Gefei Wang

Mean platelet volume: a controversial marker of disease activity in Crohn’s disease

BackgroundWe investigated and compared the capacity of mean platelet volume (MPV) and other inflammatory markers in detecting Crohn’s disease (CD) activity and differentiating CD patients from healthy controls.MethodsMPV, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cells were measured in 61 CD patients and 50 healthy subjects. Disease activity was assessed by the Crohn’s Disease Activity Index.ResultsA significant decrease in MPV was noted in patients with CD compared with healthy controls (P <0.0001), but statistical difference was not found between active and inactive CD groups. In CD, no significant correlation was found between MPV and other inflammatory markers. The overall accuracy of MPV (cutoff: 10.35 fl), CRP (cutoff: 4.85 mg/dl) and ESR (cutoff: 8.5 mm/hour) in differentiating CD patients from healthy controls was 76.6%, 65.8% and 72.1% respectively. The overall accuracy of CRP (cutoff: 4.95 mg/dl) and ESR (cutoff: 16.5 mm/hour) in determination of active CD was 80.3% and 73.8%.ConclusionsMPV declined in CD patients compared with healthy subjects. MPV had the best accuracy in determination of CD patients and healthy controls. MPV did not show a discriminative value in disease activity.

Exclusive enteral nutritional therapy can relieve inflammatory bowel stricture in Crohn's disease.

Goals: To examine the efficiency of exclusive enteral nutrition (EEN) in relieving inflammatory bowel stricture in patients with Crohn’s disease (CD). Background: Patients with CD usually develop bowel strictures due to transmural edema of intestinal wall, which can potentially be managed with conservative medical treatment. Previous studies showed that EEN therapy could induce clinical remission through its anti-inflammation effect. Methods: We achieved a prospective observational study. CD patients with inflammatory bowel stricture were preliminarily differentiated from a fibrous one, and further treated with EEN therapy for 12 weeks. Demographics and clinical variables were recorded. Nutritional (body mass index, albumin, pre-albumin, transferrin, etc.), inflammatory (C-reactive protein, erythrocyte sedimentation rate, white blood cell, etc.), and radiologic parameters (bowel wall thickness, luminal diameter, and luminal cross-sectional area) were evaluated at baseline, week 4, and week 12, respectively. Results: Between May 2012 and January 2013, 65 patients with CD were preliminarily diagnosed with inflammatory bowel stricture and 6 patients were further excluded. Among the remaining 59 cases, 50 patients (84.7%) finished the whole EEN treatment, whereas the other 9 patients (15.3%) gained progressive bowel obstruction resulting in surgery. Intention-to-treat analyses showed that 48 patients (81.4%) achieved symptomatic remission, 35 patients (53.8%) achieved radiologic remission, and 42 patients (64.6%) achieved clinical remission. Among those patients who complete the whole EEN therapy, inflammatory, nutritional, and radiologic parameters improved significantly compared with baseline. Of note, the average luminal cross-sectional area at the site of stricture increased approximately 331% at week 12 (195.7±18.79 vs. 59.09±10.64 mm2, P<0.001). Conclusions: EEN therapy can effectively relieve inflammatory bowel stricture in CD, which replenishes roles of enteral nutrition in the treatment of CD. Further studies are expected to investigate the underlying mechanisms of this effect in the future.

Preliminary case-control study to evaluate diagnostic values of C-reactive protein and erythrocyte sedimentation rate in differentiating active Crohn's disease from intestinal lymphoma, intestinal tuberculosis and Behcet's syndrome.

Background:There are few evidences of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) in differentiating active Crohn’s disease (CD) from intestinal lymphoma (IL), intestinal tuberculosis (ITB) and Behcet’s syndrome (BD). This study is designed to investigate potential differential capacity of the 3 biomarkers between these disorders. Methods:A hospital-based case-control study was performed. A total of 29 active CD, 25 IL, 30 ITB and 17 BD patients were collected. Laboratory parameters were drawn from the first blood test results on admission. Results:In active CD group, the level of CRP was 20.2 ± 4.26 mg/dL, which was statistically lower than IL (59.9 ± 10.8 mg/dL, P < 0.0001). Similarly, the level of ESR reached its lowest point in active CD group (23.8 ± 3.18 mm/hr), compared with 46.6 ± 6.46 mm/hr in IL group (P = 0.0002). CRP showed a possible diagnostic value in differentiation of IL from active CD (odds ratio = 1.028, P = 0.046). CRP also exhibited a superior ability (area under curve [AUC] = 0.821) than ESR (AUC = 0.797) and CRP+ESR (AUC = 0.800) in distinguishing active CD from IL. The optimal cutoff value was 19.7 mg/dL, and the sensitivity and specificity were 62.1% and 96.0%, respectively. Conclusions:A significant decreased level of CRP and ESR was confirmed in active CD compared with IL. Current study demonstrated a possible differential value of CRP between active CD and IL. Further studies would be performed to validate their clinical significances.

Prevention of postoperative recurrence of Crohn’s disease: Tripterygium wilfordii polyglycoside versus mesalazine

Objectives To explore effectiveness and safety of polyglycosides of Tripterygium wilfordii (GTW) and mesalazine (5-aminosalicylic acid [5-ASA]) in preventing postoperative clinical and endoscopic recurrence of Crohn’s disease. Methods In this prospective, single-centre, single-blind study, postoperative Crohn’s disease patients in remission were randomized to receive 1 mg/kg GTW daily, orally, or 4 g 5-ASA daily, orally, for 52 weeks. Patients underwent physical examinations, ileocolonoscopies and biochemical analyses at baseline and weeks 13, 26 and 52, or when clinical recurrence was suspected. Outcome measures were proportion of patients showing clinical or endoscopic recurrence at week 52, and changes in Rutgeerts’ and Crohn’s Disease Activity Index (CDAI) scores. Results Twenty-one patients were assigned to receive GTW and 18 to 5-ASA; two patients on GTW and one on 5-ASA were withdrawn. Clinical and endoscopic recurrences were less common in the GTW group (n = 4) versus the 5-ASA group (n = 9). There were improvements in Rutgeerts’ scores for those taking GTW. Mean between-group CDAI scores were similar. No serious adverse events were reported. Conclusion These findings indicate that GTW appears to be an effective, well-tolerated prophylactic regimen, superior to oral 5-ASA, for preventing clinical and endoscopic recurrence in postsurgical Crohn’s disease.

Protection of colonic anastomosis with platelet-rich plasma gel in the open abdomen

BACKGROUND Although evidence for colonic anastomosis in the damage control abdomen continues to accumulate, anastomotic leak is common and associated with greater morbidity. The purposes of our study was to evaluate the effect of platelet-rich plasma (PRP) gel on the healing of colon anastomosis and anastomotic strength in the open abdomen. METHODS PRP was prepared by enriching whole blood platelet concentration from healthy rat. In the rodent model, standard colonic anastomoses followed by closure of abdomen (Control; n=10) and anastomoses followed by open abdomen (OA; n=10) were compared to PRP-sealed anastomoses in open abdomen (OA+PRP; n=10). One week after surgery, body weight, anastomotic bursting pressure, hydroxyproline concentration, and histology of anastomotic tissue were evaluated. RESULTS All rats survived surgery and had no signs of anastomotic leakage. Compared with the control and PRP group, OA group exhibited a significant decrease in body weight, anastomotic bursting pressure, hydroxyproline concentration, and collagen deposition. No significant difference was detected in these variables between the PRP group and the control group. CONCLUSION PRP gel application prevented delayed anastomotic wound healing after open abdomen, which suggested that anastomotic sealing with PRP gel might improve outcome of colonic injuries in the setting of open abdomen.

Fistuloclysis Improves Liver Function and Nutritional Status in Patients with High-Output Upper Enteric Fistula

Background. We aimed to determine the efficacy of fistuloclysis in patients with high-output upper enteric fistula (EF). Methods. Patients were assigned into the fistuloclysis group (n = 35, receiving fistuloclysis plus total enteral nutrition (TEN)) and the control group (n = 60, receiving TEN). Laboratory variables were measured during the four-week treatment. Results. At baseline, variables were similar between the two groups. Delta value was defined as the changes from baseline to day 28. Compared with the control group, the fistuloclysis group showed greater improvements in liver function (Delta total bilirubin (TB): 20.3 ± 9.7 in the fistuloclysis group versus 15.6 ± 6.3 in the control group, P = 0.040; Delta direct bilirubin (DB): 12.5 ± 3.4 versus 10.0 ± 3.6, P = 0.011; Delta alkaline phosphatase (ALP): 98.4 ± 33.5 versus 57.6 ± 20.9, P < 0.001); nutritional status (Delta total protein: 21.8 ± 8.7 versus 10.7 ± 2.1, P < 0.001; Delta albumin: 11.3 ± 2.5 versus 4.2 ± 1.3, P < 0.001). In the fistuloclysis subgroups, biliary fistula patients had the maximum number of variables with the greatest improvements. Conclusions. Fistuloclysis improved hepatic and nutritional parameters in patients with high-output upper EF, particularly in biliary fistula patients.

Fistula patch: making the treatment of enteroatmospheric fistulae in the open abdomen easier.

BACKGROUND It remains an extreme challenge in clinical practice to manage the enteroatmospheric fistula (EAF), which is a severer complication after abdominal opening. In current literature, several methods have been established, generally focusing on controlling fistula effluent and keeping the wound bed clean. However, the loss of enteric fistula effluent would potentially lead to a risk of the disturbance of internal environment and malnutrition. METHODS We designed an innovative “fistula patch” technique for protecting open abdominal wounds from being contaminated by intestinal fistulae drainages and simultaneously applying enteral nutrition. RESULTS Eleven patients with single EAF were treated with fistula patch technique. Enteral nutrition was then administrated successfully until the definite surgery. CONCLUSION The fistula patch technique is a simple, effective, and inspiring method to control EAF, as it brings together the benefits of avoiding the loss of enteric fistula effluent, simplifying wound management, ceasing tissue destruction, and providing enteral nutrition application. LEVEL OF EVIDENCE Therapeutic/care management, level V.

Nonthyroidal Illness Syndrome: Is It Far Away From Crohn’s Disease?

Goals: This study was designed to investigate the clinical features of nonthyroidal illness syndrome (NTIS) compared with euthyroid patients in Crohn’s disease (CD), to explore the etiology of NTIS in CD, to evaluate the clinical outcomes of NTIS patients, and to inspect the correlation of clinical variables and NTIS, and their ability of differentiating NTIS from euthyroid patients. Background: NTIS has been described for more than 30 years. However, only few studies focused on the relationship between NTIS and CD. The incidence, underlying pathogenesis, clinical outcomes, and correlation with other inflammatory disease severity and nutritional variables of NTIS in CD have not been completely established. Methods: Prospectively, 44 CD patients were enrolled. Medical records and various laboratory values (including thyroidal, nutritional, and inflammatory variables) were collected in all participants. Results: The incidence of NTIS in CD was 36.4%. Albumin, Acute Physiology and Chronic Health Evaluation II score, and Crohns Disease Activity Index score in NTIS group were statistically different from those in euthyroid group. A decreased sum activity of deiodinases and a reduced ratio of TT4/FT4 were observed in NTIS group. Duration of hospitalization was significantly longer for NTIS patients than euthyroid patients. Albumin was confirmed as a protective factor of NTIS in CD. Receiver operating characteristic curve analysis demonstrated the differentiating capacity of albumin, suggesting 37.6 g/L as optimal cut-off value with sensitivity and specificity of 81.3% and 79.2%, respectively. Conclusions: NTIS was a common complication in CD. NTIS patients showed worse nutrition status and clinical outcome, and more critical disease activity and severity compared with euthyroid patients. A hypodeiodination condition and a potential thyroid-hormone–binding dysfunction may play a role in the etiology of NTIS in CD. Albumin was a meaningful protective and distinguishing marker of NTIS in CD.

Diagnostic delay in Crohn's disease is associated with increased rate of abdominal surgery: A retrospective study in Chinese patients

BACKGROUND Diagnostic delay of Crohns disease presents a challenge, and may increase the abdominal surgery rate. There have been no reports regarding diagnostic delay in Chinese patients. AIMS We aimed to evaluate the impact of diagnostic delay on outcomes of Chinese Crohns disease patients, and identify potential risk factors for the delay. METHODS Altogether, 343 Crohns disease patients from our hospital were retrospectively included. We assessed the effects of diagnostic delay on the outcomes, and identified the underlying risk factors. RESULTS Diagnostic interval was defined as the interval between the first symptoms and the diagnosis of Crohns disease. Diagnostic delay was defined according to the time interval in which the 76th to 100th percentiles of patients were diagnosed. The rates of subsequent surgery for diagnostic-delay and non-diagnostic-delay patients were 84.7% and 62.4%, respectively (odds ratio=1.108, P<0.0001). We found statistical differences between the two groups regarding age >40 years at diagnosis (35.3% versus 18.2%, P=0.004), basic educational level (48.2% versus 30.6%, P=0.005), and no family history of Crohns disease (0 versus 1.6%, P=0.045). CONCLUSIONS Diagnostic delay of Crohns disease was significantly associated with increased rates of intestinal surgery. Risk factors for diagnostic delay were age >40 years at diagnosis, basic educational level, and no family history of Crohns disease.

Efficacy of Erythropoietin Combined With Enteral Nutrition for the Treatment of Anemia in Crohn’s Disease: A Prospective Cohort Study

BACKGROUND Anemia is a common and serious complication in patients with inflammatory bowel disease. The present study was dedicated to evaluate the therapeutic efficacy of erythropoietin (EPO) combined with enteral nutrition (EN) in anemic Crohns disease (CD) patients, in terms of hemoglobin level, treatment success rate, adverse events, and predictor of this therapy. MATERIALS AND METHODS We performed a prospective study in CD patients. On the basis of hemoglobin level, all enrolled patients were divided into anemic and nonanemic groups. The anemic group was further divided into EPO and non-EPO subgroups, depending on whether EPO was prescribed. Hematological and other parameters were measured initially and in the first 4 weeks after starting treatment. RESULTS In total, 109 patients (49 nonanemic and 60 anemic, including 38 EPO and 22 non-EPO) were included. The prevalence of anemia in CD was 55.05%. Age, disease behavior, Crohns Disease Activity Index scores, C-reactive protein, and erythrocyte sedimentation rate were significantly different between anemic and nonanemic groups. An increase in hemoglobin level and a significant decrease in C-reactive protein level were observed in the EPO treatment group. Treatment success rate was 63.16% in the EPO group, whereas none of patients achieved treatment success in the non-EPO group. CONCLUSION EPO combined with EN can improve the hemoglobin level in anemic CD patients.