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대한장연구학회> Intestinal research (Intest Res)> Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

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Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

Kenji Watanabe
  • : 대한장연구학회
  • : Intestinal research (Intest Res) 18권4호
  • : 연속간행물
  • : 2020년 10월
  • : 347-354(8pages)

DOI


목차

INTRODUCTION
IMPORTANCE OF SB LESIONS IN PATIENTS WITH CD FOR CLINICAL PRACTICE
FEATURES OF SB LESIONS IN PATIENTS WITH CD
OBJECTIVE MONITORING OF SB LESIONS IN PATIENTS WITH CD
EFFICACY OF MEDICATION FOR SB LESIONS IN PATIENTS WITH CD
ENDOSCOPIC BALLOON DILATATION AND SURVEILLANCE FOR SB LESIONS IN PATIENTS WITH CD
CONCLUSIONS
FINANCIAL SUPPORT
CONFLICT OF INTEREST
AUTHOR CONTRIBUTION
ORCID
REFERENCES

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A treat-to-target strategy, in which treatment is continuously adjusted according to the results of scheduled objective monitoring, is optimal for patients with Crohn’s disease (CD) in the era of biologics. The small bowel is a common site of intractable CD, which may result from multiple strictures or expanding lesions. To improve the prognosis of patients with small bowel CD, lesions should be proactively monitored within the subclinical phase. Objective assessment of small bowel lesions is technically difficult, however, due to the relatively poor correlation between endoscopic activity and clinical symptoms or biomarker titers. The presence of proximal small bowel lesions and asymptomatic “Real Silent CD” must be considered. Endoscopy remains the gold standard to assess these lesions. In clinical practice, the advantages and disadvantages of each imaging modality and biomarker must be carefully weighed for appropriate application and reliable monitoring. The prevalence of small bowel lesions depends on the precision of the imaging modality used for detection. Clinical management should be based on the dominant location of the intestinal lesions rather than classical classification. Optimal strategies for detecting and treating small bowel lesions in patients with CD must be developed utilizing reliable, precise, and objective monitoring. (Intest Res 2020;18:347-354)

UCI(KEPA)

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  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 계간
  • : 1598-9100
  • : 2288-1956
  • : 학술지
  • : 연속간행물
  • : 2003-2021
  • : 822


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1The first step to unveil the epidemiology of inflammatory bowel disease in Central Asia

저자 : Seung Wook Hong , Byong Duk Ye

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 345-346 (2 pages)

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2Clinical management for small bowel of Crohn's disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

저자 : Kenji Watanabe

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 347-354 (8 pages)

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A treat-to-target strategy, in which treatment is continuously adjusted according to the results of scheduled objective monitoring, is optimal for patients with Crohn's disease (CD) in the era of biologics. The small bowel is a common site of intractable CD, which may result from multiple strictures or expanding lesions. To improve the prognosis of patients with small bowel CD, lesions should be proactively monitored within the subclinical phase. Objective assessment of small bowel lesions is technically difficult, however, due to the relatively poor correlation between endoscopic activity and clinical symptoms or biomarker titers. The presence of proximal small bowel lesions and asymptomatic “Real Silent CD” must be considered. Endoscopy remains the gold standard to assess these lesions. In clinical practice, the advantages and disadvantages of each imaging modality and biomarker must be carefully weighed for appropriate application and reliable monitoring. The prevalence of small bowel lesions depends on the precision of the imaging modality used for detection. Clinical management should be based on the dominant location of the intestinal lesions rather than classical classification. Optimal strategies for detecting and treating small bowel lesions in patients with CD must be developed utilizing reliable, precise, and objective monitoring. (Intest Res 2020;18:347-354)

3Colitis and Crohn's Foundation (India) consensus statements on use of 5-aminosalicylic acid in inflammatory bowel disease

저자 : Ajit Sood , Vineet Ahuja , Vandana Midha , Saroj Kant Sinha , C. Ganesh Pai , Saurabh Kedia , Varun Mehta , Sawan Bopanna , Philip Abraham , Rupa Banerjee , Shobna Bhatia , Karmabir Chakravartty , Sunil Dad

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 355-378 (24 pages)

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Despite several recent advances in therapy in inflammatory bowel disease (IBD), 5-aminosalicylic acid (5-ASA) therapy has retained its place especially in ulcerative colitis. This consensus on 5-ASA is obtained through a modified Delphi process, and includes guiding statements and recommendations based on literature evidence (randomized trials, and observational studies), clinical practice, and expert opinion on use of 5-ASA in IBD by Indian gastroenterologists. The aim is to aid practitioners in selecting appropriate treatment strategies and facilitate optimal use of 5-ASA in patients with IBD. (Intest Res 2020;18:355-378)

4Fibrostenotic strictures in Crohn's disease

저자 : Jun Hwan Yoo , Stefan Holubar , Florian Rieder

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 379-401 (23 pages)

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The use of biologic agents including anti-tumor necrosis factor monoclonal antibodies followed by anti-integrins and anti-interleukins has drastically changed the treatment paradigm of Crohn's disease (CD) by improving clinical symptoms and mucosal healing. However, up to 70% of CD patients still eventually undergo surgery mainly due to fibrostenotic strictures. There are no specific anti-fibrotic drugs yet. This review comprehensively addresses the mechanism, prediction, diagnosis and treatment of the fibrostenotic strictures in CD. We also introduce promising anti-fibrotic agents which may be available in the near future and summarize challenges in developing novel therapies to treat fibrostenotic strictures in CD. (Intest Res 2020;18:379-401)

5A glycolipid adjuvant, 7DW8-5, provides a protective effect against colonic inflammation in mice by the recruitment of CD1d-restricted natural killer T cells

저자 : Chansu Lee , Sung Noh Hong , Young-ho Kim

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 402-419 (18 pages)

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Background/Aims: The modulation of CD1d-restricted natural killer T (NKT) cells by glycolipids has been considered as a potential therapy against immunologic diseases, including inflammatory bowel disease. A recently identified a glycolipid analog, 7DW8-5, which is derived from α-galactosylceramide (α-GalCer), is as much as 100-fold more active at stimulating both human and mice NKT cells when compared to α-GalCer. We explored the effects of 7DW8-5 in mouse models of acute and chronic colitis. Methods: We investigated the effects of 7DW8-5 on intestinal inflammation by assessing the effects of 7dW8-5 on a murine dextran sulfate sodium (DSS)-induced acute colitis model and a chronic colitis-associated tumor model. Results: The acute DSS-induced colitis model showed a dose-dependent response to 7DW8-5, as mice administered 7DW8-5 showed a significant improvement in DSS-induced colitis based on their disease activity index, histologic analysis, and serum C-reactive protein levels, when compared to mice administered vehicle alone. However, DSS-induced colitis in CD1d-KO mice showed no response to 7DW8-5. A fluorescence-activating cell sorting analysis revealed an increase in NKT cells in colonic tissues of 7DW8-5-treated mice. RNA-seq and real-time quantitative polymerase chain reaction showed a significant increase in the expression of interleukin (IL)-4, IL-13, and interferon-gamma in 7DW8-5-treated mice. In addition, 7DW8-5 treatment reduced colitis-associated tumor development in an azoxymethane/DSS mouse model. Conclusions: 7DW8-5 activates NKT cells through CD1d and provides a protective effect against intestinal inflammation in mice. Therefore, 7DW8-5 may be a promising therapeutic agent for treatment of inflammatory bowel disease. (Intest Res 2020;18:402-411)

6Phenotypic characteristics of pediatric inflammatory bowel disease in Japan: results from a multicenter registry

저자 : Katsuhiro Arai , Reiko Kunisaki , Fumihiko Kakuta , Shin-ichiro Hagiwara , Takatsugu Murakoshi , Tadahiro Yanagi , Toshiaki Shimizu , Sawako Kato , Takashi Ishige , Tomoki Aomatsu , Mikihiro Inoue , Takeshi Sai

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 412-420 (9 pages)

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Background/Aims: There are few published registry studies from Asia on pediatric inflammatory bowel disease (IBD). Registry network data enable comparisons among ethnic groups. This study examined the characteristics of IBD in Japanese children and compared them with those in European children. Methods: This was a cross-sectional multicenter registry study of newly diagnosed Japanese pediatric IBD patients. The Paris classification was used to categorize IBD features, and results were compared with published EUROKIDS data. Results: A total of 265 pediatric IBD patients were initially registered, with 22 later excluded for having incomplete demographic data. For the analysis, 91 Crohn's disease (CD), 146 ulcerative colitis (UC), and 6 IBD-unclassified cases were eligible. For age at diagnosis, 20.9% of CD, 21.9% of UC, and 83.3% of IBD-unclassified cases were diagnosed before age 10 years. For CD location, 18.7%, 13.2%, 64.8%, 47.3%, and 20.9% were classified as involving L1 (ileocecum), L2 (colon), L3 (ileocolon), L4a (esophagus/stomach/duodenum), and L4b (jejunum/proximal ileum), respectively. For UC extent, 76% were classified as E4 (pancolitis). For CD behavior, B1 (non-stricturing/non-penetrating), B2 (stricturing), B3 (penetrating), and B2B3 were seen in 83.5%, 11.0%, 3.3%, and 2.2%, respectively. A comparison between Japanese and European children showed less L2 involvement (13.2% vs. 27.3%, P<0.01) but more L4a (47.3% vs. 29.6%, P<0.01) and L3 (64.8% vs. 52.7%, P<0.05) involvement in Japanese CD children. Pediatric perianal CD was more prevalent in Japanese children (34.1% vs. 9.7%, P<0.01). Conclusions: Upper gastrointestinal and perianal CD lesions are more common in Japanese children than in European children. (Intest Res 2020;18:412-420)

7Pathophysiological role of Atg5 in human ulcerative colitis

저자 : Razieh Ardali , Nasrin Kazemipour , Saeed Nazifi , Kamran Bagheri Lankarani , Iman Razeghian Jahromi , Masood Sepehrimanesh

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 421-429 (9 pages)

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Background/Aims: Ulcerative colitis (UC), along with Crohn's disease, is one of the main types of inflammatory bowel disease (IBD). On the other hand, deregulated autophagy is involved in many chronic diseases, including IBD. In this study, we aimed to investigate the role of Atg5 and microRNA-181a (miR-181a) in the pathophysiology of UC. Methods: Colon biopsy, stool, and blood samples of 6 men and 9 women were confirmed for UC. Also, 13 men and 17 women were selected as healthy control (HC). Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry were used to measure the Atg-5 content of the colon biopsies. Besides, the serum and stool levels of Atg5 were measured using ELISA. Moreover, the total RNA of blood cells was extracted and evaluated for the expression of miR-181a. Results: We found 1.2 ng/mL versus 0.46 ng/mL, 0.34 ng/mL versus 0.24 ng/mL, and 0.082 ng/mL versus 0.062 ng/mL of Atg5 in stool, intestinal tissue, and serum of UC and HCs, respectively. There was no significant difference in the expression of miR-181a in the blood samples of UC and HCs. Immunohistochemistry showed high positivity without any significant difference between the 2 groups in the quantitative analysis. Conclusions: The significant difference observed between the stool Atg5 content of the HCs and UC patients may provide new insight into using this protein as a diagnostic biomarker, however, considering the small size of our studied population further studies are needed. (Intest Res 2020;18:421-429)

8Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study

저자 : Jamilya Kaibullayeva , Aliya Ualiyeva , Ainash Oshibayeva , Anar Dushpanova , John K. Marshall

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 430-437 (8 pages)

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Background/Aims: There has been a paucity of published data on the epidemiology of inflammatory bowel disease (IBD) in Central Asia and Kazakhstan. Therefore, we aimed to study IBD prevalence and patient awareness among adults in Kazakhstan. Methods: The cross-sectional study was carried out among subjects of both sexes aged 18 years and older using IBD Alert Questionnaire (CalproQuest), single fecal calprotectin test, and endoscopy with biopsy to verify IBD from January to December 2017, across regions of Kazakhstan. All participants were included in the study after providing informed consent. Results: Out of 115,556 subjects, there were 128 confirmed IBD cases, in which 36 Crohn's disease (CD) and 92 ulcerative colitis (UC) cases identified. The age and sex-adjusted IBD prevalence were 113.9 (95% confidence interval [CI], 69.0-158.9) per 100,000 population. The age- and sex-adjusted prevalence for UC were 84.4 (95% CI, 44.8-123.9) and for CD were 29.5 (95% CI, 8.2-50.9) per 100,000 population. Conclusions: This is the first report on the prevalence of IBD with a verified diagnosis in the Central Asia and could be used to better plan and allocate healthcare resources for IBD management program. (Intest Res 2020;18:430-437)

9Advanced neoplasia detection using chromoendoscopy and white light colonoscopy for surveillance in patients with inflammatory bowel disease

저자 : Kyeong Ok Kim , Michael V. Chiorean

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 438-446 (9 pages)

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Background/Aims: Chromoendoscopy (CE) has been shown to be superior to white light endoscopy (WLE) for neoplasia detection in inflammatory bowel disease (IBD). We aimed to compare the yield of CE and WLE for the detection of overall neoplasia and advanced neoplasia in IBD. Methods: Patients who underwent surveillance colonoscopy from 1999 to 2017 were identified from our IBD database. CE procedures were compared with their respective WLE controls in a paired comparison, and frequency of all neoplasia, advanced neoplasia, and serrated neoplasia was assessed for both targeted and random biopsies. Results: A total of 290 procedures performed in 98 individuals were identified with a median follow-up 4 years (median 3 colonoscopies/patient). CE and WLE were performed in 159 and 131 episodes, respectively. CE detected neoplasia in 40.9% of colonoscopies versus 23.7% with WLE (P=0.002). In addition, CE detected more advanced neoplasia (18.2% vs. 6.1%, P=0.002) and serrated lesions (14.5% vs. 6.1%, P=0.022). Significantly fewer samples were obtained per procedure with CE (14.9±9.7 vs. 20.9±11.1, P<0.001). Cancer was diagnosed in 2 cases. Conclusions: CE has a higher detection rate than WLE for advanced neoplasia and serrated lesions in patients with IBD under surveillance. Further prospective studies evaluating the impact of CE on decreasing the risk of interval cancer and colectomy in IBD patients are warranted. (Intest Res 2020;18:438-446)

10Psychological profiles of irritable bowel syndrome patients with different phenotypes

저자 : Michel Bouchoucha , Ghislain Devroede , Noëlle Girault-lidvan , Maria Hejnar , Florence Mary , Robert Benamouzig

발행기관 : 대한장연구학회 간행물 : Intestinal research (Intest Res) 18권 4호 발행 연도 : 2020 페이지 : pp. 459-483 (25 pages)

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Background/Aims: Abnormal psychological profiles are frequently found in patients with functional gastrointestinal disorders (FGIDs). The present study aimed to evaluate the psychological profiles of FGID patients with irritable bowel syndrome (IBS), and IBS phenotypes. Methods: In 608 FGID patients, including 235 with IBS, have filled a Rome III questionnaire and the French version of the Minnesota Multiphasic Personality Inventory 2. Data analysis was performed using univariate analysis and multivariate logistic regression. Results: This study shows that IBS patients have abnormal psychological profiles with more significant symptom exaggeration and decreased test defensiveness than non-IBS patients. They have a significantly higher score for all clinical scales. Logistic regression analysis showed in IBS patients a decrease of body mass index (P=0.002), and test defensiveness score K (P=0.001) and an increase of Hypochondriasis (P<0.001) and Masculinity-Femininity scale (P=0.018). By comparison with non-IBS patients, IBS-constipation, IBS-diarrhea, and mixed IBS patients have increased Hypochondriasis value and Depression score, mixed IBS patients have higher Psychasthenia score and higher Hypomania score. No item was significantly different in the IBS-unspecified group. Conclusions: This study shows that IBS patients have different psychological profiles than other FGID patients and that psychological characteristics are associated with IBS phenotypes except for patients with unsubtyped IBS. (Intest Res 2020;18:459-468)

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