Colonoscopy CS is the standard for assessing disease activity in ulcerative colitis UC, although invasive and poorly tolerated. Bowel ultrasound BUS may be a valid alternative in UC patients; ...however, the comparative accuracy between BUS and CS is unknown.
Consecutive patients with UC were prospectively assessed by CS and BUS. Colonic wall thickening CWT >3 mm, colonic wall flow at power Doppler CWF, colonic wall pattern CWP, and presence of lymph nodes evaluated at BUS were compared with CS. The endoscopic activity was assessed according to the Mayo endoscopic sub-score 0-3. All BUS investigations were performed by two independent gastroenterologists and the kappa statistic for agreement was calculated. Ultrasonography-based criteria (Humanitas Ultrasound Criteria HUC) were developed.
A total of 53 UC patients 56% with left-sided colitis, 19% with pancolitis were prospectively enrolled. Of these, 22 patients had mucosal healing Mayo endoscopic sub-score 0-1 and 31 patients were in endoscopic activity. CWT, CWF, hypoechogenic CWP and the presence of lymph nodes significantly correlated with endoscopic activity p < 0.05. CWT p = 0.01 and CWF p = 0.09 were independent predictors for endoscopic activity. The HUC developed are: i the presence of a CWF and CWT > 3 mm; or ii the absence of a CWF and CWT > 4.43 mm. They showed high accuracy for the detection of disease activity sensitivity 0.71, specificity 1.00. The interobserver agreement for BUS was excellent kappa 0.86.
BUS is a non-invasive, easy-to-use tool to manage UC patients in clinical practice. HUC were very accurate in assessing disease activity in UC patients.
Abstract
Background
Intestinal ultrasound IUS is a promising and non-invasive cross-sectional imaging modality in the diagnosis and monitoring of ulcerative colitis UC. Unlike endoscopy, where ...standardized scoring for evaluation of disease activity is widely used, scoring for UC with IUS is currently unavailable. Therefore, we conducted a study to assess the reliability of IUS in UC among expert sonographists in order to identify robust parameters.
Methods
Thirty patients with both clinically active 25 and quiescent five UC were included. Six expert sonographers first agreed upon key IUS parameters and grading, including bowel wall thickness BWT, colour Doppler signal CDS, inflammatory fat i-fat, loss of bowel wall stratification BWS, loss of haustrations and presence of lymph nodes. Thirty video-recorded cases were blindly reviewed.
Results
Inter-observer agreement was almost perfect for BWT (intra-class correlation coefficient ICC: 0.96) and substantial for CDS κ = 0.63. Agreement was moderate for presence of lymph nodes κ = 0.41 and fair for presence of i-fat κ = 0.36, BWS κ = 0.24 and loss of haustrations κ = 0.26. Furthermore, there was substantial agreement for presence of disease activity on IUS κ = 0.77 and almost perfect agreement for disease severity ICC: 0.93. Most individual parameters showed a strong association with IUS disease activity as measured by the six readers.
Conclusion
IUS is a reliable imaging modality to assess disease activity and severity in UC. Important individual parameters such as BWT and CDS are reliable and could be incorporated in a future UC scoring index. Standardized acquisition and assessment of UC utilizing IUS with established reliability is important to expand the use of IUS globally.
Intestinal ultrasound (IUS) is a non‐invasive and accurate tool to assess inflammatory bowel disease. The ECCO‐ESGAR guideline recommends the use of IUS for the assessment of disease activity and ...complications in Crohn's disease (CD). In addition, an increasing body of evidence suggests the use of IUS as alternative to colonoscopy in monitoring CD and in assessing disease activity of ulcerative colitis. Early responsiveness of IUS findings by the first weeks of treatment and the advantage to perform the procedure in real time may dramatically change frequency of the assessment of treatment response in the future and speed up the clinical decision‐making process. Development of validated and reproducible sonographic scores to measure disease activity and therapeutic response and spread of knowledge of IUS remain relevant issues for the future in which current researchers and the International Bowel Ultrasound (IBUS) Group are actively engaged.
Immune-mediated gastrointestinal (GI) diseases, including achalasia, celiac disease, and inflammatory bowel diseases, pose significant challenges in diagnosis and management due to their complex ...etiology and diverse clinical manifestations. While genetic predispositions and environmental factors have been extensively studied in the context of these conditions, the role of viral infections and virome dysbiosis remains a subject of growing interest. This review aims to elucidate the involvement of viral infections in the pathogenesis of immune-mediated GI diseases, focusing on achalasia and celiac disease, as well as the virome dysbiosis in IBD. Recent evidence suggests that viral pathogens, ranging from common respiratory viruses to enteroviruses and herpesviruses, may trigger or exacerbate achalasia and celiac disease by disrupting immune homeostasis in the GI tract. Furthermore, alterations in the microbiota and, specifically, in the virome composition and viral–host interactions have been implicated in perpetuating chronic intestinal inflammation in IBD. By synthesizing current knowledge on viral contributions to immune-mediated GI diseases, this review aims to provide insights into the complex interplay between viral infections, host genetics, and virome dysbiosis, shedding light on novel therapeutic strategies aimed at mitigating the burden of these debilitating conditions on patients’ health and quality of life.
Inflammatory bowel diseases (IBD) are chronic, relapsing, and destructive inflammatory disorders of the gastrointestinal tract. Both Crohn's disease (CD) and ulcerative colitis (UC) seem to arise ...from an impaired dialog between the environment and gut microbiota in genetically susceptible hosts, leading to an inappropriate immune activation and resulting in the over-production of pro-inflammatory cytokines. IL-6 is a key modulator of inflammatory response. It is a phylogenetically important cytokine with relevance in IBD, as well as in other chronic inflammatory diseases and cancer. Influencing the production of this cytokine can change the balance of effector CD4+ T cell subsets and induce B cell antibody production. Moreover, given IL-6 is mostly produced from innate immune cells such as macrophages, neutrophils and mast cells, it is a strategic bridge between the innate and the adaptive system. Interestingly, IL-6 induced signaling can be primarily seen in a relatively small number of IL-6 responsive cells whereas in a chronic phase of inflammation it is able to activate almost all cells of the body through a process known as trans-signaling. In this review, we discuss the role of IL-6 in chronic inflammation, with particular emphasis on its role in CD and UC, and we explore the potential to develop anti-IL-6 agents for IBD treatment.
The risk of coronavirus disease-19 infection for healthcare professionals and patients in hospitals remains unclear.
We investigated whether precautions adopted in our inflammatory bowel disease ...(IBD) unit have minimized the risks of infection for all patients accessing our facilities in a 1-month period by assessing the rate of coronavirus disease-19 infection in the follow-up period.
Three hundred-twenty patients with IBD were included. None were infected from severe acute respiratory syndrome-coronavirus 2 in the follow-up period. None of the IBD team members were infected.
Neither pharmacological immunosuppression nor access to the hospital seem to be risk factors for infection in patients with IBD.
The dysregulation of the gut-brain axis in chronic inflammatory bowel diseases can cause neuro-psychological disturbances, but the underlying mechanisms are still not fully understood. The choroid ...plexus (CP) maintains brain homeostasis and nourishment through the secretion and clearance of cerebrospinal fluid. Recent research has demonstrated the existence of a CP vascular barrier in mice which is modulated during intestinal inflammation.
This study investigates possible correlations between CP modifications and inflammatory activity in patients with Crohn's disease (CD).
In this prospective study, 17 patients with CD underwent concomitant abdominal and brain 3 T MRI. The volume and permeability of CP were compared with levels of C-reactive protein (CRP), fecal calprotectin (FC), sMARIA and SES-CD scores.
The CP volume was negatively correlated with CRP levels (R = -0.643, p-value = 0.024) and FC (R = -0.571, p-value = 0.050). DCE metrics normalized by CP volume were positively correlated with CRP (K-trans: R = 0.587, p-value = 0.045; Vp: R = 0.706, p-value = 0.010; T1: R = 0.699, p-value = 0.011), and FC (Vp: R = 0.606, p-value = 0.037).
Inflammatory activity in patients with CD is associated with changes in CP volume and permeability, thus supporting the hypothesis that intestinal inflammation could affect the brain through the modulation of CP vascular barrier also in humans.
•Inflammation in Crohn's disease is associated with changes in the choroid plexus•Choroid plexus volume and DCE-MRI permeability change with the inflammation level•The plexus vascular barrier may constitute a gut-brain gateway of inflammation
Over the past decades, the advent of anti-TNF agents has dramatically changed the treatment algorithms for IBD. However, primarily and more importantly, secondary loss of response to anti-TNF agents, ...is often observed. Thus, new treatment options have been actively explored and some have already been incorporated in the current clinical practice. Among the class of anti-cytokine agents, the anti-IL12/IL23 monoclonal antibodies (mAbs) have been first presented, in clinical practice, by the anti-p40 mAb ustekinumab in Crohn's disease (CD). More selective anti-IL23 agents (anti-p19) have shown efficacy and are being further developed, in contrast to agents inhibiting IL-17 downstream, which have failed in IBD clinical trials despite their clear efficacy in psoriasis.
The current coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has required a complete change in the management of patients ...with inflammatory bowel disease (IBD) who need to undergo endoscopic procedures. Several preventive measures must be taken to avoid the spread of infection among health-care professionals and patients with IBD, including the use of personal protective equipment, greater attention to endoscopic room hygiene and rescheduling of non-urgent procedures. This Perspective aims to provide a guide based on the Italian and French experience to better face the difficulties encountered by endoscopists during this global health emergency. In particular, recommendations regarding the use of personal protective equipment to prevent COVID-19 transmission, both for patients and health-care professionals, are proposed and different scenarios in endoscopic IBD management are evaluated to suggest when endoscopy could be rescheduled and replaced by alternative biomarkers.
SARS-CoV-2 is a novel coronavirus that expanded worldwide, generating a pandemic of acute respiratory syndrome called "coronavirus disease 2019" (COVID-19), which resulted in a global health crisis. ...The spectrum of COVID-19 manifestations ranges from none or mild symptoms to severe respiratory failure associated with systemic manifestations, mostly gastrointestinal symptoms. Hypercoagulability is an important feature of COVID-19 disease, which can potentially influence patients' prognosis. Therefore, gastroenterologists should focus on subjects with concomitant hypercoagulable gastrointestinal disorders as they may display a higher risk of thrombotic complications during SARS-CoV-2 infection. The aim of this review is to summarize the available evidence regarding the interplay of the prothrombotic pathogenetic mechanisms of both COVID-19 and hypercoagulable digestive diseases and the possible clinical implications. We summarized the potential interplay of prothrombotic mechanisms of both COVID-19 and hypercoagulable digestive diseases in the graphical abstract.
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