Crohn's & Colitis 360最新文献

Background: Generative pre-trained transformer-4 (GPT-4) is a large language model (LLM) trained on a vast corpus of data, including the medical literature. Nutrition plays an important role in managing inflammatory bowel disease (IBD), with an unmet need for nutrition-related patient education resources. This study examines the accuracy, comprehensiveness, and reproducibility of responses by GPT-4 to patient nutrition questions related to IBD.

Methods: Questions were obtained from adult IBD clinic visits, Facebook, and Reddit. Two IBD-focused registered dieticians independently graded the accuracy and reproducibility of GPT-4's responses while a third senior IBD-focused registered dietitian arbitrated. Each question was inputted twice into the model.

Results: 88 questions were selected. The model correctly responded to 73/88 questions (83.0%), with 61 (69.0%) graded as comprehensive. 15/88 (17%) responses were graded as mixed with correct and incorrect/outdated data. The model comprehensively responded to 10 (62.5%) questions related to "Nutrition and diet needs for surgery," 12 (92.3%) "Tube feeding and parenteral nutrition," 11 (64.7%) "General diet questions," 10 (50%) "Diet for reducing symptoms/inflammation," and 18 (81.8%) "Micronutrients/supplementation needs." The model provided reproducible responses to 81/88 (92.0%) questions.

Conclusions: GPT-4 comprehensively answered most questions, demonstrating the promising potential of LLMs as supplementary tools for IBD patients seeking nutrition-related information. However, 17% of responses contained incorrect information, highlighting the need for continuous refinement prior to incorporation into clinical practice. Future studies should emphasize leveraging LLMs to enhance patient outcomes and promoting patient and healthcare professional proficiency in using LLMs to maximize their efficacy.

Background: Tofacitinib is a rapidly acting Janus kinase (JAK) inhibitor with increasing evidence of effectiveness in patients with acute severe ulcerative colitis (ASUC). However, there are scarce prospective data analyzing the efficacy and rapidity of action in hospitalized ASUC.

Methods: The TRIUMPH study is a prospective open-label interventional trial of tofacitinib in hospitalized patients with ASUC conducted in 5 hospitals across Canada (Clinicaltrials.gov: NCT04925973). Eligible participants included biologic-naïve and experienced patients with ASUC refractory to 3 days of intravenous (IV) corticosteroids (Modified Truelove-Witts Severity Index [MTWSI] > 10 despite steroids). Participants were treated with tofacitinib 10 mg twice daily and assessed daily while in hospital. The primary outcome was day 7 clinical response (MTWSI reduction of > 3 from baseline and ≤ 10).

Results: Among 24 subjects, 33.3% (8/24) had previous anti-TNF failure. Day 7 clinical response was achieved in 58.3% (14/24). The mean number of days to achieve clinical response was 2.4 (SD 1.3). Marked reduction in C-reactive protein was observed in responders within the first two days after tofacitinib initiation compared to nonresponders. Colectomy occurred in 25% (6/24) by 6 months, with no additional colectomy beyond this time point. Five participants reported a total of 13 adverse events.

Conclusions: Tofacitinib is an effective rescue therapy in hospitalized patients with steroid-refractory ASUC. Randomized controlled trials are warranted to compare JAK inhibitors with other rescue therapies, including infliximab in steroid-refractory ASUC (Clinicaltrials.gov: NCT04925973).

Background: Lifestyle factors are significant contributors to fatigue, affecting ~45% of patients with inflammatory bowel disease (IBD). Hence, we evaluated the effect of a multimodal lifestyle intervention on fatigue in patients with IBD.

Methods: Patients with quiescent IBD were enrolled in this multicenter, non-randomized, controlled interventional study. The intervention group followed a 12-month lifestyle program, which included digital group meetings with a nutritionist and a lifestyle coach focusing on nutrition, exercise, sleep, and relaxation. The program also encouraged patients to exercise more self-control over personal health. The control group received standard clinical care. Clinical data and patient-reported outcomes were collected. Fatigue was measured with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); any increase in FACIT-F was considered a positive response to the intervention. Inverse probability treatment weighting was used to correct confounding by indication.

Results: Thirty-six patients in the intervention group and 32 in the control group were compared. More patients in the intervention group (82.1%) than in the control group (54.2%) experienced improvement in fatigue, P = .029, standardized mean difference (SMD) -0.624. Over 70% of patients in the intervention group achieved a clinically relevant improvement in fatigue. Compared to the control group, quality of life improved in the intervention group. Acceptance of the health status was a significant factor for fatigue improvement (β = 7.899, SE = 1.913, P < .001).

Conclusions: Multimodal lifestyle intervention improves fatigue in patients with IBD. Acceptance appears essential for fatigue improvement; instruments evaluating acceptance could help to personalize treatment and maximize its effectiveness.

Background: Patients with Crohn's disease (CD) who have ileal or any small bowel (SB) involvement are at increased risk of developing SB cancer. Due to the rarity of this complication of CD, we aimed to describe the clinical features, presentation, and of small bowel neoplasms (SBN) in patients with CD.

Methods: A case-control study was performed to include patients ≥18 years old with a diagnosis of CD with or without SBN at a single large referral center from January 1992 to May 2023. Patients were identified using bioinformatics and natural language processing tools, as well as anatomic pathology records. Two age- and sex-matched controls were identified for each case.

Results: In total, 54 patients with CD and SBN and 108 patients with CD without SBN were identified. Of the cases, most had ileal CD (55.6%) with stricturing (59.3%) phenotype. Median duration of CD prior to SBN diagnosis was 19.5 years. Nonpenetrating/nonstricturing behavior (odds ratio [OR], 9.23; 95% CI, 2.91-29.32; P = .0008) was significantly associated with an increased odds of SBN. History of tobacco use (OR, 0.27; 95% CI, 0.13-0.60; P = .0011) and IBD-associated colonic neoplasia (OR, 0.18; 95%, CI 0.4-0.85; P = .0303) were protective in development of SBN.

Conclusions: Nonpenetrating/nonstricturing CD appeared to raise SBN risk. History of tobacco use and colonic IBD-associated neoplasia are associated with reduced risk of SBN. Further studies with large sample sizes are needed to determine true incidence and risk factors associated with SBN in CD and assess potentially protective effects of early surgery.

Background and aims: Patients with inflammatory bowel disease (IBD) are at increased risk of developing acute pancreatitis (AP). Thiopurines (TP) are a well-known cause of AP. The aims of this study were to compare the incidence of AP and TP-induced AP (TIP) between patients with and without IBD under the use of TP and to assess for risk factors of TIP.

Methods: We examined a retrospective cohort of 664 patients treated with TP from 2016 to 2021 at our institution. AP was defined as pancreatitis confirmed by symptoms, serum tests, and radiology, and TIP as AP occurring shortly after starting TP and improving after withdrawal. We compared the incidence of AP and TIP between patients with and without IBD and reviewed the clinical features of TIP patients in detail.

Results: There were 366 IBD patients and 298 without IBD. IBD patients included 249 males (52.4%) with a median age of 39 years. Among them, 211 had ulcerative colitis (UC) and 155 had Crohn's disease (CD). Azathioprine was administered to 560 patients, and 6-mercaptopurine to 104. AP occurred in 13 IBD patients but in none without IBD, with a significantly higher incidence in IBD patients (1.9% vs. 0%, P = .009). Seven of 13 patients with AP satisfied the criteria for TIP. Furthermore, 5 of the 7 TIP patients had a prior history of 5-aminosalicylic acid (5-ASA) intolerance.

Conclusions: TIP may be a condition specific to IBD. IBD patients with 5-ASA intolerance are prone to TIP.

Background: The patient experience after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) remains poorly defined, resulting in heterogeneity in clinical assessments and research. We performed a qualitative study to better understand the experience of patients after IPAA for UC, with a focus on the symptoms experienced by patients and the resultant effects on quality of life (QoL).

Methods: We conducted semi-structured focus groups among patients who had undergone IPAA for UC. We invited patients with a variety of pouch-related conditions, including patients reporting normal pouch function and those with diagnosed inflammatory conditions of the pouch. We included questions on patients' experiences and symptoms after IPAA based on 4 thematic areas identified by a previously performed systematic review: bowel symptoms, activities, general issues and quality of life, and psychosocial.

Results: We interviewed 15 individuals over the course of 4 focus groups. Participants described the significant impact that bowel symptoms after IPAA had on other activities including work and daily life, and their subsequent relation to QoL themes. Participants noted symptoms of frequency, urgency, and incontinence after IPAA, and many shared how these symptoms required them to change their lifestyle, particularly by altering their daily schedule or changing their diet. Nevertheless, most participants reported QoL improvement after IPAA.

Conclusions: In this qualitative study evaluating the experience of patients after IPAA, multiple bowel-related symptoms impact other areas of life and overall QoL. Patients undergoing IPAA for UC represent a unique patient population, and thus patient-centered outcome measures should be designed to standardize their assessment.

Background: Crohn's disease (CD) treatment is associated with increased risks of infection and malignancies. Although the safety of certolizumab pegol (CZP) is well established, long-term data from community-based observational studies are lacking.

Aim: This study aimed to evaluate long-term safety outcomes of patients from the SECURE registry receiving CZP relative to other CD treatments, including corticosteroids, immunosuppressants, and biologics. The primary outcome of this observational study was the evaluation of malignancies.

Methods: Adult patients with CD were prospectively monitored for up to 8 years. Pre-specified data were collected for all enrolled patients. Adverse events of interest (AEoIs) were reported per 100 patient-years (PY) of exposure. Incidence rate ratios (IRRs) were calculated for AEoIs using multivariate regression analysis accounting for exposure to multiple treatments. Malignancies reported after any exposure to CZP were attributed to CZP. Post-hoc analyses were conducted to evaluate non-melanoma skin cancer (NMSC), lymphoma, and pregnancy outcomes.

Results: A total of 3072 patients were enrolled in the study. The risk of AEoIs was similar between patients with only CZP exposure versus comparator exposure. Among patients with any CZP exposure, there was a higher frequency of serious infections (IRR: 2.56 [95% confidence interval (CI): 2.00, 3.29]) and hypersensitivity or anaphylactic reactions (IRR: 4.11 [95% CI: 1.80, 9.38]) versus patients with comparator exposure. Malignancy rates were similar across groups; however, concomitant use of thiopurines was associated with higher odds of NMSC (odds ratio: 2.30 [95% CI: 1.09, 4.89]). Most cases of lymphoma (5/7) occurred in patients with exposure to thiopurines. Pregnancy outcomes were similar across groups.

Conclusions: No new safety signals were identified for CZP; the use of thiopurines was identified as a risk factor for NMSC.

Trial registration: NCT00844285.

Background: Common variable immunodeficiency (CVID) predisposes patients to inflammatory bowel disease (IBD). There are limited studies characterizing adults with concomitant CVID and IBD (CVID-IBD).

Methods: Demographics, clinical courses, endoscopic findings, and disease-specific therapies were obtained in adults ≥18 years with CVID-IBD over a 5-year period.

Results: We identified 11 patients with CVID-IBD, 6 with Crohn's disease (CD), and 5 with ulcerative colitis (UC). The presenting symptoms in 10 (91%) were abdominal pain and diarrhea. A majority of patients were diagnosed with IBD before CVID. Patients with CVID-IBD were diagnosed with CVID at an older age compared to patients with CVID only. The most prevalent endoscopic finding in CD was either erythema or erosions in the ileum, whereas in UC, it was pancolitis. One patient with CD and 1 with UC required treatment with immunomodulators to achieve remission. Three patients with CD and 2 with UC required treatment with biologics to achieve remission. Eight received intravenous immunoglobulin (IVIG) for CVID. Four patients with CD and 1 with UC were diagnosed with either leukemia or lymphoma, and the most common malignancy was chronic lymphocytic leukemia (n = 3).

Conclusions: This is one of few studies evaluating demographic, clinical, endoscopic, histologic features, and therapeutic management in patients with CVID-IBD. Further studies are required to elucidate long-term differences in the clinical course and treatment of patients with CVID-IBD.

Background: Many patients with medically refractory ulcerative colitis undergo ileal pouch-anal anastomosis, which typically includes the creation of a temporary loop ileostomy. The impact of the interval between ileal pouch-anal anastomosis and loop ileostomy closure regarding endoscopic pouch inflammation has not been well defined. The aim for this project was to assess if delayed loop ileostomy closure increases patients' risk of endoscopic pouch inflammation.

Methods: This is a cohort study of patients with ulcerative colitis who underwent ileal pouch-anal anastomosis between 01/2010 and 12/2020. Patients were divided into groups-early (12-116 days) or late closure (>180 days)-based on interval between ileal pouch-anal anastomosis and loop ileostomy closure. The late closure group was further sub-divided by indication for delay which included post-operative complications and non-medical reasons. The primary outcome was development of endoscopic inflammatory pouch disease, which was a composite of pouch disease activity index score of ≥ 4, mucosal breaks beyond anastomotic lines, and diffuse pouch inflammation.

Results: Two-hundred ninety patients were included which comprised early and late cohorts of 217 and 73 patients, respectively. Compared to early closure, late closures for non-medical and pouch-related surgical complications were both not found to be associated with development of our composite outcome (P = .43 and P = .80, respectively).

Conclusions: Delaying ileostomy closure due to patient preference or logistical limitations did not result in an increased risk of endoscopic pouch inflammation, but there appears to be an association of extraintestinal manifestations with endoscopic inflammatory pouch disease, suggesting the need for a vigilant surveillance in these patients.

This editorial explores the complex relationship between inflammatory bowel disease (IBD) and extra-intestinal manifestations (EIMs) and underscores the clinician's critical need for comprehensive EIM care, as well as the physical and emotional burden imposed on the patient. The editorial concludes with actionable steps for clinicians and a call to advance IBD care with a comprehensive multidisciplinary approach that acknowledges the various challenges faced by patients. Together, we can transform the IBD journey into a partnership built on understanding, support, and shared hope.