Inflammatory Bowel Diseases最新文献

Objectives: The real-world efficacy of computer-aided detection (CADe) in improving surveillance colonoscopy performance for patients with inflammatory bowel disease (IBD) has not been established.

Methods: A retrospective, single-center study of surveillance colonoscopies in patients with IBD. Only colonoscopies indicated for surveillance, with adequate preparation and documented cecal intubation, were included. The study compared the collective adenoma detection rate (ADR) between the periods before (pre-CADe) (June 2020 to June 2021) and after (July 2021 to September 2022) the introduction of the CADe in all endoscopy units. An adjusted ADR was calculated using a multivariable logistic regression model.

Results: The study included 225 eligible colonoscopies performed during the pre-CADe period and 750 during the CADe period. Neoplastic lesions or colorectal cancer were detected in 13 (5.8%) of 225 procedures in the pre-CADe period and 27 (3.6%) of 750 procedures during the CADe period. The collective ADR was 5.2% (95% confidence interval, 3.9-6.6) in the pre-CADe period and 3.8% (95% confidence interval, 1.1-6.5) -following CADe implementation (P = .315). Subgroup analyses stratified by endoscopist experience, IBD type, and procedure timing (daytime vs after hours) corroborated a similar nonsignificant declining trend in ADR after CADe introduction.

Conclusions: In a real-world, single-center experience, the introduction of CADe did not improve neoplasms detection in patients with IBD and was associated with a nonsignificant decline in ADR. These findings call into question the utility of generic CADe systems in IBD surveillance and emphasize the need to foster IBD-specific CADe systems, as well as addressing challenges arising from physician-artificial intelligence interactions.

Background: Inflammatory bowel disease (IBD) may negatively affect health-related physical fitness. However, the development of interventions to improve health-related physical fitness and thereby disease outcomes is hindered by insufficient evidence. This study compared health-related physical fitness between patients with IBD and healthy control subjects, examined associations with disease and treatment characteristics, and explored patients' perspectives.

Methods: In this cross-sectional study, 105 patients with IBD and 102 age- and sex-matched healthy control subjects performed validated tests for body fat (4-site skinfold thickness), cardiorespiratory fitness (steep ramp test), muscular strength (steep ramp test, 60-second sit-to-stand test, hand-held dynamometry), muscular endurance (isokinetic dynamometry), and flexibility (sit-and-reach test). Data on disease and treatment characteristics, fatigue, physical activity, and patients' perspectives were collected.

Results: Patients with IBD had higher body fat (29.5% vs 26.9%; P = .012), lower steep ramp test performance (peak work rate 4.2 W/kg vs 4.8 W/kg; P < .001), fewer sit-to-stand repetitions (42 vs 47; P = .002), and reduced hamstring strength (3.0 N/kg vs 3.2 N/kg; P = .011) compared with healthy control subjects. This was associated with higher age, female sex, higher body mass index, fatigue, arthritis, and multiple biologicals used. Most patients considered physical fitness important and beneficial for their symptoms, and the majority expressed interest in professional support.

Conclusions: Patients with IBD have higher body fat and reduced cardiorespiratory fitness and muscular strength compared with healthy control subjects. Especially, patients with a higher age, female sex, higher body mass index, fatigue, arthritis, or multiple biologicals used are at risk for such impairments and may benefit from physical exercise interventions.

Background and aims: Crohn's disease (CD) itself is discussed as risk factors for anastomotic leakage (AL) after ileocecal resection (ICR). In order to gain insight into the mechanisms of anastomotic healing (AH) in Crohn's ileitis, we performed ICR in a mouse model of spontaneous ileitis. Additionally, we investigated the impact of anti-α4β7 integrin antibody on AH.

Methods: SAMP1/YitFc (SAMP1) and parental control (AKR) mice were subjected to ICR. Mice received an anti-α4β7 integrin antibody or isotype control (25 mg/kg). Functional (bursting pressure), macroscopic (healing score), and matrix-related parameters (hydroxyproline, collagenase activity, and histology) of AH were assessed at day 5. Local and systemic cytokine messenger RNA expression and lipocalin-2 in plasma and stool were measured. Effects of α4β7 integrin blockade on anastomotic cell infiltration were assessed by flow cytometry.

Results: SAMP1 mice exhibited a 5-fold higher rate of microabscess formation in the anastomoses and worse macroscopical healing. Functional healing and matrix parameters, as well as leak rate, were similar to AKR control mice. Despite an increase in systemic inflammation, a significant drop in T helper 1 cytokine expression was observed in the mesenteric lymph nodes of SAMP1 mice. Flow cytometric analyses revealed a higher proportion of mesenchymal cells and myeloid suppressor cells. Wound macrophages remained unchanged in the anastomotic tissue of anti-α4β7 integrin antibody-treated SAMP1 mice.

Conclusions: Crohn's-like ileitis mice were at higher risk for abscess formation. Anti-α4β7 integrin treatment resulted in cellular changes that did not impair functional anastomotic healing.

Background: The clinical relevance and underlying mechanism of isolated anastomotic ulcers (IAUs) following ileocolic resection (ICR) in patients with Crohn's disease (CD) are poorly understood. This study aimed to assess the postoperative recurrence (POR) risk and the mucosa-associated microbiome composition in CD patients with or without IAUs among those with a healthy neo-terminal ileum (TI).

Methods: CD patients who underwent ICR and without any ulcerations in the neo-TI (SES-CD ≤2) at first postoperative ileocolonoscopy were identified from an ongoing prospective multicenter study. The primary study outcome was time to POR measured from the first postoperative ileocolonoscopy. Cox proportional hazard models were used to assess the association of IAUs with time to POR. The mucosa-associated microbiome at first ileocolonoscopy was assessed by sequencing the 16S rRNA gene using biopsies taken from both sides of the anastomosis.

Results: Sixty patients were included, of whom 27 patients had IAUs (45.0%) at first ileocolonoscopy. Median time to first postoperative ileocolonoscopy was 6.5 months (interquartile range [IQR] 5.3-8.1). During a median follow-up duration of 3.0 years (IQR 1.4-5.5) after first postoperative ileocolonoscopy, POR was observed in 53.3%. After adjustment for clinical risk factors, IAUs were independently associated with POR (adjusted hazard ratios 5.4; 95% CI 2.4-12.4; P < .001). At the ileal and colonic side of the anastomosis, a significantly higher abundance of Klebsiella was associated with IAUs (q < 0.05).

Conclusions: IAUs in CD patients with otherwise healthy neo-TI at first postoperative ileocolonoscopy are associated with long-term POR. In addition, a differential mucosa-associated microbiome composition was observed in patients with IAUs, specifically the proteobacteria Klebsiella, suggesting that putative taxa are related to these lesions. Further validation studies in larger cohorts, along with mechanistic studies, are still required.

Background: The infliximab (IFX) biosimilar, CT-P13, is available as an intravenous (IV) and subcutaneous (SC) formulation. Although current indications allow the transition from IV CT-P13 to SC CT-P13 after two IV administrations, some clinicians prefer to postpone switching until stable clinical remission has been achieved.

Methods: We evaluate the endoscopic response, treatment persistence, clinical remission, endoscopic remission, and safety profile after one year of treatment with IFX in patients switched from IV to SC after 6 weeks (early switch group) or after 6 months (late switch group).

Results: There were no statistical differences between the two groups after one year in terms of endoscopic response (71.4% vs 70.8%, P = .95), steroid-free clinical remission (62.5% vs 68.7%, P = .51), or IFX retention rate (75.0% vs 66.7%, P = .35). We observed higher endoscopic remission rates in early switch patients as compared to late switch patients; however, this trend was not significant (69.6% vs 52.1%, P = .07). A return to IV-IFX was required in 1 of 43 early switch patients and in 3 of 44 late switch patients (2.3% vs 6.8%, P = .31). Clinical indexes, fecal calprotectin and C-reactive protein (CRP) levels significantly decreased after one year regardless of group. Adverse events were also comparable between groups (4.5% vs 8.3%, P = .46).

Conclusions: Our study has shown that early switch from IV-IFX to SC-IFX at 6 weeks is effective in terms of clinical and endoscopic remission at one year yielding similar results to late switch at 6 months.

Background: Recognition of the bidirectional effects between psychological distress (ie, anxiety, depression, perceived stress) and inflammatory bowel disease (IBD) activity has led to efforts to integrate behavioral medicine in the management of IBD. As part of a broader project focused on testing the feasibility and acceptability of digital mind-body interventions among a greater diversity of people with IBD, we collected qualitative data on the lived experience of patients from Black and/or Hispanic backgrounds in an outpatient gastroenterology setting. We aimed to understand how racial and ethnic background influences patients' illness perceptions and receptivity to a digital mind-body intervention for psychological distress in IBD.

Methods: Data were collected (2022-2023) via semi-structured interviews among IBD patients (n = 25) attending an outpatient gastroenterology practice. All data collection occurred virtually and was audio recorded. Transcripts were thematically analyzed and coded via NVivo software.

Results: We identified 3 core themes regarding the influence of racial and ethnic background on IBD experience with relevance to intervention design and content: broad impact of racial and cultural identity on IBD; resonance of gut-brain interaction with personal experience notwithstanding barriers to mental healthcare; and acceptance of digital technology in everyday life and health. For most, digital technology was part of their everyday life, and a digitally delivered self-management resource would be welcome.

Conclusions: Racial and ethnic background influences IBD patients' illness perception, coping, and desires for support. Findings can directly inform the design and content of digital behavioral interventions in IBD towards increased applicability and equitable engagement.

Background: Sexual dysfunction is common among patients with inflammatory bowel disease (IBD). For lesbian, gay, bisexual, transgender, or queer (LGBTQ+) patients, these challenges may be compounded by health disparities related to sexual health, stigma, and fear of discrimination in the clinical setting. There has been little research related to sexual health and IBD among this patient demographic.

Methods: Patients with IBD who receive care at Massachusetts General Hospital and the Brigham and Women's Hospital were invited to participate in a 4-part survey on sexual health via an electronic patient portal messaging system and outpatient clinic flyers. Patients from the broader IBD community were invited to participate via social media outlets. Demographic data, IBD disease characteristics, and information related to health care experiences and interactions with IBD providers were collected. Sexual history information was obtained using an adapted version of the IBD-Specific Sexual Dysfunction Scale.

Results: In total, 340 patients completed the survey, of which 20.3% (n = 69) identified as LGBTQ+. The majority of patients (75%, n = 255) reported distress in their sexual life due to IBD; however, only 5% (n = 17) of respondents had previously discussed the topic of sexual health with their IBD provider. One in 4 LGBTQ+ patients listed fear of discrimination as a source of discomfort in these discussions, and a similar proportion expressed uncertainty regarding whether their sexual and/or gender identity negatively impacted their IBD care.

Conclusions: Further research and enhanced provider awareness of sexual health challenges related to IBD among LGBTQ+ patients may serve as an important step toward advancing inclusive and culturally sensitive care for this patient population.