Purpose Liver steatosis is a frequently reported condition in patients with inflammatory bowel disease (IBD). Different factors, both metabolic and IBD-associated, are believed to contribute to the... Show morePurpose Liver steatosis is a frequently reported condition in patients with inflammatory bowel disease (IBD). Different factors, both metabolic and IBD-associated, are believed to contribute to the pathogenesis. The aim of our study was to calculate the prevalence of liver steatosis and fibrosis in IBD patients and to evaluate which factors influence changes in steatosis and fibrosis during follow-up. Methods From June 2017 to February 2018, demographic and biochemical data was collected at baseline and after 6-12 months. Measured by transient elastography (FibroScan), liver steatosis was defined as Controlled Attenuation Parameter (CAP) >= 248 and fibrosis as liver stiffness value (Emed) >= 7.3 kPa. IBD disease activity was defined as C-reactive protein (CRP) >= 10 mg/l and/or fecal calprotectin (FCP) >= 150 mu g/g. Univariate and multivariate regression analysis was performed; a p-value of <= 0.05 was considered significant. Results Eighty-two out of 112 patients were seen for follow-up; 56% were male. The mean age was 43 +/- 16.0 years, and mean BMI was 25.1 +/- 4.7 kg/m(2). The prevalence of liver steatosis was 40% and of fibrosis was 20%. At baseline, 26 patients (32%) had an active episode of IBD. Using a multivariate analysis, disease activity at baseline was associated with an increase in liver steatosis (B = 37, 95% CI 4.31-69.35, p = 0.027) and liver fibrosis (B = 1.2, 95% CI 0.27-2.14, p = 0.016) during follow-up. Conclusions This study confirms the relatively high prevalence of liver steatosis and fibrosis in IBD patients. We demonstrate that active IBD at baseline is associated with both an increase in liver steatosis and fibrosis during follow-up. Show less
Deen, W.K. van; Obremskey, A.; Moore, G.; Akker-van Marle, M.E. van den; Doctor, J.N.; Hwang, C. 2020
Purpose Inflammatory bowel disease (IBD) patients experience diverse symptoms and the impact of these different symptoms varies substantially. Current disease activity measures do not account for... Show morePurpose Inflammatory bowel disease (IBD) patients experience diverse symptoms and the impact of these different symptoms varies substantially. Current disease activity measures do not account for the relative importance of the different symptoms and severity levels. In this study, we aimed to quantify the relative importance of different symptoms for IBD patients and to develop a patient preference-weighted symptom (PWS) score to assess symptom burden in IBD. Methods We performed a choice-based conjoint analysis (CBCA) survey with 129 IBD patients to estimate the relative importance of four common IBD symptoms: stool frequency, abdominal pain, blood in stools, and urgency. We then developed the PWS score using the preferences obtained from the CBCA, which we validated against existing measures. Results CBCA revealed that urgency was the most important symptom to patients, followed by abdominal pain and blood in stools. Urgency associated with incontinence received particularly high scores and was perceived to be more than 3 times as important as urgency without incontinence. Our results confirmed that different symptoms are not equally bothersome, and we showed that the relation between symptom-level and importance is not linear. The PWS score, which we developed using these estimates was highly correlated with existing disease activity measures. Conclusions We quantified the relative importance of four common IBD symptoms and developed the PWS score for IBD, which takes the relative importance of different symptoms and symptom-levels into account. The PWS score can be used to obtain a patient-centered assessment of symptom burden. Show less
Marel, S. van der; Majowicz, A.; Kwikkers, K.; Logtenstein, R. van; Velde, A.A. te; Groot, A.S. de; ... ; Ferreira, V. 2012
De resultaten beschreven in dit proefschrift verschaffen nieuwe inzichten in verschillende aspecten van de behandeling van inflammatoire darmziekten. Uit grote studies is gebleken dat mutaties in... Show moreDe resultaten beschreven in dit proefschrift verschaffen nieuwe inzichten in verschillende aspecten van de behandeling van inflammatoire darmziekten. Uit grote studies is gebleken dat mutaties in genen die betrokken zijn bij het autofagie proces (autophagos: __zelf-eten__), geassocieerd zijn met de ziekte van Crohn. In dit proefschrift wordt beschreven hoe deze mutatie in dendritische cellen leidt tot hyperactivatie van het immuunsysteem. Dit mechanisme kan mogelijk een nieuw aangrijpingspunt verschaffen voor nieuwe therapie voor pati_nten die een mutatie hebben in dit gen. Anti-tumor-necrosis-factor-alpha (anti-TNF_) therapie neemt een steeds belangrijkere plaats in in de behandeling van IBD; het werkingsmechanisme is echter niet geheel duidelijk. In dit proefschrift wordt beschreven hoe regulatoire macrophagen met immuunsuppressieve en wondgenezende eigenschappen ge_nduceerd worden door anti-TNF_ therapie. Dit werkingsmechanisme kan nieuwe aangrijpingspunten verschaffen voor toekomstige therapie_n. Tevens wordt in dit proefschrift een experimentele behandeling van Crohn met mesenchymale stamcellen (MSCs) beschreven. Deze behandeling is haalbaar en veilig gebleken, hetgeen aanleiding geeft tot verder onderzoek naar de effectiviteit van MSCs in de behandeling van Crohn. Tot slot werd het v__rkomen van kwaadaardige lymfomen onderzocht in IBD pati_nten in Nederland. Deze lymfomen bleken niet vaker voor te komen in de totale groep IBD pati_nten vergeleken met gezonde mensen, wel werd een verhoogde incidentie gezien in bepaalde leeftijdsgroepen. Daarnaast bleek het ontstaan van een EBV positief lymfoom (epstein Barr virus) sterk geassocieerd te zijn met het gebruik van azathioprine, een ander immuunsuppressieve therapie. Samenvattend beschrijft dit proefschrift verschillende aspecten van IBD therapie, en worden nieuwe inzichten en aangrijpinspunten verschaft Show less
