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The ACE (Albumin, CRP and Endoscopy) Index in Acute Colitis: A Simple Clinical Index on Admission that Predicts Outcome in Patients With Acute Ulcerative Colitis
Rebecca K Grant, MSc, Gareth-Rhys Jones, PhD, Nikolas Plevris, MRCP, Ruairi W Lynch, PhD, Philip W Jenkinson, MRCS
doi : 10.1093/ibd/izaa088
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 451–457
Intravenous (IV) steroids remain the first-line treatment for patients with acute ulcerative colitis (UC). However, 30% of patients do not respond to steroids, requiring second-line therapy and/or surgery. There are no existing indices that allow physicians to predict steroid nonresponse at admission. We aimed to determine if admission biochemical and endoscopic values could predict response to IV steroids.
TRIM21 Is Decreased in Colitis-associated Cancer and Negatively Regulates Epithelial Carcinogenesis
Guangxi Zhou, MD, PhD, Huili Wu, MD, Jian Lin, PhD, Ritian Lin, PhD, Baisui Feng, MD, PhD
doi : 10.1093/ibd/izaa229
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 458–468
Tripartite motif-containing (TRIM)21 is reported to be associated with the regulation of immune response in gut mucosa. Here we studied the underlying mechanisms of TRIM21 in the pathogenesis of colitis-associated cancer (CAC).
Phenotype and Natural History of Inflammatory Bowel Disease in Patients With Concomitant Eosinophilic Esophagitis
Michael J Mintz, MD, Ashwin N Ananthakrishnan, MD, MPH
doi : 10.1093/ibd/izaa094
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 469–475
The co-occurrence of autoimmune diseases is well recognized. Though studies have suggested that eosinophilic esophagitis (EoE) is more common in patients with inflammatory bowel diseases (IBD), whether co-occurrence of EoE modifies natural history of IBD is unknown.
Characteristics and Long-Term Outcomes of Pregnancy-Onset Inflammatory Bowel Disease: A Case-Control Study
Amy Yu, MD, Sonia Friedman, MD, Ashwin N Ananthakrishnan, MD, MPH
doi : 10.1093/ibd/izaa096
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 476–481
Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Although the impact of pregnancy in patients with established IBD has been widely studied, the characteristics and outcomes of patients who develop a new diagnosis of IBD during pregnancy or the postpartum year (“pregnancy-onset”) is not well characterized.
Effect of a Practice-wide Anti-TNF Proactive Therapeutic Drug Monitoring Program on Outcomes in Pediatric Patients with Inflammatory Bowel Disease
John L Lyles, MD, Aditi A Mulgund, MD, Laura E Bauman, MD, Weizhe Su, MS, Lin Fei, PhD
doi : 10.1093/ibd/izaa102
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 482–492
Reports on the feasibility and effectiveness of translating proactive, antitumor necrosis factor (TNF) therapeutic drug monitoring (TDM) for inflammatory bowel disease into practice-wide quality improvement (QI) are lacking. We aimed to determine whether a TDM QI program improved outcomes at a large academic pediatric gastroenterology practice.
Total Abdominal Colectomies With Proctectomy Are Associated With Higher 30-Day Readmission Rates in Children With Ulcerative Colitis
Matthew D Egberg, MD, MPH, MMSc, Michael Phillips, MD, Joseph A Galanko, PhD, Michael Kappelman, MD, MPH
doi : 10.1093/ibd/izaa099
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 493–499
Hospital readmissions are a burden on patients and families and place financial strain on the health care system. Thirty-day readmission rates for adult patients undergoing colectomy are as high as 30%, and inflammatory bowel disease is a risk factor for readmission. We used a multicenter pediatric surgical database to determine the 30-day readmission rate for pediatric patients with ulcerative colitis (UC) undergoing total abdominal colectomy (TAC) and to identify risk factors for 30-day hospital readmission.
Preadmission Cannabis Use Is Positively Correlated With Inpatient Opioid Dose Exposure in Hospitalized Patients With Inflammatory Bowel Diseases
Rahul S Dalal, MD, Sonali Palchaudhuri, MD, Christopher K Snider, MPH, James D Lewis, MD, MSCE, Shivan J Mehta, MD, MBA, MSHP
doi : 10.1093/ibd/izaa104
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 500–506
Opioid use is associated with excess mortality in patients with inflammatory bowel disease (IBD). Recent data have highlighted that inpatient opioid exposure is associated with postdischarge opioid use in this population. It is unknown if preadmission use of cannabis, which is commonly used for symptom relief among patients with IBD, increases the risk for inpatient opioid exposure when patients lack access to cannabis for symptom management. We sought to determine the association between preadmission cannabis use and inpatient opioid exposure while adjusting for relevant confounders.
Favorable Outcomes and Anti-TNF Durability After Addition of an Immunomodulator for Anti-Drug Antibodies in Pediatric IBD Patients
Ruben J Colman, MD, Andrea Portocarrero-Castillo, MD, Deepika Chona, MD, Jennifer Hellmann, MD, Phillip Minar, MD, MS
doi : 10.1093/ibd/izaa108
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 507–515
Anti-drug antibodies (ADAs) to anti-tumor necrosis factor alpha (anti-TNF) drugs are associated with increased drug clearance and loss of response. We aimed to assess the effectiveness of starting an immunomodulator (IM) drug in patients with newly detected ADAs on anti-TNF monotherapy.
Trends of 5-Aminosalicylate Medication Use in Patients With Crohn Disease
Mohamed Noureldin, MBBS, MS, Shirley Cohen-Mekelburg, MD, MS, Asadullah Mahmood, MBBS, Ryan Stidham, MD, MSc, Peter D R Higgins, MD, PhD
doi : 10.1093/ibd/izaa127
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 516–521
5-aminosalicylate (5-ASA) medications have a long history of use for the treatment of inflammatory bowel disease and continue to be widely prescribed today. The effectiveness of 5-ASAs in ulcerative colitis is clear; however, studies have shown little benefit for induction or maintenance treatment of Crohn disease (CD). We aimed to quantify usage and examine trends in 5-ASA prescription rates in patients with CD.
Status of Gene Methylation and Polymorphism in Different Courses of Ulcerative Colitis and Their Comparison with Sporadic Colorectal Cancer
Chen Liu, MD, Zi-Ying Yuan, PhD, Hao Yuan, MD, Ke-Xiang Wu, MD, Bin Cao, MD
doi : 10.1093/ibd/izaa203
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 522–529
The objective of this study is to explore the common genetic and epigenetic mechanism of ulcerative colitis (UC) and sporadic colorectal cancer (SCRC) by observing genes methylation level and single nucleotide polymorphisms (SNPs) of different disease courses in UC and SCRC.
90-Day Specific Readmission for Clostridium difficile Infection After Hospitalization With an Inflammatory Bowel Disease Flare: Outcomes and Risk Factors
Pedro Palacios Argueta, MD, Miguel Salazar, MD, Bashar Attar, MD, Roberto Simons-Linares, MD, MSc, Bo Shen, MD
doi : 10.1093/ibd/izaa224
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 530–537
Patients with inflammatory bowel disease (IBD) have an increased risk for Clostridium difficile infection (CDI) and carry significantly higher morbidities and mortality than those without IBD. We aimed to investigate disease-specific readmission rates and independent risk factors for CDI within 90 days of an index hospitalization for an IBD flare.
Contribution of CD3+CD8- and CD3+CD8+ T Cells to TNF-? Overexpression in Crohn Disease–Associated Perianal Fistulas and Induction of Epithelial-Mesenchymal Transition in HT-29 Cells
Ramona S Bruckner, PhD, Marianne R Spalinger, PhD, Marieke C Barnhoorn, MD, Roger Feakins, MD, Alois Fuerst, MD
doi : 10.1093/ibd/izaa240
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 538–549
Fistulas represent a frequent and severe complication in patients with Crohn disease (CD). Tumor necrosis factor-alpha (TNF-?), transforming growth factor-beta, and interleukin (IL)-13 are known to trigger epithelial-mesenchymal transition (EMT), promoting fistula formation. Here, we investigated the role of T-lymphocytes (T cells) in fistula pathogenesis.
The Risk of Adverse Neonatal Outcomes With Maternal Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
Kristel K Leung, MD, Parul Tandon, DO, FRCPC, Vivek Govardhanam, MD, Cynthia Maxwell, MD, FRCSC, Vivian Huang, MSc, MD, FRCPC
doi : 10.1093/ibd/izaa122
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 550–562
Patients with inflammatory bowel disease (IBD) may be at increased risk of adverse neonatal outcomes. The aim of this study was to determine pooled incidences and risk factors for these outcomes.
Respiratory Tract Manifestations of Inflammatory Bowel Disease
Paul T Kr?ner, MD, MSc, Augustine Lee, MD, MSc, Francis A Farraye, MD, MSc
doi : 10.1093/ibd/izaa112
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 563–574
Inflammatory bowel disease can manifest in many extraintestinal organ systems. The most frequently involved extraintestinal locations include the mucocutaneous, hepatobiliary, and ocular organ systems. The respiratory tract is less commonly involved and is therefore frequently overlooked. Consequently, it is believed that involvement of the respiratory tract in patients with inflammatory bowel disease is underreported. The pathogenesis is thought to be multifactorial, involving the common embryologic origin shared by the respiratory and luminal digestive tract, molecular mimicry, and immunologic interactions leading to immune-complex deposition in affected tissue. The spectrum of manifestations of the respiratory tract related to inflammatory bowel disease is broad. It not only includes direct involvement of the respiratory tract (ie, airways, interstitium, and pleura) but also can result as a consequence of systemic involvement such as in thromboembolic events. In addition, it may also be related to other conditions that affect the respiratory tract such as sarcoidosis and alpha-1 antitrypsin deficiency. Though some conditions related to respiratory tract involvement might be subclinical, others may have life-threatening consequences. It is critical to approach patients with suspected inflammatory bowel disease–related respiratory tract involvement in concert with pulmonology, infectious diseases, and any other pertinent experts, as treatments may require a multidisciplinary overlap of measures. Therefore, it is of paramount importance for the clinician to be aware of the array of respiratory tract manifestations of patients with inflammatory bowel disease, in addition to the possible spectrum of therapeutic measures.
Slc26a3 (DRA) in the Gut: Expression, Function, Regulation, Role in Infectious Diarrhea and Inflammatory Bowel Disease
Qin Yu, MD
doi : 10.1093/ibd/izaa256
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 575–584
The transport of transepithelial Cl- and HCO3- is crucial for the function of the intestinal epithelium and maintains the acid-based homeostasis. Slc26a3 (DRA), as a key chloride-bicarbonate exchanger protein in the intestinal epithelial luminal membrane, participates in the electroneutral NaCl absorption of intestine, together with Na+/H+ exchangers. Increasing recent evidence supports the essential role of decreased DRA function or expression in infectious diarrhea and inflammatory bowel disease (IBD).
Characteristics and Outcomes of IBD Patients with COVID-19 on Tofacitinib Therapy in the SECURE-IBD Registry
Manasi Agrawal, MD, Erica J Brenner, MD, Xian Zhang, PhD, Irene Modesto, MD, PhD, John Woolcott, PhD
doi : 10.1093/ibd/izaa303
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 585–589
The coronavirus disease 2019 (COVID-19) pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to unprecedented loss of life and health on a global scale.1 COVID-19 outcomes are more severe among those with comorbid conditions,1 which raises concerns for patients with inflammatory bowel disease (IBD), especially given the increased infection risk with immunosuppression used for IBD therapy.
Time to Negative SARS-CoV-2 PCR Should Not Delay Care Among Patients With Inflammatory Bowel Diseases
Rachel W Winter, MD, MPH, Ashwin Ananthakrishnan, MD, MPH, Kristin E Burke, MD, MPH, Bharati Kochar, MD, MSCR, Walter W Chan, MD, MPH
doi : 10.1093/ibd/izab023
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages 590–592
The outbreak of SARS-CoV-2 has resulted in a pandemic affecting millions of individuals. The virus causes a clinical presentation varying from no symptoms to multiorgan failure and death.1, 2 There was initial concern that patients with inflammatory bowel diseases (IBD), including Crohn disease (CD) and ulcerative colitis (UC), would have increased risk for infection and severe outcomes given that treatment often involves immunosuppressants, which increase the risk of various infections
Completing the Picture in Egypt: Response to “Inflammatory Bowel Diseases in Egypt During the COVID-19 Pandemic”
Mohammed Khorshid, MBBcH, MSc, FASGE, Mohamed AbdAllah, MD
doi : 10.1093/ibd/izaa355
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Page e39
We read with great interest the editorial entitled “Inflammatory Bowel Diseases in Egypt During the COVID-19 Pandemic.” It emphasized the challenges that we have encountered to follow up with patients with inflammatory bowel disease (IBD) during the pandemic. Using telemedicine to follow up with patients is challenging. Most IBD centers did not initially have the experience to apply remote medicine in real practice.1 Fortunately, our expertise in managing IBD during the pandemic has been promising2 and preferred by most patients over the traditional model of care.
Autoimmune Encephalitis During Treatment With Adalimumab: A Case Report in Crohn’s Disease
Paula Fern?ndez Alvarez, MD, Belén Maldonado Pérez, PhD, Luisa Castro Laria, MD, Federico Argüelles-Arias, PhD
doi : 10.1093/ibd/izaa302
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages e40–e41
Biological therapy has changed the course of inflammatory bowel disease. Neurological manifestations derived directly from the treatment are uncommon, and it is difficult to establish a clear causal relationship.
Ileum Perforation in Crohn’s Disease Patient During SARS-Cov-2 Infection
Genoile Oliveira Santana, PhD, Andréa Can?rio de Santana, MS, Vanessa Barto Pfeilsticker, MS
doi : 10.1093/ibd/izaa319
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Page e42
Gastrointestinal and liver manifestations are described in approximately 15% of patients with coronavirus disease 2019 (COVID-19), and digestive comorbidities are reported in 4% of such patients.1 To the best of our knowledge, only 1 case of small bowel perforation in a Crohn’s disease (CD) patient infected by SARS-CoV-2 has been described.2 We report a case of a CD patient in the remission phase who presented with a small bowel perforation during SARS-CoV-2 infection.
More Epidemiological Studies Warranted to Determine the Cause of Inflammatory Bowel Disease
Xiaofa Qin, MD, PhD
doi : 10.1093/ibd/izaa329
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages e43–e44
I read with great interest the paper by Barash et al1 published recently in this journal with comprehensive analyses of the trends and topics of publications on inflammatory bowel disease (IBD) during the last 25 years. When analyzing the top 100 most cited articles, the article showed a dramatic increase in publications related to genetics from 0% in 1992 to 13% in 2016, but a decrease in publications on epidemiology from 12% in 1992 to 2% in 2016. This trend reflects a big problem of fashion-chasing rather than problem-solving in IBD research, as discussed in previous research.2
Colitis After CAR T-Cell Therapy for Refractory Large B-Cell Lymphoma Responds to Anti-Integrin Therapy
Ahmed Hashim, MBBS, MRCP, Piers E M Patten, FRCPath, PhD, Andrea Kuhnl, MD, Marc L Ooft, MBBS, Bu’Hussain Hayee, FRCP, PhD
doi : 10.1093/ibd/izaa320
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages e45–e46
We present a female patient aged 51 years with new-onset profuse watery diarrhea 3 weeks after infusion of axicabtagene ciloleucel CD19 chimeric antigen receptor (CAR) T-cells for refractory transformed follicular lymphoma. The infusion was promptly followed by cytokine release syndrome and neutropenic sepsis requiring admission to the intensive care unit.
Drug-induced Lupus Associated With Vedolizumab in a Patient with Crohn’s Disease
Rocio Sedano, MD, Inderdeep Dhaliwal, MD, Darryl Ramsewak, MD, Vipul Jairath, MD, PhD
doi : 10.1093/ibd/izaa331
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages e47–e48
Drug-induced lupus (DIL) is an autoimmune phenomenon whereby drug exposure leads to development of systemic lupus erythematosus (SLE)-like features. Over 100 drugs are reported to induce DIL. Tumor necrosis factor (TNF) antagonists are associated with DIL, first reported in rheumatoid arthritis.1 The pathogenesis is uncertain, although there are human leukocyte antigen-associated genetic predispositions and slow acetylating patients with reduction of N-acetyltransferase synthesis.2
Morbidly Obese Patient With Ulcerative Colitis Treated With Endoscopic Gastroplasty: A Case Report
Daniela Pugliese, MD, PhD, Tommaso Schepis, MD, Vincenzo Bove, MD, Giuseppe Privitera, MD, Ivo Boskoski, MD, PhD
doi : 10.1093/ibd/izaa334
Inflammatory Bowel Diseases, Volume 27, Issue 4, April 2021, Pages e49–e50
The prevalence of obesity among patients with inflammatory bowel disease (IBD) has recently increased, playing a potential role in IBD pathogenesis and impacting drug effectiveness and abdominal surgery outcomes.1,2 The safety of bariatric surgery to treat obese patients with IBD is controversial because of the potential long-term consequences of restrictive or malabsorptive techniques and the risk of intestinal adhesions.3
