12 results on '"Carbonnel, F"'
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2. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations
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Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, Guslandi M, Oldenburg B, Dotan I, Marteau P, Ardizzone A, Baumgart DC, D'Haens G, Portela F, Vucelic B, Söderholm J, Escher J, Koletzko S, Kolho KL, Lukas M, Mottet C, Tilg H, Vermeire S, Carbonnel F, Cole A, Novacek G, Reinshagen M, Tsianos E, Herrlinger K, Bouhnik Y, Kiesslich R, Stange E, Travis S, Lindsay J, for the European Crohn's, Colitis Organisation (ECCO, GIONCHETTI, PAOLO, Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, Guslandi M, Oldenburg B, Dotan I, Marteau P, Ardizzone A, Baumgart DC, D'Haens G, Gionchetti P, Portela F, Vucelic B, Söderholm J, Escher J, Koletzko S, Kolho KL, Lukas M, Mottet C, Tilg H, Vermeire S, Carbonnel F, Cole A, Novacek G, Reinshagen M, Tsianos E, Herrlinger K, Bouhnik Y, Kiesslich R, Stange E, Travis S, Lindsay J, for the European Crohn's and Colitis Organisation (ECCO, and Gastroenterology and Hepatology
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Complementary Therapies ,Male ,medicine.medical_specialty ,Adolescent ,Crohn's disease ,post-operative recurrence ,fistula ,paediatric ,pregnancy ,psychosomatic ,extraintestinal manifestation ,Placebo-controlled study ,Anti-Inflammatory Agents ,Inflammatory bowel disease ,Management of Crohn's disease ,Skin Diseases ,Primary sclerosing cholangitis ,law.invention ,chemistry.chemical_compound ,Mesalazine ,Randomized controlled trial ,Crohn Disease ,law ,Adrenal Cortex Hormones ,Pregnancy ,Recurrence ,Intestinal Fistula ,Medicine ,Humans ,Child ,business.industry ,Tumor Necrosis Factor-alpha ,General surgery ,Arthritis ,Gastroenterology ,Antibodies, Monoclonal ,General Medicine ,medicine.disease ,digestive system diseases ,Infliximab ,Surgery ,Anti-Bacterial Agents ,Pregnancy Complications ,Psychotherapy ,Aminosalicylic Acids ,chemistry ,Purines ,Female ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Principal changes with respect to the 2004 ECCO guidelines Ileocolonoscopy is recommended within the first year after surgery where treatment decisions may be affected (Statement 8C). Thiopurines are more effective than mesalazine or imidazole antibiotics alone in post-operative prophylaxis (Statement 8F). ### 8.1 Epidemiology of post-operative Crohn's disease In the natural history of CD, intestinal resection is almost unavoidable since about 80% of patients require surgery at some stage. Surgery is unfortunately not curative as the disease inexorably recurs in many patients. The post-operative recurrence rate varies according to the definition used: clinical, endoscopic, radiological, or surgical. It is lowest when the repeat resection rate is considered, intermediate when clinical indices are used and highest when endoscopy is employed as the diagnostic tool.1–10 Data from endoscopic follow-up of patients after resection of ileo-caecal disease have shown that in the absence of treatment, the post-operative recurrence rate is around 65–90% within 12 months and 80–100% within 3 years of the operation. The clinical recurrence without therapy is about 20–25%/year.1,10 It has been demonstrated that the post-operative clinical course of CD is best predicted by the severity of endoscopic lesions. Symptoms, in fact, appear only when severe lesions are present and it is not uncommon to observe patients with fairly advanced recurrent lesions at endoscopy who remain asymptomatic.1 For these reasons, clinical indices such as the CDAI have low sensitivity at discriminating between patients with or without post-operative recurrence.11 These data mandate strategies aimed at interrupting or delaying the natural course of post-operative recurrence. Several medications have been tried in an attempt to prevent post-operative recurrence, mostly with disappointing results. The aim of this Consensus was therefore critically to evaluate the optimal strategies for the management of post-operative recurrence in CD. Most, if not all, of the evidence available deals with …
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- 2009
3. The accuracy of preoperative imaging in measuring the length of the ileocolic segment affected by Crohn's disease: a prospective cohort study.
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Brouquet, A., Rangheard, A.‐S., Ifergan, J., Lazure, T., Carbonnel, F., Penna, C., and Benoist, S.
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CROHN'S disease diagnosis ,CROHN'S disease ,RADIOLOGISTS ,SURGERY ,INFLAMMATORY bowel disease treatment ,PATIENTS - Abstract
Aim The study aimed to evaluate the accuracy of imaging for measurement of the length of the ileocolic segment affected by Crohn's disease. Method Fifty-four consecutive patients who underwent resection between 2011 and 2014 for ileocolic Crohn's disease were prospectively studied. All had preoperative MR or CT enterography. Two independent radiologists measured the length of the diseased intestinal segment. The measurements were compared with the length of disease assessed on pathology of the non-fixed surgical specimen. Results The median preoperative length of the Crohn's disease segment on imaging was 20.5 (2-73) cm and 20 (3-90) cm, as measured by the two radiologists. Interobserver agreement was substantial (κ = 0.69) with a correlation coefficient ( r) of 0.82 ( P < 0.001). The median length of the Crohn's disease segment on pathological examination was 16.5 (2-75) cm and was closely correlated with the radiological measurement ( r = 0.76, P < 0.001). The length of the Crohn's disease segment on imaging was correct to within 5 cm of the value on pathology. It was correct in 30 (55%) patients and was underestimated and overestimated in 6 (11.1%) and 18 (33.3%). A length of disease of less than 20 cm found on imaging in 26 patients was confirmed in 25 (96%) on pathology, whereas a length of more than 20 cm found on imaging in 28 patients was confirmed in 18 (64%) on pathology. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of imaging for predicting a length of less than 20 cm were 71%, 95%, 96%, 64% and 79%. Conclusion Imaging accurately identifies the length of the ileocolic segment of Crohn's disease when it is 20 cm or less on pathological examination. In patients with more extensive disease, imaging tends to overestimate the length and should be interpreted with caution. [ABSTRACT FROM AUTHOR]
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- 2017
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4. No association of alcohol use and the risk of ulcerative colitis or Crohn's disease: data from a European Prospective cohort study (EPIC).
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Bergmann, M M, Hernandez, V, Bernigau, W, Boeing, H, Chan, S S M, Luben, R, Khaw, K-T, van Schaik, F, Oldenburg, B, Bueno-de-Mesquita, B, Overvad, K, Palli, D, Masala, G, Carbonnel, F, Boutron-Ruault, M-C, Olsen, A, Tjonneland, A, Kaaks, R, Katzke, V, and Riboli, E
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ALCOHOL drinking ,CROHN'S disease ,LONGITUDINAL method ,RESEARCH funding ,ULCERATIVE colitis ,LOGISTIC regression analysis ,DISEASE incidence ,CASE-control method ,ODDS ratio - Abstract
Background/objectives: The role of long-term alcohol consumption for the risk of developing ulcerative colitis (UC) and Crohn's disease (CD) is unclear. For the first time, to prospectively assess the role of pre-disease alcohol consumption on the risk of developing UC or CD.Subjects/methods: Nested within the European Prospective Investigation into Cancer and Nutrition (EPIC-IBD), incident UC and CD cases and matched controls where included. At recruitment, participants completed validated food frequency and lifestyle questionnaires. Alcohol consumption was classified as either: non-use, former, light (⩽0.5 and 1 drink per week), below the recommended limits (BRL) (⩽1 and 2 drinks per day), moderate (⩽2.5 and 5 drinks per day), or heavy use (>2.5 and >5 drinks per day) for women and men, respectively; and was expressed as consumption at enrolment and during lifetime. Conditional logistic regression was applied adjusting for smoking and education, taking light users as the reference.Results: Out of 262 451 participants in six countries, 198 UC incident cases/792 controls and 84 CD cases/336 controls were included. At enrolment, 8%/27%/32%/23%/11% UC cases and 7%/29%/40%/19%/5% CD cases were: non-users, light, BRL, moderate and heavy users, respectively. The corresponding figures for lifetime non-use, former, light, BRL, moderate and heavy use were: 3%/5%/23%/44%/19%/6% and 5%/2%/25%/44%/23%/1% for UC and CD cases, respectively. There were no associations between any categories of alcohol consumption and risk of UC or CD in the unadjusted and adjusted odds ratios.Conclusion: There was no evidence of associations between alcohol use and the odds of developing either UC or CD. [ABSTRACT FROM AUTHOR]- Published
- 2017
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5. Low exposure to sunlight is a risk factor for Crohn's disease.
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Nerich, V., Jantchou, P., Boutron‐Ruault, M.‐C., Monnet, E., Weill, A., Vanbockstael, V., Auleley, G.‐R., Balaire, C., Dubost, P., Rican, S., Allemand, H., and Carbonnel, F.
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PHYSIOLOGICAL effects of ultraviolet radiation ,CROHN'S disease ,ULCERATIVE colitis ,INFLAMMATORY bowel diseases ,DISEASE incidence ,REGRESSION analysis ,CONFIDENCE intervals ,DISEASE risk factors - Abstract
Background, Low sunshine exposure might contribute to the pathogenesis of inflammatory bowel disease (IBD). Aim, To assess the geographic distribution of IBD incidence in relation to sunshine exposure in France to test the hypothesis that higher sun exposure is associated with lower IBD risk. Methods, Using the national health insurance database, incidence rates of Crohn's disease (CD) and ulcerative colitis (UC) were estimated for each of the 94 French administrative areas ('de'partements'), between 2000 and 2002. The surface UV radiation intensity was obtained by combining modelling and satellite data from Meteosat, the European meteorological satellite. Relationships between incidence rates and sun exposure were tested for significance by using a Poisson regression. We mapped smoothed relative risks (sRR) for CD and UC, using a Bayesian approach and adjusting for sun exposure, to search for geographical variations. Results, Areas with a smoothed RR of CD incidence significantly above 1 corresponded to areas with low sunshine exposure, whereas those with high or medium sunlight exposure had smoothed RRs either lower than 1 or not significantly different from 1. There was no association between sun exposure and UC incidence. Conclusions, This geographic study suggests that low sunlightexposure is associated with an increased incidence of Crohn's disease. Further studies are needed to determine if this association is causal. [ABSTRACT FROM AUTHOR]
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- 2011
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6. Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn's disease: a randomised, double blind, placebo controlled GETAID trial.
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Marteau, P., Lémann, M., Seksik, P., Laharie, D., Colombel, J. F., Bouhnik, Y., Cadiot, G., Soulé, J. C., Bourreille, A., Metman, E., Lerebours, E., Carbonnel, F., Dupas, J. L., Veyrac, M., Coffin, B., Moreau, J., Abitbol, V., Blum-Sperisen, S., and Mary, J. Y.
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CROHN'S disease ,DISEASE relapse ,PLACEBOS ,LACTOBACILLUS ,PATIENTS ,IMMUNE response - Abstract
Background and aims: Early endoscopic recurrence is frequent alter intestinal resection for Crohn's disease. Bacteria are involved, and probiotics may modulate immune responses to the intestinal flora. Here we tested the probiotic strain Lactobacillus johnsonii LA1 in this setting. Patients and methods: This was a randomised, double blind, placebo controlled study. Patients were eligible if they had undergone surgical resection of < 1 m, removing all macroscopic lesions within the past 21 days. Patients were randomised to receive two packets per day of lyophilised LA1 (2×10
9 cfu) or placebo for six months; no other treatment was allowed. The primary endpoint was endoscopic recurrence at six months, with grade > 1 in Rutgeerts' classification or an adapted classification for colonic lesions. Endoscopic score was the maximal grade of ileal and colonic lesions. Analyses were performed primarily on an intent to treat basis. Results: Ninety eight patients were enrolled (48 in the LA1 group). At six months, endoscopic recurrence was observed in 30/47 patients (64%) in the placebo group and in 21/43 (49%) in the LA1 group (p = 0.15). Per protocol analysis confirmed this result. Endoscopic score distribution did not differ significantly between the LA1 and placebo groups. There were four clinical recurrences in the LA1 group and three in the placebo group. Conclusion: L johnsonii LA1 (4 × 109 cfu/day) did not have a sufficient effect, if any, to prevent endoscopic recurrence of Crohn's disease. [ABSTRACT FROM AUTHOR]- Published
- 2006
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7. Crohn's disease severity in familial and sporadic cases.
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Carbonnel, F., Macaigne, G., Beaugerie, L., Gendre, J. P., and Cosnes, J.
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- 1999
8. Syndrome arthrocutané associé à une maladie de Crohn chez une adolescente
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Guerre-Schmidt, A.-R., Pelletier, F., Carbonnel, F., Humbert, P., and Aubin, F.
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ERYTHEMA , *CUTANEOUS manifestations of general diseases , *ARTHRITIS , *CROHN'S disease , *INFLAMMATORY bowel diseases - Abstract
Abstract: Introduction: Pustulosis, erythema nodosum, arthritis and systemic manifestations are associated in the dermatosis-arthritis syndrome. It is a well recognized complication of the bowel ileo-jejunal bypass but it is also associated with inflammatory bowel diseases. Exegese: We report the case of an adolescent who presented with a dermatosis-arthritis syndrome associated to a Crohn''s disease during a referring for pustulosis, erythema nodosum and fever. The evolution is complicated by proctorragia. Colonoscopy and intestinal biopsy found a Crohn''s disease. Cutaneous and intestinal symptoms quickly improved with systemic corticosteroids. Conclusion: The dermatosis-arthritis syndrome can be associated with bowel bypass and with inflammatory bowel disease, more frequently with ulcerative colitis than with Crohn''s disease. It consists in a vesiculopustular eruption, erythema nodosum, fever, arthritis and ocular manifestations. Histopathology bears a strong resemblance with Sweet''s syndrome. Physiopathology implicates microbial proliferation, formation of immune complex against skin and activation and migration of neutrophils and increasing factors. The treatment is based on corticosteroids and non steroid anti-inflammatory drugs or dapsone. [Copyright &y& Elsevier]
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- 2006
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9. Efficacy of adalimumab in patients with Crohn's disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study
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David Laharie, Gilles Bommelaer, Carmen Stefanescu, Silvio Danese, Jacques Moreau, Matthieu Allez, Stéphane Nancey, Romain Altwegg, Anne Bourrier, Jean-Yves Mary, Xavier Roblin, Vered Abitbol, Laurence Picon, Yoram Bouhnik, Guillaume Savoye, Xavier Hébuterne, Laurent Peyrin-Biroulet, Guillaume Bouguen, Edouard Louis, Franck Carbonnel, Magaly Zappa, Maria Nachury, Hedia Brixi, Mathurin Fumery, Arnaud Bourreille, Service de Gastroentérologie [Hôpital Beaujon], Hôpital Beaujon, Service d'hépato-gastro-entérologie, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Département d'hépatologie et de gastroentérologie, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Service de gastro-entérologie et nutrition clinique, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Service de Gastro-entérologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Service des Maladies de l'Appareil Digestif et de la Nutrition [CHRU Lille], Fédération Hospitalière de France-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Hôpital Claude Huriez [Lille], Service d'hépato-gastro-entérologie et cancérologie digestive [CHU de Reims], Centre Hospitalier Universitaire de Reims (CHU Reims), Service d'hépato-gastro-entérologie, cancérologie digestive et assistance nutritionnelle [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Hépato-Gastro-Onco-Entérologie [CHRU de Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service de Gastroentérologie et nutrition [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service d'Hépato-gastro-entérologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Gastro-entérologie et Nutrition[Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'Hépato-Gastroentérologie [Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Service d'Hépato Gastroenterologie [CHU Amiens-Picardie], CHU Amiens-Picardie, Autophagie infections immunité – Autophagy Infection Immunity, Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Service de gastroentérologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Hépato-gastro-entérologie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service des Maladies de l'Appareil Digestif, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Département d'Hépato-Gastroentérologie, Hôtel-Dieu-CHU Clermont-Ferrand-Université de Clermont-Ferrand, Gastroenterology, Istituto Clinico Humanitas [Milan] (IRCCS Milan), Humanitas University [Milan] (Hunimed)-Humanitas University [Milan] (Hunimed), Université de Liège, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille-Fédération Hospitalière de France-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service d'Hépato-Gastroentérologie [CHU Rouen], Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Autophagie infection et immunité - Autophagy Infection Immunity (APY), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), OUERTANI, jeannette, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Pôle Maladies de l'appareil digestif [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service des Maladies de l'Appareil Digestif [CHU Rennes], CHU Pontchaillou [Rennes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Gastro-entérologie et Hépatologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Bouhnik, Y, Carbonnel, F, Laharie, D, Stefanescu, C, Hebuterne, X, Abitbol, V, Nachury, M, Brixi, H, Bourreille, A, Picon, L, Bourrier, A, Allez, M, Peyrin-Biroulet, L, Moreau, J, Savoye, G, Fumery, M, Nancey, S, Roblin, X, Altwegg, R, Bouguen, G, Bommelaer, G, Danese, S, Louis, E, Mary, Jy, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), CHU Lille-CHU Lille, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)
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medicine.medical_specialty ,medicine.medical_treatment ,CROHN'S DISEASE ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Clinical endpoint ,Adalimumab ,Medicine ,IBD CLINICAL ,Crohn's disease ,business.industry ,Inflammatory Bowel Disease ,Gastroenterology ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Bowel resection ,[SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy ,medicine.disease ,[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,3. Good health ,Surgery ,030220 oncology & carcinogenesis ,Cohort ,ABDOMINAL MRI ,030211 gastroenterology & hepatology ,Observational study ,[SDV.IMM.IMM] Life Sciences [q-bio]/Immunology/Immunotherapy ,business ,Cohort study ,medicine.drug - Abstract
ObjectiveThe efficacy of anti-tumour necrosis factors (anti-TNFs) in patients with Crohn's disease (CD) and symptomatic small bowel stricture (SSBS) is controversial. The aim of this study was to estimate the efficacy of adalimumab in these patients and to identify the factors predicting success.DesignWe performed a multicentre, prospective, observational cohort study in patients with CD and SSBS. The included patients underwent magnetic resonance enterography at baseline and subsequently received adalimumab. The primary endpoint was success at week 24, defined as adalimumab continuation without prohibited treatment (corticosteroids after the eight week following inclusion, other anti-TNFs), endoscopic dilation or bowel resection. The baseline factors independently associated with success were identified using a logistic regression model, leading to a simple prognostic score. Secondary endpoints were prolonged success after week 24 (still on adalimumab, without dilation nor surgery) and time to bowel resection in the whole cohort.ResultsFrom January 2010 to December 2011, 105 patients were screened and 97 were included. At week 24, 62/97 (64%) patients had achieved success. The prognostic score defined a good prognosis group with 43/49 successes, an intermediate prognosis group with 17/28 successes and a poor prognosis group with 1/16 successes. After a median follow-up time of 3.8 years, 45.7%±6.6% (proportion±SE) of patients who were in success at week 24 (ie, 29% of the whole cohort) were still in prolonged success at 4 years. Among the whole cohort, 50.7%±5.3% of patients did not undergo bowel resection 4 years after inclusion.ConclusionsA successful response to adalimumab was observed in about two-thirds of CD patients with SSBS and was prolonged in nearly half of them till the end of follow-up. More than half of the patients were free of surgery 4 years after treatment initiation.Clinical Trial registration numberNCT01183403; Results.
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- 2017
10. Non-colorectal intestinal tract carcinomas in inflammatory bowel disease: Results of the 3rd ECCO Pathogenesis Scientific Workshop (II)
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Janneke van der Woude, Bernd Bokemeyer, Laurence J. Egan, John K. Triantafillidis, Francesco Selvaggi, Gianluca Pellino, Paula Borralho Nunes, Franck Carbonnel, Marcus Harbord, Tine Jess, Renata D'Incà, Gastroenterology & Hepatology, Egan, L, D'Inca, R, Jess, T, Pellino, Gianluca, Carbonnel, F, Bokemeyer, B, Harbord, M, Nunes, P, Van der Woude, J, Selvaggi, Francesco, and Triantafillidis, J.
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Doença de Crohn ,Colorectal cancer ,pouch-anal anastomosis ,Neoplasias Intestinais ,Doenças Inflamatórias Intestinais Doenças Inflamatórias Intestinais ,Gastroenterology ,Inflammatory bowel disease ,regional enteritis ,Crohn Disease ,ileal pouch ,Risk Factors ,ulcerative-colitis ,Anus neoplasms ,human-papillomavirus infection ,risk-factors ,Crohn's disease ,General Medicine ,Anus Neoplasms ,Prognosis ,Jejunal neoplasms ,Adenocarcinoma ,complicating crohns-disease ,medicine.medical_specialty ,Intestinal Neoplasm ,Colonic Pouches ,Rectal neoplasms ,Inflammatory Bowel disease ,SDG 3 - Good Health and Well-being ,Internal medicine ,Intestinal Neoplasms ,medicine ,Humans ,population-based cohort ,Gastrointestinal cancer ,Colitis ,Ileal neoplasms ,Colonic pouches ,Jejunal Neoplasms ,Rectal Neoplasms ,business.industry ,Carcinoma ,Cancer ,restorative proctocolectomy ,Congresses as Topic ,Inflammatory Bowel Diseases ,medicine.disease ,digestive system diseases ,Ileal Neoplasms ,of-the-literature ,Risk factor ,business - Abstract
Patients with inflammatory bowel diseases (IBD) have an excess risk of certain gastrointestinal cancers. Much work has focused on colon cancer in IBD patients, but comparatively less is known about other more rare cancers. The European Crohn's and Colitis Organization established a pathogenesis workshop to review what is known about these cancers and formulate proposals for future studies to address the most important knowledge gaps. This article reviews the current state of knowledge about small bowel adenocarcinoma, ileo-anal pouch and rectal cuff cancer, and anal/perianal fistula cancers in IBD patients. (C) 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
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- 2014
11. Methotrexate Is Not Superior to Placebo for Inducing Steroid-Free Remission, but Induces Steroid-Free Clinical Remission in a Larger Proportion of Patients With Ulcerative Colitis
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Vered Abitbol, Konstantinos H. Katsanos, Georgia Malamut, Yoram Bouhnik, Jacques Moreau, Edouard Louis, Philippe Seksik, Laurent Peyrin-Biroulet, Fabrizio Bossa, Mathieu Allez, Martti Färkkilä, Arnaud Bourreille, Julie Demolin, Xavier Roblin, Dominique Deplanque, Franck Carbonnel, Gaëlle Brillaut, Pierre Michetti, Gilles Bommelaer, Silvio Danese, Jean-Frederic Colombel, David Laharie, Hélène Sarter, Gottfried Novacek, Hedia Brixi, Mathurin Fumery, Patricia Détré, Walter Reinisch, Maria Nachury, Baya Coulibaly, Jérôme Filippi, Olivier Dewit, Hépatogastroentérologie, CHU de Bicêtre, Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Nice (CHU Nice), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Département de gastroentérologie, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Toulouse [Toulouse], Institut National de la Santé et de la Recherche Médicale (INSERM), Neuropathies du système nerveux entérique et pathologies digestives, implication des cellules gliales entériques, Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut des Maladies de l'Appareil Digestif, Université de Nantes (UN), CHU Amiens-Picardie, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Clinic of Internal Medicine IV, Department of Gastroenterology and Hepathology, Universität Wien, Pole des maladies de l'appareil digestif, gastroentérologie et assistance nutritive, Hôpital Beaujon [AP-HP], Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Microorganismes, Molécules Bioactives et Physiopathologie Intestinale (LBM-E4), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC CHU ( Lille)/inserm, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Département de Pharmacologie, PRES Université Lille Nord de France-Faculté de Médecine, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Institut National de Veille Sanitaire, Institut national de veille sanitaire, Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7), CHU Cochin [AP-HP], Centre hospitalier universitaire d'Amiens (CHU Amiens-Picardie), AP-HP Hôpital Beaujon, Carbonnel, F, Colombel, Jf, Filippi, J, Katsanos, Kh, Peyrin-Biroulet, L, Allez, M, Nachury, M, Novacek, G, Danese, S, Abitbol, V, Bossa, F, Moreau, J, Bommelaer, G, Bourreille, A, Fumery, M, Roblin, X, Reinisch, W, Bouhnik, Y, Brixi, H, Seksik, P, Malamut, G, Farkkila, M, Coulibaly, B, Dewit, O, Louis, E, Deplanque, D, Michetti, P, Sarter, H, Laharie, D, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)
- Subjects
Male ,Time Factors ,Anti-Inflammatory Agents ,Gastroenterology ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,Adrenal Cortex Hormones ,Prednisone ,law ,Crohn's disease ,Gastrointestinal agent ,[CHIM.ORGA]Chemical Sciences/Organic chemistry ,Remission Induction ,Middle Aged ,Ulcerative colitis ,Clinical Trial ,3. Good health ,Europe ,Treatment Outcome ,030220 oncology & carcinogenesis ,Drug Therapy, Combination ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,Drug ,medicine.drug ,Adult ,medicine.medical_specialty ,Colon ,Nausea ,Injections, Subcutaneous ,IBD ,Placebo ,Injections, Intramuscular ,03 medical and health sciences ,Double-Blind Method ,Gastrointestinal Agents ,Internal medicine ,medicine ,Humans ,Wound Healing ,Hepatology ,business.industry ,medicine.disease ,Surgery ,Methotrexate ,Colitis, Ulcerative ,business - Abstract
BACKGROUND & AIMS: Parenteral methotrexate is an effective treatment for patients with Crohn's disease, but has never been adequately evaluated in patients with ulcerative colitis (UC). We conducted a randomized controlled trial to determine its safety and efficacy in patients with steroid-dependent UC. METHODS: We performed a double-blind, placebo-controlled trial to evaluate the efficacy of parenteral methotrexate (25 mg/wk) in 111 patients with corticosteroid-dependent UC at 26 medical centers in Europe from 2007 through 2013. Patients were given prednisone (10 to 40 mg/d) when the study began and were randomly assigned to groups (1: 1) given placebo or methotrexate (intramuscularly or subcutaneously, 25 mg weekly) for 24 weeks. The primary end point was steroid-free remission (defined as a Mayo score 1 and complete withdrawal of steroids) at week 16. Secondary endpoints included clinical remission (defined as a Mayo clinical subscore 1) and endoscopic healing without steroids at weeks 16 and/or 24, remission without steroids at week 24, and remission at both weeks 16 and 24. RESULTS: Steroid-free remission at week 16 was achieved by 19 of 60 patients given methotrexate (31.7%) and 10 of 51 patients given placebo (19.6%)-a difference of 12.1% (95% confidence interval [CI]: -4.0% to 28.1% P =.15). The proportion of patients in steroid-free clinical remission at week 16 was 41.7% in the methotrexate group and 23.5% in the placebo group, for a difference of 18.1% (95% CI: 1.1% to 35.2% P =.04). The proportions of patients with steroid-free endoscopic healing at week 16 were 35% in the methotrexate group and 25.5% in the placebo group-a difference of 9.5% (95% CI: -7.5% to 26.5% P =.28). No differences were observed in other secondary end points. More patients receiving placebo discontinued the study because of adverse events (47.1%), mostly caused by UC, than patients receiving methotrexate (26.7% P =.03). A higher proportion of patients in the methotrexate group had nausea and vomiting (21.7%) than in the placebo group (3.9% P =.006). CONCLUSIONS: In a randomized controlled trial, parenteral methotrexate was not superior to placebo for induction of steroid-free remission in patients with UC. However, methotrexate induced clinical remission without steroids in a significantly larger percentage of patients, resulting in fewer withdrawals from therapy due to active UC. ClinicalTrials.gov ID NCT00498589.
- Published
- 2016
12. Challenges to the Design, Execution, and Analysis of Randomized Controlled Trials for Inflammatory Bowel Disease
- Author
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Jean Yves Mary, Silvio Danese, Walter Reinisch, Geert R. D'Haens, Jean-Frederic Colombel, Richard N. Fedorak, S. B. Hanauer, Marc Lémann, F. Carbonnel, Brian G. Feagan, Paul Rutgeerts, William J. Sandborn, D'Haens, G, Feagan, B, Colombel, Jf, Sandborn, Wj, Reinisch, W, Rutgeerts, P, Carbonnel, F, Mary, Jy, Danese, S, Fedorak, Rn, Hanauer, S, Lemann, M, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and Gastroenterology and Hepatology
- Subjects
medicine.medical_specialty ,Endpoint Determination ,Statistics as Topic ,Disease ,Placebo ,Inflammatory bowel disease ,Gastroenterology ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Intensive care medicine ,Randomized Controlled Trials as Topic ,Crohn's disease ,Hepatology ,biology ,business.industry ,Tumor Necrosis Factor-alpha ,C-reactive protein ,Antibodies, Monoclonal ,medicine.disease ,Inflammatory Bowel Diseases ,Ulcerative colitis ,Clinical trial ,Treatment Outcome ,Research Design ,biology.protein ,business - Abstract
Treatment of inflammatory bowel disease has greatly improved with the development of targeted, monoclonal antibody–based therapies. Tumor necrosis factor antagonists are frequently used to treat patients with Crohn's disease or ulcerative colitis, but they have side effects and their efficacy often decreases with use. New, more effective drugs are therefore needed and in development. However, many agents that appeared to be promising in preclinical studies have failed to show efficacy in clinical trials. We discuss possible reasons for the failures of these reagents in trials, which include the high rate of response to placebo, an inadequate range of doses, inappropriate timing of end point measurements, the changing therapeutic environment, and the competitive trial system. We also review regulatory guidelines for end points and trial design and recommend ways to improve trials.
- Published
- 2012
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