Browsing by Subject "Ulcerative colitis"

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  • Castaneda, Anu E.; Tuulio-Henriksson, Annamari; Aronen, Eeva T.; Marttunen, Mauri; Kolho, Kaija-Leena (2013)
  • Sidoroff, Marianne; Karikoski, Riitta; Raivio, Taneli; Savilahti, Erkki; Kolho, Kaija-Leena (2010)
  • Kolehmainen, Sara (Helsingin yliopisto, 2018)
    Biologisten lääkkeiden, erityisesti TNF-alfa-salpaajien, käyttöönotto ja käytön yleistyminen ovat olleet suurimpia edistyksellisiä muutoksia tulehduksellisten suolistosairauksien hoidossa viimeisen vuosikymmenen aikana. Haavaisen koliitin hoidossa käytettävät biologiset lääkkeet ovat tehokkaita remission aikaansaamisessa sekä ylläpidossa ja niiden on osoitettu vähentävän sairaalahoidon tarvetta. Vaikka leikkaushoidon tarve haavaisessa koliitissa on pienentynyt viimeisten vuosikymmenien aikana lääkehoidon kehittyessä, on sen rooli yhä merkittävä. On yllättävää, että biologisten lääkkeiden lisääntyneen käytön vaikutus leikkaushoidon tarpeeseen on yhä epäselvä ja tutkimustulokset ristiriitaisia. Tärkeimmät leikkausindikaatiot haavaisessa koliitissa ovat lääkehoidolle reagoimaton tauti, paksusuolen dysplasia ja kolorektaalisyöpä. Biologisten lääkkeiden vaikutuksesta haavaisen koliitin leikkausindikaatioihin on niukasti tutkimustietoa. Tutkimuksen tavoitteena oli selvittää biologisten lääkkeiden vaikutuksia leikkausmääriin ja -indikaatioihin haavaisessa koliitissa. Tutkimus toteutettiin retrospektiivisesti vertailemalla kahta potilaskohorttia, jotka koostuivat kirurgisesti HYKS:ssa vuosina 2005-2007 (n=129) ja 2014-2016 (n=133) hoidetuista haavaista koliittia sairastavista potilaista. Biologista lääkehoitoa, pääasiassa TNF-alfa-salpaajia, leikkaushoitoa edeltävästi saaneiden potilaiden määrä oli noussut merkittävästi, 2.3%:sta 18.8%:iin. Taudin esiintyvyys oli lisääntynyt ja näin ollen leikkausten määrä suhteessa tautia sairastaviin oli pienentynyt huomattavasti: vuosina 2005-2007 leikkausmäärä oli 8.6/1.000 potilasvuotta ja vuosina 2014-2016 5.1/1.000 potilasvuotta, p<0.001. Leikkausindikaatioissa ei ollut havaittavissa merkittäviä muutoksia. Tärkeimmät leikkausindikaatiot vuosina 2005-2007 ja 2014-2016 olivat seuraavat: lääkehoidolle reagoimaton tauti (79.4% ja 79.1%), dysplasia (16.3% ja 12.8%) sekä kolorektaalisyöpä (4.7% ja 4.5%). Päivystysleikkausten osuus pysyi muuttumattomana, kattaen 8.5% ja 9.8% kaikista leikkauksista. Tutkimuksemme vahvistaa käsitystä siitä, että biologiset lääkkeet näyttävät olevan tehokkaita vähentämään leikkaushoidon tarvetta haavaista koliittia sairastavilla potilailla. Leikkausindikaatioissa ei kuitenkaan ole tapahtunut muutoksia, ja nykyisille lääkehoidon vaihtoehdoille reagoimaton tauti on merkittävin indikaatio leikkaushoidolle. Leikkaushoitoa edeltävä biologisten lääkkeiden käytön lisääntyminen tutkimusjaksojemme välillä kertoo, että huomattava osa biologisilla lääkkeillä hoidettavista potilaista ei saa vastetta hoidolle, vaste on riittämätön tai se hiipuu. Hoidon optimointia ja kustannuksia sekä potilaan elämänlaatua ajatellen olisi hyödyllistä pystyä tunnistamaan ennalta biologisista lääkkeistä parhaiten hyötyvät potilaat.
  • Molander, Pauliina; Ylänne, Karoliina (2019)
    Introduction: The Ulcerative Colitis (UC) Narrative is a global initiative to engage patients with UC, in order to help identify the impact of UC on patients' lives. The aim of the UC Narrative extension survey in Finland was to identify and describe the unmet needs in quality care. Methods: Seventeen Finnish physicians were surveyed in the original UC Narrative survey between 7 December 2017 and 24 January 2018. In the extension phase, Finnish UC patients, recruited through the Finnish patient association, were surveyed from 15 November to 3 December 2018, covering questions on disease characteristics, impact on life, most common challenges in communication with health care professionals (HCPs) and access to care. Results: Five hundred and eight patients with self-reported UC diagnosis participated (137 male [27.0%]). Diagnostic delay was, on average, 2.3 (SD 5.5) years; 14.4% had waited five years or more for diagnosis. Most patients (396; 78.0%) considered themselves to be in remission and rated their overall state of health as 'excellent' or 'good' (303; 59.7%). Most patients (79.6%) were satisfied with the communication with their HCPs, and the majority (74.2%) felt comfortable raising concerns and fears with HCPs. However, the satisfaction in discussing mental and emotional health impacts of UC was lower (44.3%). A relatively large number of patients (38.5%) felt that they would be a more successful person without UC. Conclusions: The UC Narrative survey highlighted the diagnostic delay in UC, challenges in communication with HCPs and the impact of UC on life from the patients' perspective.
  • Laakso, Saila; Valta, Helena; Verkasalo, Matti; Toiviainen-Salo, Sanna-Maria; Viljakainen, Heli; Mäkitie, Outi (2012)
  • Hamalainen, Anssi; Sipponen, Taina; Kolho, Kaija-Leena (2011)
  • ESPGHAN; Jongsma, Maria M. E.; Winter, Dwight A.; Huynh, Hien Q.; Kolho, Kaija-Leena; de Ridder, Lissy (2020)
    Infliximab (IFX) is administered intravenously using weight-based dosing (5 mg/kg) in inflammatory bowel disease (IBD) patients. Our hypothesis is that especially young children need a more intensive treatment regimen than the current weight-based dose administration. We aimed to assess IFX pharmacokinetics (PK), based on existing therapeutic drug monitoring (TDM) data in IBD patients <10 years. TDM data were collected retrospectively in 14 centres. Children treated with IFX were included if IFX was started as IBD treatment at age <10 years (young patients, YP) and PK data were available. Older IBD patients aged 10-18 years were used as controls (older patients, OP). Two hundred and fifteen paediatric inflammatory bowel disease (PIBD) patients were eligible for the study (110 <10 year; 105 >= 10 years). Median age was 8.3 years (IQR 6.9-8.9) in YP compared with 14.3 years (IQR 12.8-15.6) in OP at the start of IFX. At the start of maintenance treatment, 72% of YP had trough levels below therapeutic range (<5.4 mu g/mL). After 1 year of scheduled IFX maintenance treatment, YP required a significantly higher dose per 8 weeks compared with OP (YP; 9.0 mg/kg (IQR 5.0-12.9) vs. OP; 5.5 mg/kg (IQR 5.0-9.3);p <0.001). The chance to develop antibodies to infliximab was relatively lower in OP than YP (0.329 (95% CI - 1.2 to - 1.01);p <0.001), while the overall duration of response to IFX was not significantly different (after 2 years 53% (n = 29) in YP vs. 58% (n = 45) in OP;p = 0.56). Conclusion: Intensification of the induction scheme is suggested for PIBD patients aged <10 years. What is Known?
  • Voutilainen, Markku; Hutri-Kähönen, Nina; Tossavainen, Päivi; Sipponen, Taina; Pitkänen, Niina; Laitinen, Tomi; Jokinen, Eero; Rönnemaa, Tapani; Viikari, Jorma S. A.; Raitakari, Olli T.; Juonala, Markus (2018)
    Background and aims: Several genetic and environmental risk factors have been linked to chronic inflammatory bowel disease (IBD). The incidence of IBD has significantly increased in developed countries during last decades. The aim of the present study was to examine childhood risk factors for subsequent IBD diagnosis in a longitudinal cohort study of children and adolescents. Methods: A Finnish study population consisting of 3551 children and adolescents originally evaluated as part of the Cardiovascular Risk in Young Finns study in 1980. At baseline, participant BMI, insulin, lipid, C-reactive protein and blood pressure levels, socioeconomic position, dietary habits, and physical activity, were evaluated. In addition, information was gathered on rural residency, severe infections, breast feeding, parental smoking and birth weight. Subsequent IBD diagnosis status was evaluated based on nationwide registries on hospitalisations and drug imbursement decisions. Results: Altogether, 49 participants (1.4%) had IBD diagnosed during the 34 years of register follow-up, of which 31 had ulcerative colitis, 12 Crohn's disease and 6 undetermined colitis. In univariate analyses, significant correlations were observed between childhood HDL-cholesterol (risk ratio (95% CI) for 1-SD change (0.58 (0.42-0.79)) and CRP concentrations (1.20 (1.01-1.43)) with IBD. The inverse association between HDL-cholesterol and IBD remained significant (0.57 (0.39-0.82)) in a multivariable model including data on age, sex and CRP. In addition, a weighted genetic z-score of 71 single nucleotide polymorphisms associated with elevated HDL-cholesterol levels was significantly lower in IBD patients, p = 0.01). Conclusion: Low childhood HDL-cholesterol levels are associated with subsequent IBD diagnosis. In addition, a genetic risk score associated with low HDL-cholesterol levels predict later IBD suggesting that HDL-cholesterol metabolism might have a role in the pathogenesis of IBD. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
  • Piekkala, Maija; Hagström, Jaana; Tanskanen, Maarit; Rintala, Risto; Haglund, Caj; Kolho, Kaija-Leena (2013)
  • Karjalainen, E. K.; Renkonen-Sinisalo, L.; Mustonen, H. K.; Lepistö, A. H. (2019)
    AimRestorative proctocolectomy with ileal pouch-anal anastomosis is considered by many surgeons to be the standard procedure for surgical management of ulcerative colitis. There is controversy about whether or not a covering ileostomy should be constructed. The aim of this study was to evaluate the outcomes and morbidity for patients with ulcerative colitis who underwent restorative proctocolectomy with or without a diverting ileostomy. MethodThis is a retrospective study of a consecutive series of 510 patients with ulcerative colitis who were operated on in Helsinki University Hospital between January 2005 and June 2016. A diverting ileostomy was performed in 119 patients (the stoma group) compared with 391 patients with no stoma. ResultsDehydration and intestinal obstruction occurred more often in the stoma group (P ConclusionOur study shows that a diverting ileostomy is associated with considerable morbidity but it does not seem to prevent later failure of the pouch. We suggest that a diverting ileostomy should only be constructed for high-risk patients.
  • Timonen, Anni (Helsingfors universitet, 2016)
    Aim. We aimed to assess complications and functional outcomes of restorative proctocolectomy (RPC) with ileoanal anastomosis (IAA) performed on children with total colonic aganlionosis (TCA) in relation to patients with ulcerative colitis (UC). Methods. Medical records on complications, stool frequency, day- and nighttime continence, enterocolitis/pouchitis and fecal calprotectin levels of HD patients who underwent RPC with IAA in a single center were compared to similarly treated patients with pediatric-onset UC. Results. Median operative age of HD patients was 1.6 months and 5.6 years at follow-up. Fourteen patients received J-pouch and two straight IAA. Stool frequency for daytime was 3.5 and nighttime 0. Total continence rate was 79%. At least two enterocolitis/pouchitis episodes occurred in 81%, while histologically verified pouch inflammation was observed in 27%. An increased value of fecal calprotectin was observed in 4. Conclusion. Outcomes were encouraging. Stool frequency and fecal continence appeared better preserved and the frequency of histological pouch inflammation and fecal calprotectin levels were lower than in UC patients.
  • Mäki-Nevala, Satu; Ukwattage, Sanjeevi; Olkinuora, Alisa; Almusa, Henrikki; Ahtiainen, Maarit; Ristimäki, Ari; Seppälä, Toni; Lepistö, Anna; Mecklin, Jukka-Pekka; Peltomäki, Päivi (2021)
    Ulcerative colitis increases colorectal cancer risk by mechanisms that remain incompletely understood. We approached this question by determining the genetic and epigenetic profiles of colitis-associated colorectal carcinomas (CA-CRC). The findings were compared to Lynch syndrome (LS), a different form of cancer predisposition that shares the importance of immunological factors in tumorigenesis. CA-CRCs (n = 27) were investigated for microsatellite instability, CpG island methylator phenotype and somatic mutations of 999 cancer-relevant genes ("Pan-cancer" panel). A subpanel of "Pan-cancer" design (578 genes) was used for LS colorectal tumors (n = 28). Mutational loads and signatures stratified CA-CRCs into three subgroups: hypermutated microsatellite-unstable (Group 1, n = 1), hypermutated microsatellite-stable (Group 2, n = 9) and nonhypermutated microsatellite-stable (Group 3, n = 17). The Group 1 tumor was the only one with MLH1 promoter hypermethylation and exhibited the mismatch repair deficiency-associated Signatures 21 and 15. Signatures 30 and 32 characterized Group 2, whereas no prominent single signature existed in Group 3. TP53, the most common mutational target in CA-CRC (16/27, 59%), was similarly affected in Groups 2 and 3, but DNA repair genes and Wnt signaling genes were mutated significantly more often in Group 2. In LS tumors, the degree of hypermutability exceeded that of the hypermutated CA-CRC Groups 1 and 2, and somatic mutational profiles and signatures were different. In conclusion, Groups 1 (4%) and 3 (63%) comply with published studies, whereas Group 2 (33%) is novel. The existence of molecularly distinct subgroups within CA-CRC may guide clinical management, such as therapy options.
  • De Simone, Belinda; Davies, Justin; Chouillard, Elie; Di Saverio, Salomone; Hoentjen, Frank; Tarasconi, Antonio; Sartelli, Massimo; Biffl, Walter L; Ansaloni, Luca; Coccolini, Federico; Chiarugi, Massimo; De’Angelis, Nicola; Moore, Ernest E; Kluger, Yoram; Abu-Zidan, Fikri; Sakakushev, Boris; Coimbra, Raul; Celentano, Valerio; Wani, Imtiaz; Pintar, Tadeja; Sganga, Gabriele; Di Carlo, Isidoro; Tartaglia, Dario; Pikoulis, Manos; Cardi, Maurizio; De Moya, Marc A; Leppäniemi, Ari; Kirkpatrick, Andrew; Agnoletti, Vanni; Poggioli, Gilberto; Carcoforo, Paolo; Baiocchi, Gian L; Catena, Fausto (BioMed Central, 2021)
    Abstract Background Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons. Method A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019. Conclusions Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.
  • De Simone, Belinda; Davies, J; Chouillard, E; Di Saverio, S; Hoentjen, F; Tarasconi, A; Sartelli, M; Biffl, WL; Ansaloni, L; Coccolini, F; Chiarugi, M; De'Angelis, N; Moore, EE; Kluger, Y; Abu-Zidan, F; Sakakushev, B; Coimbra, R; Celentano, V; Wani, I; Pintar, T; Sganga, G; Di Carlo, I; Tartaglia, D; Pikoulis, M; Cardi, M; De Moya, MA; Leppaniemi, A; Kirkpatrick, A; Agnoletti, V; Poggioli, G; Carcoforo, P; Baiocchi, GL; Catena, F (2021)
    Background Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons. Method A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019. Conclusions Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.