Search Results for: Gestione della malattia di Crohn

The gut microbiota plays a significant role in the pathogenesis of both forms of inflammatory bowel disease (IBD), namely Crohn’s disease (CD) and ulcerative colitis (UC). While evidence suggests dysbiosis and loss of beneficial microbial species can exacerbate IBD, many new studies have identified microbes with pathogenic qualities, termed “pathobionts”, within the intestines of patients with IBD. The concept of pathobionts initiating or driving the chronicity of IBD has largely focused on the putative aggravating role that adherent invasive Escherichia coli may play in CD.

Una nuova ricerca collega le proteine anomale che si accumulano nel cervello con una forma di suicidio cellulare innescata da una molecola specifica Meg3: la sua inibizione prevenire la morte neuronale

La malattia nella maggior parte dei casi è asintomatica, in altri può causare febbre e sintomi influenzali, nausea, vomito, irritazioni della pelle, e nei casi più gravi anche emorragie potenzialmente fatali (in meno dell’1% delle persone)

Objective
Recent studies have shown that motorised spiral enteroscopy (MSE) enables deeper and total small bowel evaluation compared with single-balloon enteroscopy (SBE) in suspected Crohn’s disease (CD) when analysed per procedure. However, no randomised controlled study has compared bidirectional MSE with bidirectional SBE in suspected CD.

Design
Patients with suspected CD requiring small bowel enteroscopy were randomly assigned to either SBE or MSE between May 2022 and September 2022 in a high volume tertiary centre. Bidirectional enteroscopy was done if intended lesion could not be reached on unidirectional study. Comparison was made with regard to technical success (ability to reach lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time and total enteroscopy rates. Depth:time ratio was calculated to avoid confounding for the location of lesion.

Results
Among 125 suspected patients with CD (28% female, 18–65 years, median 41 years), 62 and 63 underwent MSE and SBE, respectively. The overall technical success (98.4 %: MSE, 90.5 %: SBE; p=0.11), diagnostic yield (95.2%: MSE; 87.3%: SBE, p=0.2) and procedure time were not significantly different. However, MSE appeared to have higher technical success (96.8% vs 80.7%, p=0.08) in deeper small bowel (distal jejunum/proximal ileum) with higher DMI, higher depth:time ratio and total enteroscopy rates when attempted (77.8% vs 11.1%, p=0.0007). Both the modalities were safe although minor adverse events were more common with MSE.

Conclusion
MSE and SBE have comparable technical success and diagnostic yield for small bowel evaluation in suspected CD. MSE scores over SBE with regard to deeper small bowel evaluation with complete small bowel coverage and higher depth of insertion in a shorter time.

Trial registration number
NCT05363930.

Basic scienceMacrophage and neutrophil heterogeneity in human inflammatory bowel disease Garrido-Trigo A, Corraliza A, Veny M, et al. Macrophage and neutrophil heterogeneity at single-cell spatial resolution in human inflammatory bowel disease. Nat Commun 2023: 14(1):4506. doi: 10.1038/s41467-023-40156-6. Patients with underlying ulcerative colitis (UC) and Crohn’s disease (CD) have heterogeneous differences in clinical manifestations and response to treatments. The molecular basis for this heterogeneity remains uncharacterised. Garrido-Trigo et al applied single-cell RNA sequencing and CosMx Spatial Molecular Imaging to human inflamed tissue to try and unravel the underlying mechanisms behind this heterogeneity. Using colonic samples from six healthy controls, six patients with UC and six patients with CD, Garrido-Trigo et al, found the highest diversity in cellular composition was in the myeloid compartment of patients with UC and CD. Resident macrophages were closest to mucosal surface in healthy controls whereas remodelling of myeloid compartment was evident with M1…

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