Sarah Fischer

Multispectral Optoacoustic Tomography for Assessment of Crohn’s Disease Activity

A preliminary study suggests that intestinal-wall assessment by means of noninvasive multispectral optoacoustic tomography may distinguish remission from active disease in patients with Crohn’s disease.

Multispectral Optoacoustic Tomography in Crohn’s Disease: Noninvasive Imaging of Disease Activity

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Long-term Combination Therapy with Anti-TNF plus Vedolizumab Induces and Maintains Remission in Therapy-refractory Ulcerative Colitis

Long-term Combination Therapy with Anti-TNF plus Vedolizumab Induces and Maintains Remission in Therapy-refractory Ulcerative Colitis

Clinical Response to Vedolizumab in Ulcerative Colitis Patients Is Associated with Changes in Integrin Expression Profiles

Background Despite large clinical success, deeper insights into the immunological effects of vedolizumab therapy for inflammatory bowel diseases are scarce. In particular, the reasons for differential clinical response in individual patients, the precise impact on the equilibrium of integrin-expressing T cell subsets, and possible associations between these issues are not clear. Methods Blood samples from patients receiving clinical vedolizumab therapy were sequentially collected and analyzed for expression of integrins and chemokine receptors on T cells. Moreover, clinical and laboratory data from the patients were collected, and changes between homing marker expression and clinical parameters were analyzed for possible correlations. Results While no significant correlation of changes in integrin expression and changes in outcome parameters were identified in Crohn’s disease (CD), increasing α4β7 levels in ulcerative colitis (UC) seemed to be associated with favorable clinical development, whereas increasing α4β1 and αEβ7 correlated with negative changes in outcome parameters. Changes in α4β1 integrin expression after 6 weeks were significantly different in responders and non-responders to vedolizumab therapy as assessed after 16 weeks with a cutoff of +4.2% yielding 100% sensitivity and 100% specificity in receiver-operator-characteristic analysis. Discussion Our data show that clinical response to vedolizumab therapy in UC but not in CD is associated with specific changes in integrin expression profiles opening novel avenues for mechanistic research and possibly prediction of response to therapy.

Precision Medicine in Inflammatory Bowel Diseases

Inflammatory bowel diseases (IBDs) are a lifelong condition of chronic, recurrent inflammation in the gut. The introduction of immunomodulators and biologic agents markedly improved the treatment of IBDs. Therefore, the use of biologics became an essential element in the rational therapy of IBDs. Various substances are currently evaluated in clinical trials, addressing different target structures and offering further approaches in the field of IBD. Regarding the growing number of treatment options, the need for prediction of therapy response became a necessity and is the subject of the present research.

I-scan optical enhancement for the in vivo prediction of diminutive colorectal polyp histology: Results from a prospective three-phased multicentre trial

Background and aims Dye-less chromoendoscopy is an emerging technology for colorectal polyp characterization. Herein, we investigated whether the newly introduced I-scan optical enhancement (OE) can accurately predict polyp histology in vivo in real-time. Methods In this prospective three-phased study, 84 patients with 230 diminutive colorectal polyps were included. During the first two study phases, five endoscopists assessed whether analysis of polyp colour, surface and vascular pattern under i-scan OE can differentiate in vivo between adenomatous and hyperplastic polyps. Finally, junior and experienced endoscopists (JE, EE, each n = 4) not involved in the prior study phases made a post hoc diagnosis of polyp histology using a static i-scan OE image database. Histopathology was used as a gold-standard in all study phases. Results The overall accuracy of i-scan OE for histology prediction was 90% with a sensitivity, specificity, positive (PPV) and negative prediction value (NPV) of 91%, 90%, 86% and 94%, respectively. In high confidence predictions, the diagnostic accuracy increased to 93% with sensitivity, specificity, PPV and NPV of 94%, 91%, 89% and 96%. Colonoscopy surveillance intervals were predicted correctly in ≥ 90% of patients. In the post hoc analysis EE predicted polyp histology under i-scan OE with an overall accuracy of 91%. After a single training session, JE achieved a comparable diagnostic performance for predicting polyp histology with i-scan OE. Conclusion The histology of diminutive colorectal polyps can be accurately predicted with i-scan OE in vivo in real-time. Furthermore, polyp differentiation with i-scan OE appears to require only a short learning curve.

Chronisch-entzündliche Darmerkrankungen

ZusammenfassungChronisch-entzündliche Darmerkrankungen (CED) sind komplexe Krankheitsbilder. Epidemiologische Studien legen nahe, dass die Inzidenz in industrialisierten Ländern zunimmt. Der Beitrag basiert auf einer Literaturrecherche in PubMed und orientiert sich an den aktuellen Empfehlungen der European Crohn’s and Colitis Organisation. Leitsymptome der CED sind anhaltende Diarrhöen, abdominelle Schmerzen und peranaler Blutabgang. Extraintestinale Manifestationen betreffen am häufigsten Gelenke, Haut, Augen und Gallenwege. Eine frühe Diagnose und therapeutische Intervention bestimmen die individuelle Prognose. In der medikamentösen Therapie werden aktuell Aminosalizylate, Kortikosteroide, Thiopurine, Calcineurininhibitoren und Biologika eingesetzt. CED bedürfen einer antiinflammatorischen und ggf. immunsuppressiven Therapie. Aufgrund extraintestinaler Komplikationen sowie der eventuellen Notwendigkeit chirurgischer Eingriffe ist ein interdisziplinäres Vorgehen von hoher klinischer Bedeutung.AbstractInflammatory bowel diseases (IBD) are complex diseases. Epidemiological studies suggest rising incidences in industrialized countries. The article is based on a literature search in PubMed and is oriented on the current guidelines published by the European Crohn’s and Colitis Organisation. IBD are characterized by chronic diarrhoea, abdominal pain and peranal haemorrhage. Extraintestinal manifestations commonly affect joints, skin, eyes and bile tracts. Early diagnosis and therapeutic intervention determine individual patient outcome. Medical treatment currently includes aminosalicylates, corticosteroids, thiopurines, calcineurin inhibitors and biologicals. IBDs require anti-inflammatory and if necessary immunosuppressive therapy. Due to extraintestinal complications and the possible need for surgical intervention, an interdisciplinary approach is important.Inflammatory bowel diseases (IBD) are complex diseases. Epidemiological studies suggest rising incidences in industrialized countries. The article is based on a literature search in PubMed and is oriented on the current guidelines published by the European Crohns and Colitis Organisation. IBD are characterized by chronic diarrhoea, abdominal pain and peranal haemorrhage. Extraintestinal manifestations commonly affect joints, skin, eyes and bile tracts. Early diagnosis and therapeutic intervention determine individual patient outcome. Medical treatment currently includes aminosalicylates, corticosteroids, thiopurines, calcineurin inhibitors and biologicals. IBDs require anti-inflammatory and if necessary immunosuppressive therapy. Due to extraintestinal complications and the possible need for surgical intervention, an interdisciplinary approach is important.

Mit modernen Medikamenten zur steroidfreien Remission@@@Colitis ulcerosa — a diagnostic and therapeutic update

Die Colitis ulcerosa stellt oft ein schwerwiegendes Krankheitsbild dar, das die Lebensqualität deutlich einschränken kann. Befallsmuster und Krankheitsaktivität weisen den Weg zur optimalen medikamentösen Therapie. Eine adäquate Lebensqualität und eine steroidfreie Remission sind realistische Ziele, ggf. auch eine Abheilung der mukosalen Entzündung. Chirurgische Interventionen müssen bei einigen Verläufen rechtzeitig berücksichtigt werden.

Mit modernen Medikamenten zur steroidfreien Remission

Die Colitis ulcerosa stellt oft ein schwerwiegendes Krankheitsbild dar, das die Lebensqualität deutlich einschränken kann. Befallsmuster und Krankheitsaktivität weisen den Weg zur optimalen medikamentösen Therapie. Eine adäquate Lebensqualität und eine steroidfreie Remission sind realistische Ziele, ggf. auch eine Abheilung der mukosalen Entzündung. Chirurgische Interventionen müssen bei einigen Verläufen rechtzeitig berücksichtigt werden.