Background/Aims: Risk of venous thrombosis is increased in patients with inflammatory bowel disease (IBD); data on Asian IBD patients is limited and status quo of thrombosis screening and prophylaxis are unknown. Therefore, we aimed to investigate the incidence, screening, prophylaxis, and risk factors for venous thrombosis among Asian IBD patients. Methods: Medical files of patients with Crohn’s disease (CD) and ulcerative colitis (UC) from 17 hospitals across China between 2011 and 2016 were reviewed for venous thrombosis, use of screening and prophylaxis. A case-control study was performed among hospitalized patients with venous thrombosis and their age-, sex-matched IBD controls hospitalized around the same period; disease characteristics and known provoking factors of venous thrombosis were recorded. Risk factors were analyzed in both univariate and logistic regression analyses. Results: A total of 8,459 IBD patients were followed for 12,373 person-year. Forty-six patients (0.54%) had venous thrombosis, yielding an incidence of 37.18 per 10,000 person-year. Incidence increased with age, especially among CD. Less than 20% of patients received screening tests and 35 patients (0.41%) received prophylaxis. Severe disease flare was an independent risk factor for venous thrombosis (odds ratio [95% confidence interval]: CD, 9.342 [1.813– 48.137]; UC, 5.198 [1.268–21.305]); past use of steroids and extensive involvement were 2 additional risk factors in CD and UC, respectively. Conclusions Incidence of venous thrombosis in China was 37.18 per 10,000 person-year (0.54%). Use of screening and prophylaxis were rare. Severe disease flare was an independent risk factor for thrombosis among hospitalized patients.

Background/Aims: Risk of venous thrombosis is increased in patients with inflammatory bowel disease (IBD); data on Asian IBD patients is limited and status quo of thrombosis screening and prophylaxis are unknown. Therefore, we aimed to investigate the incidence, screening, prophylaxis, and risk factors for venous thrombosis among Asian IBD patients. Methods: Medical files of patients with Crohn’s disease (CD) and ulcerative colitis (UC) from 17 hospitals across China between 2011 and 2016 were reviewed for venous thrombosis, use of screening and prophylaxis. A case-control study was performed among hospitalized patients with venous thrombosis and their age-, sex-matched IBD controls hospitalized around the same period; disease characteristics and known provoking factors of venous thrombosis were recorded. Risk factors were analyzed in both univariate and logistic regression analyses. Results: A total of 8,459 IBD patients were followed for 12,373 person-year. Forty-six patients (0.54%) had venous thrombosis, yielding an incidence of 37.18 per 10,000 person-year. Incidence increased with age, especially among CD. Less than 20% of patients received screening tests and 35 patients (0.41%) received prophylaxis. Severe disease flare was an independent risk factor for venous thrombosis (odds ratio [95% confidence interval]: CD, 9.342 [1.813– 48.137]; UC, 5.198 [1.268–21.305]); past use of steroids and extensive involvement were 2 additional risk factors in CD and UC, respectively. Conclusions Incidence of venous thrombosis in China was 37.18 per 10,000 person-year (0.54%). Use of screening and prophylaxis were rare. Severe disease flare was an independent risk factor for thrombosis among hospitalized patients.

Objective To analyze clinical features and prognosis of primary intestinal T cell lymphoma (ITCL)which was misdiagnosed as Crohn′s disease (CD),and summarized the key points of differentiation between ITCL and CD.Methods From January 2003 to January 2014,clinical data of patients with ITCL once misdiagnosed as CD were retrospectively analyzed,which included demographic,clinical,pathological and prognostic data.The data of 177 patients diagnosed as CD from January 2012 to January 2014 were collected. The demographic,clinical,pathological and prognostic data of these two groups were analyzed and compared. The continuous variables were compared with t test or Mann-WhitneyU test,and the differences of classification variables between two groups were analyzed by Chi-square test or Fisher exact probability method.Results A
total of 18 patients (17 males and one female)with ITCL misdiagnosed as CD were enrolled in the study,and the median age at diagnosis was 38.5 (28.8 to 42.5)years and the median duration of diagnosis was 6.00 (3.75 to 13.25)months.The common primary symptoms were abdominal pain (12/18),diarrhea (13/18)and anemia (13/18).Intestinal perforation was primary symptom in two cases (2/18).However,B symptoms of lymphoma was observed in 16 patients,which included fever in 13 patients,weight loss in 16 patients and night sweat in one patient.One or more serious complications appeared in 12 patients,which included intestinal perforation in nine patients,severe gastrointestinal bleeding in seven patients and intestinal obstruction in two patients.In 177 patients with CD,104 patients were male (58.8%),and the median age at diagnosis was 22.0 (18.0 to 29.0) years.The primary symptoms were abdominal pain (88.7%,157/177),diarrhea (55.9%,99/177),anemia (63.8%,113/177),fever (33.3%,59/177)and weight loss (59.9%,106/177).During the disease course,30 patients (16.9%)had intestinal perforation (mainly chronic),12 patients (6.8%)had intestinal obstruction and seven patients (4.0%)had severe gastrointestinal bleeding.Compared to CD patients,male patients were more common in ITCL (χ2 =8.837,P <0.01),age at diagnosis was older (χ2 =314.5,P <0.01),the disease course was shorter (U=385.0,P <0.01),weight loss (χ2 =5.867,P <0.05)and fever (χ2 =10.609,P <0.01)were more common in clinical symptoms and intestinal perforation and severe gastrointestinal bleeding were more common in complications (χ2 =9.185,24.908,both P <0.01).The lesions of ITCL were multiple lesions, small bowel involved in eight cases,colon involved in 14 cases and one case with esophagus involved.Under endoscopy examination,most lesions appeared as ulcerations and were segmentally distributed.Compared to CD, lymphocyte proliferation was more common in the intestinal histopathological findings of ITCL (17/18 vs 19.7%(35/177);χ2 =42.844,P <0.01)and granuloma was rare (0 vs 42.8%(76/177),χ2 =12.665,P <0.01). Among 18 patients with ITCL,nine received chemotherapy and the median survival time was two months. Conclusions Primary ITCL had non-specific symptoms and was easily misdiagnosed as CD.More attention should be paid to the differential diagnosis of the two disease.

Objective To investigate the efficacy and safety of the combined therapy of cyclophosphamide and thalidomide in the treatment of refractory Crohn's disease (CD).Methods This study was a prospective and open study.A total of 15 patients with refractory CD were enrolled.All patients received intravenous cyclophosphamide 200 mg every other day for two weeks,then followed by intravenous 400 mg once a week until the cumulative dose reached 6 to 8 g.when the cyclophosphamide treatment started,at the same time thalidomide was taken 25 to 75 mg every night according to the tolerance of patients.Before the treatment,two weeks' after the treatment and at the time when the cumulative dose of cyclophosphamide reached 6 to 8 g,Crohn's disease activity index (CDAI),hemoglobin (Hb),white blood cell (WBC) count,erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hs-CRP) were recorded.Endoscopy examination was conducted before the treatment and at the time when the cumulative dose of cyclophosphamide reached 6 to 8 g.The condition of mucosa healing was observed and scored by simple endoscopic score for crohn's disease (SES-CD).Adverse effects of all patients were monitored.Paired t test was performed for statistical analysis.Results Before the treatment,the CDAI of 15 patients with refractory CD was 235.87±59.87,two weeks after the treatment the CDAI declined to 135.33 ± 29.23,and the difference was statistically significant (t=7.50,P＜0.01).Before the treatment,ESR and hs-CRP was (42.13±22.80) mm/1 h and (13.73± 2.18) mg/L.Two weeks after treatment they declined to (23.80±16.63) mm/1 h and (5.77±4.77) mg/L,and the differences were statistically significant (t=2.43 and 6.17,both P＜0.05).After two-week treatment,10 patients achieved clinical remission.After the cumulative dose of cyclophosphamide reached 6 to 8 g combined therapy,CDAI of patients was 108.14 ± 47.10,which decreased significantly compared with that before treatment (t=6.30,P＜0.01).ESR,hs-CRP and WBC count was (19.35± 19.18) mm/1 h,(6.16± 5.02) mg/L and (6.28 ± 3.42) × 109/L,respectively,which decreased compared with those before treatment,and the differences were statistically significant (t=5.90,5.40 and 3.71,all P＜0.01).Twelve patients achieved clinical remission.And the lesions of 12 patients improved under endoscope,furthermore,the mucosa of four patients healed.Before the treatment,SES-CD was 9.14 ± 5.39,which declined to 5.07 ± 4.58 after the treatment,and the difference was statistically significant (t =3.14,P ＜ 0.01).During the treatment,five patients had adverse effects.Alanine aminotransferases (ALT) increased in three patients,WBC count decreased in one patient and one patient got a severe urinary infection.Conclusions Patients with refractory CD could achieve clinical remission,mucosa healing under endoscopy and better efficacy with the combined therapy of cyclophosphamide and thalidomide.However,adverse effects should be monitored during the treatment.

OBJECTIVETo investigate the differences in body composition between Crohn's disease(CD) patients and healthy subjects as well as the characteristics of human body composition in various types of CD.

METHODSA total of 57 CD patients were prospectively selected from the Sixth Affiliated Hospital of Sun Yat-sen University as the study group, while 51 healthy subjects as the control group. Protein content, mineral content, fat content, lean body mass, waist circumference, and hip circumference in the two groups were measured by body composition analyzer. Characteristics of CD at different location and different disease activity index were investigated as well.

RESULTSIntracellular fluid, extracellular fluid, weight, protein content, fat content, lean body mass, muscle weight, body fat ratio, waist hip ratio, body weight ratio, arm muscle circumference, arm circumference, quality of cells, BMI and basal metabolic rate in CD patients were significantly lower than those in control group(all P<0.05). Proportion of protein-deficiency patients and fat-deficiency patients were 66.7% and 47.4% respectively. Protein content, fat content, and lean body mass in ileocolic CD patients were lower than those with small bowel and colonic CD(all P<0.05). Protein content, fat content, lean body mass in patients with high disease activity index were lower than those in patients with low and medium index, but higher basal metablic rate was found in the former group(all P<0.05).

CONCLUSIONSThe human body composition in patients with CD are different from healthy people. Disease location and disease activity index have an impact on protein content, fat content, and lean body mass.

Adipose Tissue ; Body Composition ; Body Weight ; Crohn Disease ; physiopathology ; Humans

Objective To investigate the differences in body composition between Crohn′s disease (CD) patients and healthy subjects as well as the characteristics of human body composition in various types of CD. Methods A total of 57 CD patients were prospectively selected from the Sixth Affiliated Hospital of Sun Yat-sen University as the study group, while 51 healthy subjects as the control group. Protein content, mineral content, fat content, lean body mass, waist circumference, and hip circumference in the two groups were measured by body composition analyzer. Characteristics of CD at different location and different disease activity index were investigated as well. Results Intracellular fluid, extracellular fluid, weight, protein content, fat content, lean body mass, muscle weight, body fat ratio, waist hip ratio, body weight ratio, arm muscle circumference, arm circumference, quality of cells, BMI and basal metabolic rate in CD patients were significantly lower than those in control group (all P<0.05). Proportion of protein-deficiency patients and fat-deficiency patients were 66.7% and 47.4% respectively. Protein content, fat content, and lean body mass in ileocolic CD patients were lower than those with small bowel and colonic CD (all P<0.05). Protein content, fat content, lean body mass in patients with high disease activity index were lower than those in patients with low and medium index, but higher basal metablic rate was found in the former group (all P<0.05). Conclusions The human body composition in patients with CD are different from healthy people. Disease location and disease activity index have an impact on protein content, fat content, and lean body mass.

Objective To investigate the differences in body composition between Crohn′s disease (CD) patients and healthy subjects as well as the characteristics of human body composition in various types of CD. Methods A total of 57 CD patients were prospectively selected from the Sixth Affiliated Hospital of Sun Yat-sen University as the study group, while 51 healthy subjects as the control group. Protein content, mineral content, fat content, lean body mass, waist circumference, and hip circumference in the two groups were measured by body composition analyzer. Characteristics of CD at different location and different disease activity index were investigated as well. Results Intracellular fluid, extracellular fluid, weight, protein content, fat content, lean body mass, muscle weight, body fat ratio, waist hip ratio, body weight ratio, arm muscle circumference, arm circumference, quality of cells, BMI and basal metabolic rate in CD patients were significantly lower than those in control group (all P<0.05). Proportion of protein-deficiency patients and fat-deficiency patients were 66.7% and 47.4% respectively. Protein content, fat content, and lean body mass in ileocolic CD patients were lower than those with small bowel and colonic CD (all P<0.05). Protein content, fat content, lean body mass in patients with high disease activity index were lower than those in patients with low and medium index, but higher basal metablic rate was found in the former group (all P<0.05). Conclusions The human body composition in patients with CD are different from healthy people. Disease location and disease activity index have an impact on protein content, fat content, and lean body mass.

OBJECTIVETo study the role of miR-19a in ulcerative colitis (UC) in mice.

METHODSThe target gene of miR-19a was predicted by bioinformatics analysis. The expression of the target protein in UC colon was detected by immunohistochemistry and Western blotting. The target gene was further identified by enhanced green fluorescent protein (EGFP) report vector system.

RESULTSThe target gene of miR-19a was TNF-α as predicted by bioinformatics analysis. TNF-α expression was highly expressed in the colonic tissue of UC mice. MiR-19a could inhibit the report gene activity of TNF-α-3'UTR-WT but no that of TNF-α-3'UTR-Mut.

CONCLUSIONThe target gene of miR-19a is TNF-α, and the binding site is TNF-α 3'UTR. The possible role of miR-19a in UC pathogenesis involves regulation of TNF-α expression in the colon.

3' Untranslated Regions ; Animals ; Binding Sites ; Colitis, Ulcerative ; genetics ; metabolism ; pathology ; Immunohistochemistry ; Mice ; MicroRNAs ; genetics ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism

Objective To observe the efficacy and safety of thalidomide in refractory Crohn's disease (CD).Methods A total of 21 moderate or severe active CD patients were enrolled,who had no response to glucocorticoid and azathioprine treatment or steroid-dependent.The patients were administrated with thalidomide 100 mg/d before sleep and followed up for one year.The clinical efficacy,endoscopic findings and safety were evaluated.Results Among 21 refractory CD patients,six patients stopped medication due to adverse effect and two because of ineffectiveness,three patients continued medication not completed one year follow-up,10 patients completed one year follow-up.The clinical remission,effective and ineffective rates were 23.8％(5/21),19.0％(4/21) and 57.1％(12/21) respectively.Under endoscope,the mucosal healing,improvement and no improvement rates were 9.5％(2/21),14.3％(3/21) and 76.2％ (16/21) respectively.The adverse effect rate was 71.4％ (15/21) including rash,conspitation,sommolence,numbness of hands and feet,leucopenia and muscular soreness.The mean time of the adverse effects onset was 3.4 weeks.Conclusions Thalidomide is effective in refractory CD treatment and could be used in patients unwilling to use biological medication or receive surgery.But the adverse effects should be noted.