1
|
Dovizio M, Hartz S, Buzzoni C, Redondo I, Nedeljkovic Protic M, Birra D, Perrone V, Veronesi C, Degli Esposti L, Armuzzi A. Real-World Treatment Patterns and Healthcare Resource Use for Ulcerative Colitis and Crohn's Disease in Italy. Adv Ther 2024; 41:2282-2298. [PMID: 38619721 PMCID: PMC11133152 DOI: 10.1007/s12325-024-02840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Real-world data are used to inform decision-makers and optimise therapeutic management for patients with ulcerative colitis (UC) and Crohn's disease (CD). We analysed data on the epidemiology (by using proxies of prevalence and incidence), patient characteristics, treatment patterns and associated healthcare direct costs for the management of patients with UC and patients with CD in Italy. METHODS This retrospective observational study used administrative databases from eight Local Health Units geographically distributed across Italy. Adult patients with a hospitalisation and/or an exemption for UC or CD were included. Study outcomes were summarised descriptively, and limited statistical tests were performed. RESULTS At baseline, 9255 adults with UC and 4747 adults with CD were included. Mean (standard deviation) age at inclusion was 54.0 (18.4)/48.6 (18.1) years, for UC/CD. The estimated average incidence of UC and CD for the period 2013-2020 was 36.5 and 18.7 per 100,000, respectively. The most frequently prescribed drug category for patients with UC/CD was conventional treatment [mesalazine and topical corticosteroids (67.4%/61.1%), immunomodulators and systemic corticosteroids (43.2%/47.7%)], followed by biologic treatments (2.1%/5.1%). The mean annual total direct cost per patient was 7678 euro (€), for UC and €6925 for CD. CONCLUSION This analysis, carried-out in an Italian clinical setting, may help to optimise therapy for patients with UC and CD and provide relevant clinical practice data to inform decision-makers.
Collapse
Affiliation(s)
- Melania Dovizio
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | | | | | | | | | | | - Valentina Perrone
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | - Chiara Veronesi
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
2
|
Petersen SR, Fogh Rasmussen N, Overgaard Donskov A, Thygesen LC, Olsen KR, Juel Ahrenfeldt L, Andersen V. Socioeconomic equality in initiation of biologic treatment in Danish patients with inflammatory bowel disease. Wien Klin Wochenschr 2024:10.1007/s00508-024-02376-8. [PMID: 38789560 DOI: 10.1007/s00508-024-02376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Low socioeconomic status is associated with disadvantages in health outcomes and delivery of medical care in patients with Inflammatory Bowel Disease (IBD). Inequality in the utilisation of biologic treatment is largely unexplored. AIM To explore the potential association of socioeconomic status and time to first biologic treatment in a population-based IBD cohort. METHODS All 37,380 IBD incidences between 2000 and 2017 from the Danish National Patient Register were identified and linked to socioeconomic information including educational level, income and occupational status at diagnosis. Hazard ratios for receiving biologic treatment among socioeconomic groups were estimated using Cox proportional hazard regression. RESULTS No difference in time between diagnosis and biologic treatment initiation was found comparing patients with upper secondary, vocational, or academic education to those with lower secondary education in patients with IBD. Patients with Crohn's disease in the two highest income quartiles received biologic treatment earlier (HR 1.16; 95% CI: 1.04; 1.30 & HR 1.15; 95% CI: 1.03; 1.30). An elevated treatment rate was found for persons with "other" occupational status (unspecified source of income) compared to employed persons in patients with ulcerative colitis (HR 1.36; 95% CI: 1.11; 1.66), but not in patients with Crohn's disease. CONCLUSION This study revealed equal initiation of biologic treatment among patients with IBD across different educational background, income and occupational status. However, results are limited to a setting with free universal healthcare coverage and treatment needs should be considered and addressed in future research.
Collapse
Affiliation(s)
- Sofie Ronja Petersen
- Molecular Diagnostic and Clinical Research Unit, University Hospital of Southern Denmark, Kresten Phillipsens vej 15, Aabenraa, Denmark.
| | - Nathalie Fogh Rasmussen
- Molecular Diagnostic and Clinical Research Unit, University Hospital of Southern Denmark, Kresten Phillipsens vej 15, Aabenraa, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Research Unit, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Agnete Overgaard Donskov
- Molecular Diagnostic and Clinical Research Unit, University Hospital of Southern Denmark, Kresten Phillipsens vej 15, Aabenraa, Denmark
- Department of Geriatrics, Hospital of Southern Denmark, Aabenraa, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kim Rose Olsen
- Danish Centre for Health Economics-DaCHE, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Vibeke Andersen
- Molecular Diagnostic and Clinical Research Unit, University Hospital of Southern Denmark, Kresten Phillipsens vej 15, Aabenraa, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Noh JY, Farhataziz N, Kinter MT, Yan X, Sun Y. Colonic Dysregulation of Major Metabolic Pathways in Experimental Ulcerative Colitis. Metabolites 2024; 14:194. [PMID: 38668322 PMCID: PMC11052278 DOI: 10.3390/metabo14040194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Inflammatory bowel disease (IBD) is multifactorial chronic inflammatory disease in the gastrointestinal tract, affecting patients' quality of life profoundly. The incidence of IBD has been on the rise globally for the last two decades. Because the molecular mechanisms underlying the disease remain not well understood, therapeutic development is significantly impeded. Metabolism is a crucial cellular process to generate the energy needed for an inflammatory response and tissue repair. Comprehensive understanding of the metabolic pathways in IBD would help to unravel the disease pathogenesis/progression and facilitate therapeutic discoveries. Here, we investigated four metabolic pathways altered in experimental colitis. C57BL/6J mice were treated with dextran sulfate sodium (DSS) in drinking water for 7 days to induce experimental ulcerative colitis (UC). We conducted proteomics analysis for the colon samples using LC/MS, to profile key metabolic intermediates. Our findings revealed significant alterations in four major metabolic pathways: antioxidative defense, β-oxidation, glycolysis, and TCA cycle pathways. The energy metabolism by β-oxidation, glycolysis, and TCA cycle pathways were downregulated under UC, together with reduced antioxidative defense pathways. These results reveal metabolic re-programming in intestinal cells under UC, showing dysregulation in all four major metabolic pathways. Our study underscores the importance of metabolic drivers in the pathogenesis of IBD and suggests that the modification of metabolism may serve as a novel diagnostic/therapeutic approach for IBD.
Collapse
Affiliation(s)
- Ji Yeon Noh
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA; (J.Y.N.); (N.F.)
| | - Naser Farhataziz
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA; (J.Y.N.); (N.F.)
| | - Michael T. Kinter
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA;
| | - Xin Yan
- Department of Chemistry, Texas A&M University, College Station, TX 77843, USA;
| | - Yuxiang Sun
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA; (J.Y.N.); (N.F.)
- Department of Biochemistry & Biophysics, Texas A&M University, College Station, TX 77843, USA
| |
Collapse
|
4
|
Srinivasan AR. Treat to target in Crohn's disease: A practical guide for clinicians. World J Gastroenterol 2024; 30:50-69. [PMID: 38293329 PMCID: PMC10823901 DOI: 10.3748/wjg.v30.i1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
A treat-to-target (T2T) approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE)-II guidelines specify short, intermediate, and long-term treatment goals, documenting specific treatment targets to be achieved at each of these timepoints. Scheduled appraisal of Crohn's disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified. Consensus treatment targets in Crohn's disease comprise combination clinical and patient-reported outcome remission, in conjunction with biomarker normalisation and endoscopic healing. Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing, clinicians must consider that this may not always be appropriate, acceptable, or achievable in all patients. This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets. The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques, particularly intestinal ultrasound, holds great promise; as do emerging treatment targets such as transmural healing. Two randomised clinical trials, namely, CALM and STARDUST, have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn's disease. Findings from these studies reflect that patient subgroups and Crohn's disease characteristics likely to benefit most from a T2T approach, remain to be clarified. Moreover, outside of clinical trials, data pertaining to the real-world effectiveness of a T2T approach remains scare, highlighting the need for pragmatic real-world studies. Despite the obvious promise of a T2T approach, a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake. This highlights the need to describe strategies, processes, and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice. Hence, this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn's disease.
Collapse
Affiliation(s)
- Ashish R Srinivasan
- Department of Gastroenterology, Austin Health, Victoria, Melbourne 3083, Australia
- Department of Gastroenterology, Eastern Health, Victoria, Melbourne 3128, Australia
- Department of Medicine, University of Melbourne, Victoria, Melbourne 3052, Australia
| |
Collapse
|
5
|
Neelam PB, Sharma A, Sharma V. Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence. JGH Open 2024; 8:e13033. [PMID: 38283070 PMCID: PMC10821747 DOI: 10.1002/jgh3.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/01/2024] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
Sarcopenia is a condition marked by progressive loss of skeletal muscle mass and function while frailty is a multidimensional concept characterized by diminished physiological reserve and increased vulnerability to stressors. Both of these were previously considered as related to aging and shown to impact the quality of life and carry prognostic significance. Emerging data show that both sarcopenia and frailty carry similar relevance in chronic illness. Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and malnourishment, both of which contribute to the development of sarcopenia by increasing protein breakdown and reducing protein synthesis. The coexistence of frailty further compounds the clinical complexity of IBD patients. Published evidence suggests a bidirectional association with IBD contributing to muscle wasting, while the resultant sarcopenia and frailty could further exacerbate the disease course. Sarcopenia and frailty are independently associated with adverse outcomes, including hospitalizations, increased surgical interventions, and surgical complications. As therapeutic strategies for IBD evolve, understanding the nuanced relationship between inflammatory bowel disease, sarcopenia, and frailty is crucial for devising holistic management. Comprehensive care should encompass not only disease-modifying therapies but also interventions targeting frailty and sarcopenia, as they have been shown to have a significant impact not only on the disease course but also on the quality of life. Future research could focus on further elucidating underlying mechanisms, simple screening strategies, and developing targeted interventions to improve the overall quality of life for individuals grappling with the complex interplay of IBD, sarcopenia, and frailty.
Collapse
Affiliation(s)
- Pardhu B Neelam
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Alka Sharma
- Department of MedicineDr. BR Ambedkar Institute of Medical SciencesMohaliIndia
| | - Vishal Sharma
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| |
Collapse
|
6
|
Joo MK, Lee JW, Woo JH, Kim HJ, Kim DH, Choi JH. Regulation of colonic neuropeptide Y expression by the gut microbiome in patients with ulcerative colitis and its association with anxiety- and depression-like behavior in mice. Gut Microbes 2024; 16:2319844. [PMID: 38404132 PMCID: PMC10900276 DOI: 10.1080/19490976.2024.2319844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC), show an increased incidence of anxiety and depression; however, the association between UC-associated psychiatric disorders and the gut microbiota is unclear. This study aimed to examine whether gut microbiota from patients with UC can alter colonic gene expression, leading to anxiety- and depression-like behavior in mice receiving fecal microbiota transplantation (FMT). RNA sequencing transcriptome analyses revealed a difference in colonic gene expression between mice receiving FMT from patients with UC (UC-FMT mice) and those receiving FMT from healthy controls (HC-FMT mice). Gene ontology analysis revealed the downregulation of neuropeptide signaling pathways, including neuropeptide Y (NPY) expression, in the colons of UC-FMT mice. The protein levels of NPY also decreased in the colon and plasma of UC-FMT mice compared to those in HC-FMT mice. The oral administration of Enterococcus mundtii (EM), a bacterium isolated from the feces of patients with UC, reduced NPY expression in the colons of mice and induced intestinal inflammation, anxiety, and depression-like behavior. Reduced NPY protein levels were also observed in the plasma and hippocampus of EM-treated mice. Intraperitoneal administration of NPY significantly alleviated anxiety- and depressive-like behaviors induced by EM in mice. Capsular polysaccharide in EM was associated with EM-induced NPY downregulation in the colon. Analysis of Gene Expression Omnibus datasets showed markedly reduced NPY expression in the inflamed colons of patients with UC compared with that in the colons of healthy controls. In summary, EM-induced reduction in the colonic expression of NPY may be associated with a decrease in hippocampal NPY and anxiety- and depression-like behavior in mice.
Collapse
Affiliation(s)
- Min-Kyung Joo
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, Korea
- College of Pharmacy, Kyung Hee University, Seoul, Korea
| | - Jae-Won Lee
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, Korea
- College of Pharmacy, Kyung Hee University, Seoul, Korea
| | - Jeong-Hwa Woo
- College of Pharmacy, Kyung Hee University, Seoul, Korea
| | - Hyo-Jong Kim
- Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dong-Hyun Kim
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, Korea
- College of Pharmacy, Kyung Hee University, Seoul, Korea
| | - Jung-Hye Choi
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul, Korea
- College of Pharmacy, Kyung Hee University, Seoul, Korea
| |
Collapse
|
7
|
Li A, Coote M, Thin L. Prevalence and risk factors for early medical and surgical complications following an admission for acute severe ulcerative colitis. Therap Adv Gastroenterol 2023; 16:17562848231215148. [PMID: 38059014 PMCID: PMC10697038 DOI: 10.1177/17562848231215148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023] Open
Abstract
Background Risk factors for colectomy following an episode of acute severe ulcerative colitis (ASUC) have been well studied, but data examining the early complications following an episode is limited. Objectives We aimed to evaluate the prevalence and risk factors for medical and surgical complications within 90 days of an ASUC admission and determine if a high-intensity induction infliximab dose is associated with these complications. Design Retrospective analysis. Methods We conducted a retrospective study of ASUC admissions between January 2015 and July 2021 at a tertiary hospital. The primary outcome was the prevalence of total, medical and surgical complications within 90 days following an ASUC admission. Multivariate linear regression analysis assessed for factors associated with the prevalence of complications. Results A total of 150 patients had 186 hospital admissions for ASUC. In total, 101/186 (54.3%) admissions required rescue medical therapy. Standard infliximab induction occurred in 65/100 admissions, accelerated infliximab induction in 35/100 and cyclosporine in 1/100 of admissions. In total, 117 complications, including 74/117 (63.2%) medical and 43/117 (36.8%) surgical complications, arose. Low serum albumin was independently associated with a higher incidence of total [β = -0.08 (95% confidence interval (CI): -0.15, -0.01), p = 0.03] and surgical complications [β = -0.1 (95% CI: -0.18, -0.001), p = 0.047], while an increased age was associated with increased incidence of surgical complications [β = 0.06 (95% CI: 0.01, 0.12), p = 0.02]. A higher Charlson score was associated with increased medical complications [β = 0.12 (95% CI: 0.01, 0.24), p = 0.03]. Infliximab induction dose intensity was not associated with an increased incidence of any complications. Conclusion Early complications following an ASUC admission is prevalent although the majority are not serious. Risk factors associated with complications include low serum albumin, older age and a higher comorbidity score. Induction infliximab dose intensity, however, is not a risk factor.
Collapse
Affiliation(s)
- Angel Li
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Matthew Coote
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Lena Thin
- Department of Internal Medicine, University of Western Australia, Medical School, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, WA, Australia
| |
Collapse
|
8
|
Öhlmann H, Lanters LR, Theysohn N, Langhorst J, Engler H, Icenhour A, Elsenbruch S. Distinct Alterations in Central Pain Processing of Visceral and Somatic Pain in Quiescent Ulcerative Colitis Compared to Irritable Bowel Syndrome and Health. J Crohns Colitis 2023; 17:1639-1651. [PMID: 37161902 PMCID: PMC10637045 DOI: 10.1093/ecco-jcc/jjad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS Despite relevance to pain chronicity, disease burden, and treatment, mechanisms of pain perception for different types of acute pain remain incompletely understood in patients with inflammatory bowel disease [IBD]. Building on experimental research across pain modalities, we herein addressed behavioural and neural correlates of visceral versus somatic pain processing in women with quiescent ulcerative colitis [UC] compared to irritable bowel syndrome [IBS] as a patient control group and healthy women [HC]. METHODS Thresholds for visceral and somatic pain were assessed with rectal distensions and cutaneous thermal pain, respectively. Using functional magnetic resonance imaging, neural and behavioural responses to individually calibrated and intensity-matched painful stimuli from both modalities were compared. RESULTS Pain thresholds were comparable across groups, but visceral thresholds correlated with gastrointestinal symptom severity and chronic stress burden exclusively within UC. Upon experience of visceral and somatic pain, both control groups demonstrated enhanced visceral pain-induced neural activation and greater perceived pain intensity, whereas UC patients failed to differentiate between pain modalities at both behavioural and neural levels. CONCLUSIONS When confronted with acute pain from multiple bodily sites, UC patients' responses are distinctly altered. Their failure to prioritise pain arising from the viscera may reflect a lack of adaptive behavioural flexibility, possibly resulting from long-lasting central effects of repeated intestinal inflammatory insults persisting during remission. The role of psychological factors, particularly chronic stress, in visceral sensitivity and disease-specific alterations in the response to acute pain call for dedicated mechanistic research as a basis for tailoring interventions for intestinal and extraintestinal pain symptoms in IBD.
Collapse
Affiliation(s)
- Hanna Öhlmann
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Laura Ricarda Lanters
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jost Langhorst
- Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department for Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Adriane Icenhour
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
9
|
van Linschoten RCA, Huberts AS, van Leeuwen N, Hazelzet JA, van der Woude J, West RL, van Noord D. Validity of the self-administered comorbidity questionnaire in patients with inflammatory bowel disease. Therap Adv Gastroenterol 2023; 16:17562848231202159. [PMID: 37877105 PMCID: PMC10591493 DOI: 10.1177/17562848231202159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/01/2023] [Indexed: 10/26/2023] Open
Abstract
Background The International Consortium for Health Outcomes Measurement has selected the self-administered comorbidity questionnaire (SCQ) to adjust case-mix when comparing outcomes of inflammatory bowel disease (IBD) treatment between healthcare providers. However, the SCQ has not been validated for use in IBD patients. Objectives We assessed the validity of the SCQ for measuring comorbidities in IBD patients. Design Cohort study. Methods We assessed the criterion validity of the SCQ for IBD patients by comparing patient-reported and clinician-reported comorbidities (as noted in the electronic health record) of the 13 diseases of the SCQ using Cohen's kappa. Construct validity was assessed using the Spearman correlation coefficient between the SCQ and the Charlson Comorbidity Index (CCI), clinician-reported SCQ, quality of life, IBD-related healthcare and productivity costs, prevalence of disability, and IBD disease activity. We assessed responsiveness by correlating changes in the SCQ with changes in healthcare costs, productivity costs, quality of life, and disease activity after 15 months. Results We included 613 patients. At least fair agreement (κ > 0.20) was found for most comorbidities, but the agreement was slight (κ < 0.20) for stomach disease [κ = 0.19, 95% CI (-0.03; 0.41)], blood disease [κ = 0.02, 95% CI (-0.06; 0.11)], and back pain [κ = 0.18, 95% CI (0.11; 0.25)]. Correlations were found between the SCQ and the clinician-reported SCQ [ρ = 0.60, 95% CI (0.55; 0.66)], CCI [ρ = 0.39, 95% CI (0.31; 0.45)], the prevalence of disability [ρ = 0.23, 95% CI (0.15; 0.32)], and quality of life [ρ = -0.30, 95% CI (-0.37; -0.22)], but not between the SCQ and healthcare or productivity costs or disease activity (|ρ| ⩽ 0.2). A change in the SCQ after 15 months was not correlated with a change in any of the outcomes. Conclusion The SCQ is a valid tool for measuring comorbidity in IBD patients, but face and content validity should be improved before being used to correct case-mix differences.
Collapse
Affiliation(s)
- Reinier Cornelis Anthonius van Linschoten
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, P.O Box 10900, Rotterdam 3004BA, Netherlands
- Department of Gastroenterology & Hepatology, Erasmus MC, Rotterdam, Netherlands
| | - Anouk Sjoukje Huberts
- Department of Quality and Patientcare, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Jan Antonius Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | | | - Rachel Louise West
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Desirée van Noord
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| |
Collapse
|
10
|
Nagata T, Funakoshi S, Morihara D, Shakado S, Yokoyama K, Takata K, Tanaka T, Fukunaga A, Yamauchi R, Fukuda H, Matsuoka H, Imakiire S, Sakisaka H, Matsuoka S, Kuno N, Abe K, Ishibashi H, Ashizuka S, Hirai F. Malnutrition and inflammation status in nonobese patients with inflammatory bowel disease are associated with nonalcoholic fatty liver disease: a retrospective study. Intest Res 2023; 21:471-480. [PMID: 37559192 PMCID: PMC10626015 DOI: 10.5217/ir.2023.00035] [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: 03/23/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND/AIMS The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD. METHODS We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters. RESULTS Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m2), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment. CONCLUSIONS Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.
Collapse
Affiliation(s)
- Takahiro Nagata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Daisuke Morihara
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazuhide Takata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Atsushi Fukunaga
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroki Matsuoka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - So Imakiire
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hideto Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Matsuoka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Nobuaki Kuno
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Abe
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hideki Ishibashi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinya Ashizuka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| |
Collapse
|
11
|
Lam GA, Albarrak H, McColl CJ, Pizarro A, Sanaka H, Gomez-Nguyen A, Cominelli F, Paes Batista da Silva A. The Oral-Gut Axis: Periodontal Diseases and Gastrointestinal Disorders. Inflamm Bowel Dis 2023; 29:1153-1164. [PMID: 36527679 PMCID: PMC10320234 DOI: 10.1093/ibd/izac241] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 06/17/2023]
Abstract
One of the prospective sequelae of periodontal disease (PD), chronic inflammation of the oral mucosa, is the development of inflammatory gastrointestinal (GI) disorders due to the amplification and expansion of the oral pathobionts. In addition, chronic inflammatory diseases related to the GI tract, which include inflammatory bowel disease (IBD), can lead to malignancy susceptibility in the colon of both animals and humans. Recent studies suggest that dysbiosis of the oral microbiota can alter the microbial composition in relative abundance or diversity of the distal gut, leading to the progression of digestive carcinogenesis. The link between PD and specific GI disorders is also closely associated with the migration and colonization of periodontal pathogens and the subsequent microbe-reactive T cell induction within the intestines. In this review, an in-depth examination of this relationship and the accessibility of different mouse models of IBD and PD may shed light on the current dogma. As such, oral microbiota dysbiosis involving specific bacteria, including Fusobacterium nucleatum and Porphyromonas gingivalis, can ultimately lead to gut malignancies. Further understanding the precise mechanism(s) of the oral-gut microbial axis in PD, IBD, and colorectal cancer pathogenesis will be pivotal in diagnosis, prognosis, and future treatment.
Collapse
Affiliation(s)
- Gretchen A Lam
- Digestive Health Research Institute, Case Western Reserve University, Cleveland, OH, USA
- School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hala Albarrak
- School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Periodontics, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | - Adrian Gomez-Nguyen
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Fabio Cominelli
- Digestive Health Research Institute, Case Western Reserve University, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Andre Paes Batista da Silva
- School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Periodontics, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Fan Y, Zhang L, Jiménez MC, Bohn RL, Thompson JS, Brodovicz KG, Gray S, Melmed GY. Economic burden related to fistulas or strictures among commercially insured patients with Crohn's disease in the United States. J Manag Care Spec Pharm 2023; 29:400-408. [PMID: 36989446 PMCID: PMC10387957 DOI: 10.18553/jmcp.2023.29.4.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND: Crohn's disease (CD) is a chronic, progressive, immune-mediated gastrointestinal condition that can lead to fistulizing or stricturing complications. OBJECTIVE: To quantify the burden of illness related to fistulas and/or strictures in patients with CD. METHODS: Using the Optum Research Database from October 2015 to December 2019, patients with CD were classified according to 1 of 3 condition cohorts: CD with fistula (CD-F), CD with stricture (CD-S), or CD with fistula and stricture (CD-FS). Each cohort was matched to a nonfistula, nonstricture CD cohort. Postdiagnosis per patient per year (PPPY) costs and health care resource utilization were assessed, accounting for variable lengths of follow-up periods. Multivariable generalized linear models were used to estimate the adjusted mean costs in each cohort. RESULTS: The CD-F, CD-S, and CD-FS cohorts included 1,317; 4,650; and 894 patients, respectively. The mean age of patients within the CD-S and their comparator cohorts was higher than in the CD-F or CD-FS cohorts (59.9 vs 49.5 vs 49.6 years). At baseline, cardiovascular disease was the most common comorbidity across all condition and comparator cohorts. Condition cohorts had 2-4 times more inpatient visits, 5-8 times more surgical visits, and 2-3 times more endoscopies PPPY than comparator cohorts. Compared with their respective comparator cohort, patients in the 3 condition cohorts had higher medication, medical, and total health care costs. CONCLUSIONS: This study demonstrates a significant economic burden related to fistulas and/or strictures among patients with CD, highlighting the importance of prevention, early recognition, and appropriate management of CD-related complications. DISCLOSURES: Yanni Fan, Ling Zhang, Jennifer S Thompson, and Kimberly G Brodovicz are employees of Boehringer Ingelheim. Rhonda L Bohn, Monik C Jiménez, and Stephani Gray (Bohn Epidemiology, LLC) are paid consultants to Boehringer Ingelheim. Gil Y Melmed reports receiving grants from Pfizer; consulting fees from Boehringer Ingelheim, AbbVie, Arena, BMS, Celgene, Entasis, Ferring Lilly, Fresenius Kabi, Medtronic, Samsung Bioepis, Janssen, Takeda, Pfizer, Prometheus Labs, and TechLab. We conducted a retrospective study using administrative claims data from the Optum Research Database, a database of a commercially insured population in the United States. All patient data were anonymized and deidentified; therefore, informed consent was not necessary. Restrictions apply to the availability of these data because of a contract between Optum and Boehringer Ingelheim, and data are thus unavailable to the public. For enquiries on the dataset analyzed in this study, please contact Optum (https://www.optum.com).
Collapse
Affiliation(s)
- Yanni Fan
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | - Ling Zhang
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | | | | | | | | | | | | |
Collapse
|
13
|
Bozon A, Nancey S, Serrero M, Caillo L, Gilletta C, Benezech A, Combes R, Danan G, Akouete S, Pages L, Bourgaux JF, Cosquer GL, Boivineau L, Meszaros M, Altwegg R. Risk of Infection in Elderly Patients with Inflammatory Bowel Disease under biologics: A Prospective, Multicenter, Observational, One-Year follow-up comparative study. Clin Res Hepatol Gastroenterol 2023; 47:102107. [PMID: 36906225 DOI: 10.1016/j.clinre.2023.102107] [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: 12/27/2022] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES The emergence of biologics has improved the course of inflammatory bowel diseases (IBD) in the elderly population despite a potential higher risk of infections. We conducted a one-year, prospective, multicenter, observational study to determine the frequency of occurrence of at least one infectious event in elderly IBD patients under anti-TNF therapy compared with that in elderly patients under vedolizumab or ustekinumab therapies . METHODS All IBD patients over 65 years exposed to anti-TNF, vedolizumab or ustekinumab therapies were included. The primary endpoint was the prevalence of at least one infection during the whole one year follow-up. RESULTS Among the 207 consecutive elderly IBD patients prospectively enrolled, 113 were treated with anti-TNF and 94 with vedolizumab (n=63) or ustekinumab (n=31) (median age 71 years, 112 Crohn's disease). The Charlson index was similar between patients under anti-TNF and those under vedolizumab or ustekinumab as well as the proportion of patients under combination therapy and under concomitant steroid therapy did not differ between both both groups. The prevalence of infections was similar in patients under anti-TNF and in those under vedolizumab or ustekinumab (29% versus 28%, respectively; p=0.81). There was no difference in terms of type and severity of infection and of infection-related hospitalization rate. In multivariate regression analysis, only the Charlson comorbidity index (≥ 1) was identified as a significant and independent risk factor of infection (p=0.03). CONCLUSION Around 30 % of elderly patients with IBD under biologics experienced at least one infection during the one-year study follow-up period. The risk of occurrence of infection does not differ between anti-TNF and vedolizumab or ustekinumab therapies, and only the associated comorbidity was linked with the risk of infection.
Collapse
Affiliation(s)
- Anne Bozon
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon and INSERMU1111-CIRI, Lyon, France
| | - Mélanie Serrero
- Department of Gastroenterology, Marseille Nord Hospital, APHM, Marseille, France
| | - Ludovic Caillo
- Department of Gastroenterology, University Hospital of Nîmes, Nîmes, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Alban Benezech
- Department of Gastroenterology, Henri Duffaut Hospital, Avignon, France
| | - Roman Combes
- Department of Gastroenterology, Languedoc Gastroentérologie, Montpellier, France
| | - Guillaume Danan
- Department of Gastroenterology, Gastrodoc, Montpellier, France
| | - Sandrine Akouete
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier, France
| | - Laurence Pages
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier, France
| | | | | | - Lucile Boivineau
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Magdalena Meszaros
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France.
| |
Collapse
|
14
|
Rodriguez-Duque JC, Calleja JL, Iruzubieta P, Hernández-Conde M, Rivas-Rivas C, Vera MI, Garcia MJ, Pascual M, Castro B, García-Blanco A, García-Nieto E, Olmo SCD, Cagigal ML, Lopez-Montejo L, Fernández-Lamas T, Rasines L, Fortea JI, Vaque JP, Frias Y, Rivero M, Arias-Loste MT, Crespo J. Increased risk of MAFLD and Liver Fibrosis in Inflammatory Bowel Disease Independent of Classic Metabolic Risk Factors. Clin Gastroenterol Hepatol 2023; 21:406-414.e7. [PMID: 35124272 DOI: 10.1016/j.cgh.2022.01.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is conflicting evidence regarding the prevalence of and risk factors for metabolic-associated fatty liver disease (MAFLD) in patients with inflammatory bowel disease (IBD). We aimed to determine MAFLD prevalence and risk factors in IBD patients. METHODS Cross-sectional, case-control study included all consecutive IBD patients treated at 2 different university hospitals. Controls were subjects randomly selected from the general population and matched by age, sex, type 2 diabetes status, and body mass index in a 1:2 ratio. MAFLD was confirmed by controlled attenuation parameter. Liver biopsies were collected when MAFLD with significant liver fibrosis was suspected. In addition, age- and fibrosis stage-paired non-IBD patients with biopsy-proven MAFLD served as a secondary control group. RESULTS Eight hundred thirty-one IBD patients and 1718 controls were included. The prevalence of MAFLD and advanced liver fibrosis (transient elastography ≥9.7 kPa) was 42.00% and 9.50%, respectively, in IBD patients and 32.77% and 2.31%, respectively, in the general population (P < .001). A diagnosis of IBD was an independent predictor of MAFLD (adjusted odds ratio, 1.99; P < .001) and an independent risk factor for advanced liver fibrosis (adjusted odds ratio, 5.55; P < .001). Liver biopsies were obtained from 40 IBD patients; MAFLD was confirmed in all cases, and fibrosis of any degree was confirmed in 25 of 40 cases (62.5%). Body mass index and type 2 diabetes prevalence were significantly lower in IBD-MAFLD patients than in severity-paired patients with biopsy-proven MAFLD. CONCLUSIONS MAFLD and liver fibrosis are particularly prevalent in IBD patients, regardless of the influence of classic metabolic risk factors.
Collapse
Affiliation(s)
- Juan Carlos Rodriguez-Duque
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - José Luis Calleja
- Gastroenterology and Hepatology Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Marta Hernández-Conde
- Gastroenterology and Hepatology Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Coral Rivas-Rivas
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Isabel Vera
- Gastroenterology and Hepatology Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Maria Jose Garcia
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Marta Pascual
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Beatriz Castro
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Agustín García-Blanco
- Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Enrique García-Nieto
- Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Soraya Curiel-Del Olmo
- Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Luisa Cagigal
- Pathology Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Lorena Lopez-Montejo
- Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Tatiana Fernández-Lamas
- Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Laura Rasines
- Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - José Ignacio Fortea
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - José Pedro Vaque
- Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain; Molecular Biology Department, University of Cantabria, Santander, Spain
| | - Yza Frias
- Gastroenterology and Hepatology Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Montserrat Rivero
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Teresa Arias-Loste
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - Javier Crespo
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain.
| |
Collapse
|
15
|
Eltantawy N, El-Zayyadi IAEH, Elberry AA, Salah LM, Abdelrahim MEA, Kassem AB. Association of genetic polymorphism of NUDT15, TPMT and ITPA gene in the toxicity and efficacy of azathioprine-based regimen in Egyptian inflammatory bowel disease patients. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2023. [DOI: 10.1186/s43088-023-00340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
Background
Inflammatory Bowel disease (IBD) is a chronic progressive condition that prompts generous physical and mental morbidity. Choosing the best kind of management and medication dosage prevents new episodes of high disease activity during therapy because of adverse drug reactions (ADRs). This can lead to cessation or inefficacy of the treatment, or complete non-responsiveness to specific medications. Pharmacogenetics (PGx) is a well-established aspect in IBD. One of the exemplary instances of PGx is thiopurines, which are frequently utilized as IBD therapy. This study aimed to evaluate specific gene polymorphism involved in the toxicity and efficacy of Azathioprine (AZA) use in the management in Egyptian patients and to find the correlation between the polymorphism of Nudix Hydrolase15 (NUDT15) gene (rs116855232), The Thiopurine methyltransferase (TPMT) gene (rs1800460) and Inosine Triphosphatase (ITPA) gene (rs1127354) which are involved in the metabolism of the medications utilized in IBD management.
Methods
This prospective study was performed in 150 patients with IBD. All patients were treated with 2 mg/kg per day AZA (Imuran, GlaxoSmithKline®) for at least 3 months at therapeutic doses to induce remission. Subsequent treatment of AZA. The minimum follow-up period for those who did not experience ADR was one year. Among the studied patients, one hundred twenty-nine patients were treated with combination regimen of steroids (oral prednisone 1 mg/kg/day).
Also, treatment failure was considered among the patients who could not tolerate AZA side effects, or there was no improvement after dose modification.
Results
The most identifiable adverse effect among the studied population was anemia followed by leukopenia and myelosuppression. SNPs genotype TPMT (rs1800460) and ITPA gene (rs1127354) were significantly related to adverse effects among IBD patients receiving Azathioprine treatment. There was a lack of any variants in the NUDT15 genotype among the Egyptian population.
Conclusion
Further research is required in to clarify the relationship between NUDT15 PGx and AZA-ADRs. The effect of NUDT15 PGx on toxicity and ADRs as yet necessitates to be elucidated. Studies with a larger sample size and involving different ethnicities are also necessary.
Collapse
|
16
|
Wu L, Lv Z, Lai L, Zhou P. Assessment of influencing factors of hospitalization expenses for Crohn's disease patients: Based on LASSO and linear mixed model. Front Public Health 2022; 10:925616. [PMID: 36159299 PMCID: PMC9500361 DOI: 10.3389/fpubh.2022.925616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/23/2022] [Indexed: 01/24/2023] Open
Abstract
Aims Crohn's disease (CD) is a global disease that is dramatically increasing. This study aimed to identify the primary drivers of hospitalization expenses for CD patients to provide guidance on the allocation and control of health care costs. Methods This study retrospectively collected the homepage data of the electronic medical records of CD patients in two tertiary hospitals in Zhejiang Province, China, from January 2016 to December 2021. The influencing factors of hospitalization expenses for CD were analyzed. A linear mixed model with least absolute shrinkage (LASSO-LMM) was used to develop a predictive model for hospitalization expenses for CD patients. Results A total of 4,437 CD patients were analyzed in this study. CD patients' age, length of hospital stay, admission route, comorbidities, and main treatment were found to be statistically significant variables for CD patients' hospitalization expenses. The AIC and BIC of LASSO-LMM model were 319.033 and 306.241, respectively. Patients who were older, had a longer hospital stay, and had comorbidities had higher hospitalization expenses. The hospitalization expenses of outpatients were lower than those of emergency patients. The weight of surgical treatment was the highest among three treatments (0.602). Conclusions Identifying and examining factors that influence hospitalization expenses for CD patients can help to control healthcare expenditures. Treatment mode was the most important impact on CD hospitalization expenses. Medical security departments can consider implement personalized and precise hospitalization expense compensation scheme base on LASSO-LMM prediction model in the future.
Collapse
Affiliation(s)
- Li Wu
- Center of Clinical Evaluation, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China,Center of Clinical Evaluation, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Zhijie Lv
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,*Correspondence: Zhijie Lv
| | - Linjing Lai
- Center of Clinical Evaluation, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China,Center of Clinical Evaluation, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Penglei Zhou
- Center of Clinical Evaluation, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China,Center of Clinical Evaluation, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
| |
Collapse
|
17
|
Forlemu AN, Nana Sede Mbakop R, Aslam S, Ansari Z, Srinivasan I, Chuang KY. Effect of Comorbidities on Inflammatory Bowel Disease-Related Colorectal Cancer: A Nationwide Inpatient Review. Cureus 2022; 14:e27599. [PMID: 36059351 PMCID: PMC9433811 DOI: 10.7759/cureus.27599] [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: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The risk of inflammatory bowel disease-associated colorectal cancer (IBD-CRC) is known to increase with primary sclerosing cholangitis (PSC) and a family history of CRC. However, the impact of comorbidities such as liver disease, obesity, diabetes, chronic lung, heart, and renal disease, and psychiatric illness on the risk of IBD-CRC remains unclear. We evaluated the effect of these comorbidities on the risk of IBD-CRC. Methods A retrospective review from 2009 to 2014 was conducted using the National Inpatient Sample data for adults 18 years and older. Patients with IBD (360,892), of whom 2,831 had CRC were identified using the International Classification of Diseases, Ninth Revision codes (ICD-9). Data on comorbidities were also obtained. Adjusted odds ratios (aOR) and confidence intervals (CI) were computed via logistic regression to evaluate the effect of comorbidities on the risk of IBD-CRC; the p-value was set at <0.05. Results The mean age of IBD patients in this study was 52.36±0.03. A majority of the patients with IBD-CRC were white and were significantly older compared to those without cancer (60 vs 52 years, p<0.05). The risk of colon cancer in IBD was increased by having a non-cholestatic liver disease (aOR 1.51, CI 1.23-1.86, p<0.01). Also, patients younger than 50 years with liver disease were at an increased risk of IBD-associated colon cancer in comparison to older patients (aOR 1.83 vs 1.34, p<0.05). Notably, diabetes, chronic pulmonary disease, renal failure, psychiatric illnesses, and rheumatoid diseases, were inversely associated with the risk of IBD-CRC (p<0.05). After stratifying by IBD subtypes, non-cholestatic liver disease was still independently associated with a higher risk for colon cancer in patients with ulcerative colitis or Crohn's disease (ulcerative colitis: aOR 1.43, CI 1.08-1.89; Crohn's disease: aOR 1.46, CI 1.10-2.00). Conclusions Patients with IBD who have non-cholestatic liver disease might have a higher risk for colon cancer, even at a younger age. These patients may require close colon cancer surveillance.
Collapse
|
18
|
Alkhayyat M, Abureesh M, Almomani A, Abou Saleh M, Zmaili M, El Ouali S, Mansoor E, Rubio-Tapia A, Regueiro M. Patients With Inflammatory Bowel Disease on Treatment Have Lower Rates of Celiac Disease. Inflamm Bowel Dis 2022; 28:385-392. [PMID: 34002219 DOI: 10.1093/ibd/izab084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The association between celiac disease and inflammatory bowel disease (IBD) has been studied; however, the impact of IBD therapy on celiac disease is not known. Using a large database, we sought to describe the association of celiac disease and IBD and the impact of IBD treatment. METHODS We queried a large multicenter database (Explorys Inc.), an electronic health record data aggregate from 26 American health care systems. We identified a cohort of patients with celiac disease and IBD between 1999 and 2020 and conducted a statistical analysis using a multivariate model. RESULTS Of the 72,965,940 individuals in the database, 133,400 had celiac disease (0.18%), 191,570 (0.26%) had ulcerative colitis (UC), and 230,670 (0.32%) had Crohn disease (CD). Patients with IBD were more likely to have a diagnosis of celiac disease (odds ratio [OR], 13.680), with a greater association with CD. Treated patients with UC and with CD, respectively, had a lower risk association with celiac disease compared to those not undergoing IBD treatment, specifically corticosteroids (OR, 0.407 and 0.585), 5-aminosalicylates (OR, 0.124 and 0.127), immunomodulators (OR, 0.385 and 0.425), and anti-tumor necrosis factor drugs (OR, 0.215 and 0.242). There was no lower risk association in the vedolizumab group, but there was a higher risk association among the ustekinumab group. CONCLUSIONS In this large dataset, we showed a bidirectional association between celiac disease and IBD that was stronger with CD. Patients with IBD treated using corticosteroids, 5-aminosalicylates, immunomodulators, or anti-tumor necrosis factor drugs had a lower association with celiac disease. Additional studies are required to determine the underlying mechanisms for IBD therapy-related modification of celiac disease incidence.
Collapse
Affiliation(s)
- Motasem Alkhayyat
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - Ashraf Almomani
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohannad Abou Saleh
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammad Zmaili
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sara El Ouali
- Department of Gastroenterology, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Emad Mansoor
- Department of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Alberto Rubio-Tapia
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
19
|
Rheumatoid arthritis and inflammatory bowel disease: a bidirectional two-sample Mendelian randomization study. Semin Arthritis Rheum 2022; 55:151992. [DOI: 10.1016/j.semarthrit.2022.151992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022]
|
20
|
Baker KA, Miller TD, Marino FE, Hartmann TE. The exercise-induced inflammatory response in inflammatory bowel disease: A systematic review and meta-analysis. PLoS One 2022; 17:e0262534. [PMID: 35120159 PMCID: PMC8815877 DOI: 10.1371/journal.pone.0262534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study investigated selected inflammatory responses to acute and chronic exercise in individuals with inflammatory bowel disease (IBD). METHODS A systematic review and meta-analysis was conducted on all relevant exercise-based intervention publications with IBD participants. The study included articles that utilised a broad range of acute and chronic exercise interventions, with inflammatory biomarkers measured and symptoms documented, both pre- and post-exercise for those with IBD. The search was limited to studies published in English, the use of human participants, and primary studies, with no restrictions on date of publication or participant's age. Articles were retrieved through the electronic databases: PubMed, SPORTDiscus, and Scopus. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Six inflammatory markers were included in the meta-analysis which consisted of five studies. Exercise interventions resulted in no significant difference in IL-6 (SMD = -0.09; 95% CI = -0.49, 0.30; P = 0.64), TNF-α (SMD = 0.08; 95% CI = -0.31, 0.48; P = 0.68), CRP (SMD = -0.04; 95% CI = -0.58, 0.50; P = 0.89), IL-17 (SMD = 0.15; 95% CI = -0.45, 0.76; P = 0.62), leukocytes (SMD = 0.40; 95% CI = -0.53, 1.33; P = 0.40) or lymphocytes (SMD = 0.32; 95% CI = -0.33, 0.97; P = 0.33), thus, indicating exercise may have no effect on inflammatory markers in IBD. Bowel symptoms improved following regular moderate exercise that incorporated stress management. CONCLUSION Heterogeneity among the identified literature may have led to exercise interventions being ineffective in reducing inflammation. Although the limited number of eligible studies may reduce the reliability of results, it emphasises the need for additional research in this domain. Importantly, no adverse symptomatic responses to exercise indicate that exercise is safe for IBD patients.
Collapse
Affiliation(s)
- Kelly A. Baker
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Timothy D. Miller
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Frank E. Marino
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Tegan E. Hartmann
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| |
Collapse
|
21
|
Park J, Yoon H, Shin CM, Park YS, Kim N, Lee DH. Clinical factors to predict flare-up in patients with inflammatory bowel disease during international air travel: A prospective study. PLoS One 2022; 17:e0262571. [PMID: 35061808 PMCID: PMC8782361 DOI: 10.1371/journal.pone.0262571] [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: 06/22/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
Backgrounds and aims Inflammatory bowel disease (IBD) patients often experience disease flare-ups during international air travel. We aimed to identify risk factors associated with IBD flare-up during international air travel. Methods Patients with scheduled international air travel were enrolled in the study from the Seoul National University Bundang Hospital IBD clinic. Flight information and clinical data were collected via questionnaires and personal interviews, and risk factors associated with IBD flares were determined. Results Between May 2018 and February 2020, 94 patients were prospectively enrolled in the study (mean age, 33.0 years; males, 53.2%; mean disease duration, 56.7 months), including 56 (59.6%) with ulcerative colitis and 38 (40.4%) with Crohn’s disease. Of the 94 patients enrolled, 15 (16.0%) experienced an IBD flare-up and 79 (84.0%) remained in remission throughout travel. Logistic regression analysis revealed that high fecal calprotectin levels before travel (odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1.000–1.001, p = 0.016), the presence of a comorbidity (OR: 6.334, 95% CI: 1.129–35.526, p = 0.036), and history of emergency room visit (OR: 5.283, 95% CI: 1.085–25.724, p = 0.039) were positively associated with disease flare-up. The previous and current use of immunomodulators and biologics, time of flight, altitude, number countries visited, travel duration, objective of visit, and previous medical consultations were not associated with disease flare-up. Conclusions Elevated fecal calprotectin levels, history of emergency room visits, and the presence of a comorbidity predicted IBD flare-up during international air travel.
Collapse
Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail:
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
22
|
Barnes C, Bajracharya B, Cannalte M, Gowani Z, Haley W, Kass-Hout T, Hernandez K, Ingram M, Juvvala HP, Kuffel G, Martinov P, Maxwell JM, McCann J, Malhotra A, Metoki-Shlubsky N, Meyer C, Paredes A, Qureshi J, Ritter X, Schumm P, Shao M, Sheth U, Simmons T, VanTol A, Zhang Z, Grossman RL. The Biomedical Research Hub: a federated platform for patient research data. J Am Med Inform Assoc 2021; 29:619-625. [PMID: 35289369 PMCID: PMC8922179 DOI: 10.1093/jamia/ocab247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Objective The objective was to develop and operate a cloud-based federated system for managing, analyzing, and sharing patient data for research purposes, while allowing each resource sharing patient data to operate their component based upon their own governance rules. The federated system is called the Biomedical Research Hub (BRH). Materials and Methods The BRH is a cloud-based federated system built over a core set of software services called framework services. BRH framework services include authentication and authorization, services for generating and assessing findable, accessible, interoperable, and reusable (FAIR) data, and services for importing and exporting bulk clinical data. The BRH includes data resources providing data operated by different entities and workspaces that can access and analyze data from one or more of the data resources in the BRH. Results The BRH contains multiple data commons that in aggregate provide access to over 6 PB of research data from over 400 000 research participants. Discussion and conclusion With the growing acceptance of using public cloud computing platforms for biomedical research, and the growing use of opaque persistent digital identifiers for datasets, data objects, and other entities, there is now a foundation for systems that federate data from multiple independently operated data resources that expose FAIR application programming interfaces, each using a separate data model. Applications can be built that access data from one or more of the data resources.
Collapse
Affiliation(s)
- Craig Barnes
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Binam Bajracharya
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Matthew Cannalte
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Zakir Gowani
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Will Haley
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | | | - Kyle Hernandez
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Michael Ingram
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Hara Prasad Juvvala
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Gina Kuffel
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | | | - J Montgomery Maxwell
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - John McCann
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | | | - Noah Metoki-Shlubsky
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Chris Meyer
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Andre Paredes
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Jawad Qureshi
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Xenia Ritter
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Philip Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Mingfei Shao
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Urvi Sheth
- Open Commons Consortium, Chicago, Illinois, USA
| | - Trevar Simmons
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Alexander VanTol
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Zhenyu Zhang
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Robert L Grossman
- Center for Translational Data Science, University of Chicago, Chicago, Illinois, USA
- Department of Medicine and Computer Science, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
23
|
Hadid B, Buehring W, Mannino A, Weisberg MD, Golub IJ, Ng MK, Razi AE. Crohn's Disease Increases In-Hospital Lengths of Stay, Medical Complications, and Costs of Care following Primary Total Knee Arthroplasty. J Knee Surg 2021; 36:524-529. [PMID: 34794196 DOI: 10.1055/s-0041-1739199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The literature has shown an increase in prevalence of Crohn's disease (CD) within the United States alongside a concomitant rise in primary total knee arthroplasty (TKA) procedures. As such, with these parallel increases, orthopaedic surgeons will invariably encounter CD patients requiring TKA. Limited studies exist evaluating the impact of this disease on patients undergoing the procedure; therefore, this study endeavors to determine whether CD patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) episode of care (EOC) costs. To accomplish this, a nationwide database was queried from January 1, 2005 to March 31, 2014 to identify patients undergoing TKA. The study group, patients with CD, was randomly matched to the controls, patients without CD, in a 1:5 ratio after accounting for age, sex, and medical comorbidities associated with CD. Patients consuming corticosteroids were excluded, as they are at risk of higher rates of adverse events following TKA. This query ultimately yielded a total of 96,213 patients, with 16,037 in the study cohort and 80,176 in the control one. The study compared in-hospital (LOS), 90-day medical complications, and day of surgery and total global 90-day EOC costs between CD and non-CD patients undergoing primary TKA. The results found CD patients undergoing primary TKA had significantly longer in-hospital LOS (4- vs. 3 days, p < 0.0001) compared with non-CD patients. CD patients were also found to have significantly higher incidence and odds of 90-day medical complications (25.31 vs. 10.75; odds ratio: 2.05, p < 0.0001) compared with their counterparts. Furthermore, CD patients were found to have significantly higher 90-day EOC costs ($15,401.63 vs. 14,241.15, p < 0.0001) compared with controls. This study demonstrated that, after adjusting for age, sex, and medical comorbidities, patients with CD have prolonged in-hospital LOS, increased medical complications, and higher EOC costs following primary TKA. Therefore, it establishes the importance for orthopaedists to adequately counsel CD patients of the potential complications and outcomes following their procedure.
Collapse
Affiliation(s)
- Bana Hadid
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York.,School of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Weston Buehring
- School of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Angelo Mannino
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Miriam D Weisberg
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ivan J Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| |
Collapse
|
24
|
Öhlmann H, Koenen LR, Labrenz F, Engler H, Theysohn N, Langhorst J, Elsenbruch S. Altered Brain Structure in Chronic Visceral Pain: Specific Differences in Gray Matter Volume and Associations With Visceral Symptoms and Chronic Stress. Front Neurol 2021; 12:733035. [PMID: 34744973 PMCID: PMC8564184 DOI: 10.3389/fneur.2021.733035] [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: 06/29/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Structural brain alterations in chronic pain conditions remain incompletely understood, especially in chronic visceral pain. Patients with chronic-inflammatory or functional bowel disorders experience recurring abdominal pain in concert with other gastrointestinal symptoms, such as altered bowel habits, which are often exacerbated by stress. Despite growing interest in the gut-brain axis and its underlying neural mechanisms in health and disease, abnormal brain morphology and possible associations with visceral symptom severity and chronic stress remain unclear. We accomplished parallelized whole-brain voxel-based morphometry analyses in two patient cohorts with chronic visceral pain, i.e., ulcerative colitis in remission and irritable bowel syndrome, and healthy individuals. In addition to analyzing changes in gray matter volume (GMV) in each patient cohort vs. age-matched healthy controls using analysis of covariance (ANCOVA), multiple regression analyses were conducted to assess correlations between GMV and symptom severity and chronic stress, respectively. ANCOVA revealed reduced GMV in frontal cortex and anterior insula in ulcerative colitis compared to healthy controls, suggesting alterations in the central autonomic and salience networks, which could however not be confirmed in supplemental analyses which rigorously accounted for group differences in the distribution of sex. In irritable bowel syndrome, more widespread differences from healthy controls were observed, comprising both decreased and increased GMV within the sensorimotor, central executive and default mode networks. Associations between visceral symptoms and GMV within frontal regions were altered in both patient groups, supporting a role of the central executive network across visceral pain conditions. Correlations with chronic stress, on the other hand, were only found for irritable bowel syndrome, encompassing numerous brain regions and networks. Together, these findings complement and expand existing brain imaging evidence in chronic visceral pain, supporting partly distinct alterations in brain morphology in patients with chronic-inflammatory and functional bowel disorders despite considerable overlap in symptoms and comorbidities. First evidence pointing to correlations with chronic stress in irritable bowel syndrome inspires future translational studies to elucidate the mechanisms underlying the interconnections of stress, visceral pain and neural mechanisms of the gut-brain axis.
Collapse
Affiliation(s)
- Hanna Öhlmann
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Laura Ricarda Koenen
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro-and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Franziska Labrenz
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro-and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jost Langhorst
- Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany.,Department for Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany.,Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
25
|
Campanati A, Marani A, Martina E, Diotallevi F, Radi G, Offidani A. Psoriasis as an Immune-Mediated and Inflammatory Systemic Disease: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2021; 9:biomedicines9111511. [PMID: 34829740 PMCID: PMC8615182 DOI: 10.3390/biomedicines9111511] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022] Open
Abstract
Psoriasis is an immune-mediated inflammatory disease, with a chronic relapsing-remitting course, which affects 2–3% of the worldwide population. The progressive acquisitions of the inflammatory pathways involved in the development of psoriasis have led to the identification of the key molecules of the psoriatic inflammatory cascade. At the same time, psoriasis therapy has radically evolved with the introduction of target molecules able to modify the natural history of the disease, acting specifically on these inflammatory pathways. For these reasons, biologics have been demonstrated to be drugs able to change the disease’s natural history, as they reduce the inflammatory background to avoid irreversible organ damage and prevent systemic complications. However, several issues related to the use of biologics in patients with systemic comorbidities, remain open. All these data reflect the extraordinary potentiality of biologics, but also the unmet medical need to improve our knowledge on the long-term risk related to continuous use of these drugs, and their administration in special populations. This narrative review aims to highlight both the efficacy and safety profile of biologics in psoriasis, starting from pathophysiology and moving towards their clinical application.
Collapse
|
26
|
Juarez JE, Romero T, Mantz CA, Pepin A, Aghdam N, Suy S, Steinberg ML, Levin-Epstein RG, Nickols NG, Kaplan ID, Meier RM, Pham HT, Linson PW, Hong RL, Buyyounouski MK, Bagshaw HP, Fuller DB, Katz AJ, Loblaw A, Collins SP, Kishan AU. Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series. Adv Radiat Oncol 2021; 6:100759. [PMID: 34585025 PMCID: PMC8453194 DOI: 10.1016/j.adro.2021.100759] [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: 03/30/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose To evaluate the safety of stereotactic body radiation therapy (SBRT) for prostate cancer in men with inflammatory bowel disease (IBD). Methods and Materials We queried a consortium database for patients with IBD receiving SBRT for prostate cancer between 2006 and 2012. Identified patients were matched with patients without a history of IBD in a 3:1 fashion based on dose, fractionation, use of androgen deprivation therapy, and age distribution. Logistic regression was used to evaluate the association between having IBD and experiencing acute and late gastrointestinal (GI) and genitourinary (GU) toxicities as scored on the Common Terminology Criteria for Adverse Events scale. Time to late toxicity was evaluated using proportional hazard Cox models. Our study was limited by absence of data on prostate size, baseline International Prostate Symptom Score, and rectal dose-volume histogram parameters. Results Thirty-nine patients with flare-free IBD at time of treatment (median follow-up 83.9 months) and 117 matched controls (median follow-up 88.7 months) were identified. A diagnosis of IBD was associated with increased odds of developing any late grade GI toxicity (odds ratio [OR] 6.11, P <.001) and GU toxicity (odds ratio 6.14, P < .001), but not odds of developing late grade ≥2 GI (P = .08) or GU toxicity (P = .069). Acute GI and GU toxicity, both overall and for grade ≥2 toxicities, were more frequent in men with IBD (P < .05). Time to late GI and GU toxicity of any grade was significantly shorter in patients with IBD (P < .001). Time to late grade ≥2 GU, but not grade ≥2 GI toxicity, was also shorter in patients with IBD (P = .044 for GU and P = .144 for GI). Conclusions Patients with IBD who received SBRT for PCa had a higher likelihood of developing acute GI and GU toxicity, in addition to experiencing lower grade late toxicities that occurred earlier. However, patients with IBD did not have a higher likelihood for late grade ≥2 GI or GU toxicity after SBRT compared with the control cohort. Interpretation of this data are limited by the small sample size. Thus, men with IBD in remission should be properly counseled about these risks when considering SBRT.
Collapse
Affiliation(s)
- Jesus E Juarez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | - Tahmineh Romero
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Abigail Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC.,Department of Radiation Oncology, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Michael L Steinberg
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | | | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, California
| | - Irving D Kaplan
- Department of Radiation Oncology, Beth Israel Deaconess, Boston, Massachusetts
| | | | - Huong T Pham
- Section of Radiation Oncology, Virginia Mason Medical Center, Seattle, Washington
| | - Patrick W Linson
- Department of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, California
| | - Robert L Hong
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia
| | | | - Hilary P Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Donald B Fuller
- Division of Genesis Health care Partners Inc, CyberKnife Centers of San Diego Inc, San Diego, California
| | - Alan J Katz
- Flushing Radiation Oncology Services, New York
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Urology, University of California, Los Angeles, California
| |
Collapse
|
27
|
Zatorski H, Salaga M, Zielińska M, Mokrowiecka A, Jacenik D, Krajewska WM, Małecka-Panas E, Fichna J. Colonic inflammation induces changes in glucose levels through modulation of incretin system. Pharmacol Rep 2021; 73:1670-1679. [PMID: 34535873 PMCID: PMC8599322 DOI: 10.1007/s43440-021-00327-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
Background The role of the incretin hormone, glucagon-like peptide (GLP-1), in Crohn’s disease (CD), is still poorly understood. The aim of this study was to investigate whether colitis is associated with changes in blood glucose levels and the possible involvement of the incretin system as an underlaying factor. Methods We used a murine model of colitis induced by 2,4,6-trinitrobenzenesulfonic acid (TNBS). Macroscopic and microscopic score and expression of inflammatory cytokines were measured. The effect of colitis on glucose level was studied by measurement of fasting glucose and GLP-1, dipeptidyl peptidase IV (DPP IV) levels, prohormone convertase 1/3 (PC 1/3) and GLP-1 receptor (GLP-1R) expression in mice. We also measured the level of GLP-1, DPP IV and expression of glucagon (GCG) and PC 1/3 mRNA in serum and colon samples from healthy controls and CD patients. Results Fasting glucose levels were increased in animals with colitis compared to controls. GLP-1 was decreased in both serum and colon of mice with colitis in comparison to the control group. DPP IV levels were significantly increased in serum, but not in the colon of mice with colitis as compared to healthy animals. Furthermore, PC 1/3 and GLP-1R expression levels were increased in mice with colitis as compared to controls. In humans, no differences were observed in fasting glucose level between healthy subjects and CD patients. GLP-1 levels were significantly decreased in the serum. Interestingly, GLP-1 level was significantly increased in colon samples of CD patients compared to healthy subjects. No significant differences in DPP IV levels in serum and colon samples were observed between groups. Conclusions Changes in the incretin system during colitis seem to contribute to the impaired glucose levels. Differences in incretin levels seem to be modulated by degrading enzyme DPP-IV and PC 1/3. Obtained results suggest that the incretin system may become a novel therapeutic approach in the treatment of CD.
Collapse
Affiliation(s)
- Hubert Zatorski
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland.,Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Maciej Salaga
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland
| | - Marta Zielińska
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland
| | - Anna Mokrowiecka
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Damian Jacenik
- Department of Cytobiochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Wanda Małgorzata Krajewska
- Department of Cytobiochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Ewa Małecka-Panas
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Jakub Fichna
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland.
| |
Collapse
|
28
|
Bernstein CN, Nugent Z, Shaffer S, Singh H, Marrie RA. Comorbidity before and after a diagnosis of inflammatory bowel disease. Aliment Pharmacol Ther 2021; 54:637-651. [PMID: 34156724 DOI: 10.1111/apt.16444] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Comorbidity is an important predictor of how disease course in inflammatory bowel (IBD) evolves. AIMS To determine pre-diagnosis relative rates (RR) and post-diagnosis hazard ratios (HR) of component diseases of the Charlson Comorbidity Index (CCI) in a cohort study of persons with IBD. METHODS The University of Manitoba IBD Epidemiology Database includes all Manitobans with IBD from 1 April 1984 through 31 March 2018 and matched controls. All outpatient physician claims and hospital discharge abstracts were searched for diagnostic codes for CCI component diseases. Some diseases were collapsed into one group such that we assessed 12 conditions. We report the RR of these conditions prior to IBD and the incidence of these diagnoses after IBD. Using Cox proportional hazards regression we report post-diagnosis HR. Confidence intervals were adjusted for Bonferroni correction. RESULTS The RR of cardiovascular diseases, peripheral vascular diseases, chronic pulmonary diseases, connective tissue disease/rheumatic diseases, renal disease, liver diseases, peptic ulcer disease, and cancer were all increased prior to diagnoses of IBD compared to controls. All comorbidities were increased post IBD diagnosis. The increased HR for dementia in persons with Crohn's disease was a concerning novel finding. The increased association with paraplegia/hemiplegia was unexpected. For all comorbidities, except diabetes, the age at diagnosis was younger in IBD than controls. CONCLUSIONS Persons with IBD have a higher comorbidity burden than persons without IBD. Optimal care plans for persons with IBD should include an assessment for other comorbidities that include just about every other organ system.
Collapse
Affiliation(s)
- Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada
| | - Zoann Nugent
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada.,Cancercare Manitoba, Winnipeg, MB, Canada
| | - Seth Shaffer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada
| | - Harminder Singh
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
29
|
Hyun CK. Molecular and Pathophysiological Links between Metabolic Disorders and Inflammatory Bowel Diseases. Int J Mol Sci 2021; 22:ijms22179139. [PMID: 34502047 PMCID: PMC8430512 DOI: 10.3390/ijms22179139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023] Open
Abstract
Despite considerable epidemiological evidence indicating comorbidity between metabolic disorders, such as obesity, type 2 diabetes, and non-alcoholic fatty liver disease, and inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, as well as common pathophysiological features shared by these two categories of diseases, the relationship between their pathogenesis at molecular levels are not well described. Intestinal barrier dysfunction is a characteristic pathological feature of IBD, which also plays causal roles in the pathogenesis of chronic inflammatory metabolic disorders. Increased intestinal permeability is associated with a pro-inflammatory response of the intestinal immune system, possibly leading to the development of both diseases. In addition, dysregulated interactions between the gut microbiota and the host immunity have been found to contribute to immune-mediated disorders including the two diseases. In connection with disrupted gut microbial composition, alterations in gut microbiota-derived metabolites have also been shown to be closely related to the pathogeneses of both diseases. Focusing on these prominent pathophysiological features observed in both metabolic disorders and IBD, this review highlights and summarizes the molecular risk factors that may link between the pathogeneses of the two diseases, which is aimed at providing a comprehensive understanding of molecular mechanisms underlying their comorbidity.
Collapse
Affiliation(s)
- Chang-Kee Hyun
- School of Life Science, Handong Global University, Pohang 37554, Gyungbuk, Korea
| |
Collapse
|
30
|
Antunes JC, Seabra CL, Domingues JM, Teixeira MO, Nunes C, Costa-Lima SA, Homem NC, Reis S, Amorim MTP, Felgueiras HP. Drug Targeting of Inflammatory Bowel Diseases by Biomolecules. NANOMATERIALS 2021; 11:nano11082035. [PMID: 34443866 PMCID: PMC8401460 DOI: 10.3390/nano11082035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease (IBD) is a group of disabling, destructive and incurable immune-mediated inflammatory diseases comprising Crohn’s disease (CD) and ulcerative colitis (UC), disorders that are highly prevalent worldwide and demand a large investment in healthcare. A persistent inflammatory state enables the dysfunction and destruction of healthy tissue, hindering the initiation and endurance of wound healing. Current treatments are ineffective at counteracting disease progression. Further, increased risk of serious side effects, other comorbidities and/or opportunistic infections highlight the need for effective treatment options. Gut microbiota, the key to preserving a healthy state, may, alternatively, increase a patient’s susceptibility to IBD onset and development given a relevant bacterial dysbiosis. Hence, the main goal of this review is to showcase the main conventional and emerging therapies for IBD, including microbiota-inspired untargeted and targeted approaches (such as phage therapy) to infection control. Special recognition is given to existing targeted strategies with biologics (via monoclonal antibodies, small molecules and nucleic acids) and stimuli-responsive (pH-, enzyme- and reactive oxygen species-triggered release), polymer-based nanomedicine that is specifically directed towards the regulation of inflammation overload (with some nanosystems additionally functionalized with carbohydrates or peptides directed towards M1-macrophages). The overall goal is to restore gut balance and decrease IBD’s societal impact.
Collapse
Affiliation(s)
- Joana Costa Antunes
- Centre for Textile Science and Technology (2C2T), Campus de Azurém, University of Minho, 4800-058 Guimarães, Portugal; (J.M.D.); (M.O.T.); (N.C.H.); (M.T.P.A.); (H.P.F.)
- Correspondence: ; Tel.: +351-253-510-289
| | - Catarina Leal Seabra
- Laboratório Associado para a Química Verde (LAQV), Network of Chemistry and Technology (REQUIMTE), Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (C.L.S.); (C.N.); (S.A.C.-L.); (S.R.)
| | - Joana Margarida Domingues
- Centre for Textile Science and Technology (2C2T), Campus de Azurém, University of Minho, 4800-058 Guimarães, Portugal; (J.M.D.); (M.O.T.); (N.C.H.); (M.T.P.A.); (H.P.F.)
| | - Marta Oliveira Teixeira
- Centre for Textile Science and Technology (2C2T), Campus de Azurém, University of Minho, 4800-058 Guimarães, Portugal; (J.M.D.); (M.O.T.); (N.C.H.); (M.T.P.A.); (H.P.F.)
| | - Cláudia Nunes
- Laboratório Associado para a Química Verde (LAQV), Network of Chemistry and Technology (REQUIMTE), Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (C.L.S.); (C.N.); (S.A.C.-L.); (S.R.)
| | - Sofia Antunes Costa-Lima
- Laboratório Associado para a Química Verde (LAQV), Network of Chemistry and Technology (REQUIMTE), Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (C.L.S.); (C.N.); (S.A.C.-L.); (S.R.)
| | - Natália Cândido Homem
- Centre for Textile Science and Technology (2C2T), Campus de Azurém, University of Minho, 4800-058 Guimarães, Portugal; (J.M.D.); (M.O.T.); (N.C.H.); (M.T.P.A.); (H.P.F.)
| | - Salette Reis
- Laboratório Associado para a Química Verde (LAQV), Network of Chemistry and Technology (REQUIMTE), Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; (C.L.S.); (C.N.); (S.A.C.-L.); (S.R.)
| | - Maria Teresa Pessoa Amorim
- Centre for Textile Science and Technology (2C2T), Campus de Azurém, University of Minho, 4800-058 Guimarães, Portugal; (J.M.D.); (M.O.T.); (N.C.H.); (M.T.P.A.); (H.P.F.)
| | - Helena Prado Felgueiras
- Centre for Textile Science and Technology (2C2T), Campus de Azurém, University of Minho, 4800-058 Guimarães, Portugal; (J.M.D.); (M.O.T.); (N.C.H.); (M.T.P.A.); (H.P.F.)
| |
Collapse
|
31
|
Morsy MA, Khalaf HM, Rifaai RA, Bayoumi AMA, Khalifa EMMA, Ibrahim YF. Canagliflozin, an SGLT-2 inhibitor, ameliorates acetic acid-induced colitis in rats through targeting glucose metabolism and inhibiting NOX2. Biomed Pharmacother 2021; 141:111902. [PMID: 34328119 DOI: 10.1016/j.biopha.2021.111902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease is defined as chronic noninfectious inflammation of the gastrointestinal tract, including ulcerative colitis and Crohn's disease. Its incidence and predominance have increased globally, with no effective agents for preventing its recurrence or treatment until now. AIM The current study aimed to investigate the possible role of canagliflozin (CANA), a sodium-glucose co-transporter-2 inhibitor (SGLT-2), to prevent and treat acetic acid (AA)-induced colitis in a rat model. METHODS Colitis was induced in male Wistar rats by intrarectal instillation of 1 ml of 4% (v/v) AA. Rats were treated orally with either CANA (30 mg/kg/day, p.o.) for 10 days before or after colitis induction or sulfasalazine (360 mg/kg/day, p.o.) for 10 days before colitis induction. RESULTS AA resulted in a significant increase in disease activity index, colonic weight over length ratio, colon macroscopic damage score, and histological signs of colitis. All of these effects were significantly decreased by CANA administration. Additionally, CANA markedly inhibited AA-induced oxidative stress and inflammatory responses by significantly reducing the up-regulated levels in malondialdehyde, total nitrite, NF-κB, interleukin-1β, and TNF-α, and significantly increasing the down-regulated levels in reduced glutathione, superoxide dismutase, and interleukin-10. CANA significantly inhibited caspase-3 level while rescued survivin expression in colons. Finally, CANA reduced the elevated levels of pyruvic acid and G6PDH activity, as well as the levels of p22phox and NOX2 in the AA-induced colitis. CONCLUSION Our findings provide novel evidence that CANA has protective and therapeutic effects against AA-induced colitis by the impact of its antioxidant, anti-inflammatory, and anti-apoptotic effects.
Collapse
Affiliation(s)
- Mohamed A Morsy
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; Department of Pharmacology, Faculty of Medicine, Minia University, El-Minia 61511, Egypt.
| | - Hanaa M Khalaf
- Department of Pharmacology, Faculty of Medicine, Minia University, El-Minia 61511, Egypt
| | - Rehab A Rifaai
- Department of Histology and Cell Biology, Faculty of Medicine, Minia University, El-Minia 61511, Egypt
| | - Asmaa M A Bayoumi
- Department of Biochemistry, Faculty of Pharmacy, Minia University, El-Minia 61511, Egypt
| | - Esraa M M A Khalifa
- Department of Biochemistry, Faculty of Pharmacy, Deraya University, El-Minia 61111, Egypt
| | - Yasmine F Ibrahim
- Department of Pharmacology, Faculty of Medicine, Minia University, El-Minia 61511, Egypt
| |
Collapse
|
32
|
Alkhayyat M, Abureesh M, Gill A, Khoudari G, Abou Saleh M, Mansoor E, Regueiro M. Lower Rates of Colorectal Cancer in Patients With Inflammatory Bowel Disease Using Anti-TNF Therapy. Inflamm Bowel Dis 2021; 27:1052-1060. [PMID: 33051651 DOI: 10.1093/ibd/izaa252] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic inflammation is a key factor for the development of colorectal cancer (CRC) among patients with inflammatory bowel disease (IBD). Despite the increased use of biologic agents in patients with IBD, their impact on colorectal carcinogenesis remains unclear. With the use of a large database, we sought to describe the effect of biologics on CRC among patients with IBD. METHODS We evaluated a multicenter database (Explorys) consisting of electronic medical records from several U.S. hospitals between 1999 and 2020. A cohort of patients with a diagnosis of IBD was identified. We performed a multivariate analysis to adjust for multiple factors including medical and surgical therapies. RESULTS There were a total of 62,007,510 patients in the database between 1999 and 2020. Amongst those, 225,090 (0.36%) individuals had Crohn's disease and 188,420 (0.30%) had ulcerative colitis. After adjusting for confounding factors using multivariate analysis, patients with IBD were more likely to develop CRC. Among the IBD cohort, patients treated with anti-TNF agents were less likely to develop CRC; patients with Crohn's disease: odds ratio, 0.69; 95% confidence interval, 0.66-0.73; P < 0.0001 vs patients with ulcerative colitis: odds ratio, 0.78; 95% confidence interval, 0.73-0.83; P < 0.0001. CONCLUSIONS Patients with IBD who were treated with anti-tumor necrosis factor agents were less likely to develop CRC. Prospective studies are needed to evaluate whether anti-tumor necrosis factor drugs provide a chemoprotective effect in patients with IBD by inflammation control and mucosal healing.
Collapse
Affiliation(s)
- Motasem Alkhayyat
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - Arshpal Gill
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - George Khoudari
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohannad Abou Saleh
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Emad Mansoor
- Department of Gastroenterology and Liver Disease, Case Western Reserve University/University Hospitals, Cleveland, Ohio, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
33
|
Xu F, Wheaton AG, Barbour KE, Liu Y, Greenlund KJ. Trends and Outcomes of Hip Fracture Hospitalization Among Medicare Beneficiaries with Inflammatory Bowel Disease, 2000-2017. Dig Dis Sci 2021; 66:1818-1828. [PMID: 32700169 PMCID: PMC10416557 DOI: 10.1007/s10620-020-06476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/04/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) have a higher risk of hip fracture, but lower likelihood of having arthroplasties than non-IBD patients in Nationwide Inpatient Sample. Little is known about hip fracture-associated hospitalization outcomes. AIMS We assessed the trends in hip fracture hospitalization rates from 2000 to 2017 and estimated 30-day readmission, 30-day mortality, and length of stay in 2016 and 2017. METHODS We estimated trends of age-adjusted hospitalization rates using a piecewise linear regression. Medicare beneficiaries aged ≥ 66 years with Crohn's disease (CD, n = 2014) or ulcerative colitis (UC, n = 2971) hospitalized for hip fracture were identified. We performed propensity score matching to create 1:3 matched samples on age, race/ethnicity, sex, and chronic conditions and compared hospitalization outcomes between matched samples. RESULTS In 2017, the age-adjusted hospitalization rates (per 100) were 1.15 [95% CI = (1.07-1.24)] for CD, 0.86 [95% CI = (0.82-0.89)] for UC, and 0.59 [95% CI = (0.59-0.59)] for no IBD. The hospitalization rates for CD and UC decreased from 2000 to 2012 and then increased from 2012 to 2017. Compared to matched cohorts, CD patients had longer hospital stays (5.55 days vs. 5.30 days, p = 0.01); UC patients were more likely to have 30-day readmissions (17.27% vs. 13.71%, p < 0.001), longer hospital stays (5.59 days vs. 5.40 days, p = 0.02), and less likely to have 30-day mortality (3.77% vs. 5.15%, p = 0.003). CONCLUSIONS Prevention of hip fracture is important for older adults with IBD, especially CD. Strategies that improve quality of inpatient care for IBD patients hospitalized for hip fracture should be considered.
Collapse
Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| |
Collapse
|
34
|
Ye J, Haskey N, Dadlani H, Zubaidi H, Barnett JA, Ghosh S, Gibson DL. Deletion of mucin 2 induces colitis with concomitant metabolic abnormalities in mice. Am J Physiol Gastrointest Liver Physiol 2021; 320:G791-G803. [PMID: 33728986 DOI: 10.1152/ajpgi.00277.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients with inflammatory bowel disease (IBD) are at increased risk of under-recognized metabolic comorbidities. Chronic intestinal inflammation in IBD along with changes to the gut microbiome leads to broader systemic effects. Despite the existence of multiple animal models to study colitis, limited studies have examined the metabolic abnormalities associated with these models. In this study, a spontaneous model of colitis (mucin 2 knock-out mouse, Muc2-/-) was used to investigate the impact of intestinal disease on metabolic dysfunction. Before the onset of severe colitis, such as rectal prolapse, Muc2-/- mice exhibited impaired glucose clearance. Defects were noted in the insulin signaling pathway corresponding with upregulated genes in lipid utilization pathways, increased mitochondrial number, and peroxisome proliferator-activated coactivator 1α (PGC-1α), a transcription factor central to energy metabolism regulation. Parallel to these metabolic alterations, Muc2-/- mice exhibited systemic inflammation and bacteremia. We further characterized the dysbiotic microbiome's predicted functional categories given its contributing role to the colitic phenotype in the Muc2-/- mice. In addition to less butyrate levels, we show an increased predisposition to lipid metabolism and lipid biosynthesis pathways in the microbiome associated with the host's altered metabolic state. This study establishes the Muc2-/- mouse model that develops spontaneous colitis, as an ideal model for studying early comorbid metabolic dysfunction. Clarification of the underlying etiology of two phenotypes in this model could unravel important clues regarding the treatment of metabolic comorbidities during colitis.NEW & NOTEWORTHY This study discloses the impaired systemic energy metabolism in a classic colitis murine model (Muc2-/- knock-out model). Investigating the interaction between colitis and metabolic disorders helps to extend our knowledge on deciphering inflammatory bowel disease-associated comorbidities and provides new insight into clinical treatment.
Collapse
Affiliation(s)
- Jiayu Ye
- Department of Biology, University of British Columbia Okanagan , Kelowna, British Columbia, Canada
| | - Natasha Haskey
- Department of Biology, University of British Columbia Okanagan , Kelowna, British Columbia, Canada
| | - Hansika Dadlani
- Department of Biology, University of British Columbia Okanagan , Kelowna, British Columbia, Canada
| | - Hatem Zubaidi
- Department of Biology, University of British Columbia Okanagan , Kelowna, British Columbia, Canada
| | - Jacqueline A Barnett
- Department of Biology, University of British Columbia Okanagan , Kelowna, British Columbia, Canada
| | - Sanjoy Ghosh
- Department of Biology, University of British Columbia Okanagan , Kelowna, British Columbia, Canada
| | - Deanna L Gibson
- Department of Biology, University of British Columbia Okanagan , Kelowna, British Columbia, Canada.,Department of Medicine, University of British Columbia Okanagan , Kelowna, British Columbia, Canada
| |
Collapse
|
35
|
Edwards SJ, Barton S, Bacelar M, Karner C, Cain P, Wakefield V, Marceniuk G. Prognostic tools for identification of high risk in people with Crohn's disease: systematic review and cost-effectiveness study. Health Technol Assess 2021; 25:1-138. [PMID: 33783345 PMCID: PMC8040347 DOI: 10.3310/hta25230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Crohn's disease is a lifelong condition that can affect any segment of the gastrointestinal tract. Some people with Crohn's disease may be at higher risk of following a severe course of disease than others and being able to identify the level of risk a patient has could lead to personalised management. OBJECTIVE To assess the prognostic test accuracy, clinical impact and cost-effectiveness of two tools for the stratification of people with a diagnosis of Crohn's disease by risk of following a severe course of disease. DATA SOURCES The data sources MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched to inform the systematic reviews on prognostic accuracy, clinical impact of the prognostic tools, and economic evaluations. Additional data sources to inform the review of economic evaluations were NHS Economic Evaluation Database, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database. REVIEW METHODS Systematic reviews of electronic databases were carried out from inception to June 2019 for studies assessing the prognostic accuracy and clinical impact of the IBDX® (Crohn's disease Prognosis Test; Glycominds Ltd, Lod, Israel) biomarker stratification tool and the PredictSURE-IBD™ (PredictImmune Ltd, Cambridge, UK) tool. Systematic reviews of studies reporting on the cost-effectiveness of treatments for Crohn's disease were run from inception to July 2019. Two reviewers independently agreed on studies for inclusion, assessed the quality of included studies and validated the data extracted from studies. Clinical and methodological heterogeneity across studies precluded the synthesis of data for prognostic accuracy. A de novo economic model was developed to compare the costs and consequences of two treatment approaches - the 'top-down' and 'step-up' strategies, with step-up considered standard care - in people at high risk of following a severe course of Crohn's disease. The model comprised a decision tree and a Markov cohort model. RESULTS Sixteen publications, including eight original studies (n = 1478), were deemed relevant to the review of prognostic accuracy. Documents supplied by the companies marketing the prognostic tools were also reviewed. No study meeting the eligibility criteria reported on the sensitivity or specificity of the IBDX biomarker stratification tool, whereas one study provided estimates of sensitivity, specificity and negative predictive value for the PredictSURE-IBD tool. All identified studies were observational and were considered to provide weak evidence on the effectiveness of the tools. Owing to the paucity of data on the two tools, in the base-case analysis the accuracy of PredictSURE-IBD was assumed to be 100%. Accuracy of IBDX was assumed to be 100% in a scenario analysis, with the cost of the tests being the only difference between the analyses. The incremental analysis of cost-effectiveness demonstrated that top-down (via the use of PredictSURE-IBD in the model) is more expensive and generates fewer quality-adjusted life-years than step-up (via the standard care arm of the model). LIMITATIONS Despite extensive systematic searches of the literature, no robust evidence was identified of the prognostic accuracy of the biomarker stratification tools IBDX and PredictSURE-IBD. CONCLUSIONS Although the model indicates that standard care dominates the tests, the lack of evidence of prognostic accuracy of the two tests and the uncertainty around the benefits of the top-down and step-up treatment approaches mean that the results should be interpreted as indicative rather than definitive. STUDY REGISTRATION This study is registered as PROSPERO CRD42019138737. FUNDING This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 23. See the NIHR Journals Library website for further project information.
Collapse
|
36
|
Reinisch W, Gecse K, Halfvarson J, Irving PM, Jahnsen J, Peyrin-Biroulet L, Rogler G, Schreiber S, Danese S. Clinical Practice of Adalimumab and Infliximab Biosimilar Treatment in Adult Patients With Crohn's Disease. Inflamm Bowel Dis 2021; 27:106-122. [PMID: 32634212 PMCID: PMC7737159 DOI: 10.1093/ibd/izaa078] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 12/16/2022]
Abstract
The introduction of tumor necrosis factor (TNF) inhibitors has significantly changed the treatment landscape in Crohn's disease (CD). The overall therapeutic achievements with TNF inhibitors such as infliximab, adalimumab, and certolizumab pegol paved the way to push the boundaries of treatment goals beyond symptomatic relief and toward cessation of objective signs of inflammation, including endoscopic remission. Even though these agents are widely used for the treatment of moderate to severe CD, heterogeneity still exists in translating evidence-based guidelines on the use of anti-TNF agents into actual treatment algorithms in CD. This might be due to several reasons including disparities in health expenditure policies; lack of harmonization between countries; and variations in assessment of disease severity, use of disease monitoring tools, or application of treatment targets by physicians. With the advent of biosimilars, patent-free versions of reference biologics are now available to minimize health inequalities in drug availability. In this context, this article aims to provide practical clinical guidance for the use of infliximab and adalimumab biosimilars in patients with moderate to severe CD by outlining different clinical scenarios that patients may encounter during their treatment journey.
Collapse
Affiliation(s)
- Walter Reinisch
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Krisztina Gecse
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Peter M Irving
- Department of Gastroenterology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
- Clinic of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| |
Collapse
|
37
|
Health-Related Quality of Life Among Patients With Inflammatory Bowel Disease: A Case Control Study. Gastroenterol Nurs 2020; 44:21-30. [PMID: 33351519 DOI: 10.1097/sga.0000000000000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 09/01/2019] [Indexed: 01/04/2023] Open
Abstract
The aim of this study is to compare health-related quality of life between inflammatory bowel disease patients and age-/gender-matched controls while taking into account comorbid conditions (such as diabetes and heart disease). Data from the 2015 and 2016 National Health Interview Survey were used. Patients with inflammatory bowel disease (n = 951) were age- and gender-matched to noninflammatory bowel disease patients (n = 3,804). Patients with inflammatory bowel disease were more likely to be diagnosed with an airway disease (p < .000), heart disease (p < .000), or stomach cancer (p < .001) than age- and gender-matched individuals without inflammatory bowel disease. Even after controlling for these comorbidities, sociodemographic characteristics as well as health-related behaviors, patients with inflammatory bowel disease had significantly lower health-related quality of life than individuals of the same age and gender. Inflammatory bowel disease appears to be associated with particularly low levels of health-related quality of life. Alcohol consumption, smoking, physical activity, and body mass index may be risk factors for a decreased health-related quality of life.
Collapse
|
38
|
Černá P, Kilpatrick S, Gunn-Moore DA. Feline comorbidities: What do we really know about feline triaditis? J Feline Med Surg 2020; 22:1047-1067. [PMID: 33100169 PMCID: PMC10814216 DOI: 10.1177/1098612x20965831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PRACTICAL RELEVANCE Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia. DIAGNOSTIC CHALLENGES Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases. EVIDENCE BASE The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.
Collapse
Affiliation(s)
- Petra Černá
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, and Small Animal Clinic, The University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | | | - Danielle A Gunn-Moore
- The Royal (Dick) School of Veterinary Studies, and The Roslin Institute, University of Edinburgh, UK
| |
Collapse
|
39
|
Nuñez P, García Mateo S, Quera R, Gomollón F. Inflammatory bowel disease and the risk of cardiovascular diseases. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:236-242. [PMID: 33223261 DOI: 10.1016/j.gastrohep.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) includes both ulcerative colitis and Crohn's disease, which are well recognised as chronic systemic and immune-mediated conditions that frequently involve extraintestinal manifestations. Although comorbidities have long been the subject of research in other chronic inflammatory diseases, this concept is also emerging in IBD. Many pathologies have been linked to IBD, including cardiovascular disease, which is the main cause of death in developed countries. IBD patients are at increased risk of conditions such as early atherosclerosis and myocardial infarction or venous thrombosis and pulmonary thromboembolism. The aim of this review is to make an approximation of the physiopathology of the different manifestations of cardiovascular disease in patients with IBD and how to prevent them.
Collapse
Affiliation(s)
- Paulina Nuñez
- Universidad de Chile, Hospital San Juan de Dios, Sección de Gastroenterología, Santiago, Chile
| | - Sandra García Mateo
- Servicio de Aparato Digestivo. Hospital Clínico Universitario «Lozano-Blesa», IIS Aragón, Zaragoza, España
| | - Rodrigo Quera
- Clínica Las Condes, Departamento de Gastroenterología, Programa de Enfermedad Inflamatoria Intestinal, Santiago, Chile
| | - Fernando Gomollón
- Departamento de Medicina, Facultad de Medicina, IIS Aragón, Zaragoza, España.
| |
Collapse
|
40
|
Mapping the relationships between inflammatory bowel disease and comorbid diagnoses to identify disease associations. Eur J Gastroenterol Hepatol 2020; 32:1341-1347. [PMID: 32804850 PMCID: PMC9639789 DOI: 10.1097/meg.0000000000001869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Massive amounts of patient data are captured daily in electronic medical records (EMR). Utilizing the power of such large data may help identify disease associations and generate hypotheses that can lead to a better understanding of disease associations and mechanisms. We aimed to comprehensively identify and validate associations between inflammatory bowel disease (IBD) and concurrent comorbid diagnoses. METHODS We performed a cross-sectional study using EMR data collected between 1986 and 2009 at a large tertiary referral center to identify associations with a diagnosis of IBD. The resulting associations were externally validated using the Truven MarketScan database, a large nationwide dataset of private insurance claims. RESULTS A total of 6225 IBD patients and 31 125 non-IBD controls identified using EMR data were used to abstract 41 comorbid diagnoses associated with an IBD diagnosis. The strongest associations included Clostridiodes difficile infection, pyoderma gangrenosum, parametritis, pernicious anemia, erythema nodosum, and cytomegalovirus infection. Two IBD association clusters were found, including diagnoses of nerve conduction abnormalities and nonspecific inflammatory conditions of organs outside the gut. These associations were validated in a national cohort of 80 907 patients with IBD and 404 535 age- and sex-matched controls. CONCLUSION We leveraged a big data approach to identify several associations between IBD and concurrent comorbid diagnoses. EMR and big data provide the opportunity to explore disease associations with large sample sizes. Further studies are warranted to refine the characterization of these associations and evaluate their usefulness for increasing our understanding of disease associations and mechanisms.
Collapse
|
41
|
Gastroenterologists' preference and risk perception on the use of immunomodulators and biological therapies in elderly patients with ulcerative colitis: an international survey. Eur J Gastroenterol Hepatol 2020; 32:976-983. [PMID: 32453008 DOI: 10.1097/meg.0000000000001768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Comorbidities, polypharmacy, malignancies, and infections complicate management of elderly patients with inflammatory bowel diseases (IBD). This study assessed gastroenterologists' preference in the prescription of medications or surgery to elderly patients with IBD, and the factors associated with their choices. METHODS An international case-based survey was conducted that presented three cases of steroid-dependent ulcerative colitis assessing young-age versus elderly-age patients, with and without comorbidity. Physician characteristics and practice demographics were collected. Factors associated with selection of different choices of therapy were determined by logistic regression analysis. RESULTS A total of 424 respondents from 41 countries were included. Vedolizumab (53.2%) and thiopurines (19.4%) were the top treatment preferences for moderate-to-severe ulcerative colitis (P < 0.0001). Comorbidity and older age were independently associated with more frequent use of vedolizumab (P < 0.0001), and less frequent use of immunomodulators and anti-tumour necrosis factor (TNF; P < 0.0001). Comorbidity was the only independent predictor for selecting colectomy (P < 0.0001). A history of lymphoma (94%) and opportunistic infection (78.3%) were the most frequent conditions precluding the use of thiopurine and anti-TNF in elderly patients with IBD. Only 6.1% of respondents considered patient age a limit for vedolizumab, while 37.9% considered age as a limiting factor in prescribing thiopurines (P < 0.001). Geographical heterogeneity was identified with significantly more physicians from Oceania and North America favouring the use of vedolizumab. CONCLUSION Vedolizumab was the preferred first-line agent in the treatment of elderly patients with IBD with steroid-dependent moderate-to-severe ulcerative colitis. Older age and presence of comorbidity influenced the selection of medication. Comorbidity was the main predictor of colectomy. Geographical heterogeneity in prescribing habits may relate to medication reimbursement in individual countries.
Collapse
|
42
|
Obando C, Ding Z, Muser E, Vaidya N, Qiang W, Sun X, Wang H, Mallampati R, Xie L. Persistence, Dose Titration, and Health Care Resource Utilization Among Crohn's Disease Patients Treated With Ustekinumab: A Real-World Analysis in the United States. Adv Ther 2020; 37:2127-2143. [PMID: 32193810 PMCID: PMC7467496 DOI: 10.1007/s12325-020-01276-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. This real-world study evaluated persistence, dose titration, health care resource utilization (HCRU) and associated costs, and medication use among CD patients treated with ustekinumab (UST) in several pooled US commercial database populations. METHODS CD patients aged ≥ 18 years with medical or pharmacy claims for UST were selected from pooled data from 3 large, national commercial databases. The first observed medical or pharmacy claim for UST was the index date. Patients were required to have had ≥ 1 medical claim with a CD diagnosis during the 12 months prior to the index date and continuous health plan enrollment for a minimum of 12 months prior to and 12 months after the index date. Comparisons of outcomes during the baseline and follow-up periods were conducted using inferential statistical tests. RESULTS A total of 214 eligible UST patients were selected. The majority (74.8%) were biologic experienced (mean age: 41 years), and 83.6% remained treatment persistent during the 12-month post-index period. Among discontinuers, 25.7% restarted UST, and 8.6% switched from UST in the 12-month observation period. The mean treatment duration was 329 days. Most patients (77%) used the recommended UST dose, as defined as being within a 20% dose variation from label (90 mg/8 weeks ± 20%), 17.9% experienced dose escalation, and 5.1% experienced dose reduction. Post-index immunomodulator and corticosteroid use reduced by 20% and 28%, respectively, as compared with pre-index use among CD patients using UST. Annual all-cause ER visits and inpatient stays decreased by 20.5% and 30.3%, respectively, with similar downward trends for annual CD-related HCRU. CONCLUSIONS The majority of CD patients prescribed UST were biologic experienced, and persistence was high over the 1-year follow-up. UST treatment initiation was associated with reductions in ER visits, inpatient stays, and steroid and other medication use.
Collapse
Affiliation(s)
- Camilo Obando
- Real World Value & Evidence, Janssen Scientific Affairs LLC, Horsham, PA, USA
| | - Zhijie Ding
- Real World Value & Evidence, Janssen Scientific Affairs LLC, Horsham, PA, USA
| | - Erik Muser
- Real World Value & Evidence, Janssen Scientific Affairs LLC, Horsham, PA, USA.
| | - Neel Vaidya
- Health Economics and Outcomes Research, STATinMED Research, Ann Arbor, MI, USA
| | - Wenqin Qiang
- Health Economics and Outcomes Research, STATinMED Research, Ann Arbor, MI, USA
| | - Xiaoxi Sun
- Health Economics and Outcomes Research, STATinMED Research, Ann Arbor, MI, USA
| | - Huiqi Wang
- Health Economics and Outcomes Research, STATinMED Research, Ann Arbor, MI, USA
| | - Rajesh Mallampati
- Health Economics and Outcomes Research, STATinMED Research, Ann Arbor, MI, USA
| | - Lin Xie
- Health Economics and Outcomes Research, STATinMED Research, Ann Arbor, MI, USA
| |
Collapse
|
43
|
Marin-Jimenez I, Bastida G, Forés A, Garcia-Planella E, Argüelles-Arias F, Sarasa P, Tagarro I, Fernández-Nistal A, Montoto C, Aguas M, Santos-Fernández J, Bosca-Watts MM, Ferreiro R, Merino O, Aldeguer X, Cortés X, Sicilia B, Mesonero F, Barreiro-de Acosta M. Impact of comorbidities on anti-TNFα response and relapse in patients with inflammatory bowel disease: the VERNE study. BMJ Open Gastroenterol 2020; 7:e000351. [PMID: 32337054 PMCID: PMC7170400 DOI: 10.1136/bmjgast-2019-000351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate the impact of comorbidities and extraintestinal manifestations of inflammatory bowel disease on the response of patients with inflammatory bowel disease to antitumour necrosis factor alpha (anti-TNFα) therapy. Design Data from 310 patients (194 with Crohn’s disease and 116 with ulcerative colitis) treated consecutively with the first anti-TNFα in 24 Spanish hospitals were retrospectively analysed. Univariate and multivariate logistic regression analyses were performed to assess the associations between inflammatory bowel disease comorbidities and extraintestinal manifestations with anti-TNFα treatment outcomes. Key clinical features, such as type of inflammatory bowel disease and concomitant treatments, were included as fixed factors in the model. Results Multivariate logistic regression analyses (OR, 95% CI) showed that chronic obstructive pulmonary disease (2.67, 1.33 to 5.35) and hepato-pancreato-biliary diseases (1.87, 1.48 to 2.36) were significantly associated with primary non-response to anti-TNFα, as was the use of corticosteroids and the type of inflammatory bowel disease (ulcerative colitis vs Crohn’s disease). It was also found that myocardial infarction (3.30, 1.48 to 7.35) and skin disease (2.73, 1.42 to 5.25) were significantly associated with loss of response, along with the use of corticosteroids and the type of inflammatory bowel disease (ulcerative colitis vs Crohn’s disease). Conclusions Our results suggest that the presence of some comorbidities in patients with inflammatory bowel disease, such as chronic obstructive pulmonary disease and myocardial infarction, and of certain extraintestinal manifestations of inflammatory bowel disease, such as hepato-pancreato-biliary conditions and skin diseases, appear to be related to failure to anti-TNFα treatment. Therefore, their presence should be considered when choosing a treatment. Trial registration number NCT02861118.
Collapse
Affiliation(s)
- Ignacio Marin-Jimenez
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Ana Forés
- Department of Gastroenterology, Hospital General de Castellón, Castellón, Spain
| | | | | | - Pilar Sarasa
- Medical Department, Takeda Farmacéutica España SA, Madrid, Spain
| | - Ignacio Tagarro
- Medical Department, Takeda Farmacéutica España SA, Madrid, Spain
| | | | - Carmen Montoto
- Medical Department, Takeda Farmacéutica España SA, Madrid, Spain
| | - Mariam Aguas
- Department of Gastroenterology, Hospital La Fe, Valencia, Spain
| | | | - Marta Maia Bosca-Watts
- IBD Unit, Gastroenterology Department, University Clinic Hospital of Valencia, Valencia, Spain
| | - Rocio Ferreiro
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Olga Merino
- Department of Gastroenterology, Hospital Universitario Cruces, Bilbao, Spain
| | - Xavier Aldeguer
- Department of Gastroenterology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Xavier Cortés
- IBD Unit, Gastroenterology Section, Internal Medicine, Hospital de Sagunto, Sagunto, Spain
| | - Beatriz Sicilia
- Department of Gastroenterology, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Manuel Barreiro-de Acosta
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago de Compostela, Madrid, Spain
| |
Collapse
|
44
|
Vojdani A, Vojdani E, Herbert M, Kharrazian D. Correlation between Antibodies to Bacterial Lipopolysaccharides and Barrier Proteins in Sera Positive for ASCA and ANCA. Int J Mol Sci 2020; 21:ijms21041381. [PMID: 32085663 PMCID: PMC7073094 DOI: 10.3390/ijms21041381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 12/17/2022] Open
Abstract
Individuals with intestinal barrier dysfunction are more prone to autoimmunity. Lipopolysaccharides (LPS) from gut bacteria have been shown to play a role in systemic inflammation, leading to the opening of the gut and blood-brain barrier (BBB). This study aims to measure antibodies against LPS and barrier proteins in samples positive for anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) and compare them with these same antibodies in controls to determine whether a correlation between LPS and barrier proteins could be found. We obtained 94 ASCA- and 94 ANCA-positive blood samples, as well as 188 blood samples from healthy controls. Samples were assessed for antibodies to LPS, zonulin+occludin, S100B, and aquaporin-4 (AQP4). Results show significant elevation in antibodies in about 30% of ASCA- and ANCA-positive sera and demonstrate positive linear relationships between these antibodies. The findings suggest that individuals positive for ASCA and ANCA have increased odds of developing intestinal and BBB permeability compared to healthy subjects. The levels of LPS antibodies in both ASCA- and ANCA-positive and negative specimens showed from low and moderate to high correlation with antibodies to barrier proteins. This study shows that LPS, by damaging the gut and BBBs, contribute to the extra-intestinal manifestation of IBD. We conclude that IBD patients should be screened for LPS antibodies in an effort to detect or prevent possible barrier damage at the earliest stage possible to abrogate disease symptoms in IBS and associated disorders.
Collapse
Affiliation(s)
- Aristo Vojdani
- Immunosciences Lab, Inc. 822 S. Robertson Blvd, Ste 312, Los Angeles, CA 90035, USA
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA 92350, USA;
- Correspondence: ; Tel.: +1-310-657-1077
| | - Elroy Vojdani
- Regenera Medical, 11860 Wilshire Blvd., Ste. 301, Los Angeles, CA 90025, USA;
| | - Martha Herbert
- Martha Herbert, Pediatric Neurology, Massachusetts General Hospital, Rm CNY149-2nd Floor, Boston, MA 02114, USA;
| | - Datis Kharrazian
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA 92350, USA;
- Department of Neurology, Harvard Medical, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02129, USA
| |
Collapse
|
45
|
Lenti MV, Armuzzi A, Castiglione F, Fantini MC, Fiorino G, Orlando A, Pugliese D, Rizzello F, Vecchi M, Di Sabatino A. Are we choosing wisely for inflammatory bowel disease care? The IG-IBD choosing wisely campaign. Dig Liver Dis 2020; 52:44-50. [PMID: 31648921 DOI: 10.1016/j.dld.2019.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The "Choosing Wisely" campaigns have the aim of promoting a better clinician-patient relationship. AIMS The Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) conducted a choosing wisely campaign for IBD. METHODS Ten IG-IBD panellists conducted the campaign through a modified Delphi process. All IG-IBD members were asked to submit five statements starting with "Do not…" addressing any IBD-related procedure or treatment the necessity of which should be questioned. All recommendations were evaluated by the panellists who prioritised each item. The top ten recommendations were prioritised again by IG-IBD members, and the top five recommendations were identified. RESULTS 110 members (mean age 42 ± 12; 62 males) participated in the campaign. The top five recommendations were as follow: 1. Do not use corticosteroids for maintenance therapy, or without a clear indication; 2. Do not forget venous thromboembolism prophylaxis in hospitalised patients with active disease; 3. Do not treat perianal Crohn's disease with biologics without prior surgical evaluation; 4. Do not discontinue IBD-related medications during pregnancy unless specifically indicated; 5. Do not delay surgery. CONCLUSION The IG-IBD promoted a campaign with a bottom-up approach, identifying five recommendations that could be useful for providing a better IBD care, especially among non-IBD experts.
Collapse
Affiliation(s)
- Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | | | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
| | | | - Daniela Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fernando Rizzello
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | |
Collapse
|
46
|
Sommer JL, El-Gabalawy R, Mota N. Understanding the association between posttraumatic stress disorder characteristics and physical health conditions: A population-based study. J Psychosom Res 2019; 126:109776. [PMID: 31327594 DOI: 10.1016/j.jpsychores.2019.109776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/22/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) is commonly comorbid with a range of physical health conditions. The aim of this study was to examine the association between index trauma and PTSD symptom clusters with physical health conditions, among individuals with PTSD in a population-based sample. Data were analyzed from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309). Past-year PTSD (n = 1779) was assessed using a clinical interview in accordance with DSM-5 criteria. Multiple logistic regression models examined the associations between PTSD symptom clusters and index trauma with physical health conditions. Results of the most stringent model, adjusting for sociodemographics, other psychiatric conditions, and other PTSD symptom clusters, indicated re-experiencing symptoms were associated with cardiovascular and endocrine/metabolic conditions (adjusted odds ratio (AOR) range: 1.18-1.33) and negative alterations in mood and cognition symptoms were associated with sleep disorder (AOR = 1.16, 95% confidence interval (CI) [1.04-1.30], p = .009). Results also demonstrated significant associations between life-threatening illness with cancer, digestive, and neurologic conditions (AOR range: 2.10-3.42) and life-threatening injury with musculoskeletal and neurologic conditions (AOR range: 1.76-2.04). Finally, significant associations emerged between psychological trauma with musculoskeletal and neurologic conditions (AOR range: 0.48-0.66), and other trauma with digestive conditions and anemia (AOR range: 0.38-0.47). Results suggest PTSD symptomatology and index trauma play a differential role in their association with variable physical health conditions. Results may inform screening practices and targeted interventions to mitigate risk of PTSD and physical health conditions.
Collapse
Affiliation(s)
- Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada.
| |
Collapse
|
47
|
Wilkinson B, Trick L, Knight A, Valton V, Goodhand J, Kennedy NA, Heerasing N, Ahmad T, Bland A, Elliott R, Roiser JP, Dickens C. Factors associated with depression in people with inflammatory bowel disease: The relationship between active disease and biases in neurocognitive processing. Neurogastroenterol Motil 2019; 31:e13647. [PMID: 31267614 DOI: 10.1111/nmo.13647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/20/2019] [Accepted: 05/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression is common among people with inflammatory bowel disease (IBD), though the causes remain unclear. We conducted a cross-sectional study to investigate the role of emotional processing biases in contributing to depression among people with IBD. MATERIALS AND METHODS One hundred and twenty outpatients with IBD were recruited and: (a) completed questionnaires to record: age, sex, social support, socioeconomic status, anxiety and depression (n = 104), (b) underwent assessments of biases in emotional recognition (n = 112), emotional memory and reinforcement learning (c) had recorded from clinical records: type of IBD, duration of IBD, IBD activity and (d) provided blood for high-sensitivity C-reactive protein levels (n = 99). KEY RESULTS Sixty-eight participants had Crohn's disease and 49 had ulcerative colitis. Of these, 35 had active disease and 26 had depression. Those with depression were more likely to be female, lack social support, have active disease, be taking corticosteroids but not TNF-alpha inhibitors and exhibit less positive emotional recognition bias. On multivariable regression analysis, depression was associated independently with lack of social support (unstandardized regression coefficient (B) = -1.40, P = 0.02) and increased disease activity (B = 1.29, P = 0.03). Causal steps analysis was consistent with less positive emotional recognition bias partially mediating the effects of disease activity on depression. CONCLUSIONS AND INFERENCES This is the first study to demonstrate links between disease activity and less positive biases in emotional recognition that could explain higher rates of depression among people with active IBD. Future prospective studies are required to confirm the effects of emotional processing biases in depression and allow stronger causal inferences to be drawn.
Collapse
Affiliation(s)
- Ben Wilkinson
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Leanne Trick
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Annie Knight
- Institute of Biomedical and Clinical Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Vincent Valton
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - James Goodhand
- Exeter IBD Research Group, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nick A Kennedy
- Exeter IBD Research Group, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Neel Heerasing
- Exeter IBD Research Group, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Tariq Ahmad
- Exeter IBD Research Group, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Amy Bland
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | - Rebecca Elliott
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Chris Dickens
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
48
|
Role of glucagon-like peptides in inflammatory bowel diseases-current knowledge and future perspectives. Naunyn Schmiedebergs Arch Pharmacol 2019; 392:1321-1330. [PMID: 31359088 DOI: 10.1007/s00210-019-01698-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022]
Abstract
Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic, relapsing, intestinal inflammatory disorders with complex and yet unrevealed pathogenesis in which genetic, immunological, and environmental factors play a role. Nowadays, a higher proportion of elderly IBD patients with coexisting conditions, such as cardiovascular disease and/or diabetes is recorded, who require more complex treatment and became a great challenge for gastroenterologists. Furthermore, some patients do not respond to anti-IBD therapy. These facts, together with increasing comorbidities in patients with IBD, imply that urgent, more complex, novel therapeutic strategies in the treatment are needed. Glucagon-like peptides (GLPs) possess numerous functions in the human body such as lowering blood glucose level, controlling body weight, inhibiting gastric emptying, reducing food ingestion, increasing crypt cell proliferation, and improving intestinal growth and nutrient absorption. Thus, GLPs and dipeptidyl peptidase IV (DPP-IV) inhibitors have recently gained attention in IBD research. Several animal models showed that treatment with GLPs may lead to improvement of colitis. This review presents data on the multitude effects of GLPs in the inflammatory intestinal diseases and summarizes the current knowledge on GLPs, which have the potential to become a novel therapeutic option in IBD therapy.
Collapse
|
49
|
Kariyawasam VC, Kim S, Mourad FH, Selinger CP, Katelaris PH, Brian Jones D, McDonald C, Barr G, Chapman G, Colliwshaw J, Lunney PC, Middleton K, Wang RR, Huang T, Andrews J, Pathirana PW, Leong RW. Comorbidities Rather Than Age Are Associated With the Use of Immunomodulators in Elderly-onset Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1390-1398. [PMID: 30597066 DOI: 10.1093/ibd/izy389] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The use of immunomodulators (IMs) is often avoided in elderly patients with inflammatory bowel disease (IBD) due to concerns about complications. Our aim is to compare the use of IMs in elderly and younger patients with Crohn's disease (CD) or ulcerative colitis (UC) and identify markers that predict their use. METHODS In this retrospective cohort study, patients diagnosed with IBD from 1970 to 2009 were recruited from the "Sydney IBD Cohort." Patients diagnosed at age 60 years old or older and between 16 and old 40 years were classified as "elderly-onset" and "young-onset" respectively. RESULTS A total of 255 elderly-onset patients (115 CD, 140 UC) and 1244 young-onset patients (657 CD, 587 UC) were recruited. Most elderly-onset patients had colonic CD (61.4%), whereas young-onset patients had predominantly ileocolonic CD (42.8%, P < 0.0001). Left-sided UC was the most common disease localization for both elderly-onset (52.1%) and young-onset patients (42.2%, P = 0.013). The cumulative probability of IM exposure at 5 years post-diagnosis was significantly less in elderly-onset patients compared with young-onset patients for CD (20.0% vs 33.4%, P = 0.0002) and UC (7.8% vs 13.4%, P = 0.0007). Age at diagnosis was not associated with the time to IMs introduction. Charlson Comorbidity Index was shown to delay IM introduction in CD (hazard ratio [HR] 0.863; 95% CI, 0.787-0.946; P = 0.002) and UC (HR 0.807; 95% CI, 0.711-0.917; P = 0.001). Early IM use was associated with reduced need for abdominal and perianal surgery in CD (HR 0.177; 95% CI, 0.089-0.351; P < 0.0001). CONCLUSIONS Comorbidity and not age at diagnosis is associated with IM introduction. Early IM is associated with reduced surgery in both young- and elderly-onset CD but not UC.
Collapse
Affiliation(s)
- Viraj C Kariyawasam
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Shin Kim
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Fadi H Mourad
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Christian P Selinger
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Peter H Katelaris
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - D Brian Jones
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Charles McDonald
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Gavin Barr
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Grace Chapman
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - James Colliwshaw
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Paul C Lunney
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Kate Middleton
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Rosy R Wang
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Tony Huang
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Jane Andrews
- IBD Services, Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
| | - Priyanthi W Pathirana
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Rupert W Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| |
Collapse
|
50
|
Kinnucan J, Binion D, Cross R, Evans E, Harlen K, Matarese L, Mullins A, O'Neal B, Reiss M, Scott FI, Weaver A, Rosenberg J. Inflammatory Bowel Disease Care Referral Pathway. Gastroenterology 2019; 157:242-254.e6. [PMID: 30980795 DOI: 10.1053/j.gastro.2019.03.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/12/2019] [Accepted: 03/10/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - David Binion
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Raymond Cross
- University of Maryland School of Medicine, Baltimore, Maryland; Digestive Health Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Elisabeth Evans
- Univeristy of California-San Diego IBD Center, San Diego, California
| | - Kevin Harlen
- Capital Digestive Care, Silver Spring, Maryland; Digestive Health Physicians Association, Silver Spring, Maryland
| | - Laura Matarese
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Amy Mullins
- American Academy of Family Physicians, Washington, DC
| | - Bud O'Neal
- Our Lady of the Lake, Baton Rouge, Louisiana; Louisiana State University, Baton Rouge, Louisiana
| | - Marci Reiss
- IBD Support Foundation, Los Angeles, California; University of Southern California, Los Angeles, California
| | - Frank I Scott
- IBD Specialist, University of Colorado School of Medicine, Aurora, Colorado
| | | | | |
Collapse
|