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Neurath M.F.,Friedrich - Alexander - University, Erlangen - Nuremberg | Travis S.P.L.,Translational Gastroenterology Unit
Gut | Year: 2012

Recent studies have identified mucosal healing on endoscopy as a key prognostic parameter in the management of inflammatory bowel diseases (IBD), thus highlighting the role of endoscopy for monitoring of disease activity in IBD. In fact, mucosal healing has emerged as a key treatment goal in IBD that predicts sustained clinical remission and resection-free survival of patients. The structural basis of mucosal healing is an intact barrier function of the gut epithelium that prevents translocation of commensal bacteria into the mucosa and submucosa with subsequent immune cell activation. Thus, mucosal healing should be considered as an initial event in the suppression of inflammation of deeper layers of the bowel wall, rather than as a sign of complete healing of gut inflammation. In this systematic review, the clinical studies on mucosal healing are summarised and the effects of anti-inflammatory or immunosuppressive drugs such as 5-aminosalicylates, corticosteroids, azathioprine, ciclosporin and anti-TNF antibodies (adalimumab, certolizumab pegol, infliximab) on mucosal healing are discussed. Finally, the implications of mucosal healing for subsequent clinical management in patients with IBD are highlighted.

East J.E.,Translational Gastroenterology Unit
Clinical Endoscopy | Year: 2012

Colonoscopy based colitis surveillance is widely accepted to try to prevent development of and ensure early detection of colitis-associated colorectal cancer. Traditionally this has been performed with quadrantic random biopsies throughout the colon. Chromoendoscopy "dye-spray" with targeted biopsies only has been shown to increase dysplasia detection 4 to 5 fold on a per lesion basis. It has therefore been suggested that random biopsies should be abandoned as they do not increase dysplasia detection nor change patient clinical course. Recent British guidelines for colitis surveillance have strongly endorsed chromoendoscopy. This short review summarizes current international guidelines and looks at how to optimize white light colonoscopy in colitis considering: bowel preparation, withdrawal time, high definition, and structure enhancement. Data for advanced imaging techniques are reviewed including positive evidence in favor of chromoendoscopy, and limited data suggesting autofluoresence imaging may be promising. Narrow band imaging does not increase dysplasia detection in colitis. Confocal endomicroscopy might potentially reduce biopsies beyond that of chromoendoscopy but does not offer a clear detection advantage. Pan-colonic chromoendoscopy with targeted biopsies increases dysplasia detection and is the standard of care in the United Kingdom. It is likely that the use of chromoendoscopy for colitis surveillance will become widely accepted internationally. © 2012 Korean Society of Gastrointestinal Endoscopy.

Walsh A.,St. Vincents Hospital | Palmer R.,Translational Gastroenterology Unit | Travis S.,Translational Gastroenterology Unit
Gastrointestinal Endoscopy Clinics of North America | Year: 2014

Mucosal healing is an important therapeutic end point in clinical trials and clinical practice. There is no validated definition of mucosal healing in patients with inflammatory bowel disease, although the benefits of achieving mucosal healing include decreased need for corticosteroids, sustained clinical remission, decreased colectomy, and bowel resection. The Ulcerative Colitis Endoscopic Index of Severity is the only validated endoscopic index in ulcerative colitis. The Crohn's Disease Endoscopic Index of Severity and the Simple Endoscopic Score for Crohn's Disease are validated for Crohn disease, and the Rutgeerts Postoperative Endoscopic Index is used to predict recurrence after an ileocolic resection. © 2014 Elsevier Inc.

Halliday J.,Translational Gastroenterology Unit | Klenerman P.,University of Oxford | Barnes E.,University of Oxford
Expert Review of Vaccines | Year: 2011

Hepatitis C virus (HCV) infects more than 170 million people globally and is a leading cause of liver cirrhosis, transplantation and hepatocellular carcinoma. Current gold-standard therapy often fails, has significant side effects in many cases and is expensive. No vaccine is currently available. The fact that a significant proportion of infected people spontaneously control HCV infection in the setting of an appropriate immune response suggests that a vaccine for HCV is a realistic goal. A comparative analysis of infected people with distinct clinical outcomes has enabled the characterization of many important innate and adaptive immune processes associated with viral control. It is clear that a successful HCV vaccine will need to exploit and enhance these natural immune defense mechanisms. New HCV vaccine approaches, including peptide, recombinant protein, DNA and vector-based vaccines, have recently reached Phase I/II human clinical trials. Some of these technologies have generated robust antiviral immunity in healthy volunteers and infected patients. The challenge now is to move forward into larger at-risk or infected populations to truly test efficacy. © 2011 Expert Reviews Ltd.

Owens B.M.J.,Translational Gastroenterology Unit | Simmons A.,Translational Gastroenterology Unit | Simmons A.,Weatherall Institute of Molecular Medicine
Mucosal Immunology | Year: 2013

A growing body of evidence suggests that non-hematopoietic stromal cells of the intestine have multiple roles in immune responses and inflammation at this mucosal site. Despite this, many still consider gut stromal cells as passive structural entities, with past research focused heavily on their roles in fibrosis, tumor progression, and wound healing, rather than their contributions to immune function. In this review, we discuss our current knowledge of stromal cells in intestinal immunity, highlighting the many immunological axes in which stromal cells have a functional role. We also consider emerging data that broaden the potential scope of their contribution to immunity in the gut and argue that these so-called "non-immune" cells are reclassified in light of their diverse contributions to intestinal innate immunity and the maintenance of mucosal homeostasis. © 2013 Society for Mucosal Immunology.

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