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Medicina
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Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management
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Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 21918

Special Issue Editor

Dr. Tiziana Larussa

E-Mail Website
Guest Editor
Department of Health Sciences, University of Catanzaro ‘‘Magna Graecia’’, 88100 Catanzaro, Italy
Interests: inflammatory bowel disease; Crohn’s disease; ulcerative colitis; celiac disease; helicobacter pylori; clinical trials in inflammatory bowel disease; nutraceuticals in inflammatory bowel disease

Special Issue Information

Dear Colleagues,

Inflammatory bowel diseases (IBD), which are mainly represented by ulcerative colitis (UC) and Crohn’s disease (CD), are both characterized by a condition of chronic and relapsing intestinal inflammation. An interaction between genetic and environmental factors has been recognized in the pathogenesis of IBD, even if these mechanisms have yet to be clearly elucidated. The signs and symptoms comprise abdominal pain, diarrhea, rectal bleeding, weight loss, fever, and fatigue, and the presence of extra-intestinal manifestations, such as osteoarticular and skin involvement, is frequent. Although the so-called biologic era modified the therapeutic strategies for IBD patients, the undesirable side effects, the loss of response, and the higher costs associated with biologics heavily impact on their use. In addition to the specific medical demands, greater attention to other ‘unmet needs’ has gradually emerged in recent years for patients with IBD. Indeed, clinical management should deal with psychological distress, work disability, quality of life, and illness perceptions, and, to this purpose, the role of dedicated nursing staff is crucial for IBD patients’ optimal care. We invite investigators to contribute both with original research articles and review articles that aim to explore the complex IBD scenario, from pathogenetic mechanisms to management. Topics of interest include, but are not limited to:

  • epidemiology, clinical presentations, and extraintestinal manifestations;
  • genetic variations and immunological pathways;
  • host-microbe interaction and tolerance;
  • conventional therapies;
  • biologic therapies;
  • new biologics and small molecules;
  • drug-induced adverse events;
  • complications and surveillance;
  • social impact and related issues; and
  • nurses’ and caregivers’ roles.

Dr. Tiziana Larussa
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • inflammatory bowel disease
  • Crohn’s disease
  • ulcerative colitis
  • biologic therapy
  • JAK inhibitors
  • quality of life
  • nursing care
  • mucosal healing
  • safety

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Published Papers (6 papers)

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Research

Jump to: Review

15 pages, 5662 KiB  
Article
Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease?
by Pietro Valerio Foti, Mario Travali, Renato Farina, Stefano Palmucci, Maria Coronella, Corrado Spatola, Lidia Puzzo, Rossella Garro, Gaetano Inserra, Gaia Riguccio, Luca Zanoli and Antonio Basile
Medicina 2021, 57(3), 265; https://doi.org/10.3390/medicina57030265 - 15 Mar 2021
Cited by 10 | Viewed by 2471
Abstract
Background and Objectives: To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological [...] Read more.
Background and Objectives: To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. Material and Methods: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. Results: Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (p = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (p = 0.002). The ADC value negatively correlated with FS (p < 0.001) and was different between FS grades (p < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). Conclusions: Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients. Full article
(This article belongs to the Special Issue Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management)
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11 pages, 292 KiB  
Article
COVID-19 and Inflammatory Bowel Disease: Patient Knowledge and Perceptions in a Single Center Survey
by Rocco Spagnuolo, Tiziana Larussa, Chiara Iannelli, Cristina Cosco, Eleonora Nisticò, Elena Manduci, Amalia Bruno, Luigi Boccuto, Ludovico Abenavoli, Francesco Luzza and Patrizia Doldo
Medicina 2020, 56(8), 407; https://doi.org/10.3390/medicina56080407 - 13 Aug 2020
Cited by 15 | Viewed by 3009
Abstract
Background and objectives: Spreading of SARS-CoV-2 infection from China to countries with a higher prevalence of inflammatory bowel disease (IBD) has generated concern among gastroenterologists and patients. The aim of this survey is to evaluate knowledge about clinical importance of COVID-19, disease [...] Read more.
Background and objectives: Spreading of SARS-CoV-2 infection from China to countries with a higher prevalence of inflammatory bowel disease (IBD) has generated concern among gastroenterologists and patients. The aim of this survey is to evaluate knowledge about clinical importance of COVID-19, disease management, prevention measures, and anxiety level during pandemic among patients with IBD. Material and methods: From 15th March to 15th April 2020, a questionnaire survey was administered to 200 patients with IBD by email or phone application. The questionnaire consisted of five sections: (1) anthropometric, demographic and clinical characteristics, (2) knowledge about clinical importance of COVID-19, (3) IBD management, (4) prevention measures, (5) anxiety level during pandemic. Results: One hundred forty two questionnaires were completed. Ninety-seven patients (68.3%) were males with a mean age of 46 years (SD 13; range 17–76). Fifty-four individuals (38%) were affected by Crohn disease and 88 (62%) by Ulcerative Colitis. Most patients reported high knowledge about clinical importance of COVID-19 (80%), IBD management (72%), and prevention measures (97%). Sixty-two percent of them showed moderate-high level of anxiety. High education level was independently associated with high knowledge about clinical importance of COVID-19 (odds ratio [OR] 5, 95% confidence interval [CI] 1.49–16.6, p = 0.009) and older age (OR 1, 95%, CI 1.01–1.1, p = 0.01), while the receipt of e-format educational material with low knowledge about clinical importance of COVID-19 (OR 3, 95%, CI 1.08–9.3, p = 0.03). Displaying an active disease appeared to be independently associated with low knowledge of IBD management (OR 5.8, 95% CI 1.4–22.8, p = 0.01) and no variables other than an older age was independently associated with higher level of anxiety (OR 1.04, 95% CI 1.009–1.09, p = 0.01). Conclusions: High educational level and aging promote knowledge about clinical importance of COVID-19, while e-format educational material does not. Taken together with findings that an active disease status compromises knowledge of IBD management and the high level of anxiety related to increasing age, these data suggest the need of further supporting patient-oriented strategies in IBD during Covid-19 pandemic. Full article
(This article belongs to the Special Issue Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management)
9 pages, 1063 KiB  
Article
Gastrointestinal Symptoms of and Psychosocial Changes in Inflammatory Bowel Disease: A Nursing-Led Cross-Sectional Study of Patients in Clinical Remission
by Rosellina Margherita Mancina, Raffaele Pagnotta, Caterina Pagliuso, Vincenzo Albi, Daniela Bruno, Pietro Garieri, Patrizia Doldo and Rocco Spagnuolo
Medicina 2020, 56(1), 45; https://doi.org/10.3390/medicina56010045 - 20 Jan 2020
Cited by 31 | Viewed by 5256
Abstract
Background and Objectives: Nursing management in Inflammatory Bowel Disease (IBD) is focused on global patient care. Starting from basic knowledge of diagnostic and therapeutic management, nurses can assess the impact of IBD on patients’ quality of life not only at the physical [...] Read more.
Background and Objectives: Nursing management in Inflammatory Bowel Disease (IBD) is focused on global patient care. Starting from basic knowledge of diagnostic and therapeutic management, nurses can assess the impact of IBD on patients’ quality of life not only at the physical level, but also at the psychological, social, and emotional levels. The aim of this study was to evaluate the impact of gastrointestinal symptoms on psychosocial changes in IBD patients in remission through nursing-led Patient-Reported Outcomes. Materials and Methods: We performed a cross-sectional study of 109 IBD patients in clinical and endoscopic remission. Specialist nurses invited patients to complete questionnaires on gastrointestinal symptoms and quality of life through the Patient-Reported Outcomes Measurement Information System (PROMIS). Results: We found that the gastrointestinal symptoms that the patients reported had a significant impact on the analyzed aspects of health. More specifically, belly pain, diarrhea, and bloating were associated with depressive symptoms (p < 0.001), anxiety (p < 0.001), fatigue (p < 0.001), and sleep disturbances (p < 0.001). Moreover, these symptoms also significantly affected patients’ social dimension in terms of satisfaction with participation in social roles (p < 0.001, p < 0.05, and p < 0.001 for belly pain, diarrhea, and bloating, respectively) and physical functions (p < 0.001). The results were virtually the same in a multivariable analysis adjusted by age, gender, body mass index (BMI), and disease duration. Conclusions: Even during remission, gastrointestinal symptoms are the main factors that influence quality of life in IBD patients. This exploratory study highlights the need to adopt validated questionnaires in clinical practice, and demonstrates that PROMIS is a valid, objective, and standardized instrument that can help nursing staff to better define the consequences of the disease in a patient’s daily life. Full article
(This article belongs to the Special Issue Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management)
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Review

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18 pages, 779 KiB  
Review
Mesenchymal Stromal Cell Therapy in the Management of Perianal Fistulas in Crohn’s Disease: An Up-To-Date Review
by Gaetano Gallo, Vincenzo Tiesi, Serena Fulginiti, Gilda De Paola, Giuseppina Vescio and Giuseppe Sammarco
Medicina 2020, 56(11), 563; https://doi.org/10.3390/medicina56110563 - 27 Oct 2020
Cited by 13 | Viewed by 3217
Abstract
Crohn’s Disease (CD) is a chronic inflammatory disorder that potentially involves the entire gastrointestinal tract. Perianal fistulizing CD (pCD) is a serious and frequent complication associated with significant morbidities and a heavy negative impact on quality of life. The aim of CD treatment [...] Read more.
Crohn’s Disease (CD) is a chronic inflammatory disorder that potentially involves the entire gastrointestinal tract. Perianal fistulizing CD (pCD) is a serious and frequent complication associated with significant morbidities and a heavy negative impact on quality of life. The aim of CD treatment is to induce and maintain disease remission and to promote mucosal repair. Unfortunately, even the best therapeutic regimens in pCD do not have long-term efficacy and cause a significant number of side effects. Therefore, it is mandatory to study new therapeutical options such as the use of mesenchymal stromal cells (MSCs). These cells promote tissue repair via the induction of immunomodulation. The present review aims to analyze the existing updated scientific literature on MSCs adoption in the treatment of pCD to evaluate its efficacy and safety and to compare the use of bone marrow and adipose tissue derived MSCs, type of administration, and dose required for recovery. Full article
(This article belongs to the Special Issue Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management)
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18 pages, 576 KiB  
Review
Dermatological Manifestations in Pediatric Inflammatory Bowel Disease
by Smaranda Diaconescu, Silvia Strat, Gheorghe G. Balan, Carmen Anton, Gabriela Stefanescu, Ileana Ioniuc and Ana Maria Alexandra Stanescu
Medicina 2020, 56(9), 425; https://doi.org/10.3390/medicina56090425 - 23 Aug 2020
Cited by 6 | Viewed by 4124
Abstract
Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in [...] Read more.
Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in IBD are either specific, related to the disease activity or treatment-associated, or non-specific. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime. Materials and Methods: A systemic literature review was performed, investigating articles and case reports on dermatological manifestations in children with IBD starting from 2005. A total of 159 potentially suitable articles were identified and after the exclusion process, 75 articles were selected. Results: The most common dermatological manifestations reported in pediatric IBD are erythema nodosum and pyoderma gangrenosum. More rare cases of metastatic Crohn’s disease, epidermolysis bullosa acquisita, small-vessel vasculitis, necrotizing vasculitis, leukocytoclastic vasculitis, cutaneous polyarteritis nodosa, and Sweet’s syndrome have been reported. Oral manifestations of IBD are divided into specific (tag-like lesions, mucogingivitis, lip swelling with vertical fissures, aphthous stomatitis, and pyostomatitis vegetans) and non-specific. IBD treatment may present with side effects involving the skin and mucosa. Anti-tumor necrosis factor agents have been linked to opportunistic skin infections, psoriasiform lesions, and a potentially increased risk for skin cancer. Cutaneous manifestations such as acrodermatitis enteropathica, purpuric lesions, and angular cheilitis may appear secondary to malnutrition and/or malabsorption. Conclusions: The correct diagnosis of dermatological manifestations in pediatric IBD is of paramount importance because of their impact on disease activity, treatment options, and a patient’s psychological status. Full article
(This article belongs to the Special Issue Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management)
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9 pages, 2127 KiB  
Review
Incidence of Prostate Cancer in Inflammatory Bowel Disease: A Meta-Analysis
by Edoardo Carli, Gian Paolo Caviglia, Rinaldo Pellicano, Sharmila Fagoonee, Stefano Rizza, Marco Astegiano, Giorgio Maria Saracco and Davide Giuseppe Ribaldone
Medicina 2020, 56(6), 285; https://doi.org/10.3390/medicina56060285 - 11 Jun 2020
Cited by 13 | Viewed by 2702
Abstract
Background and objectives: Inflammatory bowel disease (IBD) is associated with an increased risk of developing colorectal cancer as well as some extra-intestinal tumors, but there are still limited data about the risk of prostate cancer (PC). To analyze if there is an increased [...] Read more.
Background and objectives: Inflammatory bowel disease (IBD) is associated with an increased risk of developing colorectal cancer as well as some extra-intestinal tumors, but there are still limited data about the risk of prostate cancer (PC). To analyze if there is an increased risk of PC in patients affected by IBD, we performed a systematic review with meta-analysis. Materials and Methods: A Pubmed search of all studies comparing standardized incidence ratio (SIR) or odds ratio (OR) or relative risks (RR) of PC between IBD and non IBD groups, published until March 2020 was conducted. The study protocol was registered on PROSPERO. Twelve studies, mostly population studies, were included. The quality score of these studies, evaluated by the Newcastle–Ottawa Scale, was 7. The heterogeneity was high among the studies in which ulcerative colitis (UC) was considered separate from Crohn’s disease (CD) and in the studies that considered UC and CD together (“IBD-studies”), while it was low in the studies which considered CD separate from UC. Results: The relative risk of developing PC was 1.71 (95% confidence interval [CI] 1.16–2.51, p = 0.007) in IBD, 1.10 (95%CI 0.98–1.25, p = 0.116) in CD, and 1.22 (95%CI 0.98–1.51, p = 0.07) in UC. Conclusions: Patients with IBD appear to have a slightly increased risk of PC compared to the general population. Full article
(This article belongs to the Special Issue Crohn's Disease and Ulcerative Colitis: From Pathophysiology to Clinical Management)
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