History Of Colitis Research Articles

Endoluminal approaches for colorectal neoplasia in inflammatory bowel disease: a viable alternative for colectomy?

BackgroundEndoscopic resection of visible dysplastic lesions in patients with inflammatory bowel disease (IBD) is an alternative to colectomy. The endoscopic techniques that can be used include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and ESD combined with EMR. These endoscopic approaches may allow organ preservation in patients with IBD. This study aimed to evaluate the outcomes of endoscopic resection, including EMR, ESD, and ESD combined with EMR, for the treatment of colorectal dysplasia in patients with IBD. MethodsThis was a retrospective review of patients with IBD who underwent endoscopic resection for colorectal dysplasia at our tertiary care center between 2014 and 2023. Patients were identified via a search of our endoscopy database. Medical records were reviewed to collect data on patient demographics, IBD history, details of endoscopic technique, procedural factors, final pathology results, and outcomes, including recurrence of dysplasia. ResultsA total of 50 patients with IBD who underwent endoscopic resection were included in the study, with 38 ESD cases, 11 ESD combined with EMR cases, and 1 EMR case. The median age was 62 years, (IQR, 54–68), and 34 patients (68%) were male. The median body mass index was 27.6 kg/m2 (IQR, 24.8–31.7). The underlying diagnoses were ulcerative colitis in 33 patients (66%) and Crohn’s disease in 17 patients (33%). The median disease duration was 27.5 years (IQR, 8–30). Polyp locations were distributed as follows: right colon, rectum, left colon, transverse colon, and cecum, with 9 polyps (18%) in each area. The median procedure time was 47.5 min (IQR, 31.2–73.7). En bloc resection was performed in 34 patients (68%), and piecemeal resection was performed in 16 patients (32%). On pathology, the median lesion size was 23.5 mm (IQR, 20.2–40.0). High-grade dysplasia was found in 7 patients (14%), whereas low-grade dysplasia was found in 15 patients (30%). During a median follow-up period of 3 years, 18% of patients experienced recurrence. No significant difference in recurrence rates was observed between the ESD and ESD combined with EMR groups. ConclusionEndoscopic resection, including EMR, ESD, and ESD combined with EMR, is an effective treatment of visible dysplastic lesions and is a safe alternative to colectomy in patients with IBD. In this cohort, favorable short-term outcomes were observed after endoscopic resection.

Systemic amyloidosis following inflammatory bowel disease, follicular lymphoma, and diffuse large B-cell lymphoma: a case report

Systemic amyloidosis is a rare disorder characterized by the widespread deposition of misfolded amyloid proteins in several organs, leading to organ failure and potentially death if not promptly recognized. The occurrence of inflammatory bowel disease (IBD), follicular lymphoma, and diffuse large B-cell lymphoma (DLBCL) developing into systemic amyloidosis is uncommon. Here is a case of a 55-year-old Asian woman with a history of IBD, follicular lymphoma, and abdominal DLBCL who developed systemic amyloidosis affecting her gastrointestinal, cardiac, and renal organs. Gastrointestinal symptoms (abdominal pain and melena) initially manifested in this patient with systemic amyloidosis. She underwent treatment with three cycles of rituximab and bendamustine. However, she passed away after 2 months of hospitalization due to multiple organ failure. Hence, physicians must be vigilant in recognizing amyloidosis as a potential complication of lymphoma or other inflammatory diseases, as early recognition can contribute to improved clinical outcomes.

Клініко-параклінічна характеристика запальних захворювань кишечника з дуже раннім початком у дітей

Over recent decades, there has been a notable increase in the incidence of inflammatory bowel disease (IBD) among children under the age of six. The management of such patients is challenging due to the severe and treatment-resistant course of the disease, alongside atypical presentations. Aim - examine the clinical and paraclinical features of IBD with an onset at a very young age. Materials and methods. The study involved 10 young children diagnosed with IBD including 3 with Crohn's Disease (CD), 2 with Ulcerative Colitis (UC), and 5 with an unclassified form of IBD. Clinical, anamnestic, laboratory, endoscopic, and histopathological methods was employed to gather comprehensive data on each case. Results. Six children experienced a severe course, while four had a moderate disease course. Identified triggers included COVID-19 or rotavirus infections, food allergies, and early artificial feeding. Three children had a family history of IBD. For 80% of children, IBD onset occurred within the first year of life following the escalation of war in Ukraine, with a severe, treatment-resistant progression. Symptoms and laboratory findings were similar in children with CD and UC. Endoscopic and histopathological findings revealed the chronic inflammation in the colon of 80% patients, with two CD patients showing terminal ileitis. In 50% of cases, endoscopic and histological features were ambiguous, presenting characteristics of both CD and UC (IBD- unclassified). Conclusion. IBD in early childhood is marked by high inflammatory activity involving the entire colon, with overlapping clinical, endoscopic, and histopathological characteristics between CD and UC, complicating accurate diagnosis and expanding the group classified as IBD- unclassified. The study adhered to the Helsinki Declaration principles, received ethical approval from local ethical committee, and obtained parental consent for child participation. Authors report no conflicts of interest.

Incidence, Risk Factors, and Correlation with Caprini Score of Deep Vein Thrombosis After Colpocleisis with/without Concomitant Hysterectomy for Pelvic Organ Prolapse in Elderly Women.

The objective was to investigate the incidence and risk factors of lowerextremity deep vein thrombosis (DVT) in elderly women undergoing colpocleisis for pelvic organ prolapse and to evaluate the predictive efficacy of the Caprini scores. Data from patients who underwent colpocleisis from August 2019 to April 2024 were retrospectively analyzed. The primary endpoint was DVT detected by ultrasonography within 7 days of surgery. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors. Efficacy parameters of the Caprini scores were analyzed and optimal cut-off values were selected. A total of 262 patients were enrolled in the study, of whom 8.4% (22 out of 262) developed DVT postoperatively. After statistical analysis, the duration of menopause, history of inflammatory bowel disease, as well as higher levels of preoperative cholesterol and preoperative D-dimer, were identified as independent risk factors. There was a significant difference in the Caprini scores between the DVT and non-DVT groups (7.27 ± 1.28 vs 6.15 ± 0.80, p < 0.001), and the risk of DVT tended to increase with higher Caprini scores. The best performance was achieved when the threshold for the Caprini score was set to 7, at which point the area under the receiver operating characteristic curve was 0.758, the sensitivity was 0.773, and the specificity was 0.662. There was a strong correlation between the occurrence of DVT after colpocleisis and the Caprini score, with higher Caprini scores indicating a higher risk of postoperative DVT. A significantly increased risk was suggested when this score was ≥ 7.

Evaluation of Acute Terminal Ileitis in Hospitalized Patients: Development of a Predictive Model to Distinguish Crohn's Disease from Other Etiologies.

Background/Objectives: Terminal ileitis (TI) is often identified on CT scans in emergency settings. Diagnosing Crohn's disease (CD) as a cause of TI is crucial due to its significant long-term implications. This study aimed to differentiate CD from other causes of acute TI and develop a predictive model for CD diagnosis. Methods: A retrospective case-control study was conducted at Shamir Medical Center including adults diagnosed with acute TI from January 2012 to December 2020. Patients with a history of inflammatory bowel disease or prior intestinal surgery were excluded. Patients were categorized into CD and non-CD groups based on their subsequent clinical course. A logistic regression model was developed and subsequently validated with additional patients hospitalized between 2021 and 2023. Results: Among 135 patients, 37 (27.4%) were diagnosed with CD. CD patients were younger (median age 27 vs. 39 years, p = 0.003), predominantly male (83.8% vs. 51%, p = 0.001), and had higher rates of chronic abdominal pain, diarrhea, anemia, and weight loss prior to hospitalization. Significant laboratory differences included higher platelet counts (p = 0.006) and lower mean corpuscular volume (MCV) (p = 0.001) in CD patients. Radiologic signs of complicated disease were more common in CD (35.1% vs. 4.1%, p < 0.001). The predictive model incorporating gender, abdominal pain history, and MCV showed an area under the curve (AUC) of 0.87, with a sensitivity of 100% and specificity of 63.6% in the validation group of 18 patients. Conclusions: This study identified key predictors of CD in patients presenting with acute TI and developed a predictive model with a substantial diagnostic capability. Use of this model for early identification and treatment of CD may potentially improve patient outcomes. Further prospective validation of this model is warranted.

Colitis associated with persistent drug-induced immune dysregulation.

Adverse drug reactions frequently involve the gastrointestinal tract. We present two cases of colitis that occurred months to years after chemotherapy and autologous stem cell transplantation for the treatment of lymphoma. Laboratory tests revealed altered immune status with decreased CD4/CD8 ratio and hypogammaglobinemia (in one patient). The patients had no history of inflammatory bowel disease or immunodeficiency. Biopsies showed chronic active colitis with crypt architectural distortion, erosions, and ulcers as well as pyloric gland metaplasia and loss of plasma cells (in one patient, respectively). Colitis appeared to be related to lymphoma therapy, but could not be attributed to a distinct drug or infectious agent, suggesting the concept of persistent immune dysregulation driving mucosal inflammation. Hence, we suggest "immune dysregulation-associated colitis" (ID-colitis) as an umbrella term for cases of chronic colitis, in which immune dysfunction is evident from blood samples or clinical information and inflammatory bowel disease has been ruled out.

Pseudopolyposis ulcerative colitis: An unusual finding

Diffuse inflammatory polyposis of the colon is a rare finding in Inflammatory Bowel Disease (IBD). Herein we describe a unique case of diffuse giant inflammatory polyposis in a 39-year-old women, admitted to the department of surgery for undetermined pancolitis without history of IBD.

Influence of familial forms of inflammatory bowel disease on the use of immunosuppressants, biological agents, and surgery in the era of biological therapies. Results from the ENEIDA project.

Familial inflammatory bowel disease (IBD) history is a controversial prognostic factor in IBD. We aimed to evaluate the impact of a familial history of IBD on the use of medical and surgical treatments in the biological era. Patients included in the prospectively maintained ENEIDA database and diagnosed with IBD after 2005 were included. Familial forms were defined as those cases with at least one first-degree relative diagnosed with IBD. Disease phenotype, the use of biological agents, or surgical treatments were the main outcomes. A total of 5263 patients [2627 Crohn's disease (CD); 2636 ulcerative colitis (UC)] were included, with a median follow-up of 31months. Of these, 507 (10%) corresponded to familial forms. No clinical differences were observed between familial and sporadic IBD forms except a lower age at IBD diagnosis and a higher rate of males in familial forms of UC. In CD, the proportions of patients treated with thiopurines (54.4% vs 46.7%; P = .015) and survival time free of thiopurines (P = .009) were lower in familial forms. No differences were found regarding the use of biological agents. Concerning surgery, a higher rate of intestinal resections was observed in sporadic CD (14.8% vs 9.9%, P = .027). No differences were observed in UC. In the era of biological therapies, familial and sporadic forms of IBD show similar phenotypes and are managed medically in a similar way; whether these is due to lack of phenotypical differences or an effect of biological therapies is uncertain. What is already known on this topic: IBD's etiopathogenesis points to an interaction between environmental and genetic factors, being familial history a controversial prognostic factor. Biological agents use and need for surgery regarding familial or sporadic forms of IBDs present conflicting results. What this study adds: Familial and sporadic forms of IBD have similar phenotypes and are managed medically and surgically in a similar way. How this study might affect research, practice or policy: Familial aggregation should not be considered a factor associated with more aggressive disease.

Dysplasia Detected in Patients With Serrated Epithelial Change Is Frequently Associated With an Invisible or Flat Endoscopic Appearance, Nonconventional Dysplastic Features, and Advanced Neoplasia.

The significance of serrated epithelial change (SEC), defined as endoscopically invisible hyperplastic polyp (HP)-like mucosal change identified in patients with inflammatory bowel disease (IBD), remains unclear. Although some studies reported an increased risk of synchronous and/or metachronous colorectal neoplasia in patients with SEC, including advanced neoplasia (high-grade dysplasia or colorectal cancer), the development of SEC is not significantly associated with increased colonic inflammation. This contrasts with the reported positive correlation between increased colonic inflammation and the risk of colorectal neoplasia in ulcerative colitis, arguing against the notion that SEC may represent a form of dysplasia. As such, this study aimed to characterize the features of synchronous and metachronous dysplasia detected in patients with SEC to identify factors contributing to the increased risk of colorectal neoplasia, including advanced neoplasia, observed in a subset of these patients. Clinicopathologic features of 46 IBD patients with SEC (n=109) and synchronous and/or metachronous dysplasia (n=153) were analyzed. All dysplastic lesions were subtyped as either conventional or nonconventional dysplasia. As controls, 45 IBD patients with endoscopically visible or polypoid HP (n=75) and synchronous and/or metachronous dysplasia (n=87) were analyzed. The SEC group included 28 (61%) men and 18 (39%) women with a mean age of 58 years and a long history of IBD (mean duration: 23 years). The majority of patients (n=34; 74%) had ulcerative colitis, and 12 (26%) had Crohn's disease. Thirty-nine (85%) patients had a history of pancolitis, and 2 (4%) had concomitant primary sclerosing cholangitis. Twenty-seven (59%) patients had multifocal SEC. SEC was predominantly found in the left colon (n=52; 48%) and rectum (n=34; 31%). Dysplasia in the SEC group was often endoscopically invisible or flat (n=42; 27%) and demonstrated nonconventional dysplastic features (n=49; 32%). Six nonconventional subtypes were identified in the SEC group, including 17 (11%) dysplasia with increased Paneth cell differentiation, 12 (8%) hypermucinous dysplasia, 8 (5%) crypt cell dysplasia, 7 (5%) goblet cell deficient dysplasia, 3 (2%) sessile serrated lesion-like dysplasia, and 2 (1%) traditional serrated adenoma-like dysplasia. Advanced neoplasia was detected in 11 (24%) patients. The SEC group was more likely to have nonconventional dysplasia (32%, P <0.001), invisible/flat dysplasia (27%, P <0.001), and advanced neoplasia (24%, P <0.001) than the control group (7%, 2%, and 0%, respectively). High-risk nonconventional subtypes (ie, hypermucinous, crypt cell, and goblet cell deficient dysplasias) accounted for 18% of all dysplastic lesions in the SEC group, which were not seen in the control group ( P <0.001). The SEC group (n=35; 76%) also had a higher rate of concordance between the location of SEC and the area of synchronous/metachronous dysplasia than the control group (n=22; 49%) ( P =0.007). In conclusion, dysplasia detected in patients with SEC is often endoscopically invisible/flat (27%), nonconventional (32%, including the high-risk subtypes), and found in the same colonic segment as SEC (76%), which may in part explain why some patients with SEC are associated with an increased risk of colorectal neoplasia, including advanced neoplasia. The finding of SEC may warrant a careful follow-up colonoscopy with increased random biopsy sampling, especially in the segment of colon with SEC.

Does Timing of Ileal Pouch-Anal Anastomosis Matter in Patients With Primary Sclerosing Cholangitis and Orthotopic Liver Transplantation? A Systematic Review and Meta-analysis.

Pouchitis is the most common complication in patients with ileal pouch-anal anastomosis (IPAA), which can develop in up to 66% of patients. There is limited data on the effect of orthoptic liver transplantation (OLT) on the risk of developing pouchitis. We aimed to objectively assess whether OLT itself significantly modifies the risk of developing pouchitis in patients with overlap PSC and inflammatory bowel disease (IBD). We searched Medline, Scopus, and Embase databases from inception through September 2023 for studies that describe the outcomes of IPAA in patients with PSC and IBD who also have a history of OLT. Pooled proportions, Odds Ratio (OR), and 95% confidence intervals (CI) for data were calculated utilizing a random effects model. Using the Freeman-Turkey double arcsine transformation (FTT) method, the pooled weight-adjusted estimate of event rates for clinical outcomes in each group was also calculated. Heterogeneity between studies was assessed using the Cochrane Q statistic (I2). Seven studies with a total of 291 patients with a history of PSC, IBD, and OLT were identified. The pooled overall risk of pouchitis in PSC/IBD patients with a history of OLT was 65% (95% CI: 0.57-0.72), with no heterogeneity observed in the analysis (I2 = 0%). In a subgroup analysis of patients who had IPAA followed by OLT, 3 studies with 28 patients were included; the pooled risk of pouchitis after IPAA and OLT was 83% (95% CI: 0.71-0.94; I2 = 0%), which was significantly higher (P < .001) than the OLT followed by IPAA group (59%; 95 CI: 0.48-0.71; I2 = 0%). There was no difference in the risk of pouchitis between OLT and non-OLT groups (OR = 1.36; 95% CI: 0.37-5.0). Our meta-analysis revelaed that pouchitis is common in patients who underwent OLT for PSC, especially in those who had IPAA before the OLT. OLT before IPAA may reduce the risk of pouchitis. Further largerstudies are warranted to reproduce this and investigate the reason behind this difference.

Mortality outcomes in early versus late onset colorectal cancer: A US National Inpatient Sample (NIS) analysis (2020).

e15651 Background: Colorectal Cancer (CRC) is the third most common cancer diagnosed in the United States and contributes to significant cancer-related morbidity and mortality. An upward trend in the incidence is noticed in the population below 50 years of age. For similar reasons, U.S. Preventive Services Task Force recommended screening at the age of 45 in 2021.For the sake of this study, we categorized early onset (EO) for age 45 and below, and late onset (LO) for above 45 years per new screening criteria. We compared socioeconomic characteristics, mortality, length of stay and hospital cost between EO and LO CRC. Methods: It is a retrospective cohort study of adult patients hospitalized in 2020 with Colorectal cancer in acute care hospitals across the USA. Patients were selected from the Nationwide Inpatient Sample (NIS) database. IRB approval was not obtained as de-identified data was utilized. Our study population included all patients with a discharge diagnosis of colorectal cancer as their primary diagnosis using the International Classification of the Diseases (ICD-10). The primary outcome was in-hospital mortality, secondary outcomes were length of hospital stay and total hospitalization charges. Analysis was performed using STATA version 18.0. Univariable and Multivariable logistic regression analysis were used to adjust for potential confounders. Results: There were 32 million discharges included in the NIS database in 2020, our study included 153809 with colorectal cancer which includes 12043 in EO and 141750 in LO CRC. Both population groups are mostly similar in terms of baseline characteristics, however EO group were more likely to have Hispanic population (18.7% vs 9.5%), history of inflammatory bowel disease (2.9% vs 1.2%), family history of CRC (6.4% vs 3.8%) and smoker (15.8% vs 12.8%). Multivariable analysis revealed that Age, Sex, Charlson Comorbidity Index, Family history, Smoking, and Median household income for patients were predictors of mortality. There was no statistically significant difference found in the adjusted mortality between the two groups (odds ratio 1.08, 95% CI 0.84-1.39). Lower length of stay was noticed in the EO group (odds ratio 0.48, 95% CI 0.07-0.89). Total deaths are lower in EO than LO group (0.04% vs 0.06%). Conclusions: There is no difference in mortality in early and late onset CRC in our study. However, EO CRC is associated with shorter length of stay in hospital. EO CRC disproportionately affects non-White patients, particularly Hispanic patients. [Table: see text]

Arterial structure and function in children with inflammatory bowel disease.

People with inflammatory bowel disease (IBD) have an increased risk of cardiovascular disease, including in younger adulthood. This may arise in part from chronic, systemic low-grade inflammation. The process of atherosclerosis may begin in childhood. We sought to determine whether pediatric IBD is associated with adverse changes in arterial structure and function as a marker of early increased cardiovascular risk. We performed a case-control study comparing children with IBD for a median disease duration of 2.49 (interquartile range 1.23, 4.38) years with healthy children. In a single visit, we collected baseline clinical and anthropometric data, and measured blood pressure, pulse wave velocity, carotid artery distensibility, and aortic and carotid intima-media thickness. High-sensitivity C-reactive protein and fasting lipids were measured. We enrolled 81 children with IBD (40 with Crohn's disease, 40 with ulcerative colitis, and 1 with unspecified IBD) and 82 control participants. After adjusting for age, sex, body mass index z-score, blood pressure, and low-density lipoprotein cholesterol, there was no difference in measures of arterial structure and function in children with IBD compared with controls, nor between those with Crohn's disease or ulcerative colitis. We did not show any differences in arterial structure and function in children with a history of IBD for less than 5 years compared with healthy controls. IBD diagnosed in childhood may provide a window of opportunity to actively reduce standard cardiovascular risk factors and improve future cardiovascular outcomes.

Magnetic Resonance Imaging Features Indicative of Permanent Colon Damage in Ulcerative Colitis: An Exploratory Study.

It is uncertain whether ulcerative colitis leads to accumulated bowel damage on cross-sectional image. We aimed to characterise bowel damage in patients with ulcerative colitis using magnetic resonance imaging [MRI], and to determine its relation with duration of disease and the impact on patients' quality of life. In this prospective study, patients with ulcerative colitis [UC] in endoscopic remission underwent MRI without bowel cleansing, and completed quality-of-life questionnaires. Participants' magnetic resonance findings were analysed considering normal values and thresholds determined in controls with no history of inflammatory bowel disease [n=40], and in patients with Crohn's disease with no history of colonic involvement [n = 12]. Subjects with UC were stratified according to disease duration [< 7 years vs 7‒14 years vs > 14 years]. We analysed 41 subjects with ulcerative colitis [20 women; Mayo endoscopic subscore 0 in 38 [92.7%] and 1 in three [7.3%]]. Paired segment-by-segment comparison of magnetic resonance findings in colonic segments documented as being affected by ulcerative colitis versus controls showed that patients with ulcerative colitis had decreased cross-sectional area [p ≤ 0.0034] and perimeter [p ≤ 0.0005] and increased wall thickness [p = 0.026] in all segments. Colon damage, defined as wall thickness ≥ 3 mm, was seen in 22 [53.7%] patients. Colon damage was not associated with disease duration or quality of life. Morphological abnormalities in the colon were highly prevalent in patients with ulcerative colitis in the absence of inflammation. Structural bowel damage was not associated with disease duration or quality of life.

Role of Healthy Lifestyle and Diet Quality in the Development of Colorectal Cancer in the Adult Population in the Kurdistan Region: A Case-Control Study.

Background The incidence of colorectal cancer (CRC) is increasing in developing countries. The factorscontributing to the risk of CRC are not known in developing countries. Therefore, this study aimed to explore the role of a healthy lifestyle on CRC in the adult population in the Kurdistan Region of Iraq. Methodology In this case-control investigation, patients previously diagnosed with CRC were included as cases (n = 84) and the healthy adult population as healthy controls (n = 87). The patients were selected from the Gastroenterology Unit of Azadi Teaching Hospital and Emergency Teaching Hospital. The healthy controls were selected from the caregivers of patients who met the eligibility criteria. Results Individuals with a history of chronic disease (63.08% vs. 40.52%; p = 0.0043), a history of hypertension (71.74% vs. 40.80%; p = 0.0003), and a history of inflammatory bowel disease (IBD) (59.42% vs. 42.16%; p = 0.0267) had a significantly higher prevalence of CRC compared to healthy controls. CRC patients had significantly lower diet quality scores than healthy controls (36.27 vs. 37.83; p = 0.0002). The study showed that CRC patients had a significantly lower lifestyle index score compared to healthy controls (10.20 vs. 11.69; p = 0.0002). In addition, CRC patients had lower scores for diet (0.42 vs. 1.00; p < 0.0001), smoking (2.92 vs. 4.0; p < 0.0001), and physical activity (1.02 vs. 1.70; p < 0.0001) compared to healthy controls. However, CRC patients and healthy controls had similar alcohol index scores (5.0 vs. 530; p = 1.000) and body mass index (1.04 vs. 1.01; p = 0.8982). Conclusions This study showed that CRC was associated with having a history of bad diet quality and unhealthy lifestyles. In addition, a history of chronic diseases, hypertension, and IBD was associated with the risk of CRC.

Association between dietary inflammation index and inflammatory bowel disease in adults: Results from National Health and Nutrition Examination Survey 2009-2010.

Previous study has demonstrated that the Dietary Inflammation Index (DII) played a role in the risk of inflammatory bowel disease (IBD), however, the prevalence and risk factors for IBD are distinct across locations and groups, and therefore, the findings are debatable and warrant further investigation. A total of 4363 participants were calculated in the National Health and Nutrition Examination Survey (NHANES) 2009 to 2010, of whom 1.21% self-reported a history of IBD. DII values were performed as a good predictor of dietary inflammation based on data from two 24-h dietary reviews in the NHANES database. Comparing the multifarious effects along with variations of the whole population by grouping populations according to DII quartiles, dietary inflammation levels increased progressively from DII quartile 1(Q1) to quartile 4(Q4). The association between DII and IBD was tested with multi-variable logistic regression models, subgroup analyses and weighted generalized additive models. Participants in the Q4 group showed the highest levels of C-reactive protein and reduced haemoglobin and albumin levels. Logistic regression confirmed the odds ratios (95% confidence intervals) of IBD for DII were 0.99 (0.86, 1.15), 0.97 (0.84, 1.13) and 0.80 (0.66, 0.98) in models 1, 2 and 3, respectively. The negative correlation between DII and IBD among United States adults from the NHANES database became increasingly apparent as covariates were adjusted. Subgroup analyses and smoothed curve fitting confirmed the inverse results. The study revealed that DII was correlated with the overall physical well-being of participants. However, there was no significant association between DII and IBD.

Reviewing the impact of obesity on inflammatory bowel disease and considerations for optimizing management.

This review examines the complex relationship between obesity and inflammatory bowel disease (IBD), encompassing their potentially shared pathogenesis, the impact of obesity on the natural history and treatment outcomes of IBD, and the management of obesity in the patient with IBD. Obesity represents a state of chronic inflammation that may not only contribute to IBD pathogenesis, but also influence disease progression, complications, and response to treatment. Increased visceral adiposity may carry negative prognostic implications for disease and treatment-specific outcomes. Antiobesity medications, endoscopic bariatric therapies, and even bariatric surgery may be effective and well tolerated in selected patients with IBD. The intersection of obesity and IBD presents a significant clinical challenge, with obesity influencing the natural history of IBD and potentially affecting treatment efficacy. As obesity prevalence among IBD patients rises, a tailored approach to management is crucial, taking into account the individualized risks and benefits of various treatment strategies, including lifestyle interventions, pharmacotherapy, endoscopic procedures, and bariatric surgery.

De Novo Inflammatory Bowel Disease after Liver Transplantation: Eleven Years' Experience in Shiraz, Iran

Background: Colon inflammation may occur after solid and liquid organ transplantations at a rate higher than in the general population. Objectives: This study aimed to investigate the incidence of de novo inflammatory bowel disease (IBD) and assess some risk factors after Orthotopic Liver Transplantation (OLT) in liver transplant patients in Shiraz, Iran. Methods: The sample study comprised patients (n = 1702) who had received liver transplants between 2001 and 2012 at the Shiraz liver transplant center. The data were obtained from patient records, which included information on their medical history, colonoscopy reports, family history of IBD, and other risk factors. The study evaluated the status of inflammatory bowel disease (IBD) among patients who had undergone liver transplantations due to Autoimmune Hepatitis (AIH) group, Primary Sclerosing Cholangitis (PSC), and other liver transplant patients. Additionally, case groups were formed, comprising AIH patients (n1 = 10) and other patients with IBD (n2 = 10), and were compared with transplant patients without IBD as the control group (n1 = 21, n2 = 21). Results: Out of the total 1702 patients, 254 (14.92%) had AIH, 211 (12.40%) had PSC, and 1237 (72.68%) had other outcomes. The mean of leukocyte counts (P-value = 0.73), types of immunosuppressant medications, and serum levels of cyclosporine (P-value = 0.77) and tacrolimus (P-value = 0.27) did not show any significant differences between the case and control groups. However, it was observed that IBD developed earlier in patients with AIH compared to other patients (20.1 ± 2.23 vs 53.9 ± 4.42 months). Conclusions: The incidence of IBD after liver transplantation was higher compared to the general population, and it occurred earlier in patients who underwent transplantation for AIH and other groups.

Nonconventional Dysplasia is Frequently Associated With Goblet Cell Deficient and Serrated Variants of Colonic Adenocarcinoma in Inflammatory Bowel Disease.

Various subtypes of nonconventional dysplasia have been recently described in inflammatory bowel disease (IBD). We hypothesized that goblet cell deficient dysplasia and serrated dysplasia may be the primary precursor lesions for goblet cell deficient (GCDAC) and serrated (SAC) variants of colonic adenocarcinoma, respectively. Clinicopathologic features of 23 GCDAC and 10 SAC colectomy cases were analyzed. All dysplastic lesions found adjacent to the colorectal cancers (n = 22 for GCDACs and n = 10 for SACs) were subtyped as conventional, nonconventional, or mixed-type dysplasia. As controls, 12 IBD colectomy cases with well to moderately differentiated adenocarcinoma that lacked any mucinous, signet ring cell, low-grade tubuloglandular, or serrated features while retaining goblet cells throughout the tumor (at least 50% of the tumor) were evaluated. The cohort consisted of 19 (58%) men and 14 (42%) women, with a mean age of 53 years and a long history of IBD (mean duration: 18 y). Twenty-seven (82%) patients had ulcerative colitis. GCDACs (57%) were more often flat or invisible than SACs (10%) and controls (25%; P = 0.023). The GCDAC and SAC groups were more likely to show lymphovascular invasion (GCDAC group: 52%, SAC group: 50%, control group: 0%, P = 0.001) and lymph node metastasis (GCDAC group: 39%, SAC group: 50%, control group: 0%, P = 0.009) than the control group. Notably, GCDACs and SACs were more frequently associated with nonconventional dysplasia than controls (GCDAC group: 77%, SAC group: 40%, control group: 0%, P < 0.001). Goblet cell deficient dysplasia (73%) was the most prevalent dysplastic subtype associated with GCDACs ( P = 0.049), whereas dysplasias featuring a serrated component (60%) were most often associated with SACs ( P = 0.001). The GCDAC group (75%) had a higher rate of macroscopically flat or invisible synchronous dysplasia compared with the SAC (20%) and control (33%) groups ( P = 0.045). Synchronous dysplasia demonstrated nonconventional dysplastic features more frequently in the GCDAC (69%) and SAC (40%) groups compared with the control group (0%; P = 0.016). In conclusion, goblet cell deficient dysplasia and dysplasias featuring a serrated component could potentially serve as high-risk markers for GCDACs and SACs, respectively.

The Natural History of Patients With Pre-Existing and De Novo Inflammatory Bowel Disease After Solid Organ Transplantation: EITOS Study of GETECCU.

Limited data are available on the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). We describe the natural history of pre-existing IBD and de novo IBD after SOT. This was a retrospective, multicenter study that included patients with pre-existing IBD at the time of SOT and patients with de novo IBD after SOT. The primary outcome was IBD progression, defined by escalation of medical treatment, surgical therapy, or hospitalization due to refractory IBD. Risk factors were identified using multivariate Cox proportional hazard analysis. A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) were included. Most patients with pre-existing IBD (92.5%) were in remission before SOT. During follow-up, 32% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 (interquartile range, 1.3-4.6) years. In the de novo cohort, 55% of patients had disease progression with a median time to flare of 1.9 (interquartile range, 0.8-3.9) years after diagnosis. In the pre-existing IBD cohort, active IBD at the time of SOT (hazard ratio, 1.80; 95% confidence interval, 1.14-2.84; P = .012) and the presence of extraintestinal manifestations (hazard ratio, 3.10; 95% confidence interval, 1.47-6.54; P = .003) were predictive factors for IBD progression. One-third of patients with pre-existing IBD and about half of patients with de novo IBD have disease progression after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for IBD progression.

Apremilast for the Treatment of Psoriasis in Special Areas in Pediatric Patients in the SPROUT Study

Introduction &amp; Objective: Psoriasis in special areas is difficult to treat and causes significant disease burden. Approved systemic therapies for moderate to severe plaque psoriasis in pediatric patients are limited and require subcutaneous injection. Apremilast, a unique oral immunomodulator that inhibits phosphodiesterase-4, is approved in multiple countries for use in adults with psoriasis, regardless of severity. In this study, the efficacy of apremilast for psoriasis in special areas in pediatric patients was assessed over 16 weeks. Materials &amp; Methods: SPROUT (NCT03701763) is a phase 3, randomized, double-blind, placebo-controlled study in patients 6-17 years with moderate to severe plaque psoriasis (Psoriasis Area and Severity Index ≥12, body surface area ≥10%, and static Physician Global Assessment [sPGA] ≥3) inadequately controlled by/inappropriate for topical therapy. Patients were stratified by age and randomized 2:1 to receive apremilast (weight-based 20 mg or 30 mg twice-a-day) or placebo for 16 weeks, then apremilast through week 52. Scalp Physician Global Assessment (ScPGA) response, modified sPGA of genitalia (sPGA-G) response, Whole Body Itch-Numeric Rating Scale (WBI-NRS) response, and change from baseline in Children’s Dermatology Life Quality Index (CDLQI) were assessed through week 16. Results: Of 245 randomized patients (apremilast: 163; placebo: 82), 101 (41.2%) were 6-11 years and 144 (58.8%) were 12-17 years; 120 (49.0%) patients weighed ≥20 to &lt;50 kg and 125 (51.0%) weighed ≥50 kg. At baseline, 81.0% of the patients treated with apremilast and 84.1% of patients treated with placebo had moderate to severe scalp psoriasis (ScPGA ≥3). Significantly more patients achieved ScPGA response at week 16 with apremilast vs placebo (36.4% vs 18.8%; P=0.0091). At baseline, 110 patients (44.9%; 45.4% apremilast and 43.9% placebo) had moderate to severe genital psoriasis (sPGA-G ≥3). Achievement of sPGA-G response at week 16 was numerically greater with apremilast vs placebo (39.2% vs 25.0%), although not significant, possibly due to small sample size (apremilast: n=74; placebo: n=36). Significantly more patients achieved WBI-NRS response at week 16 with apremilast vs placebo (52.0% vs 32.1%; P=0.0110). Greater improvements in CDLQI were seen at week 16 with apremilast vs placebo (least-squares mean change from baseline −5.1 vs −3.2; P=0.0009). Adverse events were consistent with the known apremilast safety profile. In 21 patients vaccinated during the study (including for COVID-19, influenza, diphtheria, pertussis, tetanus, meningococcus, and hepatitis B), no new safety issues occurred. Conclusions: Apremilast significantly improved scalp psoriasis, itch, and quality of life in pediatric patients with moderate to severe psoriasis. At week 16, patients with moderate to severe genital psoriasis showed a trend toward improvement, although not significant due partially to the sample size.