Inflammatory Intestinal Diseases最新文献

Introduction: Ustekinumab (UST) is increasingly used in Crohn's disease patients with prior tumor necrosis factor-α inhibitor (TNFi) failure. However, whether to switch to another biologic or continue TNFi therapy at the time of surgery remains an important unresolved clinical question.

Methods: Among patients who underwent intestinal resection during TNFi therapy at our hospital from January 2008 to February 2022, 39 patients continued TNFi after surgery (TNFi continuation group) and 15 patients switched to UST after surgery (UST switch group) were included. Clinical and endoscopic recurrence rates were compared over long-term follow-up.

Results: This retrospective cohort study showed that the cumulative 2-year clinical recurrence-free rate was 82.6% in the TNFi continuation group and 60.0% in the UST switch group, with no statistical difference in the cumulative clinical recurrence-free rate between the two groups (log-rank test; p = 0.863). The follow-up endoscopy showed that postoperative endoscopic recurrence (PER) was observed in 14 of 34 patients (38.2%) in the TNFi group and 8 of 14 patients (57.1%) in the UST switch group, with no statistical difference between the two groups (p = 0.3384). Absence of PER at follow-up correlated with better long-term clinical outcomes. A medical claims database analysis confirmed no significant difference in the cumulative clinical recurrence-free rate (p = 0.232) or subsequent intestinal surgery-free rate (p = 0.554) between the TNFi continuation group and the UST switch group.

Conclusion: In patients undergoing surgery during TNFi treatment, there was no statistically significant difference between postoperative UST switching and TNFi continuation.

Introduction: Vedolizumab (VDZ) is a gut-selective integrin antagonist approved for the treatment of ulcerative colitis. While its efficacy and safety have been demonstrated in clinical trials, real-world data on long-term treatment persistence and factors associated with loss of response are limited.

Methods: We conducted a retrospective single-center observational study to evaluate the persistence of treatment and factors influencing loss of response in 59 patients with ulcerative colitis treated using VDZ. Clinical outcomes, endoscopic findings, and the impact of concomitant immunomodulator or 5-aminosalicylic acid use were analyzed.

Results: Thirty-two patients (54.2%) had achieved clinical remission at week 24 and 27 (45.8%) had not. The cumulative VDZ persistence rate at 3 years was 39.7%. Patients who had achieved endoscopic improvement at 24 weeks exhibited a significantly higher persistence rate. The incidence of adverse events was low (1.7%). The impact of immunomodulator and 5-aminosalicylic acid co-administration on treatment persistence was minimal.

Conclusion: Endoscopic improvement at week 24 was a key predictor of long-term VDZ persistence.

Introduction: Inflammatory bowel disease (IBD) burdens patients and healthcare systems, often due to frequent emergency department (ED) visits. Comprehensive programs that connect members to providers with disease-specific expertise may improve IBD management and reduce emergency care needs.

Methods: This study evaluates the impact of a virtual condition management program on ED utilization among commercially insured members with IBD using claims data from 2017 to 2024. Propensity scores were estimated, with inverse probability of treatment weighting applied to balance baseline covariates (i.e., age, sex, prior healthcare utilization, and Charlson Comorbidity Index [CCI] scores). Weighted negative binomial regression estimated the association between program engagement and ED visit frequency, controlling for baseline characteristics. Sensitivity analyses using weighted logistic regressions evaluated the likelihood of any, gastrointestinal (GI)-related, and non-emergent ED visits post-eligibility.

Results: Engagement was significantly associated with reduced ED utilization. Members who chose to engage experienced a 45.7% reduction in ED visits, on average, compared to unengaged (p = 0.007). Males had significantly lower visits (p = 0.012), higher CCI scores were associated with fewer visits (p = 0.005), and prior ED use was strongly associated with visit frequency (p < 0.001). Sensitivity analyses reinforced these findings as engaged members had significantly lower odds of any (odds ratio [OR]: 0.50; p = 0.003), GI-related (OR: 0.46; p = 0.014), and non-emergent (OR: 0.41; p = 0.722) visits.

Conclusions: Engagement with a care management program was associated with reduced ED visitation and lower likelihoods of any, non-emergent, and GI-related visits. Virtual programs offering condition-specific expertise may improve disease management and decrease reliance on ED services for patients with chronic GI diseases.

Background: Fecal microbiota transplantation (FMT) is an emerging therapeutic strategy for inflammatory bowel disease (IBD). Every step of the FMT process, from donor recruitment and patient selection to pretreatment protocols, administration techniques, and post-FMT interventions, can significantly influence treatment outcomes. These components are interrelated, and even subtle differences in methodology may affect the overall efficacy of FMT for IBD. This review aimed to outline the current clinical experience and findings regarding FMT for IBD during the application process.

Summary: Donor screening has traditionally focused on safety. In recent years, although safety remains essential, increasing attention has been paid to the donor selection efficacy. Particularly, identifying patients who are most likely to benefit from FMT is crucial because timely and appropriate patient selection can prevent delays in effective treatment. Pretreatment strategies and FMT procedures remain hot topics of current research. Approaches, such as antibiotic pretreatment, may enhance microbial engraftment; however, the optimal antibiotic combination remains unclear. Bowel lavage is commonly used to reduce the microbial burden and facilitate donor microbiota colonization, whereas corticosteroid pretreatment has shown conflicting results. There are various routes of administration, and oral capsules are gaining popularity owing to their safety and patient acceptability. Stool preparation factors, including the use of single versus pooled donors, anaerobic processing, and storage form (fresh, frozen, or freeze-dried), can significantly influence microbial viability and clinical outcomes. Repeated FMTs tend to be more effective than single infusions; nonetheless, the optimal frequency remains unclear. Post-FMT interventions, such as dietary modifications and supplementation with prebiotics, such as pectin and alginic acid, are also promising strategies.

Key messages: Despite encouraging results, variations in treatment protocols, donor characteristics, and host factors continue to obscure the definitive predictors of FMT success. Further randomized controlled trials and mechanistic studies are required to standardize these procedures and optimize their long-term efficacy.

[This corrects the article DOI: 10.1159/000546858.].

[This corrects the article DOI: 10.1159/000547076.].

Introduction: Up to 85% of pediatric patients affected by Crohn's disease experience growth failure. This study aims to elucidate the effects of anti-tumor necrosis factor (TNF) biologics on patient growth.

Methods: This retrospective analysis examined height, height velocity and weight in pediatric patients with Crohn's disease from the Swiss Inflammatory Bowel Disease Cohort Study between 2007 and 2020 (n = 97). Z-scores were determined according to age and gender of a healthy pediatric population. Growth of patients treated with anti-TNF biologics and immunomodulators was analyzed by linear regression over 5 years and compared within each subgroup by paired Student t tests 1 year (T1), 2 years (T2), and 5 years (T5) after treatment initiation.

Results: Mean height and weight z-scores at diagnosis were -0.3 ± 1.3 and -1.0 ± 1.6, respectively (age at diagnosis 11.1 ± 2.7 years, 52.0% male). Initial treatment was led by azathioprine (58.3%) and infliximab (19.8%). Patients treated with biologics exhibited significant height increase at T1 (p = 0.022), with an overall flat height evolution (y = 0.00x - 0.31), whereas significant weight increase was maintained at T5 (p = 0.0005, y = 0.13x - 0.50). Patients on immunomodulators showed a height increase (y = 0.15x - 0.20) and a significant weight increase at T2 (p = 0.0047, y = 0.10x - 0.41). Height velocity z-scores showed a significant increase across both genders. Factors contributing to a decreased height z-score included male sex, age 10 and below at diagnosis, a concomitant corticosteroid treatment and a top-down treatment strategy.

Conclusion: Our findings indicate that anti-TNF biologics are associated with significant short-term height and long-term weight gains in pediatric patients with Crohn's disease, similar to those observed with immunomodulators.

Introduction: Fecal calprotectin (FCP) is a key biomarker for gastrointestinal inflammation, aiding in differentiating irritable bowel syndrome from active inflammatory bowel disease (IBD). Metabolic bariatric surgeries (MBSs), such as Roux-en-Y gastric bypass or sleeve gastrectomy, alter gastrointestinal physiology, potentially affecting the applicability of standard FCP cutoff values in this population.

Methods: This retrospective study included 340 patients who underwent MBS and subsequent FCP testing between January 2000 and June 2024. Patients with preoperative IBD were excluded. The primary outcome was to identify the optimal FCP cutoff values for relevant colonoscopy findings. Secondary outcomes included median FCP levels, colonoscopy results, and subgroup analyses based on sex, surgery type, and time to gastrointestinal evaluation.

Results: The median FCP level across all patients was 51 µg/g (IQR 30-82). Among 124 patients undergoing colonoscopy, the median FCP was 61 µg/g (IQR 34-104). There was no significant difference between patients with (69.5 µg/g, n = 50) or without (59 µg/g, n = 74) relevant findings, including malignancy or IBD (p = 0.101). No significant differences in FCP levels were observed between subgroups based on cholecystectomy status, biliopancreatic limb length, types of surgery, body mass index, time to presentation since MBS, or proton pump inhibitor use. ROC analysis identified an optimal cut off of 59.5 µg/g (sensitivity: 64.6%; specificity: 63.4%; area under the curve: 0.653; Youden's index 0.280).

Conclusion: In patients following MBS, the optimal FCP cutoff value would be at 59.5 µg/g. However, given the low Youden's index and the minimal difference compared to the standard cutoff value of 50 µg/g, maintaining this standard, seems more practical in clinical settings.

Introduction: The association with Helicobacter pylori infection and inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is conflicting, with the former studies reporting a protective effect while others report increased inflammation. This study examines the effect of H. pylori infection on systemic inflammation - C-reactive protein levels - among IBD patients.

Methods: This retrospective cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University Hospital, Al Khobar, Saudi Arabia, by reviewing the electronic medical records of 630 patients diagnosed with H. pylori infection, CD, or UC from January 2020 to December 2024. The levels of CRP were measured with a turbidimetric immunoassay of high sensitivity and categorized as normal or less than or equal to 1 mg/dL, moderate with a value of 1-10 mg/dL, or raised if the value is above 10 mg/dL. Kruskal-Wallis and Mann-Whitney U tests were used for statistical comparisons of CRP levels between groups.

Results: Mean CRP levels were highest in H. pylori-positive CD patients (12.69 mg/dL), UC patients (11.18 mg/dL), compared to H. pylori-negative matches (6.74 mg/dL for CD and 4.55 mg/dL for UC). The H. pylori-only group had the lowest average in CRP (2.62 mg/dL). Differences in patient categories were significant (p < 0.001); CD had 50% cases with elevated CRP, 40% for UC, and 60% for moderate elevations in H. pylori-only patients.

Conclusion: H. pylori infection is also accompanied by higher systemic inflammation in IBD, specifically in CD, characterized by high CRP.

Introduction: Both mesalazine and ozanimod are oral treatment options for patients with moderately active ulcerative colitis (UC).

Methods: Comparative analysis comparing efficacy endpoints of an 8-week non-inferiority induction study (TP0503) with 3.2 g/day mesalazine (n = 321) to the True North 10-week induction study of 1 mg/day ozanimod (n = 281). We compared the efficacy of oral mesalazine (Asacol) as monotherapy and ozanimod (Zeposia) as add-on therapy to mesalazine, without concomitant corticosteroids, following induction treatment in mesalazine-exposed but immunomodulator- and advanced therapy-naïve UC patients. Endpoints from the non-inferiority study were re-calculated using the definitions from the True North study.

Results: The two cohorts had similar age (45 ± 14 years vs. 44 ± 13.5 years) and baseline disease severity (total Mayo score; 8.5 ± 0.8 vs. 8.6 ± 1.1) for mesalazine- and ozanimod-treated patients, respectively. No differences were observed in patients achieving clinical response (reduction from baseline in the 3-component Mayo score [sum of rectal bleeding subscore/RBS, stool frequency subscore/SFS, and Mayo endoscopic score/MES) of ≥2 points and ≥35%, and a reduction from baseline in the RBS of ≥1 point or an absolute RBS ≤1} (58% vs. 58%; p = 0.917) and clinical remission (RBS = 0, SFS ≤1 [and decreases of ≥1 point from baseline SFS], and MES ≤1) (22% vs. 28%; p = 0.074) treated with mesalazine (at 8 weeks) and ozanimod (at 10 weeks), respectively. A higher percentage of patients treated with ozanimod achieved endoscopic improvement (MES ≤1 without friability) compared to mesalazine (38% vs. 29%, p = 0.018).

Conclusion: Among individuals previously exposed to mesalazine, a similar effect on clinical efficacy was observed between patients treated with mesalazine and those treated with ozanimod.