Browsing by Subject "inflammatory bowel disease"

Now showing 1 - 8 of 8
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    Deep Learning Algorithm for the Confirmation of Mucosal Healing in Crohn’s Disease, Based on Confocal Laser Endomicroscopy Images
    (2021) Udristoiu, Anca Loredana; Stefanescu, Daniela; Gruionu, Gabriel; Gruionu, Lucian Gheorghe; Iacob, Andreea Valentina; Karstensen, John Gasdal; Vilman, Peter; Saftoiu, Adrian; Medicine, School of Medicine
    Background and Aims: Mucosal healing (MH) is associated with a stable course of Crohn’s disease (CD) which can be assessed by confocal laser endomicroscopy (CLE). To minimize the operator’s errors and automate assessment of CLE images, we used a deep learning (DL) model for image analysis. We hypothesized that DL combined with convolutional neural networks (CNNs) and long short-term memory (LSTM) can distinguish between normal and inflamed colonic mucosa from CLE images. Methods: The study included 54 patients, 32 with known active CD, and 22 control patients (18 CD patients with MH and four normal mucosa patients with no history of inflammatory bowel diseases). We designed and trained a deep convolutional neural network to detect active CD using 6,205 endomicroscopy images classified as active CD inflammation (3,672 images) and control mucosal healing or no inflammation (2,533 images). CLE imaging was performed on four colorectal areas and the terminal ileum. Gold standard was represented by the histopathological evaluation. The dataset was randomly split in two distinct training and testing datasets: 80% data from each patient were used for training and the remaining 20% for testing. The training dataset consists of 2,892 images with inflammation and 2,189 control images. The testing dataset consists of 780 images with inflammation and 344 control images of the colon. We used a CNN-LSTM model with four convolution layers and one LSTM layer for automatic detection of MH and CD diagnosis from CLE images. Results: CLE investigation reveals normal colonic mucosa with round crypts and inflamed mucosa with irregular crypts and tortuous and dilated blood vessels. Our method obtained a 95.3% test accuracy with a specificity of 92.78% and a sensitivity of 94.6%, with an area under each receiver operating characteristic curves of 0.98. Conclusions: Using machine learning algorithms on CLE images can successfully differentiate between inflammation and normal ileocolonic mucosa and can be used as a computer aided diagnosis for CD. Future clinical studies with a larger patient spectrum will validate our results and improve the CNN-SSTM model.
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    Functional gastrointestinal symptoms in patients with inflammatory bowel disease: A clinical challenge
    (Elsevier, 2018) Colombel, Jean-Frederic; Shin, Andrea; Gibson, Peter R.; Medicine, School of Medicine
    Description The purpose of this clinical practice update review is to describe key principles in the diagnosis and management of functional gastrointestinal (GI) symptoms in patients with inflammatory bowel disease (IBD). Methods The evidence and best practices summarized in this manuscript are based on relevant scientific publications, systematic reviews, and expert opinion where applicable. Best practice advice 1 A stepwise approach to rule-out ongoing inflammatory activity should be followed in IBD patients with persistent GI symptoms (measurement of fecal calprotectin, endoscopy with biopsy, cross-sectional imaging). Best practice advice 2 In those patients with indeterminate fecal calprotectin levels and mild symptoms, clinicians may consider serial calprotectin monitoring to facilitate anticipatory management. Best practice advice 3 Anatomic abnormalities or structural complications should be considered in patients with obstructive symptoms including abdominal distention, pain, nausea and vomiting, obstipation or constipation. Best practice advice 4 Alternative pathophysiologic mechanisms should be considered and evaluated (small intestinal bacterial overgrowth, bile acid diarrhea, carbohydrate intolerance, chronic pancreatitis) based on predominant symptom patterns. Best practice advice 5 A low FODMAP diet may be offered for management of functional GI symptoms in IBD with careful attention to nutritional adequacy. Best practice advice 6 Psychological therapies (cognitive behavioural therapy, hypnotherapy, mindfulness therapy) should be considered in IBD patients with functional symptoms. Best practice advice 7 Osmotic and stimulant laxative should be offered to IBD patients with chronic constipation. Best practice advice 8 Hypomotility agents or bile-acid sequestrants may be used for chronic diarrhea in quiescent IBD. Best practice advice 9 Antispasmodics, neuropathic-directed agents, and anti-depressants should be used for functional pain in IBD while use of opiates should be avoided. Best practice advice 10 Probiotics may be considered for treatment of functional symptoms in IBD. Best practice advice 11 Pelvic floor therapy should be offered to IBD patients with evidence of an underlying defecatory disorder. Best practice advice 12 Until further evidence is available, fecal microbiota transplant should not be offered for treatment of functional GI symptoms in IBD. Best practice advice 13 Physical exercise should be encourage in IBD patients with functional GI symptoms. Best practice advice 14 Until further evidence is available, complementary and alternative therapies should not be routinely offered for functional symptoms in IBD.
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    IgA Nephropathy in the Setting of Anti-TNF-α Therapy for Inflammatory Bowel Disease
    (Wolters Kluwer, 2020-09-01) Strobel, Thomas; Ahmed, Waseem; De la Sancha, Carlo; Bohm, Matthew; Fischer, Monika; Medicine, School of Medicine
    Tumor necrosis factor-α (TNF-α)-inhibiting agents are a standard therapy for moderate-to-severe inflammatory bowel disease (IBD). IgA nephropathy in the setting of prolonged exposure to TNF-α inhibitors is a rare, clinically significant adverse event often overlooked by gastroenterologists but well documented in the rheumatologic literature. We present a case series of 3 patients with IBD on TNF-α inhibitors who developed biopsy-proven IgA nephropathy. Clinicians prescribing TNF-α inhibitors to patients with IBD need to be aware of this potential side effect. Therapies with alternative mechanisms of action should instead be considered.
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    The Incidence of Venous Thromboembolism in Children Following Colorectal Resection for Inflammatory Bowel Disease: A Multi-Center Study
    (Elsevier, 2020) Bence, Christina M.; Traynor, Michael D., Jr.; Polites, Stephanie F.; Ha, Derrick; Muenks, Pete; St. Peter, Shawn D.; Landman, Matthew P.; Densmore, John C.; Potter, D. Dean, Jr.; Surgery, School of Medicine
    Background/Purpose Children with inflammatory bowel disease (IBD) have increased risk for venous thromboembolism (VTE). We sought to determine incidence and risk factors for postoperative VTE in a multicenter cohort of pediatric patients undergoing colorectal resection for IBD. Methods Retrospective review of children ≤18 years who underwent colorectal resection for IBD from 2010 to 2016 was performed at four children's hospitals. Primary outcome was VTE that occurred between surgery and last follow-up. Factors associated with VTE were determined using univariable and multivariable analyses. Results Two hundred seventy-six patients were included with median age 15 years [13,17]. Forty-two children (15%) received perioperative VTE chemoprophylaxis, and 88 (32%) received mechanical prophylaxis. DVT occurred in 12 patients (4.3%) at a median of 14 days postoperatively [8,147]. Most were portomesenteric (n = 9, 75%) with the remaining catheter-associated DVTs in extremities (n = 3, 25%). There was no association with chemoprophylaxis (p > 0.99). On Cox regression, emergent procedure [HR 18.8, 95%CI: 3.18–111], perioperative plasma transfusion [HR 25.1, 95%CI: 2.4–259], and postoperative infectious complication [HR 10.5, 95%CI: 2.63–41.8] remained predictive of DVT. Conclusion Less than 5% of pediatric IBD patients developed postoperative VTE. Chemoprophylaxis was not protective but rarely used. Patients with risk factors identified in this study should be monitored or given prophylaxis for VTE.
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    Mental Health Screening as the Standard of Care in Pediatric Inflammatory Bowel Disease
    (AMA, 2019-08) Bennett, William E., Jr.; Pfefferkorn, Marian D.; Pediatrics, School of Medicine
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    Outcomes of Fecal Microbiota Transplantation in Patients With Inflammatory Bowel Diseases and Recurrent Clostridioides difficile Infection
    (Elsevier, 2020) Allegretti, Jessica R.; Kelly, Colleen R.; Grinspan, Ari; Mullish, Benjamin H.; Kassam, Zain; Fischer, Monika; Medicine, School of Medicine
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    Serologic, but Not Genetic, Markers Are Associated With Impaired Anthropometrics at Diagnosis of Pediatric Crohn's Disease
    (Wolters Kluwer, 2019-11) Naramore, Sara K.; Bennett, William E., Jr.; Jiang, Guanglong; Kugathasan, Subra; Denson, Lee A.; Hyams, Jeffrey S.; Steiner, Steven J.; Pediatrics, School of Medicine
    Objectives: Children with Crohn's disease may present with malnutrition and linear growth impairment, which can be secondary to insufficient caloric intake, chronic inflammation, malabsorption, and suppression of growth-promoting hormones. We evaluated clinical, serologic, and genetic data to determine risk factors for impaired anthropometrics in Crohn's disease at diagnosis. Methods: Our study evaluated 772 children newly diagnosed with Crohn's disease, inflammatory phenotype, enrolled in the RISK Stratification Project to determine the factors associated with anthropometric impairment. Data were collected on demographics, growth parameters, disease location, serologic and immunologic markers, and disease severity. We performed a genome-wide association study of genetic polymorphisms associated with inflammatory bowel disease. Regression analysis determined associations between anthropometrics and clinical, serologic, and genetic variables. Results: There were 59 (7%) children with height z score <−2, 126 (14%) with a weight z score <−2, and 156 (17%) with a body mass index z score <−2. Linear growth impairment was associated with hypoalbuminemia (P = 0.0052), elevated granulocyte-macrophage colony stimulating factor autoantibodies (P = 0.0110), and elevated CBir antibodies against flagellin (P = 0.0117). Poor weight gain was associated with female sex (P = 0.0401), hypoalbuminemia (P = 0.0162), and thrombocytosis (P = 0.0081). Malnutrition was associated with hypoalbuminemia (P = 0.0061) and thrombocytosis (P = 0.0011). Children with moderate or severe disease had lower weight (P = 0.02 and P = 1.16×10−6, respectively) and body mass index z scores (P = 2.7 × 10−3 and P = 1.01 × 10−6, respectively) than children with quiescent and mild disease. There was no association between age of diagnosis, Tanner stage, or disease location and having impaired anthropometrics. There was no genome-wide association between the genetic polymorphisms and the serologic variables and anthropometric measurements. Conclusions: This is the largest study evaluating growth in treatment-naïve children with Crohn's disease, inflammatory phenotype. It is the first study to use genome-wide sequencing to assess for genetic determinants of growth impairment. Granulocyte-macrophage colony stimulating factor autoantibodies and CBir antibodies are more likely to be elevated in children with growth impairment. Future investigations should evaluate the relationship between genetic polymorphisms, pathologic immune responses, and the biological pathways regulating growth.
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    Symptom Clusters and Self-Management in Adolescents with Inflammatory Bowel Disease
    (2024-07) Malloy, Caeli Louise; Miller, Wendy Trueblood; Rawl, Susan; Kroenke, Kurt; Monahan, Patrick; Steiner, Steven
    Inflammatory bowel disease (IBD) encompasses a range of chronic conditions, including Crohn’s disease and ulcerative colitis, that cause intestinal inflammation and wide-ranging, debilitating symptoms. Adolescents and young adults represent the peak age group diagnosed with IBD. For individuals with IBD, engaging in effective disease self-management and symptom management is crucial to supporting quality of life. However, youth are often ill-equipped to handle the challenges of managing a chronic condition in the context of the typical developmental challenges of adolescence and young adulthood. This dissertation explored self-management challenges and symptoms in adolescents and young adults with IBD. First, an integrative review of the literature on symptom clusters in individuals with IBD was conducted. Results revealed that symptom clusters remain an understudied phenomenon in IBD research, illuminating a gap in current understanding of the symptom experience of individuals with IBD. Second, the self-management challenges of adolescents with IBD were explored in a thematic analysis of 83 posts made in an online IBD support community. Six emerging themes about self-management challenges were identified: Desire for Normalcy; Dietary Changes; Education and Career; Healthcare System; Relationships with Others; and Symptoms and Complications. Results underscored the ways in which IBD self-management challenges permeate every aspect of life for adolescents living with the condition. Finally, a cross-sectional survey of symptoms and self-management was conducted in 105 adolescents 13-17 years old with IBD. Through latent class analysis, three symptom cluster profiles were identified: a high symptom burden profile, a low symptom burden profile, and a low energy profile. Regression analysis revealed significant demographic and self-management predictors of symptom profile membership. The results of these studies will guide future research to develop and test theoretically grounded, tailored self-management interventions aimed at promoting effective symptom management and enhancing quality of life in adolescents with IBD.