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Inflammatory Bowel Disease: From Diagnosis to Treatment

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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: 30 October 2024 | Viewed by 5404

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Special Issue Editors

Dr. Laura Maria Minordi

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Guest Editor

Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia Addomino-pelvica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168 Roma, Italy
Interests: inflammatory intestinal diseases; oncology; Abdominal CT; Abdominal MRI; PET-CT

Dr. Daniela Pugliese

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1. IBD UNIT, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Roma, Italy
2. Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
Interests: inflammatory bowel disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory intestinal conditions with unknown etiologies. Crohn’s disease (CD) and ulcerative colitis (UC) are the two main types of IBD and they have some interchangeable and some different clinical and pathological characteristics. Diagnosis is usually performed using a combination of clinical symptoms, laboratory tests, and—especially in CD patients—endoscopic and radiological exams such as MR or CT enterography. In CD patients, continuous medical therapy represents the first option, but surgery still remains a valid option in case of complications, such as abscesses, fistulas, perforation, and strictures (ranging from 48% to 52% at 5 years after diagnosis). Tight monitoring and adjustment of therapy on the basis of that assessment is important to evaluate the response to medical therapy and to identify patients requiring surgery. CT has been demonstrated to allow the precise evaluation of disease activity and complications, such as fistulas and strictures, especially when presenting acutely. MRI has replaced CT, because it offers comparable sensitivity, specificity, and accuracy to CT for the diagnosis and evaluation of CD, especially concerning disease activity.

Aim and the Scope of the Special Issue:

This Special Issue aims to provide information on clinical, diagnostic, and treatment methods for inflammatory bowel disease, especially in Crohn’s disease.

Dr. Laura Maria Minordi
Dr. Daniela Pugliese
Guest Editors

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Keywords

Crohn’s disease
ulcerative colitis
imaging
endoscopy
complications
advanced therapies
surgery

Published Papers (6 papers)

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Research

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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

Viewed by 1288

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 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

Viewed by 681

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 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

Viewed by 570

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 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

Viewed by 714

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 (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 3 | Viewed by 986

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 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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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

Viewed by 790

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 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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