Perianal disease is one of the most disabling manifestations of Crohn's disease.A multidisciplinary approach of gastroenterologist,colorectal surgeon and radiologist is necessary for its management.A correct diagn...Perianal disease is one of the most disabling manifestations of Crohn's disease.A multidisciplinary approach of gastroenterologist,colorectal surgeon and radiologist is necessary for its management.A correct diagnosis,based on endoscopy,magnetic resonance imaging,endoanal ultrasound and examination under anesthesia,is crucial for perianal fistula treatment.Available medical and surgical therapies are discussedin this review,including new local treatment modalities that are under investigation.展开更多
Inflammatory bowel disease(IBD)patients have an increased risk of venous thromboembolism(VTE),which represents a significant cause of morbidity and mortality.The most common sites of VTE in IBD patients are the deep v...Inflammatory bowel disease(IBD)patients have an increased risk of venous thromboembolism(VTE),which represents a significant cause of morbidity and mortality.The most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system,followed by the portal and mesenteric veins.However,other sites may also be involved,such as the cerebrovascular and retinal veins.The aetiology of VTE is multifactorial,including both inherited and acquired risk factors that,when simultaneously present,multiply the risk to the patient.VTE prevention involves correcting modifiable risk factors,such as disease activity,vitamin deficiency,dehydration and prolonged immobilisation.The role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also crucial.However,although guidelines recommend thromboprophylaxis for IBD patients,this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these patients.Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality.展开更多
BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis(UC) in the different Italian regions,mainly derived from the absence of a national registry.This ...BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis(UC) in the different Italian regions,mainly derived from the absence of a national registry.This prevents correct interpretation of the disease burden.AIM To assess the main clinical and epidemiological features of adult patients diagnosed with UC in Sardinia,Italy.METHODS We performed a multicenter,observational,cross-sectional study that included adult patients with UC enrolled in seven gastroenterology unit centers in Sardinia.Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.RESULTS Four hundred and forty-two patients with UC were included.The median age at diagnosis was 39years(interquartile range 28-48).After a median disease duration of 10 years,53 patients experienced proximal extension of proctitis or left-sided colitis.Seventy-five patients developed extraintestinal manifestations.Nineteen patients(4.3%) developed cancer:two with colorectal cancer and seventeen with extracolonic cancers.Mesalazine(5-ASA) remains the mainstay of treatment for UC.Overall,95 patients(21.5%) were treated with one or more biologic agents,whereas 15 patients(3.4%) underwent surgery,mostly colectomy.CONCLUSION Our results provide important insights into the clinical and epidemiological features of patients with UC,and while waiting for a national Italian registry,present eligible data on the UC population in Sardinia.展开更多
The use of biological agents and immunomodulators for inflammatory bowel disease(IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existen...The use of biological agents and immunomodulators for inflammatory bowel disease(IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination in those patients with IBD, which are candidate for biologic therapy. Available strategies to screen, diagnose and prevent bacterial and viral infections in patients with IBD prior to start biological therapy are discussed in this review.展开更多
文摘Perianal disease is one of the most disabling manifestations of Crohn's disease.A multidisciplinary approach of gastroenterologist,colorectal surgeon and radiologist is necessary for its management.A correct diagnosis,based on endoscopy,magnetic resonance imaging,endoanal ultrasound and examination under anesthesia,is crucial for perianal fistula treatment.Available medical and surgical therapies are discussedin this review,including new local treatment modalities that are under investigation.
文摘Inflammatory bowel disease(IBD)patients have an increased risk of venous thromboembolism(VTE),which represents a significant cause of morbidity and mortality.The most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system,followed by the portal and mesenteric veins.However,other sites may also be involved,such as the cerebrovascular and retinal veins.The aetiology of VTE is multifactorial,including both inherited and acquired risk factors that,when simultaneously present,multiply the risk to the patient.VTE prevention involves correcting modifiable risk factors,such as disease activity,vitamin deficiency,dehydration and prolonged immobilisation.The role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also crucial.However,although guidelines recommend thromboprophylaxis for IBD patients,this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these patients.Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality.
文摘BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis(UC) in the different Italian regions,mainly derived from the absence of a national registry.This prevents correct interpretation of the disease burden.AIM To assess the main clinical and epidemiological features of adult patients diagnosed with UC in Sardinia,Italy.METHODS We performed a multicenter,observational,cross-sectional study that included adult patients with UC enrolled in seven gastroenterology unit centers in Sardinia.Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.RESULTS Four hundred and forty-two patients with UC were included.The median age at diagnosis was 39years(interquartile range 28-48).After a median disease duration of 10 years,53 patients experienced proximal extension of proctitis or left-sided colitis.Seventy-five patients developed extraintestinal manifestations.Nineteen patients(4.3%) developed cancer:two with colorectal cancer and seventeen with extracolonic cancers.Mesalazine(5-ASA) remains the mainstay of treatment for UC.Overall,95 patients(21.5%) were treated with one or more biologic agents,whereas 15 patients(3.4%) underwent surgery,mostly colectomy.CONCLUSION Our results provide important insights into the clinical and epidemiological features of patients with UC,and while waiting for a national Italian registry,present eligible data on the UC population in Sardinia.
文摘The use of biological agents and immunomodulators for inflammatory bowel disease(IBD) is associated with an increased risk of opportunistic infections, in particular of viral or bacterial etiology. Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination in those patients with IBD, which are candidate for biologic therapy. Available strategies to screen, diagnose and prevent bacterial and viral infections in patients with IBD prior to start biological therapy are discussed in this review.
