Intestinal Research最新文献

Background/aims: The gender-specific impact of inflammatory bowel disease (IBD) on women in low- and middle-income countries remains underexplored. We aimed to assess the effects of IBD on different domains of women's health.

Methods: A cross-sectional study was conducted in women with IBD at a tertiary care center in North India. Women with IBD were interviewed using a structured questionnaire assessing menstrual, reproductive, sexual, mental, social, and financial health, and healthcare access.

Results: Two hundred and two women (median age, 41 years; ulcerative colitis [n = 155, 76.7%]) were enrolled. Anemia was present in 161 women (79.7%), with a median hemoglobin of 10.5 g/dL. Among menstruating women (n = 138), 69 (50%) had irregular cycles, and 39 (28.3%) experienced IBD exacerbations during menstruation. Sexual dysfunction was reported in 82.5% (n = 137/166). Pregnancy-related concerns were common (n= 120, 59.4%), mainly due to risk of heritability and safety of IBD medication. Ten women (4.9%) attributed pregnancy loss to disease activity. Cervical cancer screening (3.0%) and human papillomavirus vaccination (4.0%) rates were low. The median SICC-IBD (social impact of chronic conditions in IBD) score was 0.6. Forty-three women (21.3%) reported difficulties in finding a partner due to IBD. Limited access to IBD specialists (n = 150, 74.3%) and medications (n = 164, 81.2%) were reported in hometown. Fifty-five women (27.2%) relied on loans to manage treatment expenses.

Conclusions: IBD affects women across physical, reproductive, social, and financial domains. Culturally sensitive, multidisciplinary care models are essential to address these unmet needs.

In real-world clinical practice, 3 Janus kinase (JAK) inhibitors-tofacitinib, filgotinib, and upadacitinib-are now available for the treatment of ulcerative colitis. Emerging real-world evidence highlights distinct efficacy and safety profiles among these agents, largely attributed to differences in JAK selectivity and dosing strategies. Notably, data are accumulating on differential efficacy, predictors of therapeutic response, and outcomes in patients who switch between JAK inhibitors, contributing to a clearer understanding of the optimal positioning of each agent. Regarding safety, particular attention has been given to risks such as herpes zoster infection and drug-induced acne, underscoring the importance of appropriate patient education and individualized risk assessment. This review summarizes clinical trials and current real-world data on tofacitinib, filgotinib, and upadacitinib in ulcerative colitis, and discusses strategies for optimizing their clinical application.

Background/aims: The real-world management of acute severe ulcerative colitis (ASUC) varies considerably across regions and healthcare settings. This study aimed to evaluate current management practices for ASUC among gastroenterologists in India.

Methods: A structured, web-based survey covering 5 thematic domains (provider and institutional characteristics, clinical workload and initial management, diagnostic practices, infectious work-up, and strategies for rescue therapy) was disseminated via email. Responses were analyzed using descriptive statistics.

Results: A total of 228 responses were received from across India's 5 geographic zones. The majority of respondents were affiliated with either corporate hospitals (n = 76, 33.3%) or teaching hospitals (n = 68, 29.8%). The majority (n = 135, 59.2%) reported managing up to 10 ASUC cases annually. The Truelove and Witts criteria were the most commonly used for diagnosis (n = 169, 74.1%). Nutritional assessment was performed by 89 respondents (39.0%). Biopsies for cytomegalovirus during index sigmoidoscopy were obtained by 75 (32.9%). Intravenous hydrocortisone was the preferred steroid (n = 188, 82.5%). Low molecular weight heparin for thromboprophylaxis was never prescribed by 62 respondents (27.2%). Oxford criteria were most frequently used to assess steroid response (n = 150, 65.8%). More than half of the respondents (n = 125, 54.8%) reported that fewer than 50% of patients accepted rescue therapy. Rescue therapy was initiated on or after day 5 by 153 respondents (67.1%). Early involvement of colorectal surgeons was reported by 66 (28.9%). A majority (n = 200, 87.7%) were associated with low-volume centers for ileal pouch-anal anastomosis, performing < 5 procedures per year.

Conclusions: This nationwide survey reveals considerable heterogeneity in ASUC management in India. Standardizing care through patient and healthcare provider education and context-specific guidelines is imperative.

Background/aims: The development of antinuclear antibodies (ANAs) during infliximab treatment has been observed in previous clinical trials. To evaluate the clinical significance of ANA seroconversion and its potential association with the formation of antibodies against infliximab.

Methods: This retrospective study included 130 Crohn's disease patients undergoing infliximab therapy. ANA titers were measured at baseline and after 6 months of treatment. Inverse probability of treatment weighting was applied to control for confounding variables.

Results: Among the 111 patients with negative baseline ANA, 36 (32.4%) developed ANA positivity after 6 months of infliximab treatment. After adjustment with inverse probability of treatment weighting, a significantly higher proportion of patients in the ANA non-seroconversion group achieved endoscopic remission at 6 months compared to those with ANA seroconversion (64.5% vs. 35.5%: adjusted odds ratio [aOR], 3.61; 95% confidence interval [CI], 1.30-10.02; P= 0.014). At 18 months, patients in the non-seroconversion group also exhibited higher rates of both endoscopic response (57.5% vs. 42.3%: aOR, 3.38; 95% CI, 1.15-9.96; P= 0.027) and endoscopic remission (60.0% vs. 40.1%: aOR, 2.91; 95% CI, 1.06-8.01; P= 0.039) compared to the seroconversion group. Additionally, patients who developed ANA seroconversion had a higher rate of detectable antibodies against infliximab at both 6 and 18 months. A multivariable analysis identified female sex, older age at diagnosis, and lower serum albumin levels as independent predictors of ANA seroconversion at 6 months.

Conclusions: ANA non-seroconversion at 6 months was associated with higher rates of endoscopic remission and a lower likelihood of developing antibodies against infliximab.

Background/aims: Guidelines recommend that steroid treatment for ulcerative colitis (UC) is tapered or withdrawn within 3 months of initiation, and thiopurine treatment or advanced therapy is administered for steroid-dependent UC. This study aimed to clarify real-world treatment patterns and outcomes in patients with steroid-dependent UC in Japan.

Methods: A retrospective analysis of JMDC (Japan Medical Data Center) claims data was conducted to identify patients with a new UC diagnosis between June 2010 and September 2019. Index dates were the UC treatment start date (initiation of any UC treatment), steroid dependence/resistance confirmation date (identification of steroid-dependent UC), and treatment intensification date (initiation of thiopurine treatment/advanced therapy).

Results: Of 5,602 patients with newly diagnosed UC, 986 (17.6%) initiated steroids within 12 months (85.4% [842/986] received 5-aminosalicylic acid at the UC treatment start date). Of these 986 patients, 429 (43.5%) were classified as steroid-dependent (steroid dependence/resistance confirmation date). Of these 429 patients, 128 (29.8%) initiated thiopurine treatment and 75 (17.5%) initiated advanced therapy (treatment intensification date); 226 (52.7%) continued with steroids only. Across these groups, 3-6% discontinued steroids within 3 months of initiation. Hospitalization due to UC in the 12 months after the treatment intensification date occurred in 24.2% (31/128) and 18.7% (14/75) of patients who initiated thiopurine and advanced therapy, respectively.

Conclusions: Over half of patients with steroid-dependent UC continued steroid treatment only. Steroid discontinuation within 3 months of initiation was low, irrespective of whether thiopurines or advanced therapy were initiated. Management of patients with steroid-dependent UC in Japan requires further treatment optimization toward guideline adherence.

Background/aims: To assess, post hoc, tofacitinib safety/effectiveness in patients with ulcerative colitis (UC), stratified by age, using data from a 60-week post-marketing surveillance (PMS) study in Japan.

Methods: All patients with UC receiving tofacitinib in Japan were enrolled in a large PMS study. Incidence proportions of adverse events (AEs), incidence rates (IRs; unique patients with events/100 patient-years of exposure) of clinically important AEs, reasons for discontinuation, and partial Mayo score clinical remission, stratified by age ( ≥ 65 and < 65 years), were evaluated.

Results: The analysis included 212 older ( ≥ 65 years) and 1,770 younger ( < 65 years) patients. Demographics and baseline disease characteristics were generally similar between groups; however, more older versus younger patients had cardiovascular disease (23.1% vs. 4.6%). Incidence proportions of AEs were comparable between groups, but IRs (95% confidence intervals) in older versus younger patients were numerically higher for herpes zoster (9.81 [5.72-15.71] vs. 5.44 [4.28-6.82]), and higher for serious infections (4.45 [1.92-8.76] vs. 1.14 [0.65-1.85]). More older versus younger patients discontinued due to AEs (28.6% vs. 17.6%); more younger versus older patients discontinued due to insufficient clinical responses (50.3% vs. 35.2%). Clinical remission rates through 60 weeks were generally similar between groups.

Conclusions: Older patients had higher IRs of herpes zoster and serious infection than younger patients, although tofacitinib effectiveness was similar between age groups. Discontinuation due to AEs was more common in older patients. Despite the smaller sample size of older versus younger patients, a focused evaluation of older patients is of benefit.

The incidence and prevalence of elderly-onset inflammatory bowel disease (EO-IBD) are increasing worldwide. The rising incidence of EO-IBD in Asia is driven by rapid industrialization and an aging population. Older patients often have multiple comorbidities and polypharmacy, which make diagnosis and management of the disease more challenging. Additionally, Asian patients with EO-IBD exhibit unique clinical characteristics, including frequent ileal involvement. Differences in phenotype between patients with EO-IBD in Western and Asian countries may explain subsequent disparities in the natural history of these patients. Although EO-IBD often manifests with a mild clinical course at diagnosis, it poses distinct diagnostic and therapeutic challenges. Understanding these characteristics is essential for optimizing patient care and for optimizing patient outcomes. In this review, we explore the epidemiology, disease burden, and clinical characteristics of EO-IBD in Asia, as well as the therapeutic approaches for treating the disease.

Background/aims: Tofacitinib (TFB), filgotinib (FIL), and upadacitinib (UPA) are Janus kinase (JAK) inhibitors approved for moderate-to-severe ulcerative colitis (UC). The appropriate positioning of each JAK inhibitor in the treatment algorithm, however, is unclear. Furthermore, real-world efficacy of JAK inhibitors for patients with UC and prior anti-tumor necrosis factor α antibody (aTNF) treatment are not fully investigated. We compared the efficacy and safety of 3 JAK inhibitors in patients with UC, considering their prior aTNF exposure.

Methods: A retrospective study was conducted in patients with UC who started TFB, FIL, or UPA at 2 academic centers. This propensity score-matched cohort study assessed the effectiveness of the 3 JAK inhibitors for UC in patients with and without prior aTNF exposure, comparing steroid-free clinical remission and response rates after 8 weeks.

Results: Among 274 patients who met the inclusion criteria, 145 experienced aTNF exposure (TFB: 59.2%, 100/169; FIL: 34.5%, 20/58; UPA: 53.2%, 25/47). Based on propensity score-matching, UPA led to a higher steroid-free clinical remission rates than TFB (adjusted odds ratio [aOR], 5.57; 95% confidence interval [CI], 1.42-21.90) or FIL (aOR, 9.00; 95% CI, 1.42-57.10) in patients exposed to aTNF. Steroid-free clinical remission and clinical response rates did not differ significantly between each group in patients non-exposed to aTNF. The incidence of adverse events was slightly higher with UPA than TFB or FIL.

Conclusions: UPA may be more effective for UC than TFB or FIL, especially in patients with previous aTNF exposure, although consideration should be given to adverse events.

Background/aims: Crohn's disease (CD) progresses to structural bowel damage (SBD). The Lémann Index (LI) captures stricture extent/severity, penetrating disease and surgery as a SBD score, and is earmarked for future CD modification trials. Understanding knowledge gaps and perceived barriers is critical to wider adoption.

Methods: A multinational, cross-sectional study was distributed through a survey link (REDCap, Research Electronic Data Capture) to gastrointestinal professional societies with snowball sampling using 23 questionnaire items in 5 sections to determine SBD and LI knowledge, and LI acceptability. Factors associated with acceptability and perception were evaluated.

Results: Of the 107 respondents, 49 (45.8%) were female; 87 (81.3%) were from Europe. Most were inflammatory bowel disease specialists (n = 80, 74.8%) or general gastroenterologists (n = 22, 20.6%), managing > 40 CD patients per month (n = 35, 32.7%). A total of 98 (91.6%) knew about SBD; "very important" rating for clinical trials and clinical practice was 56.1% and 41.4%, respectively. A 39.3% describe LI scoring as "very difficult" or "difficult"; 33.6% reported "significant" or "a lot" of effort. Acceptability (composite scores of > 36) were significantly associated with respondents who had received LI training (P<0.001). Automated methods, intestinal ultrasound and evidence of benefit would encourage LI use in clinical trials, while additional time and automated methods would promote use in clinical practice. The top 3 perceived adoption barriers were: lack of time (60.7%), limited automated methods (47.7%) and need for dedicated radiologists (38.3%).

Conclusions: Most respondents had baseline knowledge of SBD. The LI was perceived as important for advancing future CD research and care. More training and automation will facilitate LI adoption.