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Management of Crohn's Disease and Ulcerative Colitis
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Management of Crohn's Disease and Ulcerative Colitis

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 (30 April 2024) | Viewed by 5815

Special Issue Editors

Dr. Henit Yanai

E-Mail Website
Guest Editor
1. IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
Interests: inflammatory bowel disease; ulcerative colitis; colonoscopy; gastrointestinal diseases; medical transcription; gastrointestinal endoscopy; Crohn's disease
Special Issues, Collections and Topics in MDPI journals
Dr. Jacob Eliezer Ollech

E-Mail Website
Guest Editor
1. IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
Interests: inflammatory bowel disease (IBD); Crohn's disease; ulcerative colitis; gastroenterology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues

We are delighted to invite researchers and experts to submit their research papers for consideration in our upcoming Special Issue, entitled "Management of Crohn's Disease and Ulcerative Colitis". Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic conditions that can greatly impact a patient's quality of life. Despite significant advances in understanding the underlying pathogenesis of IBD and the development of new treatment options, there remains a need for further research to optimize management strategies for these debilitating conditions.

In this Special Issue, we invite researchers to submit original research, systematic reviews, meta-analyses, and clinical trials that focus on improving the management of Crohn's disease and ulcerative colitis. Topics of interest include, but are not limited to, new therapeutics, biomarkers, diagnostic tools, and novel treatment strategies. We also encourage submissions that focus on understanding the underlying mechanisms of IBD, as well as research into the impact of IBD on patient-reported outcomes and health-related quality of life.

We believe that this Special Issue will provide a valuable platform for the dissemination of cutting-edge research in the field of IBD management. By bringing together a diverse group of experts, we aim to facilitate the exchange of ideas and promote collaboration among researchers working in this field.

We look forward to receiving your submissions and thank you in advance for your interest in this Special Issue.

Dr. Henit Yanai
Dr. Jacob Eliezer Ollech
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Crohn’s disease
  • ulcerative colitis
  • biomarkers
  • patient-reported outcomes
  • health-related quality of life

Published Papers (5 papers)

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Research

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13 pages, 1426 KiB  
Article
Early Initiation of Adalimumab Significantly Diminishes Postoperative Crohn’s Disease Endoscopic Recurrence and Is Superior to 6-Mercaptopurine Therapy: An Open-Label, Randomized Controlled Study
by Ayal Hirsch, Erez Scapa, Naomi Fliss-Isakov, Hagit Tulchinsky, Eran Itzkowitz, Yehuda Kariv, Yulia Ron, Henit Yanai, Ian White, Sharief Yassin, Nathaniel Aviv Cohen, Eli Brazovski, Iris Dotan and Nitsan Maharshak
J. Clin. Med. 2023, 12(24), 7600; https://doi.org/10.3390/jcm12247600 - 10 Dec 2023
Viewed by 844
Abstract
Postoperative recurrence (POR) is the rule in patients with Crohn’s disease (CD), mitigated with prophylactic therapy. The evidence for therapeutic choice and timing of intervention is lacking. We aimed to compare the rates of POR in patients treated early with prophylactic 6-mercaptopurine (6-MP) [...] Read more.
Postoperative recurrence (POR) is the rule in patients with Crohn’s disease (CD), mitigated with prophylactic therapy. The evidence for therapeutic choice and timing of intervention is lacking. We aimed to compare the rates of POR in patients treated early with prophylactic 6-mercaptopurine (6-MP) or adalimumab. We conducted a prospective single-center randomized open-label clinical study in which patients in surgical remission following their first ileocecectomy were randomized to receive early treatment with 6-MP or adalimumab. Patients were followed up clinically every 3 months and underwent endoscopy at weeks 32 and 58 postoperatively. The primary endpoint was endoscopic recurrence (ePOR) at 1 year (week 58), defined as a Rutgeerts score ≥ i2. We enrolled 35 patients (25 males, mean age 35 ± 1.4 years, median disease duration 5 ± 6.1 years) following ileocecectomy. Of these, seven (20%) were current smokers and nine (26%) biologics-experienced. Patients allocated to adalimumab had significantly less ePOR than patients treated with 6MP at week 32 (21% vs. 69%, p = 0.004) and 58 (47% vs. 75%), (p = 0.03, HR = 0.39, 95% CI = 0.16–0.93). POR was associated with an increased diameter of the resected small bowel surgical specimen, lower baseline body mass index (BMI), increased week 18 fecal calprotectin, increased week 18 serum alanine aminotransferase and decreased week 18 hemoglobin level. Adalimumab was more effective than 6-MP in preventing ePOR. Increased operative small bowel diameter and lower postoperative BMI were associated with ePOR. At eighteen weeks, serum hemoglobin, ALT and fecal calprotectin levels were predictive of endoscopic disease recurrence. (ClinicalTrials.gov ID NCT01629628). Full article
(This article belongs to the Special Issue Management of Crohn's Disease and Ulcerative Colitis)
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16 pages, 677 KiB  
Article
«Digesting Crohn’s Disease»: The Journey of Young Adults since Diagnosis
by Nathalie Touma, Louise Zanni, Pierre Blanc, Guillaume Savoye and Carolina Baeza-Velasco
J. Clin. Med. 2023, 12(22), 7128; https://doi.org/10.3390/jcm12227128 - 16 Nov 2023
Viewed by 839
Abstract
Crohn’s disease affects 2.5 million people in Europe (more than 100,000 people in France) and often occurs between the ages of 15 and 30, a period marked by self-construction. However, few studies have focused on the experience of the diagnosis during this sensitive [...] Read more.
Crohn’s disease affects 2.5 million people in Europe (more than 100,000 people in France) and often occurs between the ages of 15 and 30, a period marked by self-construction. However, few studies have focused on the experience of the diagnosis during this sensitive developmental stage. This study aimed to qualitatively explore the experience of Crohn’s disease in young adults since their diagnosis. Fifteen young adults (18–35 years) diagnosed with Crohn’s disease participated in a semi-directive interview. Narrative data were subjected to a thematic analysis, and thirty percent of the interviews were double-coded. The results revealed an evolution of four main themes since diagnosis: (1) course of care, (2) illness perceptions, (3) disease management and (4) self-perception. For most participants, the onset of the disease was difficult, marked by severe symptoms requiring hospitalization, numerous medical examinations and sometimes several consultations before diagnosis. This journey was more difficult when it was associated with negative relations with the medical staff, who were sometimes perceived as unsupportive. Thus, some people described this diagnostic period as an “ordeal”, while others experienced it as a “relief” from their suffering. The announcement of the diagnosis was often a “shock”, an “upheaval” or a “downfall”, followed by phases of denial associated with a desire to maintain a “normal life” and not to be defined by the disease. Despite a difficult start, most participants grew from their experience with CD, with a sense of a personal development that was made possible by self-regulation processes that enabled them to draw on their own experience and resources to adjust to their illness. By highlighting positive possibilities for evolution, this study suggests the importance of supporting the psychological resources of young adults by proposing, at an early stage, psychological support or therapies focused on acceptance and engagement. Full article
(This article belongs to the Special Issue Management of Crohn's Disease and Ulcerative Colitis)
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8 pages, 1539 KiB  
Article
Vedolizumab Is Associated with Longer Drug Sustainability Compared to Infliximab in Moderate-to-Severe Ulcerative Colitis: Long-Term Real-World Cohort Data
by Tom Konikoff, Henit Yanai, Dror Libchik, Irit Avni-Biron, Yifat Snir, Hagar Banai, Yelena Broytman, Iris Dotan and Jacob E. Ollech
J. Clin. Med. 2023, 12(13), 4488; https://doi.org/10.3390/jcm12134488 - 4 Jul 2023
Cited by 1 | Viewed by 1176
Abstract
Background and Aim: Drug sustainability (DS) is a surrogate marker for treatment efficacy. We aimed to compare the DS of two main biologics used to treat moderate-to-severe ulcerative colitis (UC), infliximab (IFX) and vedolizumab (VDZ), in a real-world setting. Methods: We conducted a [...] Read more.
Background and Aim: Drug sustainability (DS) is a surrogate marker for treatment efficacy. We aimed to compare the DS of two main biologics used to treat moderate-to-severe ulcerative colitis (UC), infliximab (IFX) and vedolizumab (VDZ), in a real-world setting. Methods: We conducted a retrospective cohort study at a tertiary medical center in Israel. We included patients treated between 1 December 2017 and 1 May 2021, who were followed for up to 300 weeks. DS was defined as corticosteroid-, surgical-, and hospitalization-free treatment. Results: 217 patients with UC were included. VDZ had a significantly longer median DS of 265.6 weeks compared to IFX’s 106.5 weeks (p = 0.001) in treatment-naïve patients, even when adjusting for disease severity (HR 0.55 95 CI 0.3–0.98, p = 0.042). In treatment-experienced patients, DS was comparable between IFX and VDZ (p = 0.593). Conclusions: VDZ showed significantly longer DS in treatment-naïve patients with UC compared to IFX, also when adjusted for disease severity. There was no difference in DS between VDZ and IFX in treatment-experienced patients and patients switching from one drug to another. VDZ may be a suitable first-line treatment for biologic-naïve patients with moderate-to-severe UC. Full article
(This article belongs to the Special Issue Management of Crohn's Disease and Ulcerative Colitis)
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Review

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19 pages, 595 KiB  
Review
IBD and Motherhood: A Journey through Conception, Pregnancy and Beyond
by Antonio M. Caballero-Mateos, Miguel Quesada-Caballero, Guillermo A. Cañadas-De la Fuente, Alberto Caballero-Vázquez and Francisco Contreras-Chova
J. Clin. Med. 2023, 12(19), 6192; https://doi.org/10.3390/jcm12196192 - 25 Sep 2023
Viewed by 1448
Abstract
Inflammatory Bowel Disease (IBD) presents distinct challenges during pregnancy due to its influence on maternal health and pregnancy outcomes. This literature review aims to dissect the existing scientific evidence on pregnancy in women with IBD and provide evidence-based recommendations for clinical management. A [...] Read more.
Inflammatory Bowel Disease (IBD) presents distinct challenges during pregnancy due to its influence on maternal health and pregnancy outcomes. This literature review aims to dissect the existing scientific evidence on pregnancy in women with IBD and provide evidence-based recommendations for clinical management. A comprehensive search was conducted across scientific databases, selecting clinical studies, systematic reviews, and other pertinent resources. Numerous studies have underscored an increased risk of complications during pregnancy for women with IBD, including preterm birth, low birth weight, neonates small for gestational age, and congenital malformations. Nevertheless, it’s evident that proactive disease management before and throughout pregnancy can mitigate these risks. Continuation of IBD treatment during pregnancy and breastfeeding is deemed safe with agents like thiopurines, anti-TNF, vedolizumab, or ustekinumab. However, there’s a call for caution when combining treatments due to the heightened risk of severe infections in the first year of life. For small molecules, their use is advised against in both scenarios. Effective disease management, minimizing disease activity, and interdisciplinary care are pivotal in attending to women with IBD. The emphasis is placed on the continual assessment of maternal and infant outcomes and an expressed need for further research to enhance the understanding of the ties between IBD and adverse pregnancy outcomes. Full article
(This article belongs to the Special Issue Management of Crohn's Disease and Ulcerative Colitis)
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Other

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16 pages, 842 KiB  
Systematic Review
The Role of Pharmacogenetics in the Therapeutic Response to Thiopurines in the Treatment of Inflammatory Bowel Disease: A Systematic Review
by Aline C. Ribeiro, Pâmela S. A. S. Gerheim, Julio Maria Fonseca Chebli, Jorge Willian L. Nascimento and Priscila de Faria Pinto
J. Clin. Med. 2023, 12(21), 6742; https://doi.org/10.3390/jcm12216742 - 25 Oct 2023
Viewed by 1090
Abstract
This study focuses on the use of thiopurines for treating inflammatory bowel diseases (IBD). These drugs undergo enzymatic changes within the body, resulting in active and inactive metabolites that influence their therapeutic effects. The research examines the role of genetic polymorphisms in the [...] Read more.
This study focuses on the use of thiopurines for treating inflammatory bowel diseases (IBD). These drugs undergo enzymatic changes within the body, resulting in active and inactive metabolites that influence their therapeutic effects. The research examines the role of genetic polymorphisms in the enzyme thiopurine S-methyltransferase (TPMT) in predicting the therapeutic response and adverse effects of thiopurine treatment. The TPMT genotype variations impact the individual responses to thiopurines. Patients with reduced TPMT activity are more susceptible to adverse reactions (AEs), such leukopenia, hepatotoxicity, pancreatitis, and nausea, which are common adverse effects of thiopurine therapy. The therapeutic monitoring of the metabolites 6-thioguanine nucleotides (6-TGN) and 6-methyl mercaptopurine (6-MMP) is proposed to optimize treatment and minimize AEs. Patients with higher 6-TGN levels tend to have better clinical responses, while elevated 6-MMP levels are linked to hepatotoxicity. Genotyping for TPMT before or during treatment initiation is suggested to tailor dosing strategies and enhance treatment efficacy while reducing the risk of myelosuppression. In conclusion, this study highlights the importance of considering genetic variations and metabolite levels in optimizing thiopurine therapy for IBD patients, focusing on balance therapeutic efficacy with the prevention of adverse effects and contributing to personalized treatment and better patient outcomes. Full article
(This article belongs to the Special Issue Management of Crohn's Disease and Ulcerative Colitis)
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