1,721,103 research outputs found
I nuovi farmaci sono in grado di modificare la storia naturale delle malattie infiammatorie intestinali?
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Predicting the durability of biological therapy in pediatric Crohn's disease: do the immunomodulators matter?
No full textInteractions Between Intestinal Microbiota and Innate Immune System in Pediatric Inflammatory Bowel Disease
No full textInflammatory bowel disease (IBD) is the result of an altered immune homeostasis within the intestinal mucosa against the gut microbiota, leading to chronic inflammation in genetically predisposed individuals. Under normal conditions, the immune system defends against pathogens and prevents the passage of excessive intestinal bacteria; regulatory pathways must maintain a low-grade, controlled inflammation in a healthy gut, but also induce a protective response against pathogens. The innate immune system is the first-line defense from microbes; dendritic cells, macrophages, and epithelial cells produce an initial, immediate response. The immune system constantly controls commensal bacteria and utilizes constitutive antimicrobial mechanisms to sustain immune homeostasis. The discovery that several genes linked to IBD modulate microbial recognition and innate immune pathways, such as nucleotide oligomerization domain 2 (Nod2), and genes that mediate autophagy (ie, ATG16L1, IRGM), has highlighted the critical role of host-microbe interactions in controlling intestinal immune homeostasis. Commensal microorganisms actively interact with the intestinal mucosa and influence the activity of the immune system as well as the amplitude of the immune response. In contrast, host factors can influence microbes, which in turn modulate disease susceptibility. In this paper, we focus on the mechanisms that mediate host-microbe interactions and how the disruption of this balance leads to chronic intestinal inflammation in IBD.Inflammatory bowel disease (IBD) is the result of an altered immune homeostasis within the intestinal mucosa against the gut microbiota, leading to chronic inflammation in genetically predisposed individuals. Under normal conditions, the immune system defends against pathogens and prevents the passage of excessive intestinal bacteria; regulatory pathways must maintain a low-grade, controlled inflammation in a healthy gut, but also induce a protective response against pathogens. The innate immune system is the first-line defense from microbes; dendritic cells, macrophages, and epithelial cells produce an initial, immediate response. The immune system constantly controls commensal bacteria and utilizes constitutive antimicrobial mechanisms to sustain immune homeostasis. The discovery that several genes linked to IBD modulate microbial recognition and innate immune pathways, such as nucleotide oligomerization domain 2 (Nod2), and genes that mediate autophagy (ie, ATG16L1, IRGM), has highlighted the critical role of host-microbe interactions in controlling intestinal immune homeostasis. Commensal microorganisms actively interact with the intestinal mucosa and influence the activity of the immune system as well as the amplitude of the immune response. In contrast, host factors can influence microbes, which in turn modulate disease susceptibility. In this paper, we focus on the mechanisms that mediate host-microbe interactions and how the disruption of this balance leads to chronic intestinal inflammation in IBD
Mucosal healing in Crohn's disease: new insights
No full textIntroduction: Traditional management of patients with Crohn's disease includes symptoms and quality of life improvement. With the advent of biological agents, mucosal healing has become an achievable goal, documented through endoscopy. However, due to the transmural nature of inflammation, the prevention of bowel damage should be included in the aims of a targeted therapeutic strategy.Areas covered: Updated literature has been searched in PubMed from 2008 to 2020. This review focuses on the state of the art in the innovative therapeutic goals in Crohn's disease, also considering still controversial aspects and future research topics in the management of Crohn's disease.Expert opinion: Although a widely agreed view supports the notion that mucosal healing and bowel damage control may promote beneficial outcomes (i.e. reduction in hospitalization and surgical rates, avoidance of steroids), long-term robust data are still missing. On the other hand, the development of -omics techniques has expanded our knowledge of the pathogenetic mechanism underlying inflammatory bowel disease and opened up new horizons in precision or personalized medicine
Gut microbiota and pediatric disease
No full textBackground: Researchers have made every effort to assess the role of gut microbiota in pediatric diseases like inflammatory bowel disease (IBD), celiac disease, asthma, allergy, and autism. The leading hypothesis is that an altered microbial composition is present (other than the presence of a specific pathogen) and that it could be involved in the pathogenesis or progression of such disorders. Methods: Cultural, molecular, metabolomic, and metagenomic approaches are trying to define the pediatric gut microbiota imbalances in different diseases. Results and Conclusion: In pediatric IBD, a marked increase in aerobes and facultative anaerobes was found, along with an increase in Enterobacteriaceae members (Escherichia coli). In both pediatric IBD and celiac disease (Th1-mediated disorders), higher bacterial cell counts were observed, jointly with a general gain of biodiversity. A preponderance of Bacteroidetes and a parallel decrease of Firmicutes was also reported in IBD, celiac disease and autism. Contrarily, dietary changes due to Western lifestyles increase Firmicutes populations and lower short-chain fatty acids production, possibly exposing 'developed' children to the infectious challenge (Escherichia and Shigella spp.). Lactobacillus and Bifidobacterium species could be protective agents for atopic diseases, while Clostridia, Enterobacteriaceae, and staphylococci can be associated with an increased risk of such Th2-mediated disorders. In the brain-gut axis view, gut microbiota could also play a role in autism. Copyright (C) 2011 S. Karger AG, Base
Is Fecal Calprotectin a Useful Marker for Small Bowel Crohn Disease?
No full textObjectives: The identification of reliable non-invasive biomarkers of Crohn disease (CD) activity is crucial. Fecal calprotectin (FC) is the most promising one. We aimed to define whether its performance for isolated ileal CD could be as useful as for colonic and ileocolonic disease.Methods: Retrospective observational study of all pediatric patients affected with CD with FC and inflammatory blood markers performed within one week from an ileocolonoscopy or magnetic resonance enterography. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of FC >50 mcg/g were evaluated for isolated ileal CD (L1), colonic CD (L2) and ilecolonic CD (L3) using ilecolonoscopy and magnetic resonance enterography as the reference standard. The best FC cut-off for each disease location was evaluated using receiver operating characteristic curves.Results: One-hundred seventy-six FC measurements from a total of 98 patients were collected (14.3% L1, 10.2% L2, 75.5% L3). The sensitivity and specificity of FC for Ll CD were 36% and 91%, respectively, compared to 93% and 75% for L2 and 70% and 95% for L3. An FC of 95 mg/kg was identified as the best cut off for identification of active isolated ileal disease, with a sensitivity of 77% and a specificity of 56% [area under the curve (confidence interval [CI] 0.56- 0.97) 0.77, P = 0.02].Conclusions: With a sensitivity of 36%, FC alone does not accurately reflect isolated Ll disease activity. A significantly lower threshold should be applied for increasing its performance for isolated small bowel CD monitoring
A pediatric non-protein losing Menetrier's disease successfully treated with octreotide long acting release
No full textPediatric Menetrier's disease (MD) is an uncommon, acute, self-limited hypertrophic gastropathy characterized by enlarged gastric folds associated with epithelial hyperplasia and usually accompanied by protein losing gastropathy. Gastric cytomegalovirus infection is found in one third of MD children and its treatment is often associated with remission. Diagnosis often requires full-thickness biopsy due to inability to detect typical histological findings with conventional endoscopic biopsy. We report an uncommon case of non self-limited pediatric MD needing endoscopic mucosal resection for diagnosis which was then successfully treated with octreotide long-acting release (LAR). To the best of our knowledge, this is the first pediatric MD case successfully treated with octreotide LAR. Our experience suggests octreotide LAR as treatment for refractory MD before gastrectomy
Natural history of anemia and efficacy and safety of oral iron therapy in children newly diagnosed with inflammatory bowel disease
No full textObjectives: Anemia is one of the most common extraintestinal manifestations of pediatric inflammatory bowel disease (IBD). We aimed to evaluate the prevalence of anemia in children newly diagnosed with IBD and assess the efficacy and safety of oral iron therapy over a 12-month follow-up period. Methods: This single-center, retrospective, observational cohort study included all children newly diagnosed with IBD at the Pediatric Gastroenterology Unit of Sapienza University of Rome from May 2015 to May 2019 presenting with anemia. At baseline, demographic, clinical, laboratory data (hemoglobin, mean corpuscular volume, serum iron, ferritin, transferrin levels, erythrocyte sedimentation rate, and c-reactive protein), and treatment received, were recorded. Clinical and laboratory data, as well as anemia therapy and adverse events, were collected every three months during the 1-year follow-up. Results: Eighty-nine out of 140 patients newly diagnosed with IBD presented with anemia (64%), 13 were excluded due to incomplete follow-up, thus 76 were included [median age 12,7, (IQR 9.8-15), 25 (33%) Crohn's disease, 51 (67%) ulcerative colitis]. All patients received Sucrosomial Iron alone or in combination with intravenous ferric carboxymaltose. Treatment with SI was effective in 67 (88%) patients at the end of follow-up [37 (48%) within 3 months], regardless of anemia severity at baseline. No serious adverse events related to SI treatment were reported. Conclusions: We confirmed a high prevalence of anemia at the time of the diagnosis of pediatric IBD. Our data suggest that Sucrosomial Iron is safe and effective, leading to anemia resolution in approximately half of the patients within three months
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