Prevalence and Associated Risk Factors of Intestinal Parasitic Infections among Egyptian Patients with Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) have a higher incidence of Clostridioides difficile infection (CDI). Previous studies have demonstrated negative clinical outcomes in IBD patients with CDI compared to patients without CDI. The clinical presentation of CDI is indistinguishable from IBD exacerbation, thus posing a frequent clinical dilemma on the role of Clostridioides infection in the testing, diagnosis, and treatment of these patients. To compare clinical outcomes of CDI in patients with IBD to those without IBD. Retrospective cohort of adult patients admitted to Rabin Medical Center Israel between the years 2014 and 2020 with a concurrent diagnosis of IBD and CDI. Matching 1:2 was performed between the IBD patients and the non-IBD population with respect to age and sex. Sixty-seven patients with IBD and 134 patients without IBD were included in the study. The groups' median age was 40.6 (interquartile range [IQR] of 29.8-68.9), with 45.8% male and 54.2% female. The non-IBD group had a higher Charlson score with 2 (IQR 0; 5) versus 0 (IQR 0; 4) in the IBD group (P value <.01). Patients with IBD had more exposure to systemic antibiotics, 71.1% versus 26.3% (P value <.01). In a multivariable analysis we found no difference in 90-day mortality and rate of relapse between the 2 study groups with an odds ratio of 1.709 (95% confidence interval 0.321-9.905) and odds ratio of 0.209 (95% confidence interval 0.055-1.513) respectively. In our cohort patients with IBD who present with diarrhea and concomitant CDI have similar rates of relapse and mortality compared with patients without IBD.

Introduction. Axial spondylitis is a chronic inflammatory disease primarily affecting the axial skeleton but can also involve peripheral joints. Axial spondylitis is often associated with extra-articular manifestations, such as inflammatory bowel diseases, emphasizing the need for rigorous monitoring and personalized therapeutic approaches. The interactions between axial spondylitis and inflammatory bowel diseases fall under the concept of “immune-mediated inflammatory diseases”, sharing common pathogenetic mechanisms. This study analyzes the prevalence and characteristics of inflammatory bowel diseases in patients with axial spondylitis. Objective. The objective of this study was to describe the baseline characteristics of patients with axial spondylitis, evaluate the prevalence of inflammatory bowel diseases in this population, and identify correlations between the two conditions, contributing to a better understanding of their pathogenetic and clinical interactions. Material and methods. This prospective observational study included 257 axial spondylitis patients followed over two years. Patients were selected according to ASAS criteria for axial spondylitis and clinical guidelines for inflammatory bowel diseases. Analyses included clinical evaluations, laboratory tests, and imaging studies. Data were processed using SPSS v22.0. Continuous variables were expressed as mean ± standard deviation or median and interquartile range, and categorical variables as percentages. Correlations were assessed using Spearman’s coefficient, with results considered significant at p&lt;0.05. Results. Among the 257 patients included (168 men and 89 women, mean age 48.2 ± 13.1 years), 13.2% were recently diagnosed with axial spondylitis. Of these, 5.1% had inflammatory bowel diseases, distributed as follows: Crohn’s disease (3.1%), ulcerative colitis (1.2%), and indeterminate colitis (0.8%). In 53.8% of cases, the diagnosis of inflammatory bowel diseases preceded axial spondylitis. Multivariate analysis identified the absence of a family history of axial spondylitis as a significant risk factor for inflammatory bowel diseases (OR = 3.4; p = 0.025). The prevalence of inflammatory bowel diseases increased with axial spondylitis duration, reaching 6.5% in patients with disease progression over eight years. Conclusions. The study highlights a high prevalence of inflammatory bowel diseases in axial spondylitis patients, indicating the need for rigorous clinical monitoring. The absence of a family history of axial spondylitis was identified as a major risk factor for inflammatory bowel diseases. These findings emphasize the importance of a multidisciplinary clinical approach, including active screening for inflammatory bowel diseases and collaboration between rheumatologists and gastroenterologists, to improve patient prognosis and quality of life.

Covering the Cover

Inflammatory bowel disease (IBD), represented by Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition that affects all age groups, predominantly in young individuals. Currently, an increase in the prevalence of IBD has been documented, in parallel with the increase in the elderly population. The scarce number of studies that better characterize the impact of IBD on Quality of Life (QoL) in the elderly motivated the present study. To evaluate the impact of IBD on the QoL of elderly people treated at a Tertiary IBD Center. Prospective cross-sectional study that included elderly patients (age ≥60 years) with quiescent or mildly active IBD treated at the HU-UFJF IBD Center between March 2019 and December 2022. Elderly companions without severe comorbidities who attended the consultation with the patients were included as a control group. Sociodemographic and IBD-related characteristics were recorded. QoL was assessed using previously validated questionnaires (WHOQOL-BREF and IBDQ). Patients with IBD with moderate to severe activity, history of recent or imminent hospitalization, serious or opportunistic infections in the last 6 months, previous neoplasia, dementia, and difficulty understanding/fulfilling the questionnaires were excluded. A total of 123 patients were included (74 with IBD and 49 in the control group), with a mean age of 67±6.2 years, 52.7% with CD, and 47.3% with UC. Mild disease activity was observed in 31.1%. Both groups (IBD patients and control) were comparable based on age, sex, BMI, and the Charlson Comorbidity Index. Patients with IBD and controls had similar QoL scores in the different domains assessed by the WHOQOL-BREF. On the other hand, when evaluating the general facet of QoL, IBD patients had significantly lower scores in General QoL (3.71±0.87 versus 4.02±0.62, respectively; P=0.021) and General Health (3.32±1.05 versus 3.69±0.94, respectively; P=0.035). The presence of mildly active IBD negatively impacted the general health score (2.91±0.99 versus 3.47±1.04, respectively; P=0.035) and the physical domain of the WHOQOL-BREF (12.27±2.63 versus 13.86±2.61, respectively; P=0.019) when compared to patients in remission. Conversely, no impact on QoL was observed with the Application of the IBDQ questionnaire regarding the type of the disease (161±38.5 versus 163.1±42.6 for CD and UC, respectively; P=0.84) or the presence of activity (152.5±38.8 versus 166.4±40.5, respectively; P=0.17). No statistically significant differences were found between elderly patients with mildly active or quiescent IBD and elderly patients without IBD when observing global QoL scores. However, IBD negatively impacted the general facet of QoL, just as mild activity was associated with lower scores in general health and the physical domain assessed by the WHOQOL-BREF. Patients with IBD treated with biological therapy had better Qol than those on conventional therapy. Future studies are needed to choose the most appropriate tool for assessing QoL in this population.

Baseline Disease Activity and Steroid Therapy Stratify Risk of COVID-19 in Patients With Inflammatory Bowel Disease

Inflammatory Bowel Disease Extending Its Reach

Background The global escalation of Inflammatory Bowel Disease (IBD) has precipitated an increased burden of disease and economic impact, particularly accentuated within the Asian context. The primary objective of this study is to predict the future prevalence trajectory of IBD in Korea and elucidate the pattern of its evolution. Methods Data from the Korean National Health Insurance Service (2004–2018) were analyzed using a validated diagnostic algorithm to identify IBD patients. An autoregressive integrated moving average (ARIMA) model, employing 2004–2017 data, predicted future trends based on past values and error correction. The model's accuracy was validated against the actual 2018 patient count. We projected IBD patient numbers and prevalence from 2018 to 2048, using a generalized linear model (GLM) to determine influencing factors. Results A consistent annual increase in the number of IBD cases across all age groups was observed from 2004 to 2018, with prevalence peaking in the 20–39 age group. The validation of our prediction model demonstrated an acceptable range of error for IBD prevalence, with a 2.45% error rate and a mean absolute difference of 2.61. The 2018–2048 projections confirm a steady rise in Crohn’s disease (CD), ulcerative colitis (UC), and IBD prevalence across both genders (Figure 1). IBD prevalence is projected to increase from 104.19 per 100,000 in 2018 to 149.59 per 100,000 by 2028, and further to 239.73 per 100,000 by 2048 (95% confidence interval [CI]: 223.73–255.73), marking a 130% increase. By 2048, the prevalence rates for UC and CD were estimated to be 159.40 per 100,000 (95% CI: 137.38–181.42) and 91.11 per 100,000 (95% CI: 0.81–181.41), respectively. The Average Annual Percent Change (AAPC) of IBD is predicted at 4.51%, varying from a 2.77% decrease in those over 60 to a 14.20% increase in the 20–39 age group. Gender-stratified forecasts show a higher AAPC in males (6.17%) compared to females (2.75%) over the next 30 years. The highest AAPC, valued at 19.48, was noted in the male group aged 20–39 years. GLM analysis indicates significant age, gender, and temporal effects on IBD prevalence, with marked gender disparities in specific age groups for both CD and UC. In UC, males aged 20–39 experienced a significantly higher increase in prevalence than females. For CD, males also showed a higher prevalence increase than females in the 20–39 and 40–59 age groups (all interaction p-values &amp;lt; 0.05; Table 1). Conclusion This study forecasts a significant increase in Korean IBD prevalence by 2048, especially among males and the 20–39 age group, highlighting the need to focus on these high-risk demographics in future disease management.

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

Inflammatory bowel disease in children and adolescents: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

BackgroundReal-life data on inflammatory bowel disease (IBD) prevalence and costs are scarce. The aims of this study were to provide an overview of the prevalence, mortality, health care utilization and costs of IBD patients in Switzerland in the years 2010, 2012, and 2014.MethodsBased on claims data of the Helsana-Group, prevalence of IBD was assessed for 2010, 2012 and 2014. Mortality rates, costs (inpatient, outpatient, medication costs) and utilization (visits, hospitalizations) were compared between patients with and without IBD, and between IBD patients treated with and without biologics. Results were extrapolated to the Swiss general population using national census data. Multivariate linear regression was used to identify socio-demographic and regional factors influencing total costs.ResultsThe overall extrapolated prevalence rates of IBD were 0.32% in 2010, 0.38% in 2012, and 0.41% in 2014. Mortality rate didn’t differ between the IBD and non-IBD population. Costs increased annually by 6% in IBD versus 2.4% in non-IBD subjects, which was solely due to increased outpatient costs. Almost one-fourth of IBD patients were hospitalized at least once a year. Costs were higher in IBD patients treated with biologics (OR = 3.98, CI: 3.72-4.27, p < 0.001) when compared to IBD patients without biologic therapies. Over 70% of the total costs in IBD patients treated with biologics were due to drug costs, compared with 28% in patients without use of biologic therapies, whereas inpatient costs didn’t differ.ConclusionsThe prevalence of IBD seems to be increasing in Switzerland. Outpatient costs increased substantially, while no decrease in inpatient costs was found. Treatment of IBD is more and more based on biologic therapies.

Purpose: The lack of reliable conventional predictive cardiovascular (CV) co-morbidities among inflammatory bowel disease (IBD) patients and the absence of literature describing the results of CV testing in this population support the present investigation to identify whether electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities are more prevalent among inflammatory bowel disease (IBD) patients than controls, and to characterize the ECG and ECHO anomalies among IBD patients with coronary artery disease (CAD). Methods: This retrospective cohort study included adult IBD patients seen in the outpatient gastroenterology clinic at Jackson Memorial Hospital (Miami, FL). Predictive variables for traditional cardiovascular disease such as hypertension, dyslipidemia, diabetes, obesity, and smoking were recorded. The primary outcomes were abnormal ECG and ECHO findings. Abnormalities on ECG were classified as major or minor, as per the Minnesota code criteria. Pathology with ECHO was defined as reduced left ventricular ejection fraction [EF] ≤ 45%, valvulopathy, wall motion abnormalities, and diastolic dysfunction, as determined by an attending cardiologist. Results: The study comprised 102 IBD patients and 385 age- and gender-matched controls. The baseline characteristics of the study population are shown in Table 1. Although clinical heart failure and CAD were observed in IBD patients more than controls, dyslipidemia and obesity were less common. IBD patients and controls had similar ECG findings (Table 2). A trend toward increase in major ECG changes in the IBD patients with CAD was observed, limited by small numbers and primarily driven by evidence of ischemia or infarction and intra-ventricular blocks (Table 2). On ECHO, an increased prevalence of mitral regurgitation was observed in the IBD group: see Table 2. This finding may be secondary to low intravascular volume from diarrhea in IBD patients.Table 1: Baseline characteristics of IBD cases and controlsTable 2: ECG and ECHO findings of IBD cases and controlsConclusion: CV disease in IBD patients is associated with substantial ECG abnormalities, underlining the importance of identifying the non-traditional IBD-specific risk factors for CVD and monitoring for its clinical consequences.

Screening for active COVID-19 infection prior to biologic therapy in IBD patients: Let's not increase our uncertainty without reducing our concerns

Reply to comment: Screening for active COVID-19 infection prior to biologic therapy in IBD patients: primum non nŏcēre

ObjectivesSeveral reports suggesting that the intestinal microbiome plays a key role in the development of inflammatory bowel disease (IBD) or colorectal cancer (CRC), but the changes of intestinal bacteria in healthy people, patients with IBD and CRC are not fully explained. The study aimed to investigate changes of intestinal bacteria in healthy subjects, patients with IBD, and patients with CRC.MaterialsWe collected data from the European Nucleotide Archive on healthy people and patients with colorectal cancer with the study accession number PRJEB6070, PRJEB7774, PRJEB27928, PRJEB12449, and PRJEB10878, collected IBD patient data from the Integrated Human Microbiome Project from the Human Microbiome Project Data Portal. We performed metagenome-wide association studies on the fecal samples from 290 healthy subjects, 512 IBD patients, and 285 CRC patients. We used the metagenomics dataset to study bacterial community structure, relative abundance, functional prediction, differentially abundant bacteria, and co-occurrence networks.ResultsThe bacterial community structure in both IBD and CRC was significantly different from healthy subjects. Our results showed that IBD patients had low intestinal bacterial diversity and CRC patients had high intestinal bacterial diversity compared to healthy subjects. At the phylum level, the relative abundance of Firmicutes in IBD decreased significantly, while the relative abundance of Bacteroidetes increased significantly. At the genus level, the relative abundance of Bacteroides in IBD was higher than in healthy people and CRC. Compared with healthy people and CRC, the main difference of intestinal bacteria in IBD patients was Bacteroidetes, and compared with healthy people and IBD, the main difference of intestinal bacteria in CRC patients was in Fusobacteria, Verrucomicrobia, and Proteobacteria. The main differences in the functional composition of intestinal bacteria in healthy people, IBD and CRC patients were L-homoserine and L-methionine biosynthesis, 5-aminoimidazole ribonucleotide biosynthesis II, L-methionine biosynthesis I, and superpathway of L-lysine, L-threonine, and L-methionine biosynthesis I. The results of stratified showed that the abundance of Firmicutes, Bacteroidetes, and Actinobacteria involved in metabolic pathways has significantly changed. Besides, the association network of intestinal bacteria in healthy people, IBD, and CRC patients has also changed.ConclusionsIn conclusion, compared with healthy people, the taxonomic and functional composition of intestinal bacteria in IBD and CRC patients was significantly changed.

Introduction: Inflammatory bowel disease (IBD) is associated with skin manifestation; Erythema :odosum and pyoderma gangrenosum being the most common but other skin disorder have been reported in IBD. Vitiligo is a rare autoimmune disease that is diagnosed based on clinical findings and examining the skin by wood lamp that reveals depigmentation patches. In the past, case studies (Shafa S et al) and case reports have suggested a link between Vitiligo and IBD. Using a large database, we aim to describe the epidemiology and risk of Vitiligo in IBD patients. Methods: We used a multi-instituitional database (Explorys Inc, Cleveland, OH), an aggregate of electronic health record data from 26 US healthcare systems. In this database, we identified patients with a Systemized Nomenclature of Medicine Clinical Terms diagnosis of IBD, CD, and vitiligo from 1999 to the present. We assessed the association of vitiligo in IBD patients without CD and CD patients without IBD and compared them with individuals with neither IBD nor CD. Results: Out of the 70,383,890 patients in the database, we identified a total of 50,020 patients with vitiligo (0.1%), 412,950 patients with IBD (0.6%), and 136,690 patients with CD (0.2%). Among those with vitiligo, there were 450 (0.4%) CD patients (without IBD), 880 (0.3%) IBD patients (without CD), 50 (0.2%) patients with both celiac and IBD, and 48,640 (0.07%) patients with neither CD nor IBD (control group). The prevalence of vitiligo was 0.4% in celiac disease (without IBD) and 0.3% in IBD (without CD). The risk of vitiligo was higher in the CD-only group [OR 5.65 (5.15–6.20)] and IBD-only group [OR 3.24 (3.03–3.46)] compared to the control group (Table). In the IBD-only group, vitiligo was more commonly associated with females compared to males [OR 1.44 (1.19–1.74), P< 0.0001], in adults aged 18–65 compared to elderly patients [2.52 (2.08–3.06), P< 0.0001], and in Caucasians compared to non-Caucasians (OR 9.0 [7.25–11.17], P< 0.0001) (Figure). Conclusion: Utilizing a large population database, we report a distinct increased association of vitiligo in IBD and CD. Further studies are necessary to confirm this association and discover the mechanism behind this association.Figure 1.: Gender-, Age- and Race-Based Prevalence ratio of vitiligo in individuals with IBD without history of celiac disease in the United States. Table 1. - Odd’s ratio comparing the prevalence of vitiligo in celiac disease and in IBD to patients with vitiligo without celiac or IBD OR, 95% CI, p-value*Compared to patients with vitiligo without celiac nor IBD Vitiligo in Celiac disease (Excluding those with IBD) OR 5.65 (5.15-6.20), P< 0.0001 Vitiligo in IBD (Excluding those with celiac) OR 3.24 (3.03-3.46), P< 0.0001 Univariate analysis used to calculate OROR; odds ratio, CI; confidence interval, IBD; Inflammatory bowel disease.