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Gerhard Rogler - One of the best experts on this subject based on the ideXlab platform.
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Das Kolitis-assoziierte kolorektale Karzinom: Epidemiologie, Pathogenese und Früherkennung
Praxis, 2014Co-Authors: Michael Scharl, Luc Biedermann, Gerhard RoglerAbstract:Colitis-associated colorectal carcinoma (CRC) accounts for about 5% of all CRC and the risk for CRC in inflammatory bowel disease (IBD) patients - according to older meta-analyses - is slightly increased when compared to normal population. Effective anti-inflammatory therapy seems to decrease this risk. Main risk factors for colitis-associated CRC are Pancolitis, duration of colitis and presence of primary sclerosing cholangitis. In contrast to sporadic CRC, a characteristic adenoma-carcinoma sequence in the pathogenesis of colitis-associated CRC cannot be found. Nevertheless, numerous cell and gene defects occur. Reactive oxygen species also seem to play a pivotal role in the pathogenesis of colitis-associated CRC. Particularly patients with chronically active Pancolitis should undergo regular surveillance colonoscopy, since prognosis of colitis-associated CRC is poor.
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Transcriptional Analysis of Left-sided Colitis, Pancolitis, and Ulcerative Colitis-associated Dysplasia
Inflammatory bowel diseases, 2014Co-Authors: Jacob Tveiten Bjerrum, Ole Haagen Nielsen, Lene Riis, Valérie Pittet, Christoph Mueller, Gerhard Rogler, Jørgen H. OlsenAbstract:BACKGROUND It is unknown why patients with extensive ulcerative colitis (UC) have a higher risk of colorectal cancer compared with patients with left-sided UC. This study characterizes the inflammatory processes in left-sided UC, Pancolitis, and UC-associated dysplasia at the transcriptional level to identify potential biomarkers and transcripts of importance for the carcinogenic behavior of chronic inflammation. METHODS The Affymetrix GeneChip Human Genome U133 Plus 2.0 was applied on colonic biopsies from UC patients with left-sided UC, Pancolitis, dysplasia, and controls. Reverse transcription polymerase chain reaction and immunohistochemistry were performed for validating selected transcripts in the initial cohort and in 2 independent cohorts of patients with UC. Microarray data were analyzed by principal component analysis, and reverse transcription polymerase chain reaction and immunohistochemistry data by the Wilcoxon's rank-sum test. RESULTS The principal component analysis results revealed separate clusters for left-sided UC, Pancolitis, dysplasia, and controls. Close clustering of dysplastic and pancolitic samples indicated similarities in gene expression. Indeed, 101 and 656 parallel upregulated and downregulated transcripts, respectively, were identified in specimens from dysplasia and Pancolitis. Validation of selected transcripts hereof identified insulin receptor alpha (INSRA) and MAP kinase interacting serine/threonine kinase 2 (MKNK2) with an enhanced expression in dysplasia compared with left-sided UC and controls, whereas laminin γ2 (LAMC2) was found with a lower expression in dysplasia compared with the remaining 3 groups. CONCLUSIONS This study demonstrates Pancolitis and left-sided UC as distinct inflammatory processes at the transcriptional level, and identifies INSRA, MKNK2, and LAMC2 as potential critical transcripts in the inflammation-driven preneoplastic process of UC.
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Topical therapy is underused in patients with ulcerative colitis
Journal of Crohn's & colitis, 2013Co-Authors: Frank Seibold, Valérie Pittet, Nicolas Fournier, Christoph Beglinger, Christian Mottet, Gerhard RoglerAbstract:The availability of new topical preparations for the treatment of left sided ulcerative colitis offers a therapy optimization for many patients. Rectal application of steroids and 5-aminosalicylic acid (5-ASA) is associated with fewer side effects and has a higher therapeutic efficacy in left-sided colitis as compared to a systemic therapy. Therefore, we were interested in the use of topical therapy in patients with ulcerative colitis. The key question was whether topical treatment is more frequently used than oral therapy in patients with proctitis and left sided colitis. Data of 800 patients of the Swiss IBD cohort study were analyzed. Sixteen percent of patients of the cohort had proctitis, 21% proctosigmoiditis and 41% Pancolitis. Topical therapy with 5-ASA or corticosteroids was given in 26% of patients with proctitis, a combined systemic and topical treatment was given in 13%, whereas systemic treatment with 5-ASA without topical treatment was given in 29%. Proportion of topical drug use decreased with respect to disease extension from 39% for proctitis to 13.1% for Pancolitis (P=0.001). Patients with severe colitis received a significantly higher dose of topical 5-ASA than patients in remission. Side effects of topical or systemic 5-ASA or budesonide treatment were less frequently seen compared to other medications. Topical treatment was frequently stopped over time. The quality of life was the same in patients with limited disease compared to patients with Pancolitis. Topical treatment in proctitis patients was underused in Switzerland. Since topical treatment is safe and effective it should be used to a larger extend.
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Therapie der Colitis ulcerosa
Praxis, 2009Co-Authors: St. R. Vavricka, Gerhard RoglerAbstract:The therapy of ulcerative colitis is dependent on disease activity and on disease location. Different therapy concepts are applied in ulcerative proctitis, left-sided colitis, Pancolitis and fulminant colitis as well as in chronic active disease and maintenance of remission. This overview presents important concepts in the treatment of ulcerative colitis.
Jacques Cosnes - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for neoplasia in inflammatory bowel disease patients with Pancolitis.
American Journal of Gastroenterology, 2010Co-Authors: Vivianne Bergeron, Ariane Vienne, Harry Sokol, Philippe Seksik, Isabelle Nion-larmurier, Agnès Ruskone-fourmestraux, Magali Svrcek, Laurent Beaugerie, Jacques CosnesAbstract:OBJECTIVES: Colorectal cancer (CRC), developing from dysplastic lesions, is the main long-term complication of Pancolitis. The aims of the present study were to assess the risks for neoplasia and advanced neoplasia (AN), respectively, in ulcerative colitis (UC) and Crohn's disease (CD) patients with Pancolitis, and to search for protective and risk factors for colorectal neoplasia. METHODS: A total of 855 inflammatory bowel disease (IBD) patients with longstanding Pancolitis (276 UC, 56 IBD unclassified (IBDu), and 523 CD) had pathological examination of a proctocolectomy specimen (n=255) or multiple biopsy samples from a surveillance colonoscopy (n=600) after median disease duration of 115 months. Risk factors for low-grade dysplasia (LGD) and AN, respectively, were searched for in the whole group of patients and in a case-control comparison after matching for IBD phenotype. RESULTS: A total of 75 patients eventually developed colorectal neoplasia: 14 adenomas, 28 nonadenomatous LGD, and 33 ANs. The 25-year cumulative risks for neoplasia and AN, respectively, were 32.8±5.7% and 25.9±5.7% in UC and IBDu vs. 12.1±2.7% and 3.9±2.0% in CD (P
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risk factors for neoplasia in inflammatory bowel disease patients with Pancolitis
The American Journal of Gastroenterology, 2010Co-Authors: Vivianne Bergeron, Ariane Vienne, Harry Sokol, Philippe Seksik, Magali Svrcek, Laurent Beaugerie, Isabelle Nionlarmurier, Agnes Ruskonefourmestraux, Jacques CosnesAbstract:OBJECTIVES: Colorectal cancer (CRC), developing from dysplastic lesions, is the main long-term complication of Pancolitis. The aims of the present study were to assess the risks for neoplasia and advanced neoplasia (AN), respectively, in ulcerative colitis (UC) and Crohn's disease (CD) patients with Pancolitis, and to search for protective and risk factors for colorectal neoplasia. METHODS: A total of 855 inflammatory bowel disease (IBD) patients with longstanding Pancolitis (276 UC, 56 IBD unclassified (IBDu), and 523 CD) had pathological examination of a proctocolectomy specimen (n=255) or multiple biopsy samples from a surveillance colonoscopy (n=600) after median disease duration of 115 months. Risk factors for low-grade dysplasia (LGD) and AN, respectively, were searched for in the whole group of patients and in a case-control comparison after matching for IBD phenotype. RESULTS: A total of 75 patients eventually developed colorectal neoplasia: 14 adenomas, 28 nonadenomatous LGD, and 33 ANs. The 25-year cumulative risks for neoplasia and AN, respectively, were 32.8±5.7% and 25.9±5.7% in UC and IBDu vs. 12.1±2.7% and 3.9±2.0% in CD (P<0.0001). In CD, patients with UC-like endoscopic appearance (n=126) had an increased risk for AN compared with those with discrete lesions (at 25 years, 10.6±7.2 vs. 1.5±0.9%). In the case-control comparison, factors associated with an increased risk of AN were primary sclerosing cholangitis (hazard ratio (HR) 4.72 (1.54-14.52)) and family history of CRC (HR 3.37 (1.02-11.14)), whereas previous segmental colectomy was protective (HR 0.25 (0.07-0.88)). CONCLUSIONS: The risk of AN in longstanding Pancolitis is higher in UC or IBDu than in CD. In CD, this risk is significantly increased in patients with UC-like endoscopic lesions. The surveillance program should focus on these latter patients.
Cyriel Y Ponsioen - One of the best experts on this subject based on the ideXlab platform.
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primary sclerosing cholangitis is associated with a distinct phenotype of inflammatory bowel disease
Inflammatory Bowel Diseases, 2012Co-Authors: Kirsten Boonstra, Karel J Van Erpecum, Karin M J Van Nieuwkerk, Joost P H Drenth, Alexander C Poen, Ben J M Witteman, H A R E Tuynman, Ulrich Beuers, Cyriel Y PonsioenAbstract:BACKGROUND: Primary sclerosing cholangitis (PSC) is strongly associated with inflammatory bowel disease (IBD). The aim of this study was to assess the IBD phenotype associated with PSC in a large well-phenotyped population-based PSC cohort using endoscopic and histopathologic criteria. METHODS: PSC cases were identified and ascertained, fulfilling well-established criteria, in 39 hospitals in a geographically defined region of The Netherlands. IBD location was recorded according to the Montreal Classification. As this classification does not consider segmental inflammation, backwash ileitis, or rectal sparing, an additional subgroup analysis was performed in 80 cases and 80 age- and sex-matched IBD controls, reviewing all endoscopy and pathology reports filed between 2000 and 2010. RESULTS: In all, 380 (66%) of a total of 579 PSC patients had coexistent IBD, mainly ulcerative colitis (UC) (75%). Overall, 207 (83%) of the PSC-UC patients had a Pancolitis, 32 (13%) a left-sided colitis, and 9 (4%) a proctitis only. Seventy (95%) PSC-Crohn's disease (CD) patients had an (ileo)colitis and four (5%) ileitis only. In the subgroup analysis 53 (66%) PSC-UC patients were identified, 24 (30%) PSC-CD patients, and three (4%) PSC-IBD-U patients. Fifty (94%) PSC-UC patients had a Pancolitis, compared with 32 (62%) matched UC patients (P < 0.001). Left-sided colitis was seen in 16 (31%) UC controls and in one PSC-UC patient (P < 0.001). Backwash ileitis and rectal sparing were rare findings (<10%) in the cohorts under study. CONCLUSIONS: IBD in PSC patients represents a distinct phenotype in that Pancolitis is observed in 94% of PSC-UC and colitis in 96% of PSC-CD patients. Backwash ileitis and rectal sparing were rare findings in the PSC-UC patients. (Inflamm Bowel Dis 2012;).
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1286 PRIMARY SCLEROSING CHOLANGITIS IS ASSOCIATED WITH Pancolitis AND NOT BACKWASH ILEITIS
Journal of Hepatology, 2011Co-Authors: Kirsten Boonstra, Karel J Van Erpecum, Joost P H Drenth, Alexander C Poen, Ben J M Witteman, H A R E Tuynman, Ulrich Beuers, C.m.j. Van Nieuwkerk, Cyriel Y PonsioenAbstract:Background and aims: PSC-IBD is reported to represent a distinct phenotype of IBD characterized by colitis, rectal sparing and backwash ileitis, but this has so far not been confirmed in large well-phenotyped cohorts. The aim of this study was to assess the IBD phenotype associated with PSC in a large Dutch PSC cohort using endoscopic and histopathological criteria. Methods: PSC cases were identified and ascertained, fulfilling well-established serological, histological and radiological criteria in 30 hospitals in The Netherlands. IBD location was recorded according to the Montreal classification. To assess the occurrence of backwash ileitis a subgroup analysis was performed in 40 cases and 80 ageand sex-matched IBD controls with at least one complete ileocolonoscopy including terminal ileum histology, reviewing 370 endoscopy and pathology reports written between 2001 and 2010. Results: 324 (64%) of a total of 506 PSC patients had coexistent IBD, mainly ulcerative colitis (UC, 72%). 147 (80%) of the PSC-UC patients had a Pancolitis, 28 (15%) a left sided colitis and eight (4%) a proctitis. Sixty (95%) PSC-Crohn's disease (CD) patients had an (ileo)colitis and three ileitis only (5%). In the subgroup analysis of 40 PSC-IBD patients twenty-seven (68%) PSC-UC patients were identified, as well as twelve (30%) PSC-CD patients and one (2%) PSC-undetermined IBD patient. Twenty-five (93%) PSC-UC patients had a Pancolitis, compared to thirty-three (61%) matched UC patients (p = 0.034). Left sided colitis was seen in seventeen (32%) UC controls and in none of the PSC-UC patients (p = 0.001). Backwash ileitis was seen in only one (4%) PSC-UC patient and in none of the UC controls. Conclusion: PSC-IBD represents a distinct IBD phenotype. The majority of Dutch PSC-UC patients have a Pancolitis. In case of PSC-CD, colonic inflammation is involved in 95% of patients. Backwash ileitis is not a prominent finding in Dutch PSC-UC cases.
Won Ho Kim - One of the best experts on this subject based on the ideXlab platform.
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Extensive Disease Subtypes in Adult Patients with Ulcerative Colitis: Non-Pancolitis Versus Pancolitis.
Digestive diseases and sciences, 2018Co-Authors: Dong Suk Shin, Jae Hee Cheon, Yong Eun Park, Yehyun Park, Soo Jung Park, Tae Il Kim, Won Ho KimAbstract:Few studies have compared Pancolitis and non-Pancolitis E3 in adult patients with ulcerative colitis (UC). This study aimed to evaluate the natural disease courses and factors affecting outcomes between Pancolitis and non-Pancolitis E3. We retrospectively analyzed 117 patients, including 93 with extensive colitis (E3) and 24 with UC confined to the rectum or left-sided colon and appendiceal orifice inflammation at the time of diagnosis, who were regularly followed up for at least 1 year. Patients with E3 were divided into two groups according to the degree of disease extension: Pancolitis group (disease extent up to the cecum or proximal ascending colon) and non-Pancolitis E3 group (disease extent above the splenic flexure but not up to the proximal ascending colon). Clinical findings at diagnosis; comorbidity; medications; Mayo score; cumulative rates of corticosteroid, immunomodulator, and anti-tumor necrosis factor (anti-TNF) alpha use; relapse; and admission were compared between the Pancolitis and non-Pancolitis E3 groups. The median follow-up duration of the 117 patients was 74 (range 15–158) months. Fifty-one patients (43.5%) had Pancolitis. The Mayo score at initial diagnosis, cumulative relapse rate, and cumulative admission rate were significantly higher in the Pancolitis group than in the non-Pancolitis E3 group (P
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extensive disease subtypes in adult patients with ulcerative colitis non Pancolitis versus Pancolitis
Digestive Diseases and Sciences, 2018Co-Authors: Dong Suk Shin, Jae Hee Cheon, Yong Eun Park, Yehyun Park, Soo Jung Park, Tae Il Kim, Won Ho KimAbstract:Few studies have compared Pancolitis and non-Pancolitis E3 in adult patients with ulcerative colitis (UC). This study aimed to evaluate the natural disease courses and factors affecting outcomes between Pancolitis and non-Pancolitis E3. We retrospectively analyzed 117 patients, including 93 with extensive colitis (E3) and 24 with UC confined to the rectum or left-sided colon and appendiceal orifice inflammation at the time of diagnosis, who were regularly followed up for at least 1 year. Patients with E3 were divided into two groups according to the degree of disease extension: Pancolitis group (disease extent up to the cecum or proximal ascending colon) and non-Pancolitis E3 group (disease extent above the splenic flexure but not up to the proximal ascending colon). Clinical findings at diagnosis; comorbidity; medications; Mayo score; cumulative rates of corticosteroid, immunomodulator, and anti-tumor necrosis factor (anti-TNF) alpha use; relapse; and admission were compared between the Pancolitis and non-Pancolitis E3 groups. The median follow-up duration of the 117 patients was 74 (range 15–158) months. Fifty-one patients (43.5%) had Pancolitis. The Mayo score at initial diagnosis, cumulative relapse rate, and cumulative admission rate were significantly higher in the Pancolitis group than in the non-Pancolitis E3 group (P < 0.001, P = 0.023 and P = 0.007, respectively). However, there was no significant difference between the groups in the rates of cumulative immunomodulator and anti-TNF alpha use (P = 0.67 and P = 0.73, respectively). In patients with extensive UC (E3), Pancolitis was associated with higher probabilities of cumulative relapse or admission, indicating poor prognosis.
Vivianne Bergeron - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for neoplasia in inflammatory bowel disease patients with Pancolitis.
American Journal of Gastroenterology, 2010Co-Authors: Vivianne Bergeron, Ariane Vienne, Harry Sokol, Philippe Seksik, Isabelle Nion-larmurier, Agnès Ruskone-fourmestraux, Magali Svrcek, Laurent Beaugerie, Jacques CosnesAbstract:OBJECTIVES: Colorectal cancer (CRC), developing from dysplastic lesions, is the main long-term complication of Pancolitis. The aims of the present study were to assess the risks for neoplasia and advanced neoplasia (AN), respectively, in ulcerative colitis (UC) and Crohn's disease (CD) patients with Pancolitis, and to search for protective and risk factors for colorectal neoplasia. METHODS: A total of 855 inflammatory bowel disease (IBD) patients with longstanding Pancolitis (276 UC, 56 IBD unclassified (IBDu), and 523 CD) had pathological examination of a proctocolectomy specimen (n=255) or multiple biopsy samples from a surveillance colonoscopy (n=600) after median disease duration of 115 months. Risk factors for low-grade dysplasia (LGD) and AN, respectively, were searched for in the whole group of patients and in a case-control comparison after matching for IBD phenotype. RESULTS: A total of 75 patients eventually developed colorectal neoplasia: 14 adenomas, 28 nonadenomatous LGD, and 33 ANs. The 25-year cumulative risks for neoplasia and AN, respectively, were 32.8±5.7% and 25.9±5.7% in UC and IBDu vs. 12.1±2.7% and 3.9±2.0% in CD (P
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risk factors for neoplasia in inflammatory bowel disease patients with Pancolitis
The American Journal of Gastroenterology, 2010Co-Authors: Vivianne Bergeron, Ariane Vienne, Harry Sokol, Philippe Seksik, Magali Svrcek, Laurent Beaugerie, Isabelle Nionlarmurier, Agnes Ruskonefourmestraux, Jacques CosnesAbstract:OBJECTIVES: Colorectal cancer (CRC), developing from dysplastic lesions, is the main long-term complication of Pancolitis. The aims of the present study were to assess the risks for neoplasia and advanced neoplasia (AN), respectively, in ulcerative colitis (UC) and Crohn's disease (CD) patients with Pancolitis, and to search for protective and risk factors for colorectal neoplasia. METHODS: A total of 855 inflammatory bowel disease (IBD) patients with longstanding Pancolitis (276 UC, 56 IBD unclassified (IBDu), and 523 CD) had pathological examination of a proctocolectomy specimen (n=255) or multiple biopsy samples from a surveillance colonoscopy (n=600) after median disease duration of 115 months. Risk factors for low-grade dysplasia (LGD) and AN, respectively, were searched for in the whole group of patients and in a case-control comparison after matching for IBD phenotype. RESULTS: A total of 75 patients eventually developed colorectal neoplasia: 14 adenomas, 28 nonadenomatous LGD, and 33 ANs. The 25-year cumulative risks for neoplasia and AN, respectively, were 32.8±5.7% and 25.9±5.7% in UC and IBDu vs. 12.1±2.7% and 3.9±2.0% in CD (P<0.0001). In CD, patients with UC-like endoscopic appearance (n=126) had an increased risk for AN compared with those with discrete lesions (at 25 years, 10.6±7.2 vs. 1.5±0.9%). In the case-control comparison, factors associated with an increased risk of AN were primary sclerosing cholangitis (hazard ratio (HR) 4.72 (1.54-14.52)) and family history of CRC (HR 3.37 (1.02-11.14)), whereas previous segmental colectomy was protective (HR 0.25 (0.07-0.88)). CONCLUSIONS: The risk of AN in longstanding Pancolitis is higher in UC or IBDu than in CD. In CD, this risk is significantly increased in patients with UC-like endoscopic lesions. The surveillance program should focus on these latter patients.
