Treatment Of Inflammatory Bowel Disease Patients Research Articles

Medical radiation exposure in inflammatory bowel disease: an updated meta-analysis

BackgroundThere have been previous studies and earlier systematic review on the relationship between inflammatory bowel disease (IBD) and radiation exposure. With the diversification of current test methods, this study intended to conduct a meta-analysis to evaluate the IBD radiation exposure in recent years.MethodsThree databases (PUBMED, EMBASE, and MEDICINE) for relevant literature up to May 1, 2023 were searched. The statistical data meeting requirements were collated and extracted.Results20 papers were enrolled. The overall high radiation exposure rate was 15% (95% CI = [12%, 19%]) for CD and 5% (95% CI = [3%, 7%]) for UC. The pooled result found that high radiation exposure rate was 3.44 times higher in CD than in UC (OR = 3.44, 95% CI = [2.35, 5.02]). Moreover, the average radiation exposure level in CD was 12.77 mSv higher than that in UC (WMD = 12.77, 95% CI = [9.93, 15.62] mSv). Furthermore, radiation exposure level of CD after 2012 was higher than those before 2012 (26.42 ± 39.61vs. 23.76 ± 38.46 mSv, P = 0.016), while UC did not show similar result (11.99 ± 27.66 vs. 10.01 ± 30.76 mSv, P = 0.1). Through subgroup analysis, it was found that disease duration (WMD = 2.75, 95% CI = [0.10, 5.40] mSv), complications (OR = 5.09, 95% CI = [1.50, 17.29]), and surgical history (OR = 5.46, 95% CI = [1.51, 19.69]) significantly increased the proportion of high radiation exposure.ConclusionThis study found that radiation exposure level of IBD patients was high, which revealed the radiation risk in the process of diagnosis and treatment of IBD patients. In the future, longer follow-up and prospective studies are needed to reveal the relationship between high radiation exposure and solid tumorigenesis.

Immunogenicity and Loss of Effectiveness of Biologic Therapy for Inflammatory Bowel Disease Patients Due to Anti-Drug Antibody Development.

Many patients with inflammatory bowel disease (IBD) experience a loss of effectiveness to biologic therapy (i.e., anti-TNF therapy, etc.). Therefore, in addition to the adverse effects of the treatment, these patients also face failure to achieve and maintain remission. Immunogenicity, the process of production of antibodies to biological agents, is fundamental to the evolution of loss of response to treatment in IBD patients. The presence of these antibodies in patients is linked to decreased serum drug levels and inhibited biological activity. However, immunogenicity rates exhibit significant variability across inflammatory disease states, immunoassay formats, and time periods. In this review, we aimed to elucidate the immunogenicity and immune mechanisms of antibody formation to biologics, the loss of therapy response, clinical results of biological treatment for IBD from systematic reviews and meta-analyses, as well as to summarize the most recent strategies for overcoming immunogenicity and approaches for managing treatment failure in IBD.

Use of real-world data to assess the effectiveness of ustekinumab in treating IBD patients: a retrospective linked database study in northwest London

ABSTRACT Background Data on the optimum positioning of biologics in the treatment of inflammatory bowel disease (IBD) are limited. Research design and methods This was a longitudinal retrospective study of linked health-care data from northwest London, UK, for adults who started ustekinumab for IBD from 1 April 20161 April 2016 to 1 April 20211 April 2021. We compared outcomes by line of therapy (1 vs. 2 or 3+) and age group (18‒59 years or ≥ 60 years). In an analysis of CD patients, we calculated risks of IBD-related hospitalization, IBD-related abdominal surgery, ustekinumab persistence, and switching by line of therapy. Results Of 163 patients screened, 149 were eligible. Age had no effect on outcomes. Elective all-cause hospital admissions were significantly higher when ustekinumab was used as second-line or third-line therapy compared with first-line treatment (p = 0.0048 and p = 0.001, respectively). In CD patients the numbers of hospital admissions were also higher with second-line or third-line therapy (p = 0.040 and p = 0.018, respectively). Use of ustekinumab as third-line therapy significantly increased the risk of IBD-related hospitalization (hazard ratio 2.5, 95% CI 1.1‒5.6, p = 0.029), IBD-related abdominal surgery (9.45, 1.2‒75.7, p = 0.03), and switching (14.6, 1.6‒131.0, p = 0.02). Drug persistence risks did not differ. Conclusions These findings support the use of ustekinumab as first-line therapy.

Expression Analysis of Long Noncoding RNA-MALAT1 and Interleukin-6 in Inflammatory Bowel Disease Patients.

Inflammatory bowel disease (IBD) manifests as chronic inflammation within the gastrointestinal tract. The study focuses on a long noncoding RNA (lncRNA) known as Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1). MALAT1's misregulation has been linked with various autoimmune diseases and regulates proinflammatory cytokines. The role of IL6 in immune-triggered conditions, including IBD, is another focal point. In this research, the expression of MALAT1 and IL6 in IBD patients was meticulously analyzed to uncover potential interactions. The study involved 33 IBD patients (13 with Crohn's disease and 20 with ulcerative colitis) and 20 healthy counterparts. Quantitative real-time polymerase chain reaction determined the MALAT1 and IL6 gene expression levels. The competitive endogenous RNA (ceRNA) regulatory network was constructed using several tools, including LncRRIsearch and Cytoscape. A deep dive into the Inflammatory Bowel Disease database was undertaken to understand IL6's role in IBD. Drugs potentially targeting these genes were also pinpointed using DGIdb. Results indicated a notable elevation in the expression levels of MALAT1 and IL6 in IBD patients versus healthy controls. MALAT1 and IL6 did not show a direct linear correlation, but IL6could serve as MALAT1's target. Analyses unveiled interactions between MALAT1 and IL6, regulated by hsa-miR-202-3p, hsa-miR-1-3p, and has-miR-9-5p. IL6's pivotal role in IBD-associated inflammation, likely interacting with other cytokines, was accentuated. Moreover, potential drugs like CILOBRADINE for MALAT1 and SILTUXIMAB for IL6 were identified. This research underscored MALAT1 and IL6's potential value as targets in diagnosis and treatment for IBD patients.

A new face of old cells: An overview about the role of senescence and telomeres in inflammatory bowel diseases.

Cellular senescence is a pivotal factor contributing to aging and the pathophysiology of age-related diseases. Despite the presence of inflammation and abnormal immune system function in both inflammatory bowel diseases (IBD) and senescence, the relationship between the two remains largely unexplored. Therefore, our study aimed to investigate the intricate connection between cellular senescence, telomeres, and IBD. The review highlights the presence of senescence markers, particularly p16 and p21, in IBD patients, suggesting their potential association with disease progression and mucosal inflammation. We emphasize the critical role of macrophages in eliminating senescent cells and how disturbance in effective clearance may contribute to persistent senescence and inflammation in IBD. Additionally, we shed light on the involvement of telomeres in IBD, as their dysfunction impairs enterocyte function and disrupts colonic barrier integrity, potentially exacerbating the pathogenesis of the disease. Targeting senescence and telomere dysfunctions holds promise for the development of innovative therapeutic approaches to mitigate intestinal inflammation and alleviate symptoms in IBD patients. By unraveling the precise role of senescence in IBD, we can pave the way for the discovery of novel therapeutic interventions that effectively address the underlying mechanisms of intestinal inflammation, offering hope for improved management and treatment of IBD patients.

Lower magnitude and faster waning of antibody responses to SARS-CoV-2 vaccination in anti-TNF-α-treated IBD patients are linked to lack of activation and expansion of cTfh1 cells and impaired B memory cell formation

Patients with inflammatory bowel disease (IBD) and healthy controls received primary SARS-CoV-2-mRNA vaccination and a booster after six months. Anti-TNF-α-treated patients showed significantly lower antibody (Ab) levels and faster waning than α4β7-integrin-antagonist recipients and controls. This prospective cohort study aimed to elucidate the underlying mechanisms on the basis of circulating T-follicular helper cells (cTfh) and B memory cells. We measured SARS-CoV-2- Wuhan and Omicron specific Abs, B- and T-cell subsets at baseline and kinetics of Spike (S)-specific B memory cells along with distributions of activated cTfh subsets before and after primary and booster vaccination. Lower and faster waning of Ab levels in anti-TNF-α treated IBD patients was associated with low numbers of total and naïve B cells vs. expanded plasmablasts prior to vaccination. Along with their low Ab levels against Wuhan and Omicron VOCs, reduced S-specific B memory cells were identified after the 2nd dose which declined to non-detectable after 6 months. In contrast, IBD patients with α4β7-integrin-antagonists and controls mounted and retained high Ab levels after the 2nd dose, which was associated with a pronounced increase in S-specific B memory cells that were maintained or expanded up to 6 months. Booster vaccination led to a strong increase of Abs with neutralizing capacity and S-specific B memory cells in these groups, which was not the case in anti-TNF-α treated IBD patients. Of note, Ab levels and S-specific B memory cells in particular post-booster correlated with the activation of cTfh1 cells after primary vaccination. The reduced magnitude, persistence and neutralization capacity of SARS-CoV-2 specific Abs after vaccination in anti-TNF-α-treated IBD patients were associated with impaired formation and maintenance of S-specific B memory cells, likely due to absent cTfh1 activation leading to extra-follicular immune responses and diminished B memory cell diversification. These observations have implications for patient-tailored vaccination schedules/vaccines in anti-TNF-α-treated patients, irrespective of their underlying disease. The study was funded by third party funding of the Institute of Specific Prophylaxis and Tropical Medicine at the Medical University Vienna. The funders had no role in study design, data collection, data analyses, interpretation, or writing of report.

Diagnosis of inflammatory bowel disease-Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn's and Colitis meeting.

Inflammatory bowel disease (IBD) is no longer a rare disease in Asia, thus it needs to prepare recommendations relevant to Asian patients. This study aimed to identify disparities in the process of the diagnosis of IBD in Asian countries/regions. In line with the 2020 Asian Organization for Crohn's and Colitis annual meeting, a multinational web-based survey about Asian physicians' perspectives on IBD was conducted. A total of 384 Asian physicians (99 in China, 93 in Japan, 110 in Korea, and 82 in other Asian countries/regions) treating IBD patients from 24 countries/regions responded to the survey. Most respondents were gastroenterologists working in an academic teaching hospital. About half of them had more than 10 years of clinical experience in caring for patients with IBD. The European Crohn's Colitis Organisation guideline was used most commonly for the diagnosis of IBD except for Japanese physicians who preferred their own national guideline. The Mayo score and Crohn's Disease Activity Index were the most commonly used activity scoring systems for ulcerative colitis and Crohn's disease, respectively. Endoscopy, not surprisingly, was the main investigation in assessing the extent and activity of IBD. On the other hand, there were disparities across countries/regions with regard to the favored modalities of small bowel and perianal evaluation of Crohn's disease, as well as the use of serologic markers. Results of the present survey revealed practical behaviors of Asian physicians in the diagnosis of IBD. Investigating the reasons for different diagnostic approaches among countries/regions might help us develop Asian guidelines further.

Treatment of inflammatory bowel disease-Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn's and Colitis meeting.

As the characteristics of inflammatory bowel disease (IBD) differ between Asians and Westerners, it is necessary to determine adequate therapeutic strategy for Asian IBD patients. We evaluated the current treatment of IBD in Asian countries/regions using a web-based survey. The Korean Association for the Study of Intestinal Diseases conducted a multinational web-based survey for current IBD care in Asia between September 16, 2020, and November 13, 2020. A total of 384 doctors treating IBD patients from 24 Asian countries/regions responded to the survey. Anti-tumor necrosis factor (TNF) agents, anti-integrins, and anti-interleukin-12/23 agents were available for use by 93.8%, 72.1%, and 70.1% of respondents in Asian countries/regions. Compared with a previous survey performed in 2014, an increased tendency for treatment with biologics, including anti-TNF agents, was observed. In the treatment of corticosteroid-refractory acute severe ulcerative colitis, 72.1% of respondents chose anti-TNF agents, followed by tacrolimus (11.7%). In the treatment of corticosteroid-refractory Crohn's disease, 90.4% chose anti-TNF agents, followed by thiopurines (53.1%), anti-interleukin-12/23 agents (39.3%), and anti-integrin agents (35.7%). In the treatment of Crohn's disease patients refractory to anti-TNF agents, the most preferred strategy was to measure serum levels of anti-TNF and anti-drug antibodies (40.9%), followed by empiric dose escalation or shortening of dosing intervals (25.3%). Although there were some differences, treatment strategies for patients with IBD were mostly similar among Asian doctors. Based on the therapeutic outcomes, it is necessary to identify the most appropriate therapeutic strategy for Asian IBD patients.

Artificial Intelligence in Inflammatory Bowel Disease Endoscopy: Advanced Development and New Horizons.

Inflammatory bowel disease (IBD) is a complex chronic immune disease with two subtypes: Crohn's disease and ulcerative colitis. Considering the differences in pathogenesis, etiology, clinical presentation, and response to therapy among patients, gastroenterologists mainly rely on endoscopy to diagnose and treat IBD during clinical practice. However, as exemplified by the increasingly comprehensive ulcerative colitis endoscopic scoring system, the endoscopic diagnosis, evaluation, and treatment of IBD still rely on the subjective manipulation and judgment of endoscopists. In recent years, the use of artificial intelligence (AI) has grown substantially in various medical fields, and an increasing number of studies have investigated the use of this emerging technology in the field of gastroenterology. Clinical applications of AI have focused on IBD pathogenesis, etiology, diagnosis, and patient prognosis. Large-scale datasets offer tremendous utility in the development of novel tools to address the unmet clinical and practice needs for treating patients with IBD. However, significant differences among AI methodologies, datasets, and clinical findings limit the incorporation of AI technology into clinical practice. In this review, we discuss practical AI applications in the diagnosis of IBD via gastroenteroscopy and speculate regarding a future in which AI technology provides value for the diagnosis and treatment of IBD patients.

Adjunctive therapeutic effects of micronutrient supplementation in inflammatory bowel disease.

Growing evidence suggests that micronutrient status may have some impact on the course of inflammatory bowel disease (IBD). However, micronutrient deficiencies are easily overlooked during the treatment of IBD patients. There have been many studies on micronutrient supplementation, in which several clinical trials have been conducted targeting vitamin D and iron, but the current research is still preliminary for other vitamins and minerals. This review provides an overview of the adjunctive therapeutic effects of micronutrient supplementation in IBD, to summarize the available evidence, draw the attention of clinicians to micronutrient monitoring and supplementation in patients with IBD, and also provide some perspectives for future research directions.

THE BENEFICIAL ROLE OF PROBIOTIC AKKERMANSIA MUCINIPHILA IN INFLAMMATORY BOWEL DISEASE

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, is a chronic relapsing gastrointestinal inflammatory disease mediated by dysregulated immune responses to resident intestinal microbiota. Current conventional approaches including aminosalicylates, corticosteroids, immunosuppressive agents, and biological therapies are focused on reducing intestinal inflammation besides inducing and maintaining disease remission, and managing complications. However, these therapies are not curative and are associated with various limitations, such as drug resistance, low responsiveness and adverse events. Recent accumulated evidence has revealed the involvement of mucin-degrading bacterium Akkermansia muciniphila (A. muciniphila) in the regulation of host barrier function and immune response. Although the role of commensal A. muciniphila in IBD is controversial and needs further investigations, most clinical and experimental results still support the protective effect of A. muciniphila in the process and development of intestinal inflammation. Therefore, A. muciniphila-targeted and -based therapies is now considered a valuable therapeutic approach to treat IBD patients. However, how to selectively enrich the growth and colonization of A. muciniphila in the host intestine with direct or indirect interventions have not been clarified. This review reveals an interesting phenomenon that not only viable A. muciniphila, but pasteurised A. muciniphila, and its ingredients such as AmEVs, Amuc_1100 and P9 also can alleviate intestinal inflammation, suggesting a therapeutic potential of A. muciniphila in the treatment of IBD. More importantly, because of the natural characteristics individual strains grow, we believe that it is more promising weapon for the treatment of IBD to improve the intestinal microenvironment of A. muciniphila than to simply increase the number of individual bacteria itself. Therefore, it has become a research hotspot in recent years to improve intestinal microenvironment and indirectly promote the colonization of A. muciniphila through the supplementation of other probiotic or prebiotics, natural diets, drugs, and herbs, and achieved good progress, holds promise for A. muciniphila-targeted and -based therapies in the treatment of IBD.

Effect of inflammatory bowel diseases on household chores.

More than a half of inflammatory bowel disease (IBD) patients experienced a moderate negative effect on their household chores due to their IBD. The negative effect was more common amongst women.

P340 Issues on implementing treat-to-target approach in Asia Pacific, Middle East and Africa: Reality, gaps, and way forward -APMA IBD Coalition

Abstract Background To understand the real-world issues and difficulties in implementing treat-to-target (T2T) approach in managing inflammatory bowel disease (IBD) patients in the Asia Pacific, Middle East and Africa (APMA) region. Methods A structured survey of 10 questions was sent to 19 IBD specialists from 14 economies/countries in the APMA region between June and August 2022, followed by three hybrid roundtable discussions to identify, elaborate and validate the gaps and challenges in T2T adoption in their healthcare setting. The survey used a series of questions exploring experts’ current practice and preference of treatment endpoints, diagnostic and monitoring tools, and major desirable improvement if resources are not constrained. Results The two major gaps expressed by of IBD specialists in the APMA region are to early diagnose and treat IBD patients (61.1%), and the lack of trained IBD nurses (50%) (Figure 1.The major gaps in the diagnosis and monitoring of IBD in routine clinical practice in APMA). While T2T approach is widely accepted among IBD specialists across the APMA region, blood tests (such as CRP, ESR) and faecal calprotectin (FC) test are two commonly used modalities by 77.8% and 72,2% IBD specialists, respectively However, the availability and cost of FC test is the second leading challenge (55.6%) faced by these specialists, with patient compliance being the most challenging (66.7%)(Figure 2.The biggest challenges in monitoring IBD patients in APMA). As to the most desired IBD monitoring tool, 88.9% considered the application of validated and reproducible intestinal ultrasound (Figure 3.Most desired IBD monitoring tool in APMA if resources are not a problem). The availability of trained IBD nurse (39%) and increasing awareness and training of general practitioner (33%) are the two most important factors that IBD specialists considered to improve care of IBD patients in the region (Figure 4.Major improvements required in diagnosis to improve IBD patient care in APMA). Conclusion Considerable gaps in implementing T2T approach to managing IBD patients in the APMA region are identified via this survey by IBD specialists. Lack of training of general practitioners, IBD nurses and availability of affordable FC are common issues identified in this region, which would deserve implementation of new educational initiatives and resources reallocation.

Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care.

Highly connected individuals disseminate information effectively within their social network. To apply this concept to inflammatory bowel disease (IBD) care and lay the foundation for network interventions to disseminate high-quality treatment, we assessed the need for improving the IBD practices of highly connected clinicians. We aimed to examine whether highly connected clinicians who treat IBD patients were more likely to provide high-quality treatment than less connected clinicians. We used network analysis to examine connections among clinicians who shared patients with IBD in the Veterans Health Administration between 2015-2018. We created a network comprised of clinicians connected by shared patients. We quantified clinician connections using degree centrality (number of clinicians with whom a clinician shares patients), closeness centrality (reach via shared contacts to other clinicians), and betweenness centrality (degree to which a clinician connects clinicians not otherwise connected). Using weighted linear regression, we examined associations between each measure of connection and two IBD quality indicators: low prolonged steroids use, and high steroid-sparing therapy use. We identified 62,971 patients with IBD and linked them to 1,655 gastroenterologists and 7,852 primary care providers. Clinicians with more connections (degree) were more likely to exhibit high-quality treatment (less prolonged steroids beta -0.0268, 95%CI -0.0427, -0.0110, more steroid-sparing therapy beta 0.0967, 95%CI 0.0128, 0.1805). Clinicians who connect otherwise unconnected clinicians (betweenness) displayed more prolonged steroids use (beta 0.0003, 95%CI 0.0001, 0.0006). The presence of variation is more relevant than its magnitude. Clinicians with a high number of connections provided more high-quality IBD treatments than less connected clinicians, and may be well-positioned for interventions to disseminate high-quality IBD care. However, clinicians who connect clinicians who are otherwise unconnected are more likely to display low-quality IBD treatment. Efforts to improve their quality are needed prior to leveraging their position to disseminate high-quality care.

S877 Smoking Adversely Impacts Therapeutic Response to Treatment in IBD Patients

Introduction: Smoking is associated with a reduced ability to induce short-term clinical response and remission in Crohn’s patients using biologics. Few studies have investigated the impact of smoking on therapeutic response of Inflammatory Bowel Disease (IBD) treatments using biologics only, but none have considered impact of smoking using biologics, immunomodulators or both. The aim of this study is to assess the utility of C-Reactive Protein (CRP)/albumin ratio in measuring treatment response in all IBD patients in relation to smoking status. Methods: Retrospective analysis was performed on adults ( >18 years old) with an ICD-9/10 code diagnosis of Crohn’s or UC disease during their index hospitalization for IBD flare to a tertiary care center between January 1st 2013 to June 1st 2017. Non-consented patients were excluded. Treatment during index hospitalization was documented as either using biologics, immunomodulators or both. Inflammation status to measure treatment response was assessed using CRP /albumin ratio. Smoking status was defined as ever or never smoker. Results: Out of 1101 IBD patients, 418 patients had a documented smoking status and a calculable CRP/Albumin ratio; 168 (40.2%) were ever smokers and 250 (59.8%) were never smokers. Among never-smoker IBD, Crohn’s and UC patients, those who received biologics, immunomodulators or both had a lower mean CRP/Albumin ratio than those who did not (Table). Never-smoker IBD and UC patients who used biologics, had statistically significant lower mean CRP/Albumin ratio than those who did not, (p=0.010 and p=0.006, respectively). Among majority of ever-smoker IBD, Crohn’s and UC patients, those who received biologics, immunomodulators or both had a higher mean CRP/Albumin ratio than those who did not (Table). Ever-smoker IBD and UC patients who used immunomodulators and biologics, had statistically significant higher mean CRP/Albumin ratio than those who did not, (p=0.026 and p=0.041, respectively). Conclusion: Smoking is associated with worsening therapeutic response to treatments in all IBD, Crohn’s and UC patients, with an amplified effect when both immunomodulators and biologics are used. On the other hand, regardless of type of therapy received, never-smokers have an improved response to treatment in all IBD, Crohn’s and UC patients. Further investigation is warranted to understand the interaction of smoking with IBD treatment at the biochemical level in the light of disease progression. Table 1. - Treatment Response in IBD Patients who are Ever vs. Never Smokers using CRP/Albumin Ratio as an Indicator All IBDN(mean) P-value Crohn'sN(mean) P-value Ulcerative ColitisN(mean) P-value Treatments Never Smokers 119 (14.41) 102 (14.5) 16 (14.3) Biologics 66 (23.7) 0.010 28 (31.9) 0.006 37 (18.1) 0.56 No Biologics 105 (17.30) 75 (17.8) 28 (17.0) Immunomodulators 80 (18.29) 0.78 55 (18.9) 0.79 25 (16.8) 0.97 No Immunomodulators 73(14.97) 61 (15.4) 11 (13.4) Both 112(19.53) 0.20 69(20.8) 0.21 42 (17.9) 0.54 None Ever Smokers Biologics No Biologics Immunomodulators No Immunomodulators Both None Number of patients (N) and their affiliated mean CRP/Albumin ratios (mean) and p-values are reported above. Biologics were defined as infliximab, adalimumab, golimumab, vedolizumab, natalizumab, certolizumab, ustekinumab or tofacitinib. Immunomodulators were defined as azathioprine, methotrexate, tacrolimus, 6-mercaptopurine, mesalamine or sulfasalazine.

Impact of Obesity on the Course of Management of Inflammatory Bowel Disease-A Review.

It is already well-known that visceral adipose tissue is inseparably related to the pathogenesis, activity, and general outcome of inflammatory bowel disease (IBD). We are getting closer and closer to the molecular background of this loop, finding certain relationships between activated mesenteric tissue and inflammation within the lumen of the gastrointestinal tract. Recently, relatively new data have been uncovered, indicating a direct impact of body fat on the pattern of pharmacological treatment in the course of IBD. On the other hand, ileal and colonic types of Crohn’s disease and ulcerative colitis appear to be more diversified than it was thought in the past. However, the question arises whether at this stage we are able to translate this knowledge into the practical management of IBD patients or we are still exploring the scientific background of this pathology, having no specific tools to be used directly in patients. Our review explores IBD in the context of obesity and associated disorders, focusing on adipokines, creeping fat, and possible relationships between these disorders and the treatment of IBD patients.

Utilization of Colonoscopy Following Treatment Initiation in U.S. Commercially Insured Patients With Inflammatory Bowel Disease, 2013-2019.

Evaluation of mucosal healing with colonoscopy is recommended for inflammatory bowel disease (IBD) management; however, little is known about real-world use of treat-to-target monitoring following IBD treatment initiation. We aimed to estimate the proportion of U.S. commercially insured IBD patients who receive colonoscopy in the 3 to 15 months after initiating treatment. We identified IBD patients, 18 to 64 years of age, in the IBM MarketScan Commercial Claims and Encounters database as those with ≥3 IBD diagnoses prior to initiation of biologic, small molecule, or immunomodulatory treatment. We excluded patients with prior colectomy and with rheumatologic and other indications for these therapies. Colonoscopies were identified using International Classification of Diseases-Ninth Revision, International Classification of Diseases-Tenth Revision, and Current Procedural Terminology procedure codes. We used Kaplan-Meier methods to estimate the proportion of newly treated IBD patients who received colonoscopy in the 3 to 6 months, 3 to 12 months, and 3 to 15 months following treatment initiation, and stratified trends by year, patient age and sex, and region. From 2013 to 2019, we identified 39 734 initiators of IBD medications (51.9% female, mean age 39.4 years). We observed similar colonoscopy incidence among ulcerative colitis patients (3-6 months: 14.2% [95% confidence interval (CI), 13.6%-14.8%]; 3-12 months: 37.7% [95% CI, 36.8%-38.6%]; 3-15 months: 46.1% [95% CI, 45.2%-47.1%]) and Crohn's disease patients (3-6 months: 11.2% [95% CI, 10.8%-11.6%]; 3-12 months: 32.2% [95% CI, 31.5%-32.9%]; 3-15 months: CD: 40.1% [95% CI, 39.3%-40.8%]). Overall colonoscopy use was slightly higher among women, patients in the Northeast, and those initiating newer biologic therapies. Fewer than half of newly treated IBD patients underwent colonoscopy within 3 to 15 months of initiating new treatment, suggesting low uptake of treat-to-target endoscopic disease monitoring in real-world practice.

Review and Analysis of German Mobile Apps for Inflammatory Bowel Disease Management Using the Mobile Application Rating Scale: Systematic Search in App Stores and Content Analysis.

BackgroundPatients suffering from inflammatory bowel disease (IBD) frequently need long-term medical treatment. Mobile apps promise to complement and improve IBD management, but so far there has been no scientific analysis of their quality.ObjectiveThis study evaluated the quality of German mobile apps targeting IBD patients and physicians treating IBD patients using the Mobile Application Rating Scale (MARS).MethodsThe German Apple App Store and Google Play Store were systematically searched to identify German IBD mobile apps for patient and physician use. MARS was used by 6 physicians (3 using Android smartphones and 3 using iPhones) to independently assess app quality. Apps were randomly assigned so that the 4 apps with the most downloads were rated by all raters and the remaining apps were rated by 1 Android and 1 iOS user.ResultsIn total, we identified 1764 apps in the Apple App Store and Google Play Store. After removing apps that were not related to IBD (n=1386) or not available in German (n=317), 61 apps remained. After removing duplicates (n=3) and apps for congresses (n=7), journals (n=4), and clinical studies (n=6), as well as excluding apps that were available in only 1 of the 2 app stores (n=20) and apps that could only be used with an additional device (n=7), we included a total of 14 apps. The app “CED Dokumentation und Tipps” had the highest overall median MARS score at 4.11/5. On the whole, the median MARS scores of the 14 apps ranged between 2.38/5 and 4.11/5. As there was no significant difference between iPhone and Android raters, we used the Wilcoxon comparison test to calculate P values.ConclusionsThe MARS ratings showed that the quality of German IBD apps varied. We also discovered a discrepancy between app store ratings and MARS ratings, highlighting the difficulty of assessing perceived app quality. Despite promising results from international studies, there is little evidence for the clinical benefits of German IBD apps. Clinical studies and patient inclusion in the app development process are needed to effectively implement mobile apps in routine care.

Caspase-8 in endothelial cells maintains gut homeostasis and prevents small bowel inflammation in mice.

The gut has a specific vascular barrier that controls trafficking of antigens and microbiota into the bloodstream. However, the molecular mechanisms regulating the maintenance of this vascular barrier remain elusive. Here, we identified Caspase‐8 as a pro‐survival factor in mature intestinal endothelial cells that is required to actively maintain vascular homeostasis in the small intestine in an organ‐specific manner. In particular, we find that deletion of Caspase‐8 in endothelial cells results in small intestinal hemorrhages and bowel inflammation, while all other organs remained unaffected. We also show that Caspase‐8 seems to be particularly needed in lymphatic endothelial cells to maintain gut homeostasis. Our work demonstrates that endothelial cell dysfunction, leading to the breakdown of the gut‐vascular barrier, is an active driver of chronic small intestinal inflammation, highlighting the role of the intestinal vasculature as a safeguard of organ function.

Weight and BMI Patterns in a Biologicals-Treated IBD Cohort

BackgroundBiologic therapies are effective at inducing and maintaining remission in people with inflammatory bowel disease (IBD). Previous studies have associated TNF-a inhibitors with weight gain, however, it is unclear if this is a class-specific effect or a manifestation of good disease control. To clarify this issue, a retrospective study was undertaken to examine weight changes over time during therapy with different biologic agents.MethodsAdult patients with IBD who received any biological therapy for at least 12 months, between 2008 and 2020, were identified at two specialised IBD services. Demographic, disease, and therapy-related data were examined.Weight change and patterns thereof were examined for each specific therapy and relationships amongst weight outcomes and various predictive factors explored.ResultsOf 294 patients (156 females), 165 received Infliximab (IFX), 68 Adalimumab (ADA), 36 Vedolizumab (VDZ) and 25 Ustekinumab (UST). There was a statistically significant weight gain over time in the IFX and VDZ groups and more weight gain in the IFX vs ADA and VDZ vs ADA at most time points.Three weight trajectories were identified: around 95% of patients had small weight loss or a modest weight gain but 5% of patients, most of whom were on IFX had marked weight gain (24.3 kg). Having a baseline high BMI, being female, having an initiation CRP ≤ 5 or albumin > 35 reduced the odds of major weight gain.ConclusionWeight gain in biologic treated IBD patients appears to be associated with clinical factors (male gender, high CRP, low albumin) and therapy-specific factors.