Intestinal Behcet`s disease (BD), generally accepted as a type of inflammatory bowel disease (IBD), could be diagnosed when patients with BD have objectively documented gastrointestinal symptoms and ...intestinal ulcerations. Similar to IBD, intestinal BD has an unpredictable disease course with relapse and remission and is often related to a poor prognosis. However, there is no single gold standard for assessment of the disease activity of intestinal BD, and its diagnosis and management depend heavily on expert opinions. The Korean IBD Study Group recently developed novel diagnostic criteria based on colonoscopy findings and clinical manifestations using a modified Delphi process to overcome drawbacks of previously used consensus for the diagnosis of intestinal BD. In addition, the recently developed disease activity index for intestinal BD, consisting of a relatively simple 8-point index, could also help in determining treatment strategies and monitoring therapeutic responses. In this review, the progress in the diagnosis and disease activity measurement of intestinal BD will be discussed. (Intest Res 2017;15:311-317)
Background:
It is unknown whether the treatment initiating time of immunomodulators such as thiopurines affects the course of Crohn's disease (CD). We evaluated the efficacy of early immunomodulator ...therapy (EIT) on the prognosis of patients with CD.
Methods:
We retrospectively analyzed 1157 patients with CD who were enrolled in the CrOhn's disease cliNical NEtwork and CohorT study and received immunomodulator therapy. The patients were divided into an EIT group and a conventional therapy group based on whether immunomodulators were initiated within six months after being diagnosed with CD. We compared the rates of intestinal surgery, bowel complications, and hospitalization because of CD between the groups.
Results:
Patient age at diagnosis and sex were not significantly different between the two groups. The mean duration of follow‐up was 105.8 ± 51.5 months. A Kaplan–Meier analysis identified that the EIT group was superior to the conventional therapy group in terms of delaying surgery (P = 0.017). In multivariate analysis, EIT was an independent predicting factor associated with delaying the onset of complications (P = 0.050). Patients were divided into two groups based on the year of CD diagnosis: from 1982 to 1999 (A) and from 2000 to 2008 (B). In group A, the time from diagnosis to the start of immunomodulatory therapy was longer (P < 0.001), and the time to first intestinal surgery was shorter than group B (P = 0.002).
Conclusions:
The early use of immunomodulators was associated with a good prognosis as defined by a need for surgery and the occurrence of complications in CD in our multicenter study.
Background/Aims: The relationship between intestinal Behçet’s disease (BD) and cancer remains unclear. We conducted a nationwide, population-based study to determine the risk of cancer in patients ...with intestinal BD. Methods: Using the National Health Insurance claims records, we collected data on 365 patients who had been diagnosed with intestinal BD between 2011 and 2014. Standardized incidence ratios (SIRs) of overall and site-specific cancers in patients with intestinal BD in comparison with the general population were calculated. Results: Among 167 men with intestinal BD, four cases of cancer were observed; among 191 women with BD, eight cases of cancer were observed. The risk of all cancers was significantly higher in women with intestinal BD than in women of the general population (SIR, 4.27; 95% confidence interval CI, 1.84 to 8.41). However, in men with intestinal BD, the risk of all cancers was not significantly higher than that in men of the general population (SIR, 2.08; 95% CI, 0.57 to 5.33). The risk of hematologic cancer was significantly higher in both men and women with intestinal BD than in their counterparts in the general population (SIR, 23.90; 95% CI, 2.89 to 86.32 in men; SIR, 34.47; 95% CI, 4.17 to 124.51 in women). In particular, patients with intestinal BD showed a higher risk of leukemia and myelodysplastic syndrome than the general population. Conclusions: Patients with intestinal BD demonstrated a higher risk of hematologic cancer, especially leukemia, than the general population. Furthermore, women with intestinal BD showed a higher risk of all cancers. (Gut Liver 2018;12:433-439)
Background
Little is known about the factors that predict clinical relapse in Crohn’s disease patients receiving thiopurine therapy to maintain remission. The objective of this study was, therefore, ...to investigate these factors.
Methods
A total of 82 Crohn’s disease patients who received their first course of azathioprine or 6-mercaptopurine treatment at Severance Hospital between June 1996 and July 2007 were recruited to the study. During the follow-up period (25.5 ± 16.6 months) 19 patients (23.2%) discontinued the medication because of significant adverse effects. Forty-five patients who continued to receive thiopurines to maintain medically or surgically induced remission were enrolled in the study. After adjusting the maintenance dose, patients in remission were followed at 2–3 month intervals. Relapse was defined as a Crohn’s disease activity index ≥150.
Results
The male-to-female ratio was 1.5:1 and the mean age was 26.3 ± 7.1 years. Cumulative relapse was 18.0% after one year and 49.2% after three years. According to multivariate Cox regression analysis, younger age (<30 years) at thiopurine therapy and increased C-reactive protein level (≥0.5 mg/dL) at remission were independent predictors of relapse (hazard ratio 19.751, 95%-confidence interval (CI) 1.996–195.402,
P
= 0.011 and hazard ratio 9.001, 95% CI 1.583–51.181,
P
= 0.013, respectively).
Conclusions
Younger age (<30 years) and increased C-reactive protein level at remission were independent predictors of relapse in Crohn’s disease patients receiving thiopurines to maintain remission. These high-risk groups warrant closer observation and possibly early introduction of biological agents.
Recent European ancestry genome-wide association studies have identified genetic variants of IRGM as significant susceptibility loci for Crohn's disease (CD). Therefore, we investigated whether ...genetic variants of IRGM confer genetic susceptibility to CD or ulcerative colitis (UC) and evaluated the genotype-phenotype associations in the Korean population.
This study included 510 inflammatory bowel disease (IBD) patients (253 patients with CD and 257 with UC) and 520 healthy controls in Koreans. Initially, we performed direct sequencing analysis to identify unique IRGM single nucleotide polymorphisms (SNPs). Three selected haplotype-tagging SNPs and one risk locus (rs72553867, rs10065172, rs4958847, and rs12654043) within the IRGM were then geno-typed in patients and controls.
IRGM SNP rs10065172 was significantly associated with CD susceptibility in terms of allelic frequency (P = 0.004; odds ratio OR = 1.42) and genotype frequency (dominant model, P = 0.008; OR = 1.62). We also found a relationship between SNP rs72553867 and CD susceptibility in the analysis of allelic frequency (P = 0.0117; OR = 0.67) and genotype frequency (dominant model, P = 0.002; OR = 0.55). In addition, we observed that the association of CD with rs10065172 became stronger in patients with younger age at diagnosis (≤ 20 years) or male gender. However, there was no significant association between the four SNPs and UC susceptibility.
This is the first study to identify SNP rs10065172 and rs72553867 in IRGM as principal CD susceptibility loci in an Asian population.
