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7 recent developments in Crohn's disease
      04/02/15 03:16 PM

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7 recent developments in Crohn's disease

Crohn's disease has been a hot topic recently, with an abundance of data being published in the journals this month. Here is a recap of the most trafficked news on Healio Gastroenterology about Crohn's disease.

1. Racial disparities exist among children with Crohn's disease

Jennifer Dotson

Disparities in hospital readmissions, complications and procedures in pediatric Crohn's disease patients are related to race, according to data from a recent retrospective review.

"We found racial inequalities exist among children and adolescents with Crohn's disease, likely due to a combination of genetic and environmental differences," Jennifer Dotson, MD, MPH, a gastroenterologist at Nationwide Children's Hospital in Columbus, Ohio, and principal investigator in the Center for Innovation and Pediatric Practice, said in a press release. "This is one of the first studies to investigate the rate of various health disparities in the Crohn's disease population in pediatrics, despite the fact that 25% of the time, Crohn's disease is diagnosed in childhood." Read more

2. Experts release international consensus statement on surveillance, management of dysplasia in inflammatory bowel disease

Tonya Kaltenbach

SCENIC, an international multidisciplinary group, has developed unifying consensus recommendations on surveillance and management of dysplasia in IBD.

"We recognized that there was variable practice in the surveillance methods for dysplasia detection in patients with IBD and there were also variable guidelines, both within the US and internationally," Tonya Kaltenbach, MD, MS, from the Veterans Affairs Palo Alto, who served on the panel, told Healio Gastroenterology. The need for an international consensus statement, she said, came from "an interest to provide a uniform recommendation" — namely on the use of chromoendoscopy for the detection of dysplasia. Read more

3. CRP, calprotectin, excludes IBD in patients with IBS symptoms

William D. Chey

Adding C-reactive protein and fecal calprotectin to symptom-based diagnostic criteria may help to rule out inflammatory bowel disease in patients with symptoms of irritable bowel syndrome, according to new research data.

"Though IBD is uncommon in patients with typical IBS symptoms and no alarming features, patients and providers remain concerned about this possibility," William D. Chey, MD, AGAF, FACG, FACP, from the University of Michigan Health System, told Healio Gastroenterology.

Adding C-reactive protein and fecal calprotectin to symptom-based diagnostic criteria may help to rule out inflammatory bowel disease in patients with symptoms of irritable bowel syndrome, according to new research data.

"Though IBD is uncommon in patients with typical IBS symptoms and no alarming features, patients and providers remain concerned about this possibility," William D. Chey, MD, AGAF, FACG, FACP, from the University of Michigan Health System, told Healio Gastroenterology.

William D. Chey

Chey and colleagues performed a systematic review and meta-analysis to assess the utility of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin and fecal lactoferrin to aid in differentiating between IBS, IBD and healthy patients. After reviewing 1,252 relevant studies, 12 involving 1,059 IBD patients (52.7% male; mean age, 40.7 ± 13.3 years), 595 IBS patients (29.9% male; mean age, 40 ± 18.2 years) and 491 healthy controls (53.5% male; mean age, 38.7 ± 13.8 years) were included in the meta-analysis.

The researchers found that none of the biomarkers could distinguish patients with IBS from healthy controls, but CRP and calprotectin had some value in distinguishing IBD from IBS or healthy controls. High CRP was predictive of IBD, while low CRP indicated the absence of IBD; CRP ≥ 1.7 mg/dl and > 2.7 mg/dl indicated > 52% and > 90% likelihood of IBD, respectively, while CRP ≤ 0.5 indicated that the probability of having IBD was 1% or less.

Likelihood of IBD also increased with calprotectin level, which had a maximal predictive value of 78.7% at 1,000 µg/g. Patients with < 40 µg/g calprotectin had &#8804; 1% chance of having IBD. However, calprotectin level could not rule out IBS entirely; on both sides of the fecal calprotectin range (20 µg/g - 1,000 µg/g) there was an 11.6% and 7.6% predictive probability of IBS, respectively, with a peak predictive probability of 280 µg/g (18.8%).

"Serum CRP and fecal calprotectin provide a noninvasive means by which to exclude IBD in patients with IBS symptoms and no alarming features," Chey said.

"Based upon these results, it may be reasonable for clinicians to consider ordering CRP or fecal calprotectin to improve their confidence in making a diagnosis of IBS," the researchers concluded, adding that "prospective studies to evaluate the clinical utility and cost effectiveness of adding CRP or fecal calprotectin to the evaluation of patients with suspected IBS in different populations would be of considerable interest." – by Adam Leitenberger

4. Slow IBD diagnosis in children leads to more advanced disease
See Also

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Slow diagnosis of inflammatory bowel disease in pediatric patients was associated with advanced bowel involvement at the time of diagnosis, according to recent data.

"Time from symptom onset to diagnosis for IBD among children and adolescents is too long: an average of 4 to 6 months," the researchers wrote. "The majority of pediatric IBD patients already have extensive involvement at diagnosis." Read more

5. FMT induces remission in pediatric patients with Crohn's disease

David L. Suskind

Children with Crohn's disease achieved remission after fecal microbiota transplant, recent study data found.

"The fecal microbiome is likely the cause or trigger of the immune response in IBD," David L. Suskind, MD, from the department of pediatrics, division of gastroenterology at Seattle Children's Hospital, told Healio Gastroenterology. "Therapies which affect the fecal microbiome such as FMT, have the potential to change our current treatment paradigm by altering the fecal microbiome instead of using medications which suppress the immune response." Read more

6. Smoking cessation programs for Crohn's improve outcomes, reduce costs

Stephanie Coward

Gilaad G. Kaplan

The integration of smoking cessation programs targeting patients with Crohn's disease is cost-effective for health care systems, recent study data found.

"Smoking is known to worsen the course of Crohn's disease, whereas individuals who quit have a similar prognosis to patients with Crohn's disease who never smoked," Stephanie Coward, MSc, and Gilaad G. Kaplan, MD, MPH, both from the University of Calgary in Alberta, Canada, told Healio Gastroenterology. "We conducted a cost-utility analysis to compare different smoking cessation strategies for patients with Crohn's disease." Read more

7. Mongersen appears to improve remission in Crohn's disease

Séverine Vermeire

Patients with Crohn's disease achieved remission and clinical response in greater proportions with mongersen, a novel oral SMAD7 antisense oligonucleotide, compared with placebo, according to recent study data.

"The impressive clinical effects of mongersen beg for follow-up studies to confirm that we have indeed entered a new phase of Crohn's disease treatment," Séverine Vermeire, MD, PhD, from the University Hospitals in Leuven, Belgium, wrote in an accompanying editorial.

Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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