Guedry 1,Joshua Z. Goldenberg 1,Douglas A. Hanes 1,Jennifer A. Beardsley 2 andJennifer Joan Ryan 1,

The findings of this systematic scoping review highlight the potential utility of NLR as an adjunctive IBD biomarker with broad applications, including differentiation from non-IBD controls, clinical and endoscopic disease activity differentiation, prediction of loss of response to treatment, and prediction of risk of complications. NLR has promise for guiding therapeutic decision making, specifically for predicting loss of response to IFX. In conclusion, NLR is an emerging IBD biomarker with potential utility at nearly every point in IBD management. As a potential IBD biomarker, NLR is particularly advantageous given that it is minimally invasive, economical, and accessible as it is easily calculated from blood count data routinely and serially monitored in patients with IBD. Additional research is justified to better understand if routine observation of NLR in research and clinical practice could beneficially impact the care of patients with IBD.

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Evidence-based clinical practice guidelines for inflammatory bowel disease 2020

Hiroshi Nakase,1,2Motoi Uchino,1Shinichiro Shinzaki,1Minoru Matsuura,1Katsuyoshi Matsuoka,1Taku Kobayashi,1Masayuki Saruta,1Fumihito Hirai,1Keisuke Hata,1Sakiko Hiraoka,1Motohiro Esaki,1Ken Sugimoto,1Toshimitsu Fuji,1Kenji Watanabe,1Shiro Nakamura,1Nagamu Inoue,1Toshiyuki Itoh,1Makoto Naganuma,1Tadakazu Hisamatsu,1Mamoru Watanabe,1Hiroto Miwa,1Nobuyuki Enomoto,1Tooru Shimosegawa,1 and Kazuhiko Koike1 ,J Gastroenterol. 2021; 56(6): 489–526.

Inflammatory bowel disease (IBD) is a general term for chronic or remitting/relapsing inflammatory diseases of the intestinal tract and generally refers to ulcerative colitis (UC) and Crohn’s disease (CD). Since 1950, the number of patients with IBD in Japan has been increasing. The etiology of IBD remains unclear; however, recent research data indicate that the pathophysiology of IBD involves abnormalities in disease susceptibility genes, environmental factors and intestinal bacteria. The elucidation of the mechanism of IBD has facilitated therapeutic development. UC and CD display heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management depends on the understanding and tailoring of evidence-based interventions by physicians. In 2020, seventeen IBD experts of the Japanese Society of Gastroenterology revised the previous guidelines for IBD management published in 2016. This English version was produced and modified based on the existing updated guidelines in Japanese. The Clinical Questions (CQs) of the previous guidelines were completely revised and categorized as follows: Background Questions (BQs), CQs, and Future Research Questions (FRQs). The guideline was composed of a total of 69 questions: 39 BQs, 15 CQs, and 15 FRQs. The overall quality of the evidence for each CQ was determined by assessing it with reference to the Grading of Recommendations Assessment, Development and Evaluation approach, and the strength of the recommendation was determined by the Delphi consensus process. Comprehensive up-to-date guidance for on-site physicians is provided regarding indications for proceeding with the diagnosis and treatment.

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Selective granulocyte and monocyte apheresis in inflammatory bowel disease: Its past, present and future

Xiu-Li ChenJing-Wei Mao, and Ying-De Wang, World J Gastrointest Pathophysiol. 2020 May 12; 11(3): 43–56.

The etiology and pathogenesis of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, are not fully understood so far. Therefore, IBD still remains incurable despite the fact that significant progress has been achieved in recent years in its treatment with innovative medicine. About 20 years ago, selective granulocyte and monocyte apheresis (GMA) was invented in Japan and later approved by the Japanese health authority for IBD treatment. From then on this technique was extensively used for IBD patients in Japan and later in Europe. Clinical trials from Japan and European countries have verified the effectiveness and safety of GMA therapy in patients with IBD. In 2013, GMA therapy was approved by China State Food and Drug Administration for therapeutic use for the Chinese IBD patients. However, GMA therapy has not been extensively used in China, although a few clinical studies also showed that it was effective in clinical and endoscopic induction of remission in Chinese IBD patients with a high safety profile. This article reviews past history, present clinical application as well as the future prospective of GMA therapy for patients with IBD.

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Inflammatory Bowel Disease in Japan Is It Similar to or Different from Westerns?

Shinji Okabayashi,1Taku Kobayashi,1 and Toshifumi Hibi1 ,doi: 10.23922/jarc.2019-003

Ulcerative colitis and Crohn’s disease, the most common types of inflammatory bowel disease, are idiopathic, intractable disease characterized by chronic inflammation in the intestine. In recent years, studies elucidating the clinical characteristics of these diseases and basic researches have suggested that the diseases are induced by the immunological abnormalities through the involvement of environmental factors with their predisposition. In Japan, significant progress of basic and epidemiological researches has been developed for these diseases and the clinical guidelines have been established. However, no fundamental treatment for these diseases has been established yet. The current number of patients in Japan continues to increase, with at least 180,000 patients suffering from ulcerative colitis and 40,000 suffering from Crohn’s disease. Thus, further studies are required to understand these diseases and improve medical treatments

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P356 Safety and effectiveness of granulocyte and monocyte adsorptive apheresis in paediatric patients with inflammatory bowel disease: a multi-centre cohort study

N ToitaH TanakaK AraiH ShimizuD AbukawaT KobayashiN YoshimuraS TanidaE Hosoi, Journal of Crohn’s and Colitis, Volume 13, Issue Supplement_1, March 2019

Background: The usefulness of granulocyte and monocyte adsorptive apheresis (GMA) in paediatric patients with inflammatory bowel disease (IBD) has not been studied in depth. We investigated the safety and effectiveness of GMA in paediatric patients with IBD who participated in a post-marketing surveillance study referred to as the PARTICULAR study.

Methods: The PARTICULAR study was a retrospective, multi-centre cohort study that included patients with ulcerative colitis (UC) or Crohn’s disease (CD) who received GMA between November 2013 and March 2017. The study enrolled patients with at least one special situation, including paediatric, being elderly, with anaemia and concomitant treatment with multiple immunosuppressants. Patients aged >18 years were excluded from this study. The GMA was performed using Adacolumn® (JIMRO, Takasaki, Japan). Each patient underwent up to 11 GMA sessions. All adverse events (AEs) were recorded during the observation time interval. Any AE, for which the causality of the GMA could not be ruled out was classified as an adverse device effect (ADE). In addition, feasibility problems (FPs) during the operation of the GMA column were recorded. The effectiveness of GMA was assessed in UC patients with a partial Mayo (pMayo) score of ≥3. Remission was defined as a pMayo score of ≤2. Patients receiving concomitant treatment with infliximab, adalimumab or calcineurin inhibitors were excluded from the effectiveness assessment.

Results: A total of 53 paediatric patients (40 UC, 13 CD) from 27 institutions, with a mean age of 15.0 years, were included. The incidence of AEs, ADEs and FPs were 18.9%, 5.7% and 20.8%, respectively. The ADEs included abdominal discomfort in 2 (3.8%) patients and one patient each with fever, nausea/vomiting and headache (1.9% each). The FPs included blood access failure in 10 patients (18.9%), venous pressure elevation in 4 (7.5%), clot formation in the apheresis lines in 2 (3.8%) and venous access difficulty in 1 patient (1.9%). A total of 17 patients (32.1%) discontinued GMA therapy ahead of the planned treatment schedule. Among these patients, the GMA therapy was discontinued for the following reasons: (1) decision by the physician (n = 12), (2) withdrawal due to AE (n = 4) and (3) withdrawal by own wish (n = 1); none were discontinued due to ADE and FP. The effectiveness of the GMA was assessed in 29 UC patients. The remission rate of the paediatric UC patients was 43.5%. Conclusions: There were AEs and FPs in approximately 20% of paediatric patients with IBD treated by GMA, but none of these discontinued the GMA treatment due to ADE or FP. Remission was achieved by GMA in 44% of the paediatric UC patients. This study showed that GMA was well tolerated treatment option for the paediatric IBD patients.

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Evidence-based clinical practice guidelines for inflammatory bowel disease

Katsuyoshi Matsuoka 1Taku Kobayashi 1Fumiaki Ueno 2 3Toshiyuki Matsui 1Fumihito Hirai 1Nagamu Inoue 1Jun Kato 1Kenji Kobayashi 1Kiyonori Kobayashi 1Kazutaka Koganei 1Reiko Kunisaki 1Satoshi Motoya 1Masakazu Nagahori 1Hiroshi Nakase 1Fumio Omata 1Masayuki Saruta 1Toshiaki Watanabe 1Toshiaki Tanaka 1Takanori Kanai 1Yoshinori Noguchi 1Ken-Ichi Takahashi 1Kenji Watanabe 1Toshifumi Hibi 1Yasuo Suzuki 1Mamoru Watanabe 1Kentaro Sugano 1Tooru Shimosegawa 1 , J Gastroenterol. 2018 Mar;53(3):305-353.

Inflammatory bowel disease (IBD) is a chronic disorder involving mainly the intestinal tract, but possibly other gastrointestinal and extraintestinal organs. Although etiology is still uncertain, recent knowledge in pathogenesis has accumulated, and novel diagnostic and therapeutic modalities have become available for clinical use. Therefore, the previous guidelines were urged to be updated. In 2016, the Japanese Society of Gastroenterology revised the previous versions of evidence-based clinical practice guidelines for ulcerative colitis (UC) and Crohn’s disease (CD) in Japanese. A total of 59 clinical questions for 9 categories (1. clinical features of IBD; 2. diagnosis; 3. general consideration in treatment; 4. therapeutic interventions for IBD; 5. treatment of UC; 6. treatment of CD; 7. extraintestinal complications; 8. cancer surveillance; 9. IBD in special situation) were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases. The guidelines were developed with the basic concept of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Recommendations were made using Delphi rounds. This English version was produced and edited based on the existing updated guidelines in Japanese.

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Pediatric inflammatory bowel disease : clinical and immunological aspects on remission treatment

Finally, we studied the immunological profile in blood at onset and in intestinal mucosa at onset and after GMA and EEN treatment. We conclude that an active approach is needed in the care of children with IBD to achieve and maintain remission. Our findings reveal that the children on IFX maintenance treatment were only in remission in 28% of the visits. The combination of GMA and mesalazine was found to be a safe and effective treatment in children with newly onset IBD. It seems plausible to speculate that the decreases in mucosal cytokines after the induction of remission may explain the good clinical result. Moreover, a change in the mucosal cytokine profile after induction of remission with EEN was observed. By investigating the chemokine receptors, we found a possible prognostic IBD marker, and by analyzing the cytokine profiles in mucosal biopsies, we have extended the knowledge of immunological phenotypes in children with IBD. Suggestions for the future Corticosteroid-free treatment alternatives must be explored and those currently in use must be optimized. To conclude, more and bigger studies are needed to explore the pathogenesis of IBD to determine new treatment alternatives.

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The efficacy and safety of selective granulocyte and monocyte apheresis for inflammatory bowel disease: A meta-analysis

Zhenfei Liu 1Xueliang Jiang 2Chengcheng Sun 3 ,Eur J Intern Med. 2016 Dec;36:e26-e27.

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Granulo-monocyto apheresis is more effective in mild ulcerative colitis than in moderate to severe disease.

Chiara De Cassan 1Edoardo Savarino 1Piero Marson 1Tiziana Tison 1Giorgia Hatem 1Giacomo Carlo Sturniolo 1Renata D’Incà 1 , World J Gastroenterol. 2014 Dec 7;20(45):17155-62.

Patients with mild UC benefit from GMA more than patients with moderate to severe disease in the short-term period. GMA should be considered a valid therapeutic option in cases of contraindications to immunosuppressants, corticosteroids and/or biologics.

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