Inflammatory Intestinal Diseases最新文献

Background: In patients with eosinophilic esophagitis (EoE), the correlation between symptoms of esophageal dysfunction and endoscopic and histologic disease activity is generally poor and probably related to multiple causes such as esophageal remodeling processes that might go undetected using endoscopy and histology as well as esophageal hypervigilance and symptom-specific anxiety. Hence, there is a need for a holistic management of patients that goes beyond the control of eosinophilia and symptoms.

Summary and key messages: Physiological esophageal testing using high-resolution manometry, functional lumen imaging probe, pH-impedance, wireless pH monitoring, and mucosal impedance may unveil the effects of chronic transmural fibro-inflammatory changes of the esophageal wall as well as esophageal hypervigilance, thereby assisting to phenotype patients, predict therapeutic response to therapy, and identify motility disorders that may need a specific targeted therapy to ameliorate patients' outcomes. This article discusses the role of functional esophageal examinations in the diagnosis and management of EoE.

Introduction: Carotegrast methyl (CGM) is an oral, small-molecule α4-integrin antagonist, which became clinically available in Japan in May 2022. CGM is approved for remission induction treatment for moderately active ulcerative colitis (UC) with an inadequate response or intolerance to 5-aminosalicylates.

Methods: We performed a single-center, retrospective, observational study of Japanese patients with moderately active UC to assess the real-world effectiveness and safety of CGM as remission induction treatment.

Results: Of 14 patients, 71% (10/14) were women, and the median (range) age was 47 (20-68) years. Disease types were proctitis in 7% (1/14), left-sided colitis in 50% (7/14), and total colitis in 43% (6/14). With a median (range) treatment duration of 8 (2-26) weeks, the rate of endoscopic improvement (Mayo endoscopic subscore [MES] of 0 or 1) was 64% (9/14), and the rate of endoscopic remission (MES of 0) was 57% (8/14). After treatment with CGM, the median (range) MES decreased significantly from 3.0 (2-3) to 0.0 (0-3) (p = 0.008), the Mayo score decreased significantly from 7.0 (5-9) to 0.0 (0-9) (p = 0.006), and the clinical activity index decreased significantly from 6.0 (1-11) to 0.0 (0-9) (p = 0.015). Stool and diarrhea frequencies decreased significantly after initiating CGM, and the percentage of patients with bloody stool and abdominal pain tended to decrease. The cumulative relapse-free rate at week 26 among 9 patients who achieved endoscopic improvement with CGM was 77.8% (95% confidence interval, 36.5%-93.9%). No adverse drug reactions, including progressive multifocal leukoencephalopathy, were reported during the study period.

Conclusion: This single-center, retrospective, observational study of 14 Japanese patients with UC showed that CGM was safe and effective as a remission induction treatment for moderately active UC with an inadequate response to 5-aminosalicylates in real-world settings.

Introduction: Patients with inflammatory bowel disease (IBD) are increasingly using online platforms to communicate with other patients and healthcare professionals seeking disease-related information and support. Free-text posts on these platforms could provide insights into patients' everyday lives, which could help improve patient care. In this proof-of-concept (POC) study, we applied text mining to extract patient needs from free-text posts on a community forum in Japan, holistically visualized the patients' perceptions and their connections, and explored the patient characteristic-dependent trends in the use of words.

Methods: Free-text posts written between May 11, 2020 and May 31, 2022 on the community forum were retrieved and subjected to text mining analysis. Trends in the use of words were extracted from the posts for correspondence and co-occurrence network analyses using KH Coder open-source text mining software.

Results: Seventy-four posts were analyzed. Using text mining methods, we successfully extracted and visualized a variety of patient concerns and their connections. The correspondence and co-occurrence analyses revealed patient segment-dependent trends in the use of words. For example, patients with a disease duration of ≤5 years were more likely to use words related to emotions or their desire to change or quit their job, such as "anxiety" and "resignation." Patients with a disease duration of >10 years were more likely to use words showing that they are finding ways to live with or accept their disease, and are getting used to the lifestyle, but some patients continued to experience worsening disease.

Conclusions: We found that free-text posts on an IBD community forum can be a useful source of information to capture the wide variety of thoughts of patients. Text mining procedures can help visualize the relative importance of the topics identified from free-text posts. Our findings of this POC study will be useful for generating new hypotheses to better understand and address the needs of patients with IBD.

Introduction: There is a close relationship between the relapse of inflammatory bowel disease (IBD) and lifestyle factors, including concomitant medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), antithrombotic drugs, smoking status, and alcohol consumption. However, solid evidence is limited regarding the risk factors at diagnosis and initial disease course. This study aimed to explore the impact of concomitant prescriptions and lifestyle factors in patients with newly diagnosed IBD using a large-scale real-world database.

Methods: This is a retrospective inception cohort study using the insurance claims database. Newly diagnosed patients with UC and CD were enrolled between January 2005 and May 2020. Concomitant prescriptions and lifestyle factors were assessed for new biologics use, surgery, and hospitalization during the first year.

Results: In total, 6,743 patients with UC and 1,000 patients with CD were enrolled. Proton pump inhibitors, antithrombotics, antibiotics, and NSAIDs were identified as associated factors for both biologics use and hospitalization in UC patients (all p < 0.01), and antithrombotics were identified as associated factors for both biologics use and hospitalization in CD patients (all p < 0.01) in multivariable analyses. Interestingly, smoking was protective against hospitalization in UC patients (p < 0.01) but not in CD patients (p = 0.997), analyzed by univariate analysis. Alcohol consumption was protective against hospitalization outcomes in UC patients (p = 0.02) but not in CD patients (p = 0.27), analyzed by univariate analysis.

Conclusion: Immediate attention should be paid to concomitant medications at diagnosis because they may have impact on the initial course of IBD.

Introduction: A secondary loss of response (LOR) to infliximab (IFX) therapy for inflammatory bowel disease (IBD) is typically associated with low IFX trough levels, often with high levels of neutralizing antibodies to IFX (ATI). A small subset of patients on long-term therapy experience a "nonimmune" LOR, without ATI and with desired IFX trough levels ≥5 μg/mL, regarded as a LOR to the mechanism of action of IFX. However, this currently accepted IFX goal level is largely derived from observations of patients within the first year of therapy and may not apply to those on treatment beyond 1 year.

Methods: Retrospective review of all IBD patients receiving IFX infusions for ≥12 months with at least 1 IFX trough and ATI measurement beyond 12 months was conducted. Chart review of all patients with absent ATI and an IFX trough ≥5 μg/mL classifies as LOR versus non-LOR based on physician assessment, with a comparison of IFX troughs between the two groups.

Results: Of 167 patients using IFX ≥12 months, 13 (7.8%) experienced a nonimmune secondary LOR. The mean duration of IFX use was over 3 years for both LOR and non-LOR patients. The mean IFX trough for those with LOR was greater than for those without LOR, 18.5 μg/mL versus 13.1 μg/mL, p = 0.110.

Conclusion: Our results did not demonstrate lower IFX levels among patients experiencing secondary nonimmune LOR on long-term therapy. Our results do not redefine the therapeutic IFX goal levels for those patients on long-term therapy and suggest that underdosing of IFX is not the cause of secondary LOR.

Introduction: Western diet pattern and its food components have been suggested to impact inflammatory bowel diseases (IBDs) clinical course. However, the importance of food processing level is uncertain. We aimed to evaluate whether the intake of foods with varying processing levels is associated with disease activity in IBD patients.

Methods: This cross-sectional study was performed at a tertiary center between August 2019 and June 2022. Consecutive adult IBD patients were recruited. Clinical disease activity was defined using HBI (Crohn's disease) and SCCAI (ulcerative colitis). Dietary intake was assessed using a food frequency questionnaire (FFQ) and a dedicated validated processed food questionnaire (PFQ) that categorizes dietary intake into three groups of processed food levels: unprocessed/minimally processed, processed, and ultra-processed. Adjusted odds ratios for active disease were determined using a multivariable logistic regression.

Results: A total of 242 IBD patients (62.8% Crohn's disease patients) were enrolled, of whom 73.1% were in clinical remission. A higher (upper tertile vs. lowest tertile) unprocessed/minimally processed foods consumption was negatively associated with active disease (OR = 0.38, 95% CI: 0.14-0.99), while high consumption of ultra-processed foods (UPFs) was positively associated with clinically active disease (OR = 3.82, 95% CI: 1.49-9.8). Consumption of UPF groups, almost invariably, was positively associated with clinically active disease, while consumption of the ultra-processed meats group had the strongest association (OR = 4.45, 95% CI: 2.07-9.79).

Conclusion: Higher consumption of UPFs is positively associated with clinically active IBD, while higher consumption of unprocessed/minimally processed foods may be protective. Prospective studies are needed to confirm these associations.

Introduction: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are associated to poor maternal and foetal outcomes during pregnancy, requiring a strict monitoring of the disease activity, preferably with non-invasive modalities. There are numerous data confirming intestinal ultrasonography (IUS) accuracy and efficacy for the detection of IBD disease activity and complications, but data in pregnant IBD patients are scarce. We aimed to evaluate the diagnostic performance and feasibility of IUS to monitor IBD activity throughout pregnancy.

Methods: A systematic literature review was performed to identify studies on the use of ultrasound modality in pregnant inflammatory bowel disease women from the date of inception until April 2024 using MEDLINE, Cochrane Library, EMBASE, and ISI Web of Science databases, with keywords including (1) ultrasound/ultrasonography, (2) pregnancy, and (3) IBD (CD and UC). Additional relevant studies were identified from cross-referencing and hand-searches of references of the retrieved articles. We included fully published observational studies and abstracts.

Results: Overall, five studies have been selected from 264 citations. All studies were highly heterogeneous in the definition of disease activity as reference standard, IUS protocols, and outcomes. Two of them used a cut-off value of faecal calprotectin (FCP) >100 μg/g. In one of them, clinical scores were used when the FCP value was ≥100-249 μg/g and FCP ≥250 μg/g was considered as an active disease independently of clinical scores. Only one study used a single reference standard with a Harvey-Bradshaw Index (HBI) >4. Across these 3 studies, results suggest a relatively good specificity (range 83-98%) but low sensitivity (range 33-84%) to detect disease's activity. Only 1 study analysed IUS performance in detecting remission with a sensitivity of 80% and a specificity of 92% compared to the reference standard. The size of the uterus limits the visualization of the terminal ileum and the sigmoid from the second trimester and the third trimester, respectively. The evaluation of the rectum remains limited.

Conclusion: IUS appears to offer a practical, readily available and non-invasive means of monitoring disease activity in IBD pregnant women. However, existing literature on IUS accuracy is limited and further studies with standardized reference comparator are needed.

Background: Eosinophilic esophagitis is an increasing condition in industrialized countries. The etiology is still somewhat unclear. It was thought that it can be part of eosinophilic gastroenteritis but nowadays seen as a separate entity and thus more often the esophagus is the only part of the gastrointestinal tract that is affected. Immunosuppressive and immunomodulatory treatment is available and can lead to symptom relief and remission.

Summary and key messages: In this article, the value and practicability of the histological criteria used for this disease are discussed. Also, the situation regarding the requirements for grading in clinical studies and routine settings is discussed.