ObjectiveTo summarize the recent progress in studies of intestinal immunity in inflammatory bowel disease (IBD). MethodsThe literatures on studying the intestinal immunity in IBD, including ulcerative colitis and Crohn disease were reviewed and analyzed. ResultsIBD comprised two main diseases that cause inflammation of the intestines: ulcerative colitis and Crohn disease. Although the diseases had some features in common, there were some important differences in clinical symptoms and pathological features. Accumulating evidence suggested that IBD results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host. Immunity studies highlighted the importance of host-microbe interactions in the pathogenesis of these diseases. Prominent among these findings were genomic regions containing nucleotide oligomerization domain 2 (NOD2), autophagy genes, miRNAs, and components of the interleukin-23/type 17 helper T-cell (Th17) pathway. The disfunction of the intestinal microbiome, intestinal epithelium, intestinal immune cells, and the intestinal vasculature played a key role in the process of IBD. The treatment with monoclonal antibody had been introduced to treat IBD and had been certificated effective. ConclusionThe study of basic intestinal immunity and regulation network of molecules in pathogenic process of IBD provides theory basis on prevention of IBD, while related genes of IBD can offer more gene therapy targets.
Crohn’s disease (CD) is a chronic, remitting and segmental inflammatory disease of the gastrointestinal tract, radiological examinations play critical roles in the diagnosis of CD. The common radiological examinations include ultrasound examinations of intestine, computed tomography enterography (CTE), and magnetic resonance enterography (MRE) in clinic. The application of CTE and MRE is limited because of radiation exposure or higher costs. The ultrasound examinations of intestine including conventional intestinal ultrasound, ultrasonic elastography, and contrast-enhanced ultrasound have been studied because of the advantages of non-invasiveness and convenience. The accuracy of the intestinal ultrasound has been already partially validated in assisting diagnosis and evaluating the disease activity and location in CD patients. This review aims at summarizing the diagnostic potency and prospect of the application of ultrasound examinations of intestine in CD patients.
ObjectiveTo investigate the current research status and its developing trend of Crohn’s disease (CD) in Chinese journals in the past 40 years, and to provide reference for future research on CD.MethodsWith “Crohn’s disease” as the retrieval word, the literature about CD published from January 1978 to December 2017 were retrieved in the SinoMed database. The distributions of publication dates, journals, research institutions, and regions of literature were analyzed by EndNote, Excel, MySQL, and GraphPad Prism softwares.ResultsA total of 2 140 papers matched the searching criteria, including 1 391 papers published in the core journals. The number of papers increased by year, especially in the past 20 years, the growth rate of the total number of papers every 5 years was 96.67%, 202.54%, 85.15%, and 29.35%, respectively. A total of 152 papers met the criteria of evidence-based documents, and the proportion of evidence-based articles in the total papers every 5 years was 2.54%, 3.92%, 4.69%, and 12.16%, respectively. In the respect of region distribution of literature, the first addresses of 1 060 papers were in East China, accounting for 50.36% of the total number of papers. Jiangsu Province, Guangdong Province, Shanghai, Zhejiang Province, and Beijing had published a total of 1 257 papers, accounting for 59.71% of the total number of papers. In our research field, most of the studies were conducted by teaching hospitals.ConclusionsIn the past 40 years, the output of research on CD increased significantly in China. The proportion of evidence-based articles has increased, while the number of evidence-based research still needs to be improved. The regional distribution of literature was unbalanced, and teaching hospitals played a vital role in the research field.
目的 探讨外科治疗克罗恩病的手术时机及手术方式。方法 回顾性分析了1998～2012年期间笔者所在医院收治的13例克罗恩病手术患者的临床资料。结果 13例患者中行急诊手术6例，择期手术7例；行左半结肠切除术2例，回盲部并小肠切除术4例，部分小肠切除术4例，右半结肠切除术2例，全结肠切除回肠造口术1例。本组仅7例获随访，随访时间12～48个月，平均38个月，有2例患者分别于术后16个月和31个月死亡，死亡原因为营养不良，消化道出血，多脏器功能衰竭；另外5例预后良好。结论 对克罗恩病正确把握手术时机及选择手术方式，围手术期结合激素及免疫抑制剂治疗是取得满意治疗效果的关键。
ObjectiveTo investigate long-term efficacy of infliximab (IFX) combined with seton placement in treatment of perianal fistulizing Crohn disease (CD) and to analyze factors affecting its clinical healing and recurrence.MethodsThe patients with perianal fistulizing CD underwent the IFX combined with seton placement therapy from July 2010 to January 2017 were collected from the HIS database of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The healing and recurrence of perianal fistulizing CD were counted and their influencing factors were analyzed.ResultsA total of 103 patients with perianal fistulizing CD were included in the study. After a median follow-up of 36 months, 64 patients (62.1%) had a complete fistula healing, 34 patients (33.0%) relapsed. The cumulative recurrence rates of fistula in the 1, 3, and 5 years was 21.8%, 32.6%, and 37.4%, respectively. The multivariate analysis showed that the Montreal classification B1 ［HR=3.987, 95% CI (1.640, 9.694), P=0.023］ and without abscess ［HR=2.724, 95% CI (1.101, 6.740), P=0.030］ were positively associated with the long-term healing of fistula, and the IFX maintenance treatment >3 times ［HR=5.497, 95% CI (1.197, 25.251), P=0.028］ was a risk factor for the recurrence of the fistula.ConclusionsLong-term healing rate of fistula by IFX combined with seton placement therapy is higher. Montreal classification B1, without abscess, and IFX maintenance treatment less than 3 times are expected to have a better long-term efficacy.
Crohn’s disease (CD) is one of inflammatory bowel diseases, characterized by lifelong relapsing-remitting clinical course. The choice of treatment protocols is based on the comprehensive evaluation of the disease. And the treatment protocols should be adjusted according to the response to the treatment and the drug tolerance. Repeated assessment of the activity of intestinal inflammation is very necessary. Each of endoscopy, Crohn’s Disease Activity Index, CT, magnetic resonance enterography, and ultrasonography (US) has its own disadvantages. US is widely used in clinical practice because of its no radiation, convenience, low cost, and high degree of patient tolerance. The two-dimensional ultrasound, Doppler ultrasound, elastosonography, and contrast-enhanced ultrasonography each provides some effective parameters for evaluation of CD activity. Some parameters are of high value, such as bowl wall thichness, bowl wall stratification, color Doppler signal, strain ratio, and relative enhancement, etc. The values of some parameters are disputed, such as the blood flow of superior mesenteric artery, time to peak, etc. Some studies combine several ultrasound parameters and calculate their respective weights to obtain an ultrasound scoring method. US, as a valid tool to evaluate CD activity, provides valuable help in solving clinical problems such as evaluation of therapeutic effect, mucosal healing, and postoperative recurrence.
ObjectiveTo summarize the occurrence of anal fistula in Crohn disease (CDAF) accompanying with preoperative rectal stenosis and analyze its influencing factors. Meanwhile to explore the effect of improved anal sphincter retention virtual-hanging (hereafter this text will be abbreviated as virtual-hanging) for treatment of CDAF. MethodsThe CDAF patients admitted to the Third People’s Hospital of Bengbu from January 2019 to June 2021 were retrospectively collected, who were treated with virtual-hanging. Meanwhile the multivariable logistic regression analysis was used to identify the risk factors for accompanying with preoperative rectal stenosis and which were used to establish a decision tree model by Chi squared automatic interaction detection method. ResultsA total of 234 patients with CDAF were collected, and the incidence of accompanying with preoperative rectal stenosis was 22.2% (52/234). The multivariate logistic regression analysis found that the patients with preoperative proctitis, Montreal subtype B2, fistula located above the musculi levator ani (MLA), single fistula accompanied by branches or multiple fistulas, lymphocyte count (Lym) ≥6.03×109/L, platelet count (PLT) ≥0.61×109/L, erythrocyte sedimentation rate (ESR) ≥39.11 mm/h, C-reactive protein (CRP) ≥5.13 mg/L, and brain natriuretic peptide (BNP) ≥313.26 ng/L had higher probability of accompanying with preoperative rectal stenosis (P<0.05). For the patients with or without preoperative rectal stenosis, the CD activity index score and perianal CD activity index score, and anal resting pressure all showed decreasing trends after treatment with the virtual-hanging, and the anal maximal contraction pressure showed a increasing trend as compared to before treatment. The decision tree consisted 18 nodes and 9 terminal nodes. The gain map of the decision tree model gradually increased from 0% to 100%; The index chart maintained a high level starting from 198% and then rapidly decreased to 100%. The area under the receiver operating characteristic curve of the decision tree model was 0.852 [95%CI (0.821, 0.908)], with a sensitivity of 84.35% and a specificity of 82.33%. ConclusionsThe incidence of accompanying with preoperative rectal stenosis in patients with CDAF is relatively higher. The effect of virtual-hanging for treatment of CDAF is better. For patients with preoperative proctitis, Montreal subtype B2, fistula above the MLA, single fistula accompanied by branches or multiple fistulas, and higher Lym, PLT, ESR, CRP, and BNP, attention should be paid to their accompanying with preoperative rectal stenosis. The decision tree model based on these factors to distinguish whether accompanying with preoperative rectal stenosis is better.
Objective To explore key genes and mechanisms of depression aggravating Crohn disease. Methods In March 2023, the Public Health Genomics and Precision Health Knowledge Base and Gene Expression Omnibus database were used to identify the overlapping differentially expressed genes between Crohn disease and depression and the key genes were screened by Metascape, STRING, Cytoscape, and protein interaction network analysis. The Gene Expression Omnibus database was used to analyze the correlations between key genes and clinical pathologies such as Crohn Disease Endoscopic Index of Severity and intestinal microvilli length. Results There were 137 overlapping differentially expressed genes between Crohn disease and depression, and 25 key genes were further screened out. Among them, CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A genes were significantly correlated with multiple clinical parameters. The functions of PROK2 and PROK2-related genes were mainly enriched in neutrophil and granulocyte migration, neutrophil and granulocyte chemotaxis, etc. Conclusions There are 25 key genes, especially CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A, that possibly contribute to the establishment and deterioration of Crohn disease caused by depressive disorder. Among these genes, PROK2 showes the possibility of regulating immune cell (neutrophils and CD8+ T cells) infiltration.
ObjectiveTo understand progress of stem cell transplantation in treatment of complex anal fistula.MethodThe relevant literatures were searched in the PubMed, Web of Science, CNKI, Wanfang, and other databases and the clinical efficacy, advantages and problems of the therapy were analyzed and summarized.ResultsThe stem cells currently used in the field of complex anal fistula were mainly the adipose tissue-derived stem cells, which had the biological characteristics of regenerative differentiation, immune regulation, and repair of intestinal mucosal barrier, which could be used as the seed cells for the treatment of complex anal fistula, its effectiveness was worthy of recognition. But its long-term clinical efficacy remained to be seen due to its clinical treatment options were different and lack of uniform standards. The safety of treatment for complex anal fistula was payed a attention because the stem cells had the oncogene activation and tumor suppressor gene inactivation characteristics.ConclusionsStem cell transplantation, as an emerging therapy, has broad prospects for patients with complex anal fistula that are difficult to solve by surgery, but its long-term efficacy is still unsatisfactory. Due to current sample size, short observation time, and lack of randomized control, current clinical data is not convincing, and high cost also limits its development of technology.