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Article ; Online: Review article: Mechanisms underlying the effectiveness of exclusive enteral nutrition in Crohn's disease.

Melton, Sarah L / Taylor, Kirstin M / Gibson, Peter R / Halmos, Emma P

2023 Volume 57, Issue 9, Page(s) 932–947

Abstract: Background: Exclusive enteral nutrition (EEN) induces remission and mucosal healing in patients with Crohn's disease, but the mechanism of action remains unknown.: Aim: To outline current understanding of the mechanisms of action of EEN.: Methods: ...

Abstract	Background: Exclusive enteral nutrition (EEN) induces remission and mucosal healing in patients with Crohn's disease, but the mechanism of action remains unknown. Aim: To outline current understanding of the mechanisms of action of EEN. Methods: From a comprehensive literature search, published data were critically examined in a narrative review. Results: Multiple potential mechanisms of action have been identified. EEN optimises nutritional status. Differences in gut microbiota in terms of overall diversity and taxonomic community structure are observed between responders and non-responders to EEN. Therapy with EEN alters microbial metabolites (including faecal short-chain fatty acids, amino acids, branched-chain amino acids and sulphide) and faecal pH. Epithelial effects and restoration of barrier function, as well as changes in mucosal cytokine profiles and T-cell subsets are observed in responders to EEN. The impact of inclusion or exclusion of specific dietary components may be of importance, but putative detrimental components are found in many formulas. A major challenge in interpreting these findings is that they often contradict or change in opposite directions to what is considered 'beneficial'. It is difficult to differentiate between the observations following EEN being driven by EEN per se and those associated with resolving inflammation. Conclusions: The mechanisms of action of EEN are likely to involve a complex interplay between host mucosal immune response and luminal environment, but the identity of key factors remains poorly understood. A better definition of pathogenic factors may aid in developing more targeted dietary treatment and provide insights into the pathogenesis of Crohn's disease.
MeSH term(s)	Humans ; Crohn Disease/therapy ; Enteral Nutrition ; Feces ; Mucous Membrane ; Diet ; Remission Induction
Language	English
Publishing date	2023-03-09
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.17451
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Article ; Online: Reply.

Prescott, Natalie J / Taylor, Kirstin M / Sanderson, Jeremy D

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2020 Volume 19, Issue 4, Page(s) 858

Language	English
Publishing date	2020-11-26
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2020.06.020
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Zs.A 5836: Show issues

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Article ; Online: Nonspecific ileitis: Impact of histopathology and gastrointestinal ultrasound in achieving the diagnosis of Crohn's disease.

Smith, Rebecca L / Taylor, Kirstin M / Friedman, Antony B / Majeed, Ammar / Perera, Natalie / Gibson, Peter R

JGH open : an open access journal of gastroenterology and hepatology

2022 Volume 6, Issue 6, Page(s) 388–394

Abstract: Background and aim: Nonspecific ileitis is inflammation of the ileum without specific diagnostic features. A minority may go on to develop Crohn's disease, but optimal pathways of further investigation have not been established. This study aimed to ... ...

Abstract	Background and aim: Nonspecific ileitis is inflammation of the ileum without specific diagnostic features. A minority may go on to develop Crohn's disease, but optimal pathways of further investigation have not been established. This study aimed to identify a cohort of patients with nonspecific ileitis and to determine the value of ileal histology and gastrointestinal ultrasound in identifying/excluding Crohn's disease. Patients and methods: In a retrospective analysis, all patients having nonspecific ileitis at colonoscopy from January 2010 to August 2021 were identified. Clinical associations with those subsequently diagnosed with Crohn's disease were examined with specific reference to ileal histology and gastrointestinal ultrasound. Results: Of 29 638 procedures, 147 patients (0.5%) had nonspecific ileitis. Crohn's disease was subsequently diagnosed in 8 patients (5.4%) at a median of 148 (range 27-603) days after colonoscopy. The presence of chronic inflammation on ileal biopsies was more common in those subsequently diagnosed with Crohn's disease (63% Conclusion: Although ileal histology was of limited value in identifying patients with nonspecific ileitis who were subsequently diagnosed with Crohn's disease, gastrointestinal ultrasound was highly informative. Prospective studies are needed to confirm the value of gastrointestinal ultrasound as a diagnostic and monitoring tool in this setting.
Language	English
Publishing date	2022-05-12
Publishing country	Australia
Document type	Journal Article
ISSN	2397-9070
ISSN (online)	2397-9070
DOI	10.1002/jgh3.12740
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Article: Lessons from an audit of exclusive enteral nutrition in adult inpatients and outpatients with active Crohn's disease: a single-centre experience.

Melton, Sarah L / Fitzpatrick, Jessica A / Taylor, Kirstin M / Halmos, Emma P / Gibson, Peter R

Frontline gastroenterology

2022 Volume 14, Issue 1, Page(s) 6–12

Abstract: Objective: To evaluate clinical outcomes, patterns of use, tolerance and nutritional outcomes of exclusive enteral nutrition (EEN) in adults with Crohn's disease and to compare initiation in the inpatient compared with ambulatory care setting.: Design/ ...

Abstract	Objective: To evaluate clinical outcomes, patterns of use, tolerance and nutritional outcomes of exclusive enteral nutrition (EEN) in adults with Crohn's disease and to compare initiation in the inpatient compared with ambulatory care setting. Design/method: Adults with Crohn's disease who received EEN at a single centre over 2.5 years were identified and outcomes assessed via examination of patient records. Results: EEN was initiated in 60 patients (23 as an outpatient) who had objective evidence of active disease. Of 49 in whom the goal was induction of remission, 28 completed EEN and 24 achieved clinical remission/response. Twenty-one withdrew prematurely, due to intolerance in 15 and disease factors in 6. Of 11 with a planned intervention, 6 fulfilled the goal of downstaging disease while two were intolerant. Completion of the prescribed therapy was associated with self-reported adherence to EEN and with improvements in disease activity scores and biochemical markers. Malnutrition halved (40% to 20%) and intentional weight loss (median 5.1 kg) was achieved in six obese patients. The major reason for intolerance was the inability to accept total avoidance of non-formula food. There were no differences in any outcomes according to the location of initiation of therapy. Conclusion: Positive outcomes occur in 70% of adult patients with Crohn's disease tolerating EEN and 81% in those who are able to completely adhere to EEN, without compromise of nutritional status. Similar success occurs when initiated as an inpatient or outpatient. Failure to tolerate EEN is the major hurdle to its use.
Language	English
Publishing date	2022-06-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2521857-8
ISSN	2041-4137
ISSN	2041-4137
DOI	10.1136/flgastro-2022-102173
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Zs.A 6880: Show issues

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Article ; Online: Cytomegalovirus in inflammatory bowel disease: a clinical approach.

Gilmore, Robert B / Taylor, Kirstin M / Morrissey, C Orla / Gardiner, Bradley J

Internal medicine journal

2020 Volume 52, Issue 3, Page(s) 365–368

Abstract: Cytomegalovirus (CMV) infection can be a challenging clinical problem in patients with inflammatory bowel disease (IBD), particularly ulcerative colitis. Clinical presentation is difficult to distinguish from an underlying disease flare. Several ... ...

Abstract	Cytomegalovirus (CMV) infection can be a challenging clinical problem in patients with inflammatory bowel disease (IBD), particularly ulcerative colitis. Clinical presentation is difficult to distinguish from an underlying disease flare. Several diagnostic modalities are now available and when combined can aid clinicians in the identification of patients who are most likely to benefit from antiviral therapy. The aim of this article is to review the available literature and outline a practical approach to the diagnosis and management of CMV in patients with IBD.
MeSH term(s)	Chronic Disease ; Colitis, Ulcerative/diagnosis ; Colitis, Ulcerative/drug therapy ; Cytomegalovirus ; Cytomegalovirus Infections/complications ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/therapy ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Inflammatory Bowel Diseases/therapy
Language	English
Publishing date	2020-10-03
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.15085
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Zs.A 792: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The Role of Epidemiological Evidence from Prospective Population Studies in Shaping Dietary Approaches to Therapy in Crohn's Disease.

Wood, Jessica A / Halmos, Emma P / Taylor, Kirstin M / Gibson, Peter R

Molecular nutrition & food research

2020 Volume 65, Issue 5, Page(s) e2000294

Abstract: Scope: The concept that dietary factors are key risk and preventive agents in the development of Crohn's disease (CD), while widely believed and supported by epidemiological evidence, has yet to lead to clear identification of those factors through ... ...

Abstract	Scope: The concept that dietary factors are key risk and preventive agents in the development of Crohn's disease (CD), while widely believed and supported by epidemiological evidence, has yet to lead to clear identification of those factors through clinical trials. The aims are to examine the strength of the epidemiological evidence of diet and its association with CD, examine how interpretation of mostly epidemiological data has shaped ideas for potential dietary therapies, and to explore other factors that have driven the design of dietary clinical trials in CD. Methods: A literature search is performed in PubMed, Medline, EMBASE, and Google Scholar for prospective cohort studies and randomized clinical trials (RCTs) using search terms-"Crohn's disease," "diet," "risk," "remission," "treat," "cohort," "randomised." Results: Only four prospective cohort studies examine the relationship of diet and CD development, but these trials have been largely ignored by dietary RCTs in CD, which have used predominantly exclusion diets in small populations without objective endpoint assessment. Only one demonstrated clinical benefit to intestinal inflammation. Conclusion: Investment in large multicenter dietary clinical trials that focus on dietary inclusions with objective endpoint assessment are needed to provide safe, sustainable dietary therapy to patients with CD.
MeSH term(s)	Clinical Trials as Topic ; Crohn Disease/diet therapy ; Crohn Disease/epidemiology ; Humans ; Prospective Studies
Language	English
Publishing date	2020-10-12
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2160372-8
ISSN	1613-4133 ; 1613-4125
ISSN (online)	1613-4133
ISSN	1613-4125
DOI	10.1002/mnfr.202000294
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Article ; Online: Early sonographic response to a new medical therapy is associated with future treatment response or failure in patients with inflammatory bowel disease.

Smith, Rebecca L / Taylor, Kirstin M / Friedman, Antony B / Gibson, David J / Con, Danny / Gibson, Peter R

European journal of gastroenterology & hepatology

2022 Volume 34, Issue 6, Page(s) 613–621

Abstract: Objective: Gastrointestinal ultrasound (GIUS) accurately assesses inflammation and is responsive to changes in inflammatory bowel disease. This study aimed to determine the prognostic utility of sonographic response in the first 14 weeks of a newly- ... ...

Abstract	Objective: Gastrointestinal ultrasound (GIUS) accurately assesses inflammation and is responsive to changes in inflammatory bowel disease. This study aimed to determine the prognostic utility of sonographic response in the first 14 weeks of a newly-instituted therapy with therapeutic response at 46 weeks and to compare its performance with standard clinical assessment tools. Methods: Patients with sonographic evidence of inflammation were assessed by GIUS, clinical activity, serum C-reactive protein and faecal calprotectin again 2, 6 and 14 weeks after commencing a new biologic or thiopurine. Treatment failure was defined as undergoing surgery, hospitalisation, escalation of dosage or introduction of new medication over 46-weeks' follow-up. Sonographic response was defined as a decrease in bowel wall thickness and improved vascularity. Results: In 31 patients (median age 49 years, 74% Crohn's disease), sonographic response at 14 weeks [OR 19.3, 95% confidence interval (CI), 3.23-101.10; P = 0.0054] and faecal calprotectin (P = 0.018), but no clinical disease activity or C-reactive protein, were predictive of subsequent treatment response. Sonographic response alone was predictive at week 6 (P = 0.016), but not week 2. 16% reduction in bowel wall thickness at 6 weeks (area-under-the-receiver-operator-curve=0.86; P = 0.002; sensitivity 72%, specificity 90%), with similar performance for 10% at 14 weeks, was associated with treatment response. Conclusion: Sonographic response as early as 6 weeks after initiation of a new therapy may accurately predict treatment outcomes over 46 weeks and is superior to other markers used to monitor disease activity.
MeSH term(s)	C-Reactive Protein/analysis ; Crohn Disease/diagnostic imaging ; Crohn Disease/drug therapy ; Feces/chemistry ; Humans ; Inflammation ; Inflammatory Bowel Diseases/diagnostic imaging ; Inflammatory Bowel Diseases/drug therapy ; Leukocyte L1 Antigen Complex ; Middle Aged
Chemical Substances	Leukocyte L1 Antigen Complex ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2022-03-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1034239-4
ISSN	1473-5687 ; 0954-691X
ISSN (online)	1473-5687
ISSN	0954-691X
DOI	10.1097/MEG.0000000000002367
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Zs.A 2932: Show issues

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Article ; Online: Pharmacist-Driven Therapeutic Infliximab Monitoring at the Point of Care Using Rapidly Assessed Drug Levels in Patients with Inflammatory Bowel Disease.

Rentsch, Clarissa A / Ward, Mark G / Luber, Raphael P / Taylor, Kirstin M / Gibson, David J / Headon, Belinda / Rosella, Ourania / Su, Heidi Y / Friedman, Antony B / Dooley, Michael / Sparrow, Miles P / Gibson, Peter R

Therapeutic drug monitoring

2023 Volume 45, Issue 3, Page(s) 383–391

Abstract: Background: Therapeutic monitoring of infliximab is limited by the time lag between drug-level measurement and dose adjustment, along with the cost of dose escalation. Strategies for dose reduction in stable patients on maintenance infliximab at ... ...

Abstract	Background: Therapeutic monitoring of infliximab is limited by the time lag between drug-level measurement and dose adjustment, along with the cost of dose escalation. Strategies for dose reduction in stable patients on maintenance infliximab at supratherapeutic levels are uncertain. This study determined the feasibility of a pharmacist-driven strategy for immediate dose adjustment using a sliding scale at the point of care in stable patients with inflammatory bowel disease on maintenance therapy. Methods: Adult patients with stable disease undergoing maintenance therapy with infliximab infusions, 5 mg/kg every 8 weeks, were prospectively studied. Trough drug levels were assessed by a rapid assay (and later by ELISA) at all infusions for up to 12 months with immediate but quantitatively small dose adjustment according to a sliding scale targeting a therapeutic range of 3-7 mcg/mL. Disease activity was assessed both clinically and biochemically. Results: The rapid assay and ELISA detected similar infliximab levels, and the strategy added approximately 30 minutes to the duration of infusion events. Only 20% of 48 patients (77% with Crohn disease) had baseline trough infliximab concentrations within the therapeutic range. This value increased 3-fold after 24 and 48 weeks of interventions. One in 2 patients had baseline supratherapeutic levels, and most were brought into the therapeutic range without a discernible impact on disease activity by 1 dose adjustment, but 2 or 3 adjustments were generally needed for 29% of patients with subtherapeutic levels. Overall, drug costs were reduced by 4%. Conclusions: Immediate dose adjustment after infliximab rapid assay performed by a pharmacist using a sliding scale is a feasible strategy. Supratherapeutic infliximab levels can be safely and quickly brought into the therapeutic range using small dose adjustments without affecting disease activity, offsetting (at least partly) costs associated with dose escalation.
MeSH term(s)	Adult ; Humans ; Infliximab/therapeutic use ; Gastrointestinal Agents/therapeutic use ; Pharmacists ; Point-of-Care Systems ; Inflammatory Bowel Diseases/drug therapy ; Drug Monitoring
Chemical Substances	Infliximab (B72HH48FLU) ; Gastrointestinal Agents
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	424443-6
ISSN	1536-3694 ; 0163-4356
ISSN (online)	1536-3694
ISSN	0163-4356
DOI	10.1097/FTD.0000000000001044
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Article ; Online: Interrater reliability of the assessment of disease activity by gastrointestinal ultrasound in a prospective cohort of patients with inflammatory bowel disease.

Smith, Rebecca L / Taylor, Kirstin M / Friedman, Antony B / Su, Heidi Y / Con, Danny / Gibson, Peter R

European journal of gastroenterology & hepatology

2021 Volume 33, Issue 10, Page(s) 1280–1287

Abstract: Objective: Gastrointestinal ultrasound is a radiological investigation for monitoring patients with inflammatory bowel disease. However, the reliability of the findings depends on the reproducibility of results between different operators. Thus, the ... ...

Abstract	Objective: Gastrointestinal ultrasound is a radiological investigation for monitoring patients with inflammatory bowel disease. However, the reliability of the findings depends on the reproducibility of results between different operators. Thus, the study aim was to assess the interrater reliability of gastrointestinal ultrasound in individuals with inflammatory bowel disease between gastroenterologists with varying GIUS experience. . Methods: Patients were prospectively recruited at the commencement of a new medical therapy for a baseline assessment, with a second assessment at the end of treatment induction (3 months). Consecutive, blinded ultrasounds were performed by two operators for every test. Gastrointestinal ultrasound examination included assessment of bowel wall thickness, vascularity, wall stratification assessment, mesenteric hyperechogenicity and lymphadenopathy. Results: Forty-nine patients were recruited (Crohn's n = 27, ulcerative colitis n = 22) with 35 returning for a repeat assessment at 3 months. At baseline, the intraclass coefficient for bowel wall thickness was near perfect (0.882). By bowel segment, the closest correlation was in the terminal ileum and differences in bowel wall thickness were similar by disease subtype. All other ultrasound indices of disease activity demonstrated substantial to near-perfect agreement with Gwet's agreement coefficient: vascularity (0.681), wall stratification (0.685), mesenteric hyperechogenicity (0.841) and lymphadenopathy (0.633). Similar findings were seen at 3 months. Conclusion: There is substantial agreement between operators of varying experience in gastrointestinal ultrasound findings in patients with Crohn's disease or ulcerative colitis and this is repeatedly demonstrated over time. Thus, a well-trained operator should be sufficient to assess disease activity in patients with inflammatory bowel disease.
MeSH term(s)	Colitis, Ulcerative/diagnostic imaging ; Crohn Disease/diagnostic imaging ; Humans ; Inflammatory Bowel Diseases/diagnostic imaging ; Prospective Studies ; Reproducibility of Results ; Ultrasonography
Language	English
Publishing date	2021-08-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1034239-4
ISSN	1473-5687 ; 0954-691X
ISSN (online)	1473-5687
ISSN	0954-691X
DOI	10.1097/MEG.0000000000002253
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Zs.A 2932: Show issues

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Article ; Online: Early Assessment With Gastrointestinal Ultrasound in Patients Hospitalised for a Flare of Ulcerative Colitis and Predicting the Need for Salvage Therapy: A Pilot Study.

Smith, Rebecca L / Taylor, Kirstin M / Friedman, Antony B / Swaine, Adrian P / Gibson, David J / Gibson, Peter R

Ultrasound in medicine & biology

2021 Volume 47, Issue 4, Page(s) 1108–1114

Abstract: Approximately 30% of patients hospitalised with severe ulcerative colitis do not respond to corticosteroids, but the decision to introduce salvage therapy is delayed to at least the third day of treatment, according to the widely applied Oxford criteria ... ...

Abstract	Approximately 30% of patients hospitalised with severe ulcerative colitis do not respond to corticosteroids, but the decision to introduce salvage therapy is delayed to at least the third day of treatment, according to the widely applied Oxford criteria to assess response. This pilot study aimed to determine if gastrointestinal ultrasound performed on admission can predict steroid-refractory disease. In 10 consecutive patients with severe ulcerative colitis, gastrointestinal ultrasound was performed within 24 h of admission. Six patients failed corticosteroids and required infliximab salvage therapy. Colonic bowel wall thickness was a median of 4.6 mm (range 4.2-5.6 mm) in those responding to steroids compared with 6.2 mm (6-7.9 mm) in those requiring salvage therapy (p = 0.009). Any colonic segment with a bowel wall thickness of >6 mm was associated with the need for salvage therapy (p = 0.033). Gastrointestinal ultrasound may provide an early indication of poor corticosteroid response and enable a timelier introduction of salvage therapy in patients with severe ulcerative colitis.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Adult ; Colitis, Ulcerative/diagnostic imaging ; Colitis, Ulcerative/drug therapy ; Colon/diagnostic imaging ; Female ; Gastrointestinal Agents/therapeutic use ; Hospitalization ; Humans ; Infliximab/therapeutic use ; Male ; Patient Selection ; Pilot Projects ; Predictive Value of Tests ; Salvage Therapy ; Symptom Flare Up ; Time Factors ; Treatment Failure ; Ultrasonography ; Young Adult
Chemical Substances	Adrenal Cortex Hormones ; Gastrointestinal Agents ; Infliximab (B72HH48FLU)
Language	English
Publishing date	2021-01-05
Publishing country	England
Document type	Journal Article
ZDB-ID	186150-5
ISSN	1879-291X ; 0301-5629
ISSN (online)	1879-291X
ISSN	0301-5629
DOI	10.1016/j.ultrasmedbio.2020.12.001
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