Inflammatory Bowel Diseases最新文献

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is associated with changes in the gut microbiome. Studies comparing fecal, gut mucosal, and salivary microbiomes are rare, and questions remain regarding the interaction of these compartments.

Methods: In this case-control study, 16S rRNA gene amplicon sequencing was performed on samples from stool, intestinal mucosa, and saliva of 120 patients with IBD. Patients with signs of non-IBD colonic inflammation (N = 28) and healthy subjects (N = 67) served as controls. A total of 480 16S profiles were analyzed. The results were evaluated with multiple clinical and pathological parameters and potential confounders were considered. The study aimed to find microbial biomarkers specific to IBD and signatures of intestinal barrier dysfunction.

Results: Fecal α-diversity of IBD patients was reduced and Pseudomonas species was significantly increased in the mucosa of IBD patients (Pseudomonas-positive mucosa [PSM positive], P value < .001, Mann-Whitney U test). Comparison of matched stool and mucosa samples showed high abundance of Pseudomonas species in gut mucosa but not in fecal samples, especially in CD patients. Interestingly, in PSM positive, Paracoccus species, Bacteroides species, and Streptococcus species were more abundant. Importantly, the results were independent of disease severity, histopathology, medication, and other metadata.

Conclusions: The opportunistic pathogenic bacterium Pseudomonas species is more prevalent in the gut mucosa of patients with IBD. This indicates a disruption of the gut barrier with increasing mucosal colonization or invasion of the bacteria. The finding is independent of clinical metadata and confounders and occurs in new-onset IBD but not in non-IBD intestinal inflammation, which suggests disease specificity.

Background: Ocular manifestations (OMs) are recognized extraintestinal complications in inflammatory bowel disease (IBD), but their incidence remains understudied. We aimed to evaluate the incidence and trends of OM in a large population-based cohort of adults with newly diagnosed IBD over the past 2 decades.

Methods: We conducted a retrospective cohort study including all adult-onset IBD patients between 2005 and 2024 in a large health maintenance organization. Patients with pre-existing OM diagnoses were excluded. The primary outcome was incident OM (uveitis, episcleritis/scleritis, or orbital inflammation) after IBD diagnosis. Annual incidence trends were assessed using the Cochran-Armitage test. Risk factors were analyzed via multivariable Cox regression, stratified by IBD type.

Results: Among 15 035 newly diagnosed IBD patients (51.8% Crohn's disease [CD], 48.2% ulcerative colitis [UC]), 349 developed an OM over 119 669 person-years (incidence: 2.9 per 1000 person-years; 95% confidence interval [CI], 2.62-3.24). OM incidence was higher in CD than UC (log-rank P < .001) and remained stable over time (P = .125). The median time to OM was 45 months. In CD, female sex (hazard ratio [HR], 1.62; 95% CI, 1.24-2.13) and systemic corticosteroid use (HR, 1.62; 95% CI, 1.18-2.22) were significant risk factors. In UC, corticosteroids (HR, 2.17; 95% CI, 1.40-3.37) and intestinal surgery (HR, 3.50; 95% CI, 1.69-7.28) were associated with increased OM risk.

Conclusion: OMs in adult-onset IBD are infrequent but clinically relevant, particularly among CD patients and those with markers of severe disease. Clinician awareness and early referral remain essential for prompt diagnosis and management.

Objective: Opioid use in Asian patients with inflammatory bowel disease (IBD) remains poorly understood. This study aimed to investigate the trends in chronic opioid use, associated clinical factors, and effects of advanced therapy (AT) on opioid use in Korean patients with IBD.

Methods: This nationwide cohort study used administrative claims data from the Korean National Health Insurance Service (2010-2022). Chronic opioid use was defined as opioid use for ≥90 days or ≥3 prescriptions within a calendar year. Logistic regression was used to identify clinical factors associated with chronic opioid use. The impact of AT on opioid use was analyzed through pre- and post-initiation comparisons using McNemar's tests, generalized estimating equations (GEE), and a linear mixed model.

Results: Chronic opioid use increased over the study period, with a higher prevalence in Crohn's disease (CD) than in ulcerative colitis (UC) (CD: 1.38%, UC: 0.53% in 2010; CD: 5.38%, UC: 1.98% in 2020). Among 49 548 newly diagnosed IBD patients, female sex, steroid and immunomodulator treatments, hospitalizations, emergency room visits, and mental disorders were positively associated with chronic opioid use in CD and UC. AT was positively associated with chronic opioid use in UC (odds ratio [OR] 1.627, P < .0001) but negatively associated with CD (OR 0.786, P = .0013). In CD, AT significantly reduced opioid users (McNemar's test: P < .0001; GEE: OR 0.478, P < .0001) and average daily doses (mean difference -15.8 morphine milligram equivalents, P = .0073).

Conclusion: Chronic opioid use has increased over the past decade among Korean patients with IBD, particularly among those with CD. AT is crucial for reducing opioid use in patients with CD.

Background: Inflammatory bowel diseases (IBD) can affect body image, quality of life, and sexual health. This study examined sexual challenges and dysfunctions among Danish individuals with and without IBD.

Methods: In this population-based cross-sectional study, 62 675 participants from the Project SEXUS cohort were linked to the Danish National Patient Register, identifying 655 individuals diagnosed with IBD between 1996 and 2017 (437 with ulcerative colitis [UC] and 218 with Crohn's disease [CD]). In addition to study-specific measures, the 5-item International Index of Erectile Function and the 6-item Female Sexual Function Index were utilized to assess sexual dysfunctions. Logistic regression was used to compare individuals with UC or CD to those without IBD. Results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results: Compared with those without IBD, individuals with IBD reported similar overall sex life satisfaction and relationship quality. However, individuals with UC more often reported hypoactive sexual desire disorder (men: aOR, 2.18; 95% CI, 1.13-4.19; women: aOR, 1.66; 95% CI, 1.04-2.66), and women with UC more often reported genital pain dysfunction (aOR, 2.30; 95% CI, 1.26-4.19). Subgroup analyses revealed that patients with active disease, stoma, or perianal involvement had particularly elevated odds of sexual dysfunctions compared with non-IBD control subjects.

Conclusions: Although the 5-item International Index of Erectile Function and 6-item Female Sexual Function Index scores did not indicate an excess of sexual dysfunction in the overall UC and CD populations, individuals with UC as well as patients with IBD experiencing active disease, stoma, or perianal involvement faced more sexual challenges than those without IBD. This highlights the need for gastroenterologists to proactively address sexual health and provide tailored support for patients with IBD.