1,721,447 research outputs found
Surgical timing in the management of Crohn's disease in the era of biological drugs.
No full textBackground The indications and the timing for surgery are obviously related to the type of complications; but a key role, in choosing the most appropriate time to perform surgery, is played not only by factors related to patient but also by the evaluation of disease intrinsic characteristics:
stenosing/penetrating/inflammatory disease, disease activity, extension, prevalent localization and the response to medical therapy. Methods The authors analyzed the literature of the past two decades by integrating it with their personal experience. The authors have paid attention above all to Crohn’s disease management. Results Advances in medical therapy over the past two decades have substantially altered the management of patients with IBD. The introduction of more aggressive regimens (top down strategy) resulted in a change of surgery, which is no longer seen as “a last resort”, to be reserved for the treatment of a longstanding disease with more serious complications, but should also be seen as “early surgery”, able to induce remissions faster and perhaps more durable, at least in the short to medium term. It is logical to wonder whether this is also a result of a change in the natural history of the disease under the influence of new therapies. Biological drugs have proved to be able to induce remission (60%), to keep it free from steroids for short-medium periods and to return the integrity of the mucosa, which is important to control the disease. Mucosal healing leads to a decrease of complications’ rate, fewer hospitalizations and thus a possible reduction in the rate of surgical interventions. There are
still doubts about the real reduction of the need for surgery. Biological drugs have positive response only in 60% of cases and it is also possible to develop antibody reactions and resistance to the drug (10%). In addition, the disease often presents as a stenosing form, for which biologics are little or no effective and so surgery, even early, is required. Prolonged periods of remission are achieved only in 15% of cases. Borrowing the positive effects of antiTNF in the treatment of rheumatic diseases, we wondered if the use of biologics in Crohn’s disease may result in a change of the natural history of the disease. This problem remains unsolved. Doubts also remain about the actual reduction in the rate of hospitalization and in the need for surgery. Conflicting data emerge from randomized trials and observational studies. Conclusions There is still no evidence of a real reduction in the rate of interventions. Even today, the ideal treatment of Crohn’s disease is an unclear argument. Surgery plays a leading role and should not be considered only as “a last resort”; early surgery may indeed allow faster and more lasting remission
European Crohn's and Colitis Organisation Topical Review on Complementary Medicine and Psychotherapy in Inflammatory Bowel Disease
No full textEuropean Crohn's and Colitis Organisation Topical Review on Complementary Medicine and Psychotherapy in Inflammatory Bowel Diseas
European Crohn's and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn's Disease
Get PDFThis ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practic
European Crohn's and Colitis Organisation Topical Review on IBD in the Elderly
Get PDFThis ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focuses on the epidemiology, pathophysiology, diagnosis, management and outcome of the two most common forms of inflammatory bowel disease, Crohn's disease and ulcerative colitis, in elderly patients. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice
European Crohn's and Colitis Organisation Topical Review on Environmental Factors in IBD
No full textThis ECCO Topical Review of the European Crohn's and Colitis Organisation [ECCO] focuses on the role of environmental factors with respect to the development of inflammatory bowel disease [IBD] as well as their influence on the course of established IBD. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice
European Crohn's and Colitis Organisation Topical Review on Environmental Factors in IBD
Get PDFThis ECCO Topical Review of the European Crohn's and Colitis Organisation [ECCO] focuses on the role of environmental factors with respect to the development of inflammatory bowel disease [IBD] as well as their influence on the course of established IBD. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.</p
European Crohn's and Colitis Organisation Topical Review on Environmental Factors in IBD
No full textThis ECCO Topical Review of the European Crohn's and Colitis
Organisation {[}ECCO] focuses on the role of environmental factors with
respect to the development of inflammatory bowel disease {[}IBD] as well
as their influence on the course of established IBD. The objective was
to reach expert consensus to provide evidence-based guidance for
clinical practice
European evidence based consensus on surgery for ulcerative colitis.
No full textThe goal of this consensus initiated by the European Crohn's
and Colitis Organisation (ECCO) was to establish European
consensus guidelines for the surgical treatment of ulcerative
colitis. The strategy to reach the consensus involved several
steps and follows the standard operating procedures for
consensus guidelines of ECCO. An open call for chairs and
participants for this consensus was made (see acknowledgements
and www.ecco-ibd). Participants were selected by
the Guidelines' Committee of ECCO (GuiCom) on the basis of
their publication record and a personal statement
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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