This editorial builds on the article by Shakhshir et al.We conducted an overview of evidence-based dietary interventions in adults with inflammatory bowel disease(IBD).In the IBD population,there may be a role for the...This editorial builds on the article by Shakhshir et al.We conducted an overview of evidence-based dietary interventions in adults with inflammatory bowel disease(IBD).In the IBD population,there may be a role for the Mediterranean diet due to its anti-inflammatory effects,long-term sustainability,and role in improving cardiovascular health.In active Crohn’s disease,the use of exclusive enteral nutrition,the Crohn’s disease exclusion diet,or the specific carbohydrate diet may be used as a short-term adjunct to medical therapy and may improve mucosal healing.The low-FODMAP diet can assist in reducing symptoms for patients without evidence of active bowel inflammation.As interest in nutritional therapy increases amongst clinicians and patients alike,it is integral that dietary therapies are understood and discussed in routine management of patients with IBD as part of holistic care,ideally through a multidisciplinary setting with involvement of experienced dietitians.This serves to improve clinician-patient engagement and reduce complications of IBD including micro and micronutrient deficiencies.展开更多
BACKGROUND Vedolizumab(VDZ),a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis(UC)patients.AIM To assess the efficacy an...BACKGROUND Vedolizumab(VDZ),a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis(UC)patients.AIM To assess the efficacy and safety of VDZ in the real-world management of UC in a large multicenter cohort involving two countries and to identify predictors of achieving remission.METHODS A retrospective review of Australian and Oxford,United Kingdom data for UC patients.Clinical response at 3 mo,endoscopic remission at 6 mo and clinical remission at 3,6 and 12 mo were assessed.Cox regression models and Kaplan Meier curves were performed to assess the time to remission,time to failure and the covariates influencing them.Safety outcomes were recorded.RESULTS Three hundred and three UC patients from 14 centres in Australia and United Kingdom,[60%n=182,anti-TNF naïve]were included.The clinical response was 79%at 3 mo with more Australian patients achieving clinical response compared to Oxford(83%vs 70%P=0.01).Clinical remission for all patients was 56%,62%and 60%at 3,6 and 12 mo respectively.Anti-TNF naive patients were more likely to achieve remission than exposed patients at all the time points(3 mo 66%vs 40%P<0.001,6 mo 73%vs 46%P<0.001,12 mo 66%vs 51%P=0.03).More Australian patients achieved endoscopic remission at 6 mo compared to Oxford(69%vs 43%P=0.01).On multi-variate analysis,anti-TNF naïve patients were 1.8(95%CI:1.3-2.3)times more likely to achieve remission than anti-TNF exposed(P<0.001).32 patients(11%)had colectomy by 12 mo.CONCLUSION VDZ was safe and effective with 60%of UC patients achieving clinical remission at 12 mo and prior anti-TNF exposure influenced this outcome.展开更多
文摘This editorial builds on the article by Shakhshir et al.We conducted an overview of evidence-based dietary interventions in adults with inflammatory bowel disease(IBD).In the IBD population,there may be a role for the Mediterranean diet due to its anti-inflammatory effects,long-term sustainability,and role in improving cardiovascular health.In active Crohn’s disease,the use of exclusive enteral nutrition,the Crohn’s disease exclusion diet,or the specific carbohydrate diet may be used as a short-term adjunct to medical therapy and may improve mucosal healing.The low-FODMAP diet can assist in reducing symptoms for patients without evidence of active bowel inflammation.As interest in nutritional therapy increases amongst clinicians and patients alike,it is integral that dietary therapies are understood and discussed in routine management of patients with IBD as part of holistic care,ideally through a multidisciplinary setting with involvement of experienced dietitians.This serves to improve clinician-patient engagement and reduce complications of IBD including micro and micronutrient deficiencies.
文摘BACKGROUND Vedolizumab(VDZ),a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis(UC)patients.AIM To assess the efficacy and safety of VDZ in the real-world management of UC in a large multicenter cohort involving two countries and to identify predictors of achieving remission.METHODS A retrospective review of Australian and Oxford,United Kingdom data for UC patients.Clinical response at 3 mo,endoscopic remission at 6 mo and clinical remission at 3,6 and 12 mo were assessed.Cox regression models and Kaplan Meier curves were performed to assess the time to remission,time to failure and the covariates influencing them.Safety outcomes were recorded.RESULTS Three hundred and three UC patients from 14 centres in Australia and United Kingdom,[60%n=182,anti-TNF naïve]were included.The clinical response was 79%at 3 mo with more Australian patients achieving clinical response compared to Oxford(83%vs 70%P=0.01).Clinical remission for all patients was 56%,62%and 60%at 3,6 and 12 mo respectively.Anti-TNF naive patients were more likely to achieve remission than exposed patients at all the time points(3 mo 66%vs 40%P<0.001,6 mo 73%vs 46%P<0.001,12 mo 66%vs 51%P=0.03).More Australian patients achieved endoscopic remission at 6 mo compared to Oxford(69%vs 43%P=0.01).On multi-variate analysis,anti-TNF naïve patients were 1.8(95%CI:1.3-2.3)times more likely to achieve remission than anti-TNF exposed(P<0.001).32 patients(11%)had colectomy by 12 mo.CONCLUSION VDZ was safe and effective with 60%of UC patients achieving clinical remission at 12 mo and prior anti-TNF exposure influenced this outcome.
