Journal of Crohn s and Colitis Impact Factor & Information

Publisher: Oxford University Press (OUP)

Current impact factor: 6.23

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 6.234
2013 Impact Factor 3.562
2012 Impact Factor 3.385
2011 Impact Factor 2.566
2010 Impact Factor 2.628
2009 Impact Factor 1.729
2008 Impact Factor 0.812

Impact factor over time

Impact factor

Additional details

5-year impact 5.43
Cited half-life 2.60
Immediacy index 1.42
Eigenfactor 0.01
Article influence 1.27
ISSN 1876-4479
OCLC 196647401
Material type Series, Periodical
Document type Journal / Magazine / Newspaper

Publisher details

Oxford University Press (OUP)

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Publications in this journal

  • Journal of Crohn s and Colitis 11/2015; DOI:10.1093/ecco-jcc/jjv205
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    ABSTRACT: INTRODUCTIONEarly stages of Crohn's disease(CD) are predominantly inflammatory and early treatment could be useful to change its natural history. We aimed to evaluate the impact of early treatment in our cohort of CD patients.METHODS Retrospectively reviewed clinical records of all CD patients at our centre who have received immunomodulators. Time from diagnosis to first CD-related major abdominal surgery or end of follow up was considered. Dates of diagnosis, of starting immunomodulators (thiopurines/anti-TNF), and of the first CD-related surgery when appropriate were collected.RESULTS422 patients received thiopurines: 189 operated patients started thiopurines after a median of 117months (IQR 44-196) since diagnosis; non-operated patients, after a median of 30months (IQR 6-128); p<0,005. Odds ratio(OR) for surgery was 1,006 (CI95% 1,004-1,008) for each month of delay in starting thiopurines.272 patients received anti-TNF: 137 operated patients started anti-TNFs after a median of 166months (IQR 90-233) since diagnosis; non-operated patients after a median of 59months (IQR 14-162); p<0,005. OR for surgery was 1,008 (CI95% 1,005-1,010) for each month of delay in starting anti-TNF.A total of 467 patients received thiopurines and/or anti-TNF: 210 operated patients started any immunomodulator after a median of 120months (IQR 48-197) since diagnosis; non-operated patients after a median of 30months (IQR 6-126); p<0,005. OR for surgery was 1,008 (CI95% 1,005-1,010) for each month of delay in starting immunomodulators.CONCLUSIONS In our experience, time between diagnosis and thiopurine or anti-TNF initiation was associated with the risk of major abdominal surgery in Crohn's disease.
    Journal of Crohn s and Colitis 11/2015; DOI:10.1093/ecco-jcc/jjv187
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    ABSTRACT: The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biologic therapy. To which extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in IBD patients. Preference was given to population-based studies, but when data from these sources were limited, large cohort studies and randomized controlled trials were also considered. In general, data on hospitalization rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biologic agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-TNFα agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer (absolute risk: low), whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature did not reveal any increase in mortality with immunosuppressant therapy or biologics/anti-TNF agents.
    Journal of Crohn s and Colitis 11/2015; DOI:10.1093/ecco-jcc/jjv190
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    ABSTRACT: Objective: Microscopic colitis (MC) is a common cause of chronic watery diarrhoea but long time follow up is sparse. We performed a retrospective review of health records and all pathology reports in a regional cohort of patients with MC to describe the change in pre- and post-diagnostic colon biopsies. Results: MC was diagnosed in 468 patients with collagenous colitis (CC), 361 with lymphocytic colitis (LC) and 226 with incomplete MC (MCi). The 2014 incidence of CC, LC and MCi was 14.5, 14.9, and 5 per 10(5). Biopsies from both right and left colon were obtained in 237 (51%) with CC, 200 (55%) with LC and 107 (47%) with MCi. The diagnostic sensitivity of both left and right sided biopsies for MC was high and did not differ. Pre-diagnostic biopsies were obtained in 150 patients and lamina propria inflammation was described in 59%, 47% and 43% of patients with a diagnosis of CC, LC and MCi within one year, while histology was normal in 16%, 13% and 21%. Post-diagnostic biopsies were obtained in 283 patients. MC persisted within the first year in 77% with CC, 64% with LC and 45% with MCi, and of whom 6%, 9% and 18% respectively changed to a different MC subgroup. Conclusion: Colonic biopsies obtained prior to the MC diagnosis often revealed increased lamina propria inflammation. The pathological changes of CC and LC are more persistent than those of MCi. Biopsies from the descending or sigmoid colon are sufficient to elucidate whether a patient with chronic watery diarrhoea has MC.
    Journal of Crohn s and Colitis 11/2015; DOI:10.1093/ecco-jcc/jjv200
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    ABSTRACT: Background and aims: In Western studies, one-third of patients with Crohn's disease have stricturing or penetrating disease at presentation and one-half will progress to complicated disease in 20 years. Asian studies indicate that the disease phenotype may be different. Our aim was to study the disease behaviour in Indian patients with Crohn's disease. Methods: In this hospital based study, we analysed (Montreal classification) disease phenotype, presence of perianal disease, need for intestinal surgery, and changes in the Montreal classification over time in Crohn's disease patients from our database. Results: In the 178 patients (median age 35, IQR 21 years; 97 males) with Crohn's disease, the proportion of various features: more patients had ileo-colonic(L3: 43.8%) than ileal(L1: 27.5%) or colonic(L2: 28.7%) disease; perianal disease was seen in 11.8% at baseline. Non-stricturing non-fistulising disease(B1) was seen in 74.7%, 65.7%, 50% and 44.4% at baseline, at 5, 10 and 15 years, respectively; stricturing disease(B2) in 21.4%, 21.9%, 28.9% and 33.3%; and penetrating disease(B3) in 3.9%, 11.4%, 21% and 16.7%, intestinal surgery required in 10.7%, 20%, 34.2% and 55.5% respectively. Kaplan-Meier analysis showed no association between progression of disease and patient age and location of the disease. Conclusion: Gender distribution and predominant ileo-colonic location of disease were similar to earlier Asian reports on Crohn's disease. Perianal disease was less frequent than reported in Western and other Asian studies. One-fourth of Indian patients had aggressive disease at diagnosis, but the tendency to progress towards aggressive disease over time was less pronounced than in Western patients.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv202
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    ABSTRACT: Background and aims: Inflammatory bowel diseases (IBD) may impair quality of life (QoL) in pediatric patients. We aimed to evaluate in a nationwide cohort if patients experience QoL in a different way when compared to their parents. Methods: Socio-demographic and psychosocial characteristics were prospectively acquired from pediatric patients and their parents included in the Swiss IBD Cohort Study. Disease activity was evaluated by PCDAI and PUCAI. QoL was assessed by using the KIDSCREEN questionnaire. QoL domains were analyzed and compared between children and parents according to type of disease, parents' age, origin, education and marital status. Results: We included 110 children & parents ( 59 CROHN'S DISEASE CD, 45 ULCERATIVE COLITIS UC, 6 IBD UNCLASSIFIED IBDU: ). There was no significant difference of QoL between CD and UC/IBDU, whether the disease was active or in remission. Parents perceived overall QoL as well as "mood", "family" and "friends" domains lower than the children themselves, independent of their place of birth and education. However, better concordance was found on "school performance" and "physical activity" domains. Marital status and age of parents significantly influenced the evaluation of QoL. Mothers and fathers being married or living in concubinage perceived significantly lower "mood", "family" and "friends" domains than their children, whereas mothers living alone HAD A LOWER PERCEPTION: of the "friends" domains; fathers living alone HAD A LOWER PERCEPTION: of "family" and "mood" sub-scores. Conclusion: Parents of Swiss pediatric IBD patients significantly underestimate overall QoL and domains of QoL of their children independently of origin and education.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv199
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    ABSTRACT: Background and aims: Spontaneous intra-abdominal abscess formation is a common complication of Crohn's disease. Percutaneous drainage (PD) may avoid surgery and preserve bowel length although there is no consensus on its efficacy as the initial treatment and the associated outcomes if unsuccesful. This study uses meta-analytical techniques to compare the outcomes of PD alone versus primary surgery for Crohn's related intra-abdominal abscess. Methods: A comprehensive search for comparative studies examining the use of PD and surgery for spontaneous Crohn's related intra-abdominal abscess was performed. Each study was reviewed and data extracted. Random-effects methods were used to combine data. Results: There were 6 studies including a total of 333 patients that met the inclusion criteria. Surgery was performed initially in 184 patients, PD was performed in 149. Groups were similar in demographics and abscess characteristics. There was a significantly higher risk of abscess recurrence following PD (OR: 6.544, 95% CI: 1.783-24.010, P: 0.005). The pooled proportion of PD patients requiring subsequent surgery was 70.7%. There was no significant difference between approaches in post-procedural complication rate (OR: 0.657, 95% CI: 0.175-2.476, P: 0.535), ultimate permanent stoma requirement (OR: 0.557, 95% CI: 0.147-2.111, P: 0.389) or length of hospital stay (difference in means: -1.006 days, 95% CI: -28.762-26.749, P: 0.943). Conclusions: PD can avoid surgery in up to 30% of patients presenting with spontaneous Crohn's related intra-abdominal abscesses, however, the suggested advantages over surgery in relation to complications and length of stay were not apparent. Further studies in this area are needed.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv198
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    ABSTRACT: Background and aims: Data on the natural history of elderly-onset ulcerative colitis (UC) are limited. We aimed to investigate clinical features and outcomes of patients with elderly-onset UC. Methods: Patients with a confirmed diagnosis of UC between 1981 and 2013 from 13 hospitals within a territory-wide Hong Kong IBD Registry were included. Clinical features and outcomes of elderly-onset patients, defined as age ≥ 60 years at diagnosis, were compared with that of non-elderly-onset disease (< 60 years at diagnosis). Results: We identified 1225 patients, of whom 12.8% (157/1225; 56.1% male) had elderly-onset UC. Median duration of follow up was 11 years (interquartile range, 6-16 years). Age-specific incidence of elderly-onset UC increased from 0.1 per 100,000 persons before 1991 to 1.3 per 100,000 persons after 2010. There were more ex-smokers (32.2% vs. 12.2% p<0.001) and higher proportion of comorbidities (p<0.001) in elderly-onset than non-elderly-onset patients. Disease extent, corticosteroids, immunosuppressants use and colectomy rates were similar between the two groups. Elderly-onset disease was an independent risk factor for cytomegalovirus infection (odds ratio 2.9, 95% confidence interval 1.6-5.2, p<0.001). More elderly-onset patients had clostridium difficile infection (11.0% vs. 5.4%, p=0.007), hospitalization for UC exacerbation (50.6% vs. 41.8%, p=0.037), colorectal cancer (3.2% vs. 0.9%, p=0.033), all-cause mortality (7.0% vs. 1.0%, p<0.001) and UC related mortality (1.9% vs 0.2%, p=0.017) than non-elderly-onset patients. Conclusions: Elderly-onset UC patients are increasing. These patients have higher risk of opportunistic infections, hospitalization, colorectal cancer and mortality than non-elderly-onset patients. Management and therapeutic strategies in this special group need careful attention.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv194
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    ABSTRACT: Background and aims: Peripheral joint complaints (pJTC) and chronic back pain (CBP) are the most common extra-intestinal manifestations in patients with inflammatory bowel disease (IBD). This prospective study evaluates variables associated with joint/back pain, including IBD disease activity. Methods: IBD patients with back pain ≥ 3 months and/or peripheral joint pain/swelling (n=155), and IBD patients without joint complaints (n=100; controls), were followed for a period of one year. Patients were classified as having spondyloarthritis (SpA) according to several sets of criteria. Statistical analysis included logistic regression models and linear mixed model analysis. Results: Of the 155 patients with joint/back pain, 13 had chronic back pain, 80 peripheral joint complaints and 62 axial and peripheral joint complaints. Smoking, female gender and IBD disease activity were independently associated with IBD joint/back pain. The ASAS criteria for axial and peripheral SpA were fulfilled in 12.3% of patients, with 9.7% (n=15) receiving a rheumatologic diagnosis of arthritis. During the 12-month follow-up, the majority of the amount of patients reporting joint/back pain remained stable. Conclusion: In our cohort, the majority of IBD patients reported joint/back pain and SpA was relatively common. To facilitate effective care, gastroenterologists should be aware of the various features of SpA to classify the joint complaints and by making use of an efficient referral algorithm to refer CBP patients to the rheumatologist.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv195
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    ABSTRACT: Background: Anastomotic leakage is a serious complication after restorative proctocolectomy with ileal pouch-anal anastomosis. Previous studies have shown significantly decreased leak rates in diverted patients with less severe clinical consequences. The aim of this study was to evaluate short and long term outcome of selective ileostomy formation in a multicentre cohort of patients undergoing pouch surgery. Methods: In a retrospective study, 621 patients undergoing pouch surgery for inflammatory bowel disease (IBD) were identified from three large centres. Anastomotic leakage was defined as any leak confirmed by either contrast extravasation on imaging or during surgical re-intervention. Results: In 305 patients (49.1%), primary defunctioning ileostomy was created during pouch surgery and 41 (6.6%) patients received a secondary ileostomy because of a leaking non-diverted pouch. Primary ileostomy formation was associated with male sex, weight loss, ASA > 2, steroid use, one-stage surgery, hand-sewn anastomosis and blood transfusion. Leak rates were comparable between diverted and non-diverted patients (16.7% vs 17.1%, p=0.92), which remained unchanged in subgroups with immunosuppressive medication. Having had an ileostomy was demonstrated to be an independent predictor of small bowel obstruction (OR 2.58, 95%CI 1.45 - 4.67) and pouch fistulas (OR 3.05, 95%CI 1.06 - 8.73). The 10-year pouch survival was comparable for patients with and without ileostomy (89% versus 88%, P=0.718). Conclusions: Leakage rates of diverted and non-diverted pouches in IBD patients were similar and relatively high. Defunctioning was independently associated with long-term complications. A staged approach without defunctioning might be the best strategy.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv201
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    ABSTRACT: Background: While family history provides important information on risk of developing Inflammatory Bowel Disease (IBD), genetic profiling of first degree relatives (FDR) of Crohn's Disease (CD) - affected individuals might provide additional information. We aimed to delineate the genetic contribution to the increased IBD susceptibility observed in FDR. Methods: N=976 Caucasian, healthy, non-related FDR; n=4997 independent CD and n=5000 healthy controls (HC); were studied. Genotyping for 158 IBD-associated single nucleotide polymorphisms (SNPs) was performed using the Illumina Immunochip. Risk allele frequency (RAF) differences between FDR and HC cohorts were correlated with those between CD and HC cohorts. CD and IBD genetic risk scores (GRS) were calculated and compared between HC, FDR and CD cohorts. Results: IBD-associated SNP RAF differences in FDR and HC cohorts were strongly correlated with those in CD and HC cohorts, correlation coefficient 0.63 [95%CI 0.53 - 0.72], p = 9.90 x 10(-19). There was a significant increase in CD-GRS (mean) comparing HC, FDR and CD cohorts: 0.0244, 0.0250 and 0.0257 respectively (p < 1 x 10(-7) for each comparison). There was no significant difference in the IBD-GRS between HC and FDR cohorts (p=0.81); however IBD-GRS was significantly higher in CD compared with FDR and HC cohorts (p < 10(-10) for each comparison). Conclusion: FDR of CD-affected individuals are enriched with IBD risk alleles compared with HC. Cumulative CD-specific genetic risk is increased in FDR compared with HC. Prospective studies are required to determine if genotyping would facilitate better risk stratification of FDR.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv197
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    ABSTRACT: Background and aims: The importance of efficient and safe treatment of Crohn's disease is highlighted by its' chronicity. Both medical and surgical treatments have shown good results in the symptomatic control of limited ileocaecal Crohn's disease. The aim of this study was to compare medical treatment with surgical treatment of ileocaecal Crohn's disease. Materials and methods: Thirty-six patients from seven hospitals with primary ileocaecal Crohn's disease were randomised to either medical or surgical treatment. The medical treatment was induction of remission with Budesonide and thereafter maintenance treatment with Azathioprine. The surgical treatment was open ileocaecal resection. Crohn's disease activity index over time expressed as area under the curve at one, three and five years was the primary endpoint. Subjective health measured as SF 36 and a Visual Analogue Scale were secondary endpoints. Results: There were no differences between the treatment groups in Crohn's disease activity index over time. General health, measured as SF36, was higher in surgical than in medical treatment at one year, but there was no corresponding difference in VAS. Due to slow inclusion rate and changes in clinical practice the study was terminated prematurely. Conclusion: The study ended up being under-powered and should be interpreted with caution but there was no clinically significant difference between the two treatment arms. Further studies are needed to address this important clinical question.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv184
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    ABSTRACT: Background and aims: Reports on imaging of active Crohn's disease (aCD) using contrast-enhanced ultrasound (CEUS) are encouraging. However, the statistical power of most of the published papers is limited due to small groups of patients included. To verify the diagnostic value of CEUS to detect active Crohn's disease aCD. Methods: A systematic literature search was performed by two independent reviewers for articles on the test characteristics of CEUS to identify aCD. The quality of the analyzed studies was evaluated using a quality assessment tool for diagnostic accuracy studies (QUADAS-2). Pooling was performed using the diagnostic random-effect model and the bivariate analysis. Results: Eight articles were included in the final analysis, with a total of 332 patients. There was no significant publication bias. Significant heterogeneity was found regarding CEUS methodology and sonographic definitions of aCD. In a bivariate analysis, pooled sensitivity yielded 0.94 (95% CI: 0.87-0.97) and pooled specificity was 0.79 (95% CI: 0.67-0.88). Spearman correlation statistics presented no significant diagnostic threshold effect (r = 0.12, P > 0.9). Subgroup analysis showed that the highest diagnostic value presented calculation of the relative intestine wall enhancement, while the presence of enhancement and analysis of the slope were equally less useful (AUC, 94%, 91%, and 90%, respectively). Conclusions: CEUS presents good sensitivity and moderate specificity in the detection of acute phase of Crohn's disease. Large scale randomized trials with quantitative evaluation of CEUS images are necessary to promote this technique in clinical practice.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv196
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    ABSTRACT: Background and aims: Psychosocial factors surrounding eating and drinking such as enjoying food, managing restrictions and maintaining social relationships remain under-researched in IBD. This study aimed to develop and validate a food-related quality of life (FR-QoL) questionnaire to systematically measure these issues in the IBD population. Methods: Following semi-structured interviews with 28 IBD patients, 150 potential questionnaire items were generated. These were ranked by 100 IBD patients and items were removed based on ceiling/floor effects and high inter-item correlations (>0.7), with 41 items being retained. In total, 323 IBD patients, 100 asthma patients (chronic disease control) and 117 healthy controls completed the FR-QoL questionnaire alongside generic and disease-specific QoL and food satisfaction questionnaires. Principle components analysis (PCA), construct and discriminant validity and test-retest reliability were calculated. Results: Twelve items were removed following PCA. The reduced questionnaire (FR-QoL-29) explained 63.9% of the variance (Cronbach's α=0.96). FR-QoL-29 correlated significantly with generic QoL (r=0.697), depression (r=-0.519), anxiety (r=-0.531) and food satisfaction (r=0.701). The FR-QoL-29 sumscores were significantly lower for IBD (89.5, SD 28.6) than asthma (125.4, SD 24.1); p<0.001) and healthy volunteers (123.0 (SD 16.5); p<0.001). Within IBD, worse food-related QoL was found in those with moderate/high disease activity (66.7, SD 22.1) compared to remission/low disease activity (92.5, SD 28.1). Test-retest reliability was good (ICC=0.83, 95% CI=0.76:0.88). Conclusions: The FR-QoL-29 shows good reliability and validity across a range of IBD characteristics. This easily administered questionnaire is a useful tool in identifying poor food-related QoL and in the future may identify areas for intervention.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv192
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    ABSTRACT: Background and aims: An increased risk of autoimmune disease has been reported in patients with IBD. Using data from the Clinical Practice Research Datalink (CPRD) this study set out to further examine this relationship. Methods: Patients with a first time IBD diagnosis were randomly matched to an equally sized IBD-free comparison group. Incidence rates for new onset autoimmune diseases were estimated. A nested case-control analysis comprising IBD patients was conducted, using conditional logistic regression to assess whether IBD severity, duration, or treatment influences the risk of developing autoimmune diseases RESULTS: During follow-up 1,069 IBD and 585 IBD free patients developed an incident autoimmune disease. An increased incidence of autoimmune disease was observed in IBD patients (IR 9.65, 95% CI 9.09-10.24) compared to the non-IBD comparison group (IR 5.22, 95% CI 4.82-5.66). In IBD patients, increased disease severity was associated with an increased risk of autoimmune disease development (OR 1.62, 95% CI 1.28-2.05). Current antibiotic use was also associated with an increased risk (AOR 1.72, 95% CI 1.07-2.78). A reduced risk of incident autoimmune diseases was observed for current long term users of aminosalicylates (AOR 0.72, 95% CI 0.57-0.91). Conclusions: Individuals with IBD had an increased incidence of developing an autoimmune disease. Increased disease severity and current antibiotic use were associated with an increased relative risk of developing additional autoimmune diseases in IBD patients. While, long term current aminosalicylate use was associated with a reduced risk.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv193
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    ABSTRACT: Background and aims: Conventional thiopurine (azathioprine and mercaptopurine) treatment during pregnancy in patients with inflammatory bowel disease (IBD) is considered to be safe, however data on the safety and teratogenicity of the non-conventional thiopurine tioguanine (TG) in pregnant IBD patients is lacking. We aim to describe the safety and teratogenicity of TG treatment during pregnancy in IBD patients. Methods: Retrospective, multicenter descriptive case series of female IBD patients using TG during pregnancy. Data on disease and medication history, pregnancy complications, pregnancy outcome, mode of delivery, preterm birth, birth weight, congenital abnormalities, laboratory signs of myelosuppression or hepatotoxicity and 6-thioguaninenucleotide (6-TGN) concentrations in mother and neonate were collected. Results: Thirteen patients (77% Crohn's disease, 23% ulcerative colitis) used TG (median dose 18g/day) during pregnancy. Nineteen pregnancies, including one twin pregnancy, were included. Spontaneous abortion occurred in three pregnancies. In seven of the 16 ongoing pregnancies a caesarean section was performed. One neonate had a mild congenital abnormality (distal shaft hypospadias). In the singleton pregnancies the median birth weight was 3410 g at a median of gestational age of 39 weeks. No preterm birth (<37 weeks) or low birth weight (<2500 g) was observed in the singleton newborns. In the twin pregnancy an induction of labour was performed at 35+1 weeks gestation because of pre-eclampsia. Both neonates had a low birth weight. Conclusions: This relatively small case series supports safe use of TG in pregnant IBD patients. Still, consideration should be given on the indication and continuation of TG during pregnancy.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv189
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    ABSTRACT: Background and aims: Azathioprine (AZA) is recommended for maintenance of steroid-free remission in IBD. The aim of this study has been to establish the incidence and severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors. Methods: We studied 510 IBD patients (338 Crohn's disease, 157 ulcerative colitis, 15 indeterminate colitis) with initiation of AZA treatment in a prospective multicenter registry study. Acute pancreatitis was diagnosed in accordance with international guidelines. Results: AZA was continued by 324 (63.5%) and stopped by 186 (36.5%) patients. The most common cause of discontinuation was nausea (12.2%). AZA-induced pancreatitis occurred in 37 patients (7.3%). Of these, 43% were hospitalized with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections, 24% had to vomit and 14% had fever. No patient had to undergo nonsurgical or surgical interventions. Smoking was the strongest risk factor for AZA-induced acute pancreatitis (p<0.0002) in univariate and multivariate analyses CONCLUSIONS: AZA-induced acute pancreatitis is a common adverse event in IBD patients, but had a mild course in all patients. Smoking is the most important risk factor.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv188
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    ABSTRACT: Background and aims: X-linked chronic granulomatous disease (X-CGD) due to hemizygous mutations in CYBB is characterized by invasive bacterial and fungal infections and granulomatous inflammation. Inflammatory bowel disease (IBD) is an additional or isolated manifestation. Allogeneic hematopoietic stem cell transplantation (alloHSCT) is the standard curative treatment. X-CGD carriers are usually healthy but those with non-random X-chromosome inactivation (XCI) may develop infectious or autoinflammatory manifestations. Methods and results: We report on two female patients with severe treatment refractory Crohn-like IBD manifesting at age 23 and eight years, respectively. NADPH-oxidase activity testing and molecular genetics proved X-CGD carrier status with non-random XCI. As in CGD, histopathology from colonic biopsies disclosed pigment-laden macrophages and reduced CD68(+) macrophages. Following submyeloablative conditioning, the younger patient was treated with alloHSCT at age 20 years. She came into remission within three months after transplantation and shows complete mucosal healing after 16 months off all medications.We suggest that children and young adults with refractory IBD should obligatorily be tested for CGD. AlloHSCT should be considered as curative therapy in severely diseased female carriers of X-CGD with non-random XCI.
    Journal of Crohn s and Colitis 10/2015; DOI:10.1093/ecco-jcc/jjv186