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      Cardiovascular implications of inflammatory bowel disease: An updated review

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          Abstract

          Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases (ASCVD) in patients with chronic inflammatory disorders, particularly those afflicted with inflammatory bowel disease (IBD). This review delves into the epidemiological connections between IBD and ASCVD, elucidating potential underlying mechanisms. Furthermore, it discusses the impact of current IBD treatments on cardiovascular risk. Additionally, the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated, drawing parallels with observations in patients with rheumatoid arthritis. This article aims to comprehensively evaluate the existing evidence supporting these associations.

          To achieve this, we conducted a meticulous search of PubMed, spanning from inception to August 2023, using a carefully selected set of keywords. The search encompassed topics related to IBD, such as Crohn’s disease and ulcerative colitis, as well as ASCVD, including coronary artery disease, cardiovascular disease, atrial fibrillation, heart failure, conduction abnormalities, heart blocks, and premature coronary artery disease. This review encompasses various types of literature, including retrospective and prospective cohort studies, clinical trials, meta-analyses, and relevant guidelines, with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.

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          Most cited references167

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          Ulcerative colitis

          Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, dysregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings. The aim of management is to induce and then maintain remission, defined as resolution of symptoms and endoscopic healing. Treatments for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, and immunosuppressants. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. The therapeutic armamentarium for ulcerative colitis is expanding, and the number of drugs with new targets will rapidly increase in coming years.
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            British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

            Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.
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              Role of the gut microbiota in nutrition and health

              Ana M Valdes and colleagues discuss strategies for modulating the gut microbiota through diet and probiotics
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                Author and article information

                Contributors
                Journal
                World J Cardiol
                WJC
                World Journal of Cardiology
                Baishideng Publishing Group Inc
                1949-8462
                26 November 2023
                26 November 2023
                : 15
                : 11
                : 553-570
                Affiliations
                Department of Gastroenterology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
                Department of Gastroenterology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
                Department of Internal Medicine, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
                Department of Gastroenterology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
                Department of Cardiology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
                Department of Cardiology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
                Department of Cardiology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India. akashbatta02@ 123456gmail.com
                Author notes

                Author contributions: Bhardwaj A writing the article; Singh A writing the article, analysis and interpretation, critical revision of the article; Midha V critical revision of the article, supervision; Sood A critical revision of the article, supervision; Wander GS critical revision of the article, supervision; Mohan B critical revision of the article, supervision; Batta A conception and design, critical revision of the article, final approval of the article.

                Corresponding author: Akash Batta, Doctor, FACC, MBBS, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Punjab, Ludhiana 141001, India. akashbatta02@ 123456gmail.com

                Article
                jWJC.v15.i11.pg553 88771
                10.4330/wjc.v15.i11.553
                10696203
                38058397
                60c2a1e2-ba86-4e3a-baab-fea94df04d9a
                ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

                History
                : 8 October 2023
                : 22 October 2023
                : 8 November 2023
                Categories
                Review

                inflammatory bowel diseases,cardiovascular disorders,pericarditis,myocarditis,thromboembolism,chronic inflammation,oxidative stress,endothelial dysfunction

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