Inflammatory Intestinal Diseases最新文献

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.

Introduction: With the recent increase in number of drugs for treating inflammatory bowel disease (IBD), it has become important to select treatments acceptable to patients. Endoscopy and biomarkers from blood and stool samples are used to evaluate IBD disease activity. This study aimed to clarify the acceptability of usage of advanced therapy and examination methods in patients through an internet-based survey.

Methods: Patients with inflammatory bowel disease were asked via the internet to participate in a survey on the acceptability of nine therapies and three examination methods. The respondents rated acceptability on a scale of 1-10 and specified the most preferred option.

Results: Responses were obtained from 388 patients with ulcerative colitis and 82 with Crohn's disease; 14.5% and 11.5% of the patients underwent intravenous infusions and subcutaneous injections, respectively. Once-daily oral administration had the highest acceptability score, which was significantly different from other administration usages (p < 0.0001), regardless of prior treatment history. Oral administration was preferred by 88.9% of patients. The ranking of examination methods from most to least acceptable was blood tests > endoscopy > stool tests, with significant differences among all groups (p < 0.0001). Blood testing (76%) and stool testing (4.5%) were the most and least preferred methods, respectively.

Conclusions: The most acceptable usage of advanced therapy in patients with inflammatory bowel disease was once-daily oral administration. Treatments that are effective, safe, and acceptable to patients should be selected, and examination methods acceptable to patients should be used.

Introduction: The Swiss Eosinophilic Esophagitis Cohort Study (SEECS) is a national cohort that was established in 2015 with the aim of improving quality of care of affected adults with eosinophilic esophagitis (EoE). Between 2020 and 2022, paper questionnaires were gradually replaced by fully electronic data capture using Research Electronic Data Capture (REDCap^®) software. We aim to provide an update of the SEECS 8 years after its launch.

Methods: The SEECS prospectively includes adults (≥18 years of age) with EoE as well as patients with gastroesophageal reflux disease (GERD) and healthy control subjects (HC). Upon inclusion and follow-up (typically once every 12-18 months), patients and physicians complete REDCap^® questionnaires, which are available in German, French, and English. Patient-reported outcomes (PROs) and biologic findings are assessed on the same day using validated instruments (EEsAI PRO for symptoms; EoE-QoL-A for QoL; EREFS for endoscopic activity; modified EoE-HSS for histologic activity). The SEECS biobank includes biosamples from patients with EoE, GERD, and HC.

Results: As of July 2023, the SEECS included 778 patients (716 [92%] with EoE, 29 [3.8%] with GERD, and 33 [4.2%] HC; 559/778 [71.9%] were male). Mean age ± SD (years) at enrollment according to diagnosis was as follows: EoE 41.9 ± 12.9, GERD 53.6 ± 16.4, HC 51.7 ± 17.2. Concomitant GERD was found in 200 patients (27.9%) of the EoE cohort. Concomitant allergic disorders (asthma, rhinoconjunctivitis, eczema) were present in 500 EoE patients (74.4%). At inclusion, 686 (95.8%) of EoE patients were on ongoing treatment (orodispersible budesonide tablet [Jorveza^®] in 281 patients [41%]; budesonide or fluticasone syrup or swallowed powder in 290 patients [42.3%]; proton-pump inhibitors in 162 patients [23.6%]; elimination diets in 103 patients [15%]; and esophageal dilation at last visit in 166 patients [24.2%]). A total of 8,698 biosamples were collected, of which 1,395 (16%) were used in the framework of translational research projects.

Conclusion: SEECS continuously grows and is operational using fully electronic data capture. SEECS offers up-to-date epidemiologic and real-world clinical efficacy data on EoE and promotes clinical and translational research.

Background: The effectiveness of dietary therapy to induce remission of eosinophilic esophagitis (EoE) has been evaluated over the last decades and summarized in meta-analyses. Choosing the dietary modality, identifying the most suitable patients, and implementing specific prerequisites are essential to ensure long-term success.

Summary: Impractical exclusive elemental diets provided the highest remission rates in EoE; however, they are not recommended due to their numerous disadvantages and detrimental effects on patient quality of life. Allergy testing-guided diets for EoE are limited; their insufficient effectiveness and low reproducibility are due to poor accuracy of skin or serum test results in identifying EoE food triggers. Initial experiences with a six-food elimination diet have provided evidence of high and predictive effectiveness rates and paved the way for less restrictive and more efficient step-up approaches, including four-food, two-food, and most recently, milk elimination diets. Dietary treatment for EoE is challenging for patients and families and requires certain skills to ensure success in the short and long term.

Key messages: The selection of appropriate patients is essential to ensure the success of and long-term adherence to dietary treatment of EoE. As normal triggers for EoE are commonly found in the staple diet, it is important to ensure adequate nutritional substitutes to avoid nutrient deficiency risks when long-lasting feeding difficulties or extensive restrictions are present. Specialized facilities in dietary therapy should adopt patient-centered and personalized approaches in order to provide timely monitoring and support for complex cases.