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New Developments in the Management of Crohn’s Disease

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Inflammatory Bowel Disease

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Crohn’s disease (CD) is a chronic immune-mediated disease characterized by recurrent transmural inflammation of the intestinal tract that, left unchecked, can lead to significant morbidity. The repertoire of available therapeutics for the treatment of CD has been expanding at a rapid pace, largely due to continuous advances in our understanding of its pathophysiology. Navigating the different medications and understanding the nuances of use and known side effects have led to the ability to tailor treatment to the specific disease in the individual patient. This has propelled clinicians into an era of personalized medicine where treatment is tailored based on the unique circumstances of the patient.

However, in spite of our ability to escalate and target therapy, there still remains a fraction of patients who either do not respond at all, respond poorly, or lose response to currently available medications. The aim of this chapter is to discuss current thinking regarding the optimization of available therapies as well as to introduce other treatments that are undergoing investigation. We discuss the determinants of prognosis, targets of therapy, drug monitoring, and prevention of postoperative recurrence. In addition, potential future therapies such as hematopoietic stem cell transplantation (HSCT), fecal microbiota transplantation (FMT), hyperbaric oxygen therapy (HBOT), and cytapheresis (CAP) that may help augment clinical response to conventional therapies or can act as stand-alone options will be discussed. Combinations of different options, together with a better understanding of how and when to use currently available treatments, will allow personalization of therapy to the individual patient.

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References

  1. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of crohn's disease in adults. Am J Gastroenterol. 2018;113(4):481–517. https://doi.org/10.1038/ajg.2018.27.

    Article  PubMed  Google Scholar 

  2. Dubinsky MC, Lamothe S, Yang HY, et al. Pharmacogenomics and metabolite measurement for 6-mercaptopurine therapy in inflammatory bowel disease. Gastroenterology. 2000;118(4):705–13. https://doi.org/10.1016/s0016-5085(00)70140-5.

    Article  CAS  PubMed  Google Scholar 

  3. Nielsen OH, Steenholdt C, Juhl CB, Rogler G. Efficacy and safety of methotrexate in the management of inflammatory bowel disease: A systematic review and meta-analysis of randomized, controlled trials. EClin Med. 2020;20:100271. https://doi.org/10.1016/j.eclinm.2020.100271.

    Article  Google Scholar 

  4. Adegbola SO, Sahnan K, Warusavitarne J, Hart A, Tozer P. Anti-TNF therapy in crohn's disease. Int J Mol Sci. 2018;19(8):2244. https://doi.org/10.3390/ijms19082244.

    Article  CAS  PubMed Central  Google Scholar 

  5. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med. 2004;350(9):876–85. https://doi.org/10.1056/NEJMoa030815.

    Article  CAS  PubMed  Google Scholar 

  6. Sandborn WJ, Hanauer SB, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn's disease: results of the CLASSIC II trial. Gut. 2007;56(9):1232–9. https://doi.org/10.1136/gut.2006.106781.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial. Gastroenterology. 2006;130(2):323–33.; quiz 591. https://doi.org/10.1053/j.gastro.2005.11.030.

    Article  CAS  PubMed  Google Scholar 

  8. Goel N, Stephens S. Certolizumab pegol. MAbs. 2010;2(2):137–47. https://doi.org/10.4161/mabs.2.2.11271.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Colombel JF, Schwartz DA, Sandborn WJ, et al. Adalimumab for the treatment of fistulas in patients with Crohn's disease. Gut. 2009;58(7):940–8. https://doi.org/10.1136/gut.2008.159251.

    Article  CAS  PubMed  Google Scholar 

  10. Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999;340(18):1398–405. https://doi.org/10.1056/NEJM199905063401804.

    Article  CAS  PubMed  Google Scholar 

  11. Tandon P, Rhee GG, Schwartz D, McCurdy JD. Strategies to optimize anti-tumor necrosis factor therapy for perianal fistulizing crohn's disease: a systematic review. Dig Dis Sci. 2019;64(11):3066–77. https://doi.org/10.1007/s10620-019-05635-1.

    Article  CAS  PubMed  Google Scholar 

  12. Park SC, Jeen YT. Anti-integrin therapy for inflammatory bowel disease. World J Gastroenterol. 2018;24(17):1868–80. https://doi.org/10.3748/wjg.v24.i17.1868.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Chapuis-Biron C, Bourrier A, Nachury M, et al. Vedolizumab for perianal Crohn's disease: a multicentre cohort study in 151 patients. Aliment Pharmacol Ther. 2020;51(7):719–27. https://doi.org/10.1111/apt.15665.

    Article  CAS  PubMed  Google Scholar 

  14. Deepak P, Loftus EV Jr. Ustekinumab in treatment of Crohn's disease: design, development, and potential place in therapy. Drug Des Devel Ther. 2016;10:3685–98. https://doi.org/10.2147/DDDT.S102141.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Feagan BG, Sandborn WJ, Gasink C, et al. Ustekinumab as induction and maintenance therapy for crohn's disease. N Engl J Med. 2016;375(20):1946–60. https://doi.org/10.1056/NEJMoa1602773.

    Article  CAS  PubMed  Google Scholar 

  16. Chapuis-Biron C, Kirchgesner J, Pariente B, et al. Ustekinumab for perianal crohn's disease: the BIOLAP multicenter study from the GETAID. Am J Gastroenterol. 2020;115(11):1812–20. https://doi.org/10.14309/ajg.0000000000000810.

    Article  PubMed  Google Scholar 

  17. De Vries LCS, Wildenberg ME, De Jonge WJ, D'Haens GR. The future of janus kinase inhibitors in inflammatory bowel disease. J Crohns Colitis. 2017;11(7):885–93. https://doi.org/10.1093/ecco-jcc/jjx003.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Beaugerie L, Sokol H. Clinical, serological and genetic predictors of inflammatory bowel disease course. World J Gastroenterol. 2012;18(29):3806–13. https://doi.org/10.3748/wjg.v18.i29.3806.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Peyrin-Biroulet L, Reinisch W, Colombel JF, et al. Clinical disease activity, C-reactive protein normalisation and mucosal healing in Crohn's disease in the SONIC trial. Gut. 2014;63(1):88–95. https://doi.org/10.1136/gutjnl-2013-304984.

    Article  PubMed  Google Scholar 

  20. Colombel JF, Adedokun OJ, Gasink C, et al. Combination therapy with infliximab and azathioprine improves infliximab pharmacokinetic features and efficacy: a post Hoc analysis. Clin Gastroenterol Hepatol. 2019;17(8):1525–32. e1. https://doi.org/10.1016/j.cgh.2018.09.033.

    Article  CAS  PubMed  Google Scholar 

  21. Kothari MM, Nguyen DL, Parekh NK. Strategies for overcoming anti-tumor necrosis factor drug antibodies in inflammatory bowel disease: Case series and review of literature. World J Gastrointest Pharmacol Ther. 2017;8(3):155–61. https://doi.org/10.4292/wjgpt.v8.i3.155.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kotlyar DS, Osterman MT, Diamond RH, et al. A systematic review of factors that contribute to hepatosplenic T-cell lymphoma in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9(1):36–41. e1. https://doi.org/10.1016/j.cgh.2010.09.016.

    Article  CAS  PubMed  Google Scholar 

  23. Shah ED, Coburn ES, Nayyar A, Lee KJ, Koliani-Pace JL, Siegel CA. Systematic review: hepatosplenic T-cell lymphoma on biologic therapy for inflammatory bowel disease, including data from the food and drug administration adverse event reporting system. Aliment Pharmacol Ther. 2020;51(5):527–33. https://doi.org/10.1111/apt.15637.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jones J, Loftus EV Jr, Panaccione R, et al. Relationships between disease activity and serum and fecal biomarkers in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2008;6(11):1218–24. https://doi.org/10.1016/j.cgh.2008.06.010.

    Article  PubMed  Google Scholar 

  25. Shah SC, Colombel JF, Sands BE, Narula N. Systematic review with meta-analysis: mucosal healing is associated with improved long-term outcomes in Crohn's disease. Aliment Pharmacol Ther. 2016;43(3):317–33. https://doi.org/10.1111/apt.13475.

    Article  CAS  PubMed  Google Scholar 

  26. Panes J, Garcia-Olmo D, Van Assche G, et al. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016;388(10051):1281–90. https://doi.org/10.1016/S0140-6736(16)31203-X.

    Article  PubMed  Google Scholar 

  27. Castiglione F, Mainenti P, Testa A, et al. Cross-sectional evaluation of transmural healing in patients with Crohn's disease on maintenance treatment with anti-TNF alpha agents. Dig Liver Dis. 2017;49(5):484–9. https://doi.org/10.1016/j.dld.2017.02.014.

    Article  CAS  PubMed  Google Scholar 

  28. Papamichael K, Cheifetz AS. Therapeutic drug monitoring in inflammatory bowel disease: for every patient and every drug? Curr Opin Gastroenterol. 2019;35(4):302–10. https://doi.org/10.1097/MOG.0000000000000536.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Moradkhani A, Beckman LJ, Tabibian JH. Health-related quality of life in inflammatory bowel disease: psychosocial, clinical, socioeconomic, and demographic predictors. J Crohns Colitis. 2013;7(6):467–73. https://doi.org/10.1016/j.crohns.2012.07.012.

    Article  PubMed  Google Scholar 

  30. Vande Casteele N, Ferrante M, Van Assche G, et al. Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease. Gastroenterology. 2015;148(7):1320–9. e3. https://doi.org/10.1053/j.gastro.2015.02.031.

    Article  CAS  PubMed  Google Scholar 

  31. Feuerstein JD, Nguyen GC, Kupfer SS, Falck-Ytter Y, Singh S. American gastroenterological association institute clinical guidelines C. american gastroenterological association institute guideline on therapeutic drug monitoring in inflammatory bowel disease. Gastroenterology. 2017;153(3):827–34. https://doi.org/10.1053/j.gastro.2017.07.032.

    Article  PubMed  Google Scholar 

  32. Restellini S, Khanna R, Afif W. Therapeutic drug monitoring with ustekinumab and vedolizumab in inflammatory bowel disease. Inflamm Bowel Dis. 2018;24(10):2165–72. https://doi.org/10.1093/ibd/izy134.

    Article  PubMed  Google Scholar 

  33. Torres J, Boyapati RK, Kennedy NA, Louis E, Colombel JF, Satsangi J. Systematic review of effects of withdrawal of immunomodulators or biologic agents from patients with inflammatory bowel disease. Gastroenterology. 2015;149(7):1716–30. https://doi.org/10.1053/j.gastro.2015.08.055.

    Article  CAS  PubMed  Google Scholar 

  34. Doherty G, Katsanos KH, Burisch J, et al. European crohn's and colitis organisation topical review on treatment withdrawal ['Exit Strategies'] in inflammatory bowel disease. J Crohns Colitis. 2018;12(1):17–31. https://doi.org/10.1093/ecco-jcc/jjx101.

    Article  PubMed  Google Scholar 

  35. Louis E, Mary JY, Vernier-Massouille G, et al. Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology. 2012;142(1):63–70 e5; quiz e31. https://doi.org/10.1053/j.gastro.2011.09.034.

    Article  CAS  PubMed  Google Scholar 

  36. Nguyen GC, Loftus EV Jr, Hirano I, et al. American gastroenterological association institute guideline on the management of crohn's disease after surgical resection. Gastroenterology. 2017;152(1):271–5. https://doi.org/10.1053/j.gastro.2016.10.038.

    Article  PubMed  Google Scholar 

  37. De Cruz P, Kamm MA, Hamilton AL, et al. Crohn's disease management after intestinal resection: a randomised trial. Lancet. 2015;385(9976):1406–17. https://doi.org/10.1016/S0140-6736(14)61908-5.

    Article  PubMed  Google Scholar 

  38. Regueiro M, Feagan BG, Zou B, et al. Infliximab reduces endoscopic, but not clinical, recurrence of crohn's disease after ileocolonic resection. Gastroenterology. 2016;150(7):1568–78. https://doi.org/10.1053/j.gastro.2016.02.072.

    Article  CAS  PubMed  Google Scholar 

  39. Chongthammakun V, Fialho A, Fialho A, Lopez R, Shen B. Correlation of the rutgeerts score and recurrence of Crohn's disease in patients with end ileostomy. Gastroenterol Rep (Oxf). 2017;5(4):271–6. https://doi.org/10.1093/gastro/gow043.

    Article  Google Scholar 

  40. Chang S, Malter L, Hudesman D. Disease monitoring in inflammatory bowel disease. World J Gastroenterol. 2015;21(40):11246–59. https://doi.org/10.3748/wjg.v21.i40.11246.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. D'Amico F, Fiorino G, Furfaro F, Allocca M, Danese S. Janus kinase inhibitors for the treatment of inflammatory bowel diseases: developments from phase I and phase II clinical trials. Expert Opin Investig Drugs. 2018;27(7):595–9. https://doi.org/10.1080/13543784.2018.1492547.

    Article  CAS  PubMed  Google Scholar 

  42. Peyrin-Biroulet L, Christopher R, Behan D, Lassen C. Modulation of sphingosine-1-phosphate in inflammatory bowel disease. Autoimmun Rev. 2017;16(5):495–503. https://doi.org/10.1016/j.autrev.2017.03.007.

    Article  CAS  PubMed  Google Scholar 

  43. Ma C, Jairath V, Khanna R, Feagan BG. Investigational drugs in phase I and phase II clinical trials targeting interleukin 23 (IL23) for the treatment of Crohn's disease. Expert Opin Investig Drugs. 2018;27(8):649–60. https://doi.org/10.1080/13543784.2018.1506764.

    Article  CAS  PubMed  Google Scholar 

  44. Sigall-Boneh R, Pfeffer-Gik T, Segal I, Zangen T, Boaz M, Levine A. Partial enteral nutrition with a Crohn's disease exclusion diet is effective for induction of remission in children and young adults with Crohn's disease. Inflamm Bowel Dis. 2014;20(8):1353–60. https://doi.org/10.1097/MIB.0000000000000110.

    Article  PubMed  Google Scholar 

  45. Levine A, Wine E, Assa A, et al. Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology. 2019;157(2):440–50. e8. https://doi.org/10.1053/j.gastro.2019.04.021.

    Article  PubMed  Google Scholar 

  46. Tyndall A, Gratwohl A. Blood and marrow stem cell transplants in auto-immune disease: a consensus report written on behalf of the European League against Rheumatism (EULAR) and the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 1997;19(7):643–5. https://doi.org/10.1038/sj.bmt.1700727.

    Article  CAS  PubMed  Google Scholar 

  47. Tyndall A, Gratwohl A. Adult stem cell transplantation in autoimmune disease. Curr Opin Hematol. 2009;16(4):285–91. https://doi.org/10.1097/MOH.0b013e32832aacb3.

    Article  CAS  PubMed  Google Scholar 

  48. Leung Y, Geddes M, Storek J, Panaccione R, Beck PL. Hematopoietic cell transplantation for Crohn's disease; is it time? World J Gastroenterol. 2006;12(41):6665–73. https://doi.org/10.3748/wjg.v12.i41.6665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Shimizu H, Suzuki K, Watanabe M, Okamoto R. Stem cell-based therapy for inflammatory bowel disease. Intest Res. 2019;17(3):311–6. https://doi.org/10.5217/ir.2019.00043.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Oyama Y, Craig RM, Traynor AE, et al. Autologous hematopoietic stem cell transplantation in patients with refractory Crohn's disease. Gastroenterology. 2005;128(3):552–63. https://doi.org/10.1053/j.gastro.2004.11.051.

    Article  PubMed  Google Scholar 

  51. Barriga F, Ramirez P, Wietstruck A, Rojas N. Hematopoietic stem cell transplantation: clinical use and perspectives. Biol Res. 2012;45(3):307–16. https://doi.org/10.4067/S0716-97602012000300012.

    Article  CAS  PubMed  Google Scholar 

  52. McGovern DP, Kugathasan S, Cho JH. Genetics of inflammatory bowel diseases. Gastroenterology. 2015;149(5):1163–76. e2. https://doi.org/10.1053/j.gastro.2015.08.001.

    Article  CAS  PubMed  Google Scholar 

  53. Baron FA, Hermanne JP, Dowlati A, et al. Bronchiolitis obliterans organizing pneumonia and ulcerative colitis after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1998;21(9):951–4. https://doi.org/10.1038/sj.bmt.1701198.

    Article  CAS  PubMed  Google Scholar 

  54. Hawkey CJ, Allez M, Clark MM, et al. Autologous hematopoetic stem cell transplantation for refractory crohn disease: a randomized clinical trial. JAMA. 2015;314(23):2524–34. https://doi.org/10.1001/jama.2015.16700.

    Article  CAS  PubMed  Google Scholar 

  55. Ciccocioppo R, Corazza GR. Mesenchymal stem cells for fistulising Crohn's disease. Lancet. 2016;388(10051):1251–2. https://doi.org/10.1016/S0140-6736(16)31209-0.

    Article  PubMed  Google Scholar 

  56. Singh UP, Singh NP, Singh B, et al. Stem cells as potential therapeutic targets for inflammatory bowel disease. Front Biosci (Schol Ed). 2010;2:993–1008. https://doi.org/10.2741/s115.

    Article  PubMed Central  Google Scholar 

  57. Eiseman B, Silen W, Bascom GS, Kauvar AJ. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery. 1958;44(5):854–9.

    CAS  PubMed  Google Scholar 

  58. Zhang F, Luo W, Shi Y, Fan Z, Ji G. Should we standardize the 1,700-year-old fecal microbiota transplantation? Am J Gastroenterol. 2012;107(11).; author reply:1755–6. https://doi.org/10.1038/ajg.2012.251.

    Article  PubMed  Google Scholar 

  59. Bak SH, Choi HH, Lee J, et al. Fecal microbiota transplantation for refractory Crohn's disease. Intest Res. 2017;15(2):244–8. https://doi.org/10.5217/ir.2017.15.2.244.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Ley RE, Hamady M, Lozupone C, et al. Evolution of mammals and their gut microbes. Science. 2008;320(5883):1647–51. https://doi.org/10.1126/science.1155725.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Fiebiger U, Bereswill S, Heimesaat MM. Dissecting the interplay between intestinal microbiota and host immunity in health and disease: lessons learned from germfree and gnotobiotic animal models. Eur J Microbiol Immunol (Bp). 2016;6(4):253–71. https://doi.org/10.1556/1886.2016.00036.

    Article  CAS  Google Scholar 

  62. O'Toole PW, Jeffery IB. Gut microbiota and aging. Science. 2015;350(6265):1214–5. https://doi.org/10.1126/science.aac8469.

    Article  CAS  PubMed  Google Scholar 

  63. Nishida A, Inoue R, Inatomi O, Bamba S, Naito Y, Andoh A. Gut microbiota in the pathogenesis of inflammatory bowel disease. Clin J Gastroenterol. 2018;11(1):1–10. https://doi.org/10.1007/s12328-017-0813-5.

    Article  PubMed  Google Scholar 

  64. Smits LP, Bouter KE, de Vos WM, Borody TJ, Nieuwdorp M. Therapeutic potential of fecal microbiota transplantation. Gastroenterology. 2013;145(5):946–53. https://doi.org/10.1053/j.gastro.2013.08.058.

    Article  PubMed  Google Scholar 

  65. Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis. 2011;53(10):994–1002. https://doi.org/10.1093/cid/cir632.

    Article  PubMed  Google Scholar 

  66. Pigneur B, Sokol H. Fecal microbiota transplantation in inflammatory bowel disease: the quest for the holy grail. Mucosal Immunol. 2016;9(6):1360–5. https://doi.org/10.1038/mi.2016.67.

    Article  CAS  PubMed  Google Scholar 

  67. Suskind DL, Brittnacher MJ, Wahbeh G, et al. Fecal microbial transplant effect on clinical outcomes and fecal microbiome in active Crohn's disease. Inflamm Bowel Dis. 2015;21(3):556–63. https://doi.org/10.1097/MIB.0000000000000307.

    Article  PubMed  Google Scholar 

  68. Cui B, Feng Q, Wang H, et al. Fecal microbiota transplantation through mid-gut for refractory Crohn's disease: safety, feasibility, and efficacy trial results. J Gastroenterol Hepatol. 2015;30(1):51–8. https://doi.org/10.1111/jgh.12727.

    Article  CAS  PubMed  Google Scholar 

  69. Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2014;8(12):1569–81. https://doi.org/10.1016/j.crohns.2014.08.006.

    Article  PubMed  Google Scholar 

  70. Orel R, Kamhi TT. Intestinal microbiota, probiotics and prebiotics in inflammatory bowel disease. World J Gastroenterol. 2014;20(33):11505–24. https://doi.org/10.3748/wjg.v20.i33.11505.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Gupta P, Andrew H, Kirschner BS, Guandalini S. Is lactobacillus GG helpful in children with Crohn's disease? Results of a preliminary, open-label study. J Pediatr Gastroenterol Nutr. 2000;31(4):453–7. https://doi.org/10.1097/00005176-200010000-00024.

    Article  CAS  PubMed  Google Scholar 

  72. Guslandi M, Mezzi G, Sorghi M, Testoni PA. Saccharomyces boulardii in maintenance treatment of Crohn's disease. Dig Dis Sci. 2000;45(7):1462–4. https://doi.org/10.1023/a:1005588911207.

    Article  CAS  PubMed  Google Scholar 

  73. Bourreille A, Cadiot G, Le Dreau G, et al. Saccharomyces boulardii does not prevent relapse of Crohn's disease. Clin Gastroenterol Hepatol. 2013;11(8):982–7. https://doi.org/10.1016/j.cgh.2013.02.021.

    Article  PubMed  Google Scholar 

  74. Limketkai BN, Akobeng AK, Gordon M, Adepoju AA. Probiotics for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2020;7:CD006634. https://doi.org/10.1002/14651858.CD006634.pub3.

    Article  PubMed  Google Scholar 

  75. Rasmussen HE, Hamaker BR. Prebiotics and inflammatory bowel disease. Gastroenterol Clin North Am. 2017;46(4):783–95. https://doi.org/10.1016/j.gtc.2017.08.004.

    Article  PubMed  Google Scholar 

  76. Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. 2011;127(Suppl 1):131S–41S. https://doi.org/10.1097/PRS.0b013e3181fbe2bf.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Al-Waili NS, Butler GJ. Effects of hyperbaric oxygen on inflammatory response to wound and trauma: possible mechanism of action. Sci World J. 2006;6:425–41. https://doi.org/10.1100/tsw.2006.78.

    Article  CAS  Google Scholar 

  78. Andre-Levigne D, Modarressi A, Pepper MS, Pittet-Cuenod B. Reactive oxygen species and nox enzymes are emerging as key players in cutaneous wound repair. Int J Mol Sci. 2017;18(10):2149. https://doi.org/10.3390/ijms18102149.

    Article  CAS  PubMed Central  Google Scholar 

  79. Brady CE 3rd, Cooley BJ, Davis JC. Healing of severe perineal and cutaneous Crohn's disease with hyperbaric oxygen. Gastroenterology. 1989;97(3):756–60. https://doi.org/10.1016/0016-5085(89)90649-5.

    Article  PubMed  Google Scholar 

  80. Dulai PS, Gleeson MW, Taylor D, Holubar SD, Buckey JC, Siegel CA. Systematic review: The safety and efficacy of hyperbaric oxygen therapy for inflammatory bowel disease. Aliment Pharmacol Ther. 2014;39(11):1266–75. https://doi.org/10.1111/apt.12753.

    Article  CAS  PubMed  Google Scholar 

  81. Saniabadi AR, Hanai H, Takeuchi K, et al. Adacolumn, an adsorptive carrier based granulocyte and monocyte apheresis device for the treatment of inflammatory and refractory diseases associated with leukocytes. Ther Apher Dial. 2003;7(1):48–59. https://doi.org/10.1046/j.1526-0968.2003.00012.x.

    Article  PubMed  Google Scholar 

  82. Saniabadi AR, Hanai H, Suzuki Y, et al. Adacolumn for selective leukocytapheresis as a non-pharmacological treatment for patients with disorders of the immune system: an adjunct or an alternative to drug therapy? J Clin Apher. 2005;20(3):171–84. https://doi.org/10.1002/jca.20046.

    Article  PubMed  Google Scholar 

  83. Vernia P, D'Ovidio V, Meo D. Leukocytapheresis in the treatment of inflammatory bowel disease: current position and perspectives. Transfus Apher Sci. 2010;43(2):227–9. https://doi.org/10.1016/j.transci.2010.07.023.

    Article  PubMed  Google Scholar 

  84. Fukunaga K, Matsumoto T. Current status and future perspectives of leukocytapheresis for inflammatory bowel disease. J Gastroenterol Hepatol. 2012;27(6):997–1003. https://doi.org/10.1111/j.1440-1746.2012.07119.x.

    Article  CAS  PubMed  Google Scholar 

  85. Sands BE, Sandborn WJ, Wolf DC, et al. Pilot feasibility studies of leukocytapheresis with the Adacolumn Apheresis System in patients with active ulcerative colitis or Crohn disease. J Clin Gastroenterol. 2006;40(6):482–9. https://doi.org/10.1097/00004836-200607000-00005.

    Article  PubMed  Google Scholar 

  86. Kashiwagi N, Sugimura K, Koiwai H, et al. Immunomodulatory effects of granulocyte and monocyte adsorption apheresis as a treatment for patients with ulcerative colitis. Dig Dis Sci. 2002;47(6):1334–41. https://doi.org/10.1023/a:1015330816364.

    Article  CAS  PubMed  Google Scholar 

  87. Fukuda Y, Matsui T, Suzuki Y, et al. Adsorptive granulocyte and monocyte apheresis for refractory Crohn's disease: an open multicenter prospective study. J Gastroenterol. 2004;39(12):1158–64. https://doi.org/10.1007/s00535-004-1465-z.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA

    Isaiah P. Schuster, Leslie Klyachman & Farah Monzur

  2. Zucker School of Medicine at Hofstra/Northwell, Mather Gastroenterology,Port Jefferson, NY, USA

    Ramona Rajapakse

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  1. Isaiah P. Schuster
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  2. Leslie Klyachman
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  3. Ramona Rajapakse
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  4. Farah Monzur
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Correspondence to Farah Monzur .

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  1. Zucker School of Medicine at Hofstra/Northwell, Mather Gastroenterology, Port Jefferson, NY, USA

    Ramona Rajapakse

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Schuster, I.P., Klyachman, L., Rajapakse, R., Monzur, F. (2021). New Developments in the Management of Crohn’s Disease. In: Rajapakse, R. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana, Cham. https://doi.org/10.1007/978-3-030-81780-0_4

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