OBJECTIVE: Crohn's disease (CD) can be associated with a wide range of extraintestinal manifestations (EIMs), including neurological ones. Published studies differ in their conclusions about the epidemiology and etiopathogenesis of neurological EIMs. The aims of this study were to demonstrate the presence and find risk factors of peripheral (somatic and autonomic) neuropathy patients with severe CD on anti-TNFα biological therapy. MATERIAL AND METHODS: A clinical examination focusing on detection of peripheral sensor-motor nervous dysfunction (including Sudoscan) and examination of autonomic nervous system dysfunction (using Ewing ́s battery tests and spectral analysis) together with laboratory tests and collection of demographic data followed by administration of questionnaires were performed on a total of 30 neurologically asymptomatic outpatients with severe CD on anti-TNFα biological therapy. RESULTS: Peripheral sensor-motor nervous function via clinical neurological examination was pathological in 36.7% and Sudoscan in 33.3% of cases. Statistically significant associations between vibration perception test and age, CD and biological therapy duration, body mass index and Crohn's Disease Activity Index were proved while statistically significant associations between temperature perception test and age and BMI were proved as well. Additionally, a decrease of total protein in a patient ́s serum below the physiological cut-off in the 6 months prior to measurement was associated with a pathological result of a Sudoscan. Cardiovascular autonomic neuropathy based on Ewing ́s battery tests was present in 56.7% of patients, no statistically significant risk factors were found. Our peripheral neuropathy questionnaire correlated with the results of the Sudoscan test and some tests of the clinical examination of peripheral sensor-motor nervous function (discriminatory contact perception test, temperature perception test). CONCLUSIONS: This study demonstrated a relatively high prevalence of peripheral (especially autonomic) neuropathy and verified some risk factors for the development of peripheral somatic neuropathy in asymptomatic patients with severe form of CD on anti-TNFα biological therapy.
- MeSH
- autonomní nervový systém MeSH
- biologická terapie MeSH
- Crohnova nemoc * farmakoterapie epidemiologie komplikace MeSH
- lidé MeSH
- nemoci autonomního nervového systému * MeSH
- nemoci periferního nervového systému * MeSH
- TNF-alfa terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The cost of caring for patients with inflammatory bowel disease (IBD) continues to increase worldwide. The cause is not only a steady increase in the prevalence of Crohn's disease and ulcerative colitis in both developed and newly industrialised countries, but also the chronic nature of the diseases, the need for long-term, often expensive treatments, the use of more intensive disease monitoring strategies, and the effect of the diseases on economic productivity. This Commission draws together a wide range of expertise to discuss the current costs of IBD care, the drivers of increasing costs, and how to deliver affordable care for IBD in the future. The key conclusions are that (1) increases in health-care costs must be evaluated against improved disease management and reductions in indirect costs, and (2) that overarching systems for data interoperability, registries, and big data approaches must be established for continuous assessment of effectiveness, costs, and the cost-effectiveness of care. International collaborations should be sought out to evaluate novel models of care (eg, value-based health care, including integrated health care, and participatory health-care models), as well as to improve the education and training of clinicians, patients, and policy makers.
- MeSH
- Crohnova nemoc * epidemiologie MeSH
- gastroenterologie * MeSH
- idiopatické střevní záněty * epidemiologie terapie MeSH
- lidé MeSH
- náklady na zdravotní péči MeSH
- ulcerózní kolitida * epidemiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Nespecifické střevní záněty (IBD) jsou skupinou zánětlivých onemocnění postihujících zažívací trakt. Incidence a prevalence IBD v dětství jsou na vzestupu. IBD se klasifikují na Crohnovu chorobu (CD) a ulcerózní kolitidu (UC). Speciální jednotky tvoří IBD u dětí mladších 6 let (VEO-IBD) a IBD s nediferencovaným postižením tlustého střeva (IBD-U). Etiologie IBD je multifaktoriální a není dosud plně objasněna. Genetické predispozice, alterace střevní mikrobioty, dieta a faktory životního prostředí v ní zcela jistě hrají roli. Klinické projevy CD se odvíjí od lokalizace postižení a obvykle se skládají z bolestí břicha, nauzey, zvracení, průjmů s/bez příměsi krve a hubnutí. U UC jsou typicky bolesti břicha s imperativními defekacemi průjmovitých stolic s makroskopickou příměsí krve. Stanovení diagnózy IBD je postaveno na anamnéze, fyzikálním vyšetření, laboratorních nálezech a zobrazovacích metodách, zejména endoskopiích.
Inflammatory bowel disease (IBD) is a group of inflammatory illnesses affecting the gastrointestinal tract. The incidence and prevalence of paediatric IBD is on the rise. IBD is classified into Crohn's disease (CD) and Ulcerative colitis (UC). Special subunits consist of IBD affecting children younger than 6 years of age (VEO-IBD) and undifferentiated affection of the colon (IBD-U). IBD aetiology is multifactorial and still not fully understood. Genetic predisposition, alterations of gut microbiota, diet and environmental factors play a role in its development. Clinical manifestations of CD depend on disease location, and they usually consist of abdominal pain, nausea, vomiting, diarrhoea with/out blood and weight loss. UC presents with abdominal pain and imperative defecations of bloody diarrheal stools. Establishing IBD diagnosis is based on careful history, thorough physical examination, laboratory work and imaging methods, mainly endoscopies.
- MeSH
- Crohnova nemoc diagnóza epidemiologie etiologie MeSH
- diagnostické zobrazování metody MeSH
- dítě MeSH
- endoskopie trávicího systému metody MeSH
- idiopatické střevní záněty * diagnóza epidemiologie etiologie MeSH
- kapslová endoskopie metody MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- ulcerózní kolitida diagnóza epidemiologie etiologie MeSH
- ultrasonografie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Background and Aims: The pathogenesis and risk factors for early postoperative endoscopic recurrence of Crohn's disease (CD) remain unclear. Thus, this study aimed to identify whether histological inflammation at the resection margins after an ileocaecal resection influences endoscopic recurrence. Methods: We have prospectively followed up patients with CD who underwent ileocaecal resection at our hospital between January 2012 and January 2018. The specimens were histologically analysed for inflammation at both of the resection margins (ileal and colonic). We evaluated whether histological results of the resection margins are correlated with endoscopic recurrence of CD based on colonoscopy 6 months after ileocaecal resection. Second, we assessed the influence of known risk factors and preoperative therapy on endoscopic recurrence of CD. Results: A total of 107 patients were included in our study. Six months after ileocaecal resection, 23 patients (21.5%) had an endoscopic recurrence of CD. The histological signs of CD at the resection margins were associated with a higher endoscopic recurrence (56.5% versus 4.8%, p < 0.001). Disease duration from diagnosis to surgery (p = 0.006) and the length of the resected bowel (p = 0.019) were significantly longer in patients with endoscopic recurrence. Smoking was also proved to be a risk factor for endoscopic recurrence (p = 0.028). Conclusions: Histological inflammation at the resection margins was significantly associated with a higher risk of early postoperative endoscopic recurrence after an ileocaecal resection for CD.
- MeSH
- anastomóza chirurgická MeSH
- chirurgická rána * imunologie MeSH
- chirurgie trávicího traktu * metody škodlivé účinky MeSH
- Crohnova nemoc * chirurgie diagnóza epidemiologie imunologie MeSH
- endoskopie trávicího systému metody statistika a číselné údaje MeSH
- ileocekální chlopeň chirurgie patologie MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace chirurgie diagnóza MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- MeSH
- Crohnova nemoc * diagnóza epidemiologie terapie MeSH
- dítě MeSH
- idiopatické střevní záněty * diagnóza epidemiologie terapie MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND AND AIMS: The pathogenesis and risk factors for early postoperative endoscopic recurrence of Crohn's disease [CD] remain unclear. Thus, this study aimed to identify whether histological inflammation at the resection margins after an ileocaecal resection influences endoscopic recurrence. METHODS: We have prospectively followed up patients with CD who underwent ileocaecal resection at our hospital between January 2012 and January 2018. The specimens were histologically analysed for inflammation at both of the resection margins [ileal and colonic]. We evaluated whether histological results of the resection margins are correlated with endoscopic recurrence of CD based on colonoscopy 6 months after ileocaecal resection. Second, we assessed the influence of known risk factors and preoperative therapy on endoscopic recurrence of CD. RESULTS: A total of 107 patients were included in our study. Six months after ileocaecal resection, 23 patients [21.5%] had an endoscopic recurrence of CD. The histological signs of CD at the resection margins were associated with a higher endoscopic recurrence [56.5% versus 4.8%, p < 0.001]. Disease duration from diagnosis to surgery [p = 0.006] and the length of the resected bowel [p = 0.019] were significantly longer in patients with endoscopic recurrence. Smoking was also proved to be a risk factor for endoscopic recurrence [p = 0.028]. CONCLUSIONS: Histological inflammation at the resection margins was significantly associated with a higher risk of early postoperative endoscopic recurrence after an ileocaecal resection for CD.
- MeSH
- anastomóza chirurgická škodlivé účinky MeSH
- chirurgická rána imunologie MeSH
- chirurgie trávicího traktu škodlivé účinky metody MeSH
- Crohnova nemoc * diagnóza epidemiologie imunologie chirurgie MeSH
- disekce MeSH
- endoskopie trávicího systému * metody statistika a číselné údaje MeSH
- ileocekální chlopeň patologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace * diagnostické zobrazování imunologie patologie MeSH
- recidiva MeSH
- rizikové faktory MeSH
- zánět patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Stricture formation is a common complication of Crohn's disease, resulting from the disease process, surgery, or drugs. Endoscopic balloon dilation has an important role in the management of strictures, with emerging techniques, such as endoscopic electroincision and stenting, showing promising results. The underlying disease process, altered bowel anatomy from disease or surgery, and concurrent use of immunosuppressive drugs can make endoscopic procedures more challenging. There is an urgent need for the standardisation of endoscopic procedures and peri-procedural management strategies. On the basis of an extensive literature review and the clinical experience of the consensus group, which consisted of representatives from the Interventional Inflammatory Bowel Disease Group, we propose detailed guidance on all aspects of the principles and techniques for endoscopic procedures in the treatment of inflammatory bowel disease-associated strictures.
- MeSH
- Crohnova nemoc komplikace diagnostické zobrazování epidemiologie patologie MeSH
- dilatace přístrojové vybavení MeSH
- gastrointestinální endoskopie metody MeSH
- hodnocení výsledků zdravotní péče MeSH
- idiopatické střevní záněty komplikace terapie MeSH
- imunosupresiva škodlivé účinky MeSH
- konsensus MeSH
- lidé MeSH
- přežití po terapii bez příznaků nemoci MeSH
- rizikové faktory MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- stenóza etiologie patologie terapie MeSH
- stenty škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Research Support, N.I.H., Extramural MeSH
- MeSH
- Crohnova nemoc epidemiologie MeSH
- idiopatické střevní záněty * epidemiologie MeSH
- lidé MeSH
- registrace MeSH
- statistika jako téma MeSH
- ulcerózní kolitida epidemiologie MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- Crohnova nemoc epidemiologie MeSH
- idiopatické střevní záněty * epidemiologie MeSH
- lidé MeSH
- registrace MeSH
- ulcerózní kolitida epidemiologie MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- biologická terapie metody MeSH
- Crohnova nemoc epidemiologie komplikace MeSH
- incidence MeSH
- interleukin-17 antagonisté a inhibitory aplikace a dávkování MeSH
- léková kontraindikace MeSH
- lidé MeSH
- nežádoucí účinky léčiv epidemiologie etiologie MeSH
- přední uveitida epidemiologie imunologie MeSH
- psoriáza epidemiologie komplikace MeSH
- spondylartritida * diagnostické zobrazování farmakoterapie imunologie MeSH
- TNF-alfa antagonisté a inhibitory aplikace a dávkování MeSH
- výběr pacientů MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
