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Background/Objectives: Crohn's disease is a chronic and debilitating intestinal disorder that alternates between remission and active flare-ups, often leading to hospitalization. Social support is known to enhance adaptation to the disease and modulate stress perception in patients, while stress may exacerbate symptoms. The aim of this study was to examine the roles of perceived stress and social support in Crohn's disease and their impact on the frequency of flare-ups. Methods: A cross-sectional observational study was conducted, assessing stress and social support in a cohort of 91 patients with Crohn's disease during flare-up and remission phases. The Perceived Stress Scale (PSS-14) and a Social Support Questionnaire were utilized for evaluation. We examined the relationship between stress and social support in Crohn's disease. The interaction between the variables studied was also observed, considering the stage of the disease. Finally, we carried out an analysis of the influence of these two variables on the development of flare-ups in Crohn's disease. Results: The study revealed that patients experience higher stress levels during flare-ups and that these levels are amplified by a lack of social support. A significant relationship was identified between the levels of social support and the occurrence of flare-ups, indicating that better social support is associated with fewer flare-ups. Conclusions: Patients with Crohn's disease in the flare-up phase are subject to considerable stress. A deficit in social support is linked to an increase in stress levels. The interaction between social support and stress plays a critical role in the development of flare-ups. [ABSTRACT FROM AUTHOR]

Background: Short bowel syndrome (SBS) in adults is defined as having less than 180 to 200 cm of remaining small bowel. Many literature sources do not provide precise epidemiological data, and challenges in estimating the prevalence of SBS include its multifactorial etiology and varying definitions. The most common pathologies leading to SBS include Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications. Case presentation: This article presents a clinical case of a 76-year-old Lithuanian patient who underwent parenteral nutrition for four months due to SBS. Before the following diagnosis, the patient had undergone two surgeries. During the hospitalization, life-threatening conditions such as stercoral peritonitis, septic shock, and acute respiratory failure, were observed and treated. As a result of SBS, hypoproteinemia and hypoalbuminemia developed, leading to the prescription of full parenteral nutrition. After correcting the malnutrition, a third surgery was performed, resulting in the discontinuation of parenteral nutrition and the resumption of a regular diet. Conclusions: Parenteral nutrition is the sole effective method for preserving the lives of patients with a short segment of the intestine. While on parenteral nutrition, patients can be prepared for reconstructive surgery. [ABSTRACT FROM AUTHOR]

• Recurrence of underlying disease after intestinal transplantation (IT) for short bowel syndrome should be taken into consideration when symptoms flare. • Magnifying endoscopy with narrow-band imaging with "VENCH scoring system" can differentiate between cute cellular rejection (ACR) and disease recurrence in patients with Crohn's disease after IT. • Early detection of ACR or disease recurrence by the VENCH score allows prompt treatment accordingly and results in favorable outcomes Crohn disease (CD) is one of the most common causes of short bowel syndrome and intestinal failure. Intestinal transplantation (IT) is sometimes needed for patients with CD who develop intestinal failure after multiple intestinal resections resulting from CD-related complications, such as uncontrollable bleeding and penetrating diseases. However, there have been few case reports concerning the endoscopic surveillance of patients with CD after IT. In this article, we present 2 patients with CD who underwent IT because of short bowel syndrome with intestinal failure. We administered posttransplantation immunosuppressants and conducted regular follow-up magnifying endoscopy with narrow-band imaging (ME-NBI). Both cases demonstrated favorable outcomes after surveillance with ME-NBI. In this report, we outline our post-IT follow-up strategies applying the VENCH scoring system, which is based on endoscopic features using ME-NBI to predict graft rejection. Our approach could effectively distinguish between acute cellular rejection and non-rejection, particularly disease recurrence of underlying CD. This study was approved by the institutional review board of Far Eastern Memorial Hospital (FEMH-105023-F). The patients provided written informed consent for publication. [ABSTRACT FROM AUTHOR]

Background and Aim: Resection for Crohn's disease (CD) related strictures is definitive but carries risk of morbidity, recurrence, and short bowel syndrome. On the contrary, the durability of endotherapy (ET) for CD‐related strictures is questionable. Prospective comparative studies are limited. We aimed to prospectively compare the outcomes of ET in CD strictures with a case‐matched surgical therapy (ST) cohort. Methods: Patients undergoing ET or resection for primary CD strictures (symptomatic, non‐traversable, < 5 cm length, n ≤ 3) between January 2021 and March 2022 in a high‐volume tertiary center were compared with regard to recurrent symptoms, escalation of therapy, re‐intervention, and re‐operation based on propensity matched analysis. Results: Fifty‐nine patients [49% ET, 57.6% male, median (years): 34 (15–74)] had ≥ 12 months of follow up. Before propensity matching, cumulative re‐intervention rate was significantly higher with ET [34.5% (10/29) vs 3.3% (1/30) ST, P = 0.002]. Recurrent symptoms (34.5% vs 26.7%, P = 0.42), escalation of medical therapy (27.5% vs 23.3%, P = 0.64), and re‐operation (7.4% vs 3.1%, P = 0.55) were comparable. In propensity matched analysis adjusted for demographics, disease, and stricture characteristics [n = 42, 21 each, 62% male, median (years): 32 (15–60)], cumulative probability of re‐intervention rates was higher in ET (28.6% vs 4.8%, P = 0.042). The cumulative probability of recurrent symptoms (ET: 33.3% vs surgery 33.3%, P = 0.93), therapy escalation (ET: 23.8% vs surgery 28.6%, P = 0.75), and re‐operation (ET: 9.5% vs surgery 4.8%, P = 0.57) was similar. Conclusions: ET for CD strictures require higher re‐interventions compared with resection although re‐operation could be avoided in the majority with comparable symptom free survival at 1 year. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD), mainly comprising ulcerative colitis and Crohn's disease, is a group of gradually progressive diseases bringing significant mental anguish and imposes serious economic burdens. Interplay of genetic, environmental, and immunological factors have been implicated in its pathogenesis. Nutrients, as crucial environmental determinants, mainly encompassing carbohydrates, fats, proteins, and micronutrients, are closely related to the pathogenesis and development of IBD. Nutrition is essential for maintaining the dynamic balance of intestinal eco‐environments to ensure intestinal barrier and immune homeostasis, while this balance can be disrupted easily by maladjusted nutrition. Research has firmly established that nutrition has the potential to shape the composition and function of gut microbiota to affect the disease course. Unhealthy diet and eating disorders lead to gut microbiota dysbiosis and further destroy the function of intestinal barrier such as the disruption of membrane integrity and increased permeability, thereby triggering intestinal inflammation. Notably, appropriate nutritional interventions, such as the Mediterranean diet, can positively modulate intestinal microecology, which may provide a promising strategy for future IBD prevention. In this review, we provide insights into the interplay between nutrition and gut microbiota and its effects on IBD and present some previously overlooked lines of evidence regarding the role of derived metabolites in IBD processes, such as trimethylamine N‐oxide and imidazole propionate. Furthermore, we provide some insights into reducing the risk of onset and exacerbation of IBD by modifying nutrition and discuss several outstanding challenges and opportunities for future study. [ABSTRACT FROM AUTHOR]

This article discusses bowel preserving surgery for stricturing jejunoileal Crohn's disease, specifically focusing on the Heineke-Mikulicz strictureplasty technique. The Heineke-Mikulicz technique is a minimally invasive option for Crohn's strictures that involves opening the stricture longitudinally, closing it transversely, and suturing the enterotomy. The article provides a step-by-step video vignette demonstrating the technique. It also discusses the use of adjuncts such as stricture biopsy and marking each strictureplasty with metallic clips. The article emphasizes the importance of documenting the number and location of strictures, as well as the length of small bowel resected and left in situ. The article concludes by mentioning the postoperative recovery process and the lack of funding for the study. [Extracted from the article]

Objective: Unusual or unexpected effect of treatment. Background: Gastric cancer is the 5th most common malignancy worldwide. Treatment consists of excision of the entire stomach. Malnutrition is a common problem in patients diagnosed with gastric cancer and has a negative impact on the course of treatment and the quality of life. Case Report: The paper presents a case report of a patient after total gastrectomy performed on 11/04/2016 due to G3 mucocellulare carcinoma. The patient had been on home parenteral nutrition for 2.5 years due to chronic malnutrition. After this period of time, an attempt was made to introduce an exclusion diet with the addition of Modulen IBD (Nestle Health Science), which is routinely used in the nutritional treatment of patients with Crohn's disease, with simultaneous discontinuation of parenteral nutrition. After 3 months, the patient was readmitted to the hospital to assess his nutritional status. He continued the diet as recommended. He maintained his body weight and reported improvement in eating habits. Conclusions: In the described case, the patient presented with symptoms of impaired bowel function resulting from longterm cessation of oral nutrition. It is possible that the nutritional and immunomodulatory effect of Modulen, in combination with the anti-inflammatory elimination diet, resulted in better nutrition of intestinal epithelial cells and gradual improvement of intestinal motility and absorption, which in turn enabled the patient to completely withdraw from parenteral nutrition. We propose that this type of nutritional management could also be considered in other cases of intestinal dysfunction. [ABSTRACT FROM AUTHOR]

B I Conclusion: i b In adult patients willing to undertake dietary therapy for management of their Crohn's disease, CDED is a well-tolerated approach and is associated with clinical remission at 6 weeks, based on this small cohort of prospective patients. B 36 b B Postpartum dietary therapy for Crohn's disease following Hartmann's procedure: A case report b R Davis SP 1 sp , E Young SP 1 sp , A Day SP 2 sp and D Sathananthan SP 1 sp SP 1 sp I Lyell McEwin Hospital, Adelaide; i SP 2 sp I The Queen Elizabeth Hospital, Adelaide, South Australia, Australia i B I Introduction: i b Medical and surgical management of Crohn's disease (CD) during pregnancy and lactation is complex. Dietary therapy is effective for inducing remission, offering a safe and effective treatment alternative when medical management is contraindicated or when patients opt for non-pharmacological therapies. Dietary therapy can therefore be a suitable option for patients with CD during pregnancy and lactation, with the potential to yield clinical benefit while optimizing nutritional intake and mitigating potential treatment-related side effects. [Extracted from the article]

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are lifelong diseases characterized by chronic inflammation of the gastrointestinal tract leading to its progressive and irreversible destruction. Whether early initiation of IBD-specific therapy impacts the long-term course of the disease remains unclear and has to be further explored in prospective disease-modification trials. Historically, surgery and hospitalization rates have been the surrogate markers to measure disease progression in IBD, providing an overview of the effectiveness of medical therapies. However, neither surgery nor hospitalization necessarily reflects a fail in therapeutic medical management, and many confounding factors make them biased outcomes. The Selecting Endpoints for Disease-Modification Trials consensus has defined the disease-modification endpoints required for these trials, including the impact of the disease on patient’s life (health-related quality of life, disability, and fecal incontinence), the mid-term disease complications (bowel damage in CD, IBD-related surgery and hospitalizations, disease extension in UC, extra-intestinal manifestations, permanent stoma, short bowel syndrome), and the development of dysplasia/cancer and mortality in the long term. Most available data in the literature regarding the impact of current therapies on disease progression focused on anti-tumor necrosis factor agents and are based on retrospective or post-hoc studies. Thus, prospective disease-modification trials are pressingly required to explore the effectiveness of early intensified treatment in patients with severe disease or at risk for disease progression. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) is characterized by idiopathic and chronic inflammation arising elsewhere within the gastrointestinal tract. Consequently, the mucosal tissue is destroyed during the active phase of the disease, and therefore, spontaneous repair of damaged tissue is required to restore the function and long-term homeostasis of the intestinal mucosa. Also, in patients with refractory Crohn's disease, loss of massive intestinal function can lead to short bowel syndrome or may lead to fatal intestinal failure. Summary: The concept of mucosal healing shares the idea that both regulation of mucosal inflammation and repair of the damaged mucosa are critical to achieve the ideal clinical outcome in patients with IBD. However, current treatments lack the option of those targeted to mucosal repair, and therefore, patients must achieve mucosal healing depending on their intrinsic system. To counteract inflammation-induced mucosal damage, various biologics or cell-based treatments are currently being developed. In the early developmental phase, various growth factors have been tested for their ability to promote mucosal repair. However, most of these factors did not show clinical benefit, except the recombinant glucagon-like peptide-2 (GLP-2). On the contrary, cell-based treatments are rapidly emerging, using both somatic stem cells and pluripotent stem cells. Key Messages: In this review, we focus on the current state of factor-based or cell-based regenerative medicine in the treatment of IBD. Additionally, we would like to introduce current examples of tissue engineering technologies and provide future prospects for the application of regenerative medicine in IBD. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease is a chronic inflammatory bowel disease that most commonly affects the ileum. As a result, it is associated with a high lifetime risk of one or more surgical resections. The surgical paradigm is to preserve intestinal length. This study aims to assess the length of ileum resected at the index operation and at subsequent ileocolic resections for Crohn's disease. Methods: This is a retrospective study assessing the clinical and pathological data of patients undergoing ileocolic resection for the management of Crohn's disease over the period 01/01/2002 to 31/07/2020 in two metropolitan Australian hospitals. Results: One hundred and seventy‐six patients were analysed: 130 underwent a single resection; 31 underwent two resections; and 15 underwent three resections. The median age at the first operation was 37.2 years (range 18–69) with 60% of patients female. The median length resected at the first surgery was 17.8 cm (IQR 12.0) for small bowel, and 5.0 cm (IQR 1.0) for large bowel. The length of ileum resected at the first surgery was significantly greater than that of the second (P = 0.0001), without significant differences between the second and third resections (P = 0.49). The time interval from diagnosis to the first surgery had no significant impact on the length of intestine resected at the index ileocolic resection. Conclusion: In Crohn's disease, the length of ileum removed at first resection is the greatest, with subsequent resection lengths less than the first. [ABSTRACT FROM AUTHOR]

Purpose: Short bowel syndrome (SBS) with intestinal failure (SBS-IF) requires long-term parenteral nutrition (PN). This study investigated the real-world etiologies of SBS, treatment patterns, and PN-related outcomes among adult patients with SBS-IF in Japan. Methods: This retrospective, observational cohort study was based on data from April, 2008 to January, 2020 from one of the largest hospital-based claim databases in Japan. Analyzed patients were aged ≥ 16 years, had received continuous PN for ≥ 6 months, and had SBS or undergone SBS-related surgery with a diagnosis of a causative disease. The primary endpoint was PN weaning. Results: We analyzed data for 393 patients. The most frequent causes of SBS-IF were ileus (31.8%), Crohn's disease (20.1%), and mesenteric ischemia (16.0%). Of 144/393 (36.6%) patients who were weaned off their PN, 48 (33.3%) were subsequently restarted on PN. Of 276/393 (70.2%) patients whose PN was initiated in hospital, 156 (56.5%) transitioned to home management. The mean duration of initial PN was 450.4 and 675.5 days for patients who were able or unable to be weaned off PN, respectively. Sepsis (67.4%), catheter-related bloodstream infections (49.1%), and liver disorders (45.0%) were the most reported PN-related complications. Conclusions: Most patients with SBS-IF in Japan could not be weaned off PN and suffered life-threatening complications. [ABSTRACT FROM AUTHOR]

Background: Short bowel syndrome (SBS) refers to a malabsorptive state caused by extensive resection of the intestinal tract that leads to chronic diarrhea, electrolyte disturbances, and malnutrition. Although relatively uncommon, patients with SBS can present to the emergency department with more serious complications that are potentially life-threatening. Among these complications, coagulopathy secondary to SBS is an underrecognized condition.Case Report: We present a case of severe coagulopathy secondary to vitamin K deficiency in SBS. The patient presented with unexplained coagulopathy and spontaneous bleeding in multiple organs. With a review of surgical history and detailed clinical evaluation, SBS complicated with vitamin K deficiency was diagnosed, and the patient was treated successfully. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When a patient with a history of repeated intestinal surgery presents with diarrhea, malnutrition, or electrolyte abnormalities, emergency physicians should suspect SBS. Among complications of SBS, vitamin K deficiency is a rare but serious cause of unexplained coagulopathy presenting to the emergency department. Understanding the pathophysiology of SBS facilitates early identification of complications and improves patient outcomes. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 48-year-old male patient with Crohn's disease and short bowel syndrome who experienced recurrent tetany. The patient had a history of gastric ulcer perforation and small intestine perforation, which required ileostomy formation. The patient presented with symptoms such as motor aphasia, diplopia, weakness in the lower extremities, and joint pain. Laboratory tests revealed electrolyte imbalances, including severe hypocalcemia, hypomagnesemia, and hyperphosphatemia. The patient was treated with medication, electrolyte supplementation, and antibiotics, which resulted in improved symptoms. The article highlights the various metabolic symptoms that can occur in patients with Crohn's disease. [Extracted from the article]

Disturbances of potassium equilibrium have also been linked to other neuromuscular diseases, such as a report of two patients with inflammatory bowel disease (IBD), hypokalemia, and myopathy (CK: 10,246 and 8499 U/l) [[11]]. In summary, considering that we have found two patients with secondary PP out of 400 IBD patients seen in 2013, we estimate its prevalence to be 0.5%. [Extracted from the article]

This article, published in the journal Endoscopy, examines the efficiency and safety of self-expandable metallic stent (SEMS) placement in Crohn's disease strictures. The study analyzed cases of SEMS placement in Crohn's disease patients at a single center between November 2020 and October 2023. The results showed that stent placement was successful in the majority of cases, with a low complication rate. The authors suggest that stent placement could be a viable option for patients with refractory Crohn's disease strictures, particularly those who have undergone repeated surgeries or have strictures in unfavorable locations. Further research is needed to explore this treatment option. [Extracted from the article]

Background and Aim: Despite widespread recommendations and use of intravenous corticosteroids (IVCS) for the treatment of acute flares of ulcerative colitis and Crohn's disease, limited evidence exists comparing outcomes of the two most common regimens, intravenous methylprednisolone (IVMP) and intravenous hydrocortisone (IVHC). IVHC has stronger mineralocorticoid effects compared with IVMP and may cause higher rates of hypokalemia. We aimed to determine differences in clinical outcomes including requirement for inpatient rescue therapy, bowel resection, and rates of hypokalemia. Methods: We conducted a multicenter cohort study of all adult patients admitted with an acute flare of inflammatory bowel disease (IBD) to the three tertiary hospitals in Auckland, New Zealand, where the protocol at each institution is either IVMP 60 mg daily or IVHC 100 mg four times daily. All patients requiring IVCS between 20 June 2016 and 30 June 2018 were included. The IVCS protocol was then changed at one hospital, where further data were collected for a further 12 months from 30 January 2019 until 30 December 2019. Results: There were 359 patients, including 129 (35.9%) patients receiving IVMP and 230 (64.1%) patients receiving IVHC. IVMP treatment was associated with a greater requirement for rescue therapy than IVHC (36.4% vs 19.6%, P = 0.001; odds ratio [OR] = 2.79; 95% confidence interval [CI], 1.64–4.75, P < 0.001), but also reduced rates of hypokalemia (55.8% vs 67.0%, P = 0.04; OR = 0.49; 95% CI, 0.30–0.81, P = 0.005). There was no difference between treatment groups for the median length of admission (5 days, interquartile range [IQR] 3–8), median duration of IVCS treatment (3 days, IQR 2–5), or bowel resection within 30 days of admission (12.4% vs 11.7%; OR = 1.04). Conclusion: For the treatment of an acute flare of IBD, treatment with IVMP results in significantly more requirement for inpatient rescue biologic or cyclosporin. In addition, it causes statistically significant less hypokalemia than IVHC, although in practice differences are negligible. [ABSTRACT FROM AUTHOR]

Crohn's disease activates the inflammatory reactions to induce intestinal disorders. Enteral nutrition (EN) could exert general immunomodulatory effects. Cecal ligation and perforation (CLP) surgery was utilized to establish Crohn's disease mice models. Survival analysis, hematoxylin-eosin staining, flow cytometry, ELISA, Western blot and liquid chromatography-tandem MS were applied. Baicalein was added to inhibit lipoxygenases. The survival rate was restored and inflammatory injury, exudate neutrophils in peritoneal lavage and serum levels of IL-6 and TNF-α were ameliorated by EN treatment as compared with CLP treatment. EN also increased ILC-3 content, 5/15-LOX level and RvD1-RvD5 in peritoneal lavage. Baicalein reversed all the detected effects of EN except ILC-3 content. EN could activate special pro-resolving mediators (SPMs) through ILCs to mitigate injuries of Crohn's disease. [ABSTRACT FROM AUTHOR]

A 38-year-old woman with a history of Crohn's disease, multiple bowel resections, and ileostomy placement presented to the hospital with symptoms of increased ileostomy output for 1 week. She reported that she was emptying her bag fifteen times a day as opposed to her normal 3–4 times a day. Upon workup, she was found to have an acute kidney injury (AKI), and stool studies were positive for Cryptosporidium. She was treated with nitazoxanide 500 mg p.o. BID for 3 days along with continued rehydration. The patient was discharged after creatinine (Cr) and electrolytes returned to baseline. She continued to have elevated ileostomy output, and 1 week later, she was readmitted for another AKI and worsening of symptoms. At this hospitalization, stool studies were negative for Cryptosporidium, and the gastroenterologist consult recommended evaluation for active Crohn's and Lomotil for possible short bowel syndrome. Eventually, her laboratory results improved, and she was discharged again before the full workup was completed. The patient's ileostomy output continued to remain high following the second hospital discharge, and she eventually returned with another AKI, her third visit in a month. The workup for active Crohn's was completed, with fecal calprotectin, serum cortisol, and small bowel follow-through all returning to normal. At this time, postinfectious inflammatory syndrome was suspected, and she was started on 60 mg of prednisone for 2 weeks. Steroid therapy elicited a significant response with normalization of her ileostomy output and return of laboratory results to baseline. The patient was discharged without return of symptoms at follow-up. [ABSTRACT FROM AUTHOR]

Short bowel syndrome is a pathological condition resulting from extensive resection of the intestine, generally performed due to congenital abnormalities, Crohn's disease, mesenteric ischemia, or neoplasms. The main consequence of this syndrome is a reduction of intestinal absorption, which causes malnutrition and dehydration. In the most severe cases, specific and complex surgical procedures are requested to manage the syndrome. Such procedures consist of the intestinal lengthening, with lead to an increase of absorptive mucosal surface and intestinal transit time and an overall enhancement of intestinal absorption. One of the most promising surgical procedures is spiral intestinal lengthening and tailoring, which consists of a spiral incision of the intestinal wall and in the elongation longitudinally of the intestine by sliding one flap over the other. The final intestinal lengthening is strictly dependent on a series of parameters, some of which are defined by the surgeon. The present paper proposes a mathematical model, based on patient specific anatomical data, which aims to help the surgeon in defining the optimal parameters for the intervention and in foreseeing its outcomes from the preoperative planning phase. Such a tool can assist the physician in the surgery room by improving the procedure and reducing surgical times. [ABSTRACT FROM AUTHOR]

Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging. We describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function. Teduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea. A literature review of similar cases yielded 18 patients who underwent 19 kidney transplants. Despite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2. In conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes. Further, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient. [ABSTRACT FROM AUTHOR]

Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging.tempspacetempspaceWe describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function.tempspacetempspaceTeduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea.tempspacetempspaceA literature review of similar cases yielded 18 patients who underwent 19 kidney transplants.tempspacetempspaceDespite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2.tempspacetempspaceIn conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes.tempspacetempspaceFurther, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient. [ABSTRACT FROM AUTHOR]

A robotic small bowel resection followed by Kono-S anastomosis was offered to the patient. Once we get close to finishing the posterior wall closing, we put in another stay stich that will be another 00 braided suture that is going to allow us to expose the area of the anastomosis that we are suturing at this moment. During the next step we will measure the diameter of the anastomosis, score the small bowel and confirm that the length of the scoring is around 7 cm. Scoring starts 1 cm to the end of the small bowel and finishes 7 cm proximal or distal to the starting point. [Extracted from the article]

Background. Biological therapy has reduced the number of cases requiring surgical interventions, but at least half of the patients are operated during their lifetime. Choosing the optimal surgical moment is based on a series of factors related to the patient, preoperative medication, long term complications of the disease. Aim. Stratification of risk factors for postoperative morbidity, based on clinical guidelines for surgical therapy in Crohn's disease. Methods. The analysis of our own series of cases, superimposed on the statistical data from the ECCO surgical treatment guide, highlighted a series of risk factors, which were stratified according to the possibilities of preoperative correction. Results. The most frequent postoperative complications were identified as: anastomotic and enterocutaneous fistulas, intraperitoneal abscesses, wound dehiscences, general complications (pneumonia, urinary infections). The following factors were taken into account: Preoperative nutritional status, especially in patients with long periods of disease evolution, preoperative corticosteroid medication, control of sepsis sources (including clostridium difficile infection), cessation or not of immunological therapy. The nutritional status of patients with malabsorption syndrome or long-standing stenoses can be improved preoperatively by parenteral nutrition, minimally invasive treatment of the sources of intraperitoneal sepsis, correction of stenosis (percutaneous drainage of abscesses, balloon dilatations for short stenoses), antibiotic therapy and discontinuation of cortisone medication, can reduce the risk of postoperative complications. Conclusion. The surgical moment is not clearly coded and it is difficult to choose. The decision must be multidisciplinary and take into account the patients' quality of life and the operative risk. Delaying the intervention can lead to nutritional degradation and increased postoperative morbidity as a result of prolonged corticotherapy or the installation of malabsorption syndrome. There are often situations in which surgery represents a new beginning for the gastroenterologist in re-initiating drug therapy, such as situations in which the timing of the intervention until the non-invasive therapeutic resources are exhausted can lead to the failure of a surgical solution that, applied early, would have been beneficial. [ABSTRACT FROM AUTHOR]

Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging. We describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function. Teduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea. A literature review of similar cases yielded 18 patients who underwent 19 kidney transplants. Despite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2. In conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes. Further, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient. [ABSTRACT FROM AUTHOR]

Background: Strictureplasty (SPX) conserves bowel length and minimizes the risk of developing short bowel syndrome in patients undergoing surgery for Crohn's disease (CD). However, SPX may be associated with a higher risk of recurrence compared with bowel resection (BR). Aim: We sought to compare morbidity and recurrence following SPX and BR in patients with fibrostenotic CD. Methods: A systematic review was performed according to PRISMA and MOOSE guidelines. Observational studies that compared outcomes of CD patients undergoing either SPX or BR were identified. Log hazard ratios (InHR) for recurrence-free survival (RFS) and their standard errors were calculated from Kaplan–Meier plots or Cox regression models and pooled using the inverse variance method. Dichotomous variables were pooled as odds ratios (OR) using the Mantel–Haenszel method. Continuous variables were pooled as weighted mean differences. Results: Twelve studies of 1026 CD patients (SPX n = 444, 43.27%; BR with or without SPX n = 582, 56.72%) were eligible for inclusion. There was an increased likelihood of disease recurrence with SPX than with BR (OR 1.61; 95% CI, 1.03, 2.52; p = 0.04; I2 = 0%). Patients who had a SPX alone had a significantly reduced RFS than those who underwent BR (HR 1.47; 95% CI, 1.08, 2.01; p = 0.02; I2 = 0%). There was no difference in morbidity between the groups (OR 0.58; 95% CI, 0.26, 1.28; p = 0.18; I2 = 0%). Conclusion: SPX should only be performed in those patients with Crohn's strictures that are at high risk for short bowel syndrome and intestinal failure; otherwise, BR is the favored surgical technique for the management of fibrostenotic CD. [ABSTRACT FROM AUTHOR]

Background: Repeated intestinal resections may have disabling consequences in patients with Crohn's disease even in the absence of short bowel syndrome. Our aim was to evaluate the length of resected small bowel in patients undergoing elective and emergency surgery for ileocolic Crohn's disease. Methods: A prospective observational study was conducted on patients undergoing surgery for ileocolonic Crohn's disease in a single colorectal centre from May 2010 to April 2018. The following patients were included: (1) patients with first presentation of ileocaecal Crohn's disease undergoing elective surgery; (2) patients with ileocaecal Crohn's disease undergoing emergency surgery; (3) patients with recurrent Crohn's disease of the distal ileum undergoing elective surgery. The primary outcomes were length of resected small bowel and the ileostomy rate. Operating time, complications and readmissions within 30 days were the secondary outcomes. Results: One hundred and sixty-eight patients were included: 87 patients in the elective primary surgery group, 50 patients in the emergency surgery group and 31 in the elective redo surgery group. Eleven patients (22%) in the emergency surgery group had an ileostomy compared to 10 (11.5%) in the elective surgery group (p < 0.0001). In the emergency surgery group the median length of the resected small bowel was 10 cm longer than into the group having elective surgery for primary Crohn's disease. Conclusions: Patients undergoing emergency surgery for Crohn's disease have a higher rate of stoma formation and 30-day complications. Laparoscopic surgery in the emergency setting has a higher conversion rate and involves resection of longer segments of small bowel. [ABSTRACT FROM AUTHOR]

Background: Intestinal failure is the most critical complication of Crohn's disease. Intestinal failure requires home parenteral nutrition, which worsens the quality of life of the patients and sometimes causes life-threatening complications.Aims: The purpose of this study was to investigate the incidence and risk factors for intestinal failure in Crohn's disease.Methods: We performed a retrospective analysis of Crohn's disease patients (162 cases) at Osaka University Hospital between January 2000 and December 2017. Kaplan-Meier analysis was used to investigate the cumulative incidence of intestinal failure. To identify the risk factors of intestinal failure, patient characteristics were analyzed by multivariate analysis, including disease classification, surgical history, medical treatment other than surgery, and cumulative inflammation was calculated using the average C-reactive protein value and disease duration.Results: The cumulative incidence of intestinal failure 5, 10, and 15 years after Crohn's disease diagnosis was 2.6%, 3.4%, and 8.6%, respectively. Multivariate analysis identified the following as independent risk factors for intestinal failure in Crohn's disease: residual small intestinal length < 200 cm (odds ratio 7.51, 95% confidence interval 2.14-29.96), non-use of anti-tumor necrosis factor-alpha therapy (3.34, 1.22-10.74), and cumulative inflammation (1.01, 1.001-1.038). We created a new predictive nomogram consisting of these risk factors.Conclusions: Intestinal failure occasionally occurred during long-term treatment of Crohn's disease. Cumulative inflammation for the first time, in addition to short residual small intestinal length and non-use of anti-tumor necrosis factor-alpha therapy, was shown to be potential risk factors for intestinal failure in Crohn's disease. [ABSTRACT FROM AUTHOR]

Crohn's disease (CD) was the cause of SBS-IF in 72.7% of the patients in the CT in comparison to 20.1% of the patients in the RW study. To the Editor, Mizushima et al. recently published remarkable explorative data on the causes, treatment patterns and outcomes of short bowel syndrome with intestinal failure (SBS-IF) in Japanese adult patients [[1]]. Evaluation of economic burden with biologic treatments in Crohn's disease patients: a mirror image study using an insurance database in Japan. [Extracted from the article]

Background: Teduglutide, a glucagon-like peptide 2 analog, has demonstrated efficacy in treating adult patients with short bowel syndrome (SBS) and dependence on parenteral nutrition (PN), but its role in chronic malabsorptive states that do not necessitate PN remains uncertain.Aims: To evaluate teduglutide use beyond its approved indications and to discuss the results of this adjunctive treatment in patients resistant to established therapy.Results: This series reports four patients treated with teduglutide off-label. The first case had Crohn's disease (CD) with persistent colocutaneous fistulae that demonstrated complete closure after 8 months of teduglutide therapy. The second case involved a PN-dependent CD patient with persistent fistulae and intra-abdominal abscesses who weaned off PN and had a significant improvement in her nutritional status after 3 months of teduglutide therapy. The third case had CD complicated by severe malnutrition and previous PN-associated line infections, but by 9 months of teduglutide therapy, she gained 5 kg and no longer required re-initiation of PN. The fourth case had a high-output diverting ileostomy with resultant impaired healing of a stage IV decubitus ulcer, and after 2 months of therapy, the patient's pre-albumin increased by 250% and the ulcer had decreased by 40% in size.Conclusion: The use of teduglutide might be broadened to include patients with functional SBS not meeting strict criteria for intestinal failure. Further studies should evaluate the efficacy of teduglutide in patients who may require short-term small intestine rehabilitation or who have chronically impaired absorptive capacity not yet requiring PN. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease, vascular disease, volvulus, adhesions, or abdominal trauma may necessitate extensive small-bowel resection resulting in an ultra-short distal duodenal or jejunal stump. If this distal duodenal or short jejunal stump is too short for stoma creation and bowel continuity restoration is hazardous or not possible at all, a distal duodenogastrostomy or proximal jejunogastrostomy in combination with drainage of the stomach is an option to prevent stump leakage. Although successful, this distal duodenogastrostomy has been described only in very few patients and in older records. We reintroduced this technique and describe a recent series of patients that confirms its usefulness in certain conditions. The technique of the distal duodenogastrostomy or proximal jejunogastrostomy with gastric drainage was used for the management of the difficult distal duodenum stump in five critically ill patients undergoing extensive bowel resection. Four patients with small-bowel ischemia and one patient suffering from perforating Crohn's disease and small-bowel volvulus were treated  successfully. The gastrostomies were subsequently converted to a duodenotransversostomy (in two patients) or the patients underwent small-bowel transplantation (two patients). One patient still has a jejunogastrostomy just after the duodenal-jejunal transition. In all five patients, the distal duodenogastrostomy or proximal jejunogastrostomy in combination with gastric drainage functioned well up to restoration of bowel continuity. In one patient, distal duodenogastrostomy and transabdominal gastric drainage functioned well for 5 years. No anastomotic leakage occurred. This procedure provides a feasible solution for an ultra-short bowel at emergency laparotomy. It enhances the surgical armamentarium and provides treatment options for these patients that were perhaps previously deemed unsalvageable. [ABSTRACT FROM AUTHOR]

The small bowel was run prior to resection and measured 280 cm. Intra-operatively, after a carefully assessment of the bowel length with calibration spheres, 3 short strictures were identified along the terminal ileum. CT Abdomen/Pelvis in May 2021 demonstrated dilated loops of distal small bowel in the abdomen and pelvis with suspected transition in the right lower quadrant, near the terminal ileum and surgical clips. Necrotizing Enterocolitis (NEC) is one of the most common life-threatening gastrointestinal disorders in neonates, with 10% of neonates effected. [Extracted from the article]

Intestinal failure is a complicated long-term condition that can have profound physical and psychosocial consequences for a patient's life. Hospitalisation can be long, with many distressing and unpleasant medical procedures being endured. Patients often have to deal with large volumes of unmanageable faecal fluid from stomas or fistulae and usually require home parenteral nutrition (HPN) for the remainder of their life. The literature focuses on how patients often have to tolerate long periods of suffering, which can be the basis for significant emotional anguish. It also addresses how the condition can contribute to myriad psychosocial difficulties, which can have devastating effects on their body image and quality of life. However, there is a lack of information regarding the effects of this condition on the family, who not only have to provide ongoing support for the patient, but also have to attempt to function normally while coping with their own fears and emotions. This article reviews the experiences of two patients, father and daughter, living with intestinal failure; it discusses their experiences and reveals how they cope with the physical aspects. It also addresses how the condition can effect psychosocial disturbances, not only for them but for those living closely with them. The article addresses ways that nurses could develop their relationship with the patient, enabling them to recognise and act early on signs of emotional malady. [ABSTRACT FROM AUTHOR]

Keywords: Cytomegalovirus; Ulcerative colitis; Colectomy; Immunosuppression EN Cytomegalovirus Ulcerative colitis Colectomy Immunosuppression 2684 2685 2 10/20/21 20211001 NES 211001 Presentation: Presented virtually as a poster at the 2020 American Society of Colon and Rectal Surgeons Annual Meeting. Four of the patients with CMV colitis in the setting of UC also had superimposed I Clostridium difficile i colitis. The majority ( I n i = 17; 77%) of the patients had CMV colitis in the setting of known inflammatory bowel disease ( I n i = 16 ulcerative colitis, I n i = 1 Crohn's disease). [Extracted from the article]

In this retrospective cohort study, we describe the anthropometric and clinical outcomes of EEN as induction therapy for pCD in NZ. Although 56.3% of our patients achieved clinical remission, these rates are lower than European pCD cohorts where remissions rates are 84-86.6%.4,5 Further prospective study is warranted to understand the reasons behind this difference. Paediatric-onset Crohn's disease (pCD) is rising in incidence in Australasia.1 Exclusive enteral nutrition (EEN) is first-line therapy for induction of remission in pCD.2 Despite its routine use, there is little published on the outcomes of EEN in New Zealand (NZ). [Extracted from the article]

Malnutrition is a major contributor to muscle loss and muscle dysfunction, known as sarcopenia. Malnutrition is common in patients with inflammatory bowel disease (IBD). IBD includes ulcerative colitis (UC) and Crohn's disease (CD). The number of patients with IBD has recently been increasing. More severe malnutrition is often seen in CD compared to UC, probably due to CD affecting the main site of nutrient absorption, extensive mucosal lesions, fistulas, short bowel syndrome after resection, or obstruction of the gastrointestinal tract. A recent meta-analysis showed the high prevalence of sarcopenia in patients with IBD, and thus sarcopenia is a very important problem for IBD. Although IBD is more common in younger patients, sarcopenia can develop through a variety of mechanisms, including malnutrition, chronic inflammation, increased inflammatory status in adipose tissue, vitamin deficiency, and imbalance of the muscle–gut axis. In addition, sarcopenia has a negative impact on postoperative complications and hospital stay in patients with IBD. Appropriate intervention for sarcopenia may be important, in addition to clinical remission and endoscopic mucosal healing in patients with IBD. Much more attention will thus be paid to sarcopenia in patients with IBD. In this review, we outline IBD and sarcopenia, based on the current evidence. [ABSTRACT FROM AUTHOR]

Crohn's disease is an inflammatory bowel disease that could induce inflammatory or fibrotic bowel strictures, the management of which includes medical therapy, endoscopic dilation or surgical resection [5]. For refractory stricture in Crohn's disease with short bowel syndrome, EUS-GJA allowed management of bowel occlusion until inflammatory disease was stabilized by medical treatment. [Extracted from the article]

Segmental dilatation following side-to-side isoperistaltic strictureplasty in Crohn's disease: a note of caution Surgical intervention in Crohn's disease (CD) is required in upwards of 80% of patients within 10 years of diagnosis.[1] Stricturing is the most common indication (29-42%), followed by fistulae (16%), failure of medical therapy (14%) and perforation (1-16%).[[2]] To avoid repeated bowel resections and subsequent short gut syndrome, bowel-conserving methods are preferable where possible.[5] The SSIS has been employed safely in long segments of stenosed bowel or segments with multiple short strictures where Heinecke-Mikulicz or Finney strictureplasties would result in tension on the suture line or a blind loop.[7] SSIS can be performed safely in active disease.[8]. [Extracted from the article]

In recent years, there has been a significant increase in the incidence of Crohn's disease. Despite significant medical progress, the treatment options available today do not meet the needs of all patients. Recent reports indicate that external environmental factors, including diet, are key in the pathomechanism of the disease. It was proven that the so-called Western dietary pattern is associated with an increased risk of disease. In the pediatric population, exclusive enteral nutrition is the only nutritional therapy option recommended today with proven high efficacy in inducing remission. Recent publications that indicate at least comparable efficacy and significantly better tolerability of a specialised elimination diet, the Crohn's Disease Exclusion Diet (CDED), provide the basis for a change in recommendations. This article discusses the mechanism of action, principles of use, and scientific evidence evaluating the efficacy of CDED in the treatment of children with Crohn's disease. [ABSTRACT FROM AUTHOR]

Keywords: Crohn's disease; fibrostenosing jejunoileal disease; inflammatory bowel disease; Michelassi's strictureplasty; short-bowel syndrome; side-to-side isoperistaltic strictureplasty; strictureplasty; terminal ileitis EN Crohn's disease fibrostenosing jejunoileal disease inflammatory bowel disease Michelassi's strictureplasty short-bowel syndrome side-to-side isoperistaltic strictureplasty strictureplasty terminal ileitis 2343 2343 1 12/31/20 20201201 NES 201201 Up to 50% of patients with Crohn's disease will have surgery in the 10 years following the diagnosis [1]. Footnotes 1 Accepted Article online 30 July 2020 References 1 Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease: ileocaecal Crohn's disease. Crohn's disease, fibrostenosing jejunoileal disease, inflammatory bowel disease, Michelassi's strictureplasty, short-bowel syndrome, side-to-side isoperistaltic strictureplasty, strictureplasty, terminal ileitis. [Extracted from the article]

Prior to her acute presentation she underwent outpatient CT/PET chest imaging demonstrating tiny hypermetabolic bibasilar ground-glass centrilobular nodules. Tissue biopsy is required to establish the diagnosis and can be challenging as the tissue sample can miss the area of deposition. Cryobiopsy specimens increase the sensitivity of conventional transbronchial forceps biopsy techniques through larger and more preserved tissue sampling5. [Extracted from the article]

Short bowel syndrome in adults occurs as a result of massive small intestinal resection commonly due to severe Crohn's disease, volvulus or tumors. Diarrhea and weight loss are hallmarks of malabsorption which are aggravated if the colon is removed along with the small intestinal resection. Enteral nutrition autonomy is difficult to achieve in such cases of malabsorption where parenteral nutrition are required more often than not. We report a case of short bowel syndrome with severe malabsorption following extensive small bowel removal. The patient eventually underwent intestinal rehabilitation surgery and achieved independence from parenteral nutrition. [ABSTRACT FROM AUTHOR]