Crohn's & Colitis 360最新文献

Background: Prior studies have examined small intestinal dysplasia and cancer in Crohn's disease; however, there is limited information on ulcerative colitis (UC). We describe characteristics of small intestinal dysplasia and cancer in patients with UC. In this study, we aimed to identify common characteristics between patients with UC that were diagnosed with small intestinal malignancy.

Methods: Electronic medical records were reviewed for 3 tertiary referral centers to identify patients with a diagnosis of UC and small intestinal dysplasia or cancer between 2010 and 2023. Data collection included demographics, family history of gastrointestinal malignancy, UC diagnosis date, duration and location of disease, prior UC medical treatment or surgery, diagnosis of primary sclerosing cholangitis (PSC), PSC-related complications, and details of cancer or dysplasia. Descriptive statistics were performed.

Results: Thirty-five patients (60% male, mean age of diagnosis 39.3 ± 21.5 years old) were identified with UC and subsequent small intestinal dysplasia or cancer. Most had pancolitis (74.3%) or pancolitis with backwash ileitis (8.57%). Half underwent surgery for their UC, and half of these had the cancer or dysplasia found at the time of surgery. Ileal dysplasia was found in 2 patients (5.71%), duodenal adenocarcinoma in 2 (5.71%), ileal adenocarcinoma 2 (5.71%), duodenal carcinoid in 4 (11.4%), ileal carcinoid in 24 (68.6%), other duodenal neuroendocrine tumor in 1 (2.86%). Primary sclerosing cholangitis was diagnosed in 5 patients (14%), and 3 required liver transplants.

Conclusions: Small intestinal dysplasia and cancer are rare in this population. Most patients with small intestinal cancer or dysplasia were male, Caucasian, and had a history of extensive colitis. Ileal carcinoid had the highest incidence. Gastroenterologists should be aware of this finding in patients with UC.

Background and aim: Nutrient pattern approach is an appropriate way to compare nutrient intakes across different populations due to the universality of nutrients' nature. The current study was purposed to examine the association between patterns of nutrient intakes and risk of ulcerative colitis (UC) among Iranian adults.

Methods: In this case-control study, we enrolled 109 UC patients and 218 age- and sex-matched controls. Dietary intakes were assessed using a validated self-administered 106-item dish-based Food Frequency Questionnaire (FFQ). We also used a pre-tested questionnaire to collect data on potential confounders. A gastroenterology specialist made the diagnosis of UC according to international criteria.

Results: In total, 2 nutrient patterns were identified using factor analysis. We found the first nutrient pattern (NP1), characterized by the high intakes of macronutrients, B-vitamins, selenium, iron, zinc, sodium, phosphorus, manganese, magnesium, copper, calcium, fiber, and vitamins E and D, was inversely associated with odds of UC. This association remained significant after taking potential confounders into account; individuals in the top tertile of NP1 score had 93% lower odds of UC compared with those in the bottom tertile (OR: 0.07, 95% CI, 0.01-0.32). Regarding NP2, containing a high amount of beta-carotene, vitamins A, K, and C, potassium, and folate, a significant inverse association was also found (OR: 0.19, 95% CI, 0.09-0.38); such that in the fully adjusted model, individuals in the third tertile of NP2 score were 64% less likely to have UC compared with those in the first tertile (OR: 0.36, 95% CI, 0.15-0.82).

Conclusion: We found that a dietary pattern rich in antioxidants, B-vitamins, macronutrients, zinc, iron, copper, calcium, potassium, fat-soluble vitamins, and fiber is inversely associated with UC.

Background and aims: Telephone or email advice lines offer a service that bridges primary and specialist care provision, supporting the needs of those living with an unpredictable disease course. This scoping review aimed to systematically synthesize published evidence with regard to Inflammatory Bowel Disease advice line services and to identify gaps in research to inform further work.

Methods: A scoping review was undertaken in accordance with the patterns, advances, gaps, evidence, and research framework. Databases searched included CINAHL, PubMed, and EMBASE. Inclusion/exclusion criteria were applied by 2 reviewers independently. Data were collected using a predefined matrix, from which the framework was applied as a means of systematically collating patterns, advances, gaps, evidence, and research recommendations.

Results: Seventeen full-text publications and 22 abstracts published between 2006 and 2023 were included. Four overarching patterns were identified: advice lines as a complex intervention, drivers for advice line encounters, patient outcomes, and economic impact of advice lines.

Conclusions: The current evidence landscape lacks empirical research supporting the clinical and economic effectiveness of advice lines. Inflammatory bowel disease advice lines are commonly a nurse-led service functioning as a complex intervention, supporting both administrative and clinical issues. They appear pivotal in preventing use of acute services and escalating or re-directing care, including treatment, investigation, and advice. Further research should focus on robust clinical and economic evaluation for patients and services, exploring patient experience of advice line services, including barriers and facilitators, and characterizing those who do not currently access the service.

Background: Data are limited on patients' experience of transition to subcutaneous treatment. This study aimed to determine what factors affect the decision to transition, to assess clinical outcomes and to elucidate patients' experience of transition.

Methods: This was a longitudinal, observational study carried out at University Hospital Galway, a tertiary referral center in Ireland, from November 2022 to December 2023. The drivers and barriers for patients eligible for transition were measured using a questionnaire with 21, 5-point Likert items. Clinical, biochemical, and patient-reported parameters were assessed at week 8 and week 26. Patients completed a survey at week 26 on their experience of treatment with subcutaneous Infliximab.

Results: Eighty of 144 eligible patients agreed to transition. Treatment persistence was 93.7% at week 26. There was no significant change in mean clinical, biochemical or patient-reported parameters at week 26. In multivariate analysis, there was higher probability of transition among patients with wholly publicly funded healthcare (OR = 3.53, 95% CI, 1.18-11.68). Among those who transitioned, the strongest drivers cited were lifestyle factors while among patients who declined transition, most commonly cited barriers included reduced contact with healthcare professionals. At week 26, 96.1% of respondents reported being able to contact the IBD team when necessary and 87.3% of respondents were satisfied with their monitoring.

Conclusions: Understanding patients' attitudes toward transition is essential to design a service that meets their needs. Services must be adequately resourced in order to ensure that patients treated with subcutaneous biologics continue to have ready access to high-quality care.

Background: Higher diversity of the oral microbiome has been associated with poorer oral health outcomes in the general population. We aimed to characterize the oral microbiota in patients with inflammatory bowel disease (IBD) and compare this with that of healthy controls (HC). We also sought to examine associations between IBD management and disease control, diet and metabolic disease with oral microbial diversity.

Methods: This prospective case-control study compared participants with IBD in clinical remission with HC. Baseline anthropometry and fasting blood metabolic markers were measured, dietary intake recorded, and oral samples were collected for 16S rRNA gene amplicon sequencing.

Results: There were 57 patients with IBD (Ulcerative colitis (UC) = 26, Crohns Disease (CD) = 31) and 24 HC enrolled. There were no significant differences in oral microbial diversity between the IBD and HC cohorts. Among participants with IBD, oral microbial diversity did not associate with IBD activity nor risk of subsequent disease flare (adj-P = .28), however the use of biologic medications was associated with a lower oral microbial alpha diversity (species richness P = .01). Higher plasma insulin concentrations were associated with a higher oral alpha diversity (species richness adj-P < .01) and with beta diversity (Pseudo-F: 2.05, P = .02).

Conclusions: Oral microbial diversity is not associated with IBD disease activity or course but is positively influenced by biologic treatment. Higher fasting insulin, however, is associated with more diverse "unhealthy" oral microbiota. Within the limitations of this small study, oral microbiota may be a better marker of metabolic health than of IBD activity.

Background: Patients with inflammatory bowel disease (IBD) frequently ask their providers for nutritional or dietary recommendations; however, providers are limited in both time and knowledge to adequately address their questions. In this single-center study, we sought to improve provider experiences with nutrition counseling for patients seen in a dedicated IBD clinic.

Methods: To understand the current state, providers, including gastroenterology fellows, attendings, and advanced practice providers were surveyed regarding their experiences with nutritional recommendations in a dedicated IBD clinic. Following the pre-intervention survey, we worked with registered dieticians on how to address key concerns and developed an informational handout based upon current guidelines. After displaying handouts in clinical workspaces for 5 weeks, providers were surveyed again to evaluate their response.

Results: All 22 respondents (100%) in the pre-intervention survey either agreed or strongly agreed that IBD patients have unique nutritional requirements. A majority (72%) strongly agreed that the clinic would benefit from more access to dieticians. Additionally, 41% of providers either strongly disagreed or disagreed that they had enough time to address nutritional concerns. Post-intervention, 57% of respondents (8/14) reported that they found the handouts helpful. A significant number of providers reported improvement in their comfort level discussing nutrition and dietary recommendations with IBD patients, with tmean Likert score increasing from 3.5 to 4.1 (P = .01).

Conclusion: In this quality improvement study, we identified key issues preventing providers from addressing patient desire for nutritional counseling and developed a novel awareness campaign that significantly improved provider confidence in discussing nutritional recommendations with their IBD patients.

Background: We evaluated the real-world effectiveness and safety of vedolizumab and ustekinumab as first-line biologics in patients with Crohn's disease (CD), by disease duration.

Methods: EVOLVE Expansion (ClinicalTrials.gov, NCT05056441) was a retrospective medical chart review study in Australia, Belgium, and Switzerland. Biologic-naïve patients with CD (≥18 years old) initiated first-line biologic treatment with vedolizumab or ustekinumab. Cumulative rates of clinical response, remission, mucosal healing, and treatment persistence were assessed over 36 months. Outcomes were compared between patients with early (≤2 years) and late (>2 years) disease at biologic initiation. Serious adverse events (SAEs), serious infections (SIs), and healthcare resource use (HCRU) were evaluated.

Results: In early (n = 249) and late (n = 371) CD subgroups, there were no significant differences over 36 months between vedolizumab and ustekinumab in the cumulative rates of clinical response (early CD, 81.6% vs 80.7%; P = .31; late CD, 83.7% vs 86.5%; P = .31) or clinical remission (early CD, 87.9% vs 85.0%; P = .74; late CD, 91.1% vs 90.6%; P = .96). In patients with early CD, mucosal healing rates were significantly higher with vedolizumab than ustekinumab at both 24 (P = .02) and 36 months (P = .03). Treatment persistence was significantly higher with ustekinumab versus vedolizumab over 36 months in patients with late CD, but similar in patients with early CD. There were no significant differences in SAEs, SIs, or HCRU.

Conclusions: Both vedolizumab and ustekinumab are effective treatment options for early- and late-stage CD. Over 36 months, mucosal healing rates in patients with early CD were significantly higher with vedolizumab than with ustekinumab.

Background: There is limited real-world data on the long-term effectiveness and safety of tofacitinib among ulcerative colitis (UC) patients, especially among the elderly. Our aim was to evaluate these parameters among UC patients who had remained on the drug 1 year after initiation of therapy.

Methods: We conducted a retrospective cohort study, utilizing the US National Veterans Affairs Healthcare System, including patients with UC who received tofacitinib. The primary endpoint was effectiveness at the end of follow-up. The secondary endpoint was to evaluate if the effectiveness was different among the elderly compared to the young. Adverse events associated with the drug, like herpes zoster, major adverse cardiovascular events, deep vein thrombosis, as well as infections and malignancy during follow-up were also assessed.

Results: In total, 159 patients were included in the study, among whom 51 were in the elderly group and 108 were in the younger group. The median duration of follow-up was 1.47 years (range, 0.01-5.49 years). Effectiveness of tofacitinib among the cohort was 56.60% (90 out of 159 patients). The effectiveness was higher in the elderly (P = .005).

Conclusion: In this nationwide cohort of UC patients, the effectiveness of tofacitinib was seen in a little over half the number of patients, with higher rates of effectiveness reported among the elderly. No new safety concerns were raised, especially among the elderly.

Background: Patients with inflammatory bowel disease (IBD) often experience symptoms refractory to available treatments, prompting the use of alternative therapies like cannabis. Previous studies have shown cannabis users require higher levels of sedation for procedures. The anti-inflammatory effects of cannabis have been studied with mixed conclusions. We aimed to investigate if patients with IBD who reported cannabis use required more resources for endoscopic procedures and were more likely to have endoscopic inflammation.

Methods: This is a retrospective case-control study of adult patients with IBD between November 2018 and November 2022 at a tertiary academic medical center undergoing endoscopic evaluation of acute complaints related to IBD. Cases were matched for age, sex, and body mass index.

Results: There were 124 patients with IBD with 62 patients reporting cannabis use and 62 patients without reported cannabis use. There was a significant difference in endoscopy duration (P < .001) and endoscopic inflammation (P = .044) between groups. There was no significant difference in recovery room length of stay (P = .15), IBD treatment during time of endoscopy (P = .84), stricture (P = .53), propofol dose administered when adjusted for procedure duration (P = .082), or endoscopic duration between cannabis users with and without endoscopic inflammation (P = .194).

Conclusions: IBD cannabis users had longer endoscopic durations and were more likely to exhibit inflammation on endoscopic evaluation compared to cannabis non-users. Our study underscores the importance of medication reconciliation for more accurate resource allocation. Additionally, federal expansion of cannabis research is needed for randomized control trials to fulfill the presently unmet need for data on patient outcomes.