Clinical utility of fecal biomarkers for the diagnosis and management of inflammatory bowel disease.

Diagnosis and monitoring of inflammatory bowel diseases rely on clinical, endoscopic, and radiologic parameters. Inflammatory biomarkers have been investigated as a surrogate marker for endoscopic diagnosis of inflammatory activity. Fecal inflammatory biomarkers such as calprotectin and lactoferrin are direct products of bowel inflammation and provide an accurate and noninvasive diagnostic and monitoring modality for Crohn's disease and ulcerative colitis.

Dose optimization is effective in ulcerative colitis patients losing response to infliximab: a collaborative multicentre retrospective study.

Background: Subjects maintained on infliximab scheduled therapy for inflammatory bowel disease may require dose optimization due to secondary loss of response. There are limited data on infliximab dose optimization for ulcerative colitis.

Aims: To investigate dose optimization in ulcerative colitis patients with secondary loss of response.

The temporal evolution of antidrug antibodies in patients with inflammatory bowel disease treated with infliximab.

Objective: To characterise the temporal evolution of antibodies to infliximab (ATI).

Design: Prospective observational study of infliximab-treated patients with inflammatory bowel disease between 2009 and 2012.

Interventions: Trough levels of infliximab and ATI were measured before each infusion by anti-λ ELISA.

Clinical applications of small bowel capsule endoscopy.

Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.

Severe and morbid obesity in Crohn's disease patients: prevalence and disease associations.

Background: Crohn's disease (CD) is frequently associated with weight loss and malnutrition. However, as the prevalence of obesity increases worldwide, it may become a clinical problem even in CD.

Aim: To assess the prevalence of severe/morbid obesity in CD patients and to compare their disease characteristics to nonobese CD patients.

Optimizing anti-TNF treatments in inflammatory bowel disease.

Background: Failure of anti-TNF treatment in inflammatory bowel disease (IBD) patients can take on several forms, each posing distinct etio-pathogenic considerations and management dilemmas.

Aim: The aim of this study is to review the mechanisms responsible for the various forms of anti-TNF failures in IBD and to elucidate strategies for optimizing clinical efficacy.

Results: Primary failures of anti-TNF induction therapy occur in up to 40% of patients in clinical trials and in 10-20% in clinical series.

Cytomegalovirus positive ulcerative colitis: A single center experience and literature review.

Aim: To compare the clinical outcome of cytomegalovirus (CMV)-positive ulcerative colitis (UC) patients with and without antiviral therapy.

Methods: This was a retrospective case-controlled study. The database of UC patients in our institution was scanned for documented presence of CMV on colonic biopsies.

Magnetic resonance enterography in Crohn's disease: a guide to common imaging manifestations for the IBD physician.

Patients with Crohn's disease (CD) frequently require cross-sectional imaging. Magnetic resonance enterography (MRE) is an accurate tool for assessment of bowel disease and of various complications of CD. The lack of non-ionizing radiation exposure is an important advantage of this imaging modality.

Addition of an immunomodulator to infliximab therapy eliminates antidrug antibodies in serum and restores clinical response of patients with inflammatory bowel disease.

There are few therapeutic options for patients with inflammatory bowel disease who lose response to infliximab because they produced antibodies against the drug. We performed a retrospective analysis to investigate whether administration of immune modulators to 5 patients who developed antibodies to infliximab (ATI) restored response to this drug; 3 patients were given azathioprine/6-mercaptopurine and 2 patients were given methotrexate. Concentrations of infliximab and ATIs, and antitumor necrosis factor (TNF) activity, were analyzed using enzyme-linked immunosorbent assay-based competition assays of serum samples collected before and after patients were given the immunomodulator.

Idiopathic liver function test abnormality in pregnancy is associated with assisted reproduction techniques.

Objective: To examine the prevalence, etiology, risk factors, and outcomes of liver abnormality in pregnancy, in a tertiary medical center, and to study the potential impact of artificial reproduction techniques (ART) on the incidence and the outcome of pregnancy-related liver abnormality.

Design: A retrospective case-control study using an electronic database and patients' files.

Setting: Tertiary referral center.

Obesity, metabolic syndrome and the risk of development of colonic diverticulosis.

Introduction: Colonic diverticulosis is a common condition with obscure pathogenesis. Obesity, hyperlipidemia and hypertension have been demonstrated to increase the risk of complicated diverticular disease, but the impact of metabolic risk factors on the prevalence of uncomplicated diverticulosis has not been clearly determined.

Aims: The aim of the study was to examine the impact of obesity and metabolic syndrome on the prevalence of colonic diverticulosis.

A patient with ulcerative colitis and central serous chorioretinopathy--a therapeutic dilemma.

We report a case of a patient with ulcerative colitis and central serous retinopathy, which is a chronic ophthalmological condition that is frequently aggravated by corticosteroid treatment and may sometimes result in severe visual impairment. This case represents an interesting therapeutic dilemma pertaining to the treatment of ulcerative colitis exacerbation in a patient with this rare condition. Awareness of this condition as a cause of visual disturbance in IBD patients and a close ophthalmological cooperation are required in order to provide the optimal care for these patients.

Prior varicella zoster virus exposure in IBD patients treated by anti-TNFs and other immunomodulators: implications for serological testing and vaccination guidelines.

Background: Varicella zoster virus (VZV) is a severe and preventable infection in immunosuppressed IBD patients. ECCO guidelines recommend VZV immunisation in patients with negative VZV exposure history. The value of patient-reported VZV exposure history for prediction of seropositivity in IBD patients remains unknown.

Anti-tumor necrosis factor and postoperative complications in Crohn's disease: systematic review and meta-analysis.

Background: Anti-tumor necrosis factor (TNF) antibodies are efficacious in patients with Crohn's disease (CD) but the influence of these medications on surgical outcomes in CD patients has been frequently debated. The aim was to evaluate the impact of preoperative treatment with anti-TNF antibodies on postoperative complications in CD patients undergoing abdominal surgery.

Methods: A systematic review and meta-analysis of comparative cohort studies was performed assessing postoperative complication rates in CD patients who were treated with anti-TNF antibodies within 3 months before surgery versus patients who were not.

Clinical and radiographic presentation of superior mesenteric vein thrombosis in Crohn's disease: a single center experience.

Background: Mesenteric vein thrombosis (MVT) is a rare and frequently underdiagnosed complication of Crohn's disease (CD). This study describes the clinical and radiological characteristics of CD /patients with superior mesenteric vein thrombosis (MVT) diagnosed by CT/MRI.

Patients And Methods: The database of Crohn's disease patients treated in Sheba Medical Center between 2005-2010 was searched for MVT diagnosis.

The decline of anti-drug antibody titres after discontinuation of anti-TNFs: implications for predicting re-induction outcome in IBD.

Background: Anti-drug antibodies can be elicited by infliximab and adalimumab, but the rate of their decay after therapy is stopped is unknown.

Aim: To investigate the decline of anti-drug antibody titre after anti-TNF cessation, and to evaluate the clinical utility of anti-drug antibody measurement before anti-TNF re-induction.

Methods: Inflammatory bowel disease (IBD) patients who stopped anti-TNF therapy and had measurable anti-drug antibodies were prospectively followed up by serial blood measurements of antibodies levels.

Detection of infliximab in breast milk of nursing mothers with inflammatory bowel disease.

Introduction: Limited data suggest the absence of infliximab in breast milk, thereby implying the safety of this drug during breast-feeding. We aimed to re-evaluate the presence of infliximab in breast milk of nursing IBD patients.

Methods: Serum and breast milk were obtained post-partum from 3 breast-feeding patients with Crohn's disease before and after re-initiation of infliximab.

Travel-associated health risks for patients with inflammatory bowel disease.

Background & Aims: There are few data on risk of travel for patients with inflammatory bowel disease (IBD). We assessed rates of illness while traveling among patients with IBD.

Methods: We performed a retrospective, case-controlled study of illnesses among 222 patients with IBD and 224 healthy individuals (controls) during 1099 total trips.

Clinical utility of antihuman lambda chain-based enzyme-linked immunosorbent assay (ELISA) versus double antigen ELISA for the detection of anti-infliximab antibodies.

Background: Anti-infliximab antibodies (ATIs) are associated with lower serum infliximab (IFX) trough levels and diminished clinical response. The current most prevalent method for detection of ATI is a double-antigen (DA) enzyme-linked immunosorbent assay (ELISA) utilizing IFX for ligand and detection antibody. Serum IFX interferes with ATI measurement in this method.

Head or tail: the orientation of the small bowel capsule endoscope movement in the small bowel.

Background And Aims: The diagnostic accuracy of capsule endoscopy has been suggested to be influenced by the direction of the passage in the intestine. It is currently unknown if a head-first or a tail-first orientation are equally common during the descent through the small bowel. The aim of the study was to identify the orientation of the capsule along the migration through the small bowel.

Reciprocal regulation of CXCR4 and CXCR7 in intestinal mucosal homeostasis and inflammatory bowel disease.

IBDs are characterized by increased influx of immune cells to the mucosa of genetically susceptible persons. Cellular migration to injury sites is mediated by chemokines. CXCL12 is a ubiquitous, constitutive chemokine that participates in stem cell proliferation and migration and mediates T lymphocyte migration to inflamed tissues.

H1N1 vaccines in a large observational cohort of patients with inflammatory bowel disease treated with immunomodulators and biological therapy.

Background: Safety data are lacking on influenza vaccination in general and on A (H1N1)v vaccination in particular in patients with inflammatory bowel disease (IBD) receiving immmunomodulators and/or biological therapy.

Aims And Methods: The authors conducted a multicentre observational cohort study to evaluate symptoms associated with influenza H1N1 adjuvanted (Pandemrix, Focetria, FluvalP) and non-adjuvanted (Celvapan) vaccines and to assess the risk of flare of IBD after vaccination. Patients with stable IBD treated with immunomodulators and/or biological therapy were recruited from November 2009 until March 2010 in 12 European countries.

Familial ulcerative colitis in Israeli Jews: its prevalence and clinical severity compared to sporadic disease.

Background: A family history of inflammatory bowel disease (IBD) is present in some ulcerative colitis (UC) patients. We aimed to investigate the familial occurrence of UC and its impact on disease severity.

Methods: A structured questionnaire was distributed to patients with UC.

The efficacy of shortening the dosing interval to once every six weeks in Crohn's patients losing response to maintenance dose of infliximab.

Background: Patients treated with infliximab for Crohn's disease (CD) frequently require intensified dosage due to loss of response. There are scant data regarding the efficacy of shortening the dosing interval to 6 weeks.

Aim: We sought to investigate the efficacy of a once every 6 weeks' strategy compared with dose-doubling.