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Pabla BS, Alex Wiles C, Slaughter JC, Scoville EA, Dalal RL, Beaulieu DB, Schwartz DA, Horst SN. Safety and Efficacy of Vedolizumab Versus Tumor Necrosis Factor α Antagonists in an Elderly IBD Population: A Single Institution Retrospective Experience. Dig Dis Sci 2022; 67:3129-3137. [PMID: 34268660 DOI: 10.1007/s10620-021-07129-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vedolizumab is a monoclonal antibody used to treat inflammatory bowel disease (IBD). There is little known about the safety and comparative efficacy of this agent in the elderly population. AIMS Here, we present data on the safety and comparative efficacy of vedolizumab versus tumor necrosis factor α antagonists (anti-TNF) in elderly patients with IBD. METHODS This retrospective cohort study included IBD patients started on vedolizumab or anti-TNF at age 60 or older at a single tertiary IBD center. Safety was evaluated by assessing for the development of serious infection. The comparative needs for IBD-related surgery, IBD-related hospitalization, and drug discontinuation for any reason were obtained. Efficacy was assessed by comparing changes in endoscopic, histologic, and patient-report outcomes. RESULTS 212 cases were identified-108 patients treated with vedolizumab and 104 patients treated with anti-TNF. There were no significant differences between cohorts in serious infection, surgical intervention, or IBD-hospitalization-free survival (p = NS). Drug discontinuation survival was different between anti-TNF and vedolizumab (p = 0.02) with more patients remaining on vedolizumab at the time of last follow-up (51.9% vs. 25.9%). Endoscopic remission and response rates were higher in the vedolizumab versus anti-TNF group (65.7% vs. 45.2%, p = 0.02; 80.0% vs. 59.3%, p < 0.001). CONCLUSIONS In a cohort of IBD patients over age 60, vedolizumab showed no statistically significant differences in infection, hospitalization, or surgical intervention-free survival as compared to anti-TNF. Vedolizumab was discontinued less frequently than anti-TNF. Patients on vedolizumab had higher rates of endoscopic remission and response.
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Affiliation(s)
- Baldeep S Pabla
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA.
| | - C Alex Wiles
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, USA
| | | | - Elizabeth A Scoville
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - Robin L Dalal
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - Dawn B Beaulieu
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - David A Schwartz
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - Sara N Horst
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
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Florence-Damilola O, Aboubakr A, Anyane-Yeboa A. Inflammatory bowel disease in underserved populations: lessons for practice. Curr Opin Gastroenterol 2022; 38:321-327. [PMID: 35762691 PMCID: PMC10332404 DOI: 10.1097/mog.0000000000000855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW The incidence of inflammatory bowel disease (IBD) is increasing in minority groups across the USA. There are racial and ethnic disparities in IBD care and outcomes that are rooted in historical injustice and inequities in the social determinants of health. RECENT FINDINGS Current literature has identified racial, ethnic and sociodemographic disparities in therapeutics and outcomes for IBD, including disease severity, morbidity and mortality. SUMMARY Strategies to achieve equity in IBD include tackling structural racism as a driver of health disparities and making actionable changes against multilevel barriers to care.
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Affiliation(s)
- Odufalu Florence-Damilola
- Division of GI & Liver Disease, Department of Medicine, Keck School of Medicine of USC; Los Angeles, California
| | - Aiya Aboubakr
- Department of Medicine, New York Presbyterian/Weill Cornell Medical Center; New York, NY
| | - Adjoa Anyane-Yeboa
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School; Boston, MA
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153
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Malloy C, Rawl SM, Miller WR. Inflammatory Bowel Disease Self-Management: Exploring Adolescent Use of an Online Instagram Support Community. Gastroenterol Nurs 2022; 45:254-266. [PMID: 35833744 PMCID: PMC9425855 DOI: 10.1097/sga.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
The purpose of this qualitative study was to explore the challenges adolescents with inflammatory bowel disease (IBD) experience with disease self-management as expressed in an online Instagram social support community. Public Instagram posts between January and December 2019 were manually collected from an online IBD support community. To focus on adolescent self-management needs, only posts from Instagram users who (1) indicated they had inflammatory bowel disease, (2) were 13-24 years old, or were in middle school, high school, or college were collected. Using thematic analysis, authors independently coded and identified emerging themes about self-management. Of 2,700 Instagram posts assessed for eligibility, 83 posts met inclusion criteria. Six major themes about inflammatory bowel disease self-management emerged: Desire for Normalcy, Dietary Changes, Education and Career, Healthcare System, Relationships With Others, and Symptoms and Complications. As the first thematic analysis of Instagram posts in an online inflammatory bowel disease community, results provide a crucial perspective of the concerns of adolescents with inflammatory bowel disease. Self-management challenges were wide-ranging and complex, underscoring the importance of IBD self-management in the adolescent population. Nurses should take a holistic approach to assess self-management challenges and tailor care to the specific needs of adolescents living with inflammatory bowel disease.
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154
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Khunsriraksakul C, Markus H, Olsen NJ, Carrel L, Jiang B, Liu DJ. Construction and Application of Polygenic Risk Scores in Autoimmune Diseases. Front Immunol 2022; 13:889296. [PMID: 35833142 PMCID: PMC9271862 DOI: 10.3389/fimmu.2022.889296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Genome-wide association studies (GWAS) have identified hundreds of genetic variants associated with autoimmune diseases and provided unique mechanistic insights and informed novel treatments. These individual genetic variants on their own typically confer a small effect of disease risk with limited predictive power; however, when aggregated (e.g., via polygenic risk score method), they could provide meaningful risk predictions for a myriad of diseases. In this review, we describe the recent advances in GWAS for autoimmune diseases and the practical application of this knowledge to predict an individual’s susceptibility/severity for autoimmune diseases such as systemic lupus erythematosus (SLE) via the polygenic risk score method. We provide an overview of methods for deriving different polygenic risk scores and discuss the strategies to integrate additional information from correlated traits and diverse ancestries. We further advocate for the need to integrate clinical features (e.g., anti-nuclear antibody status) with genetic profiling to better identify patients at high risk of disease susceptibility/severity even before clinical signs or symptoms develop. We conclude by discussing future challenges and opportunities of applying polygenic risk score methods in clinical care.
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Affiliation(s)
- Chachrit Khunsriraksakul
- Graduate Program in Bioinformatics and Genomics, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Institute for Personalized Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Havell Markus
- Graduate Program in Bioinformatics and Genomics, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Institute for Personalized Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Nancy J. Olsen
- Department of Medicine, Division of Rheumatology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Laura Carrel
- Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Bibo Jiang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Dajiang J. Liu
- Institute for Personalized Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
- *Correspondence: Dajiang J. Liu,
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155
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Bogale K, Maheshwari P, Kang M, Gorrepati VS, Dalessio S, Walter V, Stuart A, Koltun W, Bernasko N, Tinsley A, Williams ED, Clarke K, Coates MD. Symptoms associated with healthcare resource utilization in the setting of inflammatory bowel disease. Sci Rep 2022; 12:10577. [PMID: 35732802 PMCID: PMC9217979 DOI: 10.1038/s41598-022-14838-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 05/16/2022] [Indexed: 11/09/2022] Open
Abstract
Several symptoms have been connected to increased healthcare resource utilization (HRU) in the context of inflammatory bowel disease (IBD), including both Crohn's disease (CD) and ulcerative colitis (UC). This study was designed to investigate the prevalence of IBD-associated symptoms and to determine whether any are independently associated with HRU. We undertook a retrospective analysis of data related to consecutive IBD patient encounters from a tertiary care referral center between 1/1/2015 and 8/31/2019. Demographics, clinical activity, endoscopic severity, IBD-related symptom scores, anxiety and depression scores, and other key clinical data were abstracted. Four hundred sixty-seven IBD patients [247f.: 220 m; 315 CD, 142 UC and 11 indeterminate colitis] were included in this study. The most common symptoms were fatigue (83.6%), fecal urgency (68.2%) and abdominal pain (63.5%). Fatigue, abdominal pain, anxiety or depression, corticosteroids, and opioids were each positively associated with HRU, while NSAID and mesalamine use were inversely associated on bivariate analysis. The only factor that demonstrated a statistically significant association with HRU in the whole cohort on multivariable analysis was abdominal pain. Abdominal pain is independently associated with HRU and should be specifically screened for in IBD patients to identify individuals at risk of undergoing expensive interventions. This study also reinforces the importance of optimizing diagnostic and therapeutic management of abdominal pain in IBD.
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Affiliation(s)
- Kaleb Bogale
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Parth Maheshwari
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Mitchell Kang
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Venkata Subhash Gorrepati
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Shannon Dalessio
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Vonn Walter
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - August Stuart
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Walter Koltun
- Department of Surgery, Division of Colorectal Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nana Bernasko
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Andrew Tinsley
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Emmanuelle D Williams
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Kofi Clarke
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA
| | - Matthew D Coates
- Department of Medicine, Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA. .,Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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156
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Macleod A, Kavalukas SL, Scheurlen KM, Galandiuk S. State-of-the-art surgery for Crohn's disease: Part II-colonic Crohn's disease and associated neoplasms. Langenbecks Arch Surg 2022; 407:2595-2605. [PMID: 35729401 DOI: 10.1007/s00423-022-02572-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022]
Abstract
Despite advances in medical therapy, surgery continues to play a vital role in the management of Crohn's disease and its complications. Continuing from Part I of this series (small intestine/ileal disease), we focus next on colonic Crohn's disease and associated neoplasms. We will first review the surgical management of medical-refractory Crohn's colitis and its complications and then examine cancer risk, surveillance, and surgical management of Crohn's-associated colorectal dysplasia and malignancy. We conclude with a discussion of restoration of gastrointestinal continuity following colonic surgery for Crohn's disease.
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Affiliation(s)
- Anne Macleod
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA
| | - Sandra L Kavalukas
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA.,Division of Colon & Rectal Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson St, Louisville, KY, 40202, USA
| | - Katharina M Scheurlen
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA
| | - Susan Galandiuk
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA. .,Division of Colon & Rectal Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson St, Louisville, KY, 40202, USA.
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157
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Emeasoba EU, Ibeson CE, Kundal S, Biondi S, Nwosu I, Golfeyz S, Kantrowitz M, Khodorskiy D. A Rare Case of New-Onset Ulcerative Colitis in a Nonagenarian. Cureus 2022; 14:e26203. [PMID: 35891824 PMCID: PMC9307128 DOI: 10.7759/cureus.26203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
Ulcerative colitis (UC) is one of two major types of inflammatory bowel disease (IBD). It is defined as a chronic idiopathic inflammatory disease limited to the colorectal mucosal layer and characterized by relapsing and remitting episodes of inflammation. UC almost invariably involves the rectum and extends proximally in a continuous distribution to part or the entire colon. Development of disease after 75 years of age is uncommon, with new-onset over the age of 80 accounting only for 1% of all new diagnoses. We present a case of a new onset UC in a 90-year-old patient presenting with painless hematochezia.
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158
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Kataria J, Kerr J, Lourenssen SR, Blennerhassett MG. Nintedanib regulates intestinal smooth muscle hyperplasia and phenotype in vitro and in TNBS colitis in vivo. Sci Rep 2022; 12:10275. [PMID: 35715562 PMCID: PMC9206006 DOI: 10.1038/s41598-022-14491-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/08/2022] [Indexed: 02/07/2023] Open
Abstract
Chronic inflammation of the human intestine in Crohn’s disease (CD) causes bowel wall thickening, which typically progresses to stricturing and a recurrent need for surgery. Current therapies have limited success and CD remains idiopathic and incurable. Recent evidence shows a key role of intestinal smooth muscle cell (ISMC) hyperplasia in stricturing, which is not targeted by current anti-inflammatory therapeutics. However, progression of idiopathic pulmonary fibrosis, resembling CD in pathophysiology, is controlled by the tyrosine kinase inhibitors nintedanib (NIN) or pirfenidone, and we investigated these drugs for their effect on ISMC. In a culture model of rat ISMC, NIN inhibited serum- and PDGF-BB-stimulated growth and cell migration, and promoted the differentiated phenotype, while increasing secreted collagen. NIN did not affect signaling through PDGF-Rβ or NFκB but did inhibit cytokine-induced expression of the pro-inflammatory cytokines IL-1β and TNFα, supporting a transcriptional level of control. In TNBS-induced colitis in mice, which resembles CD, NIN decreased ISMC hyperplasia as well as expression of TNFα and IL-1β, without effect in control animals. NIN also inhibited growth of human ISMC in response to human serum or PDGF-BB, which further establishes a broad range of actions of NIN that support further trial in human IBD.
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Affiliation(s)
- Jay Kataria
- Gastrointestinal Diseases Research Unit, Department of Medicine, GIDRU Wing, Kingston General Hospital, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Jack Kerr
- Gastrointestinal Diseases Research Unit, Department of Medicine, GIDRU Wing, Kingston General Hospital, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Sandra R Lourenssen
- Gastrointestinal Diseases Research Unit, Department of Medicine, GIDRU Wing, Kingston General Hospital, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Michael G Blennerhassett
- Gastrointestinal Diseases Research Unit, Department of Medicine, GIDRU Wing, Kingston General Hospital, Queen's University, Kingston, ON, K7L 2V7, Canada.
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159
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Chen G, Pedarla V, Null KD, Cazzetta SE, Khan QR, Schwartz DA. Health Care Costs and Resource Utilization Among Patients With Crohn's Disease With and Without Perianal Fistula. Inflamm Bowel Dis 2022; 28:870-877. [PMID: 34525184 PMCID: PMC9165558 DOI: 10.1093/ibd/izab198] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Perianal fistula (PAF), a complication of Crohn's disease (CD), is associated with substantial economic costs and poor prognosis. We determined prevalence of PAF CD in the United States and compared costs and health care resource utilization (HRU) of PAF CD patients with matched non-PAF CD patients. METHODS This was a retrospective cohort study of claims data from the IBM MarketScan Commercial Database from October 1, 2015, to September 30, 2018. Eligible patients were aged 18 to 89 years with ≥2 CD diagnoses. Patients with PAF CD had ≥1 PAF diagnosis or procedure code and were matched with non-PAF CD patients. Cumulative prevalence of PAF CD in the US population was calculated across total patients in MarketScan. All-cause and gastrointestinal (GI)-related costs and HRU were compared between groups using a generalized linear model (GLM). RESULTS Cumulative 3-year prevalence of PAF was 7.70% of patients with CD (N = 81,862) and 0.01% of the US population. Among PAF CD (n = 1218) and matched non-PAF CD (n = 4095) patients, most all-cause costs and HRU were GI-related. Mean total all-cause and GI-related health care costs per patient and per year for PAF CD were $85,233 and $71,612, respectively, vs $40,526 and $29,458 for non-PAF CD (P < .0001). Among PAF CD vs non-PAF CD patients, GLM-adjusted proportions of patients with GI-related inpatient, outpatient, or pharmacy visits, mean GI-related inpatient length of stay, and mean GI-related surgeries were higher (P < .0001 for all comparisons). CONCLUSIONS Costs and HRU are significantly higher for patients with PAF CD vs non-PAF CD patients, highlighting the economic burden of the disease.
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Affiliation(s)
- Grace Chen
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
| | | | - Kyle D Null
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
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160
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Daraiseh NM, Black A, Minar P, Meisman A, Saxe M, Lipstein EA. iBDecide: A web-based tool to promote engagement in shared decision-making among adolescents with ulcerative colitis. PATIENT EDUCATION AND COUNSELING 2022; 105:1628-1633. [PMID: 34756638 DOI: 10.1016/j.pec.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) seek increased autonomy and self-efficacy. AYAs must learn to manage their medical care in preparation for transition to adult healthcare. Our team's research found that AYAs need more information about their disease and treatment OBJECTIVE: To develop and test the usability of a decision tool "iBDecide" to promote shared decision-making among AYAs with ulcerative colitis (UC) who are beginning to manage their treatment and medications METHODS: Using design thinking, 14 AYAs, 6 healthcare providers, 4 designers, a social worker, and a human factors researcher developed a shared decision-making tool. The System Usability Scale (SUS) assessed usability RESULTS: AYAs preferred an application with information on treatment, medication, nutrition, and symptom tracking. A web-based application, 'iBDecide', was developed to include these options. SUS results indicated that participants on average "agree" that: 'they would use iBDecide' and that 'it was easy to use and streamlined'. The mean SUS score was 78.25 (+/-12.91), range 70-90 DISCUSSION: Including AYAs in tool development helps ensure usability and improves engagement in shared decision-making. Co-designed tools may remove barriers for engagement and skill-building needed for the transition to adult care. CONCLUSION iBDecide can stimulate AYA engagement in shared decision-making in treating UC.
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Affiliation(s)
- N M Daraiseh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A Black
- College of Design, Architecture, Art, and Planning, University of Cincinnati, Cincinnati, OH, USA
| | - P Minar
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A Meisman
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Saxe
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E A Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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161
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Vedolizumab Is Associated With a Lower Risk of Serious Infections Than Anti-Tumor Necrosis Factor Agents in Older Adults. Clin Gastroenterol Hepatol 2022; 20:1299-1305.e5. [PMID: 34481954 PMCID: PMC8891388 DOI: 10.1016/j.cgh.2021.08.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Despite the increased numbers of older adults with inflammatory bowel diseases (IBDs), there are few studies regarding the safety and effectiveness of IBD treatments in older adults. The aim of this study was to compare the safety and effectiveness of anti-tumor necrosis factor (TNF)-α agents and vedolizumab in older adults with IBD. METHODS We conducted a retrospective cohort study using an active comparator, new-user design for adults age 65 years and older with IBD initiating anti-TNF-α agents and vedolizumab in the Medicare claims database from 2014 to 2017. The primary safety outcome was infection-related hospitalization (excluding intra-abdominal and perianal abscesses). Co-primary outcomes to estimate effectiveness were IBD-related hospitalization, IBD-related surgery, and new corticosteroid use 60 days or more after biologic initiation. We performed propensity score weighting to control for confounding and estimated adjusted hazard ratios and 95% confidence intervals using standardized morbidity ratio-weighted variables. RESULTS We identified 1152 anti-TNF-α new users and 480 vedolizumab new users. The median age was 71 years in both cohorts and 11% were age 80 years or older. Crohn's disease patients comprised 54% of the anti-TNF-α cohort and 57% of the vedolizumab cohort. There was no significant difference in demographics, health care utilization, or frailty in both cohorts. More than half of both cohorts had a Charlson comorbidity index of 2 or higher. Vedolizumab users had a decreased risk of infection-related hospitalization (adjusted hazard ratio, 0.47; 95% confidence interval, 0.25-0.86). There was no significant difference in the outcomes approximating effectiveness. CONCLUSIONS Older IBD patients treated with vedolizumab had a lower risk of infection-related hospitalization compared with those initiating anti-TNFs. We observed no difference in effectiveness defined by hospitalizations, surgery, or new corticosteroid use.
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162
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Dahiya DS, Perisetti A, Kichloo A, Singh A, Goyal H, Rotundo L, Vennikandam M, Shaka H, Singh G, Singh J, Pisipati S, Al-Haddad M, Sanaka MR, Inamdar S. Increasing thirty-day readmissions of Crohn’s disease and ulcerative colitis in the United States: A national dilemma. World J Gastrointest Pathophysiol 2022; 13:85-95. [PMID: 35720163 PMCID: PMC9157684 DOI: 10.4291/wjgp.v13.i3.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/20/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of Crohn’s disease (CD) and ulcerative colitis (UC) is on the rise worldwide. This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.
AIM To identify trends and adverse outcomes for 30 d readmissions for CD and UC.
METHODS This was a retrospective, interrupted trends study involving all adult (≥ 18 years) 30 d readmissions of CD and UC from the National Readmission Database (NRD) between 2008 and 2018. Patients < 18 years, elective, and traumatic hospitalizations were excluded from this study. We identified hospitalization characteristics and readmission rates for each calendar year. Trends of inpatient mortality, mean length of hospital stay (LOS) and mean total hospital cost (THC) were calculated using a multivariate logistic trend analysis adjusting for age, gender, insurance status, comorbidity burden and hospital factors. Furthermore, trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations. Stata® Version 16 software (StataCorp, TX, United States) was used for statistical analysis and P value ≤ 0.05 were considered statistically significant.
RESULTS Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC. We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9% in 2010 to 17.6% in 2018 (P-trend < 0.001), CD specific readmission rate from 7.1% in 2010 to 8.2% in 2018 (P-trend < 0.001), 30-day all-cause readmission rate of UC from 14.1% in 2010 to 15.7% in 2018 (P-trend = 0.003), and UC specific readmission rate from 5.2% in 2010 to 5.6% in 2018 (P-trend = 0.029). There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions. However, we found an increasing trend of mean THC for UC readmissions. After comparison, there was no statistical difference in the trends for 30 d all-cause readmission rate, inpatient mortality, and mean LOS between CD and UC readmissions.
CONCLUSION There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48601, United States
| | - Abhilash Perisetti
- Division of Gastroenterology, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48601, United States
| | - Amandeep Singh
- Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Hemant Goyal
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31207, United States
| | - Laura Rotundo
- Section of Digestive Diseases, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Madhu Vennikandam
- Department of Gastroenterology and Hepatology, Sparrow Hospital/Michigan State University College of Human Medicine, Lansing, MI 48912, United States
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Gurdeep Singh
- Department of Internal Medicine, Our Lady of Lourdes Memorial Hospital, Binghamton, NY 13905, United States
| | - Jagmeet Singh
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Sailaja Pisipati
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Madhusudhan R Sanaka
- Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
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Mavragani A, Fisher EB, Boynton MH, Freelon D, Frohlich DO, Barnes EL, Noar SM. A Self-management SMS Text Messaging Intervention for People With Inflammatory Bowel Disease: Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e34960. [PMID: 35522471 PMCID: PMC9123538 DOI: 10.2196/34960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/04/2022] [Accepted: 04/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile health technologies can be useful for providing disease self-management information and support to people with inflammatory bowel disease (IBD). OBJECTIVE The aim of this study was to test a self-management SMS text messaging intervention for people with IBD. Our goal was to examine intervention feasibility, acceptability, and engagement and to preliminarily evaluate improvements in certain self-reported health outcomes among participants. METHODS We developed an SMS text messaging program called Text4IBD. The program sent daily support messages and resources about disease self-management over the course of a 2-week, single-group, pretest-posttest intervention to participants (N=114) diagnosed with IBD. We examined intervention feasibility, acceptability, and engagement through Text4IBD message topic recall and use of resources (ie, visiting supplemental websites recommended by the Text4IBD program). We also assessed pretest-posttest measures of IBD-related distress, self-efficacy, perceived support, use of coping strategies, and medication adherence. Analyses examined participants' evaluations of the intervention and compared pretest-posttest changes in secondary outcomes using paired-samples statistics. RESULTS Approximately all participants who completed the intervention (n=105) were receptive to Text4IBD and viewed the program as feasible and acceptable. In addition, most participants (103/105, 98.1%) recalled at least one of the message topics sent by the program, and 79% (83/105) of them self-reported engaging with at least one of the external self-management resources recommended by the Text4IBD program. Pretest-posttest results showed reduced IBD-related distress (mean 3.33, SD 0.68 vs mean 2.86, SD 0.73; P<.001) and improvements in most other secondary outcomes. CONCLUSIONS Findings from this study highlight the value of SMS text messaging as a useful digital medium for providing support to people with IBD, particularly to those who may struggle with disease-related distress. Text4IBD was highly feasible and acceptable and may help people self-manage their IBD. Future studies should aim to evaluate this program in a randomized controlled trial in clinical settings.
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Affiliation(s)
| | - Edwin B Fisher
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marcella H Boynton
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deen Freelon
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dennis O Frohlich
- Department of Media and Journalism, Bloomsburg University of Pennsylvania, Bloomsburg, PA, United States
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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164
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Gu P, Chhabra A, Chittajallu P, Chang C, Mendez D, Gilman A, Fudman DI, Xi Y, Feagins LA. Visceral Adipose Tissue Volumetrics Inform Odds of Treatment Response and Risk of Subsequent Surgery in IBD Patients Starting Antitumor Necrosis Factor Therapy. Inflamm Bowel Dis 2022; 28:657-666. [PMID: 34291800 DOI: 10.1093/ibd/izab167] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data describing the effect of obesity on antitumor necrosis factor (anti-TNF) treatment response are inconsistent. Visceral adipose tissue (VAT) is a superior marker of adiposity to body mass index. However, its effect on treatment response is unclear. We aimed to evaluate the effect of VAT on anti-TNF treatment response. METHODS Inflammatory bowel disease (IBD) patients starting anti-TNF agents between January 1, 2009, and July 31, 2019, were included. 3-dimensional measurements of VAT volume and visceral fat index (visceral:subcutaneous adipose tissue ratio; VFI) were obtained from computed tomography (CT) scans. Subjects were categorized by predefined volume cutoffs (<1500cm3, 1500-2999cm3, ≥3000cm3) and VFI (<0.33, 0.33-0.66, ≥0.67). Primary outcomes included a composite treatment response end point at 6 and 12 months. Secondary outcomes were surgery at 6 and 12 months. Multivariable logistic regression was used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS The final cohort included 176 patients. No significant differences in treatment response at 6 months was observed. At 12 months, compared with volume <1500cm3, patients with volume 1500-2999cm3 had higher odds of response (aOR, 3.52; 95% CI, 1.16-10.71; P = .023), whereas volume ≥3000cm3 did not. Compared with VFI<0.33, VFI ≥0.67 had higher odds of surgery at 6 (aOR, 48.22; 95% CI, 4.73-491.57; P = .023) and 12 months (aOR, 20.94; 95% CI, 3.14-139.67; P = .004). Post hoc analysis suggested VAT may affect drug pharmacokinetics. CONCLUSIONS We found VAT volume is associated with anti-TNF treatment response in a nondose dependent manner, and VFI may inform risk of surgery after anti-TNF initiation. If confirmed by prospective studies, VAT volumetrics are potentially useful biomarkers to inform IBD treatment decisions.
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Affiliation(s)
- Phillip Gu
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas,TX, USA.,Department of Internal Medicine, UT Southwestern, Dallas,TX, USA
| | - Avneesh Chhabra
- Division of Musculoskeletal Radiology, Department of Radiology, UT Southwestern, Dallas,TX, USA
| | | | | | - Denisse Mendez
- Department of Internal Medicine, UT Southwestern, Dallas,TX, USA
| | - Andrew Gilman
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas,TX, USA.,Department of Internal Medicine, UT Southwestern, Dallas,TX, USA
| | - David I Fudman
- Division of Digestive and Liver Diseases, UT Southwestern, Dallas,TX, USA.,Department of Internal Medicine, UT Southwestern, Dallas,TX, USA
| | - Yin Xi
- Division of Musculoskeletal Radiology, Department of Radiology, UT Southwestern, Dallas,TX, USA.,Department of Population and Data Sciences, UT Southwestern, Dallas,TX, USA
| | - Linda A Feagins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin,TX, USA
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Begam R, Shajahan A, Shefin B, Murugan V. Synthesis of novel naphthalimide tethered 1,2,3-triazoles: In vitro biological evaluation and docking study of anti-inflammatory inhibitors. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.132364] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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166
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Pang L, Liu H, Liu Z, Tan J, Zhou LY, Qiu Y, Lin X, He J, Li X, Lin S, Ghosh S, Mao R, Chen M. Role of Telemedicine in Inflammatory Bowel Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e28978. [PMID: 35323120 PMCID: PMC8990345 DOI: 10.2196/28978] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 10/14/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Telemedicine plays an important role in the management of inflammatory bowel disease (IBD), particularly during a pandemic such as COVID-19. However, the effectiveness and efficiency of telemedicine in managing IBD are unclear. OBJECTIVE This systematic review and meta-analysis aimed to compare the impact of telemedicine with that of standard care on the management of IBD. METHODS We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases on April 22, 2020. Randomized controlled trials comparing telemedicine with standard care in patients with IBD were included, while conference abstracts, letters, reviews, laboratory studies, and case reports were excluded. The IBD-specific quality of life (QoL), disease activity, and remission rate in patients with IBD were assessed as primary outcomes, and the number of in-person clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were assessed as secondary outcomes. Review Manage 5.3 and Stata 15.1 were used for data analysis. RESULTS A total of 17 randomized controlled trials (2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group (standard mean difference 0.18, 95% CI 0.01 to 0.34; P.03). The number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (standard mean difference -0.71, 95% CI -1.07 to -0.36; P<.001). Subgroup analysis showed that adolescents in the telemedicine group had significantly higher IBD-specific QoL than those in the standard care group (standard mean difference 0.42, 95% CI 0.15 to 0.69; I2=0; P.002), but there was no significant difference between adults in the 2 groups. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between the telemedicine and standard care groups. CONCLUSIONS Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits among patients with IBD. Further research is warranted to identify the group of patients with IBD who would most benefit from telemedicine.
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Affiliation(s)
- Lanlan Pang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hengyu Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhidong Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jinyu Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Long-Yuan Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoqing Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinshen He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuehua Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sinan Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Subrata Ghosh
- NIHR Biomedical Research Centre, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Lad A, Breidenbach JD, Su RC, Murray J, Kuang R, Mascarenhas A, Najjar J, Patel S, Hegde P, Youssef M, Breuler J, Kleinhenz AL, Ault AP, Westrick JA, Modyanov NN, Kennedy DJ, Haller ST. As We Drink and Breathe: Adverse Health Effects of Microcystins and Other Harmful Algal Bloom Toxins in the Liver, Gut, Lungs and Beyond. Life (Basel) 2022; 12:life12030418. [PMID: 35330169 PMCID: PMC8950847 DOI: 10.3390/life12030418] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 12/19/2022] Open
Abstract
Freshwater harmful algal blooms (HABs) are increasing in number and severity worldwide. These HABs are chiefly composed of one or more species of cyanobacteria, also known as blue-green algae, such as Microcystis and Anabaena. Numerous HAB cyanobacterial species produce toxins (e.g., microcystin and anatoxin—collectively referred to as HAB toxins) that disrupt ecosystems, impact water and air quality, and deter recreation because they are harmful to both human and animal health. Exposure to these toxins can occur through ingestion, inhalation, or skin contact. Acute health effects of HAB toxins have been well documented and include symptoms such as nausea, vomiting, abdominal pain and diarrhea, headache, fever, and skin rashes. While these adverse effects typically increase with amount, duration, and frequency of exposure, susceptibility to HAB toxins may also be increased by the presence of comorbidities. The emerging science on potential long-term or chronic effects of HAB toxins with a particular emphasis on microcystins, especially in vulnerable populations such as those with pre-existing liver or gastrointestinal disease, is summarized herein. This review suggests additional research is needed to define at-risk populations who may be helped by preventative measures. Furthermore, studies are required to develop a mechanistic understanding of chronic, low-dose exposure to HAB toxins so that appropriate preventative, diagnostic, and therapeutic strategies can be created in a targeted fashion.
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Affiliation(s)
- Apurva Lad
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Joshua D. Breidenbach
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Robin C. Su
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Jordan Murray
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Rebecca Kuang
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Alison Mascarenhas
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - John Najjar
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Shivani Patel
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Prajwal Hegde
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Mirella Youssef
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Jason Breuler
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Andrew L. Kleinhenz
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - Andrew P. Ault
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Judy A. Westrick
- Lumigen Instrumentation Center, Department of Chemistry, Wayne State University, Detroit, MI 48202, USA;
| | - Nikolai N. Modyanov
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
| | - David J. Kennedy
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
- Correspondence: (D.J.K.); (S.T.H.); Tel.: +1-419-383-6822 (D.J.K.); +1-419-383-6859 (S.T.H.)
| | - Steven T. Haller
- College of Medicine and Life Science, University of Toledo, Toledo, OH 43614, USA; (A.L.); (J.D.B.); (R.C.S.); (J.M.); (R.K.); (A.M.); (J.N.); (S.P.); (P.H.); (M.Y.); (J.B.); (A.L.K.); (N.N.M.)
- Correspondence: (D.J.K.); (S.T.H.); Tel.: +1-419-383-6822 (D.J.K.); +1-419-383-6859 (S.T.H.)
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Delaroque C, Chervy M, Gewirtz AT, Chassaing B. Social overcrowding impacts gut microbiota, promoting stress, inflammation, and dysglycemia. Gut Microbes 2022; 13:2000275. [PMID: 34856844 PMCID: PMC8726700 DOI: 10.1080/19490976.2021.2000275] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
An array of chronic inflammatory diseases, including metabolic diseases such as obesity and diabetes, are thought to be promoted by disturbance of the intestinal microbiota. Such diseases disproportionately impact low-income communities, which are frequently afflicted by chronic stress and increased density housing. Hence, we hypothesized that overcrowded housing might promote stress, microbiota dysbiosis, inflammation, and, consequently, metabolic diseases. We tested this hypothesis in a tractable murine model of social overcrowding (SOC), in which mice were housed at twice normal density. SOC moderately impacted behavior in some widely used assays (Open Field, Elevated Plus Maze and Light/Dark tests) and resulted in a stark increase in corticosterone levels. Such indices of stress were associated with mild chronic gut inflammation, hyperglycemia, elevations in colonic cytokines, and alterations in gut microbiota composition. All of these consequences of SOC were eliminated by broad spectrum antibiotics, while some (inflammation and hyperglycemia) were transmitted by microbiota transplantation from SOC mice to germfree mice housed at normal density. Altogether, these results suggest a central role for intestinal microbiota in driving stress, inflammation, and chronic diseases that are promoted by overcrowded housing.
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Affiliation(s)
- Clara Delaroque
- Inserm U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases”, Cnrs Umr 8104, Université de Paris, Paris, France
| | - Mélissa Chervy
- Université Clermont Auvergne, Inserm U1071; Usc-inrae 2018, Microbes, Intestin, Inflammation Et Susceptibilité de l’Hôte (M2ish), 28 Place Henri Dunant, Clermont-Ferrand, France
| | - Andrew T. Gewirtz
- Center for Inflammation, Immunity and Infection, Institute for Biomedical Sciences, Georgia State University, GeorgiaCalifornia, USA
| | - Benoit Chassaing
- Inserm U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases”, Cnrs Umr 8104, Université de Paris, Paris, France,CONTACT Benoit Chassaing Inserm, U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases” Paris, France
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Hu C, Patil Y, Gong D, Yu T, Li J, Wu L, Liu X, Yu Z, Ma X, Yong Y, Chen J, Gooneratne R, Ju X. Heat Stress-Induced Dysbiosis of Porcine Colon Microbiota Plays a Role in Intestinal Damage: A Fecal Microbiota Profile. Front Vet Sci 2022; 9:686902. [PMID: 35300220 PMCID: PMC8921775 DOI: 10.3389/fvets.2022.686902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 01/24/2022] [Indexed: 12/30/2022] Open
Abstract
The pathological mechanisms of gastrointestinal disorders, including inflammatory bowel disease (IBD), in pigs are poorly understood. We report the induction of intestinal inflammation in heat-stressed (HS) pigs, fecal microbiota transplantation from pigs to mice, and explain the role of microorganisms in IBD. 24 adult pigs were subjected to HS (34 ± 1 °C; 75–85% relative humidity for 24h) while 24 control pigs (CP) were kept at 25 ± 3°C and the same humidity. Pigs were sacrificed on days 1, 7, 14, 21. Colonic content microbiome analyses were conducted. Pseudo-germ-free mice were fed by gavage with fecal microbiota from HS-pigs and CP to induce pig-like responses in mice. From 7 d, HS-pigs exhibited fever and diarrhea, and significantly lower colonic mucosal thickness, crypt depth/width, and goblet cell number. Compared with each control group, the concentration of cortisol in the peripheral blood of HS pigs gradually increased, significantly so on days 7, 14, and 21 (P < 0.01). While the concentration of LPS in HS pigs' peripheral blood was significantly higher on days 7, 14 (P < 0.01), and 21 (P < 0.05) compared with that of the control group. The colonic microbiome composition of HS-pigs was different to that of CP. By day 14, opportunistic pathogens (e.g., Campylobacterales) had increased in HS-pigs. The composition of the colonic microbiome in mice administered feces from HS-pigs was different from those receiving CP feces. Bacteroides were significantly diminished, Akkermansia were significantly increased, and intestinal damage and goblet cell numbers were higher in mice that received HS-pig feces. Moreover, we verified the relevance of differences in the microbiota of the colon among treatments. Heat stress promotes changes in gut microbiome composition, which can affect the colonic microbial structure of mice through fecal microbiota transplantation; the molecular mechanisms require further investigation. This study enhanced our understanding of stress-induced inflammation in the colon and the increase in diarrhea in mammals subjected to prolonged HS. Our results provide useful information for preventing or ameliorating deficits in pig production caused by prolonged exposure to high temperatures.
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Affiliation(s)
- Canying Hu
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
- Shenzhen Institute of Guangdong Ocean University, Shenzhen, China
| | - Yadnyavalkya Patil
- Department of Wine, Food and Molecular Biosciences, Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln, New Zealand
| | - Dongliang Gong
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
| | - Tianyue Yu
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
| | - Junyu Li
- Department of Veterinary Medicine, College of Agriculture, Guangdong Ocean University, Zhanjiang, China
| | - Lianyun Wu
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
| | - Xiaoxi Liu
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
| | - Zhichao Yu
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
| | - Xinbing Ma
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
| | - Yanhong Yong
- Department of Veterinary Medicine, College of Agriculture, Guangdong Ocean University, Zhanjiang, China
| | - Jinjun Chen
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
| | - Ravi Gooneratne
- Department of Wine, Food and Molecular Biosciences, Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln, New Zealand
| | - Xianghong Ju
- Department of Animal Science, Agricultural College, Guangdong Ocean University, Zhanjiang, China
- Shenzhen Institute of Guangdong Ocean University, Shenzhen, China
- Department of Veterinary Medicine, College of Agriculture, Guangdong Ocean University, Zhanjiang, China
- *Correspondence: Xianghong Ju
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Gobert AP, Latour YL, Asim M, Barry DP, Allaman MM, Finley JL, Smith TM, McNamara KM, Singh K, Sierra JC, Delgado AG, Luis PB, Schneider C, Washington MK, Piazuelo MB, Zhao S, Coburn LA, Wilson KT. Protective Role of Spermidine in Colitis and Colon Carcinogenesis. Gastroenterology 2022; 162:813-827.e8. [PMID: 34767785 PMCID: PMC8881368 DOI: 10.1053/j.gastro.2021.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Because inflammatory bowel disease is increasing worldwide and can lead to colitis-associated carcinoma (CAC), new interventions are needed. We have shown that spermine oxidase (SMOX), which generates spermidine (Spd), regulates colitis. Here we determined whether Spd treatment reduces colitis and carcinogenesis. METHODS SMOX was quantified in human colitis and associated dysplasia using quantitative reverse-transcription polymerase chain reaction and immunohistochemistry. We used wild-type (WT) and Smox-/- C57BL/6 mice treated with dextran sulfate sodium (DSS) or azoxymethane (AOM)-DSS as models of colitis and CAC, respectively. Mice with epithelial-specific deletion of Apc were used as a model of sporadic colon cancer. Animals were supplemented or not with Spd in the drinking water. Colonic polyamines, inflammation, tumorigenesis, transcriptomes, and microbiomes were assessed. RESULTS SMOX messenger RNA levels were decreased in human ulcerative colitis tissues and inversely correlated with disease activity, and SMOX protein was reduced in colitis-associated dysplasia. DSS colitis and AOM-DSS-induced dysplasia and tumorigenesis were worsened in Smox-/- vs WT mice and improved in both genotypes with Spd. Tumor development caused by Apc deletion was also reduced by Spd. Smox deletion and AOM-DSS treatment were both strongly associated with increased expression of α-defensins, which was reduced by Spd. A shift in the microbiome, with reduced abundance of Prevotella and increased Proteobacteria and Deferribacteres, occurred in Smox-/- mice and was reversed with Spd. CONCLUSIONS Loss of SMOX is associated with exacerbated colitis and CAC, increased α-defensin expression, and dysbiosis of the microbiome. Spd supplementation reverses these phenotypes, indicating that it has potential as an adjunctive treatment for colitis and chemopreventive for colon carcinogenesis.
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Affiliation(s)
- Alain P Gobert
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee; Program in Cancer Biolog Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yvonne L Latour
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohammad Asim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Barry
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret M Allaman
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jordan L Finley
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thaddeus M Smith
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kara M McNamara
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Program in Cancer Biolog Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kshipra Singh
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Johanna C Sierra
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alberto G Delgado
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paula B Luis
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Claus Schneider
- Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - M Kay Washington
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - M Blanca Piazuelo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shilin Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lori A Coburn
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee; Program in Cancer Biolog Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Keith T Wilson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tennessee; Program in Cancer Biolog Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee.
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171
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Nasir K, Acquah I, Dey AK, Agrawal T, Hassan SZ, Glassner K, Abraham B, Quigley EM, Blankstein R, Virani SS, Blaha MJ, Valero-Elizondo J, Cainzos-Achirica M, Mehta NN. Inflammatory bowel disease and atherosclerotic cardiovascular disease in U.S. adults—A population-level analysis in the national health interview survey. Am J Prev Cardiol 2022; 9:100316. [PMID: 35112094 PMCID: PMC8790599 DOI: 10.1016/j.ajpc.2022.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/31/2021] [Accepted: 01/15/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate the association between inflammatory bowel disease (IBD) and atherosclerotic cardiovascular disease (ASCVD) and whether this association is modified by age or sex. Methods We conducted a cross-sectional analysis using data from the 2015–2016 National Health Interview Survey (NHIS). The exposure of interest was self-reported IBD. The outcome of interest was prevalent ASCVD, which included a history of angina, myocardial infarction or stroke. We used survey-specific descriptive statistics to obtain weighted national estimates for IBD and ASCVD prevalence. Logistic regression models were used to assess the association between IBD and ASCVD, progressively adjusting for demographics and traditional risk factors. Effect modification by age and sex was evaluated. Results Among participants with IBD, the age-adjusted prevalence of ASCVD was 12.0% compared to 6.9% among those without IBD (p < 0.001). In multivariable regression analyses IBD was associated with increased odds of having ASCVD, even after adjustment for demographics and traditional risk factors (odds ratio 1.58, 95% CI 1.17–2.13). We found statistically significant interaction by age (p < 0.001) whereby those in the younger age strata had the strongest association (fully adjusted odds ratio among 18- to 44-year-olds 3.35, 95% CI 1.75, 6.40) while the association was null in those ≥65 years. Effect modification by sex was not observed. Conclusion Our analysis confirms an independent association between IBD and ASCVD in the U.S., particularly among young adults. Further studies are needed to fully establish a causal relationship between IBD and ASCVD, characterize the mechanisms underlying these associations, and identify tailored opportunities for ASCVD prevention in young and middle-aged adults with IBD.
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172
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Xu F, Wheaton AG, Liu Y, Greenlund KJ. Major ambulatory surgery among US adults with inflammatory bowel disease, 2017. PLoS One 2022; 17:e0264372. [PMID: 35202440 PMCID: PMC8870533 DOI: 10.1371/journal.pone.0264372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/09/2022] [Indexed: 01/13/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) have higher health services use than those without IBD. We investigated patient and hospital characteristics of major ambulatory surgery encounters for Crohn’s disease (CD) or ulcerative colitis (UC) vs non-IBD patients. Methods We conducted a cross-sectional study using 2017 Nationwide Ambulatory Surgery Sample. Major ambulatory surgery encounters among patients aged ≥18 years with CD (n = 20,635) or UC (n = 9,894) were compared to 9.4 million encounters among non-IBD patients. Weighted percentages of patient characteristics (age, sex, median household income, primary payers, patient location, selected comorbidities, discharge destination, type of surgeries) and hospital-related characteristics (hospital size, ownership, location and teaching status, region) were compared by IBD status (CD, UC, and no IBD). Linear regression was used to estimate mean total charges, controlling for these characteristics. Results Compared with non-IBD patients, IBD patients were more likely to have private insurance, reside in urban areas and higher income zip codes, and undergo surgeries in hospitals that were private not-for-profit, urban teaching, and in the Northeast. Gastrointestinal surgeries were more common among IBD patients. Some comorbidities associated with increased risk of surgical complications were more prevalent among IBD patients. Total charges were 9% lower for CD patients aged <65 years (Median: $16,462 vs $18,106) and 6% higher for UC patients aged ≥65 years (Median: $16,909 vs $15,218) compared to their non-IBD patient counterparts. Conclusions Differences in characteristics of major ambulatory surgery encounters by IBD status may identify opportunities for efficient resource allocation and positive surgical outcomes among IBD patients.
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Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Anne G. Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Kurt J. Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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173
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Pan L, Fu T, Cheng H, Mi J, Shang Q, Yu G. Polysaccharide from edible alga Gloiopeltis furcata attenuates intestinal mucosal damage by therapeutically remodeling the interactions between gut microbiota and mucin O-glycans. Carbohydr Polym 2022; 278:118921. [PMID: 34973740 DOI: 10.1016/j.carbpol.2021.118921] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/11/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Abstract
Gloiopeltis furcata is an edible alga that has long been consumed in China. However, the bioactive polysaccharides from G. furcata have been largely unexplored. Here, we show for the first time that a sulfated polysaccharide from G. furcata (SAO) could improve the integrity of the colonic epithelial layer and protect against dextran sulfate sodium-induced intestinal mucosal damage. Mechanistically, SAO attenuated colonic mucosal damage by therapeutically remodeling the interactions between gut microbiota and mucin O-glycans. Specifically, SAO increased the proportions of complex long-chain mucin O-glycans in the epithelial layer with two terminal N-acetylneuraminic acid residues and promoted the growth of probiotic bacteria including Roseburia spp. and Muribaculaceae. Altogether, our study demonstrates a novel application of SAO for the treatment of inflammatory bowel disease-associated mucosal damage and forms the basis to understand the therapeutic effects of natural polysaccharides from the perspective of symbiotic interactions between host mucin O-glycome and gut microbiome.
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Affiliation(s)
- Lin Pan
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Tianyu Fu
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Hao Cheng
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Jianchen Mi
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
| | - Qingsen Shang
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Qingdao Marine Biomedical Research Institute, Qingdao 266071, China.
| | - Guangli Yu
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China; Laboratory for Marine Drugs and Bioproducts, Qingdao National Laboratory for Marine Science and Technology, Qingdao 266003, China.
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174
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Arjomand A, Suskind DL. Clinical and Histologic Remission in an Adult Crohn’s Disease Patient Following the Specific Carbohydrate Diet and Its Impact on Healthcare Costs. Cureus 2022; 14:e22032. [PMID: 35340483 PMCID: PMC8913515 DOI: 10.7759/cureus.22032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/05/2022] Open
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175
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Wang JH, D’Arcy M, Barnes EL, Freedman ND, Engels EA, Song M. Associations of Inflammatory Bowel Disease and Subsequent Cancers in a Population-Based Study of Older Adults in the United States. JNCI Cancer Spectr 2022; 6:pkab096. [PMID: 35071980 PMCID: PMC8767622 DOI: 10.1093/jncics/pkab096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Cancer risk is elevated in patients with inflammatory bowel disease (IBD). A comprehensive investigation of cancer risk in older patients (≥66 years of age) is needed, because this understudied population is at high risk. METHODS We performed a case-control study using Surveillance Epidemiology and End Results-Medicare data including 1 986 735 incident cancer cases (aged 66-99 years; diagnosed 1992-2015) and 200 000 controls matched by sex, age, race and ethnicity, and selection year. IBD was identified by ulcerative colitis (UC) or Crohn's disease (CD) diagnosis codes. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with logistic regression, adjusting for potential confounders. For colorectal cancers, we further adjusted for screening rates. We assessed confounding by medication exposure among patients with prescription drug coverage. RESULTS IBD, CD, and UC were present in 0.8%, 0.3%, and 0.5% in both cancer cases and non-cancer controls. Of 51 cancers examined, IBD was statistically significantly associated with cancers of the small intestine (OR = 2.55, 95% CI = 2.15 to 3.01), intrahepatic (OR = 1.92, 95% CI = 1.47 to 2.51) and extrahepatic bile ducts (OR = 1.75, 95% CI = 1.38 to 2.22), rectum (OR = 1.61, 95% CI = 1.36 to 1.90), and colon (OR = 1.21, 95% CI = 1.10 to 1.33). CD was associated with cancers of the small intestine (OR = 4.55, 95% CI = 3.65 to 5.67), and UC was associated with cancers of the intrahepatic bile ducts (OR = 1.87, 95% CI = 1.34 to 2.61), rectum (OR = 1.80, 95% CI = 1.47 to 2.20), and colon (OR = 1.28, 95% CI = 1.14 to 1.43). After adjusting for medication exposure, IBD was not statistically significantly associated with lung cancer, melanoma, diffuse large B-cell lymphoma, and myelodysplastic syndrome. CONCLUSIONS In this large study among older adults (≥66 years of age), IBD was positively associated with gastrointestinal cancers. Associations with extraintestinal cancers may reflect the effect of immunosuppressive medications.
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Affiliation(s)
- Jeanny H Wang
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Monica D’Arcy
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, MD, USA
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Minkyo Song
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, MD, USA
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176
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Gorbenko KO, Riggs AR, Koeppel B, Phlegar S, Dubinsky MC, Ungaro R, Keefer L. Photovoice as a tool to improve patient-Provider communication in inflammatory bowel disease clinic: A feasibility study. J Eval Clin Pract 2022; 28:159-168. [PMID: 34382292 DOI: 10.1111/jep.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The emotional health of patients with inflammatory bowel disease (IBD) is critical to self-management, but has been difficult to elucidate in routine care. Patients are often unsure how to communicate their preferences and concerns to their providers in ways that could directly inform shared decision making. Photovoice is an established research methodology used to give vulnerable patients a voice through photographic expression, but has not been previously used in gastroenterology or in IBD. OBJECTIVE To determine the acceptability and feasibility of using Photovoice in an IBD clinic. PATIENT INVOLVEMENT Patients with IBD took photos in response to open-ended prompts, participated in a focus group, and brainstormed ways to share their experience with clinicians. METHODS Enrolled IBD patients received a digital camera, training on basic usage and 10 open-ended prompts related to management of their IBD. Participants completed one-hour in-depth interviews about their photos, which were audio-recorded and professionally transcribed. Three analysts coded transcripts for themes using qualitative analysis software QSR NVivo 11. A subset of patients participated in a focus group about their Photovoice experience. Gastroenterologists were interviewed, using patient photos as prompts, to evaluate feasibility of using Photovoice in the clinic. RESULTS Eleven patients completed the interviews, with five participating in the focus group. Patients shared and discussed a total of 118 photographs. We identified two major themes: disease burden and patient - provider communication. Five IBD physicians reviewed select patient photos and suggested ways to incorporate Photovoice into clinical practice. DISCUSSION Photovoice may be a feasible methodology for patients with IBD and acceptable for providers to use in a clinical setting. PRACTICAL VALUE Photovoice may help providers identify patient concerns and make their communication more patient-centred.
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Affiliation(s)
- Ksenia O Gorbenko
- Mount Sinai Health System, Institute for Health Care Delivery Science, New York, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexa Rae Riggs
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brooke Koeppel
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sydney Phlegar
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marla C Dubinsky
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan Ungaro
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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177
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Marques ICDS, Herbey II, Theiss LM, Shao CC, Fouad MN, Scarinci IC, Chu DI. Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): The importance of health literacy. Am J Surg 2022; 223:303-311. [PMID: 34119329 PMCID: PMC8655316 DOI: 10.1016/j.amjsurg.2021.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Racial/ethnic disparities in outcomes exist for patients with inflammatory bowel disease (IBD) undergoing surgery. The underlying mechanism(s) remain unclear and patient perspectives are needed. We therefore aimed to characterize the surgical experience for Black and White IBD patients using qualitative methods. METHODS Patients with IBD who had undergone surgery were recruited to same-race qualitative interviews. Semi-structured interviews explored barriers and facilitators to a positive or negative surgical experience. Transcripts were analyzed with NVivo 12 software. RESULTS Six focus groups were conducted that included 10 Black and 17 White IBD participants. The mean age was 44.8 years (SD 13.2), 52% were male and 65% had Crohn's disease. Four themes emerged that most defined the surgical experience: the impact of the IBD diagnosis, the quality of provided information, disease management and the surgery itself. Within these themes, barriers to a positive surgical experience included inadequate personal knowledge of IBD, ineffective written and verbal communication, lack of a support system and complications after surgery. Both groups reported that information was provided inconsistently which led to unclear expectations of surgical outcomes. CONCLUSIONS Black and White patients with IBD have varied surgical experiences but all stressed the importance of accurate, trustworthy and understandable health information. These findings highlight the value of providing health literacy-sensitive care in surgery.
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Affiliation(s)
| | - Ivan I. Herbey
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Lauren M. Theiss
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Connie C. Shao
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Mona N. Fouad
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Isabel C. Scarinci
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel I. Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL.,Corresponding Author: Daniel I. Chu MD MSPH,
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178
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Serafini MA, Paz AH, Nunes NS. Cholinergic immunomodulation in inflammatory bowel diseases. Brain Behav Immun Health 2022; 19:100401. [PMID: 34977822 PMCID: PMC8683952 DOI: 10.1016/j.bbih.2021.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 12/28/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are chronic intestinal disorders characterized by dysregulated immune responses to resident microbiota in genetically susceptible hosts. The activation of the cholinergic system has been proposed for the treatment of IBD patients according to its potential anti-inflammatory effect in vivo. The α-7-nicotinic-acetylcholine receptor (α7nAChR) is involved in the inhibition of inflammatory processes, modulating the production of cytokines, suppressing dendritic cells and macrophage activity, leading to the suppression of T cells. In this review, we address the most recent studies and clinical trials concerning cholinergic signaling and its therapeutic potential for inflammatory bowel diseases.
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Affiliation(s)
- Michele A. Serafini
- Biological Sciences, Physiology Graduate Program, Federal University of Rio Grande do Sul, 90050170, Porto Alegre, Brazil
- Cells, Tissue and Genes Laboratory, Experimental Research Center, Hospital de Clinicas de Porto Alegre, 90035903, Porto Alegre, Brazil
| | - Ana H. Paz
- Morphological Sciences Department, Basic Health Sciences Institute, Federal University of Rio Grande do Sul, 90050170, Porto Alegre, Brazil
- Cells, Tissue and Genes Laboratory, Experimental Research Center, Hospital de Clinicas de Porto Alegre, 90035903, Porto Alegre, Brazil
| | - Natalia S. Nunes
- Experimental Transplantation Immunotherapy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 20852, Bethesda, MD, USA
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179
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Raffals LE, Saha S, Bewtra M, Norris C, Dobes A, Heller C, O’Charoen S, Fehlmann T, Sweeney S, Weaver A, Bishu S, Cross R, Dassopoulos T, Fischer M, Yarur A, Hudesman D, Parakkal D, Duerr R, Caldera F, Korzenik J, Pekow J, Wells K, Bohm M, Perera L, Kaur M, Ciorba M, Snapper S, Scoville EA, Dalal S, Wong U, Lewis JD. The Development and Initial Findings of A Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease (SPARC IBD). Inflamm Bowel Dis 2022; 28:192-199. [PMID: 34436563 PMCID: PMC9013198 DOI: 10.1093/ibd/izab071] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clinical and molecular subcategories of inflammatory bowel disease (IBD) are needed to discover mechanisms of disease and predictors of response and disease relapse. We aimed to develop a study of a prospective adult research cohort with IBD (SPARC IBD) including longitudinal clinical and patient-reported data and biosamples. METHODS We established a cohort of adults with IBD from a geographically diverse sample of patients across the United States with standardized data and biosample collection methods and sample processing techniques. At enrollment and at time of lower endoscopy, patient-reported outcomes (PRO), clinical data, and endoscopy scoring indices are captured. Patient-reported outcomes are collected quarterly. The quality of clinical data entry after the first year of the study was assessed. RESULTS Through January 2020, 3029 patients were enrolled in SPARC, of whom 66.1% have Crohn's disease (CD), 32.2% have ulcerative colitis (UC), and 1.7% have IBD-unclassified. Among patients enrolled, 990 underwent colonoscopy. Remission rates were 63.9% in the CD group and 80.6% in the UC group. In the quality study of the cohort, there was 96% agreement on year of diagnosis and 97% agreement on IBD subtype. There was 91% overall agreement describing UC extent as left-sided vs extensive or pancolitis. The overall agreement for CD behavior was 83%. CONCLUSION The SPARC IBD is an ongoing large prospective cohort with longitudinal standardized collection of clinical data, biosamples, and PROs representing a unique resource aimed to drive discovery of clinical and molecular markers that will meet the needs of precision medicine in IBD.
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Affiliation(s)
| | - Sumona Saha
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Meenakshi Bewtra
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cecile Norris
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Angela Dobes
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Caren Heller
- Crohn’s & Colitis Foundation, New York, New York, USA
| | | | - Tara Fehlmann
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Sara Sweeney
- Crohn’s & Colitis Foundation, New York, New York, USA
| | | | | | - Raymond Cross
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Andres Yarur
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David Hudesman
- New York University Langone Health, New York, New York, USA
| | - Deepak Parakkal
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Richard Duerr
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Freddy Caldera
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Joel Pekow
- University of Chicago, Chicago, Illinois, USA
| | - Katerina Wells
- Baylor Scott and White Health and Baylor University Medical Center at Dallas, TX, USA
| | | | - Lilani Perera
- Advocate Aurora Healthcare, Milwaukee, Wisconsin, USA
| | | | - Matthew Ciorba
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Scott Snapper
- Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | - Uni Wong
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James D Lewis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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180
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Bao S, Tang Y, Lee HH, Gao R, Yang Q, Yu X, Chiron S, Coburn LA, Wilson KT, Roland JT, Landman BA, Huo Y. Inpainting Missing Tissue in Multiplexed Immunofluorescence Imaging. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12039:120390K. [PMID: 35531320 PMCID: PMC9070577 DOI: 10.1117/12.2611827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Multiplex immunofluorescence (MxIF) is an emerging technique that allows for staining multiple cellular and histological markers to stain simultaneously on a single tissue section. However, with multiple rounds of staining and bleaching, it is inevitable that the scarce tissue may be physically depleted. Thus, a digital way of synthesizing such missing tissue would be appealing since it would increase the useable areas for the downstream single-cell analysis. In this work, we investigate the feasibility of employing generative adversarial network (GAN) approaches to synthesize missing tissues using 11 MxIF structural molecular markers (i.e., epithelial and stromal). Briefly, we integrate a multi-channel high-resolution image synthesis approach to synthesize the missing tissue from the remaining markers. The performance of different methods is quantitatively evaluated via the downstream cell membrane segmentation task. Our contribution is that we, for the first time, assess the feasibility of synthesizing missing tissues in MxIF via quantitative segmentation. The proposed synthesis method has comparable reproducibility with the baseline method on performance for the missing tissue region reconstruction only, but it improves 40% on whole tissue synthesis that is crucial for practical application. We conclude that GANs are a promising direction of advancing MxIF imaging with deep image synthesis.
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Affiliation(s)
- Shunxing Bao
- Dept. of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
- Dept. of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Yucheng Tang
- Dept. of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Ho Hin Lee
- Dept. of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Riqiang Gao
- Dept. of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Qi Yang
- Dept. of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Xin Yu
- Dept. of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Sophie Chiron
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori A Coburn
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Mucosal Inflammation and Cancer, Nashville, TN, USA
- Dept. of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Keith T Wilson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Mucosal Inflammation and Cancer, Nashville, TN, USA
- Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
- Dept. of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Joseph T Roland
- Epithelial Biology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett A Landman
- Dept. of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
- Dept. of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Yuankai Huo
- Dept. of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
- Dept. of Computer Science, Vanderbilt University, Nashville, TN, USA
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181
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Montenegro ML, Corral JE, Lukens FJ, Ji B, Kröner PT, Farraye FA, Bi Y. Pancreatic Disorders in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:423-436. [PMID: 33625614 DOI: 10.1007/s10620-021-06899-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) can involve multiple organ systems, and pancreatic manifestations of IBD are not uncommon. The incidence of several pancreatic diseases is more frequent in patients with Crohn's disease and ulcerative colitis than in the general population. Pancreatic manifestations in IBD include a heterogeneous group of disorders and abnormalities ranging from mild, self-limited disorders to severe diseases. Asymptomatic elevation of amylase and/or lipase is common. The risk of acute pancreatitis in patients with IBD is increased due to the higher incidence of cholelithiasis and drug-induced pancreatitis in this population. Patients with IBD commonly have altered pancreatic histology and chronic pancreatic exocrine dysfunction. Diagnosing acute pancreatitis in patients with IBD is challenging. In this review, we discuss the manifestations and possible causes of pancreatic abnormalities in patients with IBD.
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Affiliation(s)
- Marilia L Montenegro
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Juan E Corral
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Baoan Ji
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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182
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Ishida T, Matsui H, Matsuda Y, Hosomi R, Shimono T, Kanda S, Nishiyama T, Fukunaga K, Yoshida M. Oyster (Crassostrea gigas) Extract Attenuates Dextran Sulfate Sodium-Induced Acute Experimental Colitis by Improving Gut Microbiota and Short-Chain Fatty Acids Compositions in Mice. Foods 2022; 11:foods11030373. [PMID: 35159523 PMCID: PMC8834099 DOI: 10.3390/foods11030373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/11/2022] Open
Abstract
Drugs for inflammatory bowel diseases can be associated with serious side effects, and the development of alternative candidate resources derived from natural products has attracted considerable attention. Oyster extract (OE) derived from Crassostrea gigas contains glycogen, taurine, and amino acids, and has been assigned diverse health-promoting properties. This study investigated the anti-colitis effect of OE intake on fecal microbiota and its metabolites of acute experimental colitis mouse model induced by dextran sulfate sodium (DSS). C57BL/6J mice (male) were divided into three groups: (1) American Institute of Nutrition (AIN) 93G diet + DSS-untreated, (2) AIN93G diet + DSS-treated, and (3) 5% OE diet + DSS-treated. Mice were fed each diet for 21 days, and then administered 2.5% DSS solution to induce acute colitis for 7 days. In DSS-induced colitis mice, OE decreased body weight loss and increased disease activity index during the DSS-induced period. In addition, OE tended to decrease the colon length shortening and the relative spleen weight and alleviated colonic tissue damage. Moreover, OE improved fecal short-chain fatty acids compositions and altered the structure of fecal microbiota. These results provide insight into the health-promoting property of OE in alleviating DSS-induced acute colitis, providing a basis for the development and use of functional foods.
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Affiliation(s)
- Tatsuya Ishida
- Central Research Institute, Japan Clinic Co., Ltd., 1 Nishimachi, Taishogun, Kyoto 603-8331, Japan; (T.I.); (H.M.); (Y.M.)
| | - Hiroyuki Matsui
- Central Research Institute, Japan Clinic Co., Ltd., 1 Nishimachi, Taishogun, Kyoto 603-8331, Japan; (T.I.); (H.M.); (Y.M.)
| | - Yoshikazu Matsuda
- Central Research Institute, Japan Clinic Co., Ltd., 1 Nishimachi, Taishogun, Kyoto 603-8331, Japan; (T.I.); (H.M.); (Y.M.)
| | - Ryota Hosomi
- Faculty of Chemistry, Materials, and Bioengineering, Kansai University, 3-3-35 Yamate-cho, Osaka 564-8680, Japan; (K.F.); (M.Y.)
- Correspondence: ; Tel.: +81-66-3681-765
| | - Takaki Shimono
- Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Osaka 573-1010, Japan; (T.S.); (S.K.); (T.N.)
| | - Seiji Kanda
- Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Osaka 573-1010, Japan; (T.S.); (S.K.); (T.N.)
| | - Toshimasa Nishiyama
- Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Osaka 573-1010, Japan; (T.S.); (S.K.); (T.N.)
| | - Kenji Fukunaga
- Faculty of Chemistry, Materials, and Bioengineering, Kansai University, 3-3-35 Yamate-cho, Osaka 564-8680, Japan; (K.F.); (M.Y.)
| | - Munehiro Yoshida
- Faculty of Chemistry, Materials, and Bioengineering, Kansai University, 3-3-35 Yamate-cho, Osaka 564-8680, Japan; (K.F.); (M.Y.)
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183
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Coscueta ER, Sousa AS, Reis CA, Pintado MM. Phenylethyl Isothiocyanate: A Bioactive Agent for Gastrointestinal Health. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27030794. [PMID: 35164058 PMCID: PMC8838155 DOI: 10.3390/molecules27030794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 12/30/2022]
Abstract
The incidence of gastrointestinal pathologies (cancer in particular) has increased progressively, with considerable morbidity and mortality, and a high economic impact on the healthcare system. The dietary intake of natural phytochemicals with certain bioactive properties has shown therapeutic and preventive effects on these pathologies. This includes the cruciferous vegetable derivative phenylethyl isothiocyanate (PEITC), a bioactive compound present in some vegetables, such as watercress. Notably, PEITC has antioxidant, anti-inflammatory, bactericidal, and anticarcinogenic properties. This review summarized the current knowledge on the role of PEITC as a potential natural nutraceutical or an adjuvant against oxidative/inflammatory-related disorders in the gastrointestinal tract. We also discussed the safe and recommended dose of PEITC. In addition, we established a framework to guide the research and development of sustainable methodologies for obtaining and stabilizing this natural molecule for industrial use. With PEITC, there is great potential to develop a viable strategy for preventing cancer and other associated diseases of the gastrointestinal tract. However, this topic still needs more scientific studies to help develop new PEITC products for the nutraceutical, pharmaceutical, or food industries.
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Affiliation(s)
- Ezequiel R. Coscueta
- CBQF—Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal; (A.S.S.); (M.M.P.)
- Correspondence: ; Tel.: +351-225-580-001 (ext. 8047)
| | - Ana Sofia Sousa
- CBQF—Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal; (A.S.S.); (M.M.P.)
| | - Celso A. Reis
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4169-005 Porto, Portugal;
- IPATIMUP—Institute of Molecular Pathology and Immunology, University of Porto, 4169-005 Porto, Portugal
- Medical Faculty, University of Porto, Al. Prof. Hernâni Monteiro, 4169-005 Porto, Portugal
| | - Maria Manuela Pintado
- CBQF—Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal; (A.S.S.); (M.M.P.)
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184
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Kochar B, Ufere NN, Ritchie CS, Lai JC. The 5Ms of Geriatrics in Gastroenterology: The Path to Creating Age-Friendly Care for Older Adults With Inflammatory Bowel Diseases and Cirrhosis. Clin Transl Gastroenterol 2022; 13:e00445. [PMID: 35080513 PMCID: PMC8806384 DOI: 10.14309/ctg.0000000000000445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 12/22/2022] Open
Abstract
The number of Americans 65 years or older in 2060 will be more than double what it was in 2014. Approximately 40% of patients seen in gastroenterology (GI) and hepatology practices in the United States are 60 years or older. Adapting care delivery models, curating data on shifting risk-benefit decisions with geriatric syndromes, understanding appropriate assessments, and focusing on tailored implementation strategies are challenges that are actively confronting us as we provide care for a burgeoning population of older adults. Limited availability of geriatric specialists results in an onus of specialists caring for older adults, such as gastroenterologists, to innovate and develop tailored, comprehensive, and evidence-based care for adults in later life stages. In this article, we present the 5M framework from geriatrics to achieve age-friendly healthcare. The 5Ms are medications, mind, mobility, multicomplexity, and what matters most. We apply the 5M framework to 2 chronic conditions commonly encountered in clinical GI practice: inflammatory bowel diseases and cirrhosis. We highlight knowledge gaps and outline future directions to expand evidence-based care and advance the creation of age-friendly GI care.
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Affiliation(s)
- Bharati Kochar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Boston, Massachusetts, USA
| | - Nneka N. Ufere
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine S. Ritchie
- Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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185
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Honeycutt A, Breck A, Bass S, Esposito D. Impact analysis of expanding anti-TNF therapy for Crohn's disease. J Comp Eff Res 2022; 11:79-88. [PMID: 35014551 DOI: 10.2217/cer-2021-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To estimate the impact of universal anti-TNF therapy in patients with moderate-to-severe Crohn's disease. Materials & methods: Developed a population-level Markov model to estimate the impact on health outcomes and medical expenditures of expanding anti-TNF therapy use versus current treatment practices. Results: Reductions in deaths (2600), hip fractures (980), major adverse cardiac events (2700) and patient out-of-pocket medical spending (2%) over 5 years. Total societal costs would be US$22,100 higher per patient per year, primarily due to the high cost of anti-TNF therapy. Conclusion: Expanding anti-TNF therapy use among US adult patients with moderate-to-severe Crohn's disease would reduce morbidity and mortality, decrease disease-related medical costs and increase treatment costs compared with current practice. Despite the higher costs, this approach could substantially benefit patients.
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Affiliation(s)
- Amanda Honeycutt
- RTI International, Health Economics Program, Research Triangle Park, Durham, NC 27709-2194, USA
| | - Andrew Breck
- Insight Policy Research, Arlington, VA 22209, USA
| | - Sarah Bass
- RTI International, Health Economics Program, Research Triangle Park, Durham, NC 27709-2194, USA
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186
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Zhang J, Walker ME, Sanidad KZ, Zhang H, Liang Y, Zhao E, Chacon-Vargas K, Yeliseyev V, Parsonnet J, Haggerty TD, Wang G, Simpson JB, Jariwala PB, Beaty VV, Yang J, Yang H, Panigrahy A, Minter LM, Kim D, Gibbons JG, Liu L, Li Z, Xiao H, Borlandelli V, Overkleeft HS, Cloer EW, Major MB, Goldfarb D, Cai Z, Redinbo MR, Zhang G. Microbial enzymes induce colitis by reactivating triclosan in the mouse gastrointestinal tract. Nat Commun 2022; 13:136. [PMID: 35013263 PMCID: PMC8748916 DOI: 10.1038/s41467-021-27762-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022] Open
Abstract
Emerging research supports that triclosan (TCS), an antimicrobial agent found in thousands of consumer products, exacerbates colitis and colitis-associated colorectal tumorigenesis in animal models. While the intestinal toxicities of TCS require the presence of gut microbiota, the molecular mechanisms involved have not been defined. Here we show that intestinal commensal microbes mediate metabolic activation of TCS in the colon and drive its gut toxicology. Using a range of in vitro, ex vivo, and in vivo approaches, we identify specific microbial β-glucuronidase (GUS) enzymes involved and pinpoint molecular motifs required to metabolically activate TCS in the gut. Finally, we show that targeted inhibition of bacterial GUS enzymes abolishes the colitis-promoting effects of TCS, supporting an essential role of specific microbial proteins in TCS toxicity. Together, our results define a mechanism by which intestinal microbes contribute to the metabolic activation and gut toxicity of TCS, and highlight the importance of considering the contributions of the gut microbiota in evaluating the toxic potential of environmental chemicals.
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Affiliation(s)
- Jianan Zhang
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - Morgan E Walker
- Departments of Chemistry, Biochemistry, Microbiology and Genomics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Hongna Zhang
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong, SAR, China
- Department of Occupational and Environmental Health, School of Public Health, Qingdao University, Qingdao, China
| | - Yanshan Liang
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong, SAR, China
| | - Ermin Zhao
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | | | - Vladimir Yeliseyev
- Massachusetts Host-Microbiota Center, Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Julie Parsonnet
- Department of Medicine and Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Thomas D Haggerty
- Department of Medicine and Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Guangqiang Wang
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Joshua B Simpson
- Departments of Chemistry, Biochemistry, Microbiology and Genomics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Parth B Jariwala
- Departments of Chemistry, Biochemistry, Microbiology and Genomics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Violet V Beaty
- Departments of Chemistry, Biochemistry, Microbiology and Genomics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jun Yang
- Department of Entomology and Nematology, University of California, Davis, CA, USA
| | - Haixia Yang
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - Anand Panigrahy
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - Lisa M Minter
- Department of Veterinary & Animal Sciences, University of Massachusetts, Amherst, MA, USA
| | - Daeyoung Kim
- Department of Mathematics and Statistics, University of Massachusetts, Amherst, MA, USA
| | - John G Gibbons
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - LinShu Liu
- Eastern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, Wyndmoor, PA, USA
| | - Zhengze Li
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - Hang Xiao
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - Valentina Borlandelli
- Department of Bioorganic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, Netherlands
| | - Hermen S Overkleeft
- Department of Bioorganic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, Netherlands
| | - Erica W Cloer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael B Major
- Department of Cell Biology and Physiology, and Department of Otolaryngology, Washington University, St. Louis, MO, USA
| | - Dennis Goldfarb
- Department of Cell Biology and Physiology, Institute for Informatics, Washington University, St. Louis, MO, USA
| | - Zongwei Cai
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong, SAR, China.
| | - Matthew R Redinbo
- Departments of Chemistry, Biochemistry, Microbiology and Genomics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Guodong Zhang
- Department of Food Science, University of Massachusetts, Amherst, MA, USA.
- Department of Food Science and Technology, National University of Singapore, Singapore, Singapore.
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187
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Caplan A, McConnell R, Velayos F, Mahadevan U, Lewin S. Delayed Initiation of Rescue Therapy Associated with Increased Length of Stay in Acute Severe Ulcerative Colitis. Dig Dis Sci 2022; 67:5455-5461. [PMID: 35389167 PMCID: PMC9652198 DOI: 10.1007/s10620-022-07490-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/16/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Reducing hospitalization length of stay (LOS) for acute severe ulcerative colitis (ASUC) will reduce healthcare costs, mitigate hospitalization-associated risks (e.g., venous thromboembolism), and improve quality of life. METHODS A chart review was performed of all adult ASUC-related hospitalizations at University of California, San Francisco, from July 1, 2014, to December 31, 2017. Univariate and multivariate analyses were performed to identify factors associated with LOS < 7 days versus ≥ 7 days. A subgroup analysis was performed excluding patients who underwent colectomy during hospitalization. RESULTS A total of 95 ASUC-related hospitalizations were identified. The initial univariable analysis identified the following factors associated with LOS ≥ 7 days (P < 0.05): higher maximum heart rate in the first 24 h, higher C-reactive protein, being biologic therapy naïve, and a later hospital day of biologic therapy initiation. On mixed model multivariable analysis, later hospital day of biologic initiation was associated with increased LOS ≥ 7 days (OR 3.1 95% CI 1.2-7.56, p = 0.012). CONCLUSIONS We identified multiple predictors for longer hospital LOS, including factors related to disease severity (non-modifiable) and treatment (potentially modifiable). Importantly, this study identified biologic naïve treatment status and delayed inpatient biologic therapy initiation as predictors of longer LOS (≥ 7 days) in patients who did not ultimately require colectomy during their hospital stay. Potentially modifiable strategies to reduce LOS may include early communication and patient education about biologic therapy in both the inpatient and outpatient setting.
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Affiliation(s)
- Alyssa Caplan
- Division of Gastroenterology, University of California, 513 Parnassus Avenue S-357, San Francisco, CA 94143 USA
| | | | | | - Uma Mahadevan
- Division of Gastroenterology, University of California, 513 Parnassus Avenue S-357, San Francisco, CA 94143 USA
| | - Sara Lewin
- Division of Gastroenterology, University of California, 513 Parnassus Avenue S-357, San Francisco, CA 94143 USA
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188
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Racial differences in the outcomes of IBD hospitalizations: a national population-based study. Int J Colorectal Dis 2022; 37:221-229. [PMID: 34694440 DOI: 10.1007/s00384-021-04052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE There are scarce data describing the outcomes of hospitalized patients admitted with inflammatory bowel disease (IBD) stratified by race. In this retrospective cohort study, we evaluated the difference in outcomes between adult white and black patients hospitalized with a principal diagnosis of inflammatory bowel disease. METHODS Data were obtained from the 2016 and 2017 National Inpatient Sample (NIS) database. Our primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS), total hospital charges (THC), red blood cell (RBC) transfusion, diagnosis of bowel perforation, and severe sepsis with septic shock. We conducted the analysis using STATA software. We used propensity-matched multivariate regression analysis to adjust for potential confounders. RESULTS Among 71 million hospital hospitalizations, we found 177,574 hospitalizations with a principal diagnosis of IBD, with 24,635 (13.9%) for black patients, 124,899 (70.3%) for white patients, and 28,040 (15.8%) were for others. There was no significant difference in inpatient mortality for black vs white patients. Among secondary outcomes, white compared to black patients had increased odds of having a diagnosis of bowel perforation when admitted with a diagnosis of IBD while there was no difference in the odds of developing septic shock. White patients admitted with a diagnosis of UC were also found to have increased total LOS and THC. CONCLUSION White patients hospitalized with a principal diagnosis of IBD had no difference in inpatient mortality or septic shock but had worse outcomes such as increased odds of bowel perforation compared to black patients.
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189
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Khan N, Patel D, Trivedi C, Pernes T, Kavani H, Xie D, Yang YX. The impact of IBD medications on risk of pneumonia and pneumonia-related hospitalisation: a nationwide cohort study of 56 410 IBD patients. Aliment Pharmacol Ther 2022; 55:64-72. [PMID: 34664313 DOI: 10.1111/apt.16610] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/10/2021] [Accepted: 09/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are limited data on the incidence of pneumonia and pneumonia-related hospitalisation in the IBD population, and on any association of IBD medications with such outcomes. AIMS To evaluate the impact of IBD medications on the risk of pneumonia, pneumonia-related hospitalisations and death. METHODS We conducted a retrospective cohort study of IBD patients from the nationwide Veteran Affairs (VA) dataset. The exposure of interest was different IBD medication groups. We estimated the incidence rate of pneumonia, pneumonia-related hospitalisation and mortality based on IBD medication subgroups. We used a multivariable Cox regression to estimate the adjusted hazard ratios (AHR) and 95% confidence intervals (CIs) for these outcomes. RESULTS Out of 56 410 patients with IBD, 3759 developed pneumonia, 1489 were hospitalised, and 248 died within 30 days of their pneumonia diagnosis. The crude incidence rates of pneumonia, pneumonia-related hospitalisation and pneumonia-related mortality were 6.47, 2.52 and 0.43, respectively, per 1000 person-years. In multivariable Cox regression analysis, compared to 5-ASA alone, anti-TNF medication was associated with an increased risk of pneumonia (AHR 1.39; 95% CI 1.22-1.59) and hospitalisation (AHR 1.61; 95% CI 1.31-1.98). Use of prednisone in the prior 30 days was associated with increased risk of pneumonia (AHR 2.14; 95% CI 1.92-2.38) and hospitalisation (AHR 2.44; 95% CI 2.08-2.88). CONCLUSION Anti-TNF medications and prednisone use may be associated with increased risk of developing pneumonia and pneumonia-related hospitalisation. Physicians should evaluate the risk-benefit ratio of IBD medications, especially in the elderly population.
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Affiliation(s)
- Nabeel Khan
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of Gastroenterology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Dhruvan Patel
- Division of Gastroenterology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Chinmay Trivedi
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Tyler Pernes
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Himanshu Kavani
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,St. Mary Medical Center, Langhorne, PA, USA
| | - Dawei Xie
- Department of Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Yu-Xiao Yang
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of Gastroenterology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.,Center of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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190
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Immunomodulatory Agents for Treatment of Patients with Inflammatory Bowel Disease (Review safety of anti-TNF, Anti-Integrin, Anti IL-12/23, JAK Inhibition, Sphingosine 1-Phosphate Receptor Modulator, Azathioprine / 6-MP and Methotrexate). Curr Gastroenterol Rep 2021; 23:30. [PMID: 34913108 DOI: 10.1007/s11894-021-00829-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF THE REVIEW As treatment options for Inflammatory Bowel Disease (IBD) expand each class of medication will have specific safety concerns and side-effect profiles that need to be considered for optimal treatment of patients. We will review the most recent safety data for the newly approved immunomodulator therapies for the treatment of IBD. RECENT FINDINGS There are a growing number of publications outlining safety concerns for medications used to treat IBD. We reviewed safety profile of anti-tumor necrosis factor antibodies (TNF) with specific attention to combination therapy (anti-TNF plus immunomodulator). Recent publications have demonstrated increased risk of serious infection and malignancy (lymphoma and overall cancer rates) in patients receiving anti-TNF combination therapy when compared with patients receiving anti-TNF monotherapy or immunomodulator monotherapy. Recent publications on Janus Kinase Inhibitors indicate an increased risk of infection, specifically Herpes Zoster, and increased risk of major cardiovascular events and venous thromboembolic events resulting in a black box warning for the medication. In contrast, anti-interleukin 12/23 agents and gut selective anti-integrin antibody agents have demonstrated a favorable side-effect profile with low rates of infection and malignancy. The latest class of medications to be approved, sphingosine 1-phosphate (S1P) receptor modulators, have cardiac and infectious precautions. The field of IBD treatment is rapidly evolving with several mechanistic classes of medications now available. While corticosteroids continue to be associated with the greatest, overall, safety risks, each of the newer mechanistic classes have unique safety concerns. In the future, as we gain more experience with these agents, we will need to continue to evaluate the safety profile of our therapies used alone or in combination to make informed treatment decisions with our patients.
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191
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Parente P, Pastore M, Grillo F, Fassan M, Francalanci P, Dirodi A, Rossi C, Arpa G, De Angelis P, Gullo I, Mastracci L, Alaggio R, Vanoli A. Very Early Onset-IBD: evidence for the need of a multidisciplinary approach. Pathologica 2021; 114:3-11. [PMID: 34856603 PMCID: PMC9040548 DOI: 10.32074/1591-951x-336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022] Open
Abstract
Very early onset inflammatory bowel disease (VEO-IBD) represents approximately 25% of cases of IBD-like colitis occurring during childhood and, by definition, it is characterized by an onset prior to 6 years of age. This subgroup of patients presents significant differences from IBD occurring in older children and in adults, including a more severe clinical course, a reduced responsiveness to conventional IBD therapy, and a greater proportion of cases featuring an underlying monogenic disorder. Histological findings from gastro-intestinal (GI) biopsies are characterized by an IBD-like, apoptotic or enterocolitis-like pattern, complicating the differential diagnosis with other pediatric diseases involving GI tract. Moreover, individuals with monogenic disorders may develop significant comorbidities, such as primary immunodeficiency (PID), impacting treatment options. Without an appropriate diagnosis, the clinical course of VEO-IBD has greater potential for escalated treatment regimens involving extensive surgery, more intensive medical therapies and, even more important, inadequate recognition of underlying monogenic defect that may lead to inappropriate (sometimes fatal) therapy. For these reasons, an adequate context leading to an appropriate diagnosis is imperative, calling for a close collaboration between pediatricians, pathologists, geneticists, and immunologists.
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Affiliation(s)
- Paola Parente
- Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mario Pastore
- Department of Pediatrics, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Federica Grillo
- Anatomic Pathology, Ospedale Policlinico San Martino IRCCS, Genova, Italy; Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Matteo Fassan
- Departement of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padova, Italy; Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Paola Francalanci
- Pathology Unit, Department of Diagnostic and Laboratory Medicine, IRCCS Bambino Gesù Children's Hospital, Roma, Italy
| | - Angelica Dirodi
- Department of Pediatrics, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Chiara Rossi
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanni Arpa
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, IRCCS Bambino Gesù Children's Hospital, Roma, Italy
| | - Irene Gullo
- Department of Pathology, Centro Hospitalar Universitário de São João (CHUSJ); Department of Pathology, Faculty of Medicine of the University of Porto (FMUP) and i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Portugal
| | - Luca Mastracci
- Anatomic Pathology, Ospedale Policlinico San Martino IRCCS, Genova, Italy; Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Rita Alaggio
- Pathology Unit, Department of Diagnostic and Laboratory Medicine, IRCCS Bambino Gesù Children's Hospital, Roma, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Shaikh DH, Patel H, Munshi R, Sun H, Mehershahi S, Baiomi A, Alemam A, Pirzada U, Nawaz I, Naher K, Hanumanthu S, Nayudu S. Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes. World J Gastrointest Surg 2021; 13:1436-1447. [PMID: 34950432 PMCID: PMC8649559 DOI: 10.4240/wjgs.v13.i11.1436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/29/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) occurs due to a dysbiosis in the colon. The appendix is considered a ‘safe house’ for gut microbiota and may help repopulate gut flora of patients with CDI.
AIM To study the impact of prior appendectomy on the severity and outcomes of CDI.
METHODS We retrospectively reviewed data of 1580 patients with CDI, admitted to our hospital between 2008 to 2018. Patients were grouped based on the presence or absence of the appendix. The primary aim was to (1) assess all-cause mortality and (2) the severity of CDI. Severity was defined as per the Infectious Diseases Society of America criteria. Logistic regression, and propensity score analysis using inverse probability of treatment weights (IPTW) was performed.
RESULTS Of the 1580 patients, 12.5% had a history of appendectomy. There was no statistical difference in mortality between patients with a prior appendectomy or without (13.7% vs 14%, P = 0.877). However, a history of appendectomy affected the severity of CDI [odds ratio (OR) = 1.32, 95% confidence interval: 1.01-1.75]. On IPTW, this association remained significant (OR = 1.59, P < 0.05). On multivariable analysis of secondary outcomes, prior appendectomy was also associated with toxic megacolon (OR = 5.37, P < 0.05) and colectomy (OR = 2.77, P < 0.05).
CONCLUSION Prior appendectomy may affect the severity of CDI, development of toxic megacolon and the eventual need for colectomy. Since treatment of CDI is governed by its severity, stronger antibiotic regimens or earlier use of fecal microbiota transplant may be a viable option for patients with prior appendectomy.
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Affiliation(s)
- Danial Haris Shaikh
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Harish Patel
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Rezwan Munshi
- Department of Medicine, Nassau University Medical Center, New York, NY 11554, United States
| | - Haozhe Sun
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Shehriyar Mehershahi
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Ahmed Baiomi
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Ahmed Alemam
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Usman Pirzada
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Iqra Nawaz
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Kamrun Naher
- Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Siddarth Hanumanthu
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Suresh Nayudu
- Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
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193
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Kushner T, Fairchild A, Johnson FR, Sands BE, Mahadevan U, Subramanian S, Ananthakrishnan A, Ha C, Bewtra M. Women's Willingness to Accept Risks of Medication for Inflammatory Bowel Disease During Pregnancy. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:353-365. [PMID: 34750784 DOI: 10.1007/s40271-021-00561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Women with inflammatory bowel disease (IBD) face difficult decisions regarding treatment during pregnancy: while the majority of IBD medications are safe, there is substantial societal pressure to avoid exposures during pregnancy. However, discontinuation of IBD medications risks a disease flare occurring during pregnancy. OBJECTIVE This study quantified women's knowledge about pregnancy and IBD and their willingness to accept the risks of adverse pregnancy outcomes to avoid disease activity or medication use during pregnancy. METHODS Women with IBD recruited from four centers completed an online discrete-choice experiment stated-preference study including eight choice tasks and the Crohn's and Colitis Pregnancy Knowledge questionnaire. Random-parameters logit was used to estimate preferences for both the respondent personally and what the respondent thought most women would prefer. We also tested for systematically different preferences among individuals with different demographic and personal characteristics, including IBD knowledge. The primary outcome was the maximum acceptable risk of premature birth, birth defects, or miscarriage that women with IBD were willing to accept to avoid (1) taking an IBD medication or (2) having a disease flare during pregnancy. RESULTS Among 230 respondents, women would accept, on average, up to a 4.9% chance of miscarriage to avoid a disease flare. On average, there were no statistically significant differences in women's preferences for continuing versus avoiding medication in the absence of a flare. However, prior understanding of IBD and pregnancy significantly affected preferences for IBD medication use during pregnancy: women with "poor knowledge" would accept up to a 6.4% chance of miscarriage to avoid IBD medication use during pregnancy, whereas women with "adequate knowledge" would accept up to a 5.1% chance of miscarriage in order to remain on their medication. Respondents' personal treatment preferences did not differ from their assessment of other women's preferences. CONCLUSIONS Women with IBD demonstrated a strong preference for avoiding disease activity during pregnancy. Knowledge regarding pregnancy and IBD was a strong modifier of preferences for continuation of IBD medications during pregnancy. These findings point to an important opportunity for intervention to improve disease control through education to increase medication adherence and alleviate unnecessary fears about IBD medication use during pregnancy.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - F Reed Johnson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Bruce E Sands
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Christina Ha
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Meenakshi Bewtra
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 724 Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA. .,Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
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194
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Weissman S, Patel K, Kolli S, Lipcsey M, Qureshi N, Elias S, Walfish A, Swaminath A, Feuerstein JD. Obesity in Inflammatory Bowel Disease Is Associated with Early Readmissions Characterised by an Increased Systems and Patient-level Burden. J Crohns Colitis 2021; 15:1807-1815. [PMID: 33999137 DOI: 10.1093/ecco-jcc/jjab088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Rates of obesity are rising in patients with inflammatory bowel disease [IBD]. We conducted a US population-based study to determine the effects of obesity on outcomes in hospitalised patients with IBD. METHODS We searched the Nationwide Readmissions Database 2016-2017 to identify all adult patients hospitalised for IBD, using ICD-10 codes. We compared obese (body mass index [BMI] ≥ 30) vs non-obese [BMI < 30] patients with IBD to evaluate the independent effects of obesity on readmission, mortality, and other hospital outcomes. Multivariate regression and propensity matching were performed. RESULTS We identified 143 190 patients with IBD, of whom 9.1% were obese. Obesity was independently associated with higher all-cause readmission at 30 days {18% vs 13% (adjusted odds ratio [aOR] 1.16, p = 0.005)} and 90 days (29% vs 21% [aOR 1.27, p < 0.0001]), as compared with non-obese patients, with similar findings upon a propensity-matched sensitivity analysis. Obese and non-obese patients had similar risks of mortality on index admission [0.24% vs 0.31%, p = 0.18] and readmission [1.5% vs 1.8% p = 0.3]. Obese patients had longer [5.3 vs 4.9 days] and more expensive [USD12,195 vs USD11,154] hospitalisations on index admission. Obesity did not affect the risk of intestinal surgery or bowel obstruction. Compared with index admissions, readmissions were characterised by increased mortality [6-fold], health care use, and bowel obstruction [3-fold] [all p < 0.0001]. CONCLUSIONS Obesity in IBD appears to be associated with increased early readmission, characterised by a higher burden, despite the introduction of weight-based therapeutics. Prevention of obesity should be a focus in the treatment of IBD to decrease readmission and health care burden.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Kirtenkumar Patel
- Department of Medicine, North Shore University Hospital, Conway, SC, USA
| | - Sindhura Kolli
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan Lipcsey
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nabeel Qureshi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Aaron Walfish
- Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, NY, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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195
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Glover K, Mishra D, Singh TRR. Epidemiology of Ocular Manifestations in Autoimmune Disease. Front Immunol 2021; 12:744396. [PMID: 34795665 PMCID: PMC8593335 DOI: 10.3389/fimmu.2021.744396] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 01/19/2023] Open
Abstract
The global prevalence of autoimmune diseases is increasing. As a result, ocular complications, ranging from minor symptoms to sight-threatening scenarios, associated with autoimmune diseases have also risen. These ocular manifestations can result from the disease itself or treatments used to combat the primary autoimmune disease. This review provides detailed insights into the epidemiological factors affecting the increasing prevalence of ocular complications associated with several autoimmune disorders.
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Affiliation(s)
| | | | - Thakur Raghu Raj Singh
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, Belfast, United Kingdom
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196
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Wallace JW, Constant DA, Nice TJ. Interferon Lambda in the Pathogenesis of Inflammatory Bowel Diseases. Front Immunol 2021; 12:767505. [PMID: 34712246 PMCID: PMC8547615 DOI: 10.3389/fimmu.2021.767505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Interferon λ (IFN-λ) is critical for host viral defense at mucosal surfaces and stimulates immunomodulatory signals, acting on epithelial cells and few other cell types due to restricted IFN-λ receptor expression. Epithelial cells of the intestine play a critical role in the pathogenesis of Inflammatory Bowel Disease (IBD), and the related type II interferons (IFN-γ) have been extensively studied in the context of IBD. However, a role for IFN-λ in IBD onset and progression remains unclear. Recent investigations of IFN-λ in IBD are beginning to uncover complex and sometimes opposing actions, including pro-healing roles in colonic epithelial tissues and potentiation of epithelial cell death in the small intestine. Additionally, IFN-λ has been shown to act through non-epithelial cell types, such as neutrophils, to protect against excessive inflammation. In most cases IFN-λ demonstrates an ability to coordinate the host antiviral response without inducing collateral hyperinflammation, suggesting that IFN-λ signaling pathways could be a therapeutic target in IBD. This mini review discusses existing data on the role of IFN-λ in the pathogenesis of inflammatory bowel disease, current gaps in the research, and therapeutic potential of modulating the IFN-λ-stimulated response.
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Affiliation(s)
- Jonathan W Wallace
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, United States
| | - David A Constant
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, United States
| | - Timothy J Nice
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, OR, United States
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197
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Li S, Wang T, Fu W, Kennett M, Cox AD, Lee D, Vanamala JKP, Reddivari L. Role of Gut Microbiota in the Anti-Colitic Effects of Anthocyanin-Containing Potatoes. Mol Nutr Food Res 2021; 65:e2100152. [PMID: 34633750 DOI: 10.1002/mnfr.202100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/29/2021] [Indexed: 11/07/2022]
Abstract
SCOPE Anthocyanin-containing potatoes exert anti-inflammatory activity in colitic mice. Gut bacterial dysbiosis plays a critical role in ulcerative colitis. This study examined the extent to which the anti-colitic activity of anthocyanin-containing red/purple-fleshed potatoes depends on the gut bacteria using a chemically-induced rodent model of colitis with the intact and antibiotic-ablated microbiome. METHODS AND RESULTS Four-week-old male mice (C57BL6) are randomly assigned to the control diet or 20% purple-/red-fleshed potatoes supplemented diet group. The microbiota-ablated group received an antibiotic cocktail in drinking water. At week nine, colitis is induced by 2% dextran sulfate sodium (DSS) in drinking water for five days. Administration of antibiotics resulted in a 95% reduction in gut bacterial load and fecal SCFAs. DSS-induced elevated gut permeability and body weight loss are more pronounced in antibiotic mice compared to non-antibiotic mice. Purple- or red-fleshed potato supplementation (20% w/w) ameliorated DSS-induced reduction in colon length and mucin 2 expression levels, and increase in permeability, spleen weight, myeloperoxidase (MPO) activity, and inflammatory cytokines (IL-6, IL-17, and IL1-β) expression levels in non-antibiotic mice, but not in gut microbiota ablated mice. CONCLUSIONS Anthocyanin-containing potatoes are potent in alleviating colitis, and the gut microbiome is critical for the anti-colitic activity of anthocyanin-containing potatoes.
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Affiliation(s)
- Shiyu Li
- Department of Food Science, Purdue University, 745 Agriculture Mall Drive, West Lafayette, IN, 47907, USA
| | - Tianmin Wang
- Department of Plant Science, Penn State University, University Park, PA, 16802, USA
| | - Wenyi Fu
- Department of Food Science, Purdue University, 745 Agriculture Mall Drive, West Lafayette, IN, 47907, USA
| | - Mary Kennett
- Department of Veterinary and Biomedical Sciences, Penn State University, University Park, PA, 16802, USA
| | - Abigail D Cox
- College of Veterinary Medicine, Purdue University, 625 Harrison Street, West Lafayette, IN, 47907, USA
| | - Dale Lee
- Seattle Children's Hospital, University of Washington, Seattle, WA, 98105, USA
| | - Jairam K P Vanamala
- Department of Food Science, Penn State University, University Park, PA, 16802, USA
| | - Lavanya Reddivari
- Department of Food Science, Purdue University, 745 Agriculture Mall Drive, West Lafayette, IN, 47907, USA
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198
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CCL11 exacerbates colitis and inflammation-associated colon tumorigenesis. Oncogene 2021; 40:6540-6546. [PMID: 34625710 DOI: 10.1038/s41388-021-02046-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 12/26/2022]
Abstract
CCL11, also known as eotaxin-1, is described as an eosinophil chemoattractant, which has been implicated in allergic and Th2 inflammatory diseases. We have reported that CCL11 is significantly increased in the serum of inflammatory bowel disease (IBD) patients, colonic eosinophils are increased and correlate with tissue CCL11 levels in ulcerative colitis patients, and CCL11 is increased in dextran sulfate sodium (DSS)-induced murine colitis. Here, we show that CCL11 is involved in the pathogenesis of DSS-induced colitis and in colon tumorigenesis in the azoxymethane (AOM)-DSS model of colitis-associated carcinogenesis (CAC). Ccl11-/- mice exposed to DSS then allowed to recover had significantly less body weight loss and a decrease in histologic injury versus wild-type (WT) mice. In the AOM-DSS model, Ccl11-/- mice exhibited decreased colonic tumor number and burden, histologic injury, and colonic eosinophil infiltration versus WT mice. Ccl11 is expressed by both colonic epithelial and lamina propria immune cells. Studies in bone marrow chimera mice revealed that hematopoietic- and epithelial-cell-derived CCL11 were both important for tumorigenesis in the AOM-DSS model. These findings indicate that CCL11 is important in the regulation of colitis and associated carcinogenesis and thus anti-CCL11 antibodies may be useful for treatment and cancer chemoprevention in IBD.
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199
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Serum Levels of Chemerin in Patients with Inflammatory Bowel Disease as an Indicator of Anti-TNF Treatment Efficacy. J Clin Med 2021; 10:jcm10194615. [PMID: 34640632 PMCID: PMC8509701 DOI: 10.3390/jcm10194615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 12/20/2022] Open
Abstract
Chemerin belongs to the adipokines—proteins secreted by white adipose tissue. It plays an important role in angiogenesis and metabolism and its levels correlate with inflammation severity in many clinical states. Circulating chemerin levels in IBD are only rarely evaluated, with inconsistent results. The possible impact of anti-TNF therapy treatment in IBD on chemerin levels has not been addressed. The study aim was to evaluate the serum levels of chemerin in patients with inflammatory bowel disease (IBD), depending on disease severity as well as anti-TNF treatment. Serum chemerin was measured with ELISA in 77 patients with IBD as well as in 42 healthy controls (HCs). Twenty-six participants who underwent anti-TNF therapy were re-examined after 14 weeks. Overall, IBD patients had significantly higher serum chemerin levels than HCs. In patients with IBD exacerbation, chemerin levels were significantly higher compared to the remission group. Serum chemerin levels were significantly higher in UC patients compared to CD. Chemerin correlated with the severity of CD, but not with UC. Serum levels of chemerin decreased significantly after 14 weeks of anti-TNF treatment. Chemerin correlated with the clinical severity of IBD, and its levels decreased after anti-TNF treatment, which suggests its relationship with disease activity. It may be assumed that chemerin levels may possibly be useful for anti-TNF clinical course and treatment monitoring.
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Araújo M, Silveira J, Sousa A, Bessa-Gonçalves M, Santos SG, Barrias CC. A bioinspired multifunctional hydrogel patch targeting inflammation and regeneration in chronic intestinal wounds. Biomater Sci 2021; 9:6510-6527. [PMID: 34582531 DOI: 10.1039/d1bm00118c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Healing of intestinal chronic wounds remains a major challenge as current therapies are ineffective in promoting proper regeneration of the damaged intestinal wall. An innovative concept, based on a bioinspired multifunctional alginate-melanin hybrid 3D scaffold, to target both inflammatory and regenerative processes, is proposed herein. Hydrogel-entrapped melanin nanoparticles demonstrated free-radical scavenging activity, supported by the neutralization of free-radicals in solution (90%), and the in vitro capture of reactive oxygen species (ROS) produced by stimulated macrophages in an inflammatory-mimicking environment. Notably, scaffolds could be reused (at least 3 times), while maintaining these properties. The extracellular matrix (ECM)-inspired biomaterial, containing protease-sensitive and integrin-binding domains, exhibited remarkable ability for cell colonisation. Human intestinal fibroblasts and epithelial cells (Caco-2) co-seeded on lyophilized scaffolds were able to invade/colonize the construct and produce endogenous ECM, key for neo-tissue formation and re-epithelialization. Scaffolds presented tuneable mechanical properties and could be used both in hydrated and freeze-dried states, maintaining their performance upon rehydration, which are attractive features for clinical application. Collectively, our results highlight the potential of biofunctionalized alginate-melanin hybrid 3D scaffolds as multi-therapeutic patches for modulating inflammation and tissue regeneration in chronic intestinal wounds, which address a major but still unmet clinical need. The proposed multi-therapeutic strategy may potentially be extended to the treatment of other chronic wounds.
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Affiliation(s)
- Marco Araújo
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Portugal. .,INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135, Portugal
| | - João Silveira
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Portugal. .,INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135, Portugal.,FEUP - Faculdade de Engenharia da Universidade do Porto, University of Porto, 4200-135, Portugal
| | - Aureliana Sousa
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Portugal. .,INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135, Portugal
| | - Mafalda Bessa-Gonçalves
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Portugal. .,INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135, Portugal.,ICBAS - Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Portugal
| | - Susana G Santos
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Portugal. .,INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135, Portugal.,ICBAS - Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Portugal
| | - Cristina C Barrias
- I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135, Portugal. .,INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, 4200-135, Portugal.,ICBAS - Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Portugal
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