Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn’s disease.

Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn’s disease. Cochrane Database Syst Rev. 2018 May 12;5:CD012540 Authors: Boyapati RK, Torres J, Palmela C, Parker CE, Silverberg OM, Upadhyaya SD, Nguyen TM, Colombel JF Abstract BACKGROUND: Crohn’s disease (CD) is a chronic, relapsing and remitting disease of the gastrointestinal tract that can cause significant morbidity and disability. Current treatment guidelines recommend early intervention with immunosuppressant or biological therapy in high-risk patients with a severe disease phenotype at presentation. The feasibility of therapeutic de-escalation once remission is achieved is…

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Enteral nutritional therapy for induction of remission in Crohn’s disease.

Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2018 Apr 01;4:CD000542 Authors: Narula N, Dhillon A, Zhang D, Sherlock ME, Tondeur M, Zachos M Abstract BACKGROUND: Corticosteroids are often preferred over enteral nutrition (EN) as induction therapy for Crohn’s disease (CD). Prior meta-analyses suggest that corticosteroids are superior to EN for induction of remission in CD. Treatment failures in EN trials are often due to poor compliance, with dropouts frequently due to poor acceptance of a nasogastric tube and unpalatable formulations. This systematic review…

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Low dose naltrexone for induction of remission in Crohn’s disease.

Low dose naltrexone for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2018 Apr 01;4:CD010410 Authors: Parker CE, Nguyen TM, Segal D, MacDonald JK, Chande N Abstract BACKGROUND: Crohn’s disease is a transmural, relapsing inflammatory condition afflicting the digestive tract. Opioid signalling, long known to affect secretion and motility in the gut, has been implicated in the inflammatory cascade of Crohn’s disease. Low dose naltrexone, an opioid antagonist, has garnered interest as a potential therapy. OBJECTIVES: The primary objective was to evaluate the efficacy and safety of low…

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Endoscopic scoring indices for evaluation of disease activity in ulcerative colitis.

Related Articles Endoscopic scoring indices for evaluation of disease activity in ulcerative colitis. Cochrane Database Syst Rev. 2018 Jan 16;1:CD011450 Authors: Mohammed Vashist N, Samaan M, Mosli MH, Parker CE, MacDonald JK, Nelson SA, Zou GY, Feagan BG, Khanna R, Jairath V Abstract BACKGROUND: Endoscopic assessment of mucosal disease activity is routinely used to determine eligibility and response to therapy in clinical trials of ulcerative colitis. The operating properties of the existing endoscopic scoring indices are unclear. OBJECTIVES: A systematic review was undertaken to evaluate the development and operating characteristics…

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Mesalamine (5-ASA) for the prevention of recurrent diverticulitis.

Mesalamine (5-ASA) for the prevention of recurrent diverticulitis. Cochrane Database Syst Rev. 2017 Oct 03;10:CD009839 Authors: Carter F, Alsayb M, Marshall JK, Yuan Y Abstract BACKGROUND: Diverticular disease is a common condition that increases in prevalence with age. Recent theories on the pathogenesis of diverticular inflammation have implicated chronic inflammation similar to that seen in ulcerative colitis. Mesalamine, or 5-aminosalicylic acid (5-ASA), is a mainstay of therapy for individuals with ulcerative colitis. Accordingly, 5-ASA has been studied for prevention of recurrent diverticulitis. OBJECTIVES: To evaluate the efficacy of mesalamine (5-ASA)…

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Strategies for detecting colon cancer in patients with inflammatory bowel disease.

Strategies for detecting colon cancer in patients with inflammatory bowel disease. Cochrane Database Syst Rev. 2017 Sep 18;9:CD000279 Authors: Bye WA, Nguyen TM, Parker CE, Jairath V, East JE Abstract BACKGROUND: Patients with longstanding ulcerative colitis and colonic Crohn’s disease have an increased risk of colorectal cancer (CRC) compared with the general population. This review assessed the evidence that endoscopic surveillance may prolong life by allowing earlier detection of CRC or its pre-cursor lesion, dysplasia, in patients with inflammatory bowel disease (IBD). OBJECTIVES: To assess the effectiveness of cancer surveillance…

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Placebo response and remission rates in randomised trials of induction and maintenance therapy for ulcerative colitis.

Placebo response and remission rates in randomised trials of induction and maintenance therapy for ulcerative colitis. Cochrane Database Syst Rev. 2017 Sep 08;9:CD011572 Authors: Jairath V, Zou GY, Parker CE, MacDonald JK, AlAmeel T, Al Beshir M, Almadi MA, Al-Taweel T, Atkinson NS, Biswas S, Chapman T, Dulai PS, Glaire MA, Hoekman DR, Koutsoumpas A, Minas E, Mosli MH, Samaan M, Khanna R, Travis S, D’Haens G, Sandborn WJ, Feagan BG Abstract BACKGROUND: It is important to minimize placebo rates in randomised controlled trials (RCTs) to efficiently detect treatment differences…

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Histologic scoring indices for evaluation of disease activity in Crohn’s disease.

Histologic scoring indices for evaluation of disease activity in Crohn’s disease. Cochrane Database Syst Rev. 2017 Jul 21;7:CD012351 Authors: Novak G, Parker CE, Pai RK, MacDonald JK, Feagan BG, Sandborn WJ, D’Haens G, Jairath V, Khanna R Abstract BACKGROUND: Histologic assessment of mucosal disease activity has been increasingly used in clinical trials of treatment for Crohn’s disease. However, the operating properties of the currently existing histologic scoring indices remain unclear. OBJECTIVES: A systematic review was undertaken to evaluate the development and operating characteristics of available histologic disease activity indices in…

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Interventions for treating lymphocytic colitis.

Related Articles Interventions for treating lymphocytic colitis. Cochrane Database Syst Rev. 2017 Jul 13;7:CD006096 Authors: Chande N, Al Yatama N, Bhanji T, Nguyen TM, McDonald JW, MacDonald JK Abstract BACKGROUND: Lymphocytic colitis is a cause of chronic diarrhea. It is a subtype of microscopic colitis characterized by chronic, watery, non-bloody diarrhea and normal endoscopic and radiologic findings. The etiology of this disorder is unknown.Therapy is based mainly on case series and uncontrolled trials, or by extrapolation of data for treating collagenous colitis, a related disorder. This review is an update…

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Histologic scoring indices for evaluation of disease activity in ulcerative colitis.

Related Articles Histologic scoring indices for evaluation of disease activity in ulcerative colitis. Cochrane Database Syst Rev. 2017 May 25;5:CD011256 Authors: Mosli MH, Parker CE, Nelson SA, Baker KA, MacDonald JK, Zou GY, Feagan BG, Khanna R, Levesque BG, Jairath V Abstract BACKGROUND: Disease activity can be determined using clinical, endoscopic or histologic criteria in patients with ulcerative colitis (UC). Persistent disease activity is associated with poor outcomes. Histologic disease activity has been shown to be associated with relapse, colectomy and colorectal cancer. The ability to objectively evaluate microscopic disease…

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