Inflammatory Bowel Diseases最新文献

Background and aims: The characteristics and incidence of esophagogastroduodenal involvement in Crohn disease remain unclear in Korea. In this study we aimed to investigate the prevalence and clinicopathological characteristics of Crohn disease with esophagogastroduodenal involvement.

Methods: A total of 115 patients with Crohn disease who underwent esophagogastroduodenoscopy (EGD) with esophageal, gastric, and duodenal biopsies were prospectively enrolled in 2020-2021 at a tertiary care center. Five specimens were obtained-1 each from the esophagus, gastric body, gastric antrum, duodenal bulb, and second duodenal portion-and histologically reviewed.

Results: The median patient age was 30.0 years, and 74.8% of patients were male. Based on histological features, 56 patients (48.7%) had esophagogastroduodenal involvement (15 esophageal, 44 gastric, 36 duodenal). Notable histopathological findings included non-caseating granulomas in 8 cases (7.0%), focally enhanced gastritis in 38 cases (33.0%), and lymphocytic esophagitis in 13 cases (10.7%). Endoscopic findings suggestive of esophagogastroduodenal involvement were detected in 94 of 115 patients (81.7%). Typical findings included longitudinal or aphthous erosions (esophagus, 3/115 [2.6%]; stomach, 45/115 [39.1%]; duodenum, 19/115 [16.5%]), longitudinal or aphthous ulcers [duodenum: 4/115 (3.5%)], bamboo-joint-like appearance [stomach: 81/115 (70.4%); duodenum: 3/115 (2.6%)], and scar changes [stomach: 2/115 (1.6%); duodenum: 3/115 (2.6%)]. In multivariable analysis, elevated fecal calprotectin (≥100 μg/g) was associated with esophagogastroduodenal involvement in Crohn disease (odds ratio, 6.57; 95% CI, 1.99-21.66; P <.001).

Conclusions: The proportion of esophagogastroduodenal involvement was relatively high among Korean patients with Crohn disease who underwent EGD. In patients with elevated fecal calprotectin, EGD with histopathological examination is recommended to identify esophagogastroduodenal involvement.

Background: Despite the common use of opioids in patients with inflammatory bowel disease (IBD), there are limited studies on the prevalence of chronic opioid use in this population.

Methods: We conducted a nationwide Danish register-based study to examine the prevalence proportion of chronic opioid use in patients with IBD from 1996 to 2021. Analysis was performed for patients with Crohn's disease (CD) and ulcerative colitis (UC) and stratified by sex and age groups of young adults (18-39 years), adults (40-59 years), and elderly (+60 years).

Results: A total of 51 837 patients with IBD were identified. The prevalence proportion of chronic opioid use increased from 1996 and reached the highest point at 14.26% (95% confidence interval [CI], 13.67%-14.84%) for patients with CD in 2011 and 8.21% (95% CI, 7.88%-8.54%) in patients with UC in 2012. Subsequently, the prevalence proportion of chronic opioid use decreased to 8.88% (95% CI, 8.41%-9.35%) in patients with CD and 4.96% (95% CI, 4.70%-5.21%) in patients with UC by 2021. Throughout the 25-year period, female patients had higher prevalence proportion of chronic opioid use compared with that of male patients. Elderly patients had higher prevalence proportion of chronic opioid use compared with that of adult and young adult patients.

Discussions: Many patients with IBD rely on chronic opioid use as part of their pain management. Further investigations are needed to study the complications and sequelae of chronic opioid use in patients with IBD.

Objectives: We aimed to identify plasma proteins associated with incident Crohn's disease (CD) and ulcerative colitis (UC), develop and validate predictive models for CD and UC risk, and uncover novel protein-based drug targets.

Methods: The study included 46 523 participants from England in the UK. Biobank as the development set and 47 105 participants for internal replication. An external validation set comprised 5807 participants from Scotland and Wales. Plasma proteomic profiling was performed on 2911 proteins.

Results: In the development set, 49 and 34 proteins were significantly associated with incident CD and UC risk, respectively (Bonferroni P < .05). These findings were replicated in the internal replication set. Two-sample Mendelian randomization (MR) analysis identified three proteins (TIMP1, TNFRSF10A, and LTBR) with causal associations for CD and four proteins (CCL20, OSM, NOS2, and CD300E) for UC. Among these, TIMP1 and CD300E represent novel, undrugged targets, while the remaining five are currently druggable. The proteomic-based model, incorporating age, sex, and candidate proteins, demonstrated strong predictive performance in the external validation set, with a C-index of 0.94 (95% CI, 0.88-1.00) for CD and 0.82 (95% CI, 0.73-0.92) for UC. Integrating candidate proteins or the top 10 proteins into clinically based models significantly enhanced risk prediction for both CD and UC.

Conclusions: This study identifies novel plasma protein associations with CD and UC, supported by genetic evidence, and highlights their potential as therapeutic targets. Plasma proteomics significantly improves risk prediction for incident CD and UC compared to traditional clinical models, offering new avenues for drug discovery and personalized risk assessment.

Background: Comorbid psychological distress (anxiety and depression) in inflammatory bowel disease (IBD) is common and associated with poorer outcomes and increased healthcare burden. Scalable and accessible integrated care is needed. This study examined the feasibility of implementing routine digital mental health screening and digital cognitive-behavioral therapy (COMPASS-IBD) for psychological distress in a large IBD service.

Methods: During implementation, distress was identified by screening or IBD clinician referral. Further triage determined eligibility to receive COMPASS-IBD with trainee therapist support (12 weeks). Pre- and post-intervention outcomes examined reach, acceptability, implementation, and potential effectiveness of the new pathway.

Results: Screening was completed by 827 patients (from November 2022 to September 2023), with 196 patients meeting clinical cutoffs and referred for IBD psychology triage. An additional 82 patients were directly referred via IBD clinicians. Of 91 eligible patients, 65 (71.4%) were enrolled into COMPASS-IBD. Distress significantly reduced post-intervention (Patient Health Questionnaire Anxiety and Depression Scale = -6.203; 95% confidence interval, -8.76 to -3.64; P < .001; Cohen's d = -0.553). Symptoms of anxiety, depression, and IBD-related quality of life significantly improved, but IBD symptomatology did not. Full adherence (≥5 online and ≥3 therapist sessions) to COMPASS-IBD was completed by 32.3% of patients. After initially increasing, the IBD psychology waitlist decreased in wait time (30.8%) and number (63.4%) by the end of study implementation. Patients were accepting of the new treatment pathway.

Conclusions: Routine mental health screening and COMPASS-IBD were successfully implemented in an outpatient IBD service, but support from trainee psychologists and the research team was required. This new integrated pathway can identify and treat psychological distress in IBD with minimal service resource.

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer (CRC). However, the chemopreventive role of aspirin remains uncertain due to conflicting findings in prior studies.

Methods: The study sought to evaluate the association between long-term aspirin use and the risk of CRC and all-cause mortality in patients with IBD. We conducted a nationwide propensity score-matched cohort study using Taiwan's National Health Insurance Research Database and Cancer Registry from 2008 to 2022. Time-dependent Cox models and Fine and Gray competing risk models were applied.

Results: Among 2743 matched aspirin users and 2743 nonusers, aspirin use was associated with reduced CRC risk (adjusted hazard ratio, 0.42; 95% confidence interval, 0.31-0.57) and lower all-cause mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.58-0.74). A dose-response relationship was found for cumulative exposure, while optimal daily intensity was near 80 mg/d.

Conclusions: Long-term use of low-to-moderate-dose aspirin was associated with reduced risks of CRC and mortality in patients with IBD. These findings support aspirin's potential as a chemopreventive agent and justify further randomized trials.

Background: Golimumab is an anti-TNFα biologic agent that has been approved for adults with moderately-to-severely active ulcerative colitis (UC). We investigated the efficacy, safety, and pharmacokinetics (PK) of golimumab in biologic-naïve children with moderately-to-severely active UC.

Methods: The prospective, multicenter, open-label PURSUIT 2 study enrolled biologic-naïve children (2 to <18 years) with moderately-to-severely active UC (Mayo score 6-12; endoscopic subscore ≥2) despite conventional treatment. During the 6-week induction phase, patients received subcutaneous (SC) golimumab dosed by weight (<45 kg: 120/60 mg/m2; ≥45 kg: 200/100 mg) at weeks 0/2. Week 6 clinical responders (Mayo score decrease from baseline ≥30% and ≥3 points, with either a decrease in the rectal bleeding subscore of ≥1 or a rectal bleeding subscore of 0/1) continued golimumab dose q4w during the 48-week maintenance phase. The primary endpoint was clinical remission (Mayo score ≤2 points with no individual subscore >1) at week 6. Efficacy and PK data are presented alongside a reference adult UC population who received golimumab SC 200/100 mg at weeks 0/2 and 100 mg q4w thereafter.

Results: Of the 69 patients (mean age, 13.4 ± 3.3 years) enrolled, 31.9% (22/69) were in clinical remission at week 6, and of those, 54.5% (12/22) remained in clinical remission at week 54. At week 54, 31.7% (13/41) of week 6 clinical responders achieved clinical remission. Additionally, 33.3% achieved clinical remission by the Pediatric Ulcerative Colitis Activity Index (PUCAI), 56.5% clinical response by Mayo, 40.6% endoscopic improvement, and 7.2% endoscopic remission at week 6. Of those who were clinical responders at week 6, 34.1% achieved clinical remission by PUCAI, 31.7% corticosteroid-free clinical remission by Mayo, 36.6% endoscopic improvement, and 9.8% endoscopic remission at week 54. Serum golimumab concentrations through week 6 were comparable to the reference adult UC population. Through week 54, 40.6% reported serious adverse events and 13.0% serious infections. No new safety concerns were identified.

Conclusions: Overall, the results of the PURSUIT 2 study support golimumab treatment for children with moderately-to-severely active UC. ClinicalTrials.gov ID: NCT03596645.

Background: We examined real-world utilization of treat-to-target (TTT) strategies and conducted a quality improvement (QI) project to improve uptake of TTT strategies in a learning health system, IBD Qorus.

Methods: We implemented a structured QI intervention to increase uptake of TTT in 41 gastroenterology practices in the United States, over a 13-month intervention period (November 2020 to November 2021; modified breakthrough series [BTS] collaborative), and a 10-month post-BTS observation period (December 2021 to October 2022). Through encounter-level surveys, we examined providers' "intention to TTT" based on discussion of TTT with patients, documentation of inflammation, and intention to change therapy to TTT. We examined changes in rates of "intention to TTT," and whether improvement in intention to TTT influenced site-level rates of remission.

Results: Over 13 months, there were 7932 patient visits (55% with Crohn's disease; 47% in clinical remission); patients in 2160 visits (27%) were not in endoscopic remission. Overall, rates of intention to TTT increased from 31% to 54% (P = .06) with considerable site-to-site variability and was maintained at 49% in the post-BTS observation period. The increased rate was attributable to higher rates of testing for inflammation. Despite an increase in the rate of intention to TTT, there was no significant change in site-level achievement of remission over the same time.

Conclusions: Through a QI initiative in a learning health system, rates of intention to TTT increased significantly over 12-months, though overall rates remained low. Assessing patient-, provider- and practice-level barriers and facilitators for successful implementation of a TTT strategy is warranted to improve clinical outcomes.