Inflammatory Bowel Diseases最新文献

Crohn disease is a debilitating inflammatory bowel disease lacking curative options for patients refractory to standard medical therapy. While autologous hematopoietic stem cell transplantation has demonstrated therapeutic potential in selected cases of refractory disease, there are no prior reports documenting its use in a repeat setting for this indication. A 48-year-old male patient with severe, refractory Crohn disease who failed comprehensive medical management, including multiple biologic agents is presented. Following a rapid clinical relapse six months after an initial non-myeloablative autologous hematopoietic stem cell transplantation, a second procedure was performed three years later using the same mobilization and conditioning regimen (cyclophosphamide and rabbit anti-thymocyte globulin), with the addition of one year of post-transplant cyclosporine to maintain sustained immunosuppression. At 30 months following the second autologous hematopoietic stem cell transplantation, the patient remains in sustained clinical and endoscopic remission off all immunosuppressive and biologic medications. This case documents the feasibility and favorable long-term outcome of a second non-myeloablative autologous hematopoietic stem cell transplantation, suggesting this approach may be a valid and effective salvage option for highly selected patients with severe, refractory Crohn disease.

Background: Transgender and nonbinary (TGNB) individuals comprise 0.5% to 0.6% of the U.S. population and face significant healthcare disparities, yet little is known about inflammatory bowel disease (IBD) in this group. We aimed to characterize IBD prevalence, comorbidities, healthcare utilization, and the impact of hormone replacement therapy (HRT) in TGNB individuals.

Methods: Using TriNetX, we analyzed (1) IBD prevalence among TGNB adults, (2) comparisons of IBD patients who are and who are not TGNB, and (3) comparisons of TGNB IBD patients with and without HRT. Outcomes included demographics, comorbidities, laboratory markers, healthcare encounters, IBD treatment, and cardiovascular and thrombotic events.

Results: Of 111 227 TGNB patients, prevalence of Crohn's disease and ulcerative colitis was 0.508% and 0.448%, respectively, increasing with age. TGNB patients were younger (32.5 years of age vs 46.9 years of age; P < .001), exhibited higher rates of gastrointestinal and psychiatric comorbidities, and had more outpatient, emergency, and hospital visits, yet they underwent fewer endoscopies (25.7% vs 30.7% risk; P = .011) and were less likely to receive targeted IBD therapy than cisgender patients. Patients with HRT had more outpatient encounters (66.7% vs 58.2%; P = .010) and were more likely to use therapies like mesalamine (12.4% vs 7.6%; P = .021) than those without HRT. There were no significant differences in laboratory markers or thrombotic or cardiovascular events in these analyses.

Conclusions: TGNB IBD patients experience greater gastrointestinal and psychiatric comorbidities and receive fewer interventions overall despite greater healthcare contact. HRT was not associated with worsening disease or complications. These findings highlight critical disparities and the need for further research in this population.

Background and aims: Opioids are not optimal for managing pain among patients with ulcerative colitis (UC), but the use of opiods in nationwide UC populations remains unexplored. We aimed to describe dispensed opioid use around UC diagnosis and annual trends among patients with prevalent UC.

Methods: We performed a nationwide population-based cohort study of adults with an incident (2008-2020) or a prevalent (2006-2022) UC diagnosis and matched reference individuals from the general population. We obtained data on opioid dispensations and estimated the prevalence of having ≥1 dispensation per six-month period from two years before until five years following a first UC diagnosis. We also estimated annual opioid use among participants with a prevalent UC diagnosis and their matched reference individuals.

Results: Overall, 66 929 adults with UC (including 25 417 patients with an incident diagnosis) and 641 609 matched reference individuals were included. Compared to reference individuals, patients with UC had a 1.3-fold higher prevalence of opioid use (6.4% vs 4.9%) two years before diagnosis, which peaked during the year of diagnosis (11.0%) and stabilized at a 1.7-fold higher use three to five years after diagnosis. Between 2006 and 2022 the annual prevalence of opioid use decreased by 15.0% in patients with UC and by 11.0% in reference individuals.

Conclusion: In this nationwide register-based study, adults with UC had higher prescribed opioid use within two years before and up to five years after first UC diagnosis compared with reference individuals. However, adults with prevalent UC (and reference individuals) had a declining temporal opioid use trend during 2006-2022.

Introduction: Post-traumatic stress disorder (PTSD) is diagnosed when a person experiences chronic psychological distress following a traumatic event that involves a real or perceived threat to life or bodily harm. Up to one-third of inflammatory bowel disease (IBD) patients report some PTSD symptoms due to their disease (IBD-PTS); however, most data are collected in Caucasian populations. IBD-PTS is associated with poorer outcomes. To our knowledge, this is the first study to evaluate IBD-PTS in Black and Latino/a patients.

Methods: Adult IBD patients of Black and/or Latino/a race were recruited at 2 IBD clinics. Those meeting eligibility requirements completed these assessment tools online: PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), Adverse Childhood Experience (ACE) Questionnaire, Inflammatory Bowel Disease Questionnaire (IBDQ), and Demographic and Clinical Information. White, non-Hispanic IBD patients from a previously published dataset from IBD Partners were used for age- and sex-matched controls (2:1).

Results: In total, the study included 180 matched controls and 90 participants, including 57.8% of Black and Latino/a patients who had experienced extreme fear or threats to life/bodily harm related to IBD; 33.3% who scored ≥31 on the PCL-5 (minimum criteria for IBD-PTS) vs 12.8% of matched controls. Black and Latino/a patients also reported more severe IBD-PTS symptoms. Those with higher PCL-5 scores had more adverse childhood experiences and were more likely to have been hospitalized, had surgery, or used the emergency room for IBD. More severe IBD-PTS was associated with poorer HRQoL.

Conclusions: Black and Latino/a IBD patients may have rates of IBD-PTS 2.5 times higher than White peers, with more severe PTSD symptoms. Prior nonmedical adverse life events may be risk factors for the development of IBD-PTS. Additional research is warranted.

Background: Computed tomography colonography (CTC) is increasingly utilized for the evaluation of colorectal neoplasms. However, in patients with ulcerative colitis (UC), current European Crohn's and Colitis Organisation guidelines recommend CTC only for limited indications, such as the presence of strictures.

Methods: This single-center, retrospective observational study included consecutive patients with UC who underwent preoperative CTC and were scheduled for pancolectomy for UCAN between January 2014 and June 2024. Lesion detectability on CTC was assessed in comparison with endoscopic findings, histopathological tumor depth, and morphological characteristics. Multivariable logistic regression was performed to identify factors associated with detectability on CTC.

Results: Among 50 patients with 71 histologically confirmed lesions, 49% (35/71) were detectable by CTC. Detection was highest in advanced cancer (100%, 7/7), sessile (80%, 4/5) and depressed (80%, 8/10) morphologies, and lower in non-polypoid types such as superficial elevated (58%, 14/24) and flat (8%, 2/25) lesions. Detection by depth was 29% (12/42) for intramucosal, 75% (9/12) for submucosal, 100% (5/5) for muscularis propria, 73% (8/11) for subserosa/adventitia, and 100% (1/1) for serosal lesions. Flat morphology (adjusted odds ratio [aOR], 0.06; 95% confidence interval [CI], 0.01-0.27) and intramucosal invasion (aOR, 0.10; 95% CI, 0.02-0.46) were independently associated with non-detection.

Conclusions and relevance: Despite preoperative awareness of UCAN, CTC demonstrated limited sensitivity. While CTC may serve a complementary role in selected cases, endoscopy remains essential for comprehensive lesion detection.

Introduction: There are limited data on the impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) on the risk of recurrent pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).

Methods: A retrospective cohort study was conducted in the TriNetX Research Network in adult patients with obesity and IPAA for UC with a history of pouchitis in whom a GLP-1RA was initiated compared to those patients in whom a GLP-1RA was not initiated. The primary outcome was the risk of recurrent pouchitis within 12 months. The secondary outcomes were mean number of antibiotic prescriptions, anti-diarrheal medication use, Crohns-like disease of pouch (CLDP), and pouch excision. One-to-one propensity score matching was performed.

Results: We identified 43 UC-IPAA patients with obesity and history of pouchitis (mean age 51.7 ± 14.7 years, mean body mass index [BMI] 34.4 ± 6 kg/m2, 60.4% female). After propensity score matching, the GLP-1RA cohort had a significantly decreased risk of recurrent pouchitis (26.3% vs 52.6%; adjusted odds ratio [aOR], 0.32; 95% CI, 0.12-0.84) compared to the control cohort. Mean antibiotic prescriptions were numerically lower in the GLP-1RA cohort (2 vs 4.4, P = .16). Anti-diarrheal medication use was lower in the GLP-1RA cohort (18.4% vs 47.3%; aOR, 0.23; 95% CI, 0.07-0.67). There was no difference in the risk of CLDP. Zero patients required pouch excision in both cohorts.

Conclusion: Our study in a small cohort of patients with UC-IPAA and obesity with a history of pouchitis showed that GLP-1RA use was associated with decreased risk of recurrent pouchitis and anti-diarrheal medication use.

Background and aims: Intestinal ultrasonography (IUS) is a noninvasive tool for assessing bowel inflammation. In adults, a bowel wall thickness (BWT) cutoff of 0.30 cm is used to indicate inflammation, but children do not have a widely accepted value. We propose an optimal BWT cutoff value for children.

Methods: We performed 144 IUS examinations during 2019-2024 in 133 children within 30 days before to 7 days after colonoscopy. Assessed values for the BWT from the terminal ileum to the rectum were paired with colonoscopy findings at each segment (n = 809 pairs). The cutoff value for detecting inflammation was explored with receiver operating characteristic (ROC) analysis.

Results: In children ≥6 years old IUS demonstrated excellent accuracy for detecting moderate/severe inflammation (area under the curve [AUC] 0.907) but poor accuracy for mild inflammation (AUC 0.690) or in children <6 years old (AUC, 0.667). The adult cutoff (0.30 cm) missed 32% of inflammation in children. In children ≥6 years old, a BWT cutoff of 0.27 cm detected 85% of moderate/severe and 43% of mild inflammation. Lower cutoff values (0.24 cm) were more optimal for girls and children weighing <40 kg.

Conclusions: Although IUS is an excellent tool for detecting moderate/severe bowel inflammation, this method showed limited accuracy in children <6 years old. The adult BWT cutoff missed over 30% of bowel inflammation in children. BWT cutoff of 0.27-0.30 cm in boys and 0.23-0.25 cm in girls and/or children <40 kg indicated active gut inflammation.

Background and aims: Patients with ulcerative colitis (UC) have an elevated thromboembolic risk. The comparative risks associated with advanced therapies (ADTs) remain unclear.

Methods: In this retrospective cohort study, we utilized the Japanese Medical Data Vision claims database to assess patients with UC who initiated treatment with tumor necrosis factor (TNF) inhibitors, vedolizumab, or tofacitinib. We evaluated the cumulative incidence and hazard ratios (HRs) for venous thromboembolisms (VTEs), cardiovascular events (CVEs), and major adverse cardiovascular events (MACEs). The tofacitinib dose was modeled as a time-varying covariate.

Results: In total, 8125 TNF inhibitor users, 1218 tofacitinib users, and 2469 vedolizumab users were analyzed. Compared with TNF inhibitors, vedolizumab was associated with a lower risk of VTE (HR ,50, 95% CI 0.30-0.81) and CVE (HR 0.47, 95% CI, 0.27-0.81), with no difference in MACE. Tofacitinib 5 mg and 10 mg administration twice daily (BID) showed no significant differences vs TNF inhibitors, though point estimates were lower at 5 mg and higher at 10 mg. Concomitant 5-aminosalicylic acid was associated with a lower incidence of VTE.

Conclusions: Vedolizumab demonstrated a favorable thromboembolic and cardiovascular safety profile compared with TNF inhibitors, whereas tofacitinib did not increase the risk at either dose. Concomitant 5-aminosalicylic acid may have a preventive effect against VTE. These findings may aid therapeutic decision-making for UC patients with elevated thrombotic risk.