Bowel Disease Research Articles

Gastrointestinal Disease in Common Variable Immunodeficiency Disorder (CVID): Histological Patterns, Diagnostic Clues and Pitfalls for the Pathologist and Gastroenterologist

Background/Objectives: Gastrointestinal diseases are a major cause of morbidity in common variable immunodeficiency disorder (CVID), clinically often mimicking other conditions including celiac disease and inflammatory bowel disease (IBD). Hence, diagnosis of CVID remains challenging. This study aims to raise awareness and highlight histopathological clues for CVID in intestinal biopsies, emphasizing diagnostic pitfalls for the pathologist/gastroenterologist. Methods: We reviewed 63 (18 duodenal, 23 ileal, 22 colonic) biopsies and case histories from seven CVID patients, obtained over a 31-year period, with attention to active inflammation, intraepithelial lymphocytes, plasma cells, lymphoid hyperplasia, crypt/villous architecture, subepithelial collagen, apoptosis, granulomas, and infections. Clinical information of 41 pathology requests was reviewed. Results: Gastrointestinal symptoms were variable. Histological features included IBD-like (3/7), celiac disease-like (2/7), graft-versus-host disease (GVHD)-like (2/7), lymphocytic sprue/colitis-like (3/7), collagenous colitis-like (2/7), and acute colitis-like (4/7) patterns, often overlapping (2/7) and/or changing over time (3/7). Lymphoid hyperplasia was seen in 3/7 patients; 1/7 had giardiasis; and 5/7 had few plasma cells, usually only in part of the gut (3/5). Clinical information of 12/41 (29%) pathology requests mentioned known/suspected CVID, despite being known in 33/41 (80%). Conclusions: Clinical/histological features of CVID in the gut are diverse, often mimicking IBD, microscopic colitis, celiac disease and/or GVHD, hence the importance of adequate clinical information. Some histological features are atypical of these established entities and may indicate CVID, as may overlapping/changing histological patterns and/or few plasma cells in part of the gut. Awareness of the heterogenous clinical presentation and histopathological indicators of CVID may improve diagnosis.

Possible linking and treatment between Parkinson’s disease and inflammatory bowel disease: a study of Mendelian randomization based on gut–brain axis

BackgroundMounting evidence suggests that Parkinson’s disease (PD) and inflammatory bowel disease (IBD) are closely associated and becoming global health burdens. However, the causal relationships and common pathogeneses between them are uncertain. Furthermore, they are uncurable. Thus, we aimed to identify the causal relationships and novel therapeutic targets shared between them based on their common pathophysiological mechanisms in gut–brain-axis (GBA).MethodsA meta-analysis on bidirectional Mendelian randomization (MR) utilizing various datasets was performed to estimate their causal relationship. Then, pleiotropic analysis under the composite null hypothesis (PLACO) with functional mapping combined with annotation of genetic associations (FUMA) analysis were conducted to identify pleiotropic genes. Next, blood, brain and intestine expression quantitative trait locus (eQTL) were taken to perform drug-target MR finding common causal genes in two diseases. Colocalization analysis ensured the eQTLs of corresponding gene colocalized with disease. Enrichment analysis and protein‒protein interaction (PPI) network were done to explore common pathogenesis pathways. Genes passed all analysis were regarded as drug targets.ResultsOur MR meta-analysis revealed the bidirectional causal relationship between diseases, with combined ORs for PD on IBD, CD, UC (1.050 [95% CI 1.014–1.086], 1.044 [95% CI 0.995–1.095], 1.063 [95% CI 1.016–1.120]); for IBD, CD, UC on PD (1.003 [95% CI 0.973–1.034], 1.035 [95% CI 1.004–1.067], 1.008 [95% CI 0.977–1.040]). Overall, 277, 216 and 201 genes were identified as pleiotropic genes between PD and IBD, CD, UC. Total of 733 genes were classified as tier 3 (found in only one tissue) druggable targets, 57 as tier 2 (found in two tissues, 51 protein-coding genes) and 9 as tier 3 (found in three tissues). Among 60 protein-coding druggable targets over tier 2, 18 overlapped with pleiotropic genes and enriched in mitochondria, antigen presentation, processing and immune cell regulation pathways. Three druggable genes (LRRK2, RAB29 and HLA-DQA2) passed colocalization analysis. LRRK2 and RAB29 were reported to be pleiotropic genes, and RAB29 and HLA-DQA2 were reported for the first time as potential drug targets.ConclusionsThis study established a reliable causal relationship, possible shared drug targets and common pathogenesis pathways of two diseases, which had important implications for intervention and treatment of two diseases simultaneously.

Peripheral blood immune cells from individuals with Parkinson's disease or inflammatory bowel disease share deficits in iron storage and transport that are modulated by non-steroidal anti-inflammatory drugs.

Parkinson's Disease (PD) is a multisystem disorder in which dysregulated neuroimmune crosstalk and inflammatory relay via the gut-blood-brain axis have been implicated in PD pathogenesis. Although alterations in circulating inflammatory cytokines and reactive oxygen species (ROS) have been associated with PD, no biomarkers have been identified that predict clinical progression or disease outcome. Gastrointestinal (GI) dysfunction, which involves perturbation of the underlying immune system, is an early and often-overlooked symptom that affects up to 80 % of individuals living with PD. Interestingly, 50-70 % of individuals with inflammatory bowel disease (IBD), a GI condition that has been epidemiologically linked to PD, display chronic illness-induced anemia - which drives toxic accumulation of iron in the gut. Ferroptotic (or iron loaded) cells have small and dysmorphic mitochondria-suggesting that mitochondrial dysfunction is a consequence of iron accumulation. In pro-inflammatory environments, iron accumulates in immune cells, suggesting a possible connection and/or synergy between iron dysregulation and immune cell dysfunction. Peripheral blood mononuclear cells (PBMCs) recapitulate certain PD-associated neuropathological and inflammatory signatures and can act as communicating messengers in the gut-brain axis. Additionally, this communication can be modulated by several environmental factors; specifically, our data further support existing literature demonstrating a role for non-steroidal anti-inflammatory drugs (NSAIDs) in modulating immune transcriptional states in inflamed individuals. A mechanism linking chronic gut inflammation to iron dysregulation and mitochondrial function within peripheral immune cells has yet to be identified in conferring risk for PD. To that end, we isolated PBMCs and simultaneously evaluated their directed transcriptome and bioenergetic status, to investigate if iron dysregulation and mitochondrial sensitization are linked in individuals living with PD or IBD because of chronic underlying remittent immune activation. We have identified shared features of peripheral inflammation and immunometabolism in individuals living with IBD or PD that may contribute to the epidemiological association reported between IBD and risk for PD.

Morbidity in males with 45,X/46,XY resembles the morbidity pattern in Turner syndrome: a national population-based study.

Few studies have reported on males with 45,X/46,XY mosaicism. Most studies stem from pediatric settings and knowledge of natural history and long-term health outcomes are therefore lacking. To describe long-term health outcomes in males with 45,X/46,XY in comparison to the general population. A national population-based registry study. A public uniform health care system. All males in Denmark diagnosed with 45,X/46,XY mosaicism from 1967-2016 (n=135) and 1:100 age-matched males from the background population. Hospital diagnoses, prescribed medication and surgery codes were analyzed using a Cox proportional hazards regression model yielding hazard ratios (HR). 45,X/46,XY was associated with an increased risk of being admitted to hospital (HR=1.6, CI:1.3-1.9), undergoing surgery (HR=1.8, CI:1.4-2.2), and being prescribed medication (HR=1.2, CI:1.03-1.5). This risk applied to 15/18 diagnostic groups, 6/14 medication groups, and 10/16 surgery groups. Diagnoses with increased HRs included diabetes, thyroid disorders, obesity, hypertension, ischemic heart disease, osteoporosis, and inflammatory bowel disease. Half of all 45,X/46,XY males (69/135) had ≥1 diagnosis related to the genitourinary system and nearly one-third (39/135) underwent urogenital surgery. 45,X/46,XY mosaicism in males impacts long-term health significantly. The morbidity pattern includes a wide range of diseases, most known to occur at increased frequencies in Turner syndrome. The study underscores the importance of identifying these males and follow them with systematic screening as in Turner syndrome.

Diagnosing Crohn's Disease in Presumed Cryptoglandular Perianal Fistulas: An Expert Delphi Consensus on Early Identification of Patients at Risk of Crohn's Disease in Perianal Fistulas (PREFAB).

The aim of this Delphi study was to reach consensus on a new clinical decision tool to help identify or exclude Crohn's disease (CD) in patients with perianal fistula(s) (PAF). A panel of international experts in the field of proctology/Inflammatory Bowel Disease (IBD) were invited to participate. In the first round (electronic survey), participants were asked to anonymously provide their opinion probing 1) the relevance and use of clinical characteristics suggestive of underlying CD, 2) the use of faecal calprotectin (FCP) for screening for CD and 3) on the diagnostic work-up for CD in PAF patients with raised clinical suspicion. In the second/third round (virtual consensus meetings), statements were paired/revised and presented in final sets of statements. Consensus was predefined as ≥70% (dis)agreement. Final consensus was reached on twelve statements, including screening of all PAF patients (regardless of the complexity, biological behaviour and co-existent perianal symptoms) and referral of PAF patients for a colonoscopy in case of elevated FCP levels (≥150mcg/g) and/or in case of one clinical major criterion (defined as: unintentional weight loss, unexplained diarrhea, PSC, UC, >1 internal fistula openings, fistula involving other organs (vagina/bladder), recurrent fistulation (after initial healing), proctitis and anal stenosis). Also, clinical (fistula-)characteristics that warrant raised suspicion for CD and an algorithm on the diagnostic work-/follow-up of patients with raised suspicion were defined. International consensus was reached on a new, clinical decision tool, including a practical and relevant algorithm for finding/excluding CD in PAF patients.

Advancing Pediatric Robotic Colorectal Surgery: Trends, Outcomes, and Future Directions - A Comprehensive Review.

Introduction Pediatric robotic colorectal surgery has rapidly evolved, offering enhanced precision and safety for treating complex conditions such as Hirschsprung disease (HSCR), anorectal malformations (ARM), and inflammatory bowel disease (IBD). This review analyzes recent trends, outcomes, and complications in robotic colorectal procedures for pediatric patients. Materials and Methods A systematic review was performed using PubMed, yielding 1,112 articles related to pediatric robotic colorectal surgery. After applying exclusion criteria, 35 papers were analyzed, focusing on patient characteristics, procedure types, and clinical outcomes. Results Since 2001, approximately 700 pediatric patients have undergone robotic colorectal procedures, with Hirschsprung disease being the most commonly treated condition (n=421). The review highlights that 1.7% of patients experienced Clavien-Dindo grade III complications, while 11.5% had grade I-II complications, indicating a favorable safety profile. The use of robotic platforms facilitated improved precision during perirectal dissection and reduced risk of damage to adjacent structures, particularly in cases requiring complex pelvic dissections. Despite promising outcomes, the uptake of robotic colorectal surgery remains lower than that for urologic procedures due to challenges such as cost, instrument size, and specialized training. Conclusion Robotic colorectal surgery in children is a safe and effective approach, particularly for complex conditions like HSCR and ARM. While adoption is currently limited by cost and training requirements, ongoing advancements in technology and techniques promise to broaden its application and improve outcomes in pediatric surgery.

Comorbidity in incident rheumatoid arthritis—a nationwide case-control study with bidirectional follow-up

Abstract Objectives To investigate the association between risk of different co-morbidities and diagnosis of rheumatoid arthritis (RA) using a temporal approach. Methods Retrospective, case-control study. Data were extracted from all healthcare claims for Poland between 2011-2021. Prevalent RA(n = 262 265) patients were examined to evaluate morbidity patterns. Incident RA(n = 15 879) and age-, sex- and region-matched controls were sampled 1:10 from the general population (GP). Exposure was new-onset RA identified by interspaced, repeat claims and prescription. Follow-up was performed in a bidirectional, five-year timeframe from RA diagnosis(Dx). Results RA is associated with enhanced risk of multiple organ system disorders both pre- and post-Dx, especially hematologic (IRR 1.80, 95% CI 1.58, 2.05), pulmonary (IRR 1.57, 95% CI 1.53, 1.62), gastrointestinal (IRR 1.53, 95% CI 1.46, 1.60), and cardiovascular (IRR 1.25, 95% CI 1.22, 1.27) conditions. RA appears strongly associated with interstitial lung disease (pre-Dx IRR 2.97, 95% CI 2.20, 4.02; post-Dx IRR 4.66, 95% CI 3.91, 5.56) and inflammatory bowel disease (pre-Dx IRR 1.61, 95% CI 1.25, 2.07; post-Dx IRR 2.12, 95% CI 1.70, 2.63). Enhanced post-Dx risk of thyroid cancer (IRR 1.29, 95% CI 1.00, 1.66) and lymphoma (IRR 1.50, 95% CI 1.20, 1.88) was observed, in contrast to reduced risk of colon cancer (IRR 0.77, 95% CI 0.62, 0.94). Conclusion Enhanced risk of multiple comorbidities was observed both pre- and post-RA Dx, with varying patterns across different organ systems. These data highlight the multisystem nature of RA and warrant research into causal, bidirectional relationships.

Education, intelligence, and 20 gastrointestinal disorders: A Mendelian randomization study.

Previous observational studies have suggested that higher levels of education attainment and intelligence (IQ) are associated with better health outcomes in humans. However, the causal link between education attainment and IQ and their association with health outcomes remains unclear. This study aims to investigate the distinct impacts of intelligence and educational attainment on gastrointestinal symptoms. From the genome-wide association between educational attainment and the IQ study database, results were obtained from the FinnGen summary database. We used univariate and multivariate Mendelian randomization (MR) techniques to explore the relationship between exposures and outcomes. To assess the validity of inverse-variance-weighted-based results, we used several supplementary analytical techniques and performed sensitivity analysis. Our multivariate MR study confirmed the findings from univariable analyses and showed a genetically predicted causal association between educational attainment and 8 gastrointestinal disorders, including gastroesophageal reflux disease, chronic gastritis, gastroduodenal ulcer, cirrhosis, cholelithiasis, acute pancreatitis, chronic pancreatitis, and irritable bowel syndrome. Our univariate MR study found an association between IQ and 6 gastrointestinal conditions: gastroesophageal reflux disease, cirrhosis, cholelithiasis, acute pancreatitis, pancreatic malignancy, and irritable bowel syndrome. However, the connection was much weaker in multivariate MR analysis. Our study revealed causal relationships between gastrointestinal disorders and educational attainment. Educational attainment may mediate between intelligence and the impacts on the gastrointestinal system. However, further research is required to understand the underlying pathogenic processes completely.

Leaky gut in systemic inflammation: exploring the link between gastrointestinal disorders and age-related diseases.

Global average life expectancy has steadily increased over the last several decades and is projected to reach ~ 77years by 2050. As it stands, the number of people > 60years currently outnumbers children younger than 5years, and by 2050, it is anticipated that the global population of people aged > 60years will double, surpassing 2.1 billion. This demographic shift in our population is expected to have substantial consequences on health services globally due to the disease burden associated with aging. Osteoarthritis, chronic obstructive pulmonary disease, diabetes, cardiovascular disease, and cognitive decline associated with dementia are among the most common age-related diseases and contribute significantly to morbidity and mortality in the aged population. Many of these age-related diseases have been linked to chronic low-grade systemic inflammation which often accompanies aging. Gastrointestinal barrier dysfunction, also known as "leaky gut," has been shown to contribute to systemic inflammation in several diseases including inflammatory bowel disease and irritable bowel syndrome, but its role in the development and/or progression of chronic low-grade systemic inflammation during aging is unclear. This review outlines current literature on the leaky gut in aging, how leaky gut might contribute to systemic inflammation, and the links between gastrointestinal inflammatory diseases and common age-related diseases to provide insight into a potential relationship between the intestinal barrier and inflammation.

Assessment of calprotectin levels preceding and succeeding colonoscopy

Background: Faecal calprotectin (FC) is an easily applicable faecal surrogate marker of intestinal inflammation; it has provided a new means for objectively assessing disease activity in patients with various bowel diseases. In this study, the authors assessed levels of FC before colonoscopy preparation, during bowel cleansing and 1 week after colonoscopy. Methods: This cross-sectional study was conducted on 58 individuals referred to Razi Hospital, Rasht, Iran, for colonoscopy between 2021 and 2022. For all individuals, stool sampling was repeated three times before colonoscopy, during bowel preparation and 1 week after colonoscopy. All demographical and clinical data were collected through a questionnaire. FC results, colonoscopy and pathology findings were also recorded. Results: The mean age of the participants was 48.22±11.69 years and approximately 62.1% were female. There was no statistically significant difference between the average levels of FC before colonoscopy preparation, during bowel cleansing and 1 week after colonoscopy (P>0.05). The average amount of FC at different time points was not significantly different in patients with abnormal histopathological results compared to individuals with normal findings (P>0.05). Conclusions: The study findings suggest that bowel cleansing and colonoscopy do not significantly alter FC levels.

Assessment, diagnosis and management of inflammatory bowel disease emergencies

Acute severe ulcerative colitis (ASUC) and Crohn's disease (CD) can present as medical emergencies that require immediate and coordinated care due to the risk of significant morbidity and mortality. This clinical review explores the assessment and management of inflammatory bowel disease emergencies, including ASUC, toxic megacolon, massive haemorrhage, intra-abdominal abscesses, and bowel obstruction. The review highlights the critical importance of prompt diagnosis, patient-centred care, and the integration of multidisciplinary teams (MDTs) in managing these complex cases. It also outlines the clinical approaches, necessary investigations, and both medical and surgical management strategies essential for optimising patient outcomes. The review emphasises the need for healthcare professionals to be equipped with the knowledge and confidence to manage these emergencies effectively, thus enhancing patient care and safety. This article does not aim to explore UC and CD in their entirety but rather aims to focus on the acute emergencies associated with these conditions.

S121 Crohn’s Disease and Small Bowel Adenocarcinoma: An Unexpected Finding

S121 Crohn’s Disease and Small Bowel Adenocarcinoma: An Unexpected Finding

Probiotic nanovesicles encapsulating baicalin: a strategy to overcome colorectal cancer.

Escherichia coli Nissle 1917 (EcN) is a unique probiotic utilized to treat inflammatory bowel disease and irritable bowel syndrome. Outer membrane vesicles (OMVs) from EcN can not only deliver pro-biotic anti-inflammatory molecules to cancer cells to exert anti-rectal cancer effects, but also deliver therapeutic drugs, genes, and other "cargoes" encapsulated in the vesicles to specific cells, making them an ideal vehicle for drug delivery. In this study, we successfully isolated OMVs of probiotic origin and obtained BCN-OMVs by encapsulating baicalin (BCN) in EcN-OMVs. Fluorescence microscopy showed that both fluorescently labeled EcN-OMVs and BCN-OMVs were able to enter HT-29 cells. The results of CCK-8, plate cloning, flow cytometry, and western blotting indicated that the vitality and proliferation of HT-29 cells were sensibly inhibited after treatment with BCN-OMVs. Additionally, apoptosis-related proteins and proteins involved in the NF-κB pathway were also expressed differently. The results above suggest that EcN-OMVs, serving as a bio-nanocarrier of BCN, can effectively address the limitations of BCN, such as poor water solubility and low bioavailability. They also play a significant anti-tumor role by enhancing cancer cell apoptosis, showing promising potential in targeted therapy for colorectal cancer (CRC).

Colonic drug delivery systems: Exploring the potential of biodegradable polymers for systemic effects

Targeted drug delivery to the colon is highly desirable for the local treatment of various bowel diseases, including ulcerative colitis, Crohn’s disease, amebiasis, and colonic cancer, as well as for the systemic delivery of protein and peptide drugs. The colon-specific drug delivery system (CDDS) must protect the drug during transit through the stomach and small intestine, ensuring that release and absorption occur only in the colon. The colon is an ideal site for drug absorption due to its lower enzymatic activity compared to the small intestine, which helps protect peptide drugs from degradation, and its long residence time, which enhances systemic bioavailability.While the oral route is the most convenient for CDDS, rectal administration is also used, though it can be uncomfortable and less effective for targeting the proximal colon. Intrarectal drug preparations, such as solutions, foams, and suppositories, are used for both systemic dosing and local treatment of the large intestine. The efficacy of these drugs often depends on their formulation, spreading capacity, and retention time.The colon’s high water absorption capacity and viscous contents can limit drug availability to the absorptive membrane. However, the presence of a diverse bacterial flora in the colon can be leveraged for drug metabolism and targeted delivery of peptide-based macromolecules, such as insulin. Understanding the anatomy and physiology of the gastrointestinal tract (GIT), including variations in pH, is crucial for designing effective CDDS. This knowledge helps optimize drug release and absorption, ultimately improving therapeutic outcomes for patients.

Unraveling the Role of the Human Gut Microbiome in Health and Diseases.

The human gut is a complex ecosystem that supports billions of living species, including bacteria, viruses, archaea, phages, fungi, and unicellular eukaryotes. Bacteria give genes and enzymes for microbial and host-produced compounds, establishing a symbiotic link between the external environment and the host at both the gut and systemic levels. The gut microbiome, which is primarily made up of commensal bacteria, is critical for maintaining the healthy host's immune system, aiding digestion, synthesizing essential nutrients, and protecting against pathogenic bacteria, as well as influencing endocrine, neural, humoral, and immunological functions and metabolic pathways. Qualitative, quantitative, and/or topographic shifts can alter the gut microbiome, resulting in dysbiosis and microbial dysfunction, which can contribute to a variety of noncommunicable illnesses, including hypertension, cardiovascular disease, obesity, diabetes, inflammatory bowel disease, cancer, and irritable bowel syndrome. While most evidence to date is observational and does not establish direct causation, ongoing clinical trials and advanced genomic techniques are steadily enhancing our understanding of these intricate interactions. This review will explore key aspects of the relationship between gut microbiota, eubiosis, and dysbiosis in human health and disease, highlighting emerging strategies for microbiome engineering as potential therapeutic approaches for various conditions.

Computed tomography enterography radiomics and machine learning for identification of Crohn’s disease

BackgroundCrohn’s disease is a severe chronic and relapsing inflammatory bowel disease. Although contrast-enhanced computed tomography enterography is commonly used to evaluate crohn’s disease, its imaging findings are often nonspecific and can overlap with other bowel diseases. Recent studies have explored the application of radiomics-based machine learning algorithms to aid in the diagnosis of medical images. This study aims to develop a non-invasive method for detecting bowel lesions associated with Crohn’s disease using CT enterography radiomics and machine learning algorithms.MethodsA total of 139 patients with pathologically confirmed Crohn’s disease were retrospectively enrolled in this study. Radiomics features were extracted from both arterial- and venous-phase CT enterography images, representing both bowel lesions with Crohn’s disease and segments of normal bowel. A machine learning classification system was constructed by combining six selected radiomics features with eight classification algorithms. The models were trained using leave-one-out cross-validation and evaluated for accuracy.ResultsThe classification model demonstrated robust performance and high accuracy, with an area under the curve of 0.938 and 0.961 for the arterial- and venous-phase images, respectively. The model achieved an accuracy of 0.938 for arterial-phase images and 0.961 for venous-phase images.ConclusionsThis study successfully identified a radiomics machine learning method that effectively differentiates Crohn’s disease bowel lesions from normal bowel segments. Further studies with larger sample sizes and external cohorts are needed to validate these findings.

Ayurveda management of Oral Lichen Planus

Background: Oral Lichen Planus (OLP) is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+ T cells trigger apoptosis of the basal cells of the oral epithelium. It is characterized by lesions consisting of radiating white, gray, velvety, thread-like papules in a linear, annular and retiform arrangement forming typical lacy, reticular patches, rings and streakes. Although the exact etiology of this disease is still unknown, but some factors are associated with it like dental materials, autoimmunity, food allergies, stress, trauma, bowel diseases, infectious diseases, genetics etc. Aims and Objectives: To study the role of Ayurveda Chikitsa in the management of Oral Lichen Planus. Materials and Methods: A female patient aged 41 years presented with complaints of oral lesion with burning, pain, occasionally bleeding from gums while brushing. Patient was diagnosed with disease Oral Lichen Planus. Patient was treated with administration of Deepana Pachana Aushadhis followed by Trivritta Churna, Guduchyadi Kwatha internally and with Rasayanadi Yoga being used as local application. After the two month’s treatment, a significant response seen in symptoms like burning, pain and bleeding from gums while brushing. Result: There is a need to make treatments that are widely recognized, widely successful, and capable of withstanding systematic replication available. These treatments should be able to significantly reduce the volume, recurrence and impact of Oral Lichen Planus. Conclusion: Ayurveda has great approach in curing the Oral Lichen Planus.

Perspectives on the sustained engagement with digital health tools: protocol for a qualitative interview study among people living with Inflammatory Bowel Disease or irritable bowel syndrome

IntroductionDigital health tools can be beneficial in the care of patients with chronic conditions and have the potential for widespread impact as readily scalable and cost-effective health interventions. However, benefits...

Long-term follow-up of children with Crohn's disease and small bowel mucosal lesions detected through video capsule endoscopy.

We report disease outcomes of pediatric Crohn's disease (CD) affecting the proximal small bowel (SB) and detected through video capsule endoscopy (VCE). We undertook a retrospective review of CD patients with VCE performed under age 18 between 2003 and 2017 and having received any biologics. We identified patients from our institutional registry. Eligible patients (n = 118) had their first VCE performed after a median of 0.1 years after diagnostic endoscopies at a median age of 12.2 years. The proximal SB disease group (Paris classification L4b inclusive) comprised 70 patients with extensive SB lesions in 81% and deep ulcers in 79%. Patients with Paris L1-3 disease with no findings in VCE or disease restricted to the terminal ileum comprised the control group. At first VCE, levels of albumin (34 g/L vs. 37 g/L) and hemoglobin (117 g/L vs. 127 g/L) were lower in SB patients (p < 0.02). After the first VCE, 68% were introduced to biologics, while 10% already received them. Follow-up VCE was performed after a median of 2.4 years (SB group n = 42; controls n = 21). Proximal SB findings had disappeared in 40% of SB patients, and extensive lesions and deep ulcers had decreased to 26% and 29%, respectively (p = 0.001). In the control group, one had progressed to proximal disease. During the clinical follow-up of a median of 4.7 years, one patient with SB underwent surgery for a jejunal stricture. Proximal SB disease detected through capsule endoscopy abated in most patients with biological medication.

Long-Term Sequelae of SARS-CoV-2 Infection in Patients with Inflammatory Bowel Diseases Compared to Relatives with SARS-CoV-2 Infection without Inflammatory Bowel Disease and Inflammatory Bowel Disease Patients without SARS-CoV-2: Results of a Retrospective Case-Control Study

Introduction: Long-term sequelae following acute SARS-CoV-2 infection appear to be common in patients with inflammatory bowel diseases (IBDs). Methods: We examined the frequency and characteristics of post-COVID-symptoms in patients with IBD (IBD-COVID), comparing them to two control cohorts: infected household members of the IBD-COVID patients without IBD (CONT-COVID) and IBD patients without SARS-COV-2 infection (IBD-no-COVID). A questionnaire for the retrospective documentation of possible post-COVID-19 symptoms was distributed to patients and controls from eight referral centers. Results: The 319 IBD-COVID, 108 CONT-COVID, and the 221 IBD-no-COVID patients were similar in terms of sex, age, and comorbidities. The occurrence and duration of fatigue in the IBD-COVID cohort correlated with IBD activity. Other complaints such as reduced cognitive performance (p &lt; 0.05) and sleeping disorders (p &lt; 0.05) were even more common in IBD-COVID patients. Persistent hematochezia (p &lt; 0.001), abdominal pain (p &lt; 0.005), diarrhea (p &lt; 0.0001), and anal problems (p &lt; 0.01) were more often in the IBD-COVID patients than in the CONT-COVID cohort. Furthermore, typical IBD-associated symptoms persist for a longer period after an infection. Frequency of post-COVID complaints is higher in IBD patients compared to controls. After infection, the number of outpatient consultations increased in IBD-COVID patients (7.8% vs. 10.9%, p = 0.008). Conclusion: Fatigue, cognitive impairment, and sleep disturbances are more prevalent among IBD-COVID than CONT-COVID patients. Furthermore, typical IBD-associated symptoms persist for a longer period after an infection. Frequency of post-COVID complaints is higher in IBD patients compared to controls. Tight control of IBD activity could be a suitable tool to avoid post-COVID problems.